NATIONAL INSTITUTE OF FOOD TECHNOLOGY …niftem.ac.in/Tenderdoc/21532016105315_Tender for...

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Approved Final Tender of Outsourcing of NIFTEM Dispensary Signature of Tender 1 | Approved Tender for outsourcing of Dispensary17thNovember,2016 Ref. No. NIFTEM/Tender/Dispensary /2016-17/ Date: 18.11.2016 NOTICE INVITING TENDER Name of work: Tender for Outsourcing of NIFTEM Dispensary NIFTEM invites Tender for the selection of an agency for running NIFTEM Dispensary on Outsourced basis at NIFTEM, Kundli, Sonepat (Haryana). Besides, rates/empanelment for the supply for medicines and surgical items is also invited. Interested professional Agencies/Hospitals/ Nursing Homes may submit their offer in two bid system (Technical & Financial Bid) in the prescribed format along with DD of Rs 1000/- as tender document/processing fee(Non- refundable) in favour of NIFTEM, payable at Delhi. The details of the works/services/items and other terms and conditions of the Tender can be downloaded from NIFTEM’s website i.e. www.niftem.ac.in. Corrigendum/addendum, if any, would only be appear at our website, therefore, interested agencies are advised to frequently visit our website for the same. Important dates are as under: Name of Tender Tender fee & EMD Tender uploading date and time Pre-bid Meeting date and Time Tender Closing date and Time Technical Bid Opening date and Time Financial Bid Opening date and time Tender for Outsourcing of NIFTEM Dispensary Tender Fee: Rs. 1000/- (Nonrefundable) EMD: Rs.1,00,000/- 21-11-2016 2.00 PM 30-11-2016 11.30 AM 15-12-2016 2.00 PM 15-12-2016 3.30 PM Will be communicated separately by mail/phone only to those agencies, which have been found technical qualified. Bids/ Offers complete in all respect should be addressed to The Registrar, National Institute of Food Technology Entrepreneurship & Management, Plot No. 97, Sector-56, Phase-IV, HSIIDC, Industrial Estate, Kundli, Sonepat, Haryana-131028 and dropped in the Tender Box as kept at Reception of NIFTEM. Registrar NATIONAL INSTITUTE OF FOOD TECHNOLOGY ENTREPRENEURSHIP MANAGEMENT Deemed to be University (De-novo Category) under Section 3 of the UGC Act, 1956 and an autonomous institution under Ministry of Food Processing Industries, Govt. of India Plot No. 97, Sector-56, Phase – IV, HSIIDC, Industrial Estate, Kundli , Sonepat-131028 (Haryana) Phone No. 130-2281000 Fax No. 0130-2219772 www.niftem.ac.in

Transcript of NATIONAL INSTITUTE OF FOOD TECHNOLOGY …niftem.ac.in/Tenderdoc/21532016105315_Tender for...

Approved Final Tender of Outsourcing of NIFTEM Dispensary

Signature of Tender

1 | A p p r o v e d T e n d e r f o r o u t s o u r c i n g o f D i s p e n s a r y 1 7 t h N o v e m b e r , 2 0 1 6

Ref. No. NIFTEM/Tender/Dispensary /2016-17/ Date: 18.11.2016

NOTICE INVITING TENDER

Name of work: Tender for Outsourcing of NIFTEM Dispensary

NIFTEM invites Tender for the selection of an agency for running NIFTEM Dispensary on

Outsourced basis at NIFTEM, Kundli, Sonepat (Haryana). Besides, rates/empanelment for the supply

for medicines and surgical items is also invited. Interested professional Agencies/Hospitals/

Nursing Homes may submit their offer in two bid system (Technical & Financial Bid) in the

prescribed format along with DD of Rs 1000/- as tender document/processing fee(Non-

refundable) in favour of NIFTEM, payable at Delhi. The details of the works/services/items and

o t her terms and conditions of the Tender can be downloaded from NIFTEM’s website i.e.

www.niftem.ac.in. Corrigendum/addendum, if any, would only be appear at our website, therefore,

interested agencies are advised to frequently visit our website for the same. Important dates are as

under:

Name of Tender

Tender fee & EMD

Tender uploading date and

time

Pre-bid Meeting date and

Time

Tender Closing

date and Time

Technical Bid

Opening date and

Time

Financial Bid Opening date

and time

Tender for Outsourcing of NIFTEM Dispensary

Tender Fee:

Rs. 1000/- (Nonrefundable) EMD:

Rs.1,00,000/-

21-11-2016 2.00 PM

30-11-2016 11.30 AM

15-12-2016 2.00 PM

15-12-2016 3.30 PM

Will be communicated separately by mail/phone only to those agencies, which have been found technical qualified.

Bids/ Offers complete in all respect should be addressed to The Registrar, National

Institute of Food Technology Entrepreneurship & Management, Plot No. 97, Sector-56,

Phase-IV, HSIIDC, Industrial Estate, Kundli, Sonepat, Haryana-131028 and dropped in the

Tender Box as kept at Reception of NIFTEM.

