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Membership Prospectus

Part B:

Membership Application Form

Please write in the registered name of your organisation.Please write in the name and contact details of the person who is dealing with this application on behalf of your organisation.

NAME:

DESIGNATIION:

TEL NO:EMAIL:

Company registration number: 09080083 and registered charity number: 1158524

Commsortia Membership Prospectus Part B: Membership Application Form (June 2014) 1

Application for Membership

Please answer ALL questions. Please use BLACK ink or complete this electronically, so that this form can be reproduced. Forms that are not completed correctly will be returned for proper completion. We advise you to retain a copy of this application form for your records.

The completed application form and supporting information should be sent by email to;

[email protected]

Please Note

Throughout this application form, guidance on why a question is being asked is provided in italics.

If necessary, complete your answer on a separate piece of paper, noting the number of the question, and submit it with the application.

If you cannot fulfil all the requirements of membership, don’t panic. Help is available from the Voluntary Impact Northamptonshire(VIN) www.voluntaryimpact.org.uk to develop your organisation. Contact David Ward on [email protected] to discuss your needs.

Please look at the supporting information requirements carefully. Obtaining the supporting information may take some time.

There are four types of questions in this application form:

1. Basic Information Questions - These are to capture basic details about your organisation such as where it geographically operates and the services and facilities it delivers.

2. Gateway Questions - A satisfactory answer to all gateway questions must be provided to be eligible for full membership. Gateway questions are indicated by the guidance notes being underlined.

For example:

All members must have sufficient employer’s liability insurance if they employ staff

3. Ready for Tender Questions - Certain questions are to assess the organisation’s readiness for tendering for work, and identify any support needs.

4. Reputation Questions - Certain questions are to protect Commsortia’s reputation and likelihood of securing future contracts in the interest of other members.

And finally, if you have any questions or would like some assistance to complete this application form, please email [email protected] or phone 01604 637522 and ask for David Ward.

SUPPORTING INFORMATION


http://www.voluntaryimpact.org.uk/

In addition to completing and returning this application form, you will also need to submit the following information:

Bank Statements1. N.B. To preserve

confidentiality and following their use by the Verification Panel, all bank statements supplied are destroyed as confidential waste, and no copy taken or retained on record.

Please provide:

Copies of the previous three months bank statements on your main bank account

A copy of the most recent bank statement on any other account you hold

Annual Accounts

All full members must provide satisfactory annual accounts

Newly-formed organisations will have to demonstrate that they are financially sound

Please provide copies of the organisation’s accounts and annual reports for the last three full years.

The accounts should have been appropriately audited or independently examined depending on the turnover and legal form of the organisation.

If there are any significant changes to the financial position, the organisation should provide a statement signed by the officer responsible, setting out those changes.

For newly-established organisations – please provide as much detail as possible, such as bank statements, management accounts, evidence of income etc.

Policies

All full members must have these policies in placePolicy Review process is available from VIN website

Please enclose a copy of the first FIVE policies/proceedures and complete the policy grid for the other policies. We will request one or two policies to sample and further contract specific policies as may be required:

1. Confidential Information Policy2. Health and Safety Policy3. Equal Opportunities Policy4. Environmental Policy5. Safeguarding Children Policy (if you work with children)And/or6. Safeguarding Vulnerable Adults Policy (if you work with

vulnerable adults)7. Complaints Procedure8. Business Continuity Plan9. Customer Care Policy10. Intellectual Property Rights Policy11. Counter-Fraud and Security Management Policy12. Whistleblowing Policy13. ICT Policy14. Grievance Policy15. Volunteering Policy

Governing Document

All full members must provide a signed and dated copy of their current governing document

Please provide a signed and dated copy of your governing document (Memorandum and Articles of Association, etc.).Please check that within the objects that you are able to work in a consortium/partnership. If not you may need to amend and get your board’s approval.

SECTION ONE: DETAILS ABOUT THE SERVICES YOUR ORGANISATION DELIVERS


The following questions are designed to gather information about your services so Commsortia can help to market them to commissioners. If your application is successful, it will keep this information on record and when you inform us of changes it will up-date its records. For example, it is most likely that marketing of your services will be carried out through the jointly developed and member approved website.

