aic kijabe hospital p.o. box 20, 00220 kijabe … · 2019-10-08 · pre-qualification of suppliers...

PRE-QUALIFICATION OF SUPPLIERS FOR GOODS, WORKS AND SERVICES FOR

FINANCIAL YEAR 2019-2021

AIC KIJABE HOSPITAL

P.O. BOX 20, 00220

KIJABE

AICKH/PRQS/01/2019-2021

CLOSING DATE: 25TH OCTOBER 2019

i

AICKH PREQUALIFICATION OF SUPPLIERS 2019-2021

Table of Contents

1. PRE-QUALIFICATION INSTRUCTIONS ............................................................................... 4

1.1. Introduction .............................................................................................................................. 4

1.2. Pre-qualification objective ..................................................................................................... 4

1.3. Invitation of Prequalification ................................................................................................. 4

1.4. Experience................................................................................................................................ 4

1.5. Prequalification Document ..................................................................................................... 4

1.6. Distribution of Prequalification Document .......................................................................... 4

1.7. Clarification of documents ....................................................................................................... 5

1.8. Additional Information .......................................................................................................... 5

1.9. Request for quotations/tenders ................................................................................................. 5

2. BRIEF CONTRACT REGULATIONS/GUIDELINES ............................................................ 5

2.1. Taxes on Imported Materials.................................................................................................... 5

2.2. Customs Clearance ................................................................................................................... 5

2.3. Contract Price ........................................................................................................................... 5

2.4. Payments .................................................................................................................................. 5

3. PREQUALIFICATION DATA INSTRUCTIONS ................................................................ 6

3.1. Prequalification Data Forms ................................................................................................... 6

3.2. Personnel .................................................................................................................................. 6

3.3. Financial Condition ................................................................................................................. 6

3.4. Past Performance ...................................................................................................................... 6

3.5. Declaration Statement .............................................................................................................. 6

3.6. Withdrawal of Prequalification ................................................................................................ 6

3.7. Qualification ............................................................................................................................. 7

3.8. Validity Period ......................................................................................................................... 7

3.9. Tender Opening ........................................................................................................................ 7

4. INFORMATION ON CANDIDATES ........................................................................................ 8

FORM 1. REGISTRATION DOCUMENTATION ......................................................................... 9

FORM 2. REGISTRATION OF SUPPLIERS APPLICATION FORM ...................................... 10

FORM 3. CONFIDENTIAL BUSINESS QUESTIONANNAIRE ................................................. 13

FORM 4. DECLARATION STATEMENT ..................................................................................... 17

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PRE-QUALIFICATION OF SUPPLIERS FOR GOODS, WORKS AND SERVICES FOR

FINANCIAL YEARS 2019-2021.

AIC Kijabe Hospital is a Faith based hospital and would like invite sealed applications for prequalification from

eligible Suppliers (including the current suppliers) for the supply of goods, works and services for the period

2019-2021 under the following categories;

REFERENCE NUMBER CATEGORY DESCRIPTION

AICKH/01/2019-2021 Supply and delivery of, Tonners, Tonners refill, Cartridges, and other

Computer Consumables

AICKH/02/2019-2021 Supply or Lease, repair and Maintenance of Computers, Printers, Photocopiers,

Servers, Scanners Computer Software and all Computer Accessories.

AICKH/03/2019-2021 Design, supply, Installation, Configuration, Commissioning and Maintenance of

Network Infrastructure, Information System Solutions and website

AICKH/04/2019-2021 Supply and delivery of General Office & Printed Stationery and Published

Materials (hospital designed forms/books/booklets)

AICKH/05/2019-2021 Supply and delivery of Fresh Meat, Fish, Poultry and Poultry Products

AICKH/06/2019-2021 Supply and delivery of Fresh Farm Produce (Fruits and Vegetables)

AICKH/07/2019-2021 Supply and delivery of Dairy Products

AICKH/08/2019-2021 Supply and delivery of Cereals, Kitchen Dry Food and Related Products

