ࡱ>  ;Bbjbj yËË8lllll$P0kkk$HlkkkkkllҘEEEkllEkEE^C-h-h0P/ClC@kkEkkkkk2kkkkkkkkkkkkkkkk 2: 4 REPUBLIC OF THE PHILIPPINES) CITY OF_____________________) BID-SECURING DECLARATION Invitation to Bid No._________ To : Philippine Ports Authority Pot Management Office Bataan/Aurora Admin. Bldg., Port of Lamao, Bgy. Lamao, Limay Bataan I, the undersigned, declare that: I understand that, according to your conditions, bids must be supported by a Bid Security, which may be in the form of Bid-Securing Declaration. I accept that: (a) I will be automatically disqualified from bidding for any contract with any procuring entity for a period of two (2) years upon receipt of your Blacklisting Order; and, (b) I will pay the applicable fine provided under Section 6 of the guidelines on the Use of Bid- Securing Declaration, if I have committed any of the following actions: Withdrawn my Bid during the period of bid validity required in the Bidding Documents; or Fail or refuse to accept the award and enter into contract or perform any and all acts necessary to the execution of the Contract, in accordance with the Bidding Documents after having been notified of your acceptance of our Bid during the period of validity. I understand that this Bid-Securing Declaration shall cease to be valid on the following circumstances: Upon expiration of the bid validity period, or any extension thereof pursuant to your request; I am declared ineligible or post-qualified upon receipt of your notice to such effect, and (i) I failed to timely file a request for reconsideration or (ii) I filed a waiver to avail of said right; I am declared as the bidder with the Lowest Calculated Responsive Bid, and I have furnished the performance security and signed the Contract. IN WITNESS WHEREOF, I have hereunto set my hand this ____day of ___________20 __________ at _________________, Philippines. ___________________________________ Name of Bidders Authorized Representative (Signatorys Legal Capacity) AFFIANT SUBSCRIBED AND SWORN to before me this____day of____20________at _________, Philippines. Affiant is personally known to me and was identified by me through competent evidence of identity as defined in the 2004 Rules of Notarial Practice (A.M. No. 02-8-13-SC). Affiant exhibited his/her (type of government identification card used), with his/her photograph and signature appearing thereon, with No._______ and his/her Community Tax Certificate No._________ issued on_________ at_____________ Witness my hand and seal this _________day of_________. NOTARY PUBLIC Doc. No._______: Page No.______: Book No.______: Series of 20____ FINANCIAL DATA Summary of the Applicant Firms/Contractors assets and liabilities on the basis of the attached audited financial statements, stamped RECEIVED by the Bureau of Internal Revenue or BIR authorized collecting agent, for the immediately preceding calendar year. Year 20141. Total Assets2. Current Assets3. Total Liabilities4. Current Liabilities 5. Net worth (1-3)6. Net Working Capital (2-4) The Net Financial Contracting Capacity (NFCC) must be at least equal to the approved budget for the contract to be bid. NFCC = K (current asset - current liabilities) minus value of all outstanding works under ongoing contracts including awarded contracts NFCC = ___________________________________ K = 10 for a contract duration of one year or less, 15 for more than one year up to two years and 20 for more than two years C. Or a commitment from a licensed bank to extend to it a credit line if awarded the contract to be bid in an amount not lower than ten (10%) percent of the approved budget for the contract to be bid. Attached herewith are certified true copies of the audited financial statements stamped received by the BIR or BIR authorized collecting agent for the latest/immediately preceding calendar year. __________________________ Name of Firm/Applicant ____________________________ Authorized Signing Official Date:_______________________ NOTES: If Partnership or Joint Venture, each Partner or Member Firm of Joint venture shall submit separate financial statements. OMNIBUS SWORN STATEMENT I, (Name of Affiant) , of legal age, (Civil Status) ,(Nationality) , and residing at (Address of Affiant), ________________ after having been duly sworn in accordance with law, hereby depose