ࡱ> E )bjbj ;xj ij i rrrrr8Jyp&( XZ v ooooooo$rUuTpr   prrH3p### Rrro# o##.fH4lh~  ,i@oIp0ypliu!u4l4lurHl # pp" yp u X 8: Community Services Request for Exemption Current Service Agreement Provision of[insert service/needs title]Current Service Provider[insert name of current service provider]Current Service Agreement Commenced[insert commencement date of current Service Agreement]Estimated Value of Current Service Agreement including GST and extension options[insert estimated value of current Service Agreement, including GST, over the entire term of the Service Agreement, including all extension options]Current Service Agreement Term[insert term of current Service Agreement, including all extension options]New Service Agreement Estimated Value of New Service Agreement including GST and extension options[Use if Request for Exemption is for entirely new Service Agreement.] [insert estimated value of new Service Agreement, including GST and extensions, over the entire term of the Service Agreement, including all extension options]Estimated Term of New Service Agreement[Use if Request for Exemption for entirely new Service Agreement] [insert term of new Service Agreement, including extension options]Prepared by[insert name] [insert title] [insert phone number and/or e-mail]Date[insert date] [The text in this red font represents drafting instructions. Any areas that are highlighted in yellow require the State Party to input information. Sections in black must be included in the document, sections in blue are optional. For further information about how to fill out this template, please contact  HYPERLINK "mailto:fundingandcontracting@finance.wa.gov.au" Finance. NOTES A State Agency is not required to comply with the minimum competitive requirement where an Authorised Officer of the State Agency considers that the specified procurement method is not appropriate for the relevant procurement or an emergency situation arises ( HYPERLINK "/government/multi-step-guides/western-australian-procurement-rules" Western Australian Procurement Rules - Rule C5 Exemption from Appropriate Procurement Method). The decision and justification for the decision must be recorded in writing. This template can be used by State Agencies to record the decision and justification. Note that the  HYPERLINK "/government/multi-step-guides/western-australian-procurement-rules" Western Australian Procurement Rules require State Agencies to establish and maintain an exemption register. Do not use this template for the approval requirements in relation to procuring from a registered Australian Disability Enterprise (ADE), a registered Aboriginal Business or the preferred service provider process or direct negotiations under the Delivering Community Services in Partnership Policy.] REQUIRED SERVICES An exemption from the  HYPERLINK "/government/multi-step-guides/western-australian-procurement-rules" Western Australian Procurement Rules, Rule C4.1 Use the Appropriate Procurement Method, is sought from the minimum competitive requirements for [insert details of requirement]. [Provide details of the required services, accounting for all related services.] The procurement of [insert service title] from [Service Provider] is