AICKH/09/2019-2021 Supply and delivery of Soft Drinks and other Packaged Beverages/Bottled

Mineral Water

AICKH/10/2019-2021 Supply and delivery of Bread, Cakes and other Baked Products

AICKH/11/2019-2021 Supply of Cutlery and Crockery

AICKH/12/2019-2021 Supply and delivery of Staff Uniforms, Protective Clothing and Personal

Protective Equipment (PPE) i.e. Safety shoes, Helmets, Gloves, Googles

AICKH/13/2019-2021 Supply and delivery of Cleaning Materials, Soap, Detergents & Disinfectants

AICKH/14/2019-2021 Supply and delivery of General Housekeeping Materials (mops, polish, wash

buckets, brooms, disposable bags, Sanitary Bins e.t.c)

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AICKH/15/2019-2021 Supply and delivery of Toiletries, Basins, Slippers, Towels, Pampers and

Maternity Sanitary Towels

AICKH/16/2019-2021 Supply and delivery of Hospital Linen, Beddings and Drapery

AICKH/17/2019-2021 Supply and delivery of Liquefied Petroleum Gas, Cooking Gas, Diesel and

Lubricants

AICKH/18/2019-2021 Supply, repair and Maintenance of Fire Fighting Equipment & First Aid Kits

AICKH/19/2019-2021 Supply and delivery of Telephones and Telecommunication Equipment, Audio

Visual Equipment and Accessories

AICKH/20/2019-2021 Design, Supply and delivery of Snapper Frames, Signage and Promotional

Materials e.g. T-shirts, Posters, Banners e.t.c

AICKH/21/2019-2021 Supply, delivery, installation, maintenance of Office Furniture, Fixtures and

Fittings

AICKH/22/2019-2021 Supply, Installation and Maintenance of Power Generators, Air Conditioning

and Refrigeration Equipment.

AICKH/23/2019-2021 Supply of Medical Gases and Related Supplies

AICKH/24/2019-2021 Supply and delivery of Pharmaceutical Drugs and Medicines and Vaccines

AICKH/25/2019-2021 Supply and delivery of Orthopedics Supplies ( Theatre Screws, Plates, implants

e.t.c)

AICKH/26/2019-2021 Supply and delivery of Physiotherapy Supplies (walking aids, wheelchairs e.t.c)

AICKH/27/2019-2021 Supply and delivery of Medical Consumables i.e. Surgical consumables, Sutures,

Dental consumables, radiology supplies, ENT supplies, Anesthesia consumables,

Arthroscopy consumables e.t.c

AICKH/28/2019-2021 Supply and delivery of Imaging Equipment and Accessories

AICKH/29/2019-2021 Supply and delivery of Laboratory Supplies and Consumables

AICKH/30/2019-2021 Supply, Installation and Maintenance of Bio Medical, Surgical and other

Medical Equipment

AICKH/31/2019-2021 Provision of Transport/Haulage, Car Hire, Courier services and Taxi Services

AICKH/32/2019-2021 Provision of Servicing, Maintenance and Repair of Motor Vehicles, Motorcycles,

Machinery and equipment

AICKH/33/2019-2021 Supply and delivery of Spare Parts, Tyres, Tubes and Batteries for Motor

Vehicles and Motorcycles

AICKH/34/2019-2021 Provision of Fumigation, Pest Control and Sanitary Services

AICKH/35/2019-2021 Provision of Comprehensive Insurance Services

AICKH/36/2019-2021 Supply, Installation and Maintenance of CCTV Equipment, Security Solution

System, Monitoring and Response Services

AICKH/37/2019-2021 Provision of Clearing and Forwarding services

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AICKH/38/2019-2021 Provision of Management Consultancy Services; Human Resource, ICT, Audit,

Legal, Occupational Health, Safety & Firefighting etc

AICKH/39/2019-2021 Supply and delivery of Building Materials, Paints, Plumbing and Electrical

Items

AICKH/40/2019-2021 Renovation, Repair and Maintenance of Buildings

AICKH/41/2019-2021 Provision of Architectural and building services consortiums.

