CMI spares

DECLARATION ON ACCEPTANCE OF TENDER SCOPE, SPECIFICATIONS, TERMS & CONDITIONS ( Mandatory for all Bidders)

Instruction to fill the format below-

Bidders to fill the format below( white cells) and submit with your offer . Please note that submission of this declaration is mandatory,otherwise your offer may be liable for rejection.

It is hereby declared that we have read and understood the entire tender documents available on IOCL e-tender portal https://iocletenders.nic.in under

[To be submitted by the bidder as a sheet of "Bid_Documents" in the Un-Priced Bid (Technical Bid) , otherwise the Offer may be liable for rejection] and confirm our acceptance to the Tender scope, technical specifications, all terms & conditions etc. as mentioned in these tender documents , subject to deviations (if any) indicated in the prescribed “Deviation sheet” of the tender. The Deviations indicated anywhere else other than prescribed “Deviation sheet” shall be ignored by IOCL.

It is hereby declared that we have read and understood the entire tender documents available on IOCL e-tender portal https://iocletenders.nic.in under Tender Ref No.:-9030M25C43 and confirm our acceptance to the Tender scope, technical specifications, all terms & conditions etc. as mentioned in these tender documents , subject to deviations (if any) indicated in the prescribed “Deviation sheet” of the tender. The Deviations indicated anywhere else other than prescribed “Deviation sheet” shall be ignored by IOCL. further, confirm that we have quoted the rates in the tender considering Inter-alia the 1. Tender Document(s) 2. Additional Document(s) (if any) 3. BOQ Document (Price Bid Format) 4. Corrigendum (if any) 5. Pre Bid Meeting Minutes (if any) We

We further, confirm that we have quoted the rates in the tender considering Inter-alia the 1. Tender Document(s) 2. Additional Document(s) (if any) 3. BOQ Document (Price Bid Format) 4. Corrigendum (if any) 5. Pre Bid Meeting Minutes (if any) We hereby certify that we have fully read and thoroughly understood the tender requirements and accept all terms and conditions of the tender including all corrigendum/addendum issued, if any. Our offer is in confirmation to all the terms and conditions of the tender including all corrigendum/addendum, if any and minutes of the pre-bid meeting. In the event our offer is found acceptable and contract is awarded to us, the complete tender document shall be considered for constitution of Contract Agreement. hereby certify that we have fully read and thoroughly understood the tender requirements and accept all terms and conditions of the tender including all corrigendum/addendum issued, if any. Our offer is in confirmation to all the terms and conditions of the tender including all corrigendum/addendum, if any and minutes of the pre-bid meeting. In the event our offer is found acceptable and contract is awarded to us, the complete tender document shall be considered for constitution of Contract Agreement.

We also hereby declared that none of these e-documents have been tampered with. In case of tampering of e-documents, our bid shall be rejected outright and EMD forfeited without prejudice to any other rights or remedies available to IOCL. also hereby declared that none of these e-documents have been tampered with. In case of tampering of e-documents, our bid shall be rejected outright and EMD forfeited without prejudice to any other rights or remedies available to IOCL.

Tender Ref No.: 9030M25C43

BIDDER TO FURNISH COMPLETE DETAIL IN THE GIVEN BELOW FORMAT (Offer shall be liable for rejection in case of Non compliance of the same)

Offer Reference No & Date

Bidder Name (Name of Company)

Company's Legal Status SELECT FROM DROP DOWN

Complete Address of Registered Office

Contact Nos (Land Line)

Complete Address from where Goods will be supplied

Contact Nos (Land Line)

Name & complete contact detail of Partners (For Partnership Firm) OR Name & complete contact detail of Proprietor (For of Proprietary Firm) OR Name and complete contact detail of MD/CMD (For Company)

Corporate Indentification No. (CIN)

PAN No of Company / Partnership Firm / Proprietor Firm

TAN No of Company / Partnership Firm / Proprietor Firm

GSTIN Registration No. (where order is to issued)

GSTIN Registration No. (from where invoice shall be issued)

GSTIN Registration No. (from where Goods will be Supplied)

Vendor Classification for GST Please submit GSTIN certificate and if you are registered under GST Composition Scheme vendor , submit copy of the declaration i.e., FORM GST –CMP 01 or FORM GST CMP 02 alongwith the offer. Select form Drop Down

Micro & Small enterprises (MSE) Status Micro & Small enterprises participating in the tender must submit the valid Udyam Registration Certificate as indicated in the Tender Conditions for Benefits/Preference for Micro & Small Enterprises (MSEs). Select from Drop Down

Micro & Small enterprises owned by General/SC/ST/Women Select from Drop Down

Name of Authorized Person / Signatory

Contact Nos of Authorized Person (LL)

Contact Nos of Authorized Person (Mobile)

Official E Mail address of Authorized Person

Vendor who is registered with IOCL:- Please mention your active IOCL SAP Vendor code against which all details are updated at IOCL and you have recently received the online payment from IOCL.

Vendor who is not registered with IOCL for online payments / not having IOCL SAP vendor code/existing vendor desiring to change the bank details:- Please submit the following documents (as applicable) i) Bank details as per format enclosed in the tender Documents. ii) Copy of PAN card iii) Cancelled Cheque iv) Certificate of Incorporation v) Telephone or Electricity Bill for adress proof vi) Mail ID and mobile No. of authorised person to get SMS alerts from IOCL on payment etc. in soft copy (pdf) in the folder designated for submission of MSE certificate, and hard copy through courier / post to DGM-Materials (Purchase Dept.) , Gujarat Refinery, Vadodara- 391320.

We confirm that we have filled this "DECLARATION ON ACCEPTANCE OF TENDER SCOPE, SPECIFICATIONS, TERMS & CONDITIONS" sheet of this .XLS file.