Registrar

NATIONAL INSTITUTE OF FOOD TECHNOLOGY ENTREPRENEURSHIP MANAGEMENT Deemed to be University (De-novo Category) under Section 3 of the UGC Act, 1956 and an autonomous institution under Ministry of Food Processing Industries, Govt. of India

Plot No. 97, Sector-56, Phase – IV, HSIIDC, Industrial Estate, Kundli , Sonepat-131028 (Haryana) Phone No. 130-2281000 Fax No. 0130-2219772

www.niftem.ac.in

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National Institute of Food Technology Entrepreneurship and Management (NIFTEM) Deemed to be University (De-novo Category) under Section 3 of the UGC Act, 1956 and an Autonomous Institution under Ministry of Food Processing Industries, Govt. of India

Plot No 97, Sector-56, HSIIDC Industrial Estate, Kundli-131008, District-Sonepat (Haryana)

Ref. No. NIFTEM/Tender/Dispensary /2016-17/ Date: 18.11.2016

TENDER

Tender are invited from professional Agencies/Hospitals/Nursing Homes for the selection

of an agency for Running NIFTEM Dispensary on Outsourced basis at NIFTEM Campus, Kundli,

Sonepat, and Haryana. The important dates of EOI are as under:

Tender No. NIFTEM/Tender/Dispensary /2016-17/

Name of the work Selection of an agency for running NIFTEM Dispensary on outsourced basis

Brief Scope of Work The agency has to supply professional Doctors, paramedical and nursing staff to run NIFTEM Dispensary on outsourced basis.

Period of Contract Initially one year but extendable further up to 2 more years on satisfactory performance.

Earnest Money Deposit (EMD)

Rs. 1,00,000/- (Rupees One only) in the form of DD, in favour of NIFTEM payable at SBI, New Delhi.

Tender document/ processing charges Non-refundable

Rs. 1000.00 (Rupees One thousand only) in the form of DD in favour of ”NIFTEM” Payable at SBI New Delhi.

Last date & time of submission of Bid

15-12-2016 up to 2.00 PM at NIFTEM Campus, Kundli, Sonepat.

Pre Bid Meeting & Venue 30-11-2016 at 11.30 AM at CRD Meeting Room at NIFTEM Campus, Kundli, Sonepat.

Date & Time of Opening of Technical Bid

15-12-2016 at 3.30PM at CRD Meeting Room at NIFTEM, Campus, Kundli, Sonepat.

Date & time of Financial Bid Opening

Will be intimated to the eligible & qualified Agencies through email/phone. No other mode will be adopted.

Validity of offer 180 days from the date of opening of Bids. Contact person for enquiry Mr S.K. Singh Chandel,

Officer I/c, Dispensary, NIFTEM, Plot No. 97, Sector-56, HSIIDC Industrial Estate, Kundli, Sonepat-131-028(Haryana) Phone: 0130-2281079 Email: [email protected]

1. About NIFTEM

National Institute of Food Technology Entrepreneurship and Management (NIFTEM) is a Deemed–to-be-University under De-Novo category and an autonomous Institution under the Ministry of Food Processing Industries, Government of India. It has been setup by the Ministry as a Rs. 500 crore (US $125 million) project in a sprawling campus of 100 acres plot located near Delhi NCR at Kundli, Sonepat, Haryana as an apex world-class institute of global standards in Food Technology

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Entrepreneurship and Management. The Institute will cater to the needs of various stakeholder entrepreneurs, industry, exporters, policy makers, the government and the existing institution.

2. Mandate of NIFTEM:

NIFTEM would work as-'Sector Promotion Organization' & 'Business Promotion Organization' of the food processing sector. It would be a prime academic institution and offering B.Tech, M. Tech. and Ph D. Programmes in the areas of Food Technology and Management. The Institute has been granted Deemed to be University status under De-novo category under Section 3 of the UGC Act, 1956.

Major Objectives of NIFTEM are -

One Stop Solution Provider Skill & Entrepreneurship Development Facilitating business incubation services with its ultra modern pilot plant Conducting Frontier Area Research Developing world class managerial talent knowledge repository Upgradation of SME Clusters Promoting cooperation and networking

3. Scope of Work:

PART-I(Mandatory)

i) Beneficiaries: Presently Dispensary is providing its services to approximately 900 students,

100 resident employees and their families. Besides, Dispensary also serves to

regular/contractual/ outsourced employees/guests/participants/trainees of different training

programmes etc. Thus, total no. of beneficiaries is around 1500 persons. The number may

increase/decrease with passage of time.

ii) Manpower Supply:

The agency has to provide professionally qualified manpower & services of Doctors, Nursing Staff (Male/Female), Pharmacist (Male/Female), Driver-cum-Attendant (Male) etc. Besides, agency has to also ensure the availability of further staff or any other services, as per requirement. All the staff deployed at Dispensary is required to perform their duties normally at NIFTEM Campus but in case of any requirement or otherwise, they can be asked to attend their duties at any other location, as per requirement. They can also be asked to accompany with patient to nearby hospitals for/during hospitalisation. In that case, they will be paid TA/DA etc or actual expenses, as the case may be, as per Govt. rules & as admissible to their category/status of employees. Time to time, requirement of manpower will be reviewed and decision about increase/decrease will be taken on the basis of assessment & requirement. The qualification and experience of Dispensary Staff may be as under:

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S. No.

Post Qualification & Experience No. of persons

01. Physician (Male-01 Female-01)

The person must have minimum M.B.B.S. Degree from recognised Medical College/Institute and the degree must be approved from MCI.

Preference shall be given to Postgraduate candidates or Diploma in Medicine.

The person should be registered with Medical Council of India. The person must have at least 2 years experience in a reputed

hospital/Nursing Home or having Individual Clinic or individual Practice.

