WESTERN ZONAL OFFICE ENGINEERING DEPTT. WEST WING, FIRST FLOOR, "YOGAK HEMA, NA IMAN POINT MUMBAI

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1 WESTERN ZONAL OFFICE ENGINEERING DEPTT. WEST WING, FIRST FLOOR, "YOGAK HEMA, NA IMAN POINT MUMBAI ENROLEMENT FORM FOR EMPANELMENT OF AGENCIES FOR PROPOSED ON GRID ROOF TOP 150 kwp SOLAR GENERATING SYSTEMS AT YOGAKSHEMA BUILDING, NARIMAN POINT, MUMBAI & ON GRID ROOF TOP 50 kwp SOLAR GENERATING SYSTEMS AT LIC OFFICES IN MAHRASHTRA, GUJARAT & GOA.

2 INSTRUCTIONS FOR FILLING AND SUBMISSION OF ENROLMENT FORM The Enrolment Form along with the Annexure A1,A2 and B to G & I to IV shall be completely filled in all respects along with processing fees Rs 2000/- ( for each work) non refundable by way of DD/ pay order in favour of LIC of India payable at Mumbai address to the CHIEF ENGINEER, Life Insurance corporation of India, Western Zonal Offi e, First Floor, West wi g, Yogakshe a, Nari a poi t Mu ai along with these instructions for filling and submission of enrolment form on or before Please note that no consideration will be given for postal delay a. b. c. d Contractors to note that all particulars required as per the form and Annexure shall be filled in completely in relevant blanks strictly as per the format. Simply enclosing copies of partnership deeds, Printed Brochures printed list of work or certificates fro authorities & stati g refer to su h a d su h e losure without filling the entries in the forms /Annexure does not meet the requirement. It is also essential to furnish full details of name of work, Location, full postal address with fax and telephone No etc of the employers and authorities under whom the work is carried out in the enrolment form and annexure. The forms not submitted strictly as per the above instructions within stipulated period are liable to be rejected. The eligible contractors who will be selected for issue of tenders (after scrutiny of enrolment forms) shall be informed by a letter as and when the tenders are ready for issue. Please note that no enquiries or correspondence regarding the selection for issue of tenders shall be entertained. Latest Solvency Certificate from any Nationalized/Scheduled Bank (Not more than 3 Months old) should be submitted along with Enrolment Form. Notarized Xerox copy of the solvency certificate will be entertained. The contractors are advised to follow the instructions given below:enrolment Form shall be filled-up in clean handwriting in capital letters typed. Full address of the site of work, owner or authority under whom the works have ee arried out should e gi e (Please refer A exure D & E ) The Agencies should ensure to submit the satisfactory Completion Certificate giving the value of work, year of completion and it should also tally with the value of final bill in Annexure D. The annual turnover should be based on latest Income-tax Returns, duly audited by CA or as per Audited balance sheet copy should be submitted. Separate application must be submitted for different items of works along with non refundable amount of Rs 2000/- each towards processing fees in the form of DD/ pay order drawn in favour of Life Insurance Corporation of India payable at Mumbai Please note that the submission of this enrolment form does not confer any right on you to claim issue of tenders and The Chief Engineer, LIC WZO Mumbai-21,

3 8. 9. reserve the right not to issue tender to any/all applicants without assigning any reason whatsoever. LIC Working contractors also need to apply with full details however LIC working contractors shall be given relaxation up to 15% in prequalification criteria. The contractors should ready to execute the work at all locations for all under jurisdictions of WZO Mumbai. If there is any reservation please mention the same in your enrolment form. Agreed and confirmed Yours faithfully Signature of Contractor Chief Engineer Encl : E rol e t For ith A exure A,A B to G & I to IV

