GTZ-Briefmaske f�r E-Mail-Versand f�r GTZ-B�ros (englisch

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					     Annex 7:
     Company Information Form
     BAU/CO/36 -83117529




Project                      Development Urban Water and Sanitation
                             South Sudan
Location                     Yei River County Payam, South Sudan
Project No                   08.2036.5-002.00
Subject                      Construction of various water and sanitation
                             facilities
Tender No                    Bid to Tender BAU/CO/36 -83117529
Publishing date              27.08.2012
Opening date:                25.09.2012 10:30 am
Type of tender               Open Tender / Public Opening

This Company Information Form should be submitted for the Bidder, or in the case of bids from Joint
Ventures, for each member of the Joint Venture. The form should be on the letterhead of the idder/member
of Joint Venture and should be signed by a person with the proper authority to sign. It should be included
by the Bidder in its bid.

                                     Company Information Form

Name of Bidder/Member of Joint Venture:

State whether Individual Bidder or Member of
Joint Venture:



1.     The total annual volume of construction work performed in each of the last five years is:

          Year                                             Volume of Construction Work
                                                      [Give value in currency used in Section 3]




2. The work performed as prime Contractor on works of a similar nature and volume over the last five years
is: [List also details of work under way or committed, including expected completion date.]

 No       Project Name and             Name of Client and          Type of Work performed          Value of contract
               Country                  Contact Person             and year of completion          [in currency used
Annex 7: Company Information Form for BAU/CO/36 -83117529                                                    Page 1 of 3
Page 2/3     September 16, 2012August 24, 2012



                                                                                                in 1 above]




3. The major items of equipment proposed for carrying out the Works are:

  Item of             Description, make            Condition (new, good, poor)   Owned, leased (from whom?), or
 Equipment             and age (years)               and number available         to be purchased (from whom?)




4. The qualifications and experience of key personnel proposed for administration and execution of the
Contract are: [Attach biographical data.]

           Position                              Name             Years of Experience     Year of Experience in
                                                                       (general)           proposed position




5. The proposed subcontracts and firms involved are:

 Sections of the Works                    Value of Subcontract       Subcontractor        Experience in Similar
                                                                  (name and address)             Works




6. The following financial reports (e.g. balance sheets, profit and loss statements, auditors’ reports etc) for
the last three years are attached: [List and attach]
      1.
   Annex 7: Company Information Form for BAU/CO/36 -83117529                                        Page 2 of 3
Page 3/3     September 16, 2012August 24, 2012



      2.
      3.
7. Bank information and account number where the money should be transferred.




8. We are currently involved in the following litigation:

           Other Party(ies)                           Cause of Dispute            Amount Involved




We, the undersigned, declare that the information contained in and attached to this form is true and accurate
as of the date of bid submission:
or [delete statement which does not apply]



Signed: [signature of person whose name and capacity are shown below]
Name: [insert complete name of person signing the Qualification Form]
In the capacity of [insert legal capacity of person signing the Qualification Form]
Duly authorised to sign the Qualification Form for and on behalf of: [insert complete name of
Bidder/Member of Joint Venture]




Dated on ____________ day of __________________, _______ [insert date of signing]




   Annex 7: Company Information Form for BAU/CO/36 -83117529                                    Page 3 of 3

				
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