Limited EOI for induction of TTs

Tenderer should fill in below mentioned details along with the Technical bid. (NON- COMPLIANCE OF ANY DETAILS WILL MEAN INCOMPLETE TENDER). Please state "NOT APPLICABLE" in case you have no positive answer. For example, if you are not a proprietary firm, then please state "NIL" or “NOT APPLICABLE’ against item No. 9 below instead of keeping the same blank. The blank cells shall be highlighted in RED colour till they are filled up

S. No Particulars Vendor's response

1 Name and address of the Bidder

2 Telephone Nos

3 Fax and E-Mail if any

4 Name of Contact Person

6 Nature of the firm ( state whether Limited Co. Partnership, Co-operative Society or Sole Proprietor)

7 Year of Establishment

8 Registration No. Of Company or Firm

9 Sole Proprietorship?

If yes, Give name of the Proprietor

10 Partnership firm?

If yes, Give names of the Partners

11 Private or Public Limited Company?

If yes, Give list of Directors.

12 State whether the bidder is Haulage Contractor at the supply locations covered in this tender. Choose `Yes' or `No' from the drop down list provided.

13 DSC holder name

TENDER NO. TAPSO/LPG-O/2020-21/PKD/TPT/Limited EOI/2

Tenderer should fill in below mentioned details along with the Technical bid. Cells with drop down option to be entered only using the options given in the cell. Other cells to be filled manually. 9 4 11 10 15 3 6 7 12 13 14 16 5

SL. NO. NAME OF THE BIDDER ADDRESS CONTACT NUMBER DSC HOLDER NAME PAN CARD NUMBER GST REGISTRATION CERTIFICATE No. MAIL ID EMD PAYMENT (ONLINE OR EXEMPTION) NATURE OF THE FIRM FIRM REGISTRATION CERTIFICATE FROM REGISTRAR OF FIRM ENCLOSING ALL ANNEXURES WITH ALL THE PARTNERS NAME OR CERTIFICATE OF INCORPORATION LIST OF PARTNERS AS PER ANNEXURE - FORM-A POWER OF ATTORNEY FOR DSC HOLDER AND SIGNING AUTHORITY (ANNEXURE-IX) CATEGORY DECLARATION FOR THE BID (ANNEXURE-IV) Confirmation letter from Scheduled Commercial Banks for extending loan under Govt. of India’s Stand Up India Scheme (SUIS) SC/ST CERTIFICATE NUMBER MSME DECLARATION (ANNEXURE-X) MSME CERTIFICATE NUMBER / UDYOG AADHAAR NUMBER MSME SELF- DECLARATION (ANNEXURE-XV) SAP CODE OF DISTRIBUTOR UNDERTAKING –TO BE SUBMITTED ALONGWITH TECHNICAL BID (ANNEXURE-III) UNDERTAKING FOR TRUCKS OFFERED (ANNEXURE-VI) DECLARATION A,B, C, D (ANNEXURE-VII) DECLARATION OF HOLIDAY/ BLACKLISTING (ANNEXURE-XII) INTEGRITY PACT (ANNEXURE -XIII) BANK DETAILS (ANNEXURE - XIV) Discharge of GST percentage on FCM 12% or RCM 5% (ANNEXURE - XVI) RTO REGISTRATION No. or TEMPORARY REGISTRATION No. or SUIS (TYPE OF TRUCK OFFERED) READY TRUCK or TEMPORARY REGISTRATION TRUCK or SUIS - PROPOSED TRUCK ADDRESS OF REGISTERING RTO BODY TYPE ENGINE NO. CHASSIS NO. GLW ULW RLW NAME OF REGISTERED OWNER AS PER RC BOOK RELATIONSHIP WITH THE BIDDER OWNED/ ATTACHED AFFIDAIT FOR ATTACHED TRUCK (ANNEXURE-V) NOC FOR OPERATING TRUCKS IF YES, NAME OF BOTTLING PLANT Contract Validity date Quoted Truck is offered only to this particular tender and not offered to any Oil Company including any other units of Indian Oil Corporation Date, Month & Year of original Manufacturing date of truck as per RC book / Invoice (All quoted & eligible trucks) (month / date / year)

FORM - C FORM - A DATE MONTH YEAR

Sl. No. EMD DETAILS Owned/ Attached MSME Self- Declaration Affidavit for Attached Truck Partnership deed Power of Attorney for DSC holder and signing authority NOC FOR OPERATING TRUCKS Undertaking by LPG distributors for common understanding (Annexure-XI) Declaration A, B,C,D Undertaking for trucks offered Integrity Pact Holiday/ Blacklisting UNDERTAKING –TO BE SUBMITTED ALONGWITH TECHNICAL BID (ANNEXURE-III) Constitution - Proprietor / Partnership CATEGORY DECLARATION FOR THE BID Truck is offered only to this particular tender and not offered to any Oil Company including any other units of Indian Oil Corporation as per Clause No. 1.11 Discharge of GST percentage on FCM 12% or RCM 5% (ANNEXURE - ) DECLARATION BY DISTRIBUTOR FOR OWN LOAD REQUIREMENT (ANNEXURE - XVII) Month Year Day TRUCK TYPE

Online Owned Submitted Submitted Submitted Submitted Submitted Submitted Submitted Submitted Submitted Submitted Submitted Proprietorship MSE - WOMEN Yes 0.12 Submitted 12 2022 31 14/12/2016 READY TRUCK Yes

Exemption Attached Not Applicable Not applicable Not applicable Not applicable Not applicable Not applicable Not submitted Not submitted Not submitted Not submitted Not submitted Partnership MSE - SC Not applicable 0.05 Not submitted 11 2021 30 TEMPORARY REGISTRATION Not applicable

Private Limited MSE - ST Not Applicable 10 2020 29 SUIS - PROPOSED TRUCK

Public Limited MSE - GENERAL 9 2019 28

Co-operative Society SC - READY TRUCK 8 2018 27

ST - READY TRUCK 7 2017 26

SC - PROPOSED TRUCK (SUIS) 6 2016 25

ST - PROPOSED TRUCK (SUIS) 5 2015 24

GENERAL TRANSPORTER 4 2014 23