section viii sample bidding forms...section viii. bidding forms bids and awards committee,...

Procurement of One (1) Lot Spare Parts for the Repair and Maintenance of HARRIS Handheld and Manpack Radios of the Philippine Army

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Section VIII. Bidding Forms

Bids and Awards Committee, Department of National Defense, DND Building, Camp General Emilio Aguinaldo, Quezon City

DND TWG – 4212202; BAC Secretariat - 4213531

81

Section VIII

Sample Bidding Forms


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TABLE OF CONTENTS

Sample Document Page

1 Department of Trade and Industry (DTI) 83 Business Name Registration 2 SEC Registration Certificate 84 3 Mayor’s Permit/Municipal License 85 4 Statement of all On-going Government and 86 Private Contracts including Contracts Awarded but not yet started 4A Statement of Completed Contracts Similar to the Project 87 5 Net Financial Contracting Capacity 88 6 Joint Venture Agreement 93 7 Affidavit of Bid Security Declaration 95 8 Bid Security: Bank Guarantee 97 8A Bid Security: Irrevocable Standby Letter of Credit 99 9 Technical Specifications 100 9C Production/Delivery Schedule 102 10 Omnibus Sworn Affidavit 103 11 Bid Form: Price Proposal 106 12 Bid Form: Price Proposal for Goods Offered from Abroad 108 12A Bid Form: Price Proposal for Goods Offered from within 109 the Philippines 12B Delinquency Verification 110 12C BIR Certification 111 12D Verification Slip 112 13 PHILGEPS Certificate of Registration 113 13A Tax Clearance 114 14 Bank Guarantee Form for Advance Payment 116 15 Contract Agreement Form 117


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Sample Form 1


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84

Sample Form 2


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85

Sample Form 3


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86

Sample Form 4

Statement of all Ongoing Government & Private Contracts Including Contracts Awarded but not yet Started

Business Name: :___________________________________________________ Business Address: :___________________________________________________

Name of Contract/

Project Cost

a. Owner’s Name b. Address c. Telephone Nos.

Nature of Work

Bidders Role a. Date Awarded b. Date Started c. Date of

Completion

% of Accomplishment Value of

Outstanding Works / Undelivered Portion

Description % Planned Actual

Government

Private

Total Cost

Submitted by: :__________________________________________ (Printed Name and Signature) Designation: :__________________________________________ Date: :__________________________________________


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Sample Form 4A

Statement of Completed Similar Contracts Business Name: Business Address:

Name of Contract/ Project Cost

a. Owner’s Name b. Address c. Telephone Nos.

Nature of Work

Bidders Role a. Date Awarded b. Date Started c. Date of Completion

Value of Works Description %

Note: The following documents shall be presented for verification of the above statement during Post-Qualification:

Total

1 Notice of Award OR Notice to Proceed issued by the End user OR its equivalent; 2 Copy of actual contract OR its equivalent; and 3 Certificate of Completion OR End-user’s Acceptance OR Proof of payment

Submitted by:

:__________________________________________

(Printed Name and Signature)

Designation: :__________________________________________ Date:


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Sample Form 5

NET FINANCIAL CONTRACTING CAPACITY (NFCC) STATEMENT

The Chairman, DND BAC Department of National Defense Camp General Emilio Aguinaldo Quezon City, Philippines

THIS IS TO CERTIFY that the attached computation of the Net Financial

Contracting Capacity (NFCC) of ______________________________________, [Name of Bidder]

amounting to ______________________________________________________________ (Amount in Words) (US$/PhP________________) as part of our submitted Class “A” Eligibility Documents

(Financial) in the procurement of ________________________________________ is (Name of Project) true and correct.

That this document is submitted in lieu of a commitment from a licensed bank to

extend to this Company a credit line if awarded the contract, or a cash deposit certificate as

required by Sec 23.11.1(3) of IRR-A of RA 9184.

Yours faithfully,

______________________________________ (Name and Signature of Representative)

______________________________________ (Designation)

______________________________________ (Name of Firm)


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SUBSCRIBED AND SWORN to before me this _____ day of _____________, 20___, affiant exhibited to me his/her Community Tax Certificate No. ______________ issued on _________________ at _____________________, Philippines.