and say: (If a sole proprietorship): That I am the _______________ of the ____________________________ (Designation) (Name of applicant firm/contractor) with office address at (Address of Bidder); (If a partnership, corporation, cooperative or joint venture): I am the duly authorized and designated representative of (Name of Bidder) with office address at (Address of Bidder) (If a sole proprietorship): As the owner and sole proprietor of (Name of Bidder), I have full power and authority to do, execute and perform any and all acts necessary to represent in the bidding for (Name of the Project) of the (Name of the Procuring Entity); (If a partnership, corporation, cooperative or joint venture): I am granted full power and authority to do, execute and perform any and all acts necessary and/or to represent the (Name of the Bidder) in the bidding as shown in the attached (State title of attached documents showing proof of authorization (e.g., duly authorized Secretarys Certificate issued by the corporation or by the members of the joint venture); (Name of the Bidder) is not Blacklisted or barred from bidding by the Government of the Philippines or any of its agencies, offices, corporations or Local Government Units, foreign government/foreign or international financing institution whose blacklisting rules have been recognized by the Government Procurement Policy Board; Each of the documents submitted in satisfaction of the bidding requirements is an authentic copy of the original, complete, and all statements and information provided therein are true and correct; (Name of Bidder) is authorizing the Head of the Procuring Entity or its duly authorized representative(s) to verify all the documents submitted; (If a sole proprietorship): I am not related to the Head of the Procuring Entity, members of the Bids and Awards Committee (BAC), the Technical Working Group (TWG) and the BAC Secretariat, or the end-user unit, and the project consultants, by consanguinity or affinity up to the third civil degree; (If a partnership, corporation, cooperative or joint venture): 6. None of the Officers and members of (Name of Bidder) is related to the Head of the Procuring Entity, members of the Bids and Awards Committee (BAC), the BAC Secretariat, the Technical Working Group (TWG) or the end-user and the project consultants by consanguinity or affinity up to the third civil degree; (If a corporation or joint venture); 6. None of the Officers, directors, and controlling stockholders of (Name of Bidder) is related to the Head of the Procuring Entity, members of the Bids and Awards Committee (BAC), the BAC Secretariat, the Technical Working Group (TWG) or the end-user and the project consultants by consanguinity or affinity up to the third civil degree; (Name of the Bidder) complies with existing labor laws and standards; and (Name of the Bidder) is aware of and has undertaken the following responsibilities as a Bidder: Carefully examine all the Bidding Documents; Acknowledge all conditions, local or otherwise, affecting the implementation of the Contract; Made an estimate of the facilities available and needed for the contract to be bid, if any; and Inquire or secure Supplemental/Bid Bulletin(s) issued for the (Name of the Project). IN WITNESS WHEREOF, I have hereunto set my hand this ______day of ___________,20_______at ______________, Philippines. _____________________________________________ (Affiant/Bidders Representative/Authorized Signatory) SUBSCRIBED AND SWORN to before me this ______ day of__________20_______, affiant exhibiting to me his/her Community Tax Certificate No. __________________ issued on _______________ at ____________________________ . Doc. No. __________ NOTARY PUBLIC Page No. __________ Until ________________ Book No.