Supply and installation of Submersible pump, water tank, piping arrangement etc in 332 schools in Ballia and Fatehpur to provide running water facility in all toilets constructed by POWERGRID under SVA as a CSR initiative

Name of Package: Supply and installation of Submersible pump, water tank, piping arrangement etc in 332 schools in Ballia and Fatehpur to provide running water facility in all toilets constructed by POWERGRID under SVA as a CSR initiative

Specification No.: 5002002168/OTHERS/DOM/K00 - NR3 RHQ -1

: Schedules : General guidelines for filling up the Attachments

Specification No.: 5002002168/OTHERS/DOM/K00 - NR3 RHQ -1

Supply and installation of Submersible pump, water tank, piping arrangement etc in 332 schools in Ballia and Fatehpur to provide running water facility in all toilets constructed by POWERGRID under SVA as a CSR initiative

1 Bidder may note that non-submission of Bid Form shall lead to outright rejection of their bid and no clarification shall be sought from them in this regard.

2 Fill up only green shaded cells in the relevent attachments.

3 Bid Form and Attachment-3, 4, 5, 5A, 6, 7, 8, 9, 10, 11 & 13 are enclosed here in this workbook.

4 Attachment-1 (Bid Security) : To be submitted as per proforma provided in the bidding document. Bid Security should remain valid for 250 days from the original date of Bid Opening of First Envelope.

5 Attachment-2 (Power of Attorney) : No specific format is provided by POWERGRID. Bidder may use their own format.

6 Integrity Pact : To be submitted in line with clause 6(j) of ITB, Volume-IA

7 Attachment: 12 (Declaration of Key Managerial Person and Power of Attorney holder) shall be submitted in the format provided separately in Volume-III of Bidding Documents. Bidders are required to sign and stamp the same and upload the scanned copy in line with provisions of bidding documents

8 Attachment: 14 (Format for Affidavit of Self certification regarding Minimum Local Content in line with PPP-MII order, 2017), if applicable, shall be submitted on a non-judicial stamp paper of Rs. 100/- in the format provided separately in Volume-III of the bidding documents.

9 Attachement: 15 (Certificate from statutory auditor or cost auditor of the company (in the case of companies) or from a practicing cost accountant or practicing chartered accountant (in respect of suppliers other than companies) giving the percentage of Local Content, in line with PPP-MII order, if applicable [to be submitted on the letter head of the issuer] in the format provided separately in Volume-III of the bidding documents. [NOT APPLICABLE]

8 Attachment: 16 (Compliance to the process related to the e-RA Terms & Conditions and the Business Rules governing the e-RA). [NOT APPLICABLE]

9 Attachment: 17 (Declaration regarding events encountered pursuant to ITB Clause 2.1). [APPLICABLE]

10 Attachment: 18 (Certification by the Bidder per DoE Order in line with ITB Clause 1.2.1). [APPLICABLE]

11 Attachment: 19 Bid Security Declaration

पावर ग्रिड कारपोरेशन ऑफ इण्डिया लिमिटेड

(भारत सरकार का उद्यम)

Power Grid Corporation of India Limited

(A Government of India Enterprises)

General Instruction to the Bidders for filling up this workbook of Bid Form and Attachments (1 to 11)

I While filling up the worksheets following may please be observed :

(i) Fill up only green shaded cells.

(ii) Certain data type entries have been restricted, such as Numeric values or limits of numeric values.

(iii) Select only the options provided in pull down menus.

(iv) Do not link any cell of this work book with any other work book.

(v) Do not use copy & paste or cut & paste options for filling up the data.

(vi) Do not fill the cell by dragging the other cell value in down or adjacent cell.

(vii) Do not reformat any of the cell of the work book.

II This Workbook consists of following worksheets :

Opening page of the workbook.

Names of Bidder :

● Select nos. of the JV Partners other than the Lead Partner from drop down menu.

● In case of JV partners more than 2, enter details of 3rd & more partners along with details of 2nd partner.

● Fill up names and address of the Sole Bidder. Do not leave this cell blank.

● Fill up date in dd-mmm-yyyy format from drop down menu.

● Click for Sch-1 given at the right top of the worksheet to go to Sch-1.

Sch-1 (Ex-works Prices) :

● Fill up unit rates for all the items in numeric values greater than 0 (zero). If unit rate is left blank, the corresponding item shall be deemed to be included in the total price.

● Corresponding cell for mode of transaction shall be come enable only after filling up the unit rate, therefore first fill up the unit rate and then mode of transaction for the corresponding item.

● Select either Direct or Bought-out from the drop down menu. Do not leave the cell blank the same shall be deemed to be Bought-out if the cell is left blank.

● Total amount shall get calculated automatically.

● Type Test charges shall appear automatically after filling up Sch-7 appropriately.

Sch-2 (Freight & Insurance Charges) :

● Fill up unit rates for all the items in numeric values greater than 0 (zero). If unit rate is left blank, the corresponding item shall be deemed to be included in the total price.

● Total amount shall get calculated automatically.

Sch-3 (Erection Charges) :

● Fill up unit rates for all the items in numeric values greater than 0 (zero). If unit rate is left blank, the corresponding item shall be deemed to be included in the total price.

● Total amount shall get calculated automatically.

Sch-4 (Training Charges) :

● Not applicable, hence no cell is required to be filled up.

Sch-1A (Summary of Taxes and Duties applicable on the Item(s)/Materia(s)/Equipment(s)) :

● Fill up applicable rate of Excise Duty. The amount of Excise Duty on the items mentioned as Direct in the mode of transaction in Schedule-1 shall be calculated automatically at the rate mentioned by the bidder here.

