ࡱ>  ~bjbjn1n1 ;R [g [gwff&&&&& ' ' '8D'\'t 'Rx(L`((((()H+Tl+,ѠӠӠӠӠӠӠ$ʣ&+))++&&((H >/>/>/+&(&(Ѡ>/+Ѡ>/>/+(ZȚ+"0<,SS&&yD++>/+++++-l+++R+++++++++++++fX %: Request for registration of interest for: [Insert service/needs title] Request Number: [Insert] Issued By: [Insert] (State Party) Closing Time: [[time] [am/pm], [date]], Perth, Western Australia [Closing time should be completed by inserting a time (usually 2:30pm). Do not add words such as 'western standard time' or 'daylight saving time' Please note: the text in this red font represents drafting instructions. Any areas that are highlighted in yellow require the State Party to input information. Sections listed in black must be included in the Request document, whereas sections listed in blue are optional. For further information about how to fill out this template, please contact  HYPERLINK "mailto:fundingandcontracting@finance.wa.gov.au" Finance.] Part A: About this Registration of Interest Process Your organisation is to read and keep this part. Background The State Party is undertaking a Registration of Interest (ROI) process to assist with the [planning/review] of the [insert particular service]. Further information about the proposed services can be found in Part B: Potential Service Requirements. The State Party wishes to gauge the level of interest within the community services sector for the provision of a service that will contribute to the achievement of the [insert community outcome sought]. How this ROI process works The issue of this ROI Request is not a Request for Tender. As such, it is not a commitment or representation of any kind that the State Party will issue a Request for Tender to provide the service, or that the State Party will otherwise look to procure services that contribute to the achievement of the community outcome listed above. The State Party may contact one or more of the organisations that lodge a Registration Form (the Respondents) in the future to discuss the service or the State Partys plans or needs generally. The State Party may take the Respondents views and feedback into account when developing any future Request for Tender relating to this service. However, lodgement of a Registration Form will not guarantee that the State Party will consult with your organisation, and will not result in any kind of short-listing for a further process. [Consistent with this statement, do not use an ROI as a basis for short-listing or otherwise conducting a restricted process or direct engagement an expression of interest or another suitable process should be used for this purpose.] How to register your interest If your organisation is, or may be interested in providing this service either now, or sometime in the future, please complete the Registration Form found in Part C. Please note, your Registration Form, must be submitted by the closing date and time listed on the front cover of this ROI Request. You can lodge your Registration Form by: [Delete the lodgement options you do not require] Hand or Post at: [insert address details] Email at: [insert email address] Where to get more information If you have any enquiries about this ROI process, please contact the authorised State Party representative listed below. Name: [insert] Title: [insert] Telephone: [insert] Email: [insert] Part B: Potential Service Requirements [This part should be used to provide a description of the community outcome and service requirements. It should provide enough detail to ensure Respondents are able to understand what may be required should the State Party wish to procure such services into the future. If you have developed a specification for this service, a ROI is unlikely to be the correct process to undertake. Please consider the use of an expression of interest process instead. For further information, or to clarify which process is suitable for the State Partys circumstances, please contact  HYPERLINK "mailto:fundingandcontracting@finance.wa.gov.au" Finance] Information about the proposed services is provided below. Domain and Community outcomes [The domain is a wellness category for whole populations of the Western Australian community. The community outcomes are the desired impact or change that the state party is seeking to achieve within the community. The domain and at least two community outcomes should be drawn from the  HYPERLINK "/government/publications/community-services-outcomes-measurement-framework" Outcomes Measurement Framework.] [Insert description of the domain and community outcomes sought] Service-level outcomes [The service-level outcomes are the desired change or benefit that the State Party is seeking to achieve for end users as a result of the procurement of this service.] [Insert description of the service-level outcomes sought] Description of potential service requirements  FORMTEXT [insert brief description of the services to be carried out] Part C: Registration Form This part is to be completed by your organisation and submitted to the State Party in accordance with Part A, section 1.3. Please provide all of the following details in the table format below. ROI Number: [Insert Request Number]Respondent InformationName of legal entity:[insert]Trading name:[insert]ACN and ABN (if applicable):ACN: [insert (if applicable)] ABN: [insert (if applicable)]Contact person name:[insert]Contact person position title:[insert]Contact person email address:[insert]Contact person telephone number:[insert]Registered address or address of principal place of business:[insert]Is your organisation interested, or may your organisation be interested in providing the services/work described in Part B at some time in the future? 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