Notary Public Until 31 December 20____ PTR No._______________ Issued at:_______________ Issued on:_______________ TIN No. ________________

Doc. No. _______ Page No. _______ Book No. _______ Series of _______.


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Attachment to Sample Form 5

NET FINANCIAL CONTRACTING CAPACITY (NFCC) COMPUTATION:

A. Current Assets : _________________________ B. Current Liabilities : _________________________ C. Project Costs:

1) Outstanding : _________________________ 2) Ongoing : _________________________ 3) To Be Started : _________________________

NFCC = ________________________________________ [(Current Assets minus Current Liabilities) * (15)] minus

(the value of all outstanding works or projects under ongoing contracts, including awarded contracts yet to be started)].

_____________________ ___________________________________________ (Place and Date) (Name and Signature of Representative)

__________________________________________

(Designation) __________________________________________

(Name of Firm)


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Sample Form 6

JOINT VENTURE AGREEMENT

KNOW ALL MEN BY THESE PRESENTS:

That this JOINT VENTURE AGREEMENT is entered into By and Between _____________________________________________________ of legal age, _________, (Civil Status) owner/proprietor of _______________________________ and a resident of ___________________________________________________________.

- and – _____________________________________ of legal age, _______________, (Civil Status) owner/proprietor of _________________________________________________________

and a resident of __________________________________________________________.

THAT both parties agree to be jointly and severally liable for the entire agreement.

THAT both parties agree to join together their manpower, equipment, and what is

needed to facilitate the Joint Venture to participate in the Eligibility, Bidding and Undertaking

of the here-under stated project/s to be conducted by the Department of National Defense:

________________________________________________.

(Name of Project)

That both parties agree that ________________________ and/or

_________________, shall be the Official Representative of the Joint Venture, and is

granted full power and authority to do, execute and perform any and all acts necessary

and/or to represent the Joint Venture in the bidding as fully and effectively and the Joint

Venture may do and if personally present with full power of substitution and revocation.

That this Joint Venture Agreement shall remain in effect only for the above stated

Project/s until terminated by both parties.

Done this ________ day of ____________, in ___________.

___________________________________ _________________________________ (Name and Signature of JV Partner) (Name and Signature of JV Partner)


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Republic of the Philippines) ______________________ )S.S.

ACKNOWLEDGMENT

BEFORE ME, a Notary Public for and in _________________________, this ______________________, personally appeared: ID No.: Issued by: __________________________ _________ ____________________________________ __________________________ _________ ____________________________________ who exhibited to me their identification documents described above bearing their photographs and signatures known and identified by me through competent evidence of identity, presented this integrally complete instrument and represented to me that the signatures on the instrument were voluntarily affixed by them for the purposes stated, and declaring that they have executed this instrument as their free and voluntary act and deed. This instrument consisting of __ (__) pages, including this page on which this Acknowledgment is written refers to a Joint Venture Agreement and has been signed by all the parties and their witnesses on each and every page thereof.

WITNESS MY HAND AND SEAL on the date and at the place first above written.

Name of Notary Public Serial No. of Commission Notary Public for ___ Notarial Commission Expires on __________ Roll of Attorneys No. _________ PTR No. ____; (date issued); place issued IBP O.R. No._____ (date Issued)

Doc. No. _____ ; Page No. ____ ; Book No. ____ ; Series of 2015.

* Attach signatories’ legal capacity to sign.


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Sample Form 7 REPUBLIC OF THE PHILIPPINES) CITY OF ) S.S. x_____________________x

BID-SECURING DECLARATION Invitation to Bid/Request for Expression of Interest No. 1: [Insert reference number]

To: [Insert name and address of the Procuring Entity] I/We2, the undersigned declare that:

1. I/We understand that, according to your conditions, bids must be supported by a Bid

Security, which may be in the form of a Bid-Securing Declaration.