Preference shall be given to retired persons upto 62 yrs) Age Limit- 30-62 Years

02 (Full time)

02. Staff Nurse (Male-02/ Female-01)

The person must have GNM/Diploma in Nursing(3 yrs) from recognized Institute/College or B.Sc.(Nursing) along with at least one year working experience as Nurse or equivalent in Hospital/Nursing Home etc.

The person must be registered with concerned State Nursing Council.

Preference shall be given to retired/short service/armed staff.

Age Limit- 25-50 Years

03 (Full time)

03.

Pharmacist (Male/ Female)

The person must have minimum Diploma in Pharmacy or B. Pharma along with at least 3 years working experience as Pharmacist or equivalent in a hospital/nursing home/chemist shop etc. The person should be registered with State Pharmacy Council.

Age Limit- 25-50 Years

01 (Full time)

04. Driver-cum-Dispensary Attendant (Male)

The person must have passed 8th class. The person must have valid Driving License to run Commercial

Light Motor Vehicle/Ambulance/Light Vehicle Preference shall be given to those persons, who have atleast 3

years experience to drive light motor vehicle/ambulance. Age Limit: 25 -50 Yrs

02 (Full

Time)

III) The Senior most Medical Officer (Doctor) shall be the overall In-charge of the Dispensary

and responsible for managing the affairs of the Dispensary including Medical Services, Ambulance, Housekeeping, Record Keeping. Dispensary etc other affairs whatsoever relating to medical facilities/services at NIFTEM.

IV) Doctor and other staff are required to stay either in the campus subject to allotment of suitable accommodation as per their entitlement and status on monthly prescribed license fee plus electricity charges or any other suitable accommodation subject to availability otherwise they have to make their own arrangement within radius between 5-8 Kilometres, so that in case of emergency, they could reach Dispensary within 15 minutes. In case of non-availability of suitable accommodation to the Nursing & paramedical staff, they can be provided hostel facility on usual charges.

V) Each employee/staff posted at Dispensary has to work at least 7 ½ hrs on all working days(Monday to Friday) & 05 hrs on Saturday. Normally Sunday is closed holiday. Duty hours for Driver–cum-attendant preferably would be 12 hrs in each shifts to ensure the availability of at least one Driver-cum-Attendant all times in the Dispensary. They will work in day and night shifts by rotation.

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VI) The Dispensary is required to run all the six days except Sunday and Gazetted holidays. The Dispensary will be kept closed on Sunday and Gazetted holidays, which are declared by NIFTEM but during these closings, at least one staff and one doctor, will always be available in the dispensary/Campus to attend patients & emergencies. The said staff(except doctor) will be given compensatory off in lieu of working on Sunday and Gazetted holidays.

VII) The Dispensary will be run in two shifts:

Monday to Friday:

Morning Shift 9.00 AM to 1.00 PM and Evening: 5.00 PM to 8.00 PM or 4.30 PM to 7.30 PM Saturday: Morning: 9.00 AM to 1.00 PM

However, these timing can be changed/modified as per need by the administration/Officer In-charge and in campus doctor can be called any time for any emergency.

VIII) The agency has to ensure alternative arrangement of each staff during the leave or when

they are away from the campus beyond 24 hrs. One of the doctor will always available in the campus. In case, only one doctor is employed, then agency will make alternative arrangement during their leave beyond 12 hrs. However, if doctor have some personal work around Delhi or nearby area or wants to leave campus for short period, he may take permission/inform to the Officer I/c concerned and also ensure that atleast one nursing/paramedical staff must be available in the campus/dispensary. Besides, he may also be available over mobile for consultation or any other purposes. There shall be no day, when atleast one nursing staff is not available in the Dispensary/campus.

IX) The patients being referred for hospitalisation should have a valid clinical reasons and the hospital referred as per patient’s choice only. Any unethical or biased referral will be treated as a breach of the contract.

X) While leaving HQ(NIFTEM Campus), Dispensary Staff is required to take prior permission from Medical Officer I/c. Leave of Dispensary staff will be recommended by Medical Officer I/c to Oficer I/c(Dispensary) for sanction after ensuring alternative arrangements. The leave of Medical Officer I/c will be granted by Registrar. However, in case of emergency, he can be permitted to leave the campus after alternative arrangement to attend any emergencies.

XI) The Dispensary has been established to cater the medical-aid to the campus students and employees including their family as there is no proper medical centre in vicinity of NIFTEM. It is only a welfare measure and not a claim. No one including students and employees can claim for its mandatory.

XII) The Dispensary will offer primary treatment and if required, the patient will be referred to nearby Nursing Homes/Hospitals for further treatment by the Dispensary.

XIII) The primary treatment will be extended to all the students, employees including family irrespective of any difference among regular, contractual, outsourced employees. Besides, in

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the case of any emergency, the primary treatment will also be extended to NIFTEM guests and trainees etc or as directed by the NIFTEM authorities.

XIV) Every patient, seen in the NIFTEM Dispensary as OPD patient will required to be entered in an OPD Register and thereafter medicines will be dispensed maximum 1-3 days for a particular disease at a time as per their illness, as the case may be. The doctor is required to examine patients and prescribe medicines. In absence of doctor, dispensary staff in the case of any emergency, after consultation with doctor will prescribe/dispense medicines to the patients. If required, they will be referred to nearby nursing homes/hospitals.

XV) A treatment register shall be maintained by the agency indicating type of treatment given and medicines/consumables consumed every day along with the identity and details of the patients. Signature of recipient of treatment shall be obtained for each case.