1.1. What is the Primary Purpose(s) of your organisation?

1.2.1 Please list those services/facilities which you consider are supporting your organisation to achieve its’ primary purpose.

1.2.2 Please list any additional services/facilities that your organisation delivers.

Summary paragraph

Up to five key services(current and experience)

a) .b) .c) .d) .e) .

General paragraphs with any other services, activities

1.3.1 Please identify the geographical area your organisation currently delivers its services/facilities into.

1.3.2 Please tell us the area of operation your organisation has specified in its governing document.

1.4.1 Does your organisation currently hold any public service contracts/service level agreements?

1.4.2 If yes please list these contracts/SLAs and identify the commissioning organisation

1.5 How many clients / service users did you support during your organisation’s last financial year?

1.6 Please give details of examples of innovative projects / ways of working that your organisation has developed and delivered recently.


SECTION TWO: GOVERNANCE AND CONTACT DETAILS


2.1 Registered Name of Your Organisation

2.2 Contact Name of Chair

2.3 Contact Name of Chief Officer

2.4 Telephone Number

2.5 Fax Number

2.6 Email Address - Chair

Email Address – Chief Officer

2.7 Address of Registered Office

(including postcode)

2.8 Address of Organisation

(if different from Registered Office)

2.9 Is your organisation a ‘not-for-profit’ organisation?

Only ‘not-for-profit’ organisations can become members

Yes No

2.10 What is the legal status of your organisation?

Please tick all that apply

Charitable Companies and Community Interest Companies (limited by guarantee) are eligible for membership

There are a number of other legal forms that

Charitable Company (registered charity that is also a company limited by guarantee)

Please provide your

Charity number:

SECTION THREE: FINANCIAL STANDING

3.1 Please enter the name of the person who has responsibility for your organisation’s financial matters

3.2 Please tell us who your principal bankers are

3.3 Since the last annual accounts were produced, have there been any significant changes in the financial health of the organisation?

Yes No

If yes, please provide a statement signed by the officer responsible, setting out those changes.

3.4 Over the last three years have there been any outstanding claims or litigation against the organisation?

Yes No

If yes please give details:

3.5 Over the last three years, have you ever been late with the submission of your organisation’s financial reports to Companies House, Inland Revenue or to the Charity Commission?

Yes No

If yes, please give details:

3.6 Is your organisation registered for VAT?

VAT registration is not a requirement of membership, but may impact on any sub-contracts you may undertake as a member

Yes No

If yes, please provide your VAT registration number:

3.7 Does the organisation have employer’s liability insurance?

All full members must have employer’s liability insurance if they employ staff

Yes NoIf yes, please provide the following: Name of insurer Policy number Extent of cover Expiry date

3.8 Does the organisation have public liability insurance?

All full members must have public liability insurance


3.9 Does the organisation have professional indemnity insurance?

Professional indemnity insurance is not a requirement of full membership, but some contracts require it



SECTION FOUR: CAPACITY AND ABILITY

4.1 Has the organisation ever had a contract or service level agreement terminated?

Yes No


4.2 Has your organisation ever failed to have a contract/service level agreement renewed for substantial failure to perform to the terms of the contract?

Yes No


4.3 Have any of the organisation’s contracts/service level agreements ended early by mutual agreement following allegations of default on your organisation’s part?

Yes No


4.4 Does the organisation possess an externally-accredited quality mark [QM]?

An externally-assessed quality mark is required for full members –

If your organisation is working towards an externally-assessed quality mark, please tell us, and when you expect to achieve it

Yes No Working Towards

If yes or working towards, which quality mark:

ISO 9001PQASSOMATRIXInvestors in PeopleOther (please write below):

If you are working towards a QM, when do you expect to achieve the quality mark?

