TENDER COVER SHEET

Tender Date:

Tenderer Business Name:

Tenderer Address:

Tenderer Authorised Contact:

Name & Email;

Phone & Fax; Ph: Fax:

In accordance with the following tender document and specifications, you are invited to supply a
quotation for:
Provision of Fruit and Vegetables to Portland District Health
for the period 1 June 2013 to 31 May 2014

Ref: Fruit and Vegetables Tender, 2013-018

Tender Schedule:
Tender Documents Available Date: Friday 26th April 2013
Last Date for enquiries / clarification Date: Friday 3rd May 2013, 10am
Tender Closes Date: Friday 10th May, 2013, 5pm
Evaluation Completion Target Date* Date: Friday 17th May, 2013
* Subject to availability of evaluation systems
Notification of Tender Outcome Date: Friday 24th May, 2013

PDH Authorised Contact:

Ms Ros Jones
Director of Corporate Services
Portland District Health
Bentinck Street,
Portland VIC. 3305

Phone: (03) 5521 0322 Fax: 03.5521 0358 E-mail: rjones.pdh@swarh.vic.gov.au

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 INDEX
CONTENTS PAGE

TENDER COVER SHEET 1

INDEX 2

TENDER INTRODUCTION 3

- Scope of Tender 3
- Objectives 3
- Principles 3
- Tender Notice 3
- Expressions of Interest 3

TENDER - GENERAL CONDITIONS 3

- Timetable – Schedule 3
- Information/Clarification 3
- Authorised Contact Person 4
- Evaluation Process 4
- Alternative Tender – Innovation 4
- Tender Transmission Information 4
- Late Tenders 4
- Delivery Method 4
- Insurance 4
- Indemnity 5
- Acceptance of Tender 5
- Acceptance of Goods 5
- Confidentiality 5
- HPV Access (Piggy-back) Clause 6
- HPV Common-use Clause 6
- Licences, Permits, Compliance with relevant Standards and Regulations 6
- Police Checks 6
- Evaluation – Trials and Samples 6
- Sub-Contacting 6
- Assistance with EQuIP and/or Aged Care Accreditation 6
- Reference Sites 6
- Compliance with Specifications 7
-Tender Price/ GST and Validity Period 7
- Submission and Payment of Accounts 7
- Amplifying General Conditions of Tender 7

TENDER RESPONSE 8

- Questionnaire 8, 9
- Other Documentation/Information for Tender Submission 10

OTHER DOCUMENTS 11

- Annex A – Statutory Declaration 11

- Schedule A – Tender Price 12-14
- Schedule B – Minimum Quality Standards for Tendered Product Certification 15
- Enclosure 1 – Draft Agreement 16-18
- Who can witness a Statutory Declaration 19

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TENDER INTRODUCTION

Scope of Tender

This Tender is for the provision of fruit and vegetables specified in Schedule A, in accordance with
the minimum standards specified in Schedule B, for a period of one (1) year from 1 June 2013 to
31 May 2014,

Objectives

Portland District Health is committed to a tendering system that will:

 Provide the best value for money.

 Provide the best quality goods and services for our Patients/Aged care residents/Clients.
 Treat all tenderers in a fair and timely manner.

Principles

Portland District Health will use its best endeavours to achieve these objectives and ensure the
tender process is fair to all parties involved and where possible, demonstrate that fairness to
Tenderers and potential Tenderers.

Tender Notice

Public notice is required to start the tender process. Portland District Health shall advertise in a
newspaper circulated in its district and may also advertise in any other newspaper or publication.
Portland District Health may also invite designated service providers to tender or start the process
through public notice.

Expressions of Interest

Portland District Health may, if it deems necessary, use an “expression of interest” process before
it invites tenders. If so, it will advertise publicly the purpose and nature of the agreement and the
date it will invite tenders. The aim of the expression of interest is not to elicit tenders but to assess
the capabilities of the respondents to fulfill the agreement. Portland District Health may, at its
discretion, invite tenders from all or none of the respondents by the advertised date.