4 ANNEXURE-A PRIMARY REQUIRMENTS PRE - QUALIFICATION OF CONTRACTORS The Life Insurance Corporation of India intends to invite tender for the work for Sr.No. (1) Design, Supply, Installation, Testing & commissioning of 150 kwp ON Grid Roof Top Solar Generating System at Yogakshema, Mumbai Sr. No. (2) Design, Supply, Installation, Testing & commissioning of 50 kwp ON Grid Roof Top Solar Generating System at various LIC Offices in Maharashtra Gujarat & Goa under Western Zone. Selection Criterion is as detailed below Name of the work 1.Design, Supply, Installation, Testing & commissioning of 150 kwp ON Grid Roof Top Solar Generating System at Yogakshema, Mumbai Design, Supply, Installation, Testing & commissioning of 50 kwp ON Grid Roof Top Solar Generating System at various LIC Offices in Maharashtra Gujarat & Goa under Western Zone. Estimat ed Cost (Rs. In Lac) Completio n period (in months) A B Min Bank Solvency (Rs. In Lac) The Solvency certificate should not be more than 3 months old prior to date of this publication. C Avg. Annual Turnover over past 2 Financial years (Rs. In Lac) & Qualifying Value of Single work Completed during last 02 years in India prior to date of publication of this PQN (Rs. In Lac) E 1) One work of 120 kwp. OR Two work of 90 kwp. 2) Further the agency should 135 Lac 4 months 27 Lac 270 Lac have already installed solar PV of at least 75 kwp Capacity in any Government / Semi Government / PSU Organization / Big Corporate House. 1) One work of 40 kwp. OR Two work of 25 kwp. AND 2) Further the agency should 45 Lac 3 months 9.0 Lac 90 Lac have already installed solar PV of at least 25 kwp Capacity in any Government / Semi Government / PSU Organization / Big Corporate House Note : 1. Contractor should be MNRE approved agency/ Channel Partner or respective State Nodal Body (Like NEDCAP For Andhra Pradesh, GEDA for Gujrat, D

5 MEDA for Maharashtra etc.) approved agency for Supply, Installation of solar power plants of capacities proposed or above. 2. The agency should have copy of Certificate of Electrical Inspectorate. 3. The company should have a Branch/Service centre / Office or Channel partner in respective state where the installation is/are proposed. 4. Any Agency is applying for both the works then total Bank solvency amount shall be Rs Lacs + Rs.4.5 Lacs= Rs.31.5 Lacs or Separately submitted for each amount of Rs Lacs and Rs.4.5 Lacs for works at Sr.1 & Sr. No.2 respectively. Agreed and confirmed Signature of Contractor Chief Engineer Blank Enrolment form is to be downloaded from our website or can be collected from the office of Chief Engineer on any working day in working hours till The enrolment form is to be submitted along with the processing fees of Rs 2000/- for each work. The filled in enrolment form should be submitted latest by along with application processing fee of Rs 2000/- (for each job mentioned at SR No 1 to 2 shall be SUBMITTED separately.) in the form of DD in favour of LIC of India Payable at Mumbai on a atio alized a k to The Chief E gi eer Life Insurance corporation of India, Western Zonal Office, First Floor, West wi g, Yogakshe a, Nari a poi t Mu ai , The minimum documents to be attached with the enrolment form shall be as follows 1) Bankers Solvency Certificate Not be more than three months old as on the date of submission of enrolment form ( Original or duly Notarized colour photocopy ). 2) Work completion certificates of qualifying works executed during last seven years ( Notarized colour photocopy) 3) Works in hand- Notarized copies of work orders 4) Annual turn over figures of last two years notarized copy of Income tax return ( saral form ) /copy of profit and loss balance sheet Duly certified by Chartered Accountant / Chartered Accountant. 5) In case of specialized agencies /contractors / authorized dealers : Notarised authorisaton / certificate of dealership / certification as approved applicator / installer 6) Pan NO, Service Tax No, Vat No, MST No, along with supporting documents.

6 Please note that the enrollment form received without enrolment fee and above mentioned supporting documents shall be summarily rejected. The Chief Engineer reserves the right to reject / issue tender to any/all applicants at his sole discretion without assigning any reason whatsoever. Note: Any Agencies applied and fulfilling the above criteria may not be considered for enlistment if unsatisfactory performance reports are received for the completed projects/works from their previous employers. Chief Engineer +