● Segregate and fill up the amount on which Sales Tax shall be applicable out of Ex-works supply items mentioned as direct in the mode of transaction in Schedule-1. Applicable Excise Duty on this amount will be calculated automatically at the rate mentioned by the bidder. Further, fill up the rate of applicable Sales Tax. Amount of Sales Tax shall be automatically calculated on the amount mentioned by the bidder as subjected to Sales Tax plus applicable Excise Duty at the rate mentioned by the Bidder.

● Difference of total amount quoted by the bidder as Direct Transaction and the amount mentioned by him subjected to Sales Tax shall be considered as the amount on which VAT shall become applicable and the same shall be calculated & displayed automatically. Applicable Excise Duty on this amount at the rate mentioned by the bidder shall also be calculated & displayed automatically. Fill up the rate of applicable VAT. The amount of VAT shall be calculated automatically on the amount considered to be subjected to VAT plus applicable Excise Duty at the rate mentioned by the bidder here.

● Amount as per details filled up by the bidder in the work sheets Entry Tax, Octroi and other Taxes & Duties shall be displayed in this work sheet Sch-5 but will not be added to the grand total and shall be considered as applicable.

● Click at the links to go to the work sheets Entry Tax, Octroi and other Taxes & Duties one by one.

● Fill the description, amount and rate of applicable Entry Tax. Total of this worksheet shall be displayed in Sch -1A (Taxes & Duties)

● Click at the link to go back to Sch-1A.

● Fill the description, amount and rate of applicable Octroi. Total of this worksheet shall be displayed in Sch -1A (Taxes & Duties)

● Click at the link to go back to Sch-1A.

Other Taxes & Duties :

● Fill the description, amount and rate of applicable Other Taxes & Duties. Total of this worksheet shall be displayed in Sch -1A (Taxes & Duties)

● Click at the link to go back to Sch-1A.

● Summary of all the Schedules without considering discount (mentioned in the work sheet discount) shall be displayed automatically.

● No cell is required to be filled in by the bidder in this worksheet.

Sch-7 (Type Test Charges) :

● Fill up the rates & location where type tests are proposed.

● Total of this Sch-7 shall automatically appear in Sch-1.

Bid from 2nd Envelope :

● Fill up ref. no. as bidder's ref no. of this letter.

● This letter shall consider the net price as per Sch-2A.

● Fill up names & Designation of the representatives of bidder.

● Fill up additional information as required.

Happy Bidding !

Before filling up the Bid Form, the Bidder is required to fill up the details as under :

1 Enter Details of Amendments:

Amendments to Bidding Documents issued:

Specification No.: 5002002168/OTHERS/DOM/K00 - NR3 RHQ -1 Bid Proposal Form 1st Envelope

Bid Proposal Form (First Envelope)

Bid Proposal Reference:

Bidder's Address:

Contracts & Material Department

Power Grid Corporation of India Ltd

Northern Region Transmission System-3

3rd Floor, 12, Rana Pratap Marg the receipt of which is hereby acknowledged, we the undersigned, offer to execute the Works under the above-named package in full conformity with the said Bidding Documents. In accordance with ITB Clause 6.1 of the Bidding Documents, as per which the bid shall be submitted by the bidder under “Single Stage - Two Envelope” procedure of bidding. Accordingly, we hereby submit our Bid, in two envelopes i.e. First Envelope (containing EMD and Techno-commercial part) and Second Envelope - Price Part (to be opened subsequently)

Lucknow - 226001 (Uttar Pradesh)

Name of Contract: Supply and installation of Submersible pump, water tank, piping arrangement etc in 332 schools in Ballia and Fatehpur to provide running water facility in all toilets constructed by POWERGRID under SVA as a CSR initiative

Supply and installation of Submersible pump, water tank, piping arrangement etc in 332 schools in Ballia and Fatehpur to provide running water facility in all toilets constructed by POWERGRID under SVA as a CSR initiative

1.0 Having examined the Bidding Documents, including Amendment Nos. dated 00/01/1900, the receipt of which is hereby acknowledged, we the undersigned, offer to execute the Works under the above-named package in full conformity with the said Bidding Documents. In accordance with ITB Clause 6.1 of the Bidding Documents, as per which the bid shall be submitted by the bidder under “Single Stage - Two Envelope” procedure of bidding. Accordingly, we hereby submit our Bid, in two envelopes i.e. First Envelope (containing EMD and Techno-commercial part) and Second Envelope - Price Part (to be opened subsequently)

1.1 We, including any subcontractors or manufacturers for any part of the contract, do not have any conflict of interest in accordance with ITB clause 1.2.2 .