TENDER – GENERAL CONDITIONS

Timetable – Schedule

Refer to Tender Cover Sheet

Information / Clarification

 The information contained in this document is provided to assist the preparation of a

compliant tender response.
 All information is provided in good faith, however none of the information is guaranteed,
and it is the Tenderer’s responsibility to interpret and assess the relevance of the
information provided.
 Tenderers may seek further information and / or clarification in relation to this tender from
the authorised contact person up to 10.00am on the date specified in the Tender Cover

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 Sheet.
 Portland District Health reserves the right to inform all Tenderers of any question or matter
raised, and answer given, without identifying any potential Tenderers by name.
 We also reserve the right to respond or not respond to any query or matter raised after the
last date for inquiries.

Authorised Contact Person

The authorised contact person for this tender is specified in the Tender Cover Sheet. All
communication must be directed to that person in the first instance.

Evaluation Process
Tenders will be evaluated to identify the option that offers best value to Portland District Health.
Portland District Health will not necessarily accept the lowest priced tender, or any tender.

Alternative Tender – Innovation

Tenderers are encouraged to offer and describe any proposed solutions that incorporate innovative
technology that can be demonstrated to improve the efficiency and effectiveness of any product or
process covered by this tender.

Tenderers may offer an alternative product to that specified in Schedule "A", provided full details of
such alternative are provided in your response. It is also in a tenderers interest to submit a
response that complies with Schedule A.

Tender Transmission Information

Tenders will be accepted by fax, email or post, until the Closing date and time at the addresses
as specified in the Tender Cover Sheet. Tenders should be titled Fruit and Vegetables Tender,
2013-018.

NB: Portland District Health may, at its sole discretion, extend the closing date and time.

Late Tenders
Late Tenders may not be considered.

Delivery Method
Please provide details as to how the products will be delivered and confirmation that the transport
vehicle(s) conforms to all regulatory requirements for the transport of the product. All Delivery
costs should be included in your tender response.

Insurance
Your tender submission should include details of insurance coverage with an insurer approved by
The Australian Prudential Regulatory Authority – as a minimum; the following insurance
arrangements should be in place:
 Public Liability Insurance - Minimum $10m coverage.
 Product Liability Insurance - Minimum $10m coverage.
 Professional Indemnity Insurance - Minimum $10m coverage.

The Tenderer must comply with and observe the terms of the insurance policies and must not do
anything which could result in any such policy being avoided or unenforceable or which may entitle
the insurer to limit or reduce the amount otherwise payable under the policy. The provisions of this
clause survive the expiration or earlier termination of this Agreement.

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Indemnity
1(a) The Tenderer indemnifies and agrees to keep indemnified Portland District Health and its
officers and employees in respect of Loss incurred or suffered as a result of:
(i) any breach of this agreement by the Tenderer; or
(ii) any negligent act, error or omission in connection with the performance of this
agreement by the Tenderer or its officers, employees or agents;

PROVIDED THAT this indemnity does not apply to the extent that Loss is caused by or
contributed to by Portland District Health or its officers, employees or agents.

1(b) This indemnity includes, without limitation, Loss due to bodily injury, sickness or death or
loss, destruction of damage to property.

1(c) This indemnity survives the expiration or termination of this agreement.

1(d) For the purposes of this clause, “Loss” includes loss, damage or liability of every kind,
unless too remote but does not include pure economic loss not recoverable at common
law.

2(a) Portland District Health indemnifies and agrees to keep indemnified the
Tenderer and its officers and employees in respect of Loss incurred or suffered as a result
of:
(i) any breach of this agreement by Portland District Health; or
(ii) any negligent act, error or omission in connection with the performance of this agreement
by Portland District Health or its officers, employees or agents;

PROVIDED THAT this indemnity does not apply to the extent that Loss is caused by or
contributed to by the Tenderer or its officers, employees or agents.

2(b) This indemnity includes, without limitation, Loss due to bodily injury, sickness or death or
loss, destruction of damage to property.

2(c) This indemnity survives the expiration or termination of this agreement.

2(d) For the purposes of this clause, “Loss” includes loss, damage or liability of every kind,
unless too remote but does not include pure economic loss not recoverable at common law.