We confirm that we have filled "DETAIL OF SUBMITTED DOCUMENTS TOWARDS PRE QUALIFICATION CRITERIA” of this .XLS file.(If Applicable)

We confirm that we have filled "ATC - INDIGENOUS / ATC - IMPORT" sheet of this .XLS file.

We confirm that we have filled Deviations (If any) as per sheet "DEVIATION-TECHNICAL & DEVIATION - COMMERCIAL"of this .XLS File.

We confirm that we have filled unpriced BOQ as per sheet "UN-PRICED BOQ" of this .XLS file.

We confirm that we have filled Declared Holiday Listing / black Listing & Insolvency and Bankruptcy" as per sheet "DECLARATION" of this .XLS file.

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DETAIL OF SUBMITTED DOCUMENTS TOWARDS PRE QUALIFICATION CRITERIA

Tender No.: 9030M25C43

Offer Ref No & Date:

(This Annexure is applicable for tenders having Pre-qualification criteria)

Important Instruction- IOCL reserves the right to complete the evaluation w.r.t. "Pre Qualification Criteria", based on the documents mentioned below only without taking cognizance of any other documents submitted towards "PQC", which is not mentioned below. In case Purchase Order details are not mentioned in the relevant cells and merely enclosed/attached etc. is mentioned, IOCL may not take cognizance of such documents during evaluation and bid shall be evaluated based on the details mentioned below in the relevant cell. Bidder must submit the documents in support of PQC in the specified packet only. Order (s) which are executed as per required PQC value as mentioned in the NIT shall only be considered for PQC compliance of Bidder's offer. Orders (i.e. not executed as per required PQC Value as mentioned in the NIT) shall not be considered for PQC compliance of Bidder's offer. Accordingly, please submit details of only those complete , legible and unambiguous documents for relevant orders etc., which you consider are meeting IOCL tender PQC requirements in toto.

TECHNICAL PQC:-

Sr No Purchase Order No. & Date (PO should be issued in favour of Vendor to whom Supply Order is to be issued) PO ISSUED BY (client name) M/s Order Value (On FOR despatch point / FCA / FOB Port of exit basis ) For further detail refer NIT document Documentary evidence as proof of supply (Invoice, LR/AWB/BL with Invoice, IRN, Complition Certificate issued by client etc.) For further detail refer NIT document Submitted Execution Document No & Date (Document Should contain reference of submitted PO) Value as given in Execution document Full address of the client and contact person (Name & Details i.e. Mail ID , Mobile No. etc) Page No of PQC Document Packet

In adition to above bidder to ensure submission of all necessary documents as required for meeting any other Technical PQC of IOCL tender document ( as applicable)- the detail of the documents to be furnished below.

Sr No Name & Description of Document Page No of PQC Document Packet

COMMERCIAL EXPERIENCE PQC:-

Sr No Purchase Order No. & Date (PO should be issued in favour of Vendor to whom Supply Purchase Order is to be issued) PO ISSUED BY (client name) M/s Order Value (On FOR despatch point / FCA / FOB Port of exit basis ) Documentary evidence as proof of supply (Invoice, LR/AWB/BL with Invoice, IRN, Complition Certificate issued by client etc.) For further detail refer NIT document Submitted Execution Document No & Date (Document Should contain reference of submitted PO) Value as given in Execution document Full address of the client and contact person (Name & Details i.e. Mail ID , Mobile No. etc) Page No of PQC Document Packet

FINANCIAL PQC:-

S.N. Finacial Year Details of Documentary evidence ( i.e. audited balance sheet (Profit and Loss statement of audited balance sheet) / published anual report / balance sheet in public domain which should be available free of cost) - For further detail refer NIT document Annual Turnover Page No of PQC Document Packet

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AGREED TERMS & CONDITIONS (ATC) -INDIGENOUS APPLICABLE FOR INDIAN BIDDERS ONLY

Bidders are advised to only fill the unprotected cells ( white cells) by dropdown or writting the comments as applicable as their confirmation .

Tender No. 9030M25C43

Offer Reference No.

Sl. No. Vendor’s confirmation/ acceptance/comments

1 Indicate Dispatch point. ( Place from where the material shall be despatched)

2 (a) DELIVERY PERIOD FOR SUPPLY:- Please confirm Earliest firm delivery period for supply, considering Delivery period as mentioned in the NOTICE INVITING TENDER (NIT).

2 (b) TIME PERIOD FOR SITE WORK:- Please confirm Earliest firm delivery period for Site Work / Services, considering time period as mentioned in the NOTICE INVITING TENDER (NIT).

3 Confirm acceptance of part order (for part items / part quantity) without limitation. All lump sum charges shall be considered prorata on value basis. Not Applicable

4 Confirm acceptance of Repeat Purchase order(s) as per IOCL's requirement with the same rate and terms & conditions within 6 months from the date of original Purchase Order. Note : sum of quantities of all the repeat order(s) shall not exceed the quantity of the original order. Not Applicable

5 EARNEST MONEY DEPOSIT (EMD):- Pl. confirm having submitted Earnest Money Deposit (EMD) as per Cl. No. 4 of IOCL GPC, wherever called for in the tender. Only Online EMD / BG (as applicable as per tender documents) is allowed. Not applicable for this tender

5a PRN No.of Online submitted EMD OR Bank Guarantee No. OR On date valid MSE certificate No. with date of issue. OR Letter declaring Central PSU/State PSU/Govt Organisations/JV of IOCL

6 Please confirm Name & Complete Address where the Order to be issued.

7 Please note that the Counter Sales Terms & Conditions of the vendor shall not be considered by IOCL. Noted & Confirmed

8 Please confirm acceptance of attached IOCL's General Purchase Conditions (GPC) in toto. Bidder is not required to submit soft / hard copy of IOCL GPC. Noted & Confirmed

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AGREED TERMS & CONDITIONS (ATC) -IMPORT APPLICABLE FOR FOREIGEN BIDDERS ONLY

Bidders are advised to only fill the unprotected cells ( white cells) by dropdown or writting the comments as applicable as their confirmation .

