Contract 1D Contract Name Location of the Contract Department of Public Works and Highways BIDDER’S CHECKLIST OF REQUIREMENTS FOR ITS BID, INCLUDING TECHNICAL AND FINANCIAL PROPOSALS The Technical Proposal shall contain the following © If Joint Venture, PCAB Special JV License 2 Bid Security (Form DPWH-INER{O, WU or 12 as applicable) Duly signed Organizational Chart for the Contract (Form DPWH-INFR-13) a ‘Duty signed Contractor's List of Key Personnel for the Contract (Form DPWH-INFR-14) 2” Duly signed List of Contractor's Major Equipment (Form DPWH-INFR-15) {2 Sworn statement under RA9184-IRR Sec. 25.2b)iv) (Form DPWH-INFR-16) a Signatory is proprietor/duly authorized representative of bidder. Full power and authority to perform acts or represent bidder. Not “blacklisted” or barred from bidding Each document is authentic copy of original, complete, and correct. ‘Authorizing Head of Procuring Entity to verify all documents submitted Not related to HOPE, BAC, TWG, Secretariat, PMO/IU, within 3% civil degree. Complies with existing labor laws and standards. Aware of and undertaken responsibilities as a bidder, Did not give any commission, amount, fee, or consideration. Oooooo00 Gi Certificate of PhilGEPS Registration (Platinum Membership) ‘The Financial Proposal shall contain the following: aoe signed Bid Form (Form DPWH-INFR-09) 1 Duly signed Bid Prices in the Bill Quantities (Form DPWH-INFR-17 and 18) 0 Duly initialed Detailed Estimates J Duly signed Cash Fiow by Quarter (Form DPWH-INFR-19) Page L of 1contrac 05 Location of the Contract Department of Public Works and Highways PREUMINARY EXAMINATION OF TECHNICAL PROPOSAL Date of Submision/Opering of Bis Name of Convatoe ‘Aproved Budget fore Comrae(ABC| TOTAL AMOUNT OF 810 Technical Requirements fi i Security in the prescibed form, amount and valcty period fateane cx ora [casey leaner acters’ [ime mc sacrty (eK 23 Yaccaptanee Forms ae [creck naaoers neva eter of nat |eerang suet by 3 rey © lcm ess by 2 sted by avers |nsurance erpay ou [avers or comme ant muses fersies yh Ire [cnmorc fark ys Feonn ork sa be [eammssor a er Form Submited by Contractor » [amount Requires Cs gad 18 |e. BZ e/© |5 |3 Hs ¢ oe Va ae gd ii rele gE ile 4/2 dai Hs aa le 15 4/°° Bl OE Bid Secrity in Presibed Form, Amount ad Vallty Period. lgblityRequlernent under Section 23.1 ot the IRR. ft 3 Co Tawcite (CT neue i [Bass "6 Documents any, [pedal PCAB V Ucerse and Vad Joint Venture Agreement| 3. Project Requirements, which shall iniude the followings 2 [Oveanisational Chan forthe contract tobe bi © ]lst of Contractors Key Personne (see Clause 18 313K), 80S of Baalng Documents) to 2e assigned to the contre, with their complete qulifeation data Ti [lst of Conraciors Majo Fuprent Ons owed ated near onder puree REESE soon byproot of owneshi/ease/oucase aa cerseaton of saleby of epment romeservndor forte eration cf te projet Se Cuouse 16.265.) OS of 8s) “4 Ommlbus Sworn Statement in the form prescribed by GPP 5 Cartificate of PrIGEPS Registration (Platinum Membership} Tole” Any missing, complet or paentyinsuFilet document in he abovementioned hace aground for outrgt rejection ofthe Overt ating: (Passed (Fale Pusan 3-2016 age tofDepartment of Public Works and Highways Contract ID : Contract Name: Location of the Contract: FORM OF BID SECURITY: BANK GUARTANTEE WHEREAS, Name of Bidder hereinafter called "the Bidder”, has submitted its bid dated, for the Contract 1D and Name ____, hereinafter called “the Bid” KNOW ALL MEN by these presents that We,__Name of the Bank _ of __Name of Country _, having our registered office at herein after called “the Bank", are bound unto Name of Procuring Entity , herein called “the Entity” in the sum of amount in words and figures _____ for which payment well and truly to be made to the said Entity the Bank binds itself, its successors and assigns by these presents. SEALED with the Common Seal of the Bank this day of 20 ‘THE CONDITIONS of this obligation are that: 1.) if the Bidder withdraws the 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 its bid price in accordance with the Instructions to Bidder; or 