important for the [State Party name] as it will [detail how the procurement will contribute to the achievement of community outcomes for the State Party]. [Explain the ongoing (identified) community need,and provide an indication of the criticality of the requirement and impact if the exemption is not approved.] In the event that this exemption is not approved, the following impacts are likely: [detail how the community will be negatively affected]. Service Review [Delete this section if this exemption is for a new service.] A service review was undertaken on [date] which is attached as Appendix [number]. Term The proposed Service Agreement term is [number] months/years. There will be [number] options to extend the term, available at the absolute discretion of the [State Party], each option having a [number] month/year duration. [Delete if no extension options applicable.] 1.3 Estimated Service Agreement Value The estimated total Service Agreement value of the procurement over the proposed term of the Service Agreement (including all extension options) is $[value] (GST inclusive). This value has been determined by [insert rationale for how value has been determined]. [Choose one of the options below, or insert correct price method to be used:] A fixed price for all services required under the proposed Service Agreement will be sought, and the Service Agreement will be awarded at a fixed price. Or; Prices for the services will be sought on a unit basis (i.e. number of hours). However a maximum Service Agreement value of $[value] (GST inclusive) will apply to the Service Agreement. The maximum Service Agreement value is based on [detail how the maximum value was determined]. 1.4 Availability of Funding The availability of appropriate funding has been confirmed by [State Party officer name], [title]. JUSTIFICATION [Delete the irrelevant option.] Option 1: Specified procurement method is not appropriate for the relevant procurement [Provide justification addressing why the specified procurement method is not appropriate for this procurement. Consider: Research you have undertaken Any market testing that has occurred Experience with supplier(s) of the service] Option 2: Emergency situation [Provide justification, explaining the particulars of the emergency situation and why the specified procurement method is not appropriate for this procurement.] RECOMMENDATION AND UNDERTAKING It is recommended that the [Authorised Officer] of [State Party name] approves this exemption to engage [Service Provider] for the provision of [description of services]. The [State Party name] will then be required to fulfil all obligations under the  HYPERLINK "/government/multi-step-guides/western-australian-procurement-rules" Western Australian Procurement Rules from which it is not exempt under this document. [Select one of the following options: Option 1: if the estimated total service agreement value is under $5 million including GST.] Subject to approval of this exemption, a formal Request document (based on Department of Finance templates) will be prepared and issued to the Service Provider. The approved exemption will be added to the [State Party name]s exemption register. Following the receipt of