Tender No. 9030M25C43

Offer Reference No.

Sl. No. Vendor’s confirmation/ acceptance/comments

1 Please indicate Country of origin of goods offered.

2 Indicate Major International port of Exit of shipment considering Mode of Transport (SEA/AIR) as mentioned at Sr No 13 in the NOTICE INVITING TENDER (NIT). In case of requirement of transport is through Air, the Incoterm shall be FCA International Airport of Exit and In case of requirement of transport is through Sea, the Incoterm should be FOB International Seaport of Exit

3 Please confirm that you have quoted freight charges in price BOQ as per requirement considering Mode of Transport (SEA/AIR) as mentioned at Sr No 13 in the NOTICE INVITING TENDER (NIT). In case of requirement of transport is through Air, the quoted freight should be from FCA International Airport of Exit to Mumbai Airport India and In case of requirement of transport is through Sea,the quoted freight should be from FOB International Seaport of Exit to Nhava Sheva Sea Port, Mumbai India. Confirmed

4 (a) DELIVERY PERIOD FOR SUPPLY:- Please confirm Earliest firm delivery period for supply, considering Delivery period as mentioned in the NOTICE INVITING TENDER (NIT).

4 (b) TIME PERIOD FOR SITE WORK:- Please confirm Earliest firm delivery period for Site Work / Services, considering time period as mentioned in the NOTICE INVITING TENDER (NIT).

5 Confirm acceptance of part order (for part items / part quantity) without limitation. All lump sum charges shall be considered prorata on value basis. Accepted

6 Confirm acceptance of Repeat Purchase order(s) as per IOCL's requirement with the same rate and terms & conditions within 6 months from the date of original Purchase Order. Note : sum of quantities of all the repeat orders shall not exceed the quantity of the original order. Accepted

7 You will furnish three copies of certificate of origin from Chamber of commerce along with shipping document without any extra cost to IOCL. Confirmed

8 EARNEST MONEY DEPOSIT (EMD):- Pl. confirm having submitted Earnest Money Deposit (EMD) as per Cl. No. 4 of IOCL GPC, wherever called for in the tender. Only Online EMD / BG (as applicable as per tender documents) is allowed. SELECT FROM DROPDOWN

8b PRN No.of Online submitted EMD OR Bank Guarantee No. OR DD/Banker Cheque with date of issue

9a Indicate Shipping Net Weight & Gross Weight of the quoted material(s).

9b Indicate Shipping Dimensions & Volume of the quoted material(s).

9c DECLARATION OF CARGO AS ODC / NON ODC:- Packing of the individual boxes should be done in such a way that the onsignment does not become an ODC (Over Dimensional Consignment) for Air Transport. When the size of the package exceeds the standard pallet (PIP) dimensions (for Air Transport) which are given below, they will be treated as ODC. Length 121 inches Width 84 inches Height 60 inches Maximum Gross Weight 4626 Kg Maximum Net Weight 4508 Kg Floor Load Limitations 90.7 Kg /Sq Ft SELECT FROM DROPDOWN

10a Manufacturer’s Name & Address , contact person details like Name, Telephone no., Fax no. and E-mail

10b Name and address , of your banker and other details ( like Bank account No. , SWIFT code etc.) required for Opening of Letter of Credit.

10c Please indicate the name of the Indian Agent, with his full address and percentage of commission included in your offer. Please note that Indian Agent Commission will be paid directly by Owner to Indian Agent in equivalent Indian Rupees (at the TT buying rate of exchange ruling on the date of placement of order) after the order.

11a Please confirm Name & Complete Address in favour of whom Supply Order to be issued.

11b Please confirm Name & Complete Address in favour of whom Work Order for Site Work (if applicable in the Tender) to be issued.

11c Please confirm Name & Complete Address in favour of whom Work Order for PWCAMC/PWAMC (if applicable in the Tender) to be issued.

12 Please note that the Counter Sales Terms & Conditions of the vendor shall not be considered by IOCL. Noted & Confirmed

13 Please confirm acceptance of attached IOCL's General Purchase Conditions (GPC) in toto. Bidder is not required to submit soft / hard copy of IOCL GPC. Noted & Confirmed

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PROFORMA FOR DEVIATIONS- TECHNICAL

Tender No. 9030M25C43

Bidder may stipulate here "TECHNICAL" exception(s) and deviation(s) to IOCL Tender Documents, if considered unavoidable.

Sl. No. Referred document name/ Tender document page no. Clause No. Description of Clause Deviation proposed by bidder

Bidder should note that this Annexure has been included in the Tender Document solely for the convenience of the Bidder so as to facilitate them to list out the "TECHNICAL"deviation(s)/exception(s) from/to the Tender Documents. IOCL will not consider any "TECHNICAL"deviation(s)/exception(s) which is not listed in this Annexure, for evaluation of bidder's offer.

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PROFORMA FOR DEVIATIONS-COMMERCIAL

Tender No. 9030M25C43

Bidder may stipulate here "COMMERCIAL" exception(s) and deviation(s) to IOCL General Purchase Conditions and/or Tender Documents, if considered unavoidable.

Sl. No. Referred document name/ Tender document page no. Clause No. Description of Clause Deviation proposed by bidder

Bidder should note that this Annexure has been included in the Tender Document solely for the convenience of the Bidder so as to facilitate them to list out the "COMMERCIAL"deviation(s)/exception(s) from/to the Tender Documents. IOCL will not consider any "COMMERCIAL"deviation(s)/exception(s) which is not listed in this Annexure, for evaluation of bidder's offer.