4.5 Does the organisation’s governing document specify the following powers?

All full members must have the power to trade and work in partnership within their governing documents

There is no specific membership requirement regarding the area of benefit, but a small geographical area may limit the organisation’s potential to take on contracts in the future

The power to trade Yes No

The power to work in partnership Yes No

The power to operate in Any Town and elsewhere

Yes No

4.6 Has the organisation got each of the following ICT capabilities?

All full members must have a reasonable ICT capability as most contracts will rely on the online reporting of data and E-tendering procedures are increasingly being used by commissioners

Reliable and continuous internet access Yes No

Holds its financial records on computer Yes No

Holds its performance management information on computer

Yes No An ICT Policy

Yes No


SECTION FIVE – HEALTH AND SAFETY

5.1 Does the organisation have a Health and Safety Policy?

Who is the named responsible person for Health and Safety

Yes No

5.2 Does your Health and Safety Policy cover the following areas?

All full members must have a Health and Safety Policy that covers at least the following areas

Arrangements for implementing the policy

Yes No

How the Health and Safety Policy and procedures are conveyed to staff

Yes No

Arrangements for the Health and Safety training of staff

Yes No

A risk assessment template

Yes No

5.3 Has your organisation been involved in any reportable accidents/incidents in the last three years?

Yes No


5.4 Has your organisation been subject to any of the following in the past three years?

Commsortia reserves the right to refuse membership to any organisation that may harm its reputation

Been prosecuted or had a notice served for contravention of the Health and Safety at Work Act 1974 or associated regulations

Yes No


A formal investigation by the Health and Safety Executive, or similar body charged with improving Health and Safety standards

Yes No



SECTION SIX – EQUAL OPPORTUNITIES

6.1 Does the organisation have an Equality/Diversity Policy?

All full members must have an Equality/Diversity Policy that covers at least the following:

Yes No

6.2 Does your Equality/Diversity Policy detail how the organisation deals with recruitment, training and promotion?

Yes No

6.3 Is it the policy of the organisation, as an employer, to comply with its statutory obligations under current Equality legislation?

Yes No

6.4 Does your organisation have mechanisms in place to regularly gather data on the Protected Characteristics under the Equalities Act 2010?

Yes No

6.5 In the last three years, has the organisation been the subject of formal investigation by the Equality and Human Rights Commission on grounds of alleged unlawful discrimination?

Yes No

If yes, what steps have been taken as a consequence of that investigation? Please give details:

6.6 In the last three years has any finding been made against the organisation by any court, employment tribunal or Commission in respect of the Equality Act 2010 [or any of the equality acts that predated this act]?

Yes No



SECTION SEVEN – ADDITIONAL INFORMATION

7.1 Environment

Does your organisation operate a documented environmental management system such as ISO 14001, EMAS or PQASSO?

Yes No

7.2 Environmental Policy:

Does the organisation have an Environmental Policy?

All full members must have an Environmental Policy that covers at least the following

Who is the responsible person for implementing the policy?

Yes No

7.3 Does your Environmental Policy cover the following areas?

Key actions that the organisation undertakes to minimise its environmental impact

Yes No

Details of how staff are made aware of environmental issues

Yes No

7.4 Those organisation that answer yes to 7.4 and or 7.5 may be rejected from Membership depending on severity

Has your organisation ever been successfully prosecuted by any environmental regulator or authority?If yes please provide all relevant details

Yes No

7.5 Has your organisation had any notice served upon it by an environmental regulator or authority?If yes please provide all relevant details

Yes No

7.6 Directors/Trustees

All Members’ Director/Trustee/ other person[s] who has powers of representation must NOT have been convicted of any of the following.

Has any Director/Trustee/other person[s] who has powers of representation been convicted of any of the following?:a.) Conspiracy [within the meaning of section 1 or 1A of the Criminal Law Act 1977 or article 9 or 9A of the Criminal Attempts and Conspiracy (Northern Ireland) Order 1983

