EOI Response Form Expression of Interest (EOI) For Long Term Grazing on Travelling Stock Reserves in the Central Tablelands Region Response Form Central Tablelands Local Land Services Version 1 Approved 240215 Page 1 EOI Response Form 1. General Information for Respondents This response form must be completed. Please ensure all questions are fully addressed and full details are provided. Provide attachments where necessary, clearly labelled and cross-referenced. 2. Details of the Respondent: Name of legal entity: Trading Name: ABN: Address: Telephone no: Facsimile no: e-mail address: LLS holding reference number (if applicable): 3. The Respondent’s contact person: Name: Position: Telephone no: Mobile no: Facsimile no: e-mail address: 4. Respondent’s current insurance details: Insurer Policy type Policy No. Limit Expiry Date 5. Has the Respondent read, understood and accepted the terms of all EOI documents including: Statement of Requirements: Yes No - [Please provide details of non-compliance] Central Tablelands Local Land Services Version 1 Approved 240215 Page 2 EOI Response Form 6. Is the Respondent aware of any real or preceived conflicts of interest existing? Yes [Please provide details] No 7. Response to the evaluation criteria The Respondent must respond to each of the evaluation criteria. Note: A separate Expression of Interest form must be submitted for each TSR. Nominated TSR: Evaluation criterion (i) The nominated amount being the annual dollar value for a grazing permit over the nominated TSR. A neighbour with a contiguous boundary to a reserve will receive a 25% weighting advantage over other Respondents ($400 from neighbour equates to $500 from non-neighbour). NOTE: All tendered prices are subject to an annual Consumer Price Index (CPI) increase. [insert response] Evaluation criterion (ii) Proposed approach to managing the TSR (previous record of TSR management will be considered if respondent has previously held a grazing permit) [insert response] Evaluation criterion (iii) Relevant livestock production and land management experience. (Any records available to LLS on livestock or land/invasive species management will be considered) [insert response] Central Tablelands Local Land Services Version 1 Approved 240215 Page 3 EOI Response Form Evaluation criterion (iv) Capacity of the respondent to manage the TSR (ie proximity to TSR, time available (work on property, shift work, part time, full time) and resources (materials to undertake management)) [insert response] 8. Does the Respondent certify that the information contained in this Response is true and correct, and submitted in good faith? Yes No 9. Signed by the Respondent’s authorised representative who warrants that he or she has authority to submit this Response on behalf of the Respondent: Signature: Name: Position: Date: Central Tablelands Local Land Services Version 1 Approved 240215 Page 4