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Tender No.: 9030M25C43

Offer reference no:

Sl. No. Item Description Please mention "Quoted" / "Not Quoted" HSN Code Country of Origin Bidder participating in this tender as Manufacturer or Stockist/ Trader of the tendered items.

10 Item serial no. 0010 of Enquiry cum Scope of Supply & Technical Specification of Tender Quoted Select from drop down

20 Item serial no. 0020 of Enquiry cum Scope of Supply & Technical Specification of Tender Quoted Select from drop down

30 Item serial no. 0020 of Enquiry cum Scope of Supply & Technical Specification of Tender Quoted Select from drop down

40 Item serial no. 0010 of Enquiry cum Scope of Supply & Technical Specification of Tender Quoted Select from drop down

50 Item serial no. 0020 of Enquiry cum Scope of Supply & Technical Specification of Tender Quoted Select from drop down

60 Item serial no. 0020 of Enquiry cum Scope of Supply & Technical Specification of Tender Quoted Select from drop down

70 Item serial no. 0010 of Enquiry cum Scope of Supply & Technical Specification of Tender Quoted Select from drop down

80 Item serial no. 0020 of Enquiry cum Scope of Supply & Technical Specification of Tender Quoted Select from drop down

90 Item serial no. 0020 of Enquiry cum Scope of Supply & Technical Specification of Tender Quoted Select from drop down

100 Item serial no. 0010 of Enquiry cum Scope of Supply & Technical Specification of Tender Quoted Select from drop down

110 Item serial no. 0020 of Enquiry cum Scope of Supply & Technical Specification of Tender Quoted Select from drop down

120 Item serial no. 0020 of Enquiry cum Scope of Supply & Technical Specification of Tender Quoted Select from drop down

130 Item serial no. 0010 of Enquiry cum Scope of Supply & Technical Specification of Tender Quoted Select from drop down

140 Item serial no. 0020 of Enquiry cum Scope of Supply & Technical Specification of Tender Quoted Select from drop down

150 Item serial no. 0020 of Enquiry cum Scope of Supply & Technical Specification of Tender Quoted Select from drop down

160 Item serial no. 0010 of Enquiry cum Scope of Supply & Technical Specification of Tender Quoted Select from drop down

170 Item serial no. 0020 of Enquiry cum Scope of Supply & Technical Specification of Tender Quoted Select from drop down

180 Item serial no. 0020 of Enquiry cum Scope of Supply & Technical Specification of Tender Quoted Select from drop down

190 Item serial no. 0010 of Enquiry cum Scope of Supply & Technical Specification of Tender Quoted Select from drop down

200 Item serial no. 0020 of Enquiry cum Scope of Supply & Technical Specification of Tender Quoted Select from drop down

210 Item serial no. 0020 of Enquiry cum Scope of Supply & Technical Specification of Tender Quoted Select from drop down

220 Item serial no. 0010 of Enquiry cum Scope of Supply & Technical Specification of Tender Quoted Select from drop down

230 Item serial no. 0020 of Enquiry cum Scope of Supply & Technical Specification of Tender Quoted Select from drop down

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DECLARATION OF BLACK LISTING / HOLIDAY LISTING AND DECLARATION OF INSOLVENCY & BANKRUPTCY AND DECLARATION OF RELATIONSHIP WITH IOCL DIRECTOR (S) AND CERTIFICATE TOWARDS RESTRICTIONS UNDER RULE 144 (xi) OF GFRs AND CERTIFICATE TOWARDS RESTRICTIONS UNDER RULE 144 (xi) OF GFRs, 2017 FOR TRANSFER OF TECHNOLOGY (ToT) These Declarations are mendatory for all bidders. If any bidder fails to furnish these Declarations, the offer may be liable for rejection as incomplete offer.

Tender No.: 9030M25C43

Offer reference no:

1. DECLARATION OF BLACK LISTING / HOLIDAY LISTING PLEASE SELECT YOUR LEGAL STATUS HERE FROM DROP DOWN (Here give particulars of black listing or holiday listing and/or inquiry and inabsence thereof state "NIL")

REFER CELL B5 AND SELECT YOUR LEGAL STATUS FROM THE DROP DOWN

2. DECLARATION ON PROCEEDINGS UNDER INSOLVENCY AND BANKRUPTCY CODE, 2016 PLEASE SELECT FROM THE DROP DOWN

3. DECLARATION TOWARDS RELATIONSHIP WITH IOCL DIRECTOR PLEASE SELECT FROM DROP DOWN

4. CERTIFICATE TOWARDS RESTRICTIONS UNDER RULE 144 (xi) OF GFRs, 2017 (OM F/No./7/10/2021-PPD (1) dtd. 23.02.2023) PLEASE SELECT FROM DROP DOWN

5. Bid Security Declaration from bidders in lieu of Earnest Money Deposit / Bid Security PLEASE SELECT FROM DROP DOWN

6. DMIS Policy (if applicable at clause no. 22 of NIT) PLEASE SELECT FROM DROP DOWN

5. CERTIFICATE TOWARDS RESTRICTIONS UNDER RULE 144 (xi) OF GFRs, 2017 FOR TRANSFER OF TECHNOLOGY (ToT) (OM F/No./7/10/2021-PPD (1) dtd. 23.02.2023) PLEASE SELECT FROM DROP DOWN

List of IOCL directors is available at https://www.iocl.com/AboutUs/Management.aspx

