Letter of Bid

Date of this Bid submission: [insert date (as day, month and yea,) of Bid submission]
RFB No.: [insert number (d°RFB process]
Alternative No.:[insert ident/jication No. ((this is a Bidfor an alternative]

To: [insert complete name of Employer]

(a) No reservations: We have examined and have no reservations to the bidding

document, including Addenda issued in accordance with ITB 8;

(b) Eligihility: We meet lhe eligibility requirements and have no conflict of interest
111
accordance with ITB 4;

(c) Bid-Securing Declaration: We have not been suspended nor declared ineligible by
the Employer based on execution of a Diel-Securing Declaration or Proposal-
Securing Declaration in the Employer's Country in accordance with ITl3 4.7;

(d) Exploitation and Abuse (SEA) and/or Sexual Harassment (SH.):lse/ecl

the appropriate optionfi·om (i} lo (v} below and delete the others].

We [1-11here JV, insert: "including any of our JV members"}, and any of our
subcontractors:
1. [have not been subject to disqualification by the Bank for non-compliance
with SEA/ SH obligations.l
11. [are subject to disqualification by the Bank for non-compliance with SEA/
SH obligations.]
111. [had been subject to disqualification by the Bank for non-compliance with
SEA/ SH obligations. An arbitral award on the disqualification case has
been made in our favor.]
1v. [had been subject to disqualification by the Bank for non-compliance with
SEA/ SH obligations for a period of two years. We have subsequently
provided and demonstrated that we have adequate capacity and
commitment to comply with SEA and SH prevention and response
obligations.]
v. [had been subject to disqualification by the Bank for non-compliance with
SEA/ SH obligations for a period of two years. We have attached
documents
Section JV - Bidding Forms 52

demonstrating that we have adequate capacity and commitment to comply

with SEA and SH prevention and response obligations.]
(e) Conformit
We offer to execute 111 conformity with the bidding document
y: following
the Works: [insert a brief' description o[
Works!
the

(f) Bid Price: The total price of our Bid, excluding any discounts offered in item (f)
below is: [Insert one of the options below as appropriate]

[Option 1, in case c f one lot:] Total price is: [insert the total price o[ the
Bid in lvords and figures, h1dicating the various amounts and the respective
currencies];

Or

[Option 2, in case qfmultiple lots:] (a) Total price of each lot [insert the total
price of' each lot in words and figures, indicating the various amounts and the
respective currenciesJ; and (b) Total price of all lots (sum of all lots) [insert the
total price (!/all lots in words and .figures, indicating the various amounts and
the respective currencies];

(g) Discounts: The discounts offered and the methodology for their application are:

(i) The discounts offered are: [,\Jwcijy in detail each discount u/Jered.]

(ii) The exact method of calculations to determine the net price after application of
discounts is shown below: [Spec(/j1 in detail the method that shall be used to
apply the discounts!;

(h) Bid Validity: Our Bid shall be valid until [insert day, month and year in
accordance with 1TB I8.1}, and it shall remain binding upon us and may be
accepted at any time on or before this elate;

(i) Performance Security: If our Bid is accepted, we commit to obtain a

performance security [and an Enviromnental and Social (ES) Pe,_jc)rmance
Security, Delete if not applicable] in accordance with the bidding document;

U) One Bid Per Bidder: We arc not submitting any other Bid(s) as an individual
Bidder or as a subcontractor, and we are not participating in any other Bid(s) as a
Joint Venture member, and meet the requirements of 1TB 4.3, other than alternative
Bids submitted in accordance with 1TB 13;

(k) Suspension and l)ebarmcnt: We, along with any of our subcontractors,
suppliers, consultants, manufacturers, or service providers for any part of the
contract, are not subject to, and not controlled by any entity or individual that is
subject to, a temporary suspension or a debarment imposed by the World Bank
Group or a debarment imposed by the World Bank Group in accordance with
the Agreement for Mutual Enforcement of Debarment Decisions between the
World Bank and other development banks. Further, we are not ineligible under
the Employer's Country laws or official regulations or pursuant to a decision of
the United Nations Security Council;
 Section lV - Bidding Forms 53

(1) State-owned enterprise or institution:[select the appropriate option and delete the
other] [We are not a state-owned enterprise or institution] I [We are a state-owned
enterpriseor institution but meet the requirements of 1TB 4.6];

(m) Commissions, gratuities and fees: We have paid, or will pay the following
commissions, gratuities, or fees with respect to the Bidding process or execution of the
Contract: [insert complete name of each Recipient, its full address, the reason for which
each commission or gratuity was paid and the amount and currency < [ each such
commission or gratuity]

of Rc ipicnt Address Reason Arnount.

Name'

(If none has been paid or is to be paid, indicate "none.")

(n) Binding C:ontract: We understand that this Bid, together with your written
acceptance thereof included in your Letter of Acceptance, shall constitute a
binding contract

I
bet ween us, until a formal contract is prepared and executed;
Not Bound to Accept: We understand that you are not bound to accept the lowest evaluated
cost Bid, the Most Advantageous Bid or any other Bid that you may receive;

(o) Fraud and Corruption: We hereby certify that we have taken steps to ensure that
no person acting for us or on our behalf engages in any type of Fraud and
Corruption; and

(p) Adjudicator: We accept the appointment of [insert name proposed in Bid Data Sheet}
as the Adjudicator.

for}

We do not accept the appointment of [insert name proposed in Bid Data Sheet] as the
Adjudicator, and propose instead that [insert nameJ be appointed as Adjudicator, whose daily
fees and biographical data are attached.

