PRE - QUALIFICATION OF CONTRACTORS - Life Insurance ...

ii) Enclose copy of partnershipdeed, Articles of Association orAffidavit in case of soleproprietorship as per Annexure A-1.iii)Fill-in enclosed Annexure A-2.10 Fill and enclose Annexure B givingdetails of enrolment with LIC ofIndia in the past and with otherorganisations11 Has the applicant or his partners orDirectors been black listed in thepast by any Central or StateGovt.Deptt./Organisation12 i) Annual Turn Over for last fouryears (enclose documentaryevidence or proof to support figures)ii) What evidence of proof isenclosed to support the amounts ofyearly turnoveriii) Enclose latest income taxclearance CertificateYEARi 2006-07ii 2007-08iii 2008-09iv 2009-10Rs. in LakhCertificate enclosed for Assessment year_________13i) Name and complete postaladdress of bankers14ii)Enclose solvency certificateindicating amount.iii)Bank Guarantee limit with Variousbanksi) Enclose list of immovableproperties with complete postaladdresses, full description &reasonable market value of propertyduly supported by certificate ofD.M./Collector/First ClassMagistrate/ approved valuer.ii) Whose supporting certificateis enclosedi) Rs.________ Lac with __________ii) Rs.________ Lac with __________iii) Rs.________ Lac with __________TOTAlLRs._______________________of ________________________Date ______________________

15i)Particulars of movable propertiesalong with Banker’s referenceValue of tools & plantsOther AssetsTotalii) Whose reference isenclosed?Rs.Rs.Rs.16 Fill in and enclose list of tools &plants as per Annexure-C enclosed.17 Fill in & enclose Annexure-D givingfull particulars about major workscompleted during past Four yearsNOTE: List of only those workswhich are carried out by firmrequesting for enrolment is to begiven.18 Work in Progress:i) Whether full details of majorwork on hand given in Annexure ‘E’ii) Are copies of work orders forsuch large works enclosed.19 Whether full information regardingpermanent technical staff employedgiven in Annexure ’F’20 i) How do you normally carryout works of water supply,sanitary and plumbing installationsii) Who is the license holder andwhat is his experience of this work.21i) How do you normally getwork of electrical installationscarried outii) Who is the license holder &what is his experience22 Any other information the applicantmight like to give

ANNEXURE – A1A F F I D A V I T(On Non Judicial Stamp paper of Rs.*_______/- in case the individual who is the soleproprietor of the firm)I…………………………………………………………………………………………………. s/o………………………………………………… age …………….. years, occupation business r/o…………………………………………………… do hereby state on oath as under:That I am residing in ……………………………………………………… locality ofDistrict …………………………………… since last ……………….. years.That I am the sole proprietor of a proprietary concern name and style as“……………………………………………………..” having it’s office at …………………………District …………………………. dealing in business of Government, civil contracts andancillary works attached therefore.Hence this affidavit.Deponent _________________Note: This Affidavit should be notarized.

ANNEXURE A2LIFE INSURANCE CORPORATION OF INDIACONSTITUTION OF FIRM – SOLE PROPRIETORSHIP/PARTNERSHIP/LTD.CO./OTHERDETAILS OF CONSTITUTENTSName of sole partner Age Share Technical Experienceor Director / otherYear to As AsHigh OfficialsYear to Employee contractor1 2 3 4 5 6 7 8Sr.No.Whether powerof attorneyHolderSIGNATURE OF CONTRACTOR

ANNEXURE – BLIFE INSURANCE CORPORATION OF INDIAPARTICULARS OF ENROLMENT WITH LIC AND OTHER ORGANIZATIONI. ENROLMENT WITH LIC :Name of works for 1)Which enrolled by 2)L.I.C. in the past 3)4)Sr. Nos. for which tenders were submitted :Sr. Nos. for which work-order was received:II.ENROLMENT WITH OTHER ORGANISATIONS:Sr.No.Name & Address ofAuthority with whomyou are enrolledFIRST TIMEENROLMENTYeartoyearIs copyof letterenclosedLAST RENEWAL OR ENROLMENTYeartoyearClass orCategoryLimit(Rs. inLac)Is copyof letterenclosed(1) (2) (3) (4) (5) (6) (7) (8)SIGNATURE OF CONTRACTOR