Acceptance of Tender
The lowest or any Tender may not necessarily be accepted, and no Tender shall be deemed to
have been accepted, until acceptance has been confirmed in writing. A draft agreement is detailed
in Enclosure 1.

Acceptance of Goods
If the goods required are not supplied or do not comply with the standards specified, whether the
inspection occurs prior to, or after delivery to Portland District Health, the goods may be rejected
wholly or at the discretion of Portland District Health. The cost for removal and replacement of the
rejected goods will be borne by the Tenderer.

Confidentiality
Information supplied by or on behalf of Portland District Health is confidential to Portland District
Health and Tenderers are obliged to maintain its confidentiality. The Tenderer may disclose
information to a third party engaged for the purpose of responding to this tender, providing they
preserve the confidentiality of that information.

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HPV Access (Piggyback) Clause
The following clause provides the option of permitting another health service to take advantage of
any contractual arrangements relating to this tender.
If, during the Agreement Period, a public hospital, and/or a metropolitan health service (as listed in
schedules 1 and 5 of the Health Services Act 1988 (Vic)) gives notice to the parties that it wishes
to purchase the Goods on the terms and conditions of this document, and Portland District Health
agrees, each party shall execute a document and do all things necessary to give effect to that
intent.

HPV Common Use Clause

If Health Purchasing Victoria enters into a contract in respect of the Goods with the Contractor
which may apply to all Victorian public hospitals, and/or metropolitan health services (as listed in
schedules 1 and 5 of the Health Services Act 1988 (“the Statewide contract”), then:

a. Portland District Health may give notice to the Contractor that it wishes to purchase the
Goods on the terms and conditions of the Statewide contract from a future specified date;
and
b. this Agreement shall end on the date specified by Portland District Health; and
c. the Contractor shall have no claim against Portland District Health or its agents,
employees, officers or servants in respect of this Agreement ending or Portland District
Health exercising its rights under this clause.

Licenses, Permits, Compliance with Relevant Standards and Regulations

Goods offered must comply with HACCP guidelines and any current Australian Standards relevant
to the products specified.
 Documented evidence of compliance, e.g. evidence as a HACCP compliant company,
MUST be submitted with your quotation.

Police Checks
Police checks are required for all persons acting on behalf of the successful tenderer who, as part
of the supply of the tendered goods and or services are required to be present on Portland District
Health premises other than for normal delivery and pickup services.

Evaluation – Trials & Samples

Portland District Health reserves the right to request a reasonable quantity of samples for trial as
part of the evaluation process if appropriate.

Subcontracting
Tenderers must state where they are intending to sub-contract all or part of this tender to one or
more third parties. Comprehensive details of all sub-contractors, including their role and scope in
this tender must be submitted with your response.

Assistance with EQUIP and / or Aged Care Accreditation

Successful Tenderers must agree to abide by and support the Quality, Service and Accreditation
programs undertaken by Portland District Health, including external accreditation processes such
as the Aged Care Standards Accreditation and Australian Council on Healthcare Standards EquIP
Accreditation.

Reference Sites
Your tender response should include at least three (3) reference sites using these goods and or
services including the name and position of a contact person at each site.

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Compliance with Specifications
Tenderers should indicate clearly any area in which the goods offered fail to comply with the
requirements of the specifications given or where any of the required conditions will not be met.
Notification of this non-compliance must occur with the submission of your tender / quotation – see
Schedule B.

Tender Price / GST and validity period

Tenderers are invited to submit their best offer, GST inclusive and expressed in Australian
currency. (NB: GST amounts where applicable, must still be quantified.)

Prices tendered shall be fixed for a minimum period of ninety (90) days, covering one-off supply or
initial supplies and delivery of goods and or services as specified Schedule A.

Please indicate any discounts offered for payment of accounts within a specified period.