XVI) The agency will require to maintaining Institute Pharmacy/medicines stock to provide the same to the beneficiaries/users. At a time, maximum 3 days treatment would require to be given on the advice of Medical Officer. Accordingly monthly stock will be maintained by Pharmacist/Nurse concerned. The Pharmacist will work out medicines/surgical requirements for next 6 months well in advance and put up on file through Medical Officer for approval. After approval the Medicines will be purchased either through agency or local purchase committee of NIFTEM by due procedure as laid down in GFR. At no stage, expired medicines will be kept in the Dispensary. Medicines required for VAP, First Aid Boxes at Hostels, laboratories, admn. Office or any other outdoor events shall be provided by the Dispensary. While purchasing medicine, it should be ensured that medicines must have at least six months to one year validity period.

XVII) Every month, Pharmacist will prepare monthly stock position and put up it to Medical Officer. The Medical Officer will verify the stock and indicate excess/shortfall, if any otherwise sent its report to Officer I/c(Dispensary), every month for information. The stock verification report would be signed by Pharmacist concerned and countersigned by Medical Officer. On every quarter, Accountant alogwith Officer I/c(Dispensary) will carry out physical inspection of Dispensary including medicines/stock to ascertain shortfall/excess of any item and smooth functioning of Dispensary. This is to be made to ensure to maintain transparency and to avoid any malpractices.

XVIII) The monthly expenditure on medicines, surgical etc items would be between Rs25,000 to 50,000/-. This can increase/decrease subject to actual requirement. The No. of beneficiaries will also increase/decrease in future.

XIX) Supply of Branded and Generic Medicines/Surgical/Toiletry proprietary items as required for Dispensary time to time. The supply has to make against NIFTEM’s Supply Order only.

XX) The agency has also to maintain First-aid Boxes at all the Hostels, Admn. Block, Labs or wherever required including refilling of these boxes.

XXI) Though, Dispensary is having all required tools and equipment. However the agency‘s doctors should have their own stethoscope and BP instrument.

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XXII) In case of emergency, the driver alongwith ambulance can be parked or asked to proceed to nearby hospitals or as directed by NIFTEM administration.

XXIII) The staff deployed at Dispensary should be capable to stitching on small wounds/injuries; therefore agency must have sterilization facility of the equipment.

XXIV) Besides, the agency will maintain all the tools and equipment. The agency will also assist NIFTEM to fill oxygen cylinders.

XXV) In the case of emergency or requirement as communicated by NIFTEM administration, the agency will extend support/facilitate in primary treatment/check- up/investigations or hospitalization etc. at nearby or any empanelled hospital/nursing homes, which are covered under cashless policy as purchased through Insurance Agencies.

XXVI) The Institute have already purchased Medical Insurance Policies for their staff members including their families and students, therefore the agency is required to make efforts to have a Tie up with nearby Hospitals/Nursing Homes(Sonepat/Narela/Rohini, Shalimar Delhi etc), where cashless treatment could be available in the case of emergency. The Institute patients will preferably referred to these hospitals in the case of requirement or emergency. These hospitals may be asked to extend OPD/IPD treatment, laboratory investigations, radio-diagnosis, physiotherapy, surgeries, minor and major procedures etc on preferably CGHS rates or discounted rates.

XXVII) The Institute has already purchased cashless policy for staff and their families and students, therefore, Institute will not take any responsibility of payment of any patient except in those cases, where Institute authorities has permitted for hospitalisation. In this regards, written order from the competent authority to be obtained.

XXVIII) The agency will ensure tie-up with reputed and certified pathologies like Lal Pathology etc. for Laboratory Test of students and employees. Under tie-up, there should be provision for collection of samples from NIFTEM Campus alongwith home delivery of report.

XXIX) The Agency will make arrangements to organise free Health Check-up camps in the Campus on weekly holidays(10.00 AM to 5.00PM), wherein doctors(Eye/Dental/ Physician etc) may be invited along with pathology services. During the camp, free check up and limited free investigations like Blood Sugar(F/PP), BP, Weight etc will also be arranged by the Agency. The invited doctors will be paid Rs. 2500/- as sitting charges for half day(4 hrs) and Rs.5000/-for full day(beyond 7 hrs).

XXX) To assist in Blood Donation Camp etc should be arranged periodically with the help of Red Cross/Rotary Club/District Hospital etc or through any other Blood Camp.

XXXI) In case of requirement, the agency will be providing Ambulance Services on payment basis. The chargeable mileage will start from NIFTEM Dispensary(Kundli) + 5 KM extra for any location. The driver shall possess appropriate valid driving license and all other requisite documents of the Ambulance including pollution control certificate, insurance cover note etc.

Approved Final Tender of Outsourcing of NIFTEM Dispensary

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XXXII) In the case of any untoward incidence/accident or requirement, the agency will also provide more manpower to the Institute on the approved rates.

XXXIII) The agency will also ensure that in case of requirement of any male/female attendant to take care of patients (especially students and Staff) in the hospital/nursing home for short duration or until their family members are not arrived to take care of patient. The existing staff deployed at Dispensary will take care of such patients or as directed by the administration.

XXXIV) Medical examination of Female Patients by Male Doctor or male staff cannot be carried out (unless it is an emergency) without presence of a female staff or patient’s attendant.