7 ENROLMENT FORM

8 FORM FOR ENROLMENT OF CONTRACTORS I / We am / are desirous of being enrolled on list of contractors fordesign, Supply, Installation, Testing & commissioning of 150 kwp ON Grid Roof Top Solar Generating System at Yogakshema Building Mumbai. (2) Design, Supply, Installation, Testing & commissioning of 50 kwp ON Grid Roof Top Solar Generating System at various LIC Offices in Maharashtra Gujarat & Goa under Western Zone. (1) Name of Work Mention the work for which applied For (1) Design, Supply, Installation, Testing & commissioning of 150 kwp ON Grid Roof Top Solar Generating System at Yogakshema Building Mumbai. Yes/No (2) Design, Supply, Installation, Testing & commissioning of 50 kwp ON Grid Roof Top Solar Generating System at various LIC Offices in Maharashtra Gujarat & Goa under Western Zone. Yes/No I / We give the following details for your consideration. Sl.no QUERY 1 Name of the firm : 2 Postal Address 3 PAN No TIN No. VAT Registration No. Service Tax Registration No. Contact Office Phone No. 4 ANSWER

9 Details 5 Residence Phone No. Mobile No. Fax No. Id (Block Letters) Telegraphic Address, if any 6 Month and year in which the firm was established in present name 7 Particulars of old firm (if present firm is new) if main partners of the present firm were working as construction or other contractors, in some other name in the past (The partnership deed of old firm be enclosed). Particulars of sister construction firms, if any : 8 9 i) What is the constitution of firm viz. Sole Proprietor, Partnership, Pvt. Ltd., Public Ltd., etc. ii) Enclose copy of partnership deed, Articles of Association or Affidavit in case of sole proprietorship as per Annexure A-1. iii) Fill-in enclosed Annexure A Fill and enclose Annexure B giving details of enrolment with LIC of India in the past and with other organizations 11 Has the applicant or his partners or Directors been black listed in the past by any Central or State Govt. Deptt./ Organisation

10 12 i) Annual Turn Over for last Two years (enclose documentary evidence or proof to support figures) i YEAR i Rs. in Lac

11 13 contd 14 ii) What evidence of proof is enclosed to support the amounts of yearly turnover iii) Enclose latest income tax clearance Certificate i) Name and complete postal address of bankers ii) Enclose solvency certificate indicating amount (The certificate should not be more than 3 months old). iii) Bank Guarantee limit with Various banks Certificate enclosed for Assessment year i) Enclose list of immovable properties with complete postal addresses, full description & reasonable market value of property duly supported by certificate of D.M./Collector/First Class Magistrate/ approved valuer. ii) Whose supporting certificate is enclosed i) Particulars of movable properties along with Ba ker s refere e Value of tools & plants Other Assets Total ii) Whose reference is enclosed? Fill in and enclose list of tools & plants as per Annexure-C enclosed. i) Rs. Lac with ii) Rs. Lac with iii) Rs. Lac with TOTAL Rs. of Date Rs. Rs. Rs.

12 Fill in & enclose Annexure-D giving full particulars about major works completed during past Two years NOTE: List of only those works which are carried out by firm requesting for enrolment is to be given. Work completion certificate for qualified projects must be notarized with address & contact numbers of issuing authority. Work in Progress: i) Whether full details of major work on hand given in A exure E Note: The details must be notarized. ii) Are copies of work orders for such large works enclosed Whether full information regarding permanent technical staff employed given in A exure F i) How do you normally carry out works of water supply, sanitary and plumbing installations N.A. ii) Who is the license holder and what his experience of this work is. N.A. i) How do you normally get work of electrical installations carried out ii) Who is the license holder & what is his experience (HT License) 23 Any other information the applicant might like to give 24 The agencies applying for YOGAKSHEMA work have to indicate their willingness for empanelment for this type of work under WZO, MUMBAI.

13 DECLARATION I/We agree to notify the officer accepting this application and registering my/our names on list of contractors of Life Insurance Corporation of India, of any changes in the foregoing particulars as and when they occur and to verify and confirm these annually on 1st January. I/We understand and agree that the appropriate Life Insurance Corporation of India Authority has the right as he may decide, not to issue tender form in any particular case and also to suspend, remove or blacklist my/our name from Life Insurance Corporation of India list of contractors in the event of my/our furnishing false particulars in the enrolment form or submitting non-bonafide tenders or for technical or other delinquency in regard to which the decision of appropriate Life Insurance Corporation of India Authority shall be final and conclusive. I/We certify that the particulars furnished in the enrolment forms are correct and that should it be found that I/We have given a false certificate or that if I/We fail to notify the fact of my/our subsequent amalgamation with another contractor or firm, the Life Insurance Corporation of India may remove my/our name from the list of contractors and any contract that I/We may be holding at the time may be rescinded. PLACE: DATE: SIGNATURE OF CONTRACTOR : FOR OFFICE USE ONLY: ENROLMENT FORM NO. ISSUED TO SIGNATURE OF ISSUING OFFICER

