FORM FOR ENROLMENT OF CONTRACTORS/AGENCIES FOR HIRING OF DG SETS

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LIC OF INDIA DIVISIONL OFFICE "JEEVAN PRAKASH, NAINITAL ROAD, KATHGODAM, HALDWANI 263139 FORM FOR ENROLMENT OF CONTRACTORS/AGENCIES FOR HIRING OF DG SETS Page 1 of 11

PRE QUALIFICATION TENDER NOTICE FOR INSTALLATION OF DG SET ON HIRE BASIS. Life Insurance Corporation of India intends to shortlist the agencies for Supply & Installation of new noiseless and smokeless DG set on monthly hire basis for its various Branch/Satellite and other offices situated in Uttrakhadnd under jurisdiction of Divisional Office, Haldwani. Contractors who have carried out similar nature of works and have requisite qualifications are only required to apply. Enrolment forms will be available on payment of Rs 590/- (Non-refundable) for each category for above in cash during cash hours or in form of D.D. from 06/12/2018 to 27/12/2018 on working days during office hours only from above mentioned office. Enrolment form is also available in web-site www.licindia.com/tender, which may be downloaded and submitted duly filled in along with non-refundable fees of Rs 590.00 ( Rupees Five Hundred ninety only ) for each category separately as mentioned above in the form of D.D drawn in favour of LIC of India payable at Haldwani. Eligibility criteria for above shall be as under: 1. Category Capacity of Minimum DG set Solvency (Rs.) I II From 7.5 KVA to 40 KVA From 41 KVA upto 62.5 KVA Average annual turnover for last 3 years (Rs.) Minimum capacity of DG set installed by the agency 45,000.00 2,25,000.00 At least 2 sets of 7.5 KVA each or 01 set of 30 KVA 1,40,000.00 7,10,000.00 At least 2 sets of 45.0 KVA each or 01 set of 50 KVA III Above 62.5 KVA 1,74,000.00 8,70,000.00 At least 2 sets of 62.5 KVA each or 01 set of 82.5 KVA Page 2 of 11

2. Other Requirements: A. The contractor should have experience of supply, installation, running & maintenance of noiseless DG set of capacity with in or more than that specified above as per categories applied for in Govt. Department/PSUs/Financial Institutions/Govt./Semi - sponsored institutes/reputed MNCs during last three years consecutively. B. The experience must be of similar nature involving complete works such as civil works, installation of DG sets, earthing work, integration with existing electric distribution system, electrical cabling works. C.Agency/firm should submit the GST registration certificates along with the Enrolment form/bid. D. Income tax return for last three years. Agency/firm should submit income tax clearance certificate along with the Enrolment form/bid. E. Trade license certificate and professional license no. should be furnished. F. List of organization where DG sets are installed on hire basis in last three years with supporting documents such as work order/letter of intent. G. Performance certificate of works of similar nature issued by the respective officer of the department/company along with name, designation and department to be submitted. H. PAN Card I. GST Registration Certificate J. Certified Copy of Annual Turn Over of the firm /agency All the already enlisted contractors should also apply for fresh empanelment through this NIT. Empanelment Period will be valid for next three financial years. INTERESTED AGENCIES FULFILLING THE ABOVE ELIGIBILITY CRITERION may apply for issue of enrolment forms against payment of Rs. 590.00 (Non refundable) for each category, to be paid in cash/dd in favour of LIC of India payable at Haldwani from 06/12/2018 to 27/12/2018 from the office of Manager (OS), O.S.Department, Divisional Office, Haldwani (UK).Last date of duly filled in Enrolment form with all relevant supporting documents are 27/12/2018 upto 15:00 Hrs to Manager (E & OS),LIC of India,Divisional Office,Nainital Road, Haldwani-263139 in a closed sealed cover superscribed APPLICATION FOR EMPANELEMNT OF CONTRACTORS FOR HIRING OF DG SETS UNDER CATEGORY-....Enrollment form down-loaded from the web site should be submitted along with payment of Rs.590.00(Non-refundable) Page 3 of 11

for each category in the form of D.D drawn in favour of LIC of India payable at Haldwani If any of the above supporting documents & requisite fees are not enclosed along with the enrolment form by the agency, such agency shall be declared as Non-bonafide /Non-eligible for enlistment.issue of enrolment /tender form does not mean that the agency is considered qualified. Sr. Divisional Manager reserves the right to issue/reject the enrolment form to any agency at his sole discretion without assigning any reason thereof. No Brokers/Intermediaries shall be entertained. LIC of India reserves the right to accept or reject any or all offers in full/part without assigning any reason whatsoever. Signature of the Firm / Agency ( With seal & date) Sr. Divisional Manager Page 4 of 11