XXXV) Handling of Bio-Medical Waste: Safe disposal of all kind of Bio-Medical Waste for instance

used materials along with swabs; syringes etc. shall be the responsibility of the Agency to the

satisfaction of the Officer-In-Charge (Dispensary). Records thereof shall also be maintained

by the agency and the same shall be got checked by Officer-In-Charge tri-monthly. Moreover,

agency must have a legal agreement with any contractor / company / firm which holds a

valid license for safe disposal of Bio-Medical Waste as per the provisions of Law OR the firm

/ hospital itself lawfully holds such license. No payment shall be made to the contractor /

contractor on account of that. Besides, in Health Centre, the agency shall keep Bio-Medical

waste in three different dustbins of different colours as prescribed under Law. Any laxity in

handling of Bio-Medical Waste shall warrant termination of contract forthwith.

PART-II(OPTIONAL)

SUPPLY OF MEDICINES TO THE DISPENSARY

I. The agencies, which are capable and having valid drug license and willing to supply medicines to the NIFTEM Dispensary time to time on placing work orders, may participate in the bidding process. The supply is required to make within 7 days and in some cases within 3 days as per requirement.

II. The supply should be made of only of those medicines/surgical/toiletry products, which are

ordered.

III. Any kind of inferior supply, unordered items, short supply, duplicate, under quality will be rejected forthwith and will not be considered in any manner. The payment of such items will also not be paid besides imposing penalties. The quality will be certified by Pharmacist and countersigned by Doctor.

IV. The payment will be made within 15 days after the submission of bills. All the items should be as per work order.

V. In case, the discount structure offered by the agencies is found below to our expectations (as being obtained while retail purchasing), negotiations, if required, will be made. Despite of

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negotiations, it is not necessary to award this work to any agency on the ground of fewer discounts. In this regards, decision of the Institute shall be final.

VI. Interested agencies may quote discount on MRP at Annexure-III-B(Optional) (Financial Bid format). This is optional section.

4. Facilities provided by the Institute

I. The Institute will provide sufficient space for running the Dispensary on free of cost along

with water and electricity facilities. The agency not needs to pay any charges for electricity

and water.

II. The present Dispensary equipment will be utilized by the Agency & is required to maintain

it properly at their expenses. On the expiry of contract, the agency have to hand over them

in working condition except those which are consumable nature or those having limited life.

III. The Dispensary is having Split AC, Ceiling Fans, Blowers, Geyser, lighting and furniture etc.

The Dispensary is also equipped with all required tools and equipment as required to run

the Dispensary smoothly. The bidders are advised they must visit to the Dispensary before

submitting their application/tender.

IV. The Institute Ambulance will also be given to the Agency and the same will be properly

maintained by the Agency and expenditure towards Driver, fuel, insurance, pollution,

servicing and maintenance will be borne by the Institute.

V. All the Dispensary staff are entitle for one day weekly off and it will be preferably on Sunday

or any other day as prescribed by the Officer I/c(Dispensary). Besides, they will also be

entitled for Casual leave and restricted holiday as applicable to the NIFTEM employees.

5. Eligibility Criteria

a. The Agency/Hospital/Nursing Home must have at least one year similar experience of running

Dispensary/Clinic/Poly Clinic/Nursing Home/Hospitals etc. Besides, the agencies/ Hospital/Nursing homes, those having experience in supply of professional doctors and Paramedical staff are also eligible.

b. The agency must have at least one such project, where agency is supplying professionally qualified manpower to run their unit (Clinic/Dispensary/Hospital/Nursing Home etc).

c. Average Annual financial turnover during last 3 years, ending 31st March of the previous financial years, should be at least Rs.25,00,000/-(Twenty Five Lakh only) per annum. Certificate issued by Chartered Accountant, duly supported by Balance Sheet and Profit & Loss Accounts should also be enclosed.

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d. The agency must be propriety firm/partnership firm/Private Limited/NGO etc. to run the

business. Copy of such documents must be enclosed.

e. The agency/hospital/nursing home must have registration/valid license with the appropriate authority to run Hospital/Nursing Home or such medical services. Copy of the same should be enclosed.

f. The agency may have valid drug license to sale, purchase, supply of medicines on retail/wholesale basis, duly issued by Drug Controller, if they are interested to supply medicines. Copy of the same should be enclosed.

g. The bidder must submit the copies of ITRs & Audited Annual Report (Balance Sheet and Profit

& Loss Accounts) for last three years along with the technical bid(2013-14, 2014-15, 2015-16).

h. The Agency/bidder is required to submit experience Certificate/Work orders or certificate on letterhead from their previous and current clients pertaining to their services and performance.

i. The Institute, at their discretion, may send a team of officers to any of the site(s) of bidders, without prior information to check their suitability, work, performance and professionalism.

j. The bidder should have PAN (Permanent Account Number)/TAN and Service Tax Registration

Number as applicable in the medical profession. Kindly submit a copy of PAN/TAN and Service Tax Registration number if any , as applicable in their case.

k. The agency must be registered under the Income Tax Act.

5. Tender Processing Fee: Rs 1,000/- (Non-refundable) is required to submit along with technical documents in the form of demand draft in favour of NIFTEM, payable at New Delhi, which will be non refundable.

6. EMD: The bidders/Agency are required to submit an EMD of Rs. 1,00,000/- (Rupees

One Lakh only) (Refundable) toward the work, in the form of demand draft in favour of NIFTEM, payable at Delhi. The EMD shall be forfeited in case:-

If the Bidder withdraws or amends, impairs or derogates from the tender in any respect within the period of validity of this tender.