I hereby declare that neither I in my personal name or in the name of my Proprietary concern We, hereby declare that neither We,

which is submitting the accompanying Bid/Tender nor any other concern in which I am proprietor nor any partnership firm in which I am involved as a Partner are presently on any blacklist or holiday list declared by Indian Oil Corporation Ltd. or by Ministry of Petroleum & Natural Gas (MOPNG), nor any inquiry is pending by Indian Oil Corporation Ltd. or MOPNG, in respect of any corrupt or fraudulent practice(s) against me or any other of my proprietorship concern(s) or against any partnership firm(s) in which I am or was at the relevant time involved as a partner, except as indicated in the adjuscent cell i.e. Cell C6 It is understood that if this declaration is found to be false in any particular, Indian Oil Corporation Ltd. shall have the right to reject my/our bid, and if the bid has resulted in a contract, the contract is liable to be terminated without prejudice to any other right or remedy (including blacklisting or holiday listing) available to Indian Oil Corporation Ltd which is submitting the accompanying Bid/Tender, nor any partner involved in the said firm either in his individual capacity or as proprietor or partner of any other firm or concern presently, are placed on any blacklist or holiday list declared by Indian Oil Corporation Ltd. or by Ministry of Petroleum & Natural Gas (MOPNG), nor any inquiry is pending by Indian Oil Corporation Ltd. or MOPNG, in respect of corrupt or fraudulent practice(s) against us or any partner or any other concern or firm of which he is proprietor or partner, except as indicated in the adjuscent cell i.e. Cell C6 It is understood that if this declaration is found to be false in any particular, Indian Oil Corporation Ltd. shall have the right to reject my/our bid, and if the bid has resulted in a contract, the contract is liable to be terminated without prejudice to any other right or remedy (including blacklisting or holiday listing) available to Indian Oil Corporation Ltd We hereby declare that we are presently neither placed on any holiday list or blacklist declared by Indian Oil Corporation Ltd. Or by Ministry of Petroleum & Natural Gas (MOPNG), nor any inquiry is pending by Indian Oil Corporation Ltd. or MOPNG, in respect of corrupt or fraudulent practice(s), except as indicated in the adjuscent cell i.e. Cell C6. It is understood that if this declaration is found to be false in any particular, Indian Oil Corporation Ltd. shall have the right to reject my/our bid, and if the bid has resulted in a contract, the contract is liable to be terminated without prejudice to any other right or remedy (including blacklisting or holiday listing) available to Indian Oil Corporation Ltd We hereby declare that none of the members of the Consortium are presently placed on any holiday list or blacklist declared by Indian Oil Corporation Ltd. Or by Ministry of Petroleum & Natural Gas (MOPNG), nor any inquiry is pending by Indian Oil Corporation Ltd. or MOPNG, in respect of corrupt or fraudulent practice(s), except as indicated below: It is understood that if this declaration is found to be false in any particular, Indian Oil Corporation Ltd. shall have the right to reject my/our bid, and if the bid has resulted in a contract, the contract is liable to be terminated without prejudice to any other right or remedy (including blacklisting or holiday listing) available to Indian Oil Corporation Ltd

I hereby declare that neither I in my personal name or in the name of my Proprietary concern M/s which is submitting the accompanying Bid/Tender nor any other concern in which I am proprietor nor any partnership firm in which I am involved as a Partner are presently on any blacklist or holiday list declared by Indian Oil Corporation Ltd. or by Ministry of Petroleum & Natural Gas (MOPNG), nor any inquiry is pending by Indian Oil Corporation Ltd. or MOPNG, in respect of any corrupt or fraudulent practice(s) against me or any other of my proprietorship concern(s) or against any partnership firm(s) in which I am or was at the relevant time involved as a partner, except as indicated in the adjuscent cell i.e. Cell C6 It is understood that if this declaration is found to be false in any particular, Indian Oil Corporation Ltd. shall have the right to reject my/our bid, and if the bid has resulted in a contract, the contract is liable to be terminated without prejudice to any other right or remedy (including blacklisting or holiday listing) available to Indian Oil Corporation Ltd We, hereby declare that neither We, M/s which is submitting the accompanying Bid/Tender, nor any partner involved in the said firm either in his individual capacity or as proprietor or partner of any other firm or concern presently, are placed on any blacklist or holiday list declared by Indian Oil Corporation Ltd. or by Ministry of Petroleum & Natural Gas (MOPNG), nor any inquiry is pending by Indian Oil Corporation Ltd. or MOPNG, in respect of corrupt or fraudulent practice(s) against us or any partner or any other concern or firm of which he is proprietor or partner, except as indicated in the adjuscent cell i.e. Cell C6 It is understood that if this declaration is found to be false in any particular, Indian Oil Corporation Ltd. shall have the right to reject my/our bid, and if the bid has resulted in a contract, the contract is liable to be terminated without prejudice to any other right or remedy (including blacklisting or holiday listing) available to Indian Oil Corporation Ltd We hereby declare that we are presently neither placed on any holiday list or blacklist declared by Indian Oil Corporation Ltd. Or by Ministry of Petroleum & Natural Gas (MOPNG), nor any inquiry is pending by Indian Oil Corporation Ltd. or MOPNG, in respect of corrupt or fraudulent practice(s), except as indicated in the adjuscent cell i.e. Cell C6. It is understood that if this declaration is found to be false in any particular, Indian Oil Corporation Ltd. shall have the right to reject my/our bid, and if the bid has resulted in a contract, the contract is liable to be terminated without prejudice to any other right or remedy (including blacklisting or holiday listing) available to Indian Oil Corporation Ltd We hereby declare that none of the members of the Consortium are presently placed on any holiday list or blacklist declared by Indian Oil Corporation Ltd. Or by Ministry of Petroleum & Natural Gas (MOPNG), nor any inquiry is pending by Indian Oil Corporation Ltd. or MOPNG, in respect of corrupt or fraudulent practice(s), except as indicated below: It is understood that if this declaration is found to be false in any particular, Indian Oil Corporation Ltd. shall have the right to reject my/our bid, and if the bid has resulted in a contract, the contract is liable to be terminated without prejudice to any other right or remedy (including blacklisting or holiday listing) available to Indian Oil Corporation Ltd

PLEASE SELECT FROM THE DROP DOWN

We, M/s. declare that We are not undergoing insolvency resolution Process or liquidation or bankruptcy proceeding as on date. It is understood that if this declaration is found to be false, Indian Oil Corporation Ltd. shall have the right to reject my / our bid, and forfeit the EMD, if the bid has resulted in a contract, the contract will be liable for termination without prejudice to any other right or remedy (including holiday listing) available to Indian Oil Corporation Ltd.