3.) if the Bidder having been notified of the acceptance of the Bid and award of contract to it by the Entity during the period of bid validity: a.) fails or refuses to submit the requirements for and to execute the Form of Contract in accordance with the Instruction 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 the Entity up to the above amount upon receipt of its first written demand, without the Entity having the substantiate its demand, without the Entity having to substantiate its demand, provided that In its demand the Entity will note that the amount claimed by its due to the occurrence of any one or combination of three (3) conditions stated above. The Guarantee will remain in force up to the period of days after the opening of bids as stated 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 wit in the said period. Date: Name and Signature of Bank's Authorized Signatory Position OPWH-INFR-10-2016 Page 1 of 1Department of Public Works and Highways Contract ID : Contract Name: Location of the Contract: FORM OF BID SECURITY: IRREVOCABLE LETTER OF CREDIT ROMMEL P. AGUIRRE District Engineer DPWH, Palawan 1% DEO Roxas, Palawan Irrevocable Letter of Credit No. For: Contract ID and Name WHEREAS, the conditions of this obligation are that: 1.) if the Bidder withdraws the Bid during the period of bid validity specified in the Form of Bid; or 2.) if the Bidder does not accept the correction or arithmetical errors of its bid price in accordance with the Instructions to Bidder; or 3.) if the Bidder having been notified of the acceptance of Bid and award of contract to it by the Entity during the period of bid validity: a.) fails or refuses to submit the requirements for an to execute the Form of Contract in accordance with the Instructions to Bidders; or b,) falls or refuses to furnish the Performance Security in accordance with the Instruction to Bidders; We undertake to pay the Entity up to the above amount upon receipt of its first written demand, without the Entity having to substantiate its demand, provided that in its demand the Entity will note that the amount claimed by Its due to the occurrence of any one or combination of three (3) conditions stated above. WHEREAS, we have agreed to guarantee this obligation to the Bidder. THEREFORE, we hereby affirm that we guarantors and responsible to you, on behalf of the Bidder, up to the total amount of amount of guarantee and we undertake to pay You, upon first written demand declaring the Bidder to be under default under the Instructions to Bidder and without cavil or argument, any sum or sums within the limits of amount of guarantee as aforesaid, without you needing to prove or show grounds or reasons for your demand for the sum specified therein. DPWH-INFR-11-2016 Page 1 of 2Department of Public Works and Highways Contract 1D : Contract Name: Location of the Contract: This irrevocable guarantee is valid until one hundred twenty (120) calendar days after the date of opening of bids for the said Contract on _date This certification is being issued on favor of the said Bidder in connection with your requirements of the bidding for the said Contract. We are aware that any false statements issued by us liable to perjury. Name and Signature of Authorized Financing Institution Officiat Designation Concurred by: ‘Name and Signature of Bidder’s Authorized Representative Official Designation DPWH-INER-11-2016 Page 2 of 2Bid Securing Declaration Form REPUBLIC OF THE PHILIPPINES ) cITy oF )ss. BID SECURING DECLARATION Project Identification No.: [insert number] To OPWH-Palawan 1* District Engineering Office Address Barangay III, Roxas, Palawan We, the undersigned, declare that: 1 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, Wie accept that: (a) /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) /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 68.1(f), of the IRR of RA 9184; without prejudice to other legal action the government may undertake. 