Pre-qualification for Technical Services Questionnaire. Part A Indicate the item codes, and descriptions of the work you are applying for:

Transcription

1 Pre-qualification for Technical Services Questionnaire Part A Indicate the item codes, and descriptions of the work you are applying for: ITEM CODE Item Description Part B General information Name of Organization/ Firm / Individual Consultant Trading Name (if different from above) Postal Address Physical location of Business Premises Town Street Plot No. Building name Floor Primary Contact Person for this EOI Name Mobile number

2 Nature of organization (e.g. Sole Proprietorship, NGO, Public Limited Company, Partnership, Individual Consultant etc) Names of the Proprietor, Directors or Partners and their Nationality Company/ Firm /Organisation s Operations Year established/registered: (not to be filled by Individual Consultants) Duration of Operation: Objectives, Mandate, Mission of the Firm/ Organisation : [Pre-qualification questionnaire] 1

3 Outside of your registered physical premises listed above, list the address of any and all offices in Tanzania from which you operate to provide services (Not to filled by Individual Consultants) Company/ NGO Registration No. (Attach Copy) Companies/ firms and NGOs only VAT Registration No. (Attach Copy) Firms and Companies only TIN Registration No. (Attach Copy) All applicants Trade Licence/ Business Permit (Attach Copy) Firms and Companies only Part B Financial, Organizational and Economic Information for Applicants 1. Firms/ NGOs and Companies must provide copies of the following documents: - Annual report (incl. financial report) of last 3 financial years - External independent audit report with management letter of the last financial year - Organization chart and/or bylaws - Proofs and confirmations that statutory social insurance contributions, taxes, etc. required by the national laws have been paid - Organisational Code of Conduct for staff of the applicant demonstrating provisions for corruption, fraud and safeguarding 2. Individual Consultants must provide the following: - Proofs and confirmations that statutory taxes, etc., required by the national laws, have been paid - Proofs of memberships of any relevant Professional Body - Certified copies of Certificates for all Educational qualifications listed in the CV 2 [Pre-qualification questionnaire]

4 Part C Past Performance References Applicants must prove that they have enough experience in projects and assignments comparable with the work they are bidding for in terms of scope and complexity. Applicants must prove this experience using only and exactly three references for work they have done in the last five years. Applicants must provide written proof for each of the references giving at least the following data: - Name of the contracting company/donor, name of the person who managed the contract for the company/donor and and telephone numbers for the contact who managed the contract; - Title of the project or contract or grant and / or the contract/grant number; - Time and place of execution for the work done; - Financial size of the contract; - Clear description of the services provided by the applicant (no more than one page); Please note: - No more than one of the three references provided can be for work contracted by SNV. - SNV reserves the right to contact the contact persons indicated without any further permissions from the applicant. - Even if applicants are applying for several of the listed areas of work, they may provide no more than three references in total. Part D Eligibility Do any of the following apply to your Firm/ Company or Organization, or to (any of) the Director(s) / Partner(s) / Proprietor(s) Have you or your principals been subject of legal proceedings for insolvency, bankruptcy, receivership or your business activities suspended for related reasons? Yes / No If Yes give details Have been convicted of a criminal offence related to business or professional conduct Yes / No If Yes give details Have you had any contracts terminated for poor performance in the last five years, or any contracts where damages have been claimed by the client Yes / No If Yes give details [Pre-qualification questionnaire] 3

5 Part E Organizational Capability Demonstrate that the applicant has at its disposal sufficient staff with sufficient technical and managerial skills to undertake the work in the area that is being applied for. Specifically, attach CVs of the staff employed by your firm/ organization/ company that would undertake any assignment in the area that the applicant is applying for. CVs should be written as well-pitched summaries and only contain information necessary to show the Applicant s technical/experiential capability to carry out the type of work they are applying for. Applicants who are applying as Individual Consultants should only submit their own CV. Individual CVs must be no longer than three pages each. Part F Conflict of Interest Please provide answers to the following statements: To the best of your knowledge, have you or any employee or staff member of your organization or firm, ever been employed by SNV? Yes or No (Individual Consultants should answer for themselves) If Yes, provide the name of the person in your organsiation, and a description of the employment period, including job description, the duration of the employment period and reasons for leaving Is any employee or staff member of your firm, company or organisation related (by blood, marriage or otherwise) to any employee of SNV in Tanzania? Yes or No (Individual Consultants should answer for themselves) If yes, please provide the name of your staff and the name of the SNV staff member they are related to. State the nature of the relationship. Part G - Sworn statement Having provided the pre-qualification information for the above tender category/ies above. We/I hereby state: That the information furnished in our / my application is accurate and true to the best of our / my knowledge. 4 [Pre-qualification questionnaire]

6 That in case of being pre-qualified we/i acknowledge that this grants us/me the right to participate in due time in the submission of a tender on the basis of provision in the tender documents to follow. That pre-qualified bidders will be invited randomly to participate in tenders as and when there is a requirement. We / I enclose all the required documents and information required for the pre-qualification evaluation. Date: Company/ Organization/ Individual s Name: Represented by: Signature: Stamp / Seal [Pre-qualification questionnaire] 5