We, M/s. declare that We are undergoing insolvency resolution process and/or liquidation and/or bankruptcy proceeding as on date as per Details mentioned below. (Attached detail with technical bid)

We are not undergoing insolvency resolution Process or liquidation or bankruptcy proceeding as on date.

We are undergoing insolvency resolution process and/or liquidation and/or bankruptcy proceeding as on date as per Details mentioned below. (Attached detail with technical bid)

It is understood that if this declaration is found to be false, Indian Oil Corporation Ltd. shall have the right to reject my / our bid, and forfeit the EMD, if the bid has resulted in a contract, the contract will be liable for termination without prejudice to any other right or remedy (including holiday listing) available to Indian Oil Corporation Ltd.

PLEASE SELECT FROM DROP DOWN

We, M/s. declare that that we don’t have any relationship with any of IOCL Directors

We, M/s. declare that that we have relationship with IOCL Director (s), and the same is mentioned below

that we don’t have any relationship with any of IOCL Directors

that we have relationship with IOCL Director (s), and the same is mentioned below

PLEASE SELECT FROM DROP DOWN

I have read the clause regarding restrictions on procurement from a bidder of a country which shares a land border with India. I certify that this bidder is not from such a country. I hereby certify that this bidder fulfills all requirements in this regard and is eligible to be considered.

I have read the clause regarding restrictions on procurement from a bidder of a country which shares a land border with India. I certify that this bidder is from such a country and has been registered with the Competent Authority. I hereby certify that this bidder fulfills all requirements in this regard and is eligible to be considered. Evidence of valid registration by the Competent Authority is attached.

I have read the clause regarding restrictions on procurement from a bidder of a country which shares a land border with India. I certify that this bidder is from such a country and has not been registered with the Competent Authority.

I have read the clause regarding restrictions on procurement from a bidder of a country which shares a land border with India. I certify that this bidder is from such a country and is having exclusion from Restrictions under Rule 144(xi) of General Financial Rules (GFRs) or Special Cases as defined in Annexure II of O.M. - F.No.6/18/2019-PPD dtd. 23rd July, 2020. Relevant document for the same is attached.

I/We, the authorized signatory of M/s

, participating in the subject Tender No.

, for the job as mentioned in the NIT, do hereby declare that in the event:

I / We withdraw / modify our bid during the period of bid validity OR I/We commit any other breach of tender conditions/ contract which would have otherwise attracted forfeiture of EMD OR I / We fail to / refuse to initiate the execution of the awarded Contract as per the terms of the Contract

then I / We could be debarred from being eligible for bidding / award of all future tender(s) of Indian Oil Corporation Limited for a period of SIX Months from the date of communication of such debarment.

PLEASE SELECT FROM DROP DOWN

I/We, the authorized signatory of M/s , participating in the subject Tender No. 9030M25C43, for the job as mentioned in the NIT, do hereby declare that in the event: I / We withdraw / modify our bid during the period of bid validity OR I/We commit any other breach of tender conditions/ contract which would have otherwise attracted forfeiture of EMD OR I / We fail to / refuse to initiate the execution of the awarded Contract as per the terms of the Contract then I / We could be debarred from being eligible for bidding / award of all future tender(s) of Indian Oil Corporation Limited for a period of SIX Months from the date of communication of such debarment.

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We, M/s are manufacturer of the indented items and items supplied will be manufactured by us.

We, M/s are non-manufacturer bidder (i.e. both stockists and dealers) and is submitting authorization certificates/affidavit issued by the domestic manufacturer(s) in the tender.

We, M/s are non-manufacturer bidder (i.e. both stockists and dealers) and is unable to submit tender specific authorization certificates/affidavit issued by the domestic manufacturer(s). We, M/s confirm that such affidavit from domestic manufacturers shall be submitted after placement of order, i.e. along with dispatch documents, thus forming a part of the documents against which material acceptance is granted. Hence, we are submitting the affadavit in the name of bidding entity. are non-manufacturer bidder (i.e. both stockists and dealers) and is unable to submit tender specific authorization certificates/affidavit issued by the domestic manufacturer(s). We, M/s

Not Applicable confirm that such affidavit from domestic manufacturers shall be submitted after placement of order, i.e. along with dispatch documents, thus forming a part of the documents against which material acceptance is granted. Hence, we are submitting the affadavit in the name of bidding entity.

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I have read the clause regarding restrictions on procurement from a bidder having Transfer of Technology (ToT) arrangement from such country which shares a land border with India and I hereby certify that this bidder does not have any Transfer of Technology (ToT) arrangement requiring registration with the competent authority.

I have read the clause regarding restrictions on procurement from a bidder having Transfer of Technology (ToT) arrangement from such country which shares a land border with India and I hereby certify that this bidder has valid registration for Transfer of Technology (ToT) arrangement to participate in this procurement. Evidence of valid registration by the Competent Authority is attached.