Name of the Bidder: *[insert complete name of the Bidder]

Name of the person duly authorized to sign the Bid on behalf of the Bidder:**[inser/
romplete name < [person duly authorized to sign the Bid]

Title of the person signing the Bid: [insert complete title of the person signing the !Jidl
Signature of the person named above: [insert signature of person whose name and
atpacity are shown above]
Date signed[insert date of signing] day of [insert month], [insert year]
*: In the case of the Bid submitted by joint venture specify the name of the Joint Venture
as Bidder
**: Person signing the Bid shall have the power of attorney given by the Bidder
to be attached with the Bid
 ·--
Lot Description Unit Quantity Rate Amount
3/tem lffB
no.

. ......... .................. ... ···········

Provisional sums for Physical

contingency and Employers' portion PS 2,000,000.00
of Adjudicator 2ayl1}'?11t

Total

1. Schedule of Payment Currencies

For --------- insert name of the Lot]

Separate tables is required for each lot.

A B C D
Percentage of
Rate of
Local Currency Total Bid l1rice
Name of Payment Amount Exchang
Equivalent (TBP)
Currency of e to
C=AxB l00xC
Currenc Local TBP
y Currenc
y
Local currency
1.00
Foreign Currency
#1

Foreign Currency
#2

Foreign Currency
#3

Net Bid Price* 100.00

Provisional Sums
Expressed in 1.00 2,000,000.
Local 00
Currency
Value Added Tax
(VAT) 15(¼,
TOTAL BID
PRICE
(Including
provisional sum)

*The Net Bid Price shown above does not include provisional sums, contingency and VAT
Forms of Bid Security

Form of Bid Security - Bank Guarantee

[Guarantor letterhead or SWIFT identifier code]

Beneficiary:

[Insert name and address of the Employe1J

Request for Bids No: _[Insert reference number.for the Request.fbr BicLs]

Date: [Insert date of issue]

BID GUARANTEE No.:[Insert guaranfee reference number]

Guarnntor: _[Insert name and address c?lplace c?fissue, unless indicated in !he letterhead}

We have been informed that [insert name of Lhc Bidder, which in the casP of ajoint
venture shall be the name c?f the joint venture (whether legally constifuted or
prospective) or the
names cl all ,nembers therecd] (hereinafter called ''the Applicant") has submiHerl or will
submit to the Beneficiary its Bid (hereinafter called "the Bid") for the execution off
in.serf description olcontracl] under Request for Bids No. [insert number] ("the
RFB").

Furthermore, we understand that, according to the Beneficiary's conditions, Bids must

be supported by a Bid guarantee.

At the request of the Applicant, we, as Guarantor, hereby irrevocably undertake to pay
the Beneficiary any sum or sums not exceeding in total an amount of [insert amounf in
letters/ (insert amount in numbers) upon receipt by us of the Beneficiary's complying
supported by the Beneficiary's statement, whether in the demand itself or a separate
signed document accompanying or identifying the demand, stating either that the
Applicant:

(a) has withdrawn its Biel prior to the Bid validity expiry elate specified by the
Applicant in the Letter of Biel, or any extended date provided by the Applicant; or

(b) having been notified of the acceptance of its Bid by the Beneficiary prior to the
expiry date of the Bid validity or any extension thereto provided by the Applicant,
(i) fails to execute the contract agreement or (ii) fails to furnish the performance
 security and, if required, the Environmental and Social (ES) Performance
Security, in accordance with the Instructions to Bidders ("ITB") of the
Beneficiary's bidding document.

This guarantee will expire: (a) if the Applicant is the successful Bidder, upon our
receipt of copies of the contract agreement signed by the Applicant and the
performance security and, if required, the Environmental and Social (ES) Performance
Security, issued to the Beneficiary in relation to such contract agreement; and (b) if the
Applicant is not the successful Bidder, upon the earlier of (i) our receipt of a copy of the
Beneficiary's notification to the Applicant of the results of the Bidding process; or (ii)
twenty-eight days after the expiry date of the Bid validity.
Consequently, any demand for payment under this guarantee must be received by us at the
office indicated above on or before that date.

This guarantee is subject to the Uniform Rules for Demand Guarantees (URDG) 2010
Revision, ICC Publication No. 758.

Form of Bid Security - Bid Bond

[The Surety shall.fill in this Bid Bond Fann in accordance with the instructions indicated.]

BOND NO.

BY THIS BOND [name of Bidder} as Principal (hereinafter called "the Principal"),

and [name, legal title, and address of'surety], authorized to transact business in [name
of country cf Employer], as Surety (hereinafter called "the Surety"), are held and
firmly bound unto [name qf E1nploye1) as Obligee (hereinafter catted "the Employer")
in the sum of [amount c l Bondj1 [amount in words], for the payment of which sum,
well and truly to be made, we, the said Principal and Surety, bind ourselves, our
successors and assigns, jointly and severally, firmly by these presents.