a formal Offer in response to the Request, an evaluation report will be prepared for approval by the [Authorised Officer]. The report will include details of the value for money analysis of the submitted Offer. Following approval of the report, a letter of acceptance will be issued establishing the Service Agreement and the Service Agreement award details will be published on Tenders WA. [Option 2: if the estimated total service agreement value is greater than $5 million including GST]. Subject to the approval of this exemption request, a Procurement Plan will be submitted to the Community Services Procurement Review Committee for endorsement, and then submitted to the [Authorised Officer] for approval. A formal Request document (based on Department of Finance templates) will then be prepared and issued to the Service Provider. The approved exemption will be added to the [State Party name] exemption register. Following the receipt of a formal Offer in response to the Request, an evaluation report will be prepared, including details of the value for money analysis of the submitted Offer. The report will be submitted for review by the Community Services Procurement Review Committee prior to seeking approval of the report by the [Authorised Officer]. Following approval of the report, a letter of acceptance will be issued establishing the Service Agreement and the Service Agreement award details will be published on Tenders WA. A formal Contract Management Plan will also be developed in accordance with the  HYPERLINK "/government/multi-step-guides/western-australian-procurement-rules" Western Australian Procurement Rules. SUBMITTING OFFICER [State Party name]NameTitleContact NumberSignature Date DD / MM / 202YREVIEW AND APPROVAL Authorised Officer NameTitleApproved  FORMCHECKBOX  Not Approved  FORMCHECKBOX Comments: Signature Date DD / MM / 202Y     Request for Exemption [insert service/needs title] COMMUNITY SERVICES REQUEST FOR EXEMPTION Document Version: 10 Version Date: 01-06-21 Page  PAGE 7 of  NUMPAGES 7  [Insert your agency badge here] *+3DERSmop    = a b c   / @ K O a c d y z ǿϻǿǿdzǿdzϩhU0hh.0J%hU0h 0J%hU0hU00J#5hU0hU00J%5 *hG}hS*hh. *hG}hi *hG}h hG}h hU0hY40J#5hU0hY40J%5 hY40J%5 hhhh 4+ERop^kd$$Ifl0L "  t0644 lapyt|b $$Ifgd|bgdY4gdgd  vmm $$Ifgd|bkd$$Ifl0L "  t0644 lapyt|b  b vmm $$Ifgd|bkd>$$Ifl0L "  t0644 lapyt|b  c vmm $$Ifgd|bkd$$Ifl0L "  t0644 lapyt|bc d z vtkkk $$Ifgd'kd|$$Ifl0L "  t0644 lapyt|b   , = L [ y       , - 4 = Z \ ] i j u v w x ͸ձըܱŠŠ՗ *hG}h^JhG}h^JhG}h ^J *hG}hwhU0hw0J% hG}hw *hG}hS* *hh. *hG}hi *hG}h hG}h h'hw0J#h'hgc0J#h'hh.0J#h'h0J#1  \ vmmm $$Ifgd'kd$$Ifl0k"a t0644 lapyt|b\ ] i w vmmmm $Ifgd kd$$Ifl0k"a t0644 lapyt|b vmm $Ifgd kdY$$Ifl0k"a t0644 lapytI  : 0123:;˲ˤ}}}}dN*h hh h0J56B* CJ]aJph0jh hh h0J#56CJU]aJ!h hh h0J#56CJ]aJ*jh hh h0J#56CJU]aJh hh0J#5CJaJhlhgc0J#5CJaJh h0J#5CJaJhlh0J#5CJaJhG< hG}h hG}h ^J *hG}hw^JhG}hw^J =Cvqlaaaa\\gd$M <]gd8"gdlgdU0kd$$Ifl0k"a t0644 lapytI ;<=CEQ}%GHIS͸xxxx\K h%h%6B* CJaJph7j~h%h%6B* CJPJU^JaJph(h%h%6B* CJPJ^JaJph1jh%h%6B* CJPJU^JaJph"h%6B* CJPJ^JaJph(hlh8"6B* CJPJ^JaJph+hlh8"56B* CJPJ^JaJphhlh 0J#5CJaJh h0J#56CJ]aJ  -.mq%&ѿmXXXXX(h%hw6B* CJPJ^JaJph1jh%hw6B* CJPJU^JaJph"h8"6B* CJPJ^JaJph"hw6B* CJPJ^JaJph(h%h%6B* CJPJ^JaJph"h%6B* CJPJ^JaJph(h%h%B* CJPJ]^JaJph1jh%h%6B* CJPJU^JaJph&'(LMVehq @Grʹʧ}}}}}k}}e_e[Wh+:h h8"^J h$M^J"hxI6B* CJPJ^JaJph(hlh8"6B* CJPJ^JaJph(hlhw6B* CJPJ^JaJph"hw6B* CJPJ^JaJph h%hw6B* CJaJph1jh%hw6B* CJPJU^JaJph7jh%hw6B* CJPJU^JaJph!Z:et ;A(,EagdN&gdwgd7  & FV^`VgdS & FV^`VgdSgdU0gd & Fe^e`gdU0STUVqz{|} 1SWXYZ[nu츸||r *h@h@^J h@^Jh8"h@0J#h8"hG<0J#h8"h0J# h^J *h7N"h7N"B*^Jph hOd^J h7N"^JhOdB*phh\h\0Jjh\B*Uphjh\B*Uphh\B*phh;hVGB*ph+u}07:;<k!