AICKH/42/2019-2021 General building works contractors

AICKH/43/2019-2021 Electrical works contractors

AICKH/44/2019-2021 Mechanical (plumbing & drainage) works contractors

AICKH/45/2019-2021 Medical gas installations and maintenance works contractors

Interested candidates may download Pre-qualification of supplier’s documents from the AIC Kijabe Hospital

website (https://kijabehospital.org/tenders) and pay a non-refundable fee of Kenya Shillings Three Thousand

(Kshs 3,000) only per category. Payments should be made to the below Bank Details;

Account Name: AIC Kijabe Hospital

Bank name: Kenya Commercial Bank

Account number: 1105788997

Branch: Limuru

The Original Bank deposit slip must be attached to the pre-qualification documents while submitting

the prequalification bid.

The completed pre-qualification documents clearly indicating tender number and category should be submitted

in plain sealed envelopes clearly labeled as below:

“PRE-QUALIFICATION OF SUPPLIERS FOR GOODS, WORKS AND SERVICES, REFERENCE

NUMBER……….... CATEGORY DESCRIPTION.…………” and addressed to:

The Director General

AIC Kijabe Hospital

P. O. Box 20 – 00220, Kijabe.

Or deposited in the Tender Box at AIC Kijabe Hospital, Main Hospital Offices located at Kijabe, off Nairobi -

Nakuru Highway so as to be received on or before FRIDAY, 25TH OCTOBER 2019 at 1400HRS.

https://kijabehospital.org/tenders

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1. PRE-QUALIFICATION INSTRUCTIONS

1.1. Introduction

AIC Kijabe Hospital would like to invite interested candidates who must qualify by meeting the set criteria as

provided by the AIC Kijabe Hospital to perform the contract of supply and delivery of goods, works or provision

of services.

1.2. Pre-qualification objective

The main objective is to maintain a register of suppliers and service providers to A.I.C Kijabe Hospital

as and when required basis through tender or quotations during the stated period.

1.3. Invitation of Prequalification

Suppliers registered with the Registrar of Companies under the Laws of Kenya in the supply of respective

goods, works or services are invited to submit their Prequalification documents to the Director General, AIC

Kijabe Hospital, so that they may be prequalified for submission of tenders or Quotations.

1.4. Experience

Prospective suppliers and contractors must have carried out successful supply and delivery of similar goods and

services to Corporations/NGOs/Government Institutions of similar size and complexity. Potential suppliers and

contractors must demonstrate the willingness and commitment to meet the prequalification criteria set.

1.5. Prequalification Document

This document includes a confidential business questionnaire and documents required from prospective suppliers.

In order to be considered for prequalification, prospective suppliers must submit all the information herein

requested and any bidder who does not meet all the relevant mandatory requirements will be disqualified. AIC

Kijabe Hospital reserves the right to accept or reject any or all bids and is not bound to give any reasons for its

decision.

1.6. Distribution of Prequalification Document

The completed prequalification data and other required information shall be submitted to:

The Director General

AIC Kijabe Hospital

P. O. Box 20 – 00220, Kijabe.

In order to reach on or before FRIDAY, 25TH OCTOBER 2019 at 1400HRS. AIC Kijabe Hospital located at

Kijabe, off Nairobi Nakuru Highway.

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1.7. Clarification of documents

Any questions that may arise from the prequalification documents should be sent not later than 18th October 2019

via email to [email protected]

1.8. Additional Information

AIC Kijabe Hospital reserves the right to request submission of additional information from prospective

suppliers.

1.9. Request for quotations/tenders

Request for quotations/tenders will be made available only to those bidders whose qualifications are accepted by

AIC Kijabe Hospital at the disclosure of the tender committee after the completion of the pre-qualification

process.