Our Bid, as said above have been submitted as per the followings: For Attachment-1, bidder has to fill the following data

EMD DETAIL FORM FALSE TRUE

2.0 Attachments to the Bid Form (First Envelope): Are you NSIC/MSME Registered: Yes No We are NSIC/MSME registered under Public Procurement Policy for MSEs order 2012. We have enclosed a copy of NSIC Certificate reference no. dated DD-MM-YYYY and the issued certificate is valid upto and inclusive of DD-MM-YYYY. It is to confirm that the equipment(s)/item(s)/material(s) quoted in our bid is in the list of items indicated in NSIC certificate enclosed. We have submitted Bid Guarantee in the form of Bank Guarantee (Bank Guarantee No.-, dated DD-MM-YYYY issued from ) for a sum of Rupees /-, Valid for a period of 250 days from the original date of Bid Opening as per NIT i.e. upto and inclusive of DD-MM-YYYY. Select only one Option (Yes/No)

In line with the requirement of the Bidding Documents, we enclose herewith the following Documents / Attachments: Select the Form of EMD : Bank Guarantee Bank Guarantee No. Select any one Option (Yes/No)

2.1 Attachment-1:We have submitted Bid Guarantee in the form of Bank Guarantee (Bank Guarantee No.-, dated DD-MM-YYYY issued from ) for a sum of Rupees /-, Valid for a period of 250 days from the original date of Bid Opening as per NIT i.e. upto and inclusive of DD-MM-YYYY. Bank Guarantee No. NSIC Certificate No.

Date of Issuance DD MM YYYY

Valid up to DD MM YYYY

Amount of EMD :

Name of Issuing Bank :

2.2 Attachment-2: Power of Attorney, duly notarized, indicating that the person(s) signing the bid has(ve) the authority to sign the bid and thus that the bid is binding upon the Bidder during full period of its validity, in accordance with ITB Clause 2

2.3 Attachment-3: The documentary evidence in terms of ITB Clause 6.3(c) for the qualification data has been furnished by us All the prices and the price components stated in our bid price are firm in accordance with provisions of the bidding documents. All the prices and other terms and conditions of this proposal are valid for a period of Six [06] calendar Months from the date of opening of the bid

2.4 Attachment-4: The variation and deviations from the requirements of the Conditions of Contract, Technical Specification and Drawings (excluding critical provisions as mentioned at clause 6.0 below) in your format enclosed with the Bidding Documents, including, inter alia, the cost of withdrawal of the variations and deviations indicated therein

2.5 Attachment-5: Information regarding ex-employees of Owner in our firm.

2.6 Attachment-5A: (Items, Components, Raw Material, Services proposed to be sourced from Micro and Small Enterprises): The details of the items, components, raw material, services which is proposed to bought/availed from Micro and Small Enterprises for the purpose of completion of works.

2.7 Attachment-6: Work Completion Schedule.

2.8 Attachment-7: Declaration Regarding Social Accountability

2.9 Attachment-8: Price Adjustment Data

2.10 Attachment-9 & 9-P: Integrity Pact

2.11 Attachment-10: Additional Information

2.12 Attachment-11: Declaration regarding Price Bid

2.13 Attachment-12: Declaration of Key Managerial Person and Power of Attorney holder

2.14 Attachment-13: (Information for E-payment, PF details and declaration regarding Micro/Small & Medium Enterprises)

2.15 Attachment-14 : Affidavit of Self certification regarding Minimum Local Content in line with PPP-MII order, 2017 and MoP order December 2018, if applicable.

2.16 Attachment-15: Certificate from statutory auditor or cost auditor of the company (in the case of companies) or from a practicing cost accountant or practicing chartered accountant (in respect of suppliers other than companies) giving the percentage of Local Content, in line with PPP-MII order, if applicable.

2.17 Attachment-16:Compliance to the process related to the e-RA Terms & Conditions and the Business Rules governing the e-RA

2.18 Attachment-17:Declaration by the Bidder regarding events encountered pursuant to ITB Clause 2.

2.19 Attachment-18:Certification by the Bidder per DoE Order in line with ITB Clause 1.2.1

2.20 Attachment-19:Bid Securing Declaration to be submitted by the Bidder

3.0 Second Envelope

In continuation of First Envelope of our Bid, we have submited the Second Envelope of the Bid, both of which shall be read together and in conjunction with each other, and shall be construed as an integral part of our Bid. Accordingly, Accordingly, we the undersigned, offer to execute the Works under the above-named package in full conformity with the said Bidding Documents for the sum specified in our Second Envelope Bid, in accordance with the terms & conditions of the Bidding Documents or such other sums as may be determined in accordance with the terms and conditions of the Bidding Documents. We hereby confirm that the total amout of our bid is in accordance with the prices quoted by us under different Heads, as detailed below:

i. Erection Charges excluding GST

4.0 Undertakings/Compliances

4.1 We are aware that, in line with Clause No. 17.1 (ITB), our Second Envelope (Price Bid) is liable to be rejected in case the same contains any deviation/omission from the contractual and commercial conditions and technical Specifications other than those identified in this First Envelope Bid

4.3 We declare that as specified in Clause 5.7, ITB, Vol.-IA of the Bidding Documents, prices quoted by us are fixed & firm and shall not be subject to any adjustment during performance of the contract

4.5 We declare that items left blank in the Schedules will be deemed to have been included in other items. The TOTAL for each Schedule and the TOTAL of Grand Summary shall be deemed to be the total price for executing the Works and sections thereof in complete accordance with the Contract, whether or not each individual item has been priced

4.6 We confirm that except as otherwise specifically provided our Bid Prices in Second Envelop (Price Bid) include all taxes, duties, levies and charges as may be assessed on us, our Sub-Contractor/Sub-Vendor or their employees by all municipal, state or national government authorities in connection with the Works, in and outside of India

4.7 We confirm that we have also registered/we shall also get registered in the GST Network with a GSTIN in all the states where the project is located and the states from which we shall make our supply of goods.

4.8 100% of applicable Taxes and Duties i.e. GST which are payable by the Employer under the Contract, shall be reimbursed by the Employer on production of satisfactory documentary evidence by the Contractor in accordance with the provisions of the Bidding Documents.