WHEREAS the Principal has submitted a written Bid to the Employer dated the_ day of
, 20_, for the execution of fname qf'Contract} (hcrcinaller called the "Bid").

NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION is such that if the

Principal:

(u) has withdrmvn its Hirl prior to the Bid validity expiry date set forth in the
Principal's Leller uf Bid, or any extended date provided by the Principal; or

(b) having been notified or the acceptance of its Bid by the Employer prior to the
expiry date of the Bid validity or any extension thereto pruvidcd by the Principal:
(i) failed to execute the contract agreement; or (ii) has failed to furnish the
Performance Security and, if required, the Environmental and Social (ES)
Performance Security, in accordance with the Instructions to Bidders ("ITB")
 of the Employer's bidding document.

then the Surety undertakes to immediately pay to the Employer up to the above amount
upon receipt of the Employer's first written demand, without the Employer having
to substantiate its demand, provided that in its demand the Employer shall state that
the demand arises from the occurrence of any of the above events, specifying which
event(s) has occurred.

The Surety hereby agrees that its obligation will remain in full force and effect up to
and including the date 28 days after the date of expiration Bid validity set forth in the
Principal's Letter of Bid or any extension thereto provided by the Principal.

IN TESTIMONY WHEREOF, the Principal and the Surety have caused these presents
to be executed in their respective names this day of________20

Principal: _ Corporate Seal (where appropriate)

The amount of the Bond shall be denominated in the currency of the Employer's
country or the equivalent amount in a freely convertible currency.
 Technical Proposal

Technical Proposal Forms

Key Personnel Schedule

Equipment

Site Organization Method

Statement Mobilization

Schedule Construction

Schedule

ES Management Strategies and Implementation Plans Code of

Conduct (ES)

Others
 FORMPER-1

Key Personnel Schedule

Bidders should provide the names and details of the suitably qualified Key Personnel
to perform the Contract. The data on their experience should be supplied using the Form
PER-2 below for each candidate.
Key Personnel

I. Title of position:
Name of candidate:
Duration of [insert the whole period (1·tart and end dates)for which this
appointment: position will be engaged]
Time [insert the numbe,· c!f"days/week/months/ that has been
commitment: for schecluledJc>r this position!
this position:
Expcdcd lime [insert the expected time schedulefc>r this position (e.g. allach
schedule for this high level Ciani/
position: cha,-/I
2. Title of position: [Environmental Specialist!
Name of candidate:
Duration of [insert the whole period (1·tart and end dates) fc>r which this
appointment: position will be engaged!
Time [insert the number of days/week/months/ that has been
commitment: for scheduledjc1r this position]
this position:
Expected time [insert the expected time schedule fc)/· this position (e.g. allach
schedule for this high level Gantt chart]
position:
3. Title or position: [Health and Sc(lety Specialist]
Name of candidate:
Duration of [insert the whole period (start and end dates) fc>r which this
appointment: position will be engagec
Time [insert the number c f'days/week/111onthsl that has been
commitment: for scheduled/or this position]
this position:
Expected time [insert the expected time schedulefc>r this position (e.g. attach
schedule for this high level Gani/ chart]
position:
4. Title of position: {Social Specialist]
Name of candidate:

Duration of [insert the whole period (staJ'/ and end dates) for which this
 appointment: position will be engagecn
Time [insert the number of days/-week/monthsl that has been
commitment: scheduled/or this position]
for this
position:
Expected time [insert the expected time schedulefor this position (e.g. attach
schedule for high level Gantt chart]
this position:
5. Title of position:Sexual Exploitation, Abuse and Harassment Expert
[Where a Prc>ject SEA risks are assessed to be substantial or high, Key Personnel
shall include an expert with relevant experience in addressing sexual exploitation,
sexual abuse and sexual harassment cases}
Name of candidate
Duration of [insert the whole period (1·tart and end dates) j<Jr which this
appointment: position will be engagecn
Time [insert the number of days/week/months/ that has been
commitment: scheduled.for this position]
for this
position:
Expected time [insert the expeded time schedule for this position (e.g.
schedule for atfar:h high level Ganlt chart]
this position:
6. Title of position: {insert title}

Nnmc of candidate
···-
Duration of [insert the whole period (1·tart and end dates) for which this
appointment: position will he
engaged!
Time [insert the nwnber c!f'dayslweek/111onths/ that has been
commitment: scheduled/or this position]
for this
position:
Expected time [insert the expected time sr:/11:dule_fi>r this position (e.g
schedule for at/ac:h high level Gantt chart]
this position:

Form PER-2: Resume and Declaration

Key Personnel
I Nam, ofBidde

Position l#fl: !title ofpositio11fro111 Form PER-II

Personnel Name: Date of birth:

information
Address: E-mail:

Professional qualifications:

Academic qualifications:

Language proficiency:f/ang11age and levels of'speoking, /'eading and

writing skills)
details
Address of employer:

Telephone: Contact (manager/ personnel

officer):
Fax:

Years with present employer:

Job title:

Summarize professional experience in reverse chronological order. Indicate particular technical

and managerial experience relevant to the project.