1/We understand that this Bid Securing Declaration shall cease to be valid on the following circumstances: 2. Upon expiration of the bid validity period, or any extension thereof pursuant to your request; b. Tam/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 (i) I/we filed a waiver to avail of said right; and 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 at : Name of Bidder or its Authorized Representative Signatory’s legal capacity Affiant PPB Resolution No. 16-2020, éated 16 September 2020 Page 1 of2Bid Securing Declaration Form (Qurat] [Format shall be based on the latest Rules on Notarial Practice] GPPB Resolution No. 16-2020, dated 16 September 2020 Page 2 of 2Department of Public Works and Highways Contract 11 Contract Name: Location of the Contract: CONTRACTOR'S ORGANIZATIONAL CHART FOR THE CONTRACT Submit @ copy of the Organizational Chart that the Contractor intends to use to execute the Contract if awarded to it. Indicate in the chart the names of the Project Manager, Project Engineer, Structural Engineer, Materials and Quality Control Engineer, Foremen, and other Key Engineering Personnel as required in the Instructions to Bidders (Bid Data Sheet) Include Contractors, if any. Name and Signature of Bidder’s Representative Date: Position Name of Bidder DPWH-INFR-13-2016 Page 1 of iDepartment of Public Works and Highways Contract 1D: Contract Name: Location of the Contract: LIST OF CONTRACTOR'S KEY PERSONNEL TO BE ASSIGNED TO THE CONTRACT, WITH THEIR QUALIFICATION DATA ROMMEL P, AGUIRRE District Engineer DPWH, Palawan 1 District Eng’g Office Roxas, Palawan Dear Sir/Madame: Supplementing our Organizational Chart for the above stated Contract, we submit, and certify as true and correct, the following information: 1. We have engaged the services of the following key personnel to perform the duties of the positions indicated in the above stated Contract if it Is awarded to us: Years of Experience Proposed Position (as ‘applicable) Name Total (Similar | Similar and Related) | Position Project Manager Project Engineer Materials Engineer Construction Safety Officer a fe Others (specify) I aera 2. We submit the enclosed Curriculum Vitae and Affidavits of Commitment to Work on the Contract of these key personnel, 3. We ensure that the abovementioned personnel shall employ their best care, skill, and ability in Performing the duties of their respective positions in accordance with the provisions of the Contract, including the Conditions of Contract, Specifications, and Drawings, and that they shall be personally present it the jobsite during the period of their assignment in the Contract 4, In the event that we choose to replace any of the abovementioned key personnel, we shall submit to you in writing at least fourteen (14) days before making the replacement, for your approval, the name and bio-data of the proposed replacement whose qualifications shall be ‘equal to or better than the person to be replaced. 5. We understand that any violation of the above stated conditions shall be @ sufficient ground for us to be disqualified from this Contract and future biddings of the DPWH, Very truly yours, Name and Signature of Bidder’s Authorized Representative DPWH-INFR-14-2016 Page 1 of 1Department of Public Works and Highways (DPWH) Contract 1D: = a Contract Name : Location of the Contra KEY PERSONNEL’S AFFIDAVIT OF COMMITMENT TO WORK ON THE CONTRACT ROMMEL P. AGUIRRE District Engineer DPWH, Palawan 1" District Eng’g Office Roxas, Palawan Dear Sir/Madame: 1. I confirm that has engaged my services for the position of in the above stated Contract iit 's awarded to the Contractor. 2. 1, therefore, commit to assume the sald position in the above stated Contract once it is awarded to the Contractor, and I shall employ the best care, skill, and ability to perform the duties of such position in accordance with the Conditions of Contract, Specifications, Drawings, and other provisions of the Contract Agreement. 1 am aware that I have to stay inthe jobsite for the duration of my assignment. 3. 