4.9 We further understand that notwithstanding 4.0 above, in case of award on us, you shall also bear and pay/reimburse to us, GST in respect of Supply of Services by us to you, by the Indian Laws.

5.0 Construction of Contract

5.1 We declare that we have studied clause GCC 12 relating to mode of contracting for Domestic Bidders and we are making this proposal with a stipulation that you shall award us the Contracts covering all goods and related services

6.0 We have read the provisions of following clauses and confirm that the specified stipulations of these clauses are acceptable to us: GCC Clause 8 & SCC Clause 13 (Taxes, duties and levies/Contract Price) GCC Clause 14 & SCC Clause 18 (Contract Performance Guarantee), GCC Clause 18 & SCC Clause 4 (Time the essence of Contract/Completion Schedule/Period), GCC Clause 26.5 (Patents & Royalties), GCC Clause 45 (Guarantee), GCC Clause 46 (Defect Liability Period), GCC Clause 64 & SCC Clause 15 (Payment on Account/Terms of payment), GCC Clause 66 & SCC Clause 14 (Contract Price adjustment / Price Variation/ adjustment), GCC Clause 69 (Arbitration & laws), GCC Clause 70 (Laws & jurisdiction of Contract)

7.0 We conform that we stand committed to comply with all requirements of Social Accountability Standards i.e., SA8000 (latest Standard available at www.sa-intl.org) and maintain the necessary records

8.0 We undertake, if our bid is accepted, to commence the work immediately upon your Notification of Award to us, and to achieve the Completion of the Works within the time stated in the Bidding Documents

9.0 If our bid is accepted, we undertake to provide Performance Security in the form and amount, and within the time specified in the Bidding Documents

10.0 We agree to abide by this bid for a period of 180 (One Hundred Eighty) days from the date fixed for opening of First Envelope bids as stipulated in the Bidding Documents, and it shall remain binding upon us and may be accepted by you at any time before the expiration of that period.

11.0 Until a formal Contract is prepared and executed between us, this bid, together with your written acceptance thereof in the form of your Notification of Award shall constitute a binding contract between us.

12.0 We understand that you are not bound to accept the lowest or any bid you may receive.

13.0 Commissions or gratuities, if any, paid or to be paid by us to agents relating to this Bid, and to contract execution, if we are awarded the contract, are listed below:

YES Name & Address of agent Amount & Currency Purpose of Commission or Gratuity TRUE

14.0 We hereby declare that only the persons or firms interested in this proposal as principal or principals are named herein and that no other persons or firms other than those mentioned herein have any interest in this proposal or in the Contract to be entered into, if we are awarded the contract, that this proposal is made without any connection with any other person, firm or party like-wise submitting a proposal and that this proposal is in all respects for and in good faith, without collusion or fraud.

Thanking you, we remain,

Yours faithfully,

For & On Behalf of

Date: DD MM YYYY Name:

Place: Designation:

Business Address: ……………………………………………………………………….

Name of Principal Officer:

Address of Principal Officer:

Note: (Written power of Attorney of Signatories of bid to commit the Bidder must be enclosed with the bid. Bidders may use their own proforma for furnishing the required information with the bid)

Specification No.: 5002002168/OTHERS/DOM/K00 - NR3 RHQ -1 Attachment-3

Supply and installation of Submersible pump, water tank, piping arrangement etc in 332 schools in Ballia and Fatehpur to provide running water facility in all toilets constructed by POWERGRID under SVA as a CSR initiative

[DOCUMENTS IN SUPPORT OF MEETING THE SPECIFIED QUALIFYING REQUIREMENT]

Bidder's Address:

Contracts & Materials (NR-III RHQ)

Power Grid Corporation of India Ltd.,

3rd Floor, 12, Rana Pratap Marg

Lucknow - 226001 (Uttar Pradesh)

We submit the required documents/information as per clause ITB 6.3(c) as below:

S No. Particulars For Individual Firm

1 Name of the Firm 01 01 2000

2 Head Office/ Registered Office Address 02 02 2001

3 Telephone 03 03 2002

5 Contact Person 05 05 2004

6 Place of Incorporation/ Registration 06 06 2005

7 Year of Incorporation/ Registration 07 07 2006

8 Nationality of 08 08 2007

Owner (i) 09 09 2008

Owner (ii) 10 10 2009

Owner (iii) 11 11 2010

[Necessary documents to eatablish legal status of the bidder should be uploaded with the bid] 12 12 2011

A1. Average Annual Turnover 13 2012

Sr. No. Financial Year Turnover* (in Rs. Cr) Documents submitted in support of Turnover 14 2013

Average of Best 3 #NUM! 21 2020

* Note- Annual total income as incorporated in the profit & loss account except non-recurring income, i.e., sale of fixed assets.