Submission and payment of accounts

The contractor shall submit a valid Tax Invoice for payment on a monthly* basis as agreed upon.
Portland District Health upon checking the account and being satisfied as to the accuracy will
forward payment to the contactor within 30* days. Any GST liability should be clearly identified on
Tax Invoices.
(* Invoice and payment frequency may be varied)

Amplifying General Conditions of Tender

i. Should the contractor fail to supply any article at the time mentioned in the order, the
articles may be sought elsewhere and the expenses over and above the agreement price
will be deducted from the contractor’s account;

ii. The contractor is to ensure a delivery docket with item, price per unit and date is signed
by the food services Facilitator or his/her deputy and left with them;

iii. Should the contractor fail to deliver goods of the correct quality mentioned in this tender,
the officer receiving the supplies is empowered to reject those goods and if not immediately
replaced with the correct quality and quantity, cause a supply to be sought elsewhere; the
extra expense associated with this action will be charged as in clause (i) above;

iv. In the event of a difference between the contractor and the officer receiving the supplies as
to the quality or quantity, any variation shall be decided by the authorised Portland District
Health representative;

v. Any repetition of irregularity in the quality or quantity of supply, or delay in delivery or

replacing when required, or in the performance of the agreement, can lead to the
immediate termination of the agreement;

vi. The contractor is to ensure the premises from which the product is provided, is fully
compliant in regards to hygiene and any other requirement as it pertains to the provision of
the goods specified in Schedule A to this Tender document. In this regard, the contractor is
to allow the Portland District Health representative to inspect their premises on a regular
basis;

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 ………………………………………… ……………………………………………
Director of Corporate Services Date

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 TENDER RESPONSE

Tenderers are required to submit such information as is necessary to enable Portland District
Health to assess the Tenderer’s ability to fulfill the tender requirements. ( This questionnaire
has been prepared to assist Tenderer’s in providing the required information.)

Tenderer Profile

Tenderer’s Name: …………………………………………………………..

Tenderer’s ABN: …………………………………………………………..

Tenderer’s ACN (if applicable): …………………………………………..

Address: …………………………………………………………….

……………………………………………………………..

……………………………………………………………..

Phone & Fax: ……………………………………………………………..

After Hours Ph:………….………………………………………………………

E-Mail: ………………………………………………………………

Is Tenderer an individual, partnership, or limited liability company?

……………………………………………………………..

If partnership, provide names and addresses of partners:

………………………………………………………………

………………………………………………………………

………………………………………………………………

How many years has Tenderer been in business under its current business name?

………………………………………………………………

How many years has Tenderer been in business providing goods / services relating to
this tender?
……………………………………………………………….

Does the Tenderer have a financial interest in any other types of business? (If yes,
specify).
……………………………………………………………….

Supply details / references for products / services Tenderer has previously provided

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 relating to the requirements of this tender.

…………………………………………………………………………………..

…………………………………………………………………………………..

………………………………………………………………………………….

Where appropriate, list principal individuals / personnel involved in provision of

services relating to this tender, and their experience.

…………………………………………………………………………………..

……………………………………………………………………………………

…………………………………………………………………………………….

……………………………………………………………………………………..

List specific equipment that will be utilized in the provision of services relating to this
tender:
…………………………………………………………………………………….

……………………………………………………………………………………..

………………………………………………………………………………………

………………………………………………………………………………………..

Provide details of tenderer’s financial ability to meet the terms, conditions and service
requirements as outlined in this tender document:

………………………………………………………………………………………..

………………………………………………………………………………………..

Provide bank details or other financial institutions where references may be obtained:

…………………………………………………………………………………………

…………………………………………………………………………………………..

……………………………………………………………………………………………

Provide names and details of 3 professional referees:

1. ……………………………………………………………………………………

2. ……………………………………………………………………………………

3. …………………………………………………………………………………….