1 do not allow the use of my name to enable the Contractor to qualify for the above stated Contract without my commitment to assume the said position, since I understand that to do so shall be a sufficient ground for my disqualification from this Contract and future biddings of the DP WH. 4. I submit, and certify as true and correct, my bio-data as follows Name Date of Birth Nationality Educational Attainment Specialty PRC License No. and Date Employment Record From | To Total Period Name @Adaress of Employer | Postion | FOR | fo | Total ParoDepartment of Public Works and Highways (DPWH) SontrecttB: yo ge Contract Name : Location of the Contrs h. Work Experience (Projects Handled) i, Project Name & Location i. Project Description | 1. Part of Project | 1. Start Date ll. Owner's Name & Address i, Total Project Cost I Handled ii. Completion Date “li My Position Ji. Cost of Part smpleted Projects: (On-going Projects: Very truly yours, (ame and Signature of Personnel) Noted by: (Name and Signature of the Duly Authorized Bidders Representative) (Date) (Position of the Duly Authorized Bidder’s Representative) "(Name of the Bidder) REPUBLIC OF THE PHILIPPINES) cary oF ) SUBSCRIBED and SWORN TO before me this ay of 2017 at . affiant exhibiting to me his/her Residence Certificate Wo Issued at Notary Public Dac. No. ee until Page No fare PTR No, — Book No. = Issued at ee Series No, Issued on110 1 beg +2ppIg 40 auley wonsog _annewasarden 5 sapplg Jo asmeuBIs pue aweN, ‘AgOYS e1eC GTA ath UI paquosaid se juauidiNbe AsoyEIOge) sOTeUL LUNI yaays eed GIG ALA UI paquasad Se quawiainba uoRDNNSUAD JofeU! wnWUILE jauraaiby asey2ung) 3 spun syun uowdinda a4) 94 |10Us (PS5e7) g JOpUN syiUN yuauudinbs ath ret ‘O17 wou 2120419185 uoRE “peNUOD siyt 204 aIqejene penju0> r BEBE x att A I a os Sie ae DaUNO "V aseyoung/9S57 = 3as PA|SIBUMO Uuon1pu03 uuone207, ieee rare on aed | feouewonag 4294/1900, uonduaseg 40 40014 tpn (oN /Aupedes ce _| a —————— :__ssauppy ssoursna aaa Soa EEEt WEN ssaujsng ALITIQVIIVAY 40 SNOILLVII4ILNaD A GALUOddNS ‘1OVULNOD JHA OL G3NDISSV 39 OL SLINN IN3WAINDA AYOLVUOBVT GNY NOTLINYISNOD YOCYH S.YOL2VALNOD 40 15TT "39843409 a4 JO HONeI07 reweN 3eU0D, :qT peqU0D sAeMYBIH PUL SHOM DHIGNd Jo WoURLedaGREPUBLIC OF THE PHILIPPINES) CITY/MUNICIPALITY OF i155; AFFIDAVIT 1, [Name of Affant), of legal age, [Qvil 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:] am the sole proprietor or authorized representative of [Name of Bidder] with office address at (adaress of Bidder}; Ifa 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], 1 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 DPWH, Palawan 1* ict Engineering Office, Roxas, Palawan as shown in the attached duly notarized Special Power of Attorney; [if a partnership, corporation, cooperative, or joint venture:] 1 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 DPWH, Palawan 1* District Engineering Office, Roxas, Palawan 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, mem in, or Inter ith an lacklis ined rovidi in the 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; DPWH-INFR-16-2016 Page 1of 3Omnibus Sworn Statement (Revised) 6, [Select one, delete the rest:] Lif 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/Implementing Unit, and the project consultants by consanguinity or affinity up to the third civil degree; Lif 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 examining all of the Bidding Documents; b. Acknowledge 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 Supplementa/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 ment wi or given, fail erform 1 iny of the obliaati dun ings in the contri Il_be sufficient itute_criminal_fiability for Swindli tafa) or commission of fraud with unfaithfulness or abuse of confidence through under jigation involvin jeliver certai the prejudice of the public and the government of the Philippines pursuant to Articl \ct No. 381. meni vised Peni IN WITNESS WHEREOF, I have hereunto set my hand this at Philippines. DPWH-INFR-16-2016 Page 2013Department of Public Works and Highways Contract 1D: Contract Name: Location of the Contract: INANE OF BIDDER OR TTS AUTHORIZED” REPRESENTATIVE] Signatory’s legal capacity Affiant (Jurat] [Format shall be based on the latest Rules on Notarial Practice] DPWH-INFR-16-2016 Page 3 of 3