(rfq) document for development of four laning of rewa ring road on ...

RFQ <strong>document</strong> <strong>for</strong> <strong>development</strong> <strong>of</strong> Four Laning <strong>of</strong> Rewa Ring Road on BOT (Toll + Annuity) basisprovided as per table below:Sl.No.1.2.3.4.Name <strong>of</strong> Member Role*{Refer Clause2.2.6(d)} $Percentage <strong>of</strong> equity in theConsortium{Refer Clauses2.2.6(a), (c) & (g)}* The role <strong>of</strong> each Member, as may be determined by theApplicant, should be indicated in accordance with instruction 4 atAnnex-IV.(d) The following in<strong>for</strong>mation shall also be provided <strong>for</strong> each Member<strong>of</strong> the Consortium:Name <strong>of</strong> Applicant/ member <strong>of</strong> Consortium:No. Criteria Yes No1. Has the Applicant/ constituent <strong>of</strong> theConsortium been barred £ by the Central/ StateGovernment, or any entity controlled by it, fromparticipating in any project (BOT or otherwise).2. If the answer to 1 is yes, does the bar subsist ason the date <strong>of</strong> Application.3.Has the Applicant/ constituent <strong>of</strong> theConsortium paid liquidated damages <strong>of</strong> morethan 5% <strong>of</strong> the contract value in a contract dueto delay or has been penalised due to anyother reason in relation to execution <strong>of</strong> acontract, in the last three years?6. A statement by the Applicant and each <strong>of</strong> the Members <strong>of</strong> itsConsortium (where applicable) or any <strong>of</strong> their Associatesdisclosing material non- per<strong>for</strong>mance or contractual non-compliancein past projects, contractual disputes and litigation/ arbitration in therecent past is given below (Attach extra sheets, if necessary):___________________________________$All provisions contained in curly parenthesis shall be suitably modified by the Applicantto reflect the particulars relating to such Applicant.£ or has been declared by the Authority as non per<strong>for</strong>mer/blacklistedNIT No. MPRDC/BOT (T+A)/PQ/2012/ 7783 Bhopal, dated 27.09.2012 - 48 -