Bid Securing Declaration Form
[shall be submitted with the Bid if bidder opts to provide this form of bid security]
_________________________________________________________________________
REPUBLIC OF THE PHILIPPINES)
CITY OF _______________________) S.S.
BID SECURING DECLARATION
Project Identification No.: [Insert number]
To: [Insert name and address of the Procuring Entity]
I/We, 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
procurement 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 No. 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; and
c. I am/we are declared the bidder with the Lowest Calculated Responsive Bid, and
I/we have furnished the performance security and signed the Contract.
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 OR ITS AUTHORIZED
REPRESENTATIVE]
[Insert signatory’s legal capacity]
Affiant
[Jurat]
[Format shall be based on the latest Rules on Notarial Practice]
Name of Representative
Company Name
Address
NOTARIZED STATEMENT
“Supplier Name” acknowledges that notice, request or consent shall be deemed to have been given or
made when received in person, through an authorized representative, or when sent by registered mail,
electronic mail (e-mail), facsimile and shall be effective when delivered and duly received.
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]
[Insert Signatory’s Legal Capacity]
Affiant
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 _____
Omnibus Sworn Statement (Revised)
[shall be submitted with the Bid]
_________________________________________________________________________
REPUBLIC OF THE PHILIPPINES )
CITY/MUNICIPALITY OF ______ ) S.S.
AFFIDAVIT
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 or authorized representative 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, or authorized representative
of [Name of Bidder], I have full power and authority to do, execute and perform any and
all acts necessary to participate, submit the bid, and to sign and execute the ensuing
contract for [Name of the Project] of the [Name of the Procuring Entity], as shown in the
attached duly notarized Special Power of Attorney;
[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 to participate, submit the
bid, and to sign and execute the ensuing contract for [Name of the Project] of the [Name
of the Procuring Entity], as shown in the attached [state title of attached document
showing proof of authorization (e.g., duly notarized Secretary’s Certificate,
Board/Partnership Resolution, or Special Power of Attorney, whichever is applicable;)];
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, by itself or by
relation, membership, association, affiliation, or controlling interest with another
blacklisted person or entity as defined and provided for in the Uniform Guidelines
on Blacklisting;
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:]
[If a sole proprietorship:] The owner or sole proprietor is 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 responsibilities as a Bidder in
compliance with the Philippine Bidding Documents, which includes:
a. Carefully examining all of the Bidding Documents;
b. Acknowledging all conditions, local or otherwise, affecting the implementation of the
Contract;
c. Making an estimate of the facilities available and needed for the contract to be bid, if
any; and
d. Inquiring or securing 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 any procurement project or activity.
10. In case advance payment was made or given, failure to perform or deliver any of
the obligations and undertakings in the contract shall be sufficient grounds to
constitute criminal liability for Swindling (Estafa) or the commission of fraud with
unfaithfulness or abuse of confidence through misappropriating or converting any
payment received by a person or entity under an obligation involving the duty to
deliver certain goods or services, to the prejudice of the public and the
government of the Philippines pursuant to Article 315 of Act No. 3815 s. 1930, as
amended, or the Revised Penal Code.