Yes No



where the conspiracy relates to participation in a criminal organisation as defined as Article 2 of Authority Framework Decision 2008/841/JHA]b.) Corruption [within the meaning of section 1[2] of the Public Bodies Corrupt Practices Act 1989 or section 1 of the Prevention of Corruption Act 1906; where the offence relates to active corruption.]c.) Bribery [the offence of bribery, where the offence relates to active corruption; (i) bribery within the meaning of section 1 or 6 of the Bribery Act 2010]d.) Fraud [where the offence relates to fraud affecting the European Communities’ financial interests as defined by Article 1 of the convention on the protection of the financial interests of the European Communities, within the meaning of:i) the offence of cheating the Revenueii) the offence of conspiracy to defraudiii) fraud or theft within the meaning of the Theft Act 1968, the Theft Act (Northern Ireland) 1969 and the Theft Act 1978 or the Theft (Northern Ireland) Order 1978iv) fraudulent trading within the meaning of section 458 of the Companies Act 1985, article 451 of the Companies (Northern Ireland) Order 1986 or section 993 of the Companies Act 2006v) fraudulent evasion within the meaning of section 170 of the Customs and Excise Management Act 1979 or section 72 of the Value Added Tax Act 1994vi) an offence in connection with taxation in the European Union within the meaning of section 71 of the Criminal Justice Act 1993vii) destroying, defacing or concealing of documents or procuring the execution of a valuable security within the meaning of section 20 of the Theft Act 1968 or section 19 of the Theft Act (Northern Ireland) 1969;viii) fraud within the meaning of section 2, 3 or 4 of the Fraud Act 2006; orix) making, adapting, supplying or offering to supply articles for use in frauds within the meaning of section 7 of Then Fraud Act 2006]e.) Money Laundering [within the meaning of section 340(11) of the Proceeds of Crime Act 2002; (i) an offence in connection with the proceeds of criminal conduct within the meaning of section 93A, 93B, or 93C of the Criminal Justice Act 1988 or article 45, 46 or 47 of the Proceeds of Crime (Northern Ireland) Order 1996; orii) an offence in connection with the proceeds of drug trafficking within the meaning of


section 49, 50 or 51 of the Drug Trafficking Act 1994]f.) Or any other offence within the meaning of Article 45(1) of Directive 2004/18/EC as defined by the national law of any relevant State

7.7 Please let us know if you are aware that any officer/director/trustee of the organisation been involved in any other organisation which has been subject to any disputes, judgements, prosecution or decisions that may negatively impact on Commsortia’s reputation.

Yes No


7.8 Data Protection and Freedom of Information

Does the organisation acknowledge its duties under the Data Protection Act and is it willing to give all reasonable assistance where appropriate or necessary to comply with such duties?

Does the organisation acknowledge its duties under the Freedom of Information Act and is it willing to give all reasonable assistance where appropriate or necessary to comply with such duties?

This is a requirement of full membership

Yes No

Yes No

7.9 StaffingHow many members of staff are employed by your organisation?

For employees, please provide the total number of full-time equivalents relevant to the following staff categories

Permanent Staff

Casual Staff

Volunteers

7.10 Please tell us what staff turnover your organisation has experienced for each of the last three financial years (excludes short term project contracts)

Year Turnover(% of overall staff)


There is no specific membership requirement regarding turnover or number of staff, but a high turnover may indicate an underlying issue that may hinder the organisation’s ability to win and fulfil any contracts, and require further discussion

7.11 Please tell us how much you spent on staff training last year

There is no specific membership requirement regarding expenditure on staff training, but the question is often asked in tender documents

7.12 How does the organisation determine the training needs of its staff?

7.13 Does your organisation hold contract(s) for the supply of goods/services with any of the following commissioning bodies?

Borough Council of Wellingborough

Corby Borough Council

Daventry District Council

East Northants District Council

Kettering Borough Council

Northampton Borough Council

South Northamptonshire District Council

Northamptonshire Healthcare NHS Foundation Trust

Nene Clinical Commissioning Group

Corby clinical Commissioning Group

Northamptonshire County Council

Northamptonshire Probation Trust

Other (please specify)

Holding existing contracts is a useful indicator of being ‘fit for contracting’

Yes No

If yes please briefly describe the purpose of each contract and indicate the annual value of each contract:

MEMBERSHIP PROSPECTUS: – DECLARATION

This declaration must be signed by two authorised people on behalf of the applicant organisation. At least one of the signatories must be a member of the applicant organisation’s governing body. This Prospectus and Declaration is referred to in sections 3.1.2, and 4.1 of the Member’s Collaboration Agreement, and as such this Declaration and Membership Prospectus forms part of this Members Collaboration Agreement.