If the bidder having been notified of the acceptance of his tender by the Buyer during the period of its validity,

If the Bidder fails to furnish the Performance Security for the due performance of the contract within reasonable period including prescribed period.

If the Bidder fails to sign the agreement within prescribed period. Fails or refuse to execute the contract. Fails to respond to queries by the NIFTEM.

Approved Final Tender of Outsourcing of NIFTEM Dispensary

Signature of Tender

11 | A p p r o v e d T e n d e r f o r o u t s o u r c i n g o f D i s p e n s a r y 1 7 t h N o v e m b e r , 2 0 1 6

7. Release of EMD/Performance Security- The EMD of unsuccessful bidders will be returned

immediately after the award of work. However, EMD of successful agency will only be

returned after submission of performance security in the form of DD/bank guarantee within

30 days from the issue of work order and in case of Bank Guarantee it will be returned only

after verification from the bank.

8. Bidding Procedure

Bidding Application must be accompanied by the following:-

i. Technical Bid on the Tender document appearing at Annexure- I duly filled in, signed and

stamped along with following documents.

ii. Earnest Money Deposit (EMD) & Tender document Fee (non-refundable) as specified in the form of Bank Drafts (cheques are not accepted) drawn in favour of NIFTEM payable at Kundli/Delhi from SBI.

iii. Proof of permanent address.

iv. Proof of Registration of Firm

v. Proof of Registration to run similar business

vi. Proof of Drug License

vii. Proof of Propriety/Partnership/Private Ltd/Public Limited/NGO

viii. A complete list of clients with details of services. In this regards, please enclose detailed work orders/certificates describing the services being given/provided to those organisation.

ix. Details of Bank Account of Agency i.e Account No., IFSC Code, MICR No., Bank Name and address. Copy of passbook or bank statement duly signed by bidder to be attached.

x. Copies of Audited Balance Sheet, profit and Loss Acc. and Income Tax Return of last 3 years.

xi. Details of PAN/TAN/Service Tax Registration number/ ESI & EPF No, as applicable.

xii. An authorisation letter in favour of the person signing the Tender documents. If not signed by the Proprietor/Partner/Director.

xiii. An attested copy of the certificate of registration/incorporation pertaining to the legal status of the bidder.

xiv. Tender document with Annexure-II, Annexure-III(Financial Bid), Annexure-III B(Financial Bid-Optional) duly signed and stamped on each page as acceptance of the

Approved Final Tender of Outsourcing of NIFTEM Dispensary

Signature of Tender

12 | A p p r o v e d T e n d e r f o r o u t s o u r c i n g o f D i s p e n s a r y 1 7 t h N o v e m b e r , 2 0 1 6

terms and conditions laid down by NIFTEM authority, otherwise it will be treated as incomplete submission and consequently tender will be rejected out rightly.

xv. The bidder should furnish an undertaking to the effect that the firm has not been black listed in India or abroad by any government department/agency in the attached Performa. (Annexure – IV).

xvi. Technical & Financial Bids should be kept in a separate envelopes and sealed properly and super scribed as “Technical/Financial Bid Selection of an agency for running NIFTEM Dispensary on Outsourced basis” and the sealed covers be put in a bigger sealed envelope and duly super scribed in block letters as shown below:

“TENDER FOR ” Selection of an agency for running NIFTEM Dispensary on Outsourced basis” and it should be addressed to the “Registrar, National Institute of Food Technology Entrepreneurship and Management, Plot No.-97, Sector-56, HSIIDC Industrial Estate, Kundli-131028, District-Sonepat (Haryana)”. Tender should be dropped in the Tender Box or submitted to the NIFTEM, Reception or through registered post. Only one Tender should be included in one cover. Incomplete Tender will not be entertained and summarily rejected.

xvii. Opening of sealed Tenders will take place as per above schedule in the “Meeting Room,

National Institute of Food Technology Entrepreneurship and Management, Plot No.-97, Sector-56, HSIIDC Industrial Estate, Kundli-131008, District-Sonepat (Haryana)”in the presence of the representatives of the firms/Bidders, who may wish to be present at that time. No separate intimation will be sent to the firms/Bidders in this regard. In case of any change in the opening schedule of bids, the same will be notified at our website. The agencies may see our website.

xviii. The Institute will not be responsible for any delay or postal delay.

9. Validity of tender The Tender will be valid up to 180 days from the date of technical bid.

10. Clarification on bid document/work: Bidder requiring any clarification to this tender

shall notify to Institute in writing who will respond (in writing) to the clarifications sought

not later than 14 days prior to the date of opening of tender. The address and contact no. For

seeking clarifications regarding this tender are given below.

Shri S.K. Singh Chandel,

Assistant Registrar/In-charge(Dispensary)

NIFTEM, Kundli Sonepat(Haryana) 131028

0130-2281079, Mobile No. 9215611973 email: [email protected]

11. Evaluation Procedure:

Approved Final Tender of Outsourcing of NIFTEM Dispensary

Signature of Tender

13 | A p p r o v e d T e n d e r f o r o u t s o u r c i n g o f D i s p e n s a r y 1 7 t h N o v e m b e r , 2 0 1 6

i) The Technical Bids will be scrutinized based on eligibility criteria as indicated in the

tender document.

ii) Technically qualified agencies will be called for PPT Presentation (10 Minutes) on the

date and time, as communicated to them through mail/phone, before a duly constituted

Technical Evaluation Committee. Their PPT should be consisting of 3 parts, first part

should be introduction of the agency, strength, services being provided/carried so far,

experience, financial soundness, second part should have information, coloured

photographs or video clippings(Maximum 3 Minute) about those

sites/hospitals/nursing homed/dispensary, where agency is providing their services

and third part should have strategy to run NIFTEM Dispensary at NIFTEM and value

added ideas to raise the general health of campus residents. Agencies are also required

to submit a hard copy of their presentation (preferably hard /spiral bounded.