Duration Relevant experience

Project Role
of
involvemen
t
[maila [role and
project {time in [describe the experience relevant to this
responsibilities on
detaili] role} position}
the project}

Declaration

I, the undersigned Key Personnel, certify that to the best of my knowledge and
 belief: the information contained in this Form PER-2 correctly describes myself, my
qualifications and my expenence.
I confirm that I am available as certified in the following table and throughout the expected time
schedule for this position as provided in the Bid

Commitment Details
Commitment to duration of {insert period (.1·tart and end dates).fcn· which this
contract: Key Personnel is available to ·work on this contract]
Time commitment: {insert the number of days/week/months/ that this
Key Personnel will be engaged}
I understand that any misreprescntc1tion or omission in this Form may:
(a) be taken into consideration during Bid evaluation;
(b) my disqualification from participating in the Bid;
(c) my dismissal from the conlracl.

Name of Key Personnel: [insert name]

Signatiire:

Date: (clay month year):

Countersignature of authorized representative of the Bidder:

Signature: _

Date: (day month year): _

Equipment

The Bidder shall provide adequate information to demonstrate clearly that it has the
capability to meet the requirements for the key equipment listed in Section III
(Evaluation and Qualification Criteria). A separate Form shall be prepared for each item
of equipment listed, or for alternative equipment proposed by the Bidder. The Bidder
shall provide all the information requested below, to the extent possible. Fields with
asterisk(*) shall be used for evaluation.

Type of Equipment*
Equipment Name of manufacturer, Model and power rating
Information

Capacity* Ycar of manufacture*

Current Current location

Status

Details of current commitments

Source Indicate source of the equipment

D Owned D Rented 0 Leased □ Specially manufactured
The following information shall be provided only for equipment not owned by the Bidder.
The following information shall be provided only for equipment not owned by the Bidder.
Owner Name of owner

Address of owner

Telephone Contact name and title

Fax Telex

..Agr: ents Det il of rent?l/ l •se / manufacture agreements Sl!ecific to t Pt: J'::
(
Site Organization

[insert Site Organization information]

The Bidder shall show, in a diagrammatical form, the structure for his management of the
Contract from the level of Company Director down to Personnel responsible for sections
of the Works (e.g. Foremen), indicating the lines of responsibility. Sub-Contractors shall also
be included.
Method Statement

[insert Method Statement]

The Bidder shall here present his method statement for the construction and
completion of the Works.
Mobilization Schedule

[insert Mobilization Schedule}

The bidder shall present his mobilization schedule for the construction materials,
machinery, equipment and key personnel for the completion of the work during the
construction period.
 Construction Schedule

[insert Construction Schedule]

The bidder shall present his master work schedule for the construction work during
the construction period
ES Management Strategies and Implementation Plans

(ES-MSIP)

The Bidder shall submit comprehensive and concise Environmental and Social
Management Strategies and Implementation Plans (ES-MSIP) as required by
ITB
11.1 (i) of the Bid Data Sheet. These strategies and plans shall describe in
detail the actions, materials, equipment, management processes etc. that will
be implemented by the Contractor, and its subcontractors.
In developing these strategies and plans, the Bidder shall have regard to the ES
provisions of the contract including those as may be more fully described in the
Works Requirements in Section VII.
 Code of Conduct for Contractor's Personnel (ES) Form

Note to .the Bidder:

The minimum content of the Code of Conduct form as set out by the Employer shall not
be substantially modified. However, the Bidder may add requirements as appropriate,
including taking into account Contract-specific issues/risks.

The Bidder shall initial and submit the Code of Conduct form as part of its bid.

CODE OF CONDUCT FOR CONTRACTOR'S PERSONNEL

We are the Contractor, [enter name <d' Contractor]. We have signed a contract with
[enter name cf Employer] for [enter description of the Works]. These Works will be
carried out at [enter the Site and other locations where the Works will be carried
out]. Our contract requires us to implement measures to address environmental and
social risks related to the Works, including the risks of sexual exploitation, sexual
abuse and sexual harassment.

This Code of Conduct is part of our measures to deal with environmental and social
risks related to the Works. It applies to all our staff, laborers and other employees
at the Works Site or other places where thr Works are being carried out. 1t also applies
to the personnel uf each subcontractor and any other personnel assisting us in the
execution of the Works. All such persons are referred to as "Contractor's Personnel"
and are subject to this Code of Conduct.

This Code of Conduct identifies the behavior that we require from all Contractor's Personnel.

Our workplace is an environment where unsafe, offensive, abusive or violent

behavior will not he tolerated and where all persons should feel comfortable raising
issues or concerns without fear of retaliation.