Bidder Name (Name of Company)

Offer Reference No & Date

Name of Authorized Person / Signatory

Contact Nos of Authorized Person (LL)

Contact Nos of Authorized Person (Mobile)

Official E Mail address of Authorized Person

Complete Address of Registered Office

IOCL Vendor Code, if any

GST Registered/Non Registered/Compound Scheme Select form Drop Down GSTIN for Order - GSTIN for Invoicing - GSTIN for Goods Supply - Select form Drop Down GSTIN for Order - GSTIN for Invoicing - GSTIN for Goods Supply -

Submission of Declaration & Acceptance of Tender Submitted Submitted

Submission of Declaration of Holiday Listing / Black Listing Declaration not Submitted Declaration not Submitted

Submission of Declaration on Insolvency Proceeding

Submission of Relationship with IOCL Director

Submission of Declaration towards OM F.No.6/18/2019-PPD dated 23rd July, 2020 for country which shares a land border

PRN No in case of Online EMD Payment EMD BG No. If applicable and submitted

MSE CERTIFICATE - SUBMITTED / NOT SUBMITTED / NOT APPLICABLE

UDYAM REGISTRATION NO.

MSE CATEGORY -MICRO/SMALL

MSE ACTIVITY - MANUFACTURER / SERVICES

PARTICIPATED AS MANUFACTURER / TRADER

QUOTED ITEM IN UDYAM - COVERED / NOT COVERED

PREFERENCE OPTED OR NOT OPTED

EMD BENEFIT FOR MSE - YES / NO

PURCHASE PREFERENCE FOR MSE - YES / NO

PPP-MII POLICY RESERVED FOR CLASS - 1 CLASS 1 & CLASS 2 LOCAL SUPPLIER CAN PARTICIPATE CLASS 1, CLASS 2 & NON LOCAL SUPPLIER CAN PARTICIPATE NOT APPLICABLE

IF PPP-MII APPLICABLE, DECLARATION / CERTIFICATION FROM OEM - SUBMIITED / NOT SUBMITTED

% LOCAL CONTENT IN OFFERED ITEM

PURCHASE PREFERENCE FOR PPP-MII - YES / NO

DMIS POLICY - APPLICABLE / NOT APPLICABLE

HSN CODE / SAC CODE , AS APPLICABLE

% LOCAL CONTENT IN OFFERED ITEM

DECLARATION / CERTIFICATION FROM OEM - SUBMIITED / NOT SUBMITTED

DMIS - COMPLIED / NOT COMPLIED

Commercial Deviation In case of no deviation, Payment term, Defect Liability term PBG term (if applicable), PRS Clause shall be as per Tender. For deviation in the above clause (s) or any other deviation pl refer deviation sheet.

Dispatch Point - For Indigenous Offer Major International Port of Exit - For Import Offer

Delivery Period for Supply

Time Period for Services

Acceptance of Part Order Clause Not Applicable Accepted Not Applicable

Acceptance of Repeat Order Clause Not Applicable Accepted Not Applicable

Non Acceptance of Counter Sales T & C Noted & Confirmed Noted & Confirmed Noted & Confirmed

Acceptance of GPC Noted & Confirmed Noted & Confirmed Noted & Confirmed

Name & Complete Address in favour of whom Supply Order to be issued.

Name & Complete Address in favour of whom Service Order to be issued, if applicable Not Applicable being Indigenous Offer

Name & Complete Address in favour of whom PWCAMC/PWAMC Order to be issued, if Applicable Not Applicable being Indigenous Offer

Country of Origin of Goods Not Applicable being Indigenous Offer

Three copies of Certificate of Origin with supply w/o additional cost - For Import offer Not Applicable being Indigenous Offer Confirmed Confirmed

Shipping Net Weight & Gross Weight Not Applicable being Indigenous Offer

Shipping Dimensions & Volume Not Applicable being Indigenous Offer

Declaration of Cargo as NON ODC / ODC Not Applicable being Indigenous Offer SELECT FROM DROPDOWN SELECT FROM DROPDOWN

Manufacturer Name & Address Not Applicable being Indigenous Offer

Name & Address of Bank for L/C opening Not Applicable being Indigenous Offer

Name & Address of India Agent if any Not Applicable being Indigenous Offer

TECHNICAL PQC COMPLIANCE SELECT FROM DROP DOWN SELECT FROM DROP DOWN

COMMERCIAL EXPERIENCE PQC COMPLIANCE SELECT FROM DROP DOWN SELECT FROM DROP DOWN

FINANCIAL PQC COMPLIANCE SELECT FROM DROP DOWN SELECT FROM DROP DOWN

TECHNICAL RECOMMENDATION SELECT FROM DROP DOWN SELECT FROM DROP DOWN

COMMERCIAL RECOMMENDATION SELECT FROM DROP DOWN SELECT FROM DROP DOWN

Any other deviation if any

FINAL RECOMMENDATION SELECT FROM DROP DOWN SELECT FROM DROP DOWN

DEVIATION SHEET -JRMM204

Guarantee / Warranty (Defect liability Period)

Performance bank Guaranty (PBG)

Price Reduction Schedule (PRS)

Any other deviation, if any

Select, Excess (+), Less (-) Less (-)

Tender Inviting Authority: DY GENERAL MANAGER (MATERIALS), INDIAN OIL CORPORATION, GUJARAT REFINERY, VADODARA

Tender No: 9030M25C43

Important Instructions to fill BOQ: 1. DONOT INSERT ANY ADDITIONAL SHEET, ROWS, COLUMN AND ANY CONDITION IN BOQ SHEET. PLEASE DO NOT TAMPER THE BOQ SHEET. Enabled Cells (CYAN COLOUR) are only to be filled by bidder. Non-compliance shall lead to rejection of the BID. 2. Uploading of Scanned copy of Price bid is not acceptable and such bid shall be summarily rejected. 3. Bidders should quote for the complete scope of the tender strictly as per the technical specification & scope of tender. 4. Please enter the Packing and Forwarding charges, Freight charges, GST Rate applicable Extra in % . In case the bidder does not indicate the Packing and Forwarding charges/ Freight charges/ GST Rate , the same shall be considered as inclusive. 5. Financial evaluation of the offers shall be done as per the evaluation criteria of tender.