2. BRIEF CONTRACT REGULATIONS/GUIDELINES

2.1. Taxes on Imported Materials

The supplier will have to pay customs duty, VAT and any other applicable taxes for all imported materials

to be supplied unless the item(s) is/are donor funded.

2.2. Customs Clearance

The suppliers shall be responsible for custom clearance of their imported goods and materials.

2.3. Contract Price

The contract shall be of unit price type or cumulative of computed unit price and quantities required. Quantities

may increase or decrease as determined by demand on the authority of the Director General or Tender Committee.

Prices quoted should be inclusive of all delivery charges and valid for 90 days.

2.4. Payments

All local purchase shall be on credit terms stipulated in the Contract Agreement.

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3. PREQUALIFICATION DATA INSTRUCTIONS

3.1. Prequalification Data Forms

i) The attached questionnaire forms Form-1, Form-2, Form-3 and Form-4, are to be completed by

prospective suppliers/contractors who wish to be pre-qualified for submission of tenders for the

specified category.

ii) The prequalification application forms which are not filled out completely and submitted in the

prescribed manner may not be considered. All the documents that form part of the proposal must be

written in the English language and in indelible ink.

3.2. Personnel

The names and pertinent information and the CVs of the key personnel for individual or group to execute the

contract must be indicated in the Form.

3.3. Financial Condition

The supplier’s financial condition will be determined by the latest financial statement submitted with the

prequalification documents as well as the letters of reference from their bankers regarding supplier’s credit

position. Potential suppliers/contractors will be pre-qualified on the satisfactory information given.

3.4. Past Performance

Past performance will be given due consideration in pre-qualifying bidders. Letter of reference from past

customers should be included (at least from three organizations- attach copy of LPO/LSO/Contract)

3.5. Declaration Statement

Application must include a sworn declaration statement Form by the Tenderer ensuring the accuracy of the

information given.

3.6. Withdrawal of Prequalification

Should a condition arise between the time the firm is pre-qualified to bid and the bid opening date which could

substantially change the performance and qualification of the bidder or the ability to perform such as but not

limited to bankruptcy, change in ownership or new commitments, then AIC Kijabe Hospital reserves the right to

reject the tender from such a bidder even though they have been initially pre-qualified.

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3.7. Qualification

It is understood and agreed that the pre-qualification data on prospective bidders is to be used by AIC Kijabe

Hospital in determining, according to its sole judgment and discretion, the qualifications of prospective bidders

to perform in respect to the Tender Category as described by the client.

Prospective bidders will not be considered qualified unless in the judgment of AIC Kijabe Hospital and net

current assets or working capital sufficient to satisfactorily execute the contract for goods/services.

3.8. Validity Period

The request for pre-qualification must remain valid for not less than 90 days from the date of submission. AIC

Kijabe Hospital shall endeavor to complete the evaluation within the period. Suppliers shall not contact AIC

Kijabe Hospital on the matters relating to their Pre-qualification Document from the time of opening to the time

the evaluation is finalized and official communication sent to them. Any effort by the supplier to influence AIC

Kijabe Hospital in the pre-qualification shall result in rejection of their qualification document.

3.9. Tender Opening

A tender opening committee shall open the Tenders on a date to be set by the Hospital. Tenderers are not

required to be present during the opening.

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4. INFORMATION ON CANDIDATES

i) The firm must declare any conflict of interest in relation to any member of staff. AIC Kijabe Hospital will

not procure goods or services from suppliers where the employees have not declared conflict of interest.

ii) AIC Kijabe Hospital may carry out a source audit exercise for the shortlisted prequalified Suppliers.

iii) Tenderers shall not contact AIC Kijabe Hospital on matters relating to their tender from the time of opening

to the time the evaluation is finalized and official communication sent to them. Any effort by the Tenderer

to influence AIC Kijabe Hospital in the tender evaluation shall result in the cancellation of their tender.