Sr. No. Financial Year Networth (in Rs. Lakh)

A3. Liquid Assets/evidence of access to or availability of credit facilities

Sr. No. Description in Rs. Cr Documents submitted in support of Liquid Assets/Access to or availability of credit facilities

1 Liquid Assets/Access to or availability of credit facilities

B. Work Experience Details as on originally scheduled date of Bid Opening i.e. on 13.04.2022 23

S. No. Description Work #1 Work #2 Work #3 24

a Name & details of the Work 25

b Ref. No. of Award Letter/Contract/WO 26

c Date of Award Letter/Contract/WO (in dd-mm-yyyy format) dd mm yyyy dd mm yyyy dd mm yyyy 27

d Name of the Client with Contact details 28

e Value of Work as per Award Letter/Contract/WO 29

f Value of Work as per Final Execution 30

g Scheduled Date of Completion as per the Contract (in dd-mm-yyyy format) dd mm yyyy dd mm yyyy dd mm yyyy 31

h Date of actual Completion (in dd-mm-yyyy format) dd mm yyyy dd mm yyyy dd mm yyyy

i Copy of Award Letter/Contract/WO enclosed: (YES/NO)

k Reference Details of Completion Certificate/Performance Certificate/Any Other document like Acceptance of Final Bill by client issued by the client

k1 Ref. No. of Completion/Performance Certificate

k2 Date of issue of Completion/Performance Certificate (in dd-mm-yyyy format) dd mm yyyy dd mm yyyy dd mm yyyy

k3 Name and Designation of person issuing Completion/Performance Certificate

k4 Name of Company/Client who have issued Completion/Performance Certificate

k5 Name of work as per Completion/Performance Certificate

k6 Date of actual Completion as per Completion/Performance Certificate (in dd-mm-yyyy format) dd mm yyyy dd mm yyyy dd mm yyyy

k7 Amount of final work as per Completion/Performance Certificate

k8 Copy of Completion/Performance Certificate attached/enclosed: (YES/NO)

k9 File name by which Completion/Performance Certificate is attached/uploaded YES

C. Status of Firm (Proprietary/ Partnership/ Pvt. Ltd. Company/Public Ltd. Company)

Status of Firm Document Submitted Yes

No Affidavit for Proprietorship

Partnership Deed

D Other Documents Certificate of Incorporation

i PAN Detail Copy of PAN Card Submitted (Y/N)

ii Copy of Partnership Deed/ affidavit for Proprietorship/ Company MoA and AoA or Certificate of Incorporation, as applicable submitted (Y/N)

Date: DD-MM-YYYY Name: 0 Pvt. Ltd. Company

Place: 0 Designation: 0 Public Ltd. Company

Specification No.: 5002002168/OTHERS/DOM/K00 - NR3 RHQ -1 Attachment-4

Supply and installation of Submersible pump, water tank, piping arrangement etc in 332 schools in Ballia and Fatehpur to provide running water facility in all toilets constructed by POWERGRID under SVA as a CSR initiative

[ALTERNATIVE, DEVIATIONS AND EXCEPTIONS TO THE PROVISIONS]

Bidder's Address:

Contracts & Material Department, Northern Region-III

Power Grid Corporation of India Ltd

Northern Region-III Headquarters,

3rd Floor, 12, Rana Pratap Marg

Lucknow - 226001 (Uttar Pradesh)

Irrespective of whatever has been stated to the contrary anywhere else in our offer, only following are the deviations and variations from and exception to the specifications and tender documents for the above mentioned subject work. These deviations and variations are exhaustive. Except for these deviations the entire work shall be performed as per your specifications and other tender documents. Further, we agree that additional conditions, if any, found in our offer other than those stated below, save that pertaining to any rebates offered shall not be given effect to

Sl. No. Ref. of page, Clause & Name of Documents Description of Deviation Cost of withdrawal (Rs.)

Date: DD-MM-YYYY Name: 0

Place: 0 Designation: 0

Tender Enquiry No: 0 Attachment-4

[ALTERNATIVE, DEVIATIONS AND EXCEPTIONS TO THE PROVISIONS]

Sl. No. Ref. of page, Clause & Name of Documents Description of Deviation Cost of withdrawal (Rs.)

Date: DD-MM-YYYY Name: 0

Place: 0 Designation: 0

Tender Enquiry No: 0 Schedule-4

Supply and installation of Submersible pump, water tank, piping arrangement etc in 332 schools in Ballia and Fatehpur to provide running water facility in all toilets constructed by POWERGRID under SVA as a CSR initiative

[Technical Deviations Schedule]

Bidder's Address:

The following are the Technical deviations and variations from and exceptions to the specifications and documents for the subject package. These deviations and variations are exhaustive. Except these deviations, the entire work shall be performed as per your specifications and document.

Sl. No. Vol./ Clause Ref/ Page No. As Specified in the specification Technical Deviation & Variations/Exceptions

Date: DD-MM-YYYY Name: 0

Place: 0 Designation: 0

Tender Enquiry No: 0 Schedule-4

[Technical Deviations Schedule]

Sl. No. Vol./ Clause Ref/ Page No. As Specified in the specification Technical Deviation & Variations/Exceptions

Date: DD-MM-YYYY Name: 0

Place: 0 Designation: 0

Tender Enquiry No: 0 Schedule-4A

Supply and installation of Submersible pump, water tank, piping arrangement etc in 332 schools in Ballia and Fatehpur to provide running water facility in all toilets constructed by POWERGRID under SVA as a CSR initiative

[ Deviations on important/critical conditions along with their withdrawal price]

Bidder's Address:

The following are the deviations/variations/exceptions to the provisions of important conditions stipulated in Conditions of Contract, Vol-I. We undertake to execute the contract in line with the provisions of Bidding Documents in respect of above said clauses in case POWERGRID agree to pay- us the withdrawal price indicated below against each such deviations/ variations/ exceptions.