%*.;[bdet ̽̆}w}}ohSh7 6 hrk0J%hU0h7 0J%hU0hN&0J#hG<h7 6hG<h@^J *h!]^J *h!]h!]^J htG^J h!]^JhU0h!]0J# hOd0J#hU0h0J# hS*^J *h@h@^J h@^J *hS*hS*^J *hS*h@^J) !%'*17GV\ #$);O`   $)>A[\Ļꇇ·~~~hU0hZ0J#h7 h7 ^JhSh7 6hSh`T6hShS6$h0h7 5B*CJ^JaJphhU0h0J#h7 B*^Jph *h7 h7 B*^Jphh7 h7 B*^Jph *h7 h7 ^J hi^J h7 ^J1 $()+, $)BEIa¹唇}hn.0J%5\]htGhb(0J%5\]hU0h0J#h+:ha *hN&hN&^J *hZFhN&^JhN&hN&^JhShN&6hShS6 *hU0hZ0J%hU0hZ0J#hU0h0J#hU0hi0J%hU0hZ0J%/I2PO F!"K#$'' ( $Ifgd`vHgdgdgd|Jw & FgdgdtGgdU0 & FgdU0HIks| !%012:;OPh!%*-.2?EU^_orzĻ٬Ш hn.^J *hn.^J *h`vHh ^J h ^Jh+:h@u hn.0J#htG0J%5\hn.0J%5\htGhb(0J%5\hU0h+:0J# htG0J#hU0h0J#htGhb(0J%5\]htG0J%5\]5 rstu6 7 D N O f j o t !-!D!F!^!b!g!!!!!ݼݶh7h 0J% *h7h0J%h7h0J%h7h 0J#h7h 0J#h7h0J# hn.^Jh\hn.0Jj) hn.B*Uphhn.B*phjhn.B*Uph hBQ|^J *h`vHh ^J h ^J1!!!!!/"I"L"M"R""""/#2#3#J#K#N#S#~###$$$$$$4$8$>$$$$$$%4%8%>%%%%%&4&8&>&?&B&P&&&''''#')'ŻhxIh`vH0J%h7h`vH0J%h7h7M0J% *h7h0J% *hxIh0J%hxIh0J%h7h0J# hxI0J#h7h0J#h7h 0J%h7h0J% *hn.0J%;)'R'W'X'Y'Z'd''''''''''''''' ( ((((((((,(-(.(7(8(9(:(仲zzzslb\ hW3aJhv4hW35aJ h`vH5aJ h7M5aJhv4h`vHB*aJphhv4h`vH5aJ hG}h`vH *heh`vH5aJheh`vH5aJh`vHh7h0J%hB*phh\hn.0Jjb hn.B*Uphhn.B*phjhn.B*Uph hn.0J%hxIh`vH0J%$ (((( $$Ifa$gd`vHskd $$If9p##  t 0#649ap yt`vH((((|| $$Ifa$gd`vHvkdT $$If90 p#  t0#649ayt`vH((,(-(|| $$Ifa$gd`vHvkd $$If90 p#  t0#649ayt`vH-(.(8(9(;(@(A(P(||l||c $IfgdW3$ $Ifa$gdW3 $$Ifa$gd`vHvkd$$If90 p#  t0#649ayt`vH:(;(?(@(A(D(E(I(J(K(N(O(P(Q(c(e(f(w(x(y(z((((((((((((((((((((滷氠晻晻th撃jh5UaJjh5UaJjhv4h|+5UaJ h$k5aJ hW3h`vHhv4h`vH56B*aJph h#]5aJh`vH hG}h`vH *hxIaJ *hW3h`vHaJ *hW3hW3aJhv4h`vHaJhv4h`vH5aJ h7M5aJheh`vHaJ'P(Q(e(y(w $Ifgd`vH & FgdU0vkd"$$If90p# t0#649ayt`vHy(z(((t $$Ifa$gdW3 $$Ifa$gd`vHskd$$If9##  t 0#649ap yt`vH((((|p $$Ifa$gdW3 $$Ifa$gd`vHvkdu$$If90 #L  t0#649ayt`vH((((((xl`` $$Ifa$gd`vH $$Ifa$gd$k$ j $Ifa$gd$kvkd$$If90 #L  t0#649ayt`vH(((((((((((((((((((((((((((((((())))3)üËü}uqquqquqquqqh^ *h5{9hVG^Jh5{9hVG^Jh9jh9U h`vHh`vH *hxIaJ *hW3hW3aJheh`vHaJ hW3aJhv4hW35aJ h`vH5aJ h7M5aJ hG}h`vHhv4h`vHaJhv4h`vH5aJjhv4h|+5UaJjh5UaJjh5UaJ$((((((((zzj^^U $Ifgd`vH $$Ifa$gd`vH$ $Ifa$gdW3 $$Ifa$gdW3xkdy$$If90 #L  t0#649ayt`vH((((((((())5)6)xvxvxvxvtvgd gd`vHxkd$$If9Q0Q#W t0#649ayt`vH 3)5)6)T)_)q)s)))))))))))))))))))))))))) h`vHh`vHh9 jhnhVGUmHnHuh^%mHnHujh|bhVGUh hhxI h|bhVGh|bhVG5hVGh5{9hVG^J6)_)))))))gd`vH$a$gd|bgd|b$a$gd|b9 0&P 1h:p|b. A!"