IN WITNESS WHEREOF, I have hereunto set my hand this __ day of ___, 20__ at
____________, Philippines.
[Insert NAME OF BIDDER OR ITS AUTHORIZED
REPRESENTATIVE]
[Insert signatory’s legal capacity]
Affiant
[Jurat]
[Format shall be based on the latest Rules on Notarial Practice]
APPENDIX “1”
Bid Form for the Procurement of Goods
[shall be submitted with the Bid]
_________________________________________________________________________
BID FORM
Date : _________________
Project Identification No. : _________________
To: [name and address of Procuring Entity]
Having examined the Philippine Bidding Documents (PBDs) including the
Supplemental or Bid Bulletin Numbers [insert numbers], the receipt of which is hereby duly
acknowledged, we, the undersigned, offer to [supply/deliver/perform] [description of the
Goods] in conformity with the said PBDs for the sum of [total Bid amount in words and
figures] or the total calculated bid price, as evaluated and corrected for computational errors,
and other bid modifications in accordance with the Price Schedules attached herewith and
made part of this Bid. The total bid price includes the cost of all taxes, such as, but not
limited to: [specify the applicable taxes, e.g. (i) value added tax (VAT), (ii) income tax, (iii)
local taxes, and (iv) other fiscal levies and duties], which are itemized herein or in the Price
Schedules,
If our Bid is accepted, we undertake:
a. to deliver the goods in accordance with the delivery schedule specified in the
Schedule of Requirements of the Philippine Bidding Documents (PBDs);
b. to provide a performance security in the form, amounts, and within the times
prescribed in the PBDs;
c. to abide by the Bid Validity Period specified in the PBDs and it shall remain binding
upon us at any time before the expiration of that period.
[Insert this paragraph if Foreign-Assisted Project with the Development Partner:
Commissions or gratuities, if any, paid or to be paid by us to agents relating to this
Bid, and to contract execution if we are awarded the contract, are listed below:
Name and address Amount and Purpose of
of agentCurrencyCommission 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 us.
We understand that you are not bound to accept the Lowest Calculated Bid or any
Bid you may receive.
We certify/confirm that we comply with the eligibility requirements pursuant to the
PBDs.
The undersigned is authorized to submit the bid on behalf of [name of the bidder] as
evidenced by the attached [state the written authority].
We acknowledge that failure to sign each and every page of this Bid Form, including the
attached Schedule of Prices, shall be a ground for the rejection of our bid.
Name: ___________________________________________________________________
Legal capacity: _____________________________________________________________
Signature: ________________________________________________________________
Duly authorized to sign the Bid for and behalf of: __________________________________
Date: ___________________
Price Schedule for Goods Offered from Abroad
[shall be submitted with the Bid if bidder is offering goods from Abroad]
______________________________________________________________________________
For Goods Offered from Abroad
Name of Bidder _________________________ Project ID No._________ Page ___ of ___
1 2 3 4 5 6 7 8 9
Item Description Country Quantity Unit price CIF Total CIF Unit Price Unit price Total Price
of origin port of entry Delivered Delivered delivered
or CIP
(specify port) or Duty Unpaid Duty Paid DDP
price per
(DDU) (DDP) (col 4 x 8)
CIP named item
place
(col. 4 x
(specify border 5)
point or place of
destination)
Name: ___________________________________________________________________
Legal Capacity: ____________________________________________________________
Signature: ________________________________________________________________
Duly authorized to sign the Bid for and behalf of: __________________________________
Price Schedule for Goods Offered from Within the Philippines
[shall be submitted with the Bid if bidder is offering goods from within the Philippines]
______________________________________________________________________________
For Goods Offered from Within the Philippines
Name of Bidder ________________________ Project ID No._________ Page ___of___
1 2 3 4 5 6 7 8 9 10
Item Description Country Quantity Unit Transportation Sales and Cost of Total Total Price
of origin price and all other other Incidental Price, delivered
EXW costs taxes Services, if per unit Final
per incidental to payable if applicable, Destination
item delivery, per Contract per item (col
item is 5+6+7+ (col 9) x
awarded, 8) (col 4)
per item
Name: ___________________________________________________________________
Legal Capacity: ____________________________________________________________
Signature: ________________________________________________________________
Duly authorized to sign the Bid for and behalf of: __________________________________
Contract Agreement Form for the Procurement of Goods (Revised)
[Not required to be submitted with the Bid, but it shall be submitted within ten (10) days after
receiving the Notice of Award]
_________________________________________________________________________
CONTRACT AGREEMENT
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,
particularly [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
in specified currency] (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 as required by the 2016 revised Implementing Rules
and Regulations of Republic Act No. 9184 shall be deemed to form and be read
and construed as integral part of this Agreement, viz.:
i. Philippine Bidding Documents (PBDs);
i. Schedule of Requirements;
ii. Technical Specifications;
iii. General and Special Conditions of Contract; and
iv. Supplemental or Bid Bulletins, if any
ii. Winning bidder’s bid, including the Eligibility requirements, Technical and
Financial Proposals, and all other documents or statements submitted;
Bid form, including all the documents/statements contained in the Bidder’s
bidding envelopes, as annexes, and all other documents submitted (e.g.,
Bidder’s response to request for clarifications on the bid), including
corrections to the bid, if any, resulting from the Procuring Entity’s bid
evaluation;
iii. Performance Security;
iv. Notice of Award of Contract; and the Bidder’s conforme thereto; and
v. Other contract documents that may be required by existing laws and/or
the Procuring Entity concerned in the PBDs. Winning bidder agrees that
additional contract documents or information prescribed by the
GPPB that are subsequently required for submission after the
contract execution, such as the Notice to Proceed, Variation Orders,
and Warranty Security, shall likewise form part of the Contract.