REQUIRED CONDUCT
Cont1actor's Personnel shall:
1. carry out his/her duties competently and diligently;
2. comply with this Code of Conduct and all applicable laws, regulations and other
requirements, including requirements to protect the health, safety and well-being
of other Contractor's Personnel and any other person;
3. maintain a safe working environment including by:
a. ensuring that workplaces, machinery, equipment and processes under
each person's control are safe and without risk to health;
b. wearing required personal protective equipment;
a. using appropriate measures relating to chemical, physical and
biological substances and agents; and
 b. following applicable emergency operating procedures.
4. report work situations that he/she believes are not safe or healthy and remove
himself/herself from a work situation which he/she reasonably believes presents
an imminent and serious danger to his/her life or health;
5. treat other people with respect, and not discriminate against specific groups such
as women, people with disabilities, migrant workers or children;
6. not engage in Sexual Harassment, which means unwelcome sexual advances,
requests for sexual favors, and other verbal or physical conduct of a sexual nature
with other Contractor's or Employer's Personnel;
7. not engage in Sexual Exploitation, which means any actual or attempted abuse of
position of vulnerability, differential power or trust, for sexual purposes,
including, but not limited to, profiting monetarily, socially or politic:<1lly from
the sexual exploitation of another;
8. not engage in Sexual Abuse, which means the actual or threatened physical
intrusion of a sexual nature, whether by force or under unequal or coercive
conditions;
9. not engage in c1ny form of sexual activity with individuals under the age of 18,
except in case of pre-existing marriage;
10. complete relevant training courses that will be provided related to the
f'.nvironmcntal and social aspects of the Contract, including on health and safety
matters, and Sexual Fxploit:ition and Abuse (SEA), and Sexual
Harassment(SII);
11. report violations of this Code of Conduct; and
12. not retaliate against any person who reports violations of this Code of
Conduct, whether to us or the Employer, or who makes use of the grievance
mechanism for Contractor's Personnel or the project's Grievance Redress
Mechanism.
RAISING CONCERNS
If any person observes behavior that he/she believes may represent a violation of this
Code of Conduct, or that otherwise concerns him/her, he/she should raise the issue
promptly. This can be done in either of the following ways:
I. Contact [enter name cf the Contractor's Social },-'xpert with relevant experience in
handling gender-based violence, or (l such person is not required under the
Contract, another individual designated by the Contractor to handle these matters]
in writing at this address [ ] or by telephone at [ ] or in person at [ ]; or
2. Call [ ] to reach the Contractor's hotline ([lany) and leave a message.

The person's identity will be kept confidential, unless reporting of allegations is

mandated by th:e country law. Anonymous complaints or allegations may also be
submitted and will be given all due and appropriate consideration. We take
seriously al} reports of possible misconduct and will investigate and take
appropriate action. We will provide warm referrals
to service providers that may help support the person who experienced the alleged
incident, as appropriate.
There will be no retaliation against any person who raises a concern in good faith about
any behavior prohibited by this Code of Conduct. Such retaliation would be a
violation of this Code of Conduct.
CONSEQUENCES OF VIOLATING THE CODE OF CONDUCT
Any violation of this Code of Conduct by Contractor's Personnel may result in serious
consequences, up to and including termination and possible referral to legal authorities.

FOR CONTRACTOR'S PERSONNEL:

I have received a copy of this Code of Conduct written in a language that I comprehend.
I understand that ifl have any questions about this Code of Conduct, I can contact
[enter name cf Contractor's contact person with relevant experience] requesting an
explanation.

Name of Contractor's Personnel: [insert name]

Signature:

Date: (day monlh year): _

Countersignature of authorized representative of the Contractor:

Signature: _
Date: (day month year): _

ATTACHMENT l: Behaviors constituting Sexual Exploitation and Abuse (SEA)

and behaviors constituting Sexual Harassment (SH)
 ATTACHMENTlTOTHECODEOFCONDUCTFORM

BEHAVIORS CONSTITUTING SEXUAL EXPLOITATION AND ABUSE

(SEA) AND BEHAVIORS CONSTITUTING SEXUAL HARASSMENT (SH)

The following non-exhaustive list is intended to illustrate types of prohibited behaviors:

(I) Examples of sexual exploitation and abuse include, but are not limited to:

• A Contractor's Personnel tells a member of the community that he/she can

get them jobs related to the work site (e.g. cooking and cleaning) in
exchange for sex.
• A Contractor's Personnel that is connecting electricity input to households says
that he can connect women headed households to the grid in exchange for sex.
• A Contractor's Personnel rapes, or otherwise sexually assaults a member of the
community.
• A Contractor's Personnel denies a person access to the Site unless he/she
performs a sexual favor.
• A Contractor's Personnel tells a person applying for employment under the
Contract lhal he/she will only hire him/her if he/she has sex with him/her.
(2) Examples of sexual harassment in a work context
• Contractor's Personnel comment on the appearance of another Contractor's
Personnel (either positive or negative) and sexual desirnhility.
• When a Contractor's PersU1111t:l complains about comments made by nnother
Contrador's Personnel on his/her appearance, the other Cu11Lrnctor's Personnel
comment that he/slw. i<; "asking for it" because of how he/she dresses.
e Unwelcome louclting of a Contractor':; or Employer's P8r<;onnel by another
Contractor's PP-r<;onncl.
• A Contractor's Personnel tells another Contractor's Personnel that he/she will get
him/her a salary raise, or promotion if he/she sends him/her naked photographs of
himsclf-1/herself.
 Bidder's Qualification