iv) AIC Kijabe Hospital does not bind itself to assign supply of goods, works and services but shall endeavor to

ensure tenders for specific goods, works and services will be treated equitably.

v) Applicants will be informed in writing of the results of the application, without assigning any reason for AIC

Kijabe Hospital’s decision thereof.

vi) Tenderers will meet all costs associated with preparation and submission of their applications.

vii) It is AIC Kijabe Hospital policy to require that tenderers observe the highest standard of professional and

moral ethics during the selection and execution of such contracts.

viii) Will reject a Tender for pre-qualification if it determines that a Tenderer has engaged in corrupt or

fraudulent activities in competing for the contract in question;

ix) Will declare a Tender ineligible, for pre-qualification if at any time it determines that Tenderer has engaged

in corrupt or fraudulent practices in competing for, or in executing, a similar contract; and

x) Will have the right to examine financial records relating to the performance of such services to determine

capability.

xi) Will declare a Tender ineligible for prequalification if at any time it determines that Tenderer has no legal

capacity to enter into a contract for the procurement.

xii) Will declare a Tender ineligible for pre-qualification if at any time it determines that Tenderer is insolvent,

in receivership, bankrupt or in the Process of being wound up and is not the subject of legal proceedings

related to the foregoing.

xiii) Will declare a Tender ineligible, for prequalification if at any time AIC Kijabe Hospital determines that

a Tenderer is related to an employee of the hospital or a Member of Board or Finance and Procurement

Committee of the Hospital unless otherwise pre-declared to avoid conflict of interest.

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FORM 1. REGISTRATION DOCUMENTATION

Mandatory Requirements:

a) Copy of Certificate of Registration/Incorporation of Business Name.

b) Copy of PIN Certificate of firm/company/individual from Kenya Revenue Authority

c) Copy of valid Tax Compliance Certificate from Kenya Revenue Authority e.g. Electronic Tax Register

(ETR) certificates (where applicable)

d) Must submit certified bank statements for the most recent 12 months

e) Certified Audited accounts for the last two (2) years

f) Attach letters of recommendation from the firm’s banker.

g) Copy of valid Trade License/ Current business licenses from relevant authorities e.g. County government

h) Copy of Registration certificate as a contractor by Ministry of Roads and Public Works and other relevant

authorities for all civil/ works contractors (where applicable)

i) Copy of Practicing Certificate for all professionals e.g. certificate of affiliated bodies/associations

(Pharmacist license, legal, medical) (where applicable)

j) Copy of Memorandum of Association or CR12

k) Transport Hire firms must attach evidence of having taken all the Insurance covers.

l) Where mandatory for service provision, each firm must attach evidence of registration with Professional

bodies/Authorities e.g. IATA, Municipal / City Council Certificates of health for food stuffs handling.

m) Copy of quality assurance certificates if any e.g. ISO 9000/9001 (where applicable)

n) Letters of recommendation from three (3) of your major clients

o) Certificates of memberships /affiliations /associations (where applicable)

p) The Original Bank deposit slip MUST be attached to the pre-qualification documents while

submitting the prequalification bid.

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FORM 2. REGISTRATION OF SUPPLIERS APPLICATION FORM

I/We …………………………………………………………………. hereby apply for registration as supplier (s)

(Name of Company/Firm)

of ………………………………………………………………………………………………………………….

(Category Description)

…………………………………………………………………………………………………………………….

(Reference No.)

Post Office Address………………………………………………………………………………………............

Town ………………………………………………………………………………………………………..........

Street ………………………………………………………………………………………………………..........

Name of building …………………………………………………………………………………………...........

Room /Office No. ……………………………………………… Floor No. …………………………….............

Telephone Nos. …………………………………………………………………………………………..............

Email address ……….…………………………………………………………………………………................

Full Name of applicant …………………………………………………………………………………...............

Other branches location ……………………………………………………………………………….................

Management Personnel

Chief Executive ………………………………………………………………………………………….............

Secretary ……………………………………………………………………………………………….................