Name of the Bidder/ Bidding Firm / Company :

Sl. No. Item Description Item Code / Make Quantity Units Estimated Rate in Rs. P HSN CODE (In case of Supply) SAC CODE (In case of Service) CATEGORY [SUPPLY or SERVICE] Addition / Deduction Addition / Deduction Values Currency Convertion against each Item Quoted Currency in INR / Other Currency For OFFER IN INR Ex-Works Unit Price for Supply OR Unit Price for Service For OFFER OTHER THAN INR FCA / FOB Price for Supply (Refer NIT clause No 12) OR Unit Price for Service Packing & Forwarding (in % of Basic Rate) Third Party Inspection Charges (in % of Basic Rate) Freight charges (in % of Basic Rate) Applicable Rate of GST (in %) Transit Insurance to be borne by IOCL (PRE FILLED VALUE) Total Landed Cost of Line item quoted in INR Currenncy (PRE FILLED FORMULA) FOR FOREIGN BIDDERS Air Freight Charges (From Port of Exit to Mumbai port) (Refer NIT clause No 12) Insurance Charges (%) (PRE FILLED VALUE) CIF Value (PRE FILLED FORMULA) Customs Duty (in %) (PRE FILLED VALUE) Cess on Customs Duty (in %) (PRE FILLED VALUE) Value after Custom duty and Cess (PRE FILLED FORMULA) GST applicable (in %) (PRE FILLED VALUE) Value After GST (PRE FILLED FORMULA) Port handling Charges (%) (in %) (PRE FILLED VALUE) Inland transportation Charges (%) (PRE FILLED VALUE) For Foreign Bidders - Total Landed Cost of line item in Non-INR Currency (PRE FILLED VALUE)

1 List of item(s) / work(s) as per tender documents

LIP SEAL FOR DIAL INDICATOR Item10 / 7590102611 / 9031 EA SUPPLY Excess(+) Full Conversion USD

TOP SEAL F/UPPER BEARING HOUSING Item20 / 7590102591 / 9031 EA SUPPLY Excess(+) Full Conversion USD

UPPER BEARING,P/N:2227 Item30 / 7590109281 / 9031 EA SUPPLY Excess(+) Full Conversion USD

BOTTOM SEAL F/UPPR BRG HUSG Item40 / 7590102601 / 9031 EA SUPPLY Excess(+) Full Conversion USD

SETS O RING F/LOWER SHAFT Item50 / 7590101781 / 9031 EA SUPPLY Excess(+) Full Conversion USD

O RING FOR MAIN HEAD FLNGE Item60 / 7590101741 / 9031 EA SUPPLY Excess(+) Full Conversion USD

KNUCKLE PIN ITEM NO-7 Item70 / 7590103161 / 9031 EA SUPPLY Excess(+) Full Conversion USD

PAWL PIN ITEM NO-8 Item80 / 7590103201 / 9031 EA SUPPLY Excess(+) Full Conversion USD

PAWL BUSHING ITEM NO-10 Item90 / 7590103241 / 9031 EA SUPPLY Excess(+) Full Conversion USD

PAWL ITEM NO-11 Item100 / 7590102888 / 9031 EA SUPPLY Excess(+) Full Conversion USD

SPACER-CYLINDER PIN ITEM NO-12 Item110 / 7590103261 / 9031 EA SUPPLY Excess(+) Full Conversion USD

CYLINDER CLEVIS PIN ITEM NO-14 Item120 / 7590103321 / 9031 EA SUPPLY Excess(+) Full Conversion USD

WASHERS,CYLINDER PIN,SET, P/N-3530B Item130 / 7590107771 / 9031 EA SUPPLY Excess(+) Full Conversion USD

LUBE HOSES NO.5,7,8, P/N-9910A-18.75,UOP Item140 / 7590104781 / 9031 EA SUPPLY Excess(+) Full Conversion USD

LIP SEAL SET, MAIN BEARING,P/N-2536-2537 Item150 / 7590102771 / 9031 EA SUPPLY Excess(+) Full Conversion USD

SECONDARY SEAL SLEEVE,P/N:0189C Item160 / 7590109268 / 9031 EA SUPPLY Excess(+) Full Conversion USD

O RING F/HUSG TOP HEAD JOINT Item170 / 7590101721 / 9031 EA SUPPLY Excess(+) Full Conversion USD

SETS O RING F/SECONDARY SEAL Item180 / 7590102101 / 9031 EA SUPPLY Excess(+) Full Conversion USD

HYDRAULIC PUMP DISCHRGE FILTR ELEMENT Item190 / 7590102001 / 9031 EA SUPPLY Excess(+) Full Conversion USD

FLANGE GASKET, SIGHT GLASS ASSY,P/N-2410 Item200 / 7590107731 / 9031 EA SUPPLY Excess(+) Full Conversion USD

O RING FOR SIGHT GLASS, P/N-2740 Item210 / 7590107721 / 9031 EA SUPPLY Excess(+) Full Conversion USD

PACKS OF LUBRICATE GREASE Item220 / 7590102021 / 9031 EA SUPPLY Excess(+) Full Conversion USD

PAWAL SPRINGS,P/N-61,RV-III,UOP Item230 / 7590100011 / 9031 EA SUPPLY Excess(+) Full Conversion USD

Total in Figures

Quoted Rate in Figures Select

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