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Government of Sri Lanka Ministry of Provincial Councils and Local Government Local Government Enhancement Sector Project Design and Supervision Consultants - Southern Province Package Number - DSC SP AT 01 Expression of Interest (EOI) Consulting Firms Project Number Project Name Project Country I. Consulting Firm Information CMS No. 1 / date: Country of Incorporation: 2 Consultant Name: EOI Submission Authorized by: Acronym: Position Associations (Joint Venture or Sub-consultancy) CMS No. 1 Consultant Acronym Country of Incorporation 2 Joint Venture (JV) or Subconsultant EOI Submission Authorized By Position Present the rationale for and benefits of working in association (JV or Sub-consultant) with others rather than undertaking the assignment independently (as appropriate). Describe the proposed management and coordination approach of the association and the role of each firm. 1 If already registered on ADB s Consultant Management System (CMS). CMS registration is not mandated under EA-administered selection. 2 The lead consultant must submit a copy of the Certificate of Incorporation of itself and of each JV member and sub-consultant through VII. EOI Attachments.

I confirm that: 2 Documentation regarding our corporate structure including beneficial ownership has been attached. Documentation regarding our Board of Directors has been attached. A written agreement to associate for the purpose of this Expression of Interest has been signed between the consortium partners and has been attached. Once your team is shortlisted and invited for submission of the Proposal, it is not permissible to transfer the invitation to any other firm, such as Consultant s parent companies, subsidiaries and affiliates. The Client will reject a Proposal if the Consultant drops a JV member without the Client s prior consent, which is given only in exceptional circumstances, such as debarment of the JV partner or occurrence of Force Majeure. 3 II. Assignment Specific Qualifications and Experience For online submission: Your EOI shall demonstrate technical competence and geographical experience based on project references entered in full registration under your CMS profile. We encourage you to update Project Information under your CMS prior to filling EOI. For offline submission: Please use the same format for uniformity in provision of details. A. Technical Competence Cross-referencing from your profile projects in Section E. Project References, highlight the technical qualifications of your entity/consortium in undertaking similar assignments. Provide details of past experiences working with similar project authorities. Experience as Design and Supervision Consultants in urban / rural infrastructure projects, especially in externally funded projects will be need to be highlighted clearly. B. Geographical Experience Cross-referencing from your profile projects in Section E. Project References, present experiences in similar geographic areas. Province, Country, Similar areas etc. 3 Paras. 3 and 7, Section 1 of the Standard Request for Proposal (SRFP), ADB wbsite.

3 C. Management Competence (Please answer each question in one paragraph of 3-5 sentences) 1. Describe standard policies, procedures, and practices that your entity has to assure quality interaction with clients and outputs. Please state if your company is ISO certified. 2. How will your firm/consortium handle complaints concerning the performance of experts or quality of the reports submitted for this assignment? What internal controls are in place to address and resolve complaints? 3. How will you ensure the quality of your firm s/consortium s performance over the life of this assignment? 4. Describe standard policies, procedures and practices that your firm has put in place to avoid changes/replacements of personnel and to ensure the continuity of professional services once contracted. 5. Describe what social protection practices you have in place to safeguard the well-being of your proposed experts? Specifically describe arrangements you have in place for medical, accident, and life insurance coverage during the assignment. 6. Provide the following details (i) Total Number of Years of Experience in Consultancy Firm; (ii) Strength of key experts as permanent staff; (iii) Details on Consultants Head office support to field office in project implementation. D. Other Information (maximum of 500 words)

4 E. Project References Please select most relevant projects to demonstrate the firm s technical qualifications and geographical experience (maximum 20 most relevant and best projects executed). SN Project Period Client Country Firm 1 2 3 4 5 6 7 8 9 10 11 Project Summary SN 1 Project Title Country / Region Start Date Completion Date Continuous / Intermittent Client Funding Source Description (indicate your role and input inperson-months) SN 2 Project Title Country / Region Start Date Completion Date Continuous / Intermittent Client Funding Source Description (indicate your role and input in person-months) (Please insert more tables as necessary) III. Comments on Terms of Reference