__________ Series of __________ STATEMENT OF ALL ON-GOING GOVERNMENT AND PRIVATE CONTRACTS, INCLUDING CONTRACTS AWARDED BUT NOT YET STARTED, WHETHER SIMILAR OR NOT SIMILAR IN NATURE (Use separate sheets if necessary) Names of the Contract or Title Of the Project 1] Owners Name And Address  Nature/ Scope of Work 2] Contractors Role (in percentage) 3] Total Contract Value At Date of Award 5] Value of Outstanding Works Estimated Time of Completion % of Accomplishment Contract DurationAwardProject Completion DateEscalated Value to Present Prices 4] Planned Actual Start Completeda) Government Contracts i. On-going ii. Awarded but not yet started b) Private Contracts i. On going ii. Awarded but not yet started  NOTES: 1] As appearing or defined in the contract entered/executed by the parties 2] With special reference to the Scope of Works as described/enumerated in the advertised Invitation to Bid. 3] Indicate whether as Sole Contractor, Sub-Contractor or Member in a Joint Venture/Consortium 4] Indicate the FOREX used if Contract Value is expressed in a currency other than the Philippine Peso. Specify the Escalation Factor used to escalate the Contract Value from completion date to the advertisement date of the Invitation to Bid per section 23.11.2(3) of R.A. 9184. 5] State Month and Year. ________________________ ____________________ Name of Firm/Applicant Authorized Signing Official Date: _________________________ BREAKDOWN OF MAJOR OPERATIONS OF SIMILARLY COMPLETED PROJECTS (To be Filled-up by the Contractor/Applicant) Major Operations of Work Unit of Measure Quantity Similar Major Operations of Works 1] Unit of Measure Quantity Project. No. 1Project No. 2Project No. 3Project No. 4Project No. 5 CONCRETING WORKS STEEL WORKS PAINTING WORKS  CU.M. LIN.M SQ.M. 4.00 110.00 1236.00 NOTE: 1] Submit the Certificate of Completion/Certificate of Acceptance by the project owner, Final Recapitulation/Bill of Quantities and/or Constructors Performance Evaluation System (CPES) ratings, 1st, 2nd & final visit (If applicable). Projects with no Certificate of Completion/Acceptance and Recapitulation/Bill of Quantities shall not be considered. 2] The Owners Certificate of Final Acceptance; or the Constructors Performance Evaluation Summary (CPES) Final Rating and/or the Certificate of Completion, must be satisfactory. ______________________ __________________ Name of Firm/Applicant Authorized Signing Official Date: ______________________ STATEMENT ON AVAILABILITY OF KEY PERSONNEL I hereby declare that the following key personnel enumerated below for the various positions/functions, namely: Project Manager, Project Engineer, Materials Engineer, Construction Safety and Health Officer, and Foreman are available for the project applied for: Position of Key Personnel NameNo. of Key Personnel Experience in the Position (Years) Attachments AnnexesProject Manager-PRC License (EE Preferred) -Complete Qualifications & Experience Data -Certificate of Commitment Annex __ Project Engineer-PRC License (EE Preferred) -Complete Qualifications & Experience Data -Certificate of Commitment Annex __ Materials Engineer-PRC License (EE Preferred) -Submit valid & Renewed DPWH Cert. of Accreditation -Complete Qualifications & Experience Data -Certificate of Commitment Annex __ Safety Officer-Cert. of Safety & Health Const. Related Course issued by DOLE accredited Trainings -Complete Qualifications & Experience Data -Certificate of Commitment Annex __ Foreman-Complete Qualifications & Experience Data -Certificate of CommitmentAnnex __ Other Position(s)-Complete Qualifications & Experience Data -Certificate of CommitmentAnnex __  NOTE: Minimum qualification requirement: (work experience is similar in nature and complexity to the project to be bidded-out with regards to Registration Particulars of the Contractors License) Project Manager - Five (5) years Materials Engineer One (1) year Project Engineer - Three (3) years Foreman - Five (5) years ________________________ _____________________ Name of Firm/Applicant Authorized Signing Official Date:________________________ STATEMENT ON AVAILABILITY OF CONSTRUCTION EQUIPMENT/TOOLS (Please use separate Sheets if necessary) I hereby declare that the following equipment listed below which are owned, under lease or under purchase agreement are in good operating condition and are available for the project applied for, to wit: No. of Unit(s) DESCRIPTION (Type, Model, Make) Capacity Output Owned/Leased and/or under purchase agreement Submitted Proof of Ownership/Leased/Purchase Agreement (Mark as Annex A.Z) Manufacturer Engine Serial No.  Chassis No. (if applicable) Location StatusOne (1) unitConcrete MixerOne (1) unitConcrete VibratorOne (1) unitBar CutterOne (1) unitWelding Machine Note: 1] Indicate if owned or leased. 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