To establish its qualifications to perform the contract in accordance with Section III
(Evaluation and Qualification Criteria) the Bidder shall provide the information requested
in the corresponding Information Sheets included hereunder
Form ELI -l.1: Bidder Information Form

Date:
RFB No. and title:
Page of ages

Bidder's name

In case of Joint Venture (JV), name of each member:

Bidder's actual or intended countty ofregistration:

[indicate country qf Constitution]
Bidder's actual or intended year of incorporation:

Bidder's legal address [in country of registration]:

Bidder's authorized representative information

Name:
Address:
Telerho ne/Fax numbers: _
E-mail cicklress:
1. Attached are copies of original documents of
□ Articles oflnco1voration (or equivalent documents of constitution or association),
and/or documents of registration of the legal entity named above, in accordance
with ITH 4.4.
□ In case of JV, letter of intent to form JV or JV agreement, in accordance with 1TB
4.1.
□ In case of state-owned enterprise or instrtution, in accordance with 1TB 4.6
documents establishing:
• Legal and financial autonomy
• Operation under commercial law
• Establishing that the Bidder is not under the supervision of the Employer
2. Included are the organizational chart, a list of Board of Directors, and the beneficial
ownership.ff/required under BDS !TB 47.1, the succes fit! Bidder shall provide
additional i11jcm11ation on beneficial ownership, using the Beneficial Ownership
Disclosure Form.}
Form ELI -1.2: Information Form for JV Bidders

(to be completed for each member of Joint Venture)

Date:
RFB No. and title:
Page of pages

Bidder's Joint Venture name:

JV member's name:

··-·-· · ·
JV member's country of registration:

-····- ·····-····--•··· ···-· -········--·----· ·············-··-· --------- ....

JV member's year of constitution:

----·· ..... ··--····-·-

JV member's legal address in countty of constitution:

.. ----··· ···--······----- ···-·•·······---·········--··--·-···-

···········•--···
JV mcmber'r.authorized representMive mfonnation
Name:
Address:
Telephone/Fax numbers:

E-mail address:
I. Attached are copies of original documents of

□ Articles of Incorporation (or equivalent documents of constitution or

association), and/or registration documents of the legal entity named above, in
accordance with 1TB 4.4.
□ In case of a state-owned enterprise or institution, documents establishing legal and
financial autonomy, operation in accordance with commercial law, and is not under
Lhe supervision of the Employer, in accordance with ITl3 4.6.
2. Included are the organizational chart, a list of Board of Directors, and the beneficial
ownership./{/ required under EDS ITB 47.1, the succes.sjid Biele/er shall provide
additional information on benejicial ownership for each JV member using the
Beneficial Ownership Disclosure Form.]
 Year of Amount in Contract Identification Total Contract Amount
dispute dispute (currency), USO
(currency) Equivalent
(exchange rate)

Contract
Identification: Name
of Employer:
Address of
Employer:
Matter in dispute:
Party who initiated the dispute:

Status uf dispute:
Contract
Identification: Name
of Employer:
Address of
Employer: Matter in
dispute:
Party who initialed the dispute:
Status of dispute:

Litigation History in accordance with Section III, Evaluation and Qualification ·-

Criteria
D No Litigation History
D Litiration History
Year of Outcome as Contract Identification Total Contract Amount
award percentage (currency), USD
of Net Equivalent (exchange rate)
Worth

I····
[insert [insert Contract Identification: [indicate (insert
year/ percentage} complete contract name, number, amount]
and any other identification]
Name of Employer: [insertfitll name]
Address of Employer: [insert
street/city/counlfy]
Matter in dispute: [indicate main
issues in dispute]
Party who initiated the dispute:
 Form CON -2:
Historical Contract Non-Performance, Pending Litigation and Litigation History

Bidder's Name:
Date:
Joint Venture Member's Name
RFB No. and title:
Page of '
ages

Non-Performed Contracts in accordance with Section III, Evaluation and Qualifica tion Criteria
.,
---•-········-············· .

□ Contract non-pcrfonmmcc did not occur since 1st January [insert yemj

□
Year Contract(s) Non-
not performed since 1 st
Contract[insert
January year}
Identification
performed

portion of
contract
 Total Contract
Amount (current
value, currency,
exchange rate and
US$ equivalent)
insert amount]

tion Criteria
 Form CON-3
Environmental and Social Performance Declaration

[The following table shall be.filled in for the Biclcler, each member of a Joint Venture and each
Specialized Subcontractm]

Bidder's Name: [insertfull name]

Date: {insert day, month, yew}
Joint Venture Member's or Specialized Subcontractor's Name: [insert.fit!! name]
RFB No. and title: [insert RFB number and title_/
Page [insert page numbe,j of [insert total numbe,j pages