2. I/We accept that: (a) I/We will be automatically disqualified from bidding for any contract with any procuring entity for a period of two (2) years upon receipt of your Blacklisting Order; and, (b) I/We will pay the applicable fine provided under Section 6 of the Guidelines on the Use of Bid Securing Declaration, within fifteen (15) days from receipt of the written demand by the procuring entity for the commission of acts resulting to the enforcement of the Bid Securing Declaration under Sections 23.1 (b), 34.2, 40.1 and 69.1, except 69.1 (f), of the IRR of RA 9184; without prejudice to other legal action the government may undertake.

3. I/We understand that this Bid-Securing Declaration shall cease to be valid on the following

circumstances:

(a) Upon expiration of the bid validity period, or any extension thereof pursuant to your request;

(b) I am/we are declared ineligible or post-disqualified upon receipt of your notice to such

effect and; (i) I/we failed to timely file a request for reconsideration or (ii) I/we filed a waiver to avail of said right;

(c) I am/we are declared as the bidder with the Lowest Calculated and Responsive

Bid/Highest Rated and Responsive Bid”, and I/we have furnished the performance security and signed the Contract.

____________________


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2GPPB Resolution No. 15-2014, dated 20 June 2014 page 1 of 2 IN WITNESS WHEREOF, I/We have hereunto set my/our hand/s this ___ day of

[month] [year] at [place of execution]. [Insert NAME OF BIDDER’S AUTHORIZED REPRESENTATIVE]

Affiant SUBSCRIBED & SWORN to before me this__day of [month] [year] at [place of

execution], Philippines. Affiant/s is/are personally known to me and was/were identified by me through competent evidence of identity as defined in the 2004 Rules on Notarial Practice (A.M. No. 02-8-13-SC). Affiant/s exhibited to me his/her [insert type of government identification card used], with his/her photograph and signature appearing thereon, with no.___and his/her Community Tax Certificate No.___issued on___at____.

Witness my hand and seal this ___day of [month] [year]. NAME OF NOTARY PUBLIC Serial No. of Commission___ Notary Public for___until___ Roll of Attorneys No.___ PTR No.__, [date issued], [place issued] IBP No. __, [date issued], [place issued] Doc No___ Page No__ Book No__ Series of__.

page 2 of 2


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95

Sample Form 8

Form of Bid Security: BANK GUARANTEE

Bank Guarantee No. _____________

Name of Bidder . IAEB Number . Page of .

WHEREAS, ________________________________________________________________

[Name of Bidder]

(hereinafter called the “Bidder”) has submitted his bid dated _____________________________, for

the __________________________________________, (hereinafter called the “Bid”).

[Name of Project]

KNOW ALL MEN by these presents that We _______________________________________

[Name of Bank]

of ___________________________________, having our registered office at __________________

(Name of Country]

___________________________________________, (hereinafter called the “Bank,”) are bound unto

(Address of Bank] Department of National Defense (hereinafter called “the ENTITY”), in the sum of

____________________________________________________________, for which payment well

and truly to be made to the said ENTITY the Bank binds himself, his successor and assigns by these

presents.

SEALED with the Common Seal of the said Bank this ________ day of ______ 2009.

THE CONDITIONS of this obligation are: 1. If the Bidder withdraws his Bid during the period of bid validity specified in the Form of

Bid; or 2. If the Bidder does not accept the correction of arithmetical errors of his bid price in

accordance with the Instructions to Bidder; or 3. If the Bidder having been notified of the acceptance of his bid by the Employer during the

period of bid validity: (a) fails or refuses to execute the Form of Agreement in accordance with the

Instructions to Bidders, if required; or (b) fails or refuses to furnish the Performance Security in accordance with the

Instructions to Bidders.

We undertake to pay to the ENTITY up to the above amount upon receipt of his first written

demand, without the ENTITY having to substantiate his demand, provided that in his demand the

ENTITY will note that the amount claimed by him is due to him owing to the occurrence of one or both

of the two (2) conditions, specifying the occurred condition or conditions.


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The GUARANTEE will remain in force up to and including the date ONE HUNDRED

TWENTY (120) CALENDAR DAYS after the deadline for submission of Bids as such deadline is in the

Instructions to Bidders or as it may be extended by the ENTITY, notice of which extension(s) to the

Bank is hereby waived. Any demand in respect of this Guarantee should reach the Bank not later

than the above date.