General Manager …………………………………………………………………………………………………

Other……………………………………………………………………………………………………..............

Partnership (if applicable)

Names of Partners

3. Business founded or incorporated …………………………………………………………………..................

4. Under present management since ………………………………………………………………………………

5. Net worth equivalent Ksh……………………………………………………………………………...............

6. Bank reference and address ……………………………………………………………………………...........

7. Bonding company reference address…………………………………………………………........................

8. Enclose copy of organization chart of the firm indicating the main fields of activities

……………………………………………………………………………………………………………………

10 Have you previously been supplying goods/works/services to AIC Kijabe Hospital?

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if yes, give details and indicate three of AIC Kijabe Hospital last purchase order number and date issued

………………………………………………………………………………………………………………........

………………………………………………………………………………………………………………….....

.……………………………………………………………………………………………………………………

Do you have any pending orders with AIC Kijabe Hospital? if yes give details

…………………………………………………………………………………………………………………….

…………………………………………………………………………………………………………………….

Have you ever failed to honor any AIC Kijabe Hospital purchase order or committed an offence under

procurement & disposal act?

if yes give order details

……………………………………………………………………………….……………………………………

……………………………………………………….……………........................................................................

Have you ever been debarred from participating in procurement by any public or private company?

……………………………………………………………..................................................................................

Supervisory Personnel

Name ……………………………………………………………………………………………………………...

Academic Qualification ………………………………………………………………………………………......

Under graduate……………………………………………………………………………………………………

Post graduate………………………………………………………………………………………………………

Diploma…………………………………………………………………………………………………………...

High School……………………………………………………………………………………………………….

Professional Qualification …………………………………………………………………………………………

(Attach Certificates if any)

Length of service with Contractor or Supplier position held

……………………………………………………………………………………………………………………

(Attach copies of certificates of at least 2 key personnel in the organization)-

Technical Personnel

a)………………………………………………………………………………………………………………..

b) ………………………………………………………………………………………………………………...

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c)…………………………………………………………………………………………………………………

d)……………………………………………………………………………………………………………………….

e) ……………………………………………………………………………………………………………………...

Authorized Signature …………………………………………………………

Name of Signatory …………………………………………………………

Title of Signatory …………………………………………………………

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FORM 3. CONFIDENTIAL BUSINESS QUESTIONANNAIRE

You are requested to give the particulars indicated in Part 1 and either Part 2 (a), 2(b) or 2(c) whichever

applied to your type of business.

You are advised that it is a serious offence to give false information on this form.

If a Kenyan citizen, indicate under “Citizenship Details” whether by Birth, Naturalization or Registration

Part 1. General:

Business Name………………………………………………………………………………………………...

Location of business premises…………………………………………………………………………………

Plot No……………………………………………………………………………………………...................

Street/Road……………………………………………………………………………………………………....

Postal Address……………………... Tel. No……………………………… Fax…………………….

Email…………………………………………………………………………………………………………….

Nature of business…………………………………………………………………………………………….

Registration Certificate No……………………………………………………………………….....................

When Business founded or incorporated…………………………………………………………………….

Current Trade License…………………………………Expiry Date……………………………………….

Maximum value of business which you can handle at any one time Ksh………………………………..........

Name of your bankers…………………………………………Branch………………………….....................

Account Number………………………………………………. Swift code………………………………….

Part 2(a) - Sole proprietor:

Your name in full…………………………………………………Age……………………………………….

Nationality…………………………………………………. Country of origin……………………………….

Citizenship details……………………………………………………………………………………………...

Part 2(b) - Partnership

Give details of partners as follows

Name Nationality Citizenship Details Shares

1……………………………………………………………………………………………………...

2……………………………………………………………………………………………………...

3……………………………………………………………………………………………………...

4……………………………………………………………………………………………………...

5…………………………………………………………………………………………………….

14


Part 2(c) - Registered Company:

Public or Private

State the nominal and issued capital of the company

Nominal Ksh…………………………………………………………………………………………………...