ANNEXURE – CLIFE INSURANCE CORPORATION OF INDIAPARTICULARS OF SHUTTERING TOOLS AND PLANTSr.ItemSpecification Quantity Estimated RemarksNo.Value(1) (2) (3) (4) (5) (6)1. a) Shuttering platesb) Shuttering Wooden Planksc) Wooden propsd) Steel props2. Concrete Mixers3. Concrete Vibratorsi) Petrol Drivenii) Electric Driven4. Tower Hoist5. Trucks6. Welding Equipments7. Pump-Sets8. Floor-Polishing Machine9. Cranes10. OthersSIGNATURE OF CONTRACTOR

ANNEXURE – DLIFE INSURANCE CORPORATION OF INDIASr.No.Name and Complete PostalAddress ofOwnerLIST OF MAJOR SIMILAR NATURE OF WORKS COMPLETED DURING LAST FOUR YEARSOrderValue ofwork asper finalbill (Rs. inLac)CommencementofworkmonthYearCompletionofworkmonthYearPenaltylevied fordelay ofcompletion,if anySite ofWork &Nature ofWorkAuthorityunderwhom workwas carriedRef. No.& DateContractAmount(Rs. inLac)Is copyenclosed(1) (2) (3) out (4) (5) (6) (7) (8) (9) (10) (11)SIGNATURE OF CONTRACTOR

ANNEXURE – ELIFE INSURANCE CORPORATION OF INDIALIST OF SIMILAR NATURE OF WORKS IN HANDSr.No.Name and Complete Postal Address ofSite of Work& Nature ofWorkOwnerAuthority underwhom workwas carried outRef. No. &DateOrderAmount(Rs. inLac)Is copyenclosedDate ofcommencementofworkScheduleddate ofcompletionof workProgress madeand expecteddate ofcompletion andreasons fordelay, if any(1) (2) (3) (4) (5) (6) (7) (8) (9) (10)SIGNATURE OF CONTRACTOR

ANNEXURE – FLIFE INSURANCE CORPORATION OF INDIAPARTICULARS OF PERMANENT TECHNICAL STAFFSr.No.Name Designation Age AcademicQualificationService withthe FirmDetails ofExperienceYear to Year(1) (2) (3) (4) (5) (6) (7)SIGNATURE OF THE CONTRACTOR

ANNEXURE – GENROLMENT CHECKLISTCHECKLIST FOR ENROLMENT:Sr. No. Description of Enclosure Refer Item of form1. Partnership deed / Articles of Association /Affidavit ()() Annexure A-1 (Appendix VII – B)8 (ii)2. Annexure (A-2) as supplied 8 (ii)(Particulars of Partners)3. Annexure – E (as supplied) 9 (Particulars of enrolment in LICand other Organization)4. Proof of Turnover 11 (ii)5. Latest I.T.C.C. 11 (iii)6. Solvency Certificate 12 (ii)7. Certificate of Bank Guarantee 12 (iii)8. Immovable Property Certificate 13 (ii)9. Movable Property reference 14 (i)10. () Annexure ‘C’ (as supplied) 15 (Particulars of shutteringtools/ plant)11. () Annexure ‘D’ (as supplied) 16 (List of major workscompleted during last 4 years)12. () Annexure ‘E’ (as supplied) 17 (List of work in hand)13. () Copies of work order 17 (ii)14. () Annexure ‘F’ (as supplied) 18 (Particulars of permanenttechnical staff)NOTE: Suitable modification to the above shall be made for different kind of Works.