Sl. No. Vol./ Section Clause No./ Page No. Deviations/Variations/Exceptions Withdrawal Price (INR)

Date: DD-MM-YYYY Name: 0

Place: 0 Designation: 0

Tender Enquiry No: 0 Schedule-4A

[ Deviations on important/critical conditions along with their withdrawal price]

Sl. No. Vol./ Section Clause No./ Page No. Deviations/Variations/Exceptions Withdrawal Price

Date: DD-MM-YYYY Name: 0

Place: 0 Designation: 0

Specification No.: 5002002168/OTHERS/DOM/K00 - NR3 RHQ -1 Attachment-5

Supply and installation of Submersible pump, water tank, piping arrangement etc in 332 schools in Ballia and Fatehpur to provide running water facility in all toilets constructed by POWERGRID under SVA as a CSR initiative

[ Information regarding Ex-employees of POWERGRID in our Firm]

Bidder's Address:

Contracts & Material Department, Northern Region-III

Power Grid Corporation of India Ltd

Northern Region-III Headquarters,

3rd Floor, 12, Rana Pratap Marg

Lucknow - 226001 (Uttar Pradesh)

We hereby furnish the details of ex-employees of POWERGRID who had retired/resigned at the level of General Manager and above from POWERGRID and subsequently have been employed by us.

Sl. No. Name of the person with designation in POWERGRID Date of Retirement/ resignation from POWERGRID (DD-MM-YYYY) Date of joining and designation in our organisation

Date: DD-MM-YYYY Name: 0

Place: 0 Designation: 0

Specification No.: 5002002168/OTHERS/DOM/K00 - NR3 RHQ -1 Attachment-5A

Supply and installation of Submersible pump, water tank, piping arrangement etc in 332 schools in Ballia and Fatehpur to provide running water facility in all toilets constructed by POWERGRID under SVA as a CSR initiative

[ Items, Components, Raw Material, Services Proposed to be sourced from Micro and Small Enterprises]

Bidder's Address:

Contracts & Material Department, Northern Region-III

Power Grid Corporation of India Ltd

Northern Region-III Headquarters,

3rd Floor, 12, Rana Pratap Marg

Lucknow - 226001 (Uttar Pradesh)

We hereby furnish the details of the items, components, raw material, services which we propose to buy/avail from Micro and Small Enterprises(MSEs) for the purposes of completion of works under the subject package:

Sl. No. Item Description Quantity proposed to be bought/ sub-contracted Name of Micro and Small Enterprises

Name & Address Category (Micro or Small)

The above is a list of items we propose to procure from MSEs. However, based on the situations during the executions of the contract, the above list may undergo changes. We hereby confirm that the details regarding actual procurement from MSEWs carried out by us, as per the format provided at ANNEXURES-(ANNEX)-VOL-I of the bidding document, shall be submitted along with the bills for payment against supplies made/works done during execution of contract.

Date: DD-MM-YYYY Name: 0

Place: 0 Designation: 0

Specification No.: 5002002168/OTHERS/DOM/K00 - NR3 RHQ -1 Attachment-5A

Supply and installation of Submersible pump, water tank, piping arrangement etc in 332 schools in Ballia and Fatehpur to provide running water facility in all toilets constructed by POWERGRID under SVA as a CSR initiative

[ Items, Components, Raw Material, Services Proposed to be sourced from Micro and Small Enterprises]

Sl. No. Item Description Quantity proposed to be bought/ sub-contracted Name of Micro and Small Enterprises

Name & Address Category (Micro or Small)

Date: DD-MM-YYYY Name: 0

Place: 0 Designation: 0

Specification No.: 5002002168/OTHERS/DOM/K00 - NR3 RHQ -1 Attachment-6

Supply and installation of Submersible pump, water tank, piping arrangement etc in 332 schools in Ballia and Fatehpur to provide running water facility in all toilets constructed by POWERGRID under SVA as a CSR initiative

[ Work Completion Schedule]

Bidder's Address:

Contracts & Material Department, Northern Region-III

Power Grid Corporation of India Ltd

Northern Region-III Headquarters,

3rd Floor, 12, Rana Pratap Marg

Lucknow - 226001 (Uttar Pradesh)

The Schedule for completion of various activities shall be as under:

Sl. No. Name of Activity Period from Date of LOA

Commencement Completion

Date: DD-MM-YYYY Name: 0

Place: 0 Designation: 0

Specification No.: 5002002168/OTHERS/DOM/K00 - NR3 RHQ -1 Attachment-7

Supply and installation of Submersible pump, water tank, piping arrangement etc in 332 schools in Ballia and Fatehpur to provide running water facility in all toilets constructed by POWERGRID under SVA as a CSR initiative

[ Declaration regarding Social Accountability]

Bidder's Address:

Contracts & Material Department, Northern Region-III

Power Grid Corporation of India Ltd

Northern Region-III Headquarters,

3rd Floor, 12, Rana Pratap Marg

Lucknow - 226001 (Uttar Pradesh)

We conform that we stand committed to comply all requirements of Social Accountability Standards i.e., SA8000 (latest Standard available at www.sa-intl.org) and maintain the necessary records.

