Engagement of Insurance Brokers for Placement of Mega Risk Insurance Policy as well as other Insurance Policies to be undertaken by DVC during the tenure of contract along with settlement of Insurance Claims and other insurance related matters

ATTACHMENT - 1 : Declaration in support of Qualification Requirement(Technical & Financial)

Engagement of Insurance Brokers for Placement of Mega Risk Insurance Policy as well as other Insurance Policies to be undertaken by DVC during the tenure of contract along with settlement of Insurance Claims and other insurance related matters

NIT No: DVC/Tender/Head Quarter/COS/CONST-WS/7/2026-ENGINEERING-HQ Dated 09.10.26

Bidder's Name and Address

TIA's ADDRESS Sr. General Manager, C&M Department, 3rd Floor, DVC Towers, VIP Road, Kolkata-700054

Sl. No. Qualification Requirement Bidder to enter (Yes/No) ( Bidder have to select Yes/No for each Sl. No.)

1 The bidder satifies the Technical Qualification requirement as per Clause No 5.1 of Section-I, Volume-I of NIT.

2 The bidder satifies the Financial Qualification requirement as per Clause No 5.2 of Section-I, Volume-I of NIT.

3 The bidder satifies the Financial Qualification requirement as per Clause No 5.3 of Section-I, Volume-I of NIT.

4 The bidder satifies the Financial Qualification requirement as per Clause No 5.4 of Section-I, Volume-I of NIT.

Note: We decleare that (i) we have uploaded the scan copies of the supporting documents as per the above declarations in Sl. No. "1,2, 3 & 4" within the last date & time of Bid uploading period. (ii) we will produce the hard copies of the same, as and when asked by the Employer following the terms & conditions of the NIT, within the time frame as asked in the NIT. (iii) We further understand and agree that if we fail to upload all the scan copies of the above documents within the last date & time of Bid uploading period , or, if any declaration furnished by us online for Envelope1 is found to be false during verification of the scan copies of the supporting documents, which changes the eligibility status of us, then DVC will take necessary action as per the terms and conditions of NIT. (iv) We further understand and agree that on receipt of intimation from the Employer, if we fail to submit the hard copies of the supporting documents (original /"self-authenticated duly attested by Public Notary") within the time frame as asked in the NIT, or, if any of the hard copy of the supporting documents furnished by us for Envelope1 as asked in the NIT, is found to be not matching during verification with that of the scan copies of the supporting documents for Envelope1 as uploaded by us which changes the eligibility status of us, then DVC will take necessary action as per the terms and conditions of NIT.

TECHNO-COMMERCIAL SCHEDULE

Bidder’s Name, Address, Phone No./Fax No./email ID

Quotation No. and Date

Job Name Engagement of Insurance Brokers for Placement of Mega Risk Insurance Policy as well as other Insurance Policies to be undertaken by DVC during the tenure of contract along with settlement of Insurance Claims and other insurance related matters

NIT No. and Date DVC/Tender/Head Quarter/COS/CONST-WS/7/2026-ENGINEERING-HQ Dated 09.10.26

Sl. No. Clauses (as per NIT) Bidder’s Compliance/Comment

1 Whether “Scope of Work” of NIT is accepted.

2 Whether all the "Terms and Conditions” of the NIT is accepted (including Additional Terms and Conditions).

3 Whether Validity of Offer for 180 day from the date of opening is accepted.

4 Submitted/Uploaded GST Registration Certificate .

5 Submitted/Uploaded the Documents towards Status of the firm i.e. Company Registration Certificate / Partnership deed / Proprietorship documents alongwith authority of the person signing the bid

6 Submitted/Uploaded the EPF & ESI Registration Certificate as employer, if applicable.

7 Submitted/uploaded copy of PAN

8 Submitted Letter of Bid & notarised Affidavit in original (as per the prescribed format)

9 Submitted the notarised Power of Attorney in original (as per the prescribed format)

10 Submitted the hard copy of Banker's details for making payments through RTGS/NEFT in original (as per the prescribed fromat)

11 Have you ever been debarred by DVC/Nodal Ministry?

12 GST Registration No

NOTE: It is confirmed that no deviation has been taken in the bid in respect of the technical as well as commercial issues of the NIT. If anything in contrary to the terms of the NIT is found in the bid the same shall be considered as withdrawn and the respective terms of the NIT shall be ruling.