Environmental and Social Pe1forn1ance Ded · ti; ; d

in accordance with Section III, Qualification Criteria, and Requirements
D No suspension or termination of contract: An employer has not suspended or
terminated , contract and/or called the performance security for a contract for reasons
related td Environmental, or Social(ES) performance since the date specified in
Section III, Evaluation and Qualification Criteria, Sub-Factor 2.5.
D Declaration of suspension (ff termination of contract: The following contrnct(s)
has/have been suspended or terminated and/or Performance Security called by an
employer(s) for reason
related to Environmental, or Social (ES)performancc smcc the date specified 111 Section
rrr,
Evaluation and Qualification Criteria, Sub-Factur 2.5. Details arc described below:
 Yea
r Suspended Total Contract
or Contrad Amount
terminated Identification (current value,
portion of currency,
contract exchange rate
and US$
equivalent)
[inserl
!(insert amount Contract Identification: [indicate complete 1insert amount}
lvea,j
contract fand percentage_/ name/ number, and any other
idenl(/ication/
Name of Employer: finsert.fitll name]
Address of Employer: [insert slreet/citylcounlly}
Reason(s) for suspension or termination:
[indicate main reason(s) e.g.fhr gender-based
rinser{ violence; sexual exploitation or sexual abuse
yem] breache5] finsert amounl}

!{insert amount Contract Identification: [indicate complete

contract lcmd percentage] name/ number, and any other
ident{ficalionj
Name of Employer: [insertfitll name]
Address of Employer: [insert streetlcitylcounhyJ
Reason(s) for suspension or termination:
(indicate •
 main reason(s)}
... ... [list all applicable contracts] ...

Performance Security called by an employer(s) for reasons related to ES performance

I.
Year Contract Identification otal Contract
mount
(current

alue,equivalent)
US$ currency,
!
l[inserl Contract Identification: /indicate co,;;;;l te contract name/ m;;;1ber, and I insert amount]
ea,] any other ident[fication]
Name of Employer: [insertfitll name]

Address of Employer: [insert street/city/country/

Reason(s) for calling of performance security: {indicate main reason(s)

e.g. fhr gender-based violence; sexual exploitation, or sexual abuse breaches]

-··-···--······-·········-----··--·--·······-········-- .,. ......... ··-- -······ -----······"''"""-· ··-···----·-········--····-·----·-····
···---·-.,··-·· ···-···· -···------·----···--·---•-····----------- -·-··-·-·
 Form CON-4
Sexual Exploitation and Abuse (SEA) and/or Sexual Harassment Performance
Declaration
[The.following table shall be filled in by the Bidder, each member of a Joint Venture and
each subcontractor proposed by the Biclcle1}
Bidder's Name: [insert.fitll name}
Date: [insert day, month,
yea,] Joint Venture Member's or Subcontractor's Name:
[insertfitll name} RFB No. and title: [insert RFB number
and LitleJ
Page [insert page numbe1j of [insert total nwnbe,j pages

SEA and/or SH Declaration

in accordance with Section HI, Evaluation and Qualification Criteria
- .. - ·--------•-··---- ·--·-
We:

□ (a) have not been subject to disqualification by the Bank for non-compliance with SEA/ SH
obligations
□ (b) are subject to disqualification by the Bank for non-compliance with SEA/ SH obligations
□ (c) had been subject to rlisrpialification by the Bank fi.)r non-compliance with SEA/ SH
obligations. An arbitral award on the disqualification case has been made in our favor.
[J (d) had been suhject to disquulil'ication by the Bank for non-complianeP.with SEA/ SH
obligations for a period ol'two years. We have subsequently demonstrated that we
have adequate capacity and commitment to comply with SEA/ SH obligations.
D(e) had been subject to disqualification by the Bank for non-compliance with SEA/ SH
obligations for a period of two years. We have attached evidence den1onstrating that
we have adequate capacity
and co1rnnitment to comply with SEA/ SI-I obligations.

--·----·······--- ----·- ..... ··--···-··-····· ··-·· ---·-'-······-·· ------ --------···-·········-·---

[{l (c) abo\le is applica/Jle, attach evidence ( l an arbitral award reversing

tltefimlings 011 the issues underlying the disqual[fication.J
·•·····-·-··---------•-··

[{f (d) or (e) above are applicable, provide the following i, f'ormation:j
---··· ·····-- -··--- -·-···· ------------------- - ---··-
·- -------
 Period of disqualification: From: To:

·---------------····-·--····· --- ----·--·-----

If previously provided on another Bank financed works contract, details of evidence that
demonstrated adequate capacity and commitment to comply with SEA/ SI-I obligations
(as per (cl) above)
Name of Employer:
Name of Project:
Contract description:
Brief summaiy of evidence provided:

Contact Information: (Tel, email, name of contact person): _

As an alternative to the evidence under (d), other evidence demonstrating adequate capacity and

!commitment to comply with SEA/ SH obligations (as per (e) above) [attach details as appropriate].
 Form CCC: Current Contract Commitments/ Works in Progress

Bidders and each member of a JV should provide information on their current

commitments on all contracts that have been awarded, or for which a letter of intent or
acceptance has been received, or for contracts approaching completion, but for which
an unqualified, full completion certificate has yet to be issued.

Name of contract Employer, Value of Estimated Average

contact outstanding completion monthly
address/tel/fax work (current date mvo1cmg over
US$ last six months
equivalent) (US$/month)
I.

2.

3.

4.

5.

etc.

Form FIN - 3.1: Financial Situation and Performance

Bidder's Name:
Date:
Joint Venture Member's Name----------- RFB No.
and title:
Page of ages

1. Financial data
 1. Sources of Finance
Specify sources of finance to meet the cash flow requirements on works currently in
progress and for future contract commitments.