We declare, by signing this application to join the consortium known as Commsortia, that:

2. We confirm that we are duly authorised to sign this declaration on behalf of this applicant organisation (hereinafter to be referred to as ’our organisation’).


3. We confirm that this application to join the Commsortia Consortium has been authorised by our organisation’s management committee, governing body or board.

4. We certify that the information we have supplied to support this application is true and confirm that the enclosures are current, accurate and adopted or approved by our organisation’s management committee, governing body or board.

5. We understand that, if we make any seriously misleading statements (whether deliberate or accidental, or if we knowingly withhold any information) at any stage during the application process, or during membership, this could make our organisation’s application invalid/ put its membership at risk.

6. We understand that a copy of this form, the supporting papers as supplied, together with the decision of the Membership Verification (Application) Panel will be retained on record by Commsortia. However, to preserve confidentiality and following their use by the Verification Panel, all bank statements supplied will be destroyed as confidential waste. Furthermore no copy is taken or retained on Commsortia’s records

7. If our organisation’s Membership Application is successful, our organisation and its representatives by signing this Declaration willingly agree to:

A. Provide Commsortia with up to date information about this organisation’s public services and facilities so that Commsortia can further support our organisation to market our services and develop public service tenders/grant funding bids.

B. Provide Commsortia with new, replacement, updated and revised documents as they are adopted and/or approved by our organisation’s management committee, governing body or board, including all those supplied to support this Membership Application Form, such as annual accounts, annual reports, governing documents, policies, quality marks, and any other information necessary, to support Commsortia to respond to commissioner’s questions such as those contained in Pre-Qualification Questionnaires and other tender documents, on our organisation’s behalf.

C. Inform Commsortia within seven days of awareness of any potential legal actions or challenges that may be taken against our organisation such as those caused by breeches of employment law, safeguarding, fraud, financial misconduct, health and safety, equal opportunities legislation, criminal offences, and any other action that may bring Commsortia and its members into disrepute, or weaken the consortium’s reputation.

D. Inform Commsortia of any significant changes in our organisation’s financial position, positive or negative, at the earliest possible time, including the potential, or need to liquidate our organisation.

E. Inform Commsortia about our organisation’s potential merger with other organisation(s), and inform Commsortia about our organisation’s decision to merge.

F. Become a signatory, if our organisation is not already a signatory, of the Local Compact as soon as is reasonably practicable following confirmation of our organisation’s membership.

G. Ensure that, if our organisation has not already achieved a recognised externally accredited Quality Mark covering its governance, management and services, our organisation will take all steps as are necessary to achieve such accreditation within two years of our organisation’s application being considered by the Commsortia Membership Verification Panel.

H. Ensure that following the achievement of a recognised externally accredited Quality Mark, as described in G above, it commits to maintain it, but if our organisation ever fails to maintain it, our organisation will inform Commsortia within 10 days of this failure, and commit to restore it (or achieve a similar Quality Mark) within one year of the date of its withdrawal.


I. Support Commsortia in furthering its Vision and Mission, its Aims, Values and Social Business Principles as described in Part A of this Membership Prospectus.

J. Adhere to the effective development of consortium bids through sound project management, as guided by and agreed with Commsortia, especially to the adherence to agreed work deadlines including the effective communication of required information, to Commsortia.

K. Consistently and accurately gather and provide, at the agreed time, all required information and data such as service outputs, outcomes and financial information to Commsortia when providing services under sub contract to Commsortia.

L. Support Commsortia, and its members, to identify and take steps, to minimise or eradicate, business risk.

8. Abide by all of the above (1-6) conditions, requirements and procedures and as from time to time set out in this Membership Prospectus and Commsortia’s Articles of Association.

Signatory One (Main Contact)Name (please print)

Designation

Signed

Dated

Signatory TwoName (please print)

Designation

Signed

Dated


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