Application under section 3 of the Local Authorities (Members' Interests) Act 1968

Before filling in this form, please read Part 2 of our Local Authorities (Members’ Interests) Act 1968: Guide for members of local authorities on managing financial conflicts of interest.

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Local authority

Name of member requiring approval

Your name We need this so we can contact the person making the application on the local authority's behalf.

Your email address We need this so we can contact the person making the application on the local authority's behalf.

Your phone number We need this so we can contact the person making the application on the local authority's behalf.

Is this application urgent?

Yes No

If it is urgent, please explain why. Please make sure your explanation includes a date - what deadlines are you working to?

The names of the parties to the contract If a company, state its legal name as it appears on the Companies Register.

Describe the member's interest in the contract For example, is the member a party to the contract/subcontract, or a director and shareholder of the company that is a party to the contract/subcontract, or is their spouse a party to the contract/subcontract?

Description of the contract Include the contract start and end dates, and goods or services to be provided under the contract.

Is the application for prior approval or retrospective approval?

Prior approval Retrospective approval

If this application is for retrospective approval... ... why was prior approval not sought?

Financial year for which approval is sought

Monetary amount for which approval is sought Specify whether the amount includes or excludes GST

What is the local authority's standard process/procurement policy for contracts of this type or value?

Describe the process used to select the proposed contractor If the local authority's standard process/procurement policy was not followed, explain why.

Why does the local authority wish to use the proposed contractor for this work? For instance, how the local authority justifies its choice based on cost, performance, quality, expertise, or experience

Were other potential contractors considered or given the opportunity to quote or tender?

Yes No

If not, why not?

Who was involved in making the recommendation or decision to award the contract? We need to know the positions of those involved, not their names.

Has the member had any involvement in any local authority decisions or discussions about the procurement process? If the answer is yes, please include a description of that involvement.

Is there any other relevant information we should consider?

Other supporting information You're welcome to attach files that would help us in assessing your situation.

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