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Other documentation and information to be provided by Tenderer in support of the
tender submission:

1. Proof of insurance as per General Tender Conditions.

2. Completion of Statutory Declaration – Annex A.

3. Completion of Tender Prices for goods – Schedule A.

4. Completion of Minimum Quality Standards Certificate – Schedule B.

5. HACCP or equivalent Compliance Certificates as per General Tender Conditions.

6. Copy of ongoing Continuous Quality Improvement Program.

7. Police Checks (may be required) refer to General Tender Conditions.

8. Any other relevant supporting documentation.

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Annex A Statutory Declaration
Definitions:
Bidder; Any business entity who submits a response to this tender, including the Tenderer.
Industry Association; Any organization of which the bidders are members.
Tenderer price; The amount indicated by the bidder in their tender response.
Tenderer; The person or entity completing this response – namely,

…………………………………………………………………………………………… (Tenderer’s name)

I / We …………………………………………………………… do solemnly and sincerely declare that

ii) I am the Tenderer and make this declaration on my own behalf or
iii) I hold the position of ……………………………………………………………… with the
Tenderer and am duly authorised to make this declaration on behalf of the Tenderer.
(Cross out above option as appropriate.)

No knowledge of tender prices:

Prior to submission of this tender, neither the Tenderer nor any of its employees or its agents had
knowledge of the tender price of any other bidder, individual or entity that proposed to submit a
response to this tender.
Disclosure of tender price or information:
Prior to the close of tender responses, neither the Tenderer nor any of its employees nor agents
disclosed the Tenderer’s tender price or information relating to this tender to:
a) Any other bidder who responded to this tender.
b) Any person, company, or other entity proposing to submit a response to this tender.
c) Any person or organization associated with a bidder, person, company or other entity of any
kind referred to in a) or b) above.
Genuine Competition:
The Tenderer is genuinely competing to win this tender, and has not entered into any contract,
agreement, arrangement or understanding that bidders for this tender would include an identical or
similar condition or qualification in their tender response.
Industry Association Agreements / Unsuccessful Tenderer’s Fees:
Neither the Tenderer, nor any of its employees or agents has entered into any contract, agreement,
arrangement or understanding (other than as disclosed to Portland District Health in the Tenderer’s
tender response) that the successful bidder for this tender will pay any money to, or provide any
other benefit or financial advantage to an Industry Association or Unsuccessful Bidder in respect to
this tender.

I acknowledge that this declaration is true and correct and I make it in the belief that a person
making a false declaration is liable to the penalties of perjury.

Signature of person making declaration:……………………………………………….…….……

DECLARED at………………………………………………………………… In the state of Victoria

This …………………………… day of ………………………. 201….

Before me* (Signature): ………………………………………..……..………………………….……

Name & Qualification (Print):…………………………………………………………………………

Address:………………………………………………………………………………………………….
[*See end doc. - Who can witness a Statutory Declaration under sec. 107A(1) of Evidence Act 1958]

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Schedule A TENDER PRICE

PROVISION OF FRUIT AND VEGETABLES to Portland District Health - Ref: Fruit and
Vegetables Tender, 2013-018

28 Day Tender Price

Cycle per unit Quality/Grade/Comment
Description Unit
Average (Incl. GST if (if applicable)
applic.)

FRESH FRUIT:

Apples Red Delicious Carton 8

Avocadoes Each 12

Bananas Box 8

Cantaloupe Each 32

Honey Dew Melon Each 20

Kiwi Fruit Box 4

Lemons Each 60

Oranges Carton 4

Pears Box 3

Pineapple Each 16

Strawberries Punnet 60

Tomatoes, 2 inch
Carton 8
Med/Ripe

Tomatoes, Cherry Punnet 40

Water Melon Each 8

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 FRESH VEGETABLES:

Cabbage Each 12

Capsicum Green Each 32

Capsicum Red Each 32

Capsicum Yellow Each 32

Cauliflower Each 35

Celery Bunch 60

Cucumber
Bag 4
Continental

Egg Plant Kg 4

Leeks Each 70

Lettuce – Cos
Box 6
(Already Cut)

Lettuce – Mesclun Mix Box 6

Mushrooms Box 6

Parsley Bunch 20

Potatoes New Chats 5 Kg Bag 28

Silver beet Bunch 60

Sweet Potatoes Kg 35
Carton-
Zucchini 5
10Kg

*Tender price should be price as per Unit listed for each item (eg Kg, Bunch or Carton).
Any alternative pricing not as per listed Unit type must be clearly marked.