3. In consideration for the sum of [total contract price in words and figures] or such
other sums as may be ascertained, [Named of the bidder] agrees to [state the
object of the contract] in accordance with his/her/its Bid.
4. The [Name of the procuring entity] agrees to pay the above-mentioned sum in
accordance with the terms of the Bidding.
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.
[Insert Name and Signature] [Insert Name and Signature]
[Insert Signatory’s Legal Capacity] [Insert Signatory’s Legal Capacity]
for: for:
[Insert Procuring Entity] [Insert Name of Supplier]
Acknowledgment
[Format shall be based on the latest Rules on Notarial Practice]
BATAAN GENERAL HOSPITAL AND MEDICAL CENTER
Balanga City, Bataan
ISO-QMS 9001 Certified
CERTIFICATE OF AFTER-SALES SERVICE/WARRANTY/PARTS,
CORRECTION OF DEFECTS
(NAME OF COMPANY)
Agrees and commits to arrange replacement, should there be any defective/ damaged items or
items not in conformity with the required specifications for (Name of the Project). The
replacement item/s shall be delivered within seven (7) calendar days from the receipt of notice of
defect/ damage/ non-conformity.
(Other warranty terms offered if any)
(Name and Signature)
Authorized Representative
(Date)
PRO-F-60-00
BATAAN GENERAL HOSPITAL AND MEDICAL CENTER
Balanga City, Bataan
ISO-QMS 9001 Certified
List of Ongoing Government and Private Contracts, including those awarded but not yet started
Business Name : _____________________________________________
Business Address : _____________________________________________
Value of
Owners Amount of Outstanding
Name of the Contract Date of the Contract Kinds of
Name/ Contract Contracts (in
Contract Duration Goods
Address figures)
This statement shall be supported with:
1. Notice of Award and / or Contract
2. Notice to Proceed
3. Purchase Order
4. Sales Invoice, Delivery Receipt and / or Official Receipt
Submitted by:
(Print Name and Signature)
Designation : _____________________
Date : _____________________
PRO-F-63-01
BATAAN GENERAL HOSPITAL AND MEDICAL CENTER
Balanga City, Bataan
ISO-QMS 9001 Certified
Statement identifying the Bidder’s Single Largest Completed Contract Similar in nature
Business Name : ____________________________________________
Business Address : ____________________________________________
Amount of
Name of the Date of the Contract Owners Kinds of Date of Delivery
completed
Contract Contract Duration Name/Address Goods Completion
contract
Note: This statement shall be supported with:
1. Notice of Award and / or Contract
2. Notice to Proceed issued by the Owner
3. Purchase Order
4. Sales invoice and/or Delivery Receipt
5. Owner’s Certificate of Final Acceptance or Certificate of Completion
Submitted by:
(Print Name and Signature)
Designation : _____________________
Date : _____________________
PRO-F-62-01