INSTRUCTIONS FOR FILLING AND SUBMISSION OF ENROLMENT FORM The Enrolment form (from page- 1 to 9) & Annexure A and B shall be completely filled in all respect along with cost of Enrolment Form of Rs. 590/- (nonrefundable) for each category by way of cash during cash hours/demand draft in favour of Life Insurance Corporation of India payable at Haldwani, Life Insurance Corporation of India, Divisional Office- Haldwani,Nainital Road, Haldwani- 263139 along with these instructions for filling and submission of Enrolment Form on or before 27/12/2018. Please note that no consideration will be given for postal delays. 1. Contractors to note that all particulars required as per the form and Annexure shall be filled in completely with relevant supporting documents strictly as per the format.. 2. The forms not submitted strictly as per the above instructions within stipulated period are liable to be rejected. 3. The eligible agencies, which will be selected for issue of tenders after scrutiny of enrolment forms, shall be informed by a letter. Please note that no enquiries or correspondence regarding the selection for issue of tenders shall be entertained. 4. Please note that the submission of this enrolment form does not confer any right on you to claim issue of tenders and the Sr. Divisional Manager reserve the right not to issue tender to any/all applicants without assigning any reason whatsoever. Encl: Enrolment Form with Annexure A to B (Total No of pages 11) Agreed & confirmed Sr. Divisional Manager Signature of the Firm / Agency ( With seal & date) Note: These instructions for filling and submission of Enrolment Form shall also be duly signed and submitted along with Enrolment Form with Annexure A and B. Page 5 of 11

FORM FOR ENROLMENT OF CONTRACTORS I/We am/are desirous of being enrolled on list of contractors for and hereby apply for the same. Sl.NO. NAME OF WORK PLEASE MENTION THE WORK/CATEGORY FOR WHICH APPLIED 1. Category-I (Hiring of DG set 7.5 KVA to 40 KVA) 2. Category-II (Hiring of DG set 41 KVA to 62.5 KVA) 3. Category-III (Above 62.5 KVA) Signature of the Firm / Agency ( With seal & date) Page 6 of 11

FORM FOR ENROLMENT OF CONTRACTORS Sl.No. Description Remarks 1. Name of the Firms/Agency 2. Address & phone No. Fax no. E-Mail ID 3. Name of contact person Phone No. 4. Name of the Proprietors/Partners 5. PAN Card(Enclose attested copy) 6. Trade Licence Certificate(Enclose copy) 7. GST registration (Enclose attested copy) 8. Professional Licence No. (Enclose copies). 9. List of clients with D.G. Set supplied on hire basis with date & location of installation during last three years(enclose as per annexure-a) 10. List of contracts in hand (Enclose as per annexure-b) 11. Copies of work-order (Enclose attested copies) 12. Income Tax return for the last three years (Enclose attested copies) 13. Average annual turn over of the firm/agency (Enclose certified copy) i. F.Y. 2015-2016 Page 7 of 11

ii. F.Y. 2016-2017 iii. F.Y. 2017-2018 iv. Average 14. Performance certificate issued by clients during last three years (Enclose attested copies). Place: Signature of vendor with seal Date: Page 8 of 11

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 NOTE: THE FILLED IN ENROLMENT FORM SHOULD REACH IN THE OFFICE ON OR BEFORE 27/12/2018 up to 15.00 Hrs. SIGNATURE OF ISSUING OFFICER Page 9 of 11

List of works completed. Annexure A. Sl No Details of the Organisation / Firm Name of Firm / Agency Postal Address Capacity of D.G Set ( KVA) Type of D.G Set Reference No & Date Details of Order Date of Commencement Contract period Contract amount ( Rs.) Signature of the Firm / Agency ( With seal & date) Page 10 of 11

List of contracts in hand. Annexure B. Sl No Details of the Organisation / Firm Name of Firm / Agency Postal Address Capacity of D.G Set ( KVA) Type of D.G Set Reference No & Date Details of Order Date of Commencement Contract period Contract amount ( Rs.) Signature of the Firm / Agency ( With seal & date) Page 11 of 11