#$%S $$If!vh#v #v:V l t065 5pyt|b$$If!vh#v #v:V l t065 5pyt|b$$If!vh#v #v:V l t065 5pyt|b$$If!vh#v #v:V l t065 5pyt|b$$If!vh#v #v:V l t065 5pyt|b$$If!vh#v#va:V l t0655apyt|b$$If!vh#v#va:V l t0655apyt|b$$If!vh#v#va:V l t0655apytI$$If!vh#v#va:V l t0655apytIDyK yK vmailto:fundingandcontracting@finance.wa.gov.auyX;H,]ą'c9DyK yK https://www.wa.gov.au/government/multi-step-guides/western-australian-procurement-rulesyX;H,]ą'c9DyK yK https://www.wa.gov.au/government/multi-step-guides/western-australian-procurement-rulesyX;H,]ą'c9DyK yK https://www.wa.gov.au/government/multi-step-guides/western-australian-procurement-rulesyX;H,]ą'c9DyK yK https://www.wa.gov.au/government/multi-step-guides/western-australian-procurement-rulesyX;H,]ą'c9DyK yK https://www.wa.gov.au/government/multi-step-guides/western-australian-procurement-rulesyX;H,]ą'c$$If!vh#v#:V 9  t 0#65#/ / 049p yt`vH$$If!vh#v #v:V 9 t0#65 5/ 49yt`vH$$If!vh#v #v:V 9 t0#65 5/ 49yt`vH$$If!vh#v #v:V 9 t0#65 5/ 49yt`vH$$If!vh#v#v:V 9 t0#655/ 49yt`vH$$If!vh#v#:V 9  t 0#65#/ / 049p yt`vH$$If!vh#vL #v:V 9 t0#65L 5/ 49yt`vH$$If!vh#vL #v:V 9 t0#65L 5/ 49yt`vHhDehDe$$If!vh#vL #v:V 9 t0#65L 5/ 49yt`vH$$If!vh#v#vW:V 9Q t0#655W/ 49yt`vH; DdyEYaB  Ab?bWestern Australian State Government Coat of ArmsPicture 37Western Australian State Government Coat of Arms"bד#խ+>K<5'nyד#խ+>K<5PNG  IHDRWS0 sRGBgAMA a cHRMz&u0`:pQ<PLTEٟ pHYs!!IDATX_lk:@#( DZ%cU^!-E`R]R{ 0  .RUDAv!D s1In/n=no>ٽ?3w>}Zϳ3fep_,Ѿ}"ٖo6hՍXK$\]o$.1~E6 * I(ƺ- ePޜP(`Nj B=^@3?ׄ^ξy)s+ydb'^*n%n3X8`ْ/=Qn:8d֨휝.0ʖU0Cְ*\4Wnvo6U:ɳ"Sd9]$kRǝoMyc+40>LQL;ӌt8nS6=`lnXb;\lZK|0#j[3&S~zJ6i=Jb:@aKb7n&b+f (fҿ Yޯj5-Sre M7%_WG{16PGZV)/l4ɊO5H6llUmMS.w] VSoCklѬv6- .}b` |ёNS2ҰsVB (83w@2cdav,v'li' UmSdmEx`v[).:l&+ ̡I6B[N0;&6 ؁M49_vm7b`µn{j֝Ъ¤N&BnAI]A%'F^m~;]UհFա[w>Mr;қFU6讕!~,ȳտ}d:K5谿˶S6666666666666666666666666666666666666666666666666hH6666666666666666666666666666666666666666666666666666666666666666662 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@66666 OJPJQJ_HmH nH sH tH N`N 'Normal$xxa$CJ_HaJmH sH tH H@H 7 Heading 1 $h@&5CJ ^JaJD@D w Heading 2@&56OJQJ^JDA D Default Paragraph FontRi@R 0 Table Normal4 l4a (k ( 0No List F@F U00Header$ B#a$CJ2/2 U00 Header CharCJ@ @@ U00Footer B#PCJ2/!2 U00 Footer CharCJP2P  0 Balloon Text CJOJQJ^JaJN/AN  0Balloon Text CharCJOJQJ^JaJl>@l U0Title$$X&dPa$m$#5@CJ4KHOJPJQJ^JaJ4D/aD U0 Title Char5@CJ4KHPJaJ4rsr   Table Grid7:V0 D/D 7Heading 1 Char5CJ ^JaJ6U`6  0 Hyperlink >*B*ph@@@   List Paragraph ^m$F/F wHeading 2 Char56OJQJ^JXOX W3Report Table Style <<a$ CJPJaJB' B i0Comment ReferenceCJaJ<< i0 Comment TextCJaJB/B i0Comment Text CharCJaJ@j@ !i0Comment Subject 5\N/N  i0Comment Subject Char5CJ\aJFV !F 90FollowedHyperlink >*B*ph@o1@ ' Instructions6B* ^Jph:OB: |b Table text$$a$^J2oQ2 U0Optional B*ph3Rv!aR  h0Unresolved MentionB*ph`^\q D rD_0Revision'CJ_HaJmH sH tH PK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭Vj\{cp/IDg6wZ0s=Dĵw %;r,qlEآyDQ"Q,=c8B,!gxMD&铁M./SAe^QשF½|SˌDإbj|E7C<bʼNpr8fnߧFrI.{1fVԅ$21(t}kJV1/ ÚQL×07#]fVIhcMZ6/Hߏ bW`Gv Ts'BCt!LQ#JxݴyJ] C:= ċ(tRQ;^e1/-/A_Y)^6(p[_&N}njzb\->;nVb*.7p]M|MMM# ud9c47=iV7̪~㦓ødfÕ 5j z'^9J{rJЃ3Ax| FU9…i3Q/B)LʾRPx)04N O'> agYeHj*kblC=hPW!alfpX OAXl:XVZbr Zy4Sw3?WӊhPxzSq]y !1x @@ ;&u !)':((3))!"#%&'(*+,-27: c \  (((-(P(y(((((6)) $)./01345689;2:G' L U z tX !XXXXXXGG!T # @ 0(  B S  ?H0(   _Hlk73613790 _Hlt135832116 _Hlt135832117G!@@!f n !!!!: (+dh{=H<O !!!!33333333Edz]i : et  !!6!!!!!!  k k ^_oorr?PRWX !^!!!!!!!!m:HTS ifHTSpn  HTS\'zHTS?=cKHTS!!.~X/:l6_1b1RI2\6B3HTS5$2TVN=LOBa~M7OHTSgWHTS,^H{O_8qq;hVdξ hDtyjV((jVִFt> <SHtZʑn=u /wHTS^`o(. \^ `\o(.80^8`0o(..80^8`0o(... ^`o( .... ^`o( ..... `^``o( ...... `^``o(....... `^``o(........h ^`o(hH.1 ^`hH. 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