5 IV. Comments on Budget Adequacy V. Key Considerations in approaching this assignment (no more than 9,000 characters summarizing approach and methodology) VI. Key Experts List of experts is only required for Consultants Qualifications Selection (CQS). Attach CV of each expert. SN Name Email Position/Title Nationality 1 2 3 4 5 (Please insert more rows as necessary) VII. EOI Attachments SN Description 1 Certificate of Incorporation of the lead member 2 Certificate of Incorporation of the JV member (for each member) 3 Certificate of Incorporation of the Sub-Consultant (for each sub-consultant) 4 Letter of Association / JV (if any) 5 Project Information Sheets as in Appendix 1 - of at least 20 Projects illustrating the details required for evaluating the EoI interms on Technical, Management and Geographical Competence - The Project sheets should indicate the actual details of firms contribution in terms of expert inputs and fee received, services rendered etc. 6. ISO Certifications 7. Proof of working in the project - Main Contracts, Client Certificates / Completion Certificates etc. (Please insert more rows as necessary)

6 VIII. Eligibility Declaration 4 We, the undersigned, certify to the best of our knowledge and belief: We have read the advertisement, including the terms of reference (TOR), for this assignment. Neither the consulting firm nor its JV member or sub-consultant or any of its experts prepared the TOR for this activity. We confirm that the project references submitted as part of this EOI accurately reflect the experience of the specified firm/consortium. We further confirm that, if any of our experts is engaged to prepare the TOR for any ensuing assignment resulting from our work product under this assignment, our firm, JV member or sub-consultant, and the expert(s) will be disqualified from short-listing and participation in the assignment. All consulting entities and experts proposed in this EOI are eligible to participate in ADB-funded, -supported and administered activities. The lead entity and JV member or sub-consultant are NOT currently sanctioned by ADB or other MDBs. Neither the consulting firm nor the JV member or sub-consultant has ever been convicted of an integrity-related offense or crime related to theft, corruption, fraud, collusion or coercion. We understand that it is our obligation to notify ADB should any member of the consortium become ineligible to work with ADB or other MDBs or be convicted of an integrity-related offense or crime as described above. JV member or sub-consultant, including all proposed experts named in this EOI, confirmed their interest in this activity in writing. JV member or sub-consultant, including all proposed experts named in this EOI, authorized us in writing to represent them in expressing interest in this activity. None of the proposed consortiums are subsidiaries of and/or dependent on the Executing Agency or the Implementing Agency or individuals related to them. We understand that any misrepresentations that knowingly or recklessly mislead, or attempt to mislead may lead to the automatic rejection of the proposal or cancellation of the contract, if awarded, and may result in further remedial action, in accordance with ADB s Anticorruption Policy. 4 Eligibility refers to ADB s Guidelines on the Use of Consultants by Asian Development Bank and its Borrowers, Clause 1.13 together with Clauses 1.10-1.11 and 1.23-1.25 on integrity and anti-corruption policies.

7 Project Sheets Proforma Appendix 1 Indicate up to 20 reference projects from the past 10 years that the firm/association/joint venture feels are relevant. (Maximum of 2 Sheets per project) Project Name Name of Client Country Participation As lead firm As associate firm / JV firm Value of Services (In SLR/$) Project location within Country Total ( (SLR / $) Value of Services Provided by your firm (in SLR/ $) Source of Financing / Funding Consultancy Services Total for assignment Contribution of your Firm (i) No. of Key Expert (ii) No. of Key person months Assignment - Continuous / Intermittent Duration Length of Consultancy Assignment Start Date (dd/mm/yyyy) Completion Date (dd/mm/yyyy) Reasons for delay (if any) Other Details Name of Associate Firms (if any) Name of Senior Staff (Project Director/Coordinator, Team Leader) Involved and Functions Performed Detailed Narrative Description of the Project Detailed Description of the Actual Services Provided by your Firm Please tick the areas of services rendered by your firm in the above Project: (Realistic information to be given - EA may ask for the proof for what has been ticked as performed rendered) Project Feasibility - Yes / No Procurement Support - Yes / No Detailed Design and estimates - Yes / No Contract Management - Yes / No Construction Supervision - Yes / No Project Management - Yes / No Social Safeguard assessment / Institutional Strengthening - Yes / No Implementation : Environmental Safeguard / Assessment Implementation - Yes / No Training - Yes/ No Completion Reports - Yes / No - Yes / No O & M advisory - Yes / No Project s completed after 01 January 2006 will be considered for Evaluation. (Ongoing Projects with substantial completion certificate from the client (with minimum of 90 % fee paid or 90 % physical progress) will be considered - Client certification compulsory for consideration of ongoing subprojects) Format as above should be followed strictly in attaching the information of 20 Projects (Maximum)