Appendix 6 Reference statement form 

Tender ERIN Specific Action Project

	

Attention! For each lot (target country) this form must be completed separately and a certificate of sound implementation must be added and signed. So use 1 form for each lot (target country). If you, for example, submit a tender for 5 lots (target countries), you must complete this form 5 times (so for each lot), add and sign a certificate of sound implementation and send it them with your submission for a tender.

Attention! This reference form must be completed in English.

GENERAL	
Organisation name and legal form of Tenderer		
Contact person and contact details of Tenderer	Name:
Phone:
Mobile phone:
E-mail:	
Lot (target country)		

Sufficiently qualified staff
For each lot for which he submits a tender the Tenderer must give a summary of the educational and professional qualifications of the executive staff and in particular of the persons who are responsible for the actual delivery of the services.

Number of qualified staff for the lot in question (target country)		

Complete the names in the following table and briefly mention the courses these persons have followed, and their skills and work experience.

Name	Courses, skills and work experience	

		

The table moves automatically along with the scope of the answer.

Experience with similar work
Tenderer must offer a declaration and a description of the most important similar services over the past 3 years (2015, 2014 and 2013) for each lot for which a tender is submitted. Attention: an early termination of an agreement during the last 3 years in order to replace it with a similar contract for the lot or lots and which the contracting service knows about will result in the exclusion of the Tenderer for the lot in question

Organisation name for which similar services have been or are delivered 		
Address details of this organisation		
Contact person and contact details of this organisation		

Complete the description of the similar services in the following table (grey row).

Brief description of similar services 	
	
The table moves automatically along with the scope of the answer.

Signing

This tender form has been answered truthfully and in full and signed by a legal representative of Tenderer.

	Signature Tenderer	
Name: 		
Function:		
Company:		
Signature:		
Date:		

Certificate of sound implementation
Add your certificate of sound implementation of the stated similar services by the organisation for which these services have been delivered.