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 28 Day Tender
Cycle Price kg Quality/Grade/
Description Cut /Size Pack Size Average (Incl. Comment
GST if (if applicable)
applic.)
PROCESSED VEGETABLES:

Whole Peeled 10 Kg 10
Carrots
Hand

Onions Large peeled 10 Kg 12

Potatoes Whole Peeled 10 Kg 10

Pumpkin Peeled ¼ 5 Kg 50

Deliveries required: 6 days per week, Monday – Saturday

How long are prices fixed for? Months (** 3 month min.)

Additional Notes:
Quantities;
The above quantities are estimates only within a 28 day menu cycle. Portland District Health
reserves the right to adjust the mix of quantities and varieties required if the menu mix or
preparation processes at Portland District Health change.
Pricing;
**Prices tendered should be fixed for minimum 3 months. Any tender price variation from
this requirement must be clearly noted and accompanied by a clear explanation and any
relevant evidence.
Price variations - Portland District Health acknowledges that prices may vary subject to
market influences beyond the control of the supplier. Upon request and subject to materiality
and provision of supporting evidence, the supplier may be given the opportunity to review their
pricing on a quarterly basis. Adjustments requested outside of the quarterly review option may
only be considered when extreme market circumstances occur.

Price submission;
Tender prices and any relevant information as to variations proposed, specific fruit and
vegetables quality or varieties etc should be submitted using the template provided above.

Tender Exclusions;
Portland District Health has reserved the right to award the supply of Fruit to Sea View House
as a separate contract.

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Schedule B Certification Declaration: Minimum Quality Standards

All goods provided under this Tender are to be provided in accordance with the Australia New
Zealand Food Standards Code Chapters 1 to 4, the Victorian Food Act 1984 as amended 2001,
as well as any other regulatory requirements relating to the particular product and in addition:

 As applicable, all products are to be received with a ‘Use By’ or ‘Best Before’ date for the
particular product that allows for the maximum retention by Portland District Health of the
product, before use;

 Best quality product only is to be provided for all products specified in this Tender;

 Best quality ingredients only are to be used in the making of any products specified in this
Tender;

 As applicable, all ingredients used in the making of products specified in this Tender are to be
specified in Attachment A;

 All products must be of fresh quality, transported in accordance with regulatory requirements
for the particular product and delivered in a manner that ensures the product is received in a
fresh and hygienic condition; and

 Transport vehicles must meet prevailing Victorian Food Act Regulations.

I hereby declare we are compliant with the aforementioned and acknowledge and agree to provide
provisions and services in accordance with the minimum quality standards specified above.

………………………………………... ……………………………………
Tenderer’s signature Date

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Enclosure 1 AGREEMENT for PROVISION OF FRUIT AND VEGETABLES

The following draft agreement will be completed and signed by the successful Tenderer and
Portland District Health. This Agreement includes all terms, conditions and tender specifications
contained within this tender document and the tender response and pricing schedule as submitted
by the successful Tenderer.

Agreement between Portland District Health and ……………………………………….

Authorised contact for Tenderer: …………………………………………….

Authorised contact for PDH: Director of Corporate Services, PDH

Description of Goods / Services Provided: Fruit and Vegetables

Commencement Date: 1st June 2013

Expiry Date: 31st May 2014

Extension Options: Not Applicable – new tenders will be sought.

Transport of product Details: In accordance with the Victorian Food Act, 1984.

Dates / Times / frequency for delivery of required goods / services: Six (6) days per week,
Monday to Saturday.

Service Standards: In accordance with Schedule B – Minimum Quality Standards

PDH Contractor Requirements / Police Checks: Not required for this agreement.

Performance / monitoring indicators and requirements: Regular monitoring and remedial

action is to be in accordance with the terms relating to “Acceptance of Goods”.

Periodic Reports and matters to be included in these reports: No specific reporting

requirements for this agreement.

Documentation Required: As detailed in “Other Documentation to be provided” within the tender

invitation document.

Training Requirements: Not applicable for this agreement.

Occupational Health and Safety: The Tenderer agrees to carry out its duties in a safe manner,
observe all requirements under prevailing Occupational Health and Safety Regulations, observe
the safety provisions of Portland District Health and report any matters of concern to the
designated Portland District Health contact.