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21 ANNEXURE - I Particulars of Regional / Branch Offices/Service Centers Number of Offices: Within the state of Maharashtra Within the State of Gujarat Within the State of Goa Total Number of Offices Please furnish information about Regional/ Branch Offices/ Service Centers in the following format.. (Specify states to cover) states City / State Date: Address Name of Person No. Of Qualified In-charge and Support Phone No Engineers & their qualificatio ns Whether adequate trained Manpower, knowledge base & stock of spares available for support Signature of Authorized Official with Seal

22 ANNEXURE - II Particulars of Service Centers Managed by Third Parties / Franchisee Number of Offices: Within the State of Maharashtra, Gujarat & Goa Rest of India Total Number of Offices City / State Name and Address of the service provider Date: Name of Person In-charge and Phone No No. Of Trained Service Engineers Whether adequate trained Manpower, knowledge base and stock of spares maintained Signature of Authorized Official with Seal Page

23 Engineering Department, Western, Zonal Office, Yogakshema, 1 St Floor, West wing, Nariman Point, Mumbai Tel: , , wz_engg@licindia.com ANNEXURE III A. List of Major Clients and related references: Solar Generating Systems System supplied during the last two years provide copies of major contracts executed/ copy of Purchase Orders for each of the model) Name of the clients & contact details Date: CONTRACTOR Details of equipment supplied Signature of Authorized Official with Seal Chief Engineer

24 Engineering Department, Western, Zonal Office, Yogakshema, 1 St Floor, West wing, Nariman Point, Mumbai Tel: , , wz_engg@licindia.com ANNEXURE-IV AFFIDAVIT (On Non Judicial Stamp Paper of appropriate value for the contractors applying for Builders work) I/We, agree to notify the officer accepting this application and registering my/our names on list of contractors for Works as mentioned in the PQN for which I applied for Life Insurance Corporation of India, I/We agree to execute the all type of jobs required for the respective trade for which I/We applied for the as per list of works mentioned in PQN at a time as per instructions received from time to time. If, I/We fail to Execute any jobs as mentioned above, the Life Insurance Corporation of India may remove my/our name from the list of contractors and any contract that I/We may be holding at the time may be rescinded and in addition to this forfeiture of deposit amount, no payment for incomplete work etc. PLACE : DATE : CONTRACTOR SIGNATURE OF CONTRACTOR Chief Engineer

25 Engineering Department, Western, Zonal Office, Yogakshema, 1 St Floor, West wing, Nariman Point, Mumbai Tel: , , wz_engg@licindia.com ANNEXURE G ENROLMENT CHECKLIST Sr. No Description of Enclosure Refer Item of form Bidding Capacity (Rs. In Lac) Separate Not Applicable enclosure with details calculation as per prescribed formula. (An affidavit duly notarized in support of this statement is must) Partnership deed / Articles of Association / 9 (ii) Affidavit ( ) ( ) Annexure A-1 Annexure (A-2) as supplied 9 (ii) (Particulars of Partners) 4. Annexure E (as supplied) 5. Proof of Turnover 10 (Particulars of enrolment in LIC and other Organization) 12 (ii) 6. Latest I.T.C.C. 12 (iii) 7. Solvency Certificate 13 (ii) 8. Certificate of Bank Guarantee Not Applicable 9. Immovable Property Certificate 14 (ii) 10. Movable Property reference 15 (i) 11. ( A e ure C as supplied Not Applicable 12. ( A e ure D as supplied 13. ( A e ure E as supplied 17 (List of major works completed during last 4 years) 18 (List of work in hand) ( ) Copies of work order ( A e ure F as supplied (*)ANNEXURE - I 18 (ii) 19 (Particulars of permanent technical staff) (*)ANNEXURE - II (*)ANNEXURE - III (*)ANNEXURE IV (*)AFFIDAVIT SIGNATURE OF CONTRACTOR CONTRACTOR Chief Engineer