No. Source of finance Amount (US$ equivalent)

3
----·-···-· -----

Type of Financial information Historic information for previous ears,

in
(amount in currency, currency, exchange rntc, USD
(currency)
equivalent)

t
---·-··-····.

J
··----·········---·-····--·.--·-

Year2 Year3 Year4 Year 5

Yea r_1
-----··--
Statement of Financial Position (Information from Balance Sheet)
·-- ,,

Total Assets (TA)

Total Liabilities (TL)

-···--·--···· '" -------·---·--·-··· ... --·----·-··· -·------------ -··--·-·-·--

Total Equity/Net Worth (NW)

--
Current Assets (CA)

.......

Current Liabilities (CL)

--·-·"

Working Capital (WC)

,
Information from Income Statement

Total Revenue (TR)

., ,,

·------

Cash Flow Information

-.

Cash Flow from Operating

Activities
._ ,.
--- ---

1. Financial documents
 The Bidder and its parties shall provide copies of financial statements for

years pursuant Section III, Evaluation and Qualifications Criteria, Sub-factor 3.2.
The financial statements shall:

(a) Reflect the Jin:rncial situation of the Bidder or in case ofJV member, and
not an afiiliated entity (such as parent company or group member).

(b) Be inc!epenc!enlly audited or cctiificd in accordance with Inca I legislation.

(c) Be complete, including all notes to the financial statements.

(d) Correspond to accounting periods already completed and audited.

□ Attached are copies of financial statements2 for the years required above;
and complying with the requirements

Form FIN - 3.2: Average Annual Construction Turnover

Bidder's Name:
 Date:
Joint Venture Member's Name
RFB No. and title:
Page of ages

Annual turnover data (construction only)

I
Year Amount Exchange rate USD cquivalcnt
Currency
[indicat [insert amount and indicate currcnc}J
e yem]

Average
Annual
Constructlon
Turnover*

Sec Section Ill, Evaluation and Qualification Criteria, Sub-Factor 3.2.

Form FIN - 3.3: Financial Resources

Specify proposed sources of financing, such as liquid assets, unencumbered real assets, lines of credit,
and other financial means, net of current commitments, available to meet the total construction cash flow
demands of the subject contract or contracts as specified in Section III, Evaluation and Qualification
Criteria

Source of financing Amount (US$ equivalent)

1.

2.

,..,
_).

4.
 Form EXP - 4.1: General Construction Experience

Bidder's Name:
Date:
Joint Venture Member's Name
RFB No. and title:
Page of pages

Starting Ending Contract Identification Role of

Year Bidder
·
Year

Contract name:
-·
Brief Description of the Works performed by
the Bidder:
Amount of contract:
Name of Employer:
:Address:
Contract name:

Brief Description of the Works performed by

the Bidder:
Amount of contract:
····-----···
Name of Employer:
Address:
···-······--·-··•-·········" - ··~-····-
·-" --···
Contract name:

Brief Description of the Works performed by

the Bidder:
Amount of contract:
Name of Employer:
Address:

----·---·····--
•···· ··-·····-·--·"·-
 Information
Similar Contract No.

Contract Identification
Award date

,Compktio11date
Prime Management Sub
Role in Contract Member in JV Contracto contracto
Contractor □ □ r □ r □

Total Contract Amount US$ -1-

*
If member in a JV or subcontractor,
specify participation in total
Contract amount

_Employer's
+------------------------------------------------------------------------------------------------------------------------------ 1

N_an1e-: Address:
Telephone/fax
number

E-mail:
 Similar Contract No. Information

Description of the similarity 111

accordance with Sub-Factor 4.2(a)

of Section III:
·----······.

1. Amount
-----------······--···--···--··--·-···----.... , ----··· ----·----------·--·····--·-----------

2. Physical size of required works

----------------- -·----··-----·······-------·-·-····------""""""""""·'·'•"""-••··----·-·· -------····

3. Complexity
4. Methods/Technology

5. Construction rale for key

activities
--·-··-·······--···--······-·--·----······-·········-··-··

6. Other Characteristics
........ ··-·

Form EXP - 4.2(a) (cont.)

Specific Construction and Contract Management Experience (cont.)
 Form EXP - 4.2(c): Specific Experience in Managing ES aspects

[The.following table shall be.filled in.for contracts pe1jcmned by the Bidder,

and each member ofa Joint Venture]

Bidder's Name:
Date:
Bidder's JV Member Name: ---------
RFB No. and title:
Page of ages

1. Key Requirement no 1 in accordance with 4.2 (c): _

Form EXP - 4.2(c): Specific Experience in Managing ES aspects

[The.following table shall be.filled in.for contracts pe1jcmned by the Bidder,

and each member ofa Joint Venture]

Bidder's Name:
Date:
Bidder's JV Member Name: ---------
RFB No. and title:
Page of ages

2. Key Requirement no 1 in accordance with 4.2 (c): _

······--

Contract Identification
Award date
·····--

Completion date
1. Key Requirement no 2 in accordance with 4.2 (c): _
2. Key Requirement no 3 in accordance with 4.2 (c): _