The PPT Presentation/Performance will be assessed on the following parameters:

How old agency (2 marks for

each completed years but maximum 10 marks) (Enclose

proof)

Is agency/ Hospital

/ Nursing Home is

Regd. Partners

hip Firm/

Pvt Ltd/Ltd

firm. (Enclose

proof)

Is agency/ Hospital/ Nursing Home is

registered with

appropriate authority

with a valid license to

run the Hospital/ Nursing House/ Medical Services (Enclose

proof)

If agency owner/

Directors/ Partners & associate

team members are

qualified professional

doctor. (2 Marks for each such associated

persons but maximum 10

marks) (Enclose a

copy of valid salary

proof(Bank))

Is agency has

established any

Dispensary/ Nursing

Home/ Clinic/

Hospital during last 5 years (5 marks for such each unit but

maximum 20 marks) (Enclose

proof)

If agency is running any

Clinic/ Polyclinic/

Dispensary/ Day Care/ Hospital/

Nursing Home by providing Professionals

(+5 Nos.) (5 Marks for

each such units but maximum 20 marks for

each such units).

Annual Turn Over during 2014-15 or

2015-16 ( > 25 Lakh -

2 marks, > 50 Lakh up to 99 Lakh- 4

marks, >1 Crore up to 2 Crore- 6

Marks, >2.1 Crore up to 3

Crore- 8 marks, 3.25

Crore or above -10

marks)

1 2 3 5 6 7 8 10 10 10 20

20 20

10

Note: The agency has to enclose documentary evidence, if claiming for above

parameters otherwise marks will not be given.

iii) The Institute may send an Officer or a team to those sites/Hospital/Nursing, which is being

run by the Agency/Hospital/Nursing Home to assess their capability, quality of work &

suitability to the requirement. This will also be taken in to account while selection.

iv) Financial Bids Opening: The financial bids (Annexure-III) (Annexure-III-B-Optional) shall

be opened only of those agencies, which full fills the prescribed eligibility criteria and scored

Approved Final Tender of Outsourcing of NIFTEM Dispensary

Signature of Tender

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minimum 50 % marks in the above assessment. Annexure-III-B is Optional for those

agencies, who are interested to supply medicine during the contract period.

v) Normally, deviation shall not be allowed in the eligibility conditions. However, in case of

deviation of taxes etc., the same will be borne by the bidder and shall not be reimbursed.

10. The award of work: The selection of the Agency will be made on the basis of L1 (Lowest

quote) rates for Agency Charges. In case of tie between the agencies, the work will be

awarded to that agency whose financial turnover would be high.

11. PRE-BID MEETING: In case, after pre-bid meeting (wherever applicable) any

modification(s)/addition(s)/deletion(s) or any alternation in the requirement(s)/

specification(s)/ condition(s) etc, the same will be placed only on NIFTEM’s website- www.

niftem.ac.in, therefore all the bidders are advised to visit our website before filling their

Tender. Corrigendum/addendum in respect of this Tender, if any, shall only be uploaded

at NIFTEM’s website and shall not be advertised in the newspapers. All the prospective

bidders are advised to keep themselves updated for such corrigendum before

submitting their tender. The bidders are advised to be in touch our website regularly.

In this regard, the Institute will not be responsible in any manner.

12. General Term & Conditions

1. The bidders may modify or withdraw their bid after submission provided that the written

notice of modification or withdrawal is received by the buyer prior to the deadline

prescribed for submission of bids. A withdrawal notice may be sent by fax but is to bne

followed be a signed conformation copy be post not later than the deadline for submission of

bids. No bid may be withdrawn in the interval between the deadline for submission of bids

and expiry of the period of specified bid validity. Withdrawal and modification of bid during

this period will result in forfeiture of bidder’s bid security.

2. The Agency have to enclose Tender fee and EMD as mentioned above, failing which Tender

will not be accepted. Later date Tender fee or EMD will not be considered in any form. In

case of Tender is not processed due to any reason or cancelled, EMD will be refunded within

30 days after such decision.

3. If the agency is registered with MSME/NSIC/DIC/ or any other appropriate Govt. authority,

where the Govt. has granted some exemptions to such units and if the agency is claiming for

any exemption, is required to submit relevant documents/Govt. orders alongwith tender. In

such cases, only EMD will be exempted but not tender processing fee & Performance

Security.

Approved Final Tender of Outsourcing of NIFTEM Dispensary

Signature of Tender

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4. Unless exempted specifically, tenders not accompanied with the prescribed EMD/Cost of

Tender shall be rejected. EMD/Cost of Tender shall be in the prescribed mode of payment as

asked in the NIT, otherwise, the tender shall be liable to be rejected.

5. The bidders /agencies shall observe the highest standards of ethics during the submission of tender, procurement and execution of the contract. In case of evidence of cartel formation by the bidder(s) EMD is liable to be forfeited.