Date: DD-MM-YYYY Name: 0

Place: 0 Designation: 0

Specification No.: 5002002168/OTHERS/DOM/K00 - NR3 RHQ -1 Attachment- 8

Supply and installation of Submersible pump, water tank, piping arrangement etc in 332 schools in Ballia and Fatehpur to provide running water facility in all toilets constructed by POWERGRID under SVA as a CSR initiative

(Price Adjustment Data)

Bidder's Address:

Bidder’s name & Address: To

Name : Contracts & Materials Department

Power Grid Corporation of India Limited

Address : #REF! Northern Region Transmission System-III

#REF! 3rd Floor, 12, Rana Pratap Marg,

Lucknow-226001 (Uttar Pradesh)

We hereby furnish the relevant details pertaining to the price adjustment provisions for items as specified in your specifications and documents for the Supply and installation of Submersible pump, water tank, piping arrangement etc in 332 schools in Ballia and Fatehpur to provide running water facility in all toilets constructed by POWERGRID under SVA as a CSR initiativeThe necessary documentary evidence are enclosed :

Sl. No. Name of Materials/Labour Name of the published index Value of index (30 days prior to date of opening of bids)

1 Supply & Placement of Reinforcement Steel

A High Speed Diesel coefficient Wholesale Price Index Number for ‘High Speed Diesel’ (Individual commodity) (monthly) (Base: 2004-05=100) as published by Office of Economic Advisor, Ministry of Commerce & Industry (www.eaindustry.nic.in).

L Labour coefficient Indian Labour Bureau, Shimla, Govt. of India (monthly) (Base: 2001 = 100) (www.labourbureau.nic.in)

B Ferrous Metals coefficient Wholesale Price Index Number for ‘Ferrous Metals’ (Group Item) (monthly) (Base: 2004-05=100) as published by Office of Economic Advisor, Ministry of Commerce & Industry (www.eaindustry.nic.in).

2 For Concreting

A High Speed Diesel, coefficient a = Wholesale Price Index Number for High Speed Diesel’ (Individual commodity) (monthly) (Base: 2004-05=100) as published by Office of Economic Advisor, Ministry of Commerce & Industry (www.eaindustry.nic.in).

L Labour, coefficient l = Indian Labour Bureau, Shimla, Govt. of India (monthly) (Base: 2001 = 100) (www.labourbureau.nic.in)

B Cement & Lime, coefficient b = Wholesale Price Index Number for ‘Cement & Lime’ (Group Item) (monthly) (Base: 2004-05=100) as published by Office of Economic Advisor, Ministry of Commerce & Industry (www.eaindustry.nic.in).

C Structural Clay Products coefficient Wholesale Price Index Number for ‘Structural Clay Products’ (Group Item) (monthly) (Base: 2004-05=100) as published by Office of Economic Advisor, Ministry of Commerce & Industry (www.eaindustry.nic.in).

The Bidders are required to indicate the value of indices for various components as of 30 days prior to the date of bid opening. In case bid opening date is extended after submission of bids because of any reason, indices as of 30 days prior to actual date of bid opening shall be considered for placement of award and for payment towards price adjustment.

Date : DD-MM-YYYY Printed Name : 0

Place : 0 Designation : 0

Specification No.: 5002002168/OTHERS/DOM/K00 - NR3 RHQ -1 Attachment-9

Supply and installation of Submersible pump, water tank, piping arrangement etc in 332 schools in Ballia and Fatehpur to provide running water facility in all toilets constructed by POWERGRID under SVA as a CSR initiative

Bidder’s name & Address:

Address : #REF! #REF!

Contracts & Materials Department

Power Grid Corporation of India Limited

Northern Region Transmission System-III

3rd Floor, 12, Rana Pratap Marg,

Lucknow-226001 (Uttar Pradesh)

Format of Integrity Pact is enclosed in Volume-III of the bidding document

Date : DD-MM-YYYY Printed Name : 0

Place : 0 Designation : 0

Specification No.: 5002002168/OTHERS/DOM/K00 - NR3 RHQ -1 Attachment- 10

Supply and installation of Submersible pump, water tank, piping arrangement etc in 332 schools in Ballia and Fatehpur to provide running water facility in all toilets constructed by POWERGRID under SVA as a CSR initiative

(Additional Information)

Bidder's Name & Address:

Address : #REF! #REF! #REF! #REF!

Contracts & Materials Department

Power Grid Corporation of India Limited

Northern Region Transmission System-III

3rd Floor, 12, Rana Pratap Marg,

Lucknow-226001 (Uttar Pradesh)

We have enclosed with our proposal the following additional information for the subject package:

1.0 Litigation History

The bidder should provide detailed information on any litigation or arbitration arising out of contracts completed or under execution by it over the last five years. A consistent history of awards involving litigation against the Bidder or any partner of JV may result in rejection of Bid. [Reference ITB clause 6.3 (k)]

1.1 Details of litigation history resulting from Contracts completed or under execution by the bidder over the last five years. A consistent history of awards invlolving litigation against the Bidder or any patner of JV may result in rejection of Bid. [(Refer ITB Clause 6.3 (k)]

Year Name of client, cause of litigation/arbitration and matter in dispute Details of Contract and date Award for or against the bidder Disputed amount

2 Details regarding previous transgressions of Integrity Pact

The bidder should provide detailed information on any transgression of Integrity Pact that occurred in the last 10 years with any other Public Sector Undertaking or Government department or any other Company, in any country.

Year Name of Client Details of Transgression of Integrity Pact by the bidder

3 Current Contract Commitments of works in progress

Bidders should provide information on their current commitments on all contracts that have been awarded, or for which a letter of intent or acceptance has been received, or for contracts approaching completion, but for which an unqualified, full completion certificate has yet to be issued.

