NHS East Leicestershire & Rutland
Clinical Commissioning Group,
NHS West Leicestershire Clinical
Commissioning Group and NHS
Leicester City Clinical
Commissioning Group
Invitation to Tender for the Provision
of Improved Access to Psychological
Therapies (IAPT) in Leicester,
Leicestershire & Rutland
Annex 3: Bid Declarations, Conflict of
interest declarations, Freedom of
Information 2000 & Environmental
Information Regulations 2004 Caveats
Your NHS partner for
improving health and
integrating care
link to page 3 link to page 4 link to page 5 link to page 6
Table of Contents
Declaration of Consent, Powers and Authority ......................................................................................... 3
Declaration of Tendered Bid .................................................................................................................... 4
Conflict of Interest Declaration ................................................................................................................. 5
Freedom of Information 2000 and Environmental Information Regulations 2004 Caveats ....................... 6
NHS Midlands & Lancashire Commissioning Support Unit
2
Declaration of Consent, Powers and Authority
This declaration confirms that the submitted bid for the provision of Improving Access to
Psychological Therapies services for East Leicestershire & Rutland Clinical Commissioning
Group (CCG), West Leicestershire CCG and Leicester City CCG has been submit ed by a
representative of the bidder’s organisation who has the necessary consents, powers and
authority from the organisation.
Declaration
I certify that I am a Bidder Member of
[insert potential Bidder name] and that
[insert
potential Bidder name] has the necessary consents, powers and authority to bid for,
and provide, the Services detailed in this ITT response.
An authorised signatory, in his/ her own name, on behalf of the potential Bidder and
Relevant Organisations, must sign a copy of this declaration.
Signed
Name
Position
Date
NHS Midlands & Lancashire Commissioning Support Unit
3
Declaration of Tendered Bid
This declaration confirms that the submitted bid for the provision of Improving Access to
Psychological Therapies services for East Leicestershire & Rutland Clinical Commissioning
Group (CCG), West Leicestershire CCG and Leicester City CCG has been submit ed accurately
and compliantly
.
Declaration
I certify that the information supplied in the questionnaire is accurate to the best of my knowledge
and belief and accords with the basic criteria of eligibility as set out in the ITT and that we have
not collaborated with other Potential Bidders in the completion of this ITT.
I also understand it is a criminal offence, punishable by imprisonment, to give or offer any gift or
consideration whatsoever as an inducement or reward to any servant of a public body, therefore
I hereby certify and undertake and bind and oblige ourselves and our Connected Persons (as
defined below) that we and our Connected Persons have not canvassed or solicited nor wil in the
future canvass or solicit any officer or employee of the following organisations: NHS Midlands and
Lancashire CSU or any person acting as an adviser for the groups listed above in connection
with the selection of Bidders and/or the selection of any submissions, proposals or bids in relation
to this project and that our Connected Persons have not nor wil so canvass or solicit.
For the purposes of this declaration "Connected Persons" means any person connected with us
within the meaning given by Section 839 of the Income and Corporation Taxes Act 1988 and any
of the respective directors, officers, employees, solicitors, accountants, bankers or other financial
or professional advisers of us and/or of our Connected Persons. Other expressions used in this
declaration shall, unless otherwise stated, have the meanings assigned to them in the ITT issued
by the above named organisations.
I agree that we shall be responsible for any failure on the part of Connected Persons to abide by
such terms to the same extent as if such failure had been our own action or omission. I hereby
declare that I am authorised by the under mentioned Potential Bidder to supply the information
given above and that, at the date of signing, the information given is a true and accurate record.
An authorised signatory, in his/ her own name, on behalf of the potential Bidder and Relevant
Organisations, must sign a copy of this declaration.
Signed
Name
Position
Date
NHS Midlands & Lancashire Commissioning Support Unit
4
Conflict of Interest Declaration
This declaration identifies any, if any exist, potential conflicts of interest that may have an effect on
the submitted bid for the provision of Improving Access to Psychological Therapies services for East
Leicestershire & Rutland Clinical Commissioning Group (CCG), West Leicestershire CCG and
Leicester City CCG.
By completing and signing this declaration, this is done so on the understanding that you have read
and understood East Leicestershire & Rutland Clinical Commissioning Group (CCG), West
Leicestershire CCG and Leicester City CCG’s policies on Conflict of Interest
LEICESTER CITY CCG - http://3xmatc1p0cnc3crfv93ovogp-wpengine.netdna-ssl.com/wp-
content/uploads/2018/08/Conflicts_of_Interest_2018.pdf
EAST LEICESTERSHIRE & RUTLAND CCG - https://eastleicestershireandrutlandccg.nhs.uk/wp-
content/uploads/2018/11/ELR-CORPORATE-024-Conflicts-of-Interest-Policy-v4-Dec-2017-
APPROVED-8.pdf
WEST LEICESTERSHIRE CCG - https://www.westleicestershireccg.nhs.uk/publications/corporate-
documents/policies/23-conflict-of-interest-policy-2017-18/file
Declaration
Please identify any potential conflicts of interest that could arise through participation in this ITT
(taking into account all Relevant Organisations), and how these wil be dealt with. Examples of
circumstances in which potential conflicts could arise include (but are not limited to) where:
A Relevant Organisation or any person employed or engaged by or otherwise connected with a
Relevant Organisation has carried or is carrying out any work for a CCG or a CSU or predecessor
body in the last six months;
A Relevant Organisation is providing services for more than one potential Bidder in respect of this
project or procurement process.
A conflict of interest shall not be deemed to arise solely by virtue of a person's employment or
engagement by a Clinical Commissioning Group, Commissioning Support Unit or predecessor
body, or other NHS body (although bidders are requested to disclose such relationships for
information purposes only). For example, GPs engaged under a GMS contract wil not be
considered to have a conflict of interest by virtue of such practicing arrangements.
If no potential conflict of interest is identified, please state this in the response.
Response
Signed
Name
Position
Date
NHS Midlands & Lancashire Commissioning Support Unit
5
Freedom of Information 2000 and Environmental Information
Regulations 2004 Caveats This pro-forma should be completed and submitted where the Bidder considers that the information
submitted or any part of it is confidential and/or commercially sensitive in relation to its bid for the
provision of Improving Access to Psychological Therapies services for East Leicestershire &
Rutland Clinical Commissioning Group (CCG), West Leicestershire CCG and Leicester City CCG.
Pro Forma
No.
Section of the Final
Reason(s) why the Bidder
Length of time
Tender (or other
considers this information is
during which the
submission) which
confidential and/or commercially
Bidder estimates
the Bidder wishes to sensitive and why it should be
such exemption
designate as
exempt from disclosure under the
should apply
confidential and/or
Freedom of Information Act 2000 or
commercially
the Environmental Information
sensitive
Regulations 2004
Signed
Name
Position
Date
NHS Midlands & Lancashire Commissioning Support Unit
6
Get to know us or
get in touch
mlcsu
Midlands and Lancashire Commissioning Support Unit
midlandsandlancashirecsu.nhs.uk
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