DATE _________________ SIGNATURE OF THE BANK ____________________________

WITNESS _______________________________ SEAL ____________________________

_______________________________________

(Signature, Name and Address)


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Sample Form 8A

Form of Bid Security: IRREVOCABLE STANDBY LETTER OF CREDIT

Irrevocable Standby Letter of Credit No. ____________________ Name of Bidder . IAEB Number . Page of .

WHEREAS, ________________________________________________________________

[Name and Address of Bidder]

(hereinafter called the “Bidder”) has submitted his bid dated ____________________________, for

the_________________________________________________, (hereinafter called the “Bid”).

[Name of Project]

KNOW ALL MEN by these presents that We, ____________________________________ of

[Name of Bank]

____________________________, having our registered office at ___________________________

[Name of Country] [Address of Bank]

___________________________________________, (hereinafter called the “Bank,”) are bound unto

Department of National Defense (hereinafter called “the ENTITY”), in the sum of

____________________________________________________________, for which payment well

and truly to be made to the said ENTITY the Bank binds himself, his successor and assigns by these

presents.

SEALED with the Common Seal of the said Bank this ________ day of ______ 2009.

THE CONDITIONS of this obligation are: 1. If the Bidder withdraws his Bid during the period of bid validity specified in the Form of

Bid; or 2. If the Bidder does not accept the correction of arithmetical errors of his bid price in

accordance with the Instructions to Bidder; or 3. If the Bidder having been notified of the acceptance of his bid by the Employer during

the period of bid validity: a) fails or refuses to execute the Form of Agreement in accordance with the

Instructions to Bidders, if required; or b) fails or refuses to furnish the Performance Security in accordance with the

Instructions to Bidders.

We undertake to pay to the ENTITY up to the above amount upon receipt of his first written

demand, without the ENTITY having to substantiate his demand, provided that in his demand the

ENTITY will note that the amount claimed by him is due to him owing to the occurrence of one or both

of the two (2) conditions, specifying the occurred condition or conditions.

The IRREVOCABLE STANDBY LETTER OF CREDIT will remain in force up to and including

the date ONE HUNDRED TWENTY (120) CALENDAR DAYS after the deadline for submission of

Bids as such deadline is in the Instructions to Bidders or as it may be extended by the ENTITY, notice

of which extension(s) to the Bank is hereby waived. Any demand in respect of this Guarantee should

reach the Bank not later than the above date.

DATE _________________ SIGNATURE OF THE BANK ____________________________

WITNESS _______________________________ SEAL ____________________________

(Signature, Name and Address)


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Sample Form 9

Item Nr

Technical Specification Statement of Compliance

(Comply/Not Comply)

Quantity Unit Description Specification

Brand New Spare Parts for the Repair and Maintenance of HARRIS RF5800V-HH 2-5 Watts VHF/FM Radios of the Philippine Army

1 613 pcs PWB

Assembly, RF Module

P/N 12011-3200-01 – The A1A1 Assembly of RF-5800V-HH Radio Contains the Radio Frequency Portion of the Radio: Receiver, Transmitter, Filters, and Tuning Circuits. Provides an interface between the Transmit / Receive Antenna and A1A2 VHF Digital Assembly.

2 143 pcs Front Panel Assembly

P/N 12011-7009-02 Contains the Keypad and LCD that make up the Radio’s Man Machine Interface (MMI) and includes Audio Microphone and Speaker.

3 157 pcs Digital Board

Assembly

P/N 12011-4600-01 – A1A2 Assembly of RF-5800V-HH Radio. Processes Voice and Data Signals. Contains the circuits responsible for Encryption and Frequency Hopping. It is responsible for Radio Control System.

4 123 pcs Antenna Port

Assembly

P/N: 12041-5500-A1 – Provides a 50-Ohm Antenna Port for a threaded N-Connector (TNC).

5 163 pcs Battery

Interface Assembly

P/N 12030-6020-01 – Provides connection of Battery to Radio.