Details of Contract Value of outstanding work (Rs.) Estimated completion date

Date: DD-MM-YYYY Printed Name : 0

Place:. 0 Designation : 0

Specification No.: 5002002168/OTHERS/DOM/K00 - NR3 RHQ -1 0 Attachment- 10

Supply and installation of Submersible pump, water tank, piping arrangement etc in 332 schools in Ballia and Fatehpur to provide running water facility in all toilets constructed by POWERGRID under SVA as a CSR initiative

(Additional Information)

Bidder's Name & Address:

Contracts & Materials Department

Power Grid Corporation of India Limited

Northern Region Transmission System-III

3rd Floor, 12, Rana Pratap Marg,

Lucknow-226001 (Uttar Pradesh)

We have enclosed with our proposal the following additional information for the subject package:

S. No. Brief description of Information Ref. and Page No.

Note: The Bidder should accordingly upload the scanned copies of the relevant documents (Refer Clause 6.3 of ITB, Volume - IA of bidding documents).

Date: DD-MM-YYYY Printed Name : 0

Place:. 0 Designation : 0

Specification No.: 5002002168/OTHERS/DOM/K00 - NR3 RHQ -1 Attachment-11

Supply and installation of Submersible pump, water tank, piping arrangement etc in 332 schools in Ballia and Fatehpur to provide running water facility in all toilets constructed by POWERGRID under SVA as a CSR initiative

[ Declaration Regarding Price Bid]

Bidder's Address:

Contracts & Material Department, Northern Region-III

Power Grid Corporation of India Ltd

Northern Region-III Headquarters,

3rd Floor, 12, Rana Pratap Marg

Lucknow - 226001 (Uttar Pradesh)

Further, we hereby confirm that except as mentioned in the Attachment-2 (Alternative, Deviations and Exceptions to the Provisions) hereof and/or the Covering Letter, forming part of Envelope-II of our bid

(i) there are no discrepancies/inconsistencies and deviations/omissions/ reservations to the Bidding Documents, in the Envelope-III bid

We also confirm that in case any discrepancies/inconsistencies and deviations/ omissions/reservations, as referred to in para (i) and (ii) above, is observed in the Second Envelope, the same shall be deemed as withdrawn/rectified without any financial implication, whatsoever to POWERGRID. However, in case of any arithmetical errors, the same shall be governed as per the provisions of ITB Sub-clause 17

Date: DD-MM-YYYY Name: 0

Place: 0 Designation: 0

Specification No.: 5002002168/OTHERS/DOM/K00 - NR3 RHQ -1 ATTACHMENT-13

Supply and installation of Submersible pump, water tank, piping arrangement etc in 332 schools in Ballia and Fatehpur to provide running water facility in all toilets constructed by POWERGRID under SVA as a CSR initiative

(Information for E-payment, PF details and declaration regarding Micro/Small & Medium Enterprises)

Bidder’s Name and Address (Sole Bidder) : To:

Contracts & Materials Deptt

Name : 0 Power Grid Corporation of India Ltd.,

Address : 0 3rd Floor

12 Rana Pratap Marg

Lucknow-226001 (UP)

I We are furnishing the following details of Statutory Registration Numbers and details of Bank for electronic payment.

1. Name of the Supplier/ Contractor in whose favour payment is to be made 0

2. Address with PIN Code and State

Registered Office:

Correspondence Address:

3. (a) Status – Company/others

[Declaration of Micro/ Small/ Medium Enterprise under Micro/ Small & Medium Enterprises Development Act 2006, if applicable]

3. (b) Are you a MSE owned by SC/ST* entrepreneurs in line with Public Procurement Policy for Micro & Small Enterprises (MSEs) order 2012 including subsequent Amendment/notification/order (Indicate Yes/No) Yes (Documentary Evidence attached)

Note: Documentary Evidence is to be attached. Please refer remarks at the end of Attachment. No

3. (c ) If 3(b) is 'Yes', please mention whether you are (Proprietary MSE/Private Limited Company) owned by SC/ST Entrepreneurs

3. (d) Are you a MSE owned by Women in line with Public Procurement Policy for Micro & Small Enterprises (MSEs) order 2012, Public Procurement Policy for Micro & Small Enterprises (MSEs) Amendment order 2018 including subsequent Amendment/notification/order (Indicate Yes/No)

Note: Documentary Evidence is to be attached.

4. Permanent Account (PAN) No.

5. GSTIN Numbers

6. GSTIN in the States/UT from where the Supply of Goods takes place

Name of States/UT GSTIN No.

GSTIN in the States/UT from where the Supply of Services takes place (States where the site under the subject package is situated)

Name of States/UT GSTIN No.

9. PF Registration No. of the Company

10. PF Regional Office covered (with Address)

11. Name of Contact Person

12. Telephone No(s)

13. Bank Details for Electronic Payment

Name of the Bank:

Address of Branch:

Type of Account:

Type of Account: Current Account

14. 9 digit MICR code printed at bottom in middle, next to cheque no.

15. IFSC (for RTGS)/NEFT Code (to be obtained from the Bank) Sample Cancelled Cheque to be enclosed

We hereby declare that the above information are true and correct and we agree that the payment on account of this Contract, in the event of award, be made in the above account maintained in the above mentioned Bank.

* The definition of MSEs owned by SC/ST is as given under:

a. In case of proprietary MSE, proprietor(s) shall be SC/ST.

b. In case of partnership MSE, the SC/ST partners shall be holding atleast 51% shares in the unit.

c. In case of Private Limited companies, atleast 51% share shall be held by SC/ST promoters.

Documentary evidence: Please provide scanned copy(ies) of the SC/ST certificates issued by District Authority as applicable for SC/ST MSE category as per (a), (b) or (c ) above.

Date : DD-MM-YYYY Printed Name : 0

Place : 0 Designation : 0