Regulatory Requirements: The contractor will carry out all activities in strict accordance with
Portland District Health Policies and Procedures and will comply with all relevant regulatory and
statutory guidelines.

Privacy / Confidentiality: In addition to the Confidentiality terms as outlined within the tender
invitation, the successful tenderer will also ensure that representatives are aware of the sensitive

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nature of health information and that everyone engaged in the provision of health services has a
duty to protect and maintain patient confidentiality.

Payment terms and conditions: 30 Days payment terms in accordance with terms as outlined in
the tender invitation.

Required Insurance coverage: As per terms specified within the “Insurance” section of the tender
invitation. Certificates of Currency for required insurances that expire during the term of this
contract must be supplied to Portland District Health as soon as possible after policy renewal and
at any other time if requested.

Dispute and Grievance Procedure: If either party raises legitimate concerns as to the
performance of obligations within the terms of this agreement, both parties should endeavour to
resolve those concerns through consultation and or mediation.

Termination details: This agreement may be terminated before its due date by either party giving
three months written notice of such an intention.

In the event of the contractor not being able to fulfill this contract due to unforeseen
circumstances, the contractor and Portland District Health may, by mutual agreement at that time,
make alternative arrangements.

A serious breach of any of the terms of this agreement or sustained unsatisfactory performance
may give cause for immediate cancellation by either party.

Signed on Behalf of: Portland District Health

Signature: ………………………………………………………………………..

Name (Print): ….…………………………………………………………………….

Position: …….………………………………………………………………….

Date: ……….……………………………………………………………….

Signed on Behalf of Tenderer (Name):

Signature: ………………………………………………………………………..

Name (Print): ……………………………………………………………………….

Position: ……………………………………………………………………….

Date: ……………………………………………………………………….

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PDH Use only:

Originator: Department:

Original to: Date:

Copy to: Date:

Review on: Review by:

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Who can witness a Statutory Declaration under sec. 107A(1) of Evidence Act 1958
107A List of persons who may witness statutory declarations
(1) Any of the following persons may witness the signing of a statutory declaration—
(a) a justice of the peace or a bail justice;
(b) a public notary;
(c) an Australian lawyer (within the meaning of the Legal Profession Act 2004);
(d) a clerk to an Australian lawyer;
(e) the prothonotary or a deputy prothonotary of the Supreme Court, the registrar or a
deputy registrar of the County Court, the principal registrar of the Magistrates' Court or a
registrar or deputy registrar of the Magistrates' Court;
(f) the registrar of probates or an assistant registrar of probates;
(g) the associate to a judge of the Supreme Court or of the County Court;
(h) the associate of an Associate Judge of the Supreme Court or of an associate judge of
the County Court;
(i) a person registered as a patent attorney under Chapter 20 of the Patents Act 1990 of the
Commonwealth;
(j) a member of the police force;
(k) the sheriff or a deputy sheriff;
(l) a member or former member of either House of the Parliament of Victoria;
(m) a member or former member of either House of the Parliament of the Commonwealth;
(n) a councillor of a municipality;
(o) a senior officer of a Council as defined in the Local Government Act 1989;
(p) a person registered under the Health Practitioner Regulation National Law to practise in
the medical profession (other than as a student);
(q) a person registered under the Health Practitioner Regulation National Law—
(i) to practise in the dental profession as a dentist (other than as a student); and
(ii) in the dentists division of that profession;
(r) a veterinary practitioner;
(s) a person registered under the Health Practitioner Regulation National Law to practise in
the pharmacy profession (other than as a student);
(t) a principal in the teaching service;
(u) the manager of an authorised deposit-taking institution;
(v) a member of the Institute of Chartered Accountants in Australia or the Australian Society
of Accountants or the National Institute of Accountants;
(w) the secretary of a building society;
(x) a minister of religion authorised to celebrate marriages;
(y) a person employed under Part 3 of the Public Administration Act 2004 with a
classification that is prescribed as a classification to which this section applies or who
holds office in a statutory authority with such a classification;
(z) a fellow of the Institute of Legal Executives (Victoria).

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