Appendix A

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INFORMATION TO BE SUBMITTED BY TENDERER

FORM 1

SCHEDULE OF COMPLETED PROJECTS UNDERTAKEN BY THE FIRM AS A MAIN CONTRACTOR FOR THE LAST 3

YEARS (DO NOT INCLUDE PROJECTS COMPLETED BEFORE 1ST

JAN 2007)

Note : Tenderer is required to submit the following information in the form below to ensure that all information required for the tender

evaluation is submitted.

S/N Project Title

Name, Address, Tel & Fax

of Employer/Client

(list person/firm from

whom reference can be

obtained)

Contract Value*

Date of

Contractual

Commencement

& Completion

Actual date of

Completion

LD (days), if

any

A

B

Total Contract Value

*If unit of Currency is foreign, please give the equivalent in Singapore Dollars.

Appendix A

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FORM 2

SCHEDULE OF CURRENT PROJECTS UNDERTAKEN BY THE FIRM

S/N Description of Project

Name, Address, Tel & Fax

of Employer/Client

(list person/firm from whom

reference can be obtained)

Contract Value*

Date of

Contractual

Commencement

& Completion

*If unit of Currency is foreign, please give the equivalent in Singapore Dollars.

Appendix A

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FORM 3

CLIENTS’ ASSESSMENT ON MAIN CONTRACTOR’S PERFORMANCE IN

PROJECT WITHIN PAST 3 YEARS

(Note : Contractor to submit forms for a minimum of but not limited to 3 projects)

Name of Contractor: ________________________________________________

Project Title: ________________________________________________

________________________________________________

Contract Value: ________________________________________________

Commencement Date: ________________________________________________

Completion Date: ________________________________________________

Client’s Particulars

Name: ________________________________________________

Address: ________________________________________________

________________________________________________

Office Tel: ________________________________________________

Email: ________________________________________________

Name of Client’s

Representative: ________________________________________________

Designation ________________________________________________

Assesment on performance of Contractor

No Attribute Performance Rating (Tick where applicable)

Excellent Good Average Poor Very

Poor

1 Progress of Work/Delivery

2 Quality of Workmanship

3 Quality of Materials

4 Response to Instructions

5 Performance during Defects

Liability Period

6 Site Planning and Control

7 Inconvenience to

Tennant/Public

8 Testing & Commissioning

Client Representative’s Comments:

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Official Stamp of Client

Client’s Representative’s Signature/Date

Appendix A

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FORM 4

RESOURCES AND EXPERIENCE

A) Tenderer to submit organization chart showing site organization set-up

B) DETAILS OF PROPOSED SITE MANAGEMENT TEAM FOR THIS PROJECT

S/N Designation Name Qualification Years of

experience

Years with

the firm

Experience

in NUS

projects

(Yes/No)

1

2

3

4

Project

Manager

M&E

Coordinator

Workplace

Safety &

Health Officer

Site Safety

Coordinator

(recognized

degree)

(recognized

diploma)

(qualifications

approved by

MOM)

(qualifications

approved by

MOM)

eg. yes

Tenderer to submit curriculum vitae of each of the above site management team to be

deployed on this project. The information shall include :

1) Name

2) NRIC/Passport No

3) Nationality

4) Present position

5) Qualifications

6) Years of experience

7) Projects handled including project value and role undertaken

Appendix A

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FORM 5

FINANCIAL STANDING

1) Name of Bankers

_____________________________________________________________________

_____________________________________________________________________

2) Financial Background

Note : Tenderer must complete the form below in addition to submission of

the audited financial reports.

YEAR

200_ 200_ 200_ Ave (3 Years)

Net Tangible Worth

Revenue, Turnover, Sales

Current Assets

Current Liabilities

Current Ratio :

Current Assets .

Current Liabilities

Net Profit after Tax

Net Profit Margin :

Net Profit After Tax

Sale

Net Operating Income

Long Term Liabilities

Shareholders Equity

Gearing Ratio (%):

Long Term Liabilities

Shareholders Equity x 100

3. Financial Statement

Tenderer to submit statement of Profit and Loss Account for the preceding 3 years

certified by Accountants and a certified copy of latest audited Financial Report.

Appendix A

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FORM 6

DECLARATION ON LEGAL STANDING

DETAILS OF LEGAL ISSUES (LITIGATION, ARBITRATION, ETC) THAT

THE FIRM IS INVOLVED CURRENTLY

S/N Name of Project Client/ Sub-

Contractor Details of legal issue

Appendix A

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FORM 7

SAFETY PERFORMANCE

1) MOM SAFETY RECORD

Has the firm been involved in projects that have accumulated demerit points for

safety violation by MOM in the last 3 years?

Yes No

If yes, please provide details of the safety violation and the parties involved. Please

also advise on the number of such projects and the number of such occurrences.

Year Project Title Demerit Points Safety Violation

Description

Please state demerit points accumulated in MOM record

_______Points

Appendix A

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DECLARATION

The undersigned hereby certify that to the best of my knowledge, the particulars

given in the tender forms are true and correct. The Employer, or its representative, is

authorized to make direct enquiries, request for information and make references to

any person, firm, public official or organization named in the forms to verify the

information submitted herein or regarding the competence and general reputation of

the undersigned.

Dated this ________________ day of ________________________ 20 ___________

Signature : __________________________________________________

Name : ____________________________________________________

In the capacity of

____________________________________________________________________

duly authorised to sign tenders for and on behalf of __________________________

____________________________________________________________________

(IN BLOCK LETTERS)

Address: _____________________________________________________________

____________________________________________________________________

Signature of Witness: __________________________________________________

Name of Witness: _____________________________________________________

Address: _____________________________________________________________

____________________________________________________________________

Occupation: __________________________________________________________