6 38 pcs Latch, Battery P/N: 12011-6016-01 – Serves as lock of the battery while connected to the Radio.

7 5 pcs Keypad

PTT/Vol/SQU P/N: 12011-6025-01 – Keypad for PTT, Squelch On/Off, and volume control.

8 38 pcs Front Panel,

Flexible Cable P/N: W56-0003-030 – Connects the Front Panel and Digital Board Module.

9 9 pcs Knob, Rotary

Switch

P/N 12011-6027-01 – Turns RF-5800V-HH On/Off. Selects Nets 1 through 5. Places the Radio in Scan Operation, if Scan is enabled. Places the Radio in Front Panel (FP) mode, permitting access to all Presets and Keypad Functions.

10 6 pcs Rubber Pad Assembly

(Keypad Front)

P/N: 12011-6020-01 – Serves as Keypad for Radio’s Front Panel.


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________________________________________________

Name and Signature of Bidder/Authorized Representative

Designation:______________

Date:____________________

11 91 pcs Dust

Cap/Audio Connector Cap

P/N: 12011-6055-01 – Protects the Audio Connector from dirt, dust and water to avoid terminal corrosion,

12 40 pcs Battery Latch

Spring

P/N Z20-0009-003 – Provides tension force to Battery Latch Lock to hold the Battery.

13 61 pcs Flex Interface

Assembly

P/N 12011-5220-02 – Provide connections with ancillary port, and toggle, rotary knob and Keypad Vol/PTT/Squelch switches.

Brand New Spare Parts for the Repair and Maintenance of HARRIS RF5800H - MP 20 Watts HF/SSB Radios of the Philippine Army

14 46 pcs Rear Panel Assembly

P/N 10535-4000-02 Contains Power supply assembly, and provides interface connector to the batteries.

15 40 pcs Hold Up Battery

B41-0010-003 Applies constant voltage to the radio memory circuits to retain the data while the radio is off.


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SCHEDULE OF REQUIREMENTS

Sample Form 9C The delivery schedule expressed as weeks/months stipulates hereafter a delivery

date which is the date of delivery to the Delivery Site. The bidder must state in the last column opposite each parameter and required delivery schedule either “Comply” or “Not Comply”.

Item Nr

Description Quantity Delivered

days/weeks/months

Comply/ Not

Comply

1 Brand New Spare Parts for the Repair and

Maintenance of HARRIS RF5800V-HH 2-5 Watts VHF/FM Radios of the Philippine Army

To be delivered within One Hundred Twenty days (120) calendar days upon receipt of NTP by the supplier.

PWB Assembly, RF Module 613 Pieces

Front Panel Assembly 143 Pieces

Digital Board Assembly 157 Pieces

Antenna Port Assembly 123 Pieces

Battery Interface Assembly 163 Pieces

Latch, Battery 38 Pieces

Keypad PTT/Vol/SQU 5 Pieces

Front Panel, Flexible Cable 38 Pieces

Knob, Rotary Switch 9 Pieces

Rubber Pad Assembly (Keypad

Front) 6 Pieces

Dust Cap/Audio Connector Cap 91 Pieces

Battery Latch Spring 40 Pieces

Flex Interface Assembly 61 Pieces

2 Brand New Spare Parts for the Repair and

Maintenance of HARRIS RF5800H - MP 20 Watts HF/SSB Radios of the Philippine Army

To be delivered within One Hundred Twenty days (120) calendar days upon receipt of NTP by the supplier.

Rear Panel Assembly 46 Pieces

Hold Up Battery 40 Pieces

3 Technical assistance during the conduct of repair

______________________________________________

Name and Signature of Bidder/Authorized Representative

Designation:______________

Date:____________________


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Sample Form 10

Omnibus Sworn Statement

REPUBLIC OF THE PHILIPPINES)S.S. CITY/MUNICIPALITY OF ______ )

A F F I D AV I T

I, [Name of Affiant], of legal age, [Civil Status], [Nationality], and residing at [Address of Affiant], after having been duly sworn in accordance with law, do hereby depose and state that:

