Working for the Council – Contractors

If you would like to work for the Council as one of our approved contractors please complete the contractor application below

Millbrook Parish Council Contractor Application Form

Company/Your Organisation

Principal Point of Contact(Required)

Name(Required)

First Last

Job Title

Organisation/Company Name

Primary Address for Correspondence

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Telephone Number

Mobile

Email(Required)

Type of Business

(i.e. Sole Trader, Partnership etc.)

Certification, Health & Safety and Insurance

Certification(Required)

Please list any Trade, or Professional Association that you/the organisation belongs to, with names and registration numbers...

What percentage of your workforce holds a current Health & Safety Awareness Certificate?(Required)

Please enter a number from 0 to 100.

Are you able to provide details of competence, training and/or qualifications held by any of your employees, if required to do so?(Required)

Who is the appointed Health & Safety Officer?(Required)

First Last

Contact Number of Health & Safety Officer(Required)

Has the organisation been subject to any formal notices issued by the Health & Safety Executive?(Required)

(If yes, please give details in the box below)

Details for Formal Notices from Health & Safety Executive

Do you currently hold the following?(Required)

(check all that apply; if successful, you will be asked to provide the above insurance and copies of the policy)

Public Liability Insurance

Employers Liability Insurance

Are there any reasons why the organisation might be, or might become, ineligible under Regulations 23 of the Public Contracts Regulations 2015?(Required)

(If yes, please give details in the box below)

Details for Regulation 23 of the Public Contracts Regulations

Environmental Policy

Millbrook Parish Council has an Environment and Climate Change policy that obliges us to consider the environmental impact of works carried out or items supplied by its contractors. Employing local contractors is one way to reduce this impact. We would be grateful if contractors who have their own environmental policy could upload a copy. Depending on the nature of the work we are contracting out, we may need to ask for more information from applicants about how they try to reduce the environmental impact of their work.

Max. file size: 2 GB.

Environmental Policy Information

(In the event you don't have a formal policy; but wish to share some information regarding your commitment to environmental safety please use the box below)

Reference 1

If you cannot provide at least one reference, please skip the next two sections and in the box below, in no more than 300 words, please provide an explanation of your organisation, e.g. your organisation is a new start-up or you have provided services in the past but not under a contract.

Referee 1 - Organisation Name

Referee 1 - Contact Name

First Last

Referee 1 - Contact Number

Referee 1 - Address

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Referee 1 - Brief details of work completed

Reference 2

Referee 2 - Organisation Name

Referee 2 - Contact Name

First Last

Referee 2 - Contact Number

Referee 2 - Address

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Referee 2 - Brief details of work completed

References Ext.

Explanation of Organisation

Only fill out this field if you don't have any references. If you cannot provide at least one reference, in no more than 300 words, please provide an explanation of your organisation, e.g. your organisation is a new start-up or you have provided services in the past but not under a contract.

Declaration & Confirmation

Name of Signee(Required)

First Last

Name

This field is for validation purposes and should be left unchanged.

Data protection

The information you provide on this form will be held by Millbrook Parish Council and used by us to process the allocation of works.
Your information will not be used for any other purpose by Millbrook Parish council and will not be passed onto any other third party without your permission.
In accordance with Millbrook Parish Council’s Retention Policy, the information you provide on this form will be retained for a maximum of one year after the fulfilment of the work order, after which period it will be destroyed in a secure manner. Electronic data will be maintained in a secure manner.
More information on this can be found in our Privacy Policy.