Provide any other comments in support of your suitability for leasing the Land TENDERER’S INSURANCE Details of Tenderer's Workcover Insurer: insurance Policy number: Sum insured: Current to: Details of Tenderer's public liability Insurer: insurance Policy number: Sum insured: Current to: PLEASE ATTACH A COPY OF YOUR CURRENT INSURANCE CERTIFICATE FOR EACH INSURANCE POLICY MENTIONED ABOVE. LEGAL COMPLIANCE Has the Tenderer or any of the Yes No Tenderer's Personnel ever been If Yes, give details: found guilty of an offence under environmental or other legislation? Has the Tenderer or any of the Yes No Tenderer's Personnel ever received If Yes, give details: notice from a relevant authority of an alleged breach of environmental or other legislation? Yes No Is the Tenderer aware of any currently existing circumstances If Yes, give details: which would place the Tenderer or any of the Tenderer's Personnel in breach of any environmental or other legislation? CONFLICTS OF INTEREST AND MATERIAL INTERESTS Does a Conflict of Interest exist? Yes No If Yes, give details: Yes No
Provide any other comments in support of your suitability for leasing the Land TENDERER’S INSURANCE Details of Tenderer's Workcover insurance Insurer: Policy number: Sum insured: Current to: Details of Tenderer's public liability insurance Insurer: Policy number: Sum insured: Current to: PLEASE ATTACH A COPY OF YOUR CURRENT INSURANCE CERTIFICATE FOR EACH INSURANCE POLICY MENTIONED ABOVE. LEGAL COMPLIANCE Has the Tenderer or any of the Tenderer's Personnel ever been found guilty of an offence under environmental or other legislation? Yes No If Yes, give details: Has the Tenderer or any of the Tenderer's Personnel ever received notice from a relevant authority of an alleged breach of environmental or other legislation? Yes No If Yes, give details: Is the Tenderer aware of any currently existing circumstances which would place the Tenderer or any of the Tenderer's Personnel in breach of any environmental or other legislation? Yes No If Yes, give details: CONFLICTS OF INTEREST AND MATERIAL INTERESTS Does a Conflict of Interest exist? Yes No If Yes, give details: Yes No
2017%20Tender%20Form.docx