1. Select one, delete the other: If a sole proprietorship: I am the sole proprietor of [Name of Bidder] with office address at [address of Bidder]; If a partnership, corporation, cooperative, or joint venture: I am the duly authorized and designated representative of [Name of Bidder] with office address at [address of Bidder];

2. Select one, delete the other: If a sole proprietorship: As the owner and sole proprietor of [Name of Bidder], I have full power and authority to do, execute and perform any and all acts necessary to represent it in the bidding for [Name of the Project] of the [Name of the Procuring Entity]; If a partnership, corporation, cooperative, or joint venture: I am granted full power and authority to do, execute and perform any and all acts necessary and/or to represent the [Name of Bidder] in the bidding as shown in the attached [state title of attached document showing proof of authorization (e.g., duly notarized Secretary’s Certificate issued by the corporation or the members of the joint venture)];

3. [Name of Bidder] is not “blacklisted” or barred from bidding by the Government of the Philippines or any of its agencies, offices, corporations, or Local Government Units, foreign government/foreign or international financing institution whose blacklisting rules have been recognized by the Government Procurement Policy Board;

4. Each of the documents submitted in satisfaction of the bidding requirements is an authentic copy of the original, complete, and all statements and information provided therein are true and correct;

5. [Name of Bidder] is authorizing the Head of the Procuring Entity or its duly authorized representative(s) to verify all the documents submitted;

6. Select one, delete the rest:


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If a sole proprietorship: I am not related to the Head of the Procuring Entity, members of the Bids and Awards Committee (BAC), the Technical Working Group, and the BAC Secretariat, the head of the Project Management Office or the end-user unit, and the project consultants by consanguinity or affinity up to the third civil degree; If a partnership or cooperative: None of the officers and members of [Name of Bidder] is related to the Head of the Procuring Entity, members of the Bids and Awards Committee (BAC), the Technical Working Group, and the BAC Secretariat, the head of the Project Management Office or the end-user unit, and the project consultants by consanguinity or affinity up to the third civil degree; If a corporation or joint venture: None of the officers, directors, and controlling stockholders of [Name of Bidder] is related to the Head of the Procuring Entity, members of the Bids and Awards Committee (BAC), the Technical Working Group, and the BAC Secretariat, the head of the Project Management Office or the end-user unit, and the project consultants by consanguinity or affinity up to the third civil degree;

7. [Name of Bidder] complies with existing labor laws and standards; and

8. [Name of Bidder] is aware of and has undertaken the following responsibilities as a Bidder: a) Carefully examine all of the Bidding Documents;

b) Acknowledge all conditions, local or otherwise, affecting the

implementation of the Contract;

c) Made an estimate of the facilities available and needed for the contract to be bid, if any; and

d) Inquire or secure Supplemental/Bid Bulletin(s) issued for the [Name of the Project].

9. [Name of Bidder] did not give or pay, directly or indirectly, any commission, amount, fee, or any form of consideration, pecuniary or otherwise, to any person or official, personnel or representative of the government in relation to the subject project under procurement. IN WITNESS WHEREOF, I have hereunto set my hand this __ day of ___, 20__

at ____________, Philippines. _______________________________________________________

Name and Signature of Bidder’s Representative/Authorized Signatory

Designation:____________

Date:__________________


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103

SUBSCRIBED AND SWORN to before me this__day of (month) (year) at (place of execution), Philippines. Affiant/s is/are personally known to me and was/were identified by me through competent evidence of identity as defined in the 2004 Rules on Notarial Practice (A.M. No. 02-8-13-SC). Affiant/s exhibited to me his/her (insert type of government identification card used) with his/her photograph and signature appearing thereon, with no___and his/her Community Tax Certificate No.___issued on___at____. Witness my hand and seal this ___day of (month) (year) NAME OF NOTARY PUBLIC Serial No. of Commission___ Notary Public for___until___ Roll of Attorneys No.___ PTR No.__(date issued), (place issued) IBP No. __(date issued), (place issued) Doc No___ Page No__ Book No__ Series of__ * This form will not apply for WB funded projects. ** Attach signatory’ legal capacity to sign.


