PRE QUALIFICATION QUESTIONNAIRE For CONTRACTORS
MINISTRY OF WORKS AND TRANSPORT Corner Richmond and London Streets, Port of Spain PRE QUALIFICATION QUESTIONNAIRE for CONTRACTORS April 15, 2016 Prequalification Questionnaire for Contractors 1 Page
Contents 1.0 COMPANY GENERAL INFORMATION . 3 1.1 CONTRACTORS’ FIELD OF SPECIALIZATION AND SERVICES OFFERED . 4 1.2 Business Registration / Incorporation Details. 4 1.3 REGISTRATION DETAILS. 5 2.0 Asset Register. 6 3.0 Financial Capacity. 6 4.0 Breach of Contract . 7 5.0 Supporting Documents . 8 6.0 Terms and Conditions . 8 7.0 Statement of Submission . 9 8.0 CHECKLIST . 10 Please read each field carefully and fill out in BLOCK LETTERS. All fields are mandatory where applicable. Forms with incomplete or inaccurate information will not be acknowledged. Applications must be delivered in person. Please note that qualification does not guarantee an award of contract. Prequalification Questionnaire for Contractors 2 Page
1.0 COMPANY GENERAL INFORMATION Business Name: Business Address: ---------------- -------------------Town / City Street Name MANDATORY -----County: Town / City St George East [ ] Victoria East [ ] Caroni [ ] Tobago [ ] Nariva/Mayaro [ ] St George West [ ] Victoria West [ ] St Patrick [ ] St Andrew/ St David [ ] Telephone No: Mobile No. Fax: Email Address: Mailing Address (if different): PRIMARY CONTACT Name: Position: Email: Telephone: Fax: Mobile: OFFICERS President/C.E.O: Vice President/Managing Director: Corporate Secretary: Type/Structure of Organization (Please tick appropriate option): Sole Proprietor [] Partnership [] Limited Liability [ ] Joint Venture [ ] Unspecified Other [] Private Company (with unlimited liability) [] Consortium [] [] If other, please ------------------------------------------- ------------------------------------------------- Addresses of Subsidiary Offices (if any): ------------------ -------------------------------- -------------------------------- --------------Prequalification Questionnaire for Contractors 3 Page
1.1 CONTRACTORS’ FIELD OF SPECIALIZATION AND SERVICES OFFERED Please indicate the Contractors’ Field of Specialization and Services Offered. Desilting Work Reinforced concrete & rubble masonry river wall Reinforced concrete and reinforced block box drain Hydraulic structures including flap & sluice gates Road rehabilitation and patching Slope Stabilization (landslip repairs) Drainage - Construction of box drains and culverts Constructions of Sidewalk 1.2 Business Registration / Incorporation Details Address Surname Directors/Owners Start Date End Date dd/mm/yyyy dd/mm/yyyy Address Surname Secretaries Start Date End Date dd/mm/yyyy dd/mm/yyyy Name First Name Name First Name Prequalification Questionnaire for Contractors 4 Page
1.3 REGISTRATION DETAILS Please provide copies of the undermentioned Incorporation Documents: Notice of Directors Last Annual Return Filed Notice of Secretary Certificate of Incorporation/Continuance Notice of Address Registration Certificate Articles of Association Certificate Information V.A.T No: Valid V.A.T Clearance Certificate B.I.R No.: Valid Income Tax Certificate N.I.S Reg. No: Prequalification Questionnaire for Contractors 5 Page
2.0 Asset Register Qty PLANT / EQUIPMENT TYPE Model OWN OR RENT? Year of Manufacturer yyyy/mm/dd ARE PLANT / EQUIPMENT IN WORKING CONDITION? Yes No 3.0 Financial Capacity FINANCIAL CAPACITY Please provide the following financial information:a) A copy of the Financial Statements of your organization for the last three (3) years of trading or for the period that is available if trading is less than three (3) years to demonstrate the soundness of the Company’s Current Financial position. Financial Statements must be signed by a Certified Accountant. Audited Financial Statements are preferred. b) If the organization is a Subsidiary or Group, the information in (a) above is required for both the subsidiary and the Ultimate Parent Company. Where a Consortium or Association is proposed, the information is requested for each member Company. Please indicate reasons for any non-submission of information. Prequalification Questionnaire for Contractors 6 Page
Bank Information Name and Address of Bank/Financial Institution. Telephone Number: 4.0 Breach of Contract Has the business or any of its affiliates ever been liable for Breach of Contract? Yes [ ] No [ ] If yes, please provide details: Do you have any judgements currently outstanding? Yes [ ] No [ ] If yes, please provide details: Prequalification Questionnaire for Contractors 7 Page
5.0 Supporting Documents Must attach the following documents along with your completed registration form: Copies of two (2) forms of Valid National Identification i.e. (National I.D. Card, Passport, Drivers Permit) of each Director or Sole Trader. 6.0 Terms and Conditions The Ministry of Works and Transport (MOWT) reserves the right to make reasonable inquiries of clients and related people indicated in this submission so as to establish performance levels and performance capacities of the Applicants. We advise that all information received will be considered confidential and will be maintained accordingly. We contend that the information provided is certified as a true and fair representation and it is acknowledged that if facts are acquired by the Ministry by means of reasonable investigations which indicate differently, the Ministry retains the discretionary authority to disqualify the applicant from further consideration and may remove the Applicant(s) name from any list the Ministry may maintain. It is also acknowledged that all costs incurred whilst preparing this prequalification submission are for the account of the Applicant. Prequalification Questionnaire for Contractors 8 Page
7.0 Statement of Submission I hereby certify that all information specified in this registration form and supporting documents is true and accurate. I understand and agree that if any of the information herein is found to be false or misleading the Ministry reserves the absolute right to disqualify the application and immediately revoke the registration of the company from its list of contractors and suppliers. Should a contract be awarded as a result of the misrepresentation on the particulars of the registration, the MOWT reserves the right to rescind the contract upon the discovery of the false or misleading information. Applicant Name (Blocks): FIRST NAME SURNAME National I.D/PP/D.P. Number: Position /Job Title: (Authorized) Signature: Date: / / dd / mm / yyyy Company Stamp Here Prequalification Questionnaire for Contractors 9 Page
8.0 CHECKLIST (Not limited to the following) CHECKLIST Certificates and Clearances Incorporation/Registration Document Financial Statements (Audited preferred) Client Reference Letters Is the Questionnaire signed and dated? N.B. Your Questionnaire may not be processed if any of the aforementioned information is not submitted. Prequalification Questionnaire for Contractors 10 P a g e
For Official Use Only Date: Processing Officer: Name in Blocks Signature Prequalification Questionnaire for Contractors 11 P a g e
PRE QUALIFICATION QUESTIONNAIRE for CONTRACTORS April 15, 2016 . Prequalification Questionnaire for Contractors 2 P a g e Contents 1.0 COMPANY GENERAL INFORMATION. 3 1.1 CONTRACTORS' FIELD OF SPECIALIZATION AND SERVICES OFFERED .
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To find the Professional Services Pre-Qualification form, click Show Quick Criteria Maintenance button . There is only one Professional Services Questionnaire RFx each year. Active Queries 6. The fields you can use to search for the Pre-Qualification Questionnaire are displayed. The most commonly used fields for a search are: Field Description
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