Issued Ksh……………………………………………………………………………………………………...

Give details of all directors as follows

Name Nationality Citizenship Details Shares

1……………………………………………………………………………………………………..

2……………………………………………………………………………………………………………..

3……………………………………………………………………………………………………..

4……………………………………………………………………………………………………...

5………………………………………………………………………………………………….....

Date………………………………………………………………………………………………………….

Signature of Tenderer……………………………………………………………………………………......

Organization and Business Information

Managing Director…………………………………………………………………………………………....

Company Secretary……………………………………………………………………………………………

General Manager………………………………………………………………………………………………

Others…………………………………………………………………………………………………………

NAMES OF THE APPLICANTS CLIENTS IN THE LAST TWO YEARS

NAMES OF OTHER CLIENTS AND VALUES OF CONTRACT/ORDERS

1. Name of 1st Client (organization)

i) Name of Client (organization) …………………………………………………………………………….

ii) Address of Client (organization) ………………………………………………………………….............

iii) Name of Contact Person at the client (organization) …………………………………………………….

iv) Telephone No. of Client ………………………………………………………………………………….

v) Value of Contract …………………………………………………………………………………............

vi) Duration of Contract (date) ………………………………………………………………………...........

(Attach documental evidence of existence of contract)

15


2. Name of 2nd Client (organization)

i) Name of Client (organization) …………………………………………………………………….............

ii) Address of Client (organization) …………………………………………………………………………

iii) Name of Contact Person at the client (organization) ………………………………….…………………

iv) Telephone No. of Client …………………………………………………………………………………

v) Value of Contract …………………………………………………………………………………………

vi) Duration of Contract (date) ………………………………………………………………………………


3. Name of 3rd Client (organization)

i) Name of Client (organization) …………………………………………………………………………….

ii) Address of Client (organization) ……………………………………………………………………….

iii) Name of Contact Person at the client (organization) ………………………………………………….

iv) Telephone No. of Client ……………………………………………………………………………….

v) Value of Contract ………………………………………………………………………………………

vi) Duration of Contract (date) ……………………………………………………………………………


4. Name of 4th Client (Organization)

(i) Name of Client Organization………………………………………………………………………………

(ii) Name of Contact Person at the Client Organization………………………………..................................

(iii) Address……………………………………………………………………………….............................

(iv) Telephone No. of Client ……………………………………………………………………………....

v) Value of Contract ……………………………………………………………………………………….

vi) Duration of Contract (date) …………………………………………………………………………….


5. Name of 5th Client (Organization)

(i) Name of Client Organization………………………………………………………………………………

(ii) Name of Contact Person at the Client Organization………………………………..................................

(iii) Address………………………………………………………………………………............................

(iv) Telephone No. of Client ………………………………………………………………………............

v) Value of Contract ………………………………………………………………………………………

vi) Duration of Contract (date) ……………………………………………………………………………

16



6. What measures are undertaken by your company to ensure that goods, works or services provided are

of world quality standards? (Attach evidence)

17


FORM 4. DECLARATION STATEMENT

Having studied the prequalification information for the above project, I/We hereby state:

i) That the information furnished in our application is accurate to the best of our knowledge.

ii) That in case of being pre-qualified we acknowledge that this grants us the right to participate in

due time in the submission of tenders or quotations on the basis of the provision in the tender or

quotation documents.

iii) That when the call for tenders/quotations is issued and the legal technical or financial conditions or

the contractual capacity of the firm changes, I/We shall inform you and acknowledge your right to

review the prequalification made.

Applicants (Bidder Firm) Name…………………………………………………………………………………….

Name of Signatory……….……………………………………………………………………………......................

(Full name and designation of person signing, official stamp or seal)

Signature……………………………………………………………………………………………….………….

Date……………………………………………………………………………………………………………….

aic kijabe hospital p.o. box 20, 00220 kijabe … · 2019-10-08 · pre-qualification of suppliers...

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