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104

Sample Form 11

Bid Form: Price Proposal

Date: IAEB No: The Secretary of National Defense Department of National Defense Camp Gen Emilio Aguinaldo Quezon City

Attention: The Chairman DND Bids and Awards Committee

Gentlemen: Having examined the Bidding Documents including Bid Bulletin Numbers

___________________ [insert numbers], the receipt of which is hereby duly acknowledged, I/we, the undersigned, offer to the Procurement of Spare Parts for the Repair of Harris Handheld and Manpack Radios of the Philippine Army in conformity with the said Bidding Documents for the sum of _________________________________________________________________________________________ [total Bid amount in words and figures] or such other sums as may be ascertained in accordance with the Schedule of Prices attached herewith and made part of this Bid.

I/We undertake, if our Bid is accepted, to deliver the goods in accordance with the delivery schedule specified in the Schedule of Requirements.

If our Bid is accepted, I/we undertake to provide a performance security in the form, amounts, and within the times specified in the Bidding Documents.

I/We agree to abide by this Bid for the Bid Validity Period specified in BDS provision for ITB Clause 22.2 and it shall remain binding upon us and may be accepted at any time before the expiration of that period.

Commissions or gratuities, if any, paid or to be paid by us to agents relating to this Bid, and to contract execution if I/we are awarded the contract, are listed below:

Name and address of Agent

Amount and Currency Purpose of Commission or

Gratuity

(if none, state “None”)

Until a formal Contract is prepared and executed, this Bid, together with your written acceptance thereof and your Notice of Award, shall be binding upon me/us.

I/We understand that you are not bound to accept the lowest or any Bid you may receive.

I/We certify/confirm that I/we comply with the eligibility requirements as per ITB Clause 5 of the Bidding Documents.

Dated this ________________ day of ________________ 2017.

_____________________ _____________________

[signature] [in the capacity of]

Duly authorized to sign bid for and in behalf of ______________________________


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106

Sample Form 12

For Goods Offered from Abroad

Name of Bidder . Invitation to Bid Number . Page of .

1 2 3 4 5 6 7 8 9

Item Description Country

of origin

Quantity Unit price CIF port of

entry (specify port)

or CIP named place

(specify border

point or place of

destination)

Total CIF or CIP

price per item

(col. 4 x 5)

Unit Price

Delivered At

Place (DAP)

Unit price

Delivered

Duty Paid

(DDP)

Total Price

delivered DAP

(col 4 x 7)

1 PWB Assembly, RF Module 613 Pieces

2 Front Panel Assembly 143 Pieces

Note: If a particular column is not applicable, write “NA” only. Note: In case of discrepancy between unit price and total, the unit price shall prevail

_______________________________________________________ Name and Signature of Bidder’s Representative/Authorized Signatory Designation: _________ Date: _______________


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107

Sample Form 12A

For Goods Offered Within the Philippines

Name of Bidder . Invitation to Bid Number . Page of .

1 2 3 4 5 6 7 8 9 10 11

Item Description Country of

origin Quantity

Unit price EXW per

item

Cost of local labor, raw

material, and component

2

Total price EXW per item (cols. 4 x 5)

Unit prices per

item final destination and

unit price of other incidental

services

Sales and other taxes payable per

item if Contract is awarded

Total Price delivered

Final Destination (col 8 + 9) x

4

Put N/A on the items if

Not Applicable

1 PWB Assembly, RF Module 613 Pieces

2 Front Panel Assembly 143 Pieces

Note: If a particular column is not applicable, write “NA” only. Note: In case of discrepancy between unit price and total, the unit price shall prevail

_______________________________________________________ Name and Signature of Bidder’s Representative/Authorized Signatory Designation: _________ Date: _______________


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108

Sample Form 12B


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109

Sample Form 12C


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110

Sample Form 12D


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111

Sample Form 13


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112

Sample Form 13A For Local Bidder


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113

Sample Form 13A For Foreign Bidder


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114

Sample Form 14

Bank Guarantee Form for Advance Payment

To: [name and address of PROCURING ENTITY]

[name of Contract] Gentlemen and/or Ladies: In accordance with the payment provision included in the Special Conditions of Contract, which amends Clause 11.1 of the General Conditions of Contract to provide for advance payment, [name and address of Supplier] (hereinafter called the “Supplier”) shall deposit with the PROCURING ENTITY a bank guarantee to guarantee its proper and faithful performance under the said Clause of the Contract in an amount of [amount of guarantee in figures and words]. We, the [bank or financial institution], as instructed by the Supplier, agree unconditionally and irrevocably to guarantee as primary obligator and not as surety merely, the payment to the PROCURING ENTITY on its first demand without whatsoever right of objection on our part and without its first claim to the Supplier, in the amount not exceeding [amount of guarantee in figures and words]. We further agree that no change or addition to or other modification of the terms of the Contract to be performed thereunder or of any of the Contract documents which may be made between the PROCURING ENTITY and the Supplier, shall in any way release us from any liability under this guarantee, and we hereby waive notice of any such change, addition, or modification. This guarantee shall remain valid and in full effect from the date of the advance payment received by the Supplier under the Contract until [date]. Yours truly,

Signature and seal of the Guarantors

[name of bank or financial institution] [address] [date]

___________________ Designation


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115

Sample Form 15

Contract Agreement Form

THIS AGREEMENT made the _____ day of __________ 20_____ between

[name of PROCURING ENTITY] of the Philippines (hereinafter called “the Entity”) of the one part and [name of Supplier] of [city and country of Supplier] (hereinafter called “the Supplier”) of the other part:

WHEREAS the Entity invited Bids for certain goods and ancillary services, viz., [brief description of goods and services] and has accepted a Bid by the Supplier for the supply of those goods and services in the sum of [contract price in words and figures] (hereinafter called “the Contract Price”).

NOW THIS AGREEMENT WITNESSETH AS FOLLOWS: 1. In this Agreement words and expressions shall have the same meanings as are respectively assigned to them in the Conditions of Contract referred to. 2. The following documents shall be deemed to form and be read and construed as part of this Agreement, viz.:

(a) the Bid Form and the Price Schedule submitted by the Bidder; (b) the Schedule of Requirements; (c) the Technical Specifications; (d) the General Conditions of Contract; (e) the Special Conditions of Contract; and (f) the Entity’s Notification of Award.

3. In consideration of the payments to be made by the Entity to the Supplier as hereinafter mentioned, the Supplier hereby covenants with the Entity to provide the goods and services and to remedy defects therein in conformity in all respects with the rovisions of the Contract 4. The Entity hereby covenants to pay the Supplier in consideration of the provision of the goods and services and the remedying of defects therein, the Contract Price or such other sum as may become payable under the provisions of the contract at the time and in the manner prescribed by the contract.

IN WITNESS whereof the parties hereto have caused this Agreement to be executed in accordance with the laws of the Republic of the Philippines on the day and year first above written. Signed, sealed, delivered by the (for the Entity)

Signed, sealed, delivered by the (for the Supplier). Republic of the Philippines)


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116

______________________ )S.S.

ACKNOWLEDGMENT

BEFORE ME, a Notary Public for and in _________________________, this ______________________, personally appeared: ID No.: Issued by: __________________________ _________ ____________________________________ __________________________ _________ ________________________________ who exhibited to me their identification documents described above bearing their photographs and signatures known and identified by me through competent evidence of identity, presented this integrally complete instrument and represented to me that the signatures on the instrument were voluntarily affixed by them for the purposes stated, and declaring that they have executed this instrument as their free and voluntary act and deed. This instrument consisting of __ (__) pages, including this page on which this Acknowledgment is written refers to a (title of document) and has been signed by all the parties and their witnesses on each and every page thereof.

WITNESS MY HAND AND SEAL on the date and at the place first above written.

Name of Notary Public Serial No. of Commission Notary Public for ___ Notarial Commission Expires on __________ Roll of Attorneys No. _________ PTR No. ____; (date issued); place issued IBP O.R. No._____ (date Issued)

Doc. No. _____ ; Page No. ____ ; Book No. ____ ; Series of 2015.