6. Person signing the bid or other documents connected with Tender must clearly write

his/her name and specify the capacity in which signing.

7. Before submitting the filled in Tender document to the Institute, the bidders may seek

clarifications, if any in Pre Bid Meeting or by visiting on any working day. They can meet

Officer I/c(Dispensary) also.

8. The Institute reserves the right to modify any condition of the Tender before opening of the

Technical Bids.

9. No agency will be allowed to alter or revoke the bid after opening of the bids and during the

validity of tender. The EMD of agency may be forfeited, if the agency withdraws or amends

or deviates from the Tender in any respect.

10. The authorized representative of the NIFTEM reserves the right to enter and inspect the

Dispensary at any point of time.

11. The Institute reserve the right to cancel/reject full or any part of the tender without

assigning any reason.

12. Every payment made to the Contractor shall be subject to deduction of tax at source and

other taxes as applicable form time to time.

13. Acceptance of the Tender will be intimated to the successful agency through work order duly

signed by the authorized signatory of the Institute.

14. In case of interpretation, modification and any alteration with respect to terms & conditions

the Institute, successful agency will jointly look into such aspect and the decision of the

competent authority will be final and binding to agency.

15. Period of Contract: The selection of agency will be initially for a period of one year but can

be extended further to the maximum up to 2 more years based on satisfactory performance

and mutual consent. Further extension will be decided by NIFTEM.

Approved Final Tender of Outsourcing of NIFTEM Dispensary

Signature of Tender

16 | A p p r o v e d T e n d e r f o r o u t s o u r c i n g o f D i s p e n s a r y 1 7 t h N o v e m b e r , 2 0 1 6

16. The Agency will deploy Medical Officers & other paramedical staff in White Apron and

Ambulance Drivers-cum-Attendant in White Uniform (Pant-Shirt). The Doctor, Nursing Staff

will must wear Apron while duty. The expenditure will be borne by the agency.

17. The Medical Officer of the Agency will prepare and send a monthly duty roster for Medical

& Paramedical staff to Officer I/c(Dispensary) for approval. After approval, its copies will be

issued to all concerned for implementation. The duty roster can be changed from time to

time depending upon the need of the NIFTEM management and proper substitute shall be

engaged in case of leave of Medical Officer & staff.

18. The agency shall produce attested documents of Medical Officer & other paramedical staff

before deployment to Officer-in-Charge for consideration of their eligibility. The agency will

also carry out police verification of all their employees deployed at NIFTEM Dispensary at

the cost.

19. The Ambulance shall be equipped with the following items :

i) Oxygen Cylinder with complete attachments. ii) B.P. Apparatus, iii) Stethoscope, iv) Gloves (Disposables) & Cotton, v) Suction Catheters, vi) Disposable syringes, vii) Intra Venus (I / V) Sets, viii) Adhesive Tapes, ix) Cannulas, x) 10 nos. wooden Splints of various sizes, xi) 12 nos. Bandages (size- 10 cm x 4 meter) etc.

Besides, the following tools / medicines also required to be in the Ambulance all the time:

i) Apparatus Trey ii) Adequate quantity of Anti Tetanus (To be carried along whenever carrying

patient), iii) Injection Atropine, Adrenaline, Coramine, Nevocam, iv) Crocin Liquid (60ml), v) Tablets Antihistamine, Antispasmodic, vi) Syringes with needles – 2cc, 5cc, 10cc, 50cc, vii) General Medicines like PCM, Antibiotic, Painkiller, Antacid preparation, Eye Drop,

etc.

20. The agency will execute a Contract agreement on non-judicial stamp paper of Rs.100/-

within 30 days from the issue of work order. The cost of Stamp Paper will be borne by the

agency. The draft of agreement will be shared by the agency on the basis of tender

Approved Final Tender of Outsourcing of NIFTEM Dispensary

Signature of Tender

17 | A p p r o v e d T e n d e r f o r o u t s o u r c i n g o f D i s p e n s a r y 1 7 t h N o v e m b e r , 2 0 1 6

documents describing various clauses of agreement. The agreement will be signed by

authorised person of the agency and Registrar, NIFTEM. Until the execution of proper

contract agreement, the clauses mentioned in the tender document and Work

Order/LOI shall constitute contract agreement between both parties (Agency and

NIFTEM) for all kind of differences/dispute/arbitration/ legal purposes.

21. The quoted agency charges will not be changed during the entire contract, however, if any

revision of salaries of the Doctor, Paramedical Staff, and Nursing staff, will be considered.

22. If at any stage it has been found that electricity or water have been misused, the agency will

be fined appropriately and may result in tentative/cancellation of permission.

23. The agency will be paid/reimbursement towards the purchase/consumption of Medicines,

Surgical items etc. subject to production of bill/cash memo/proof of purchase and stock

entry. The consumption/stock entry must be signed by concerned Medical Officer I/c and

countersigned by Officer I/c(Dispensary).

24. Repairing and maintenance as well as cost of spare of any tools & equipments, will be borne

by the Institute.

25. All kind of records, registers etc will also be maintained by the Agency at their expenses but

that shall be property of NIFTEM for all purposes. NIFTEM will provide stationeries to the

Dispensary.

26. The Doctor/Medical Officer I/c or Dispensary staff will not issue any Medical Certificate

regarding bed rest/complete rest/location change etc to Students & Staff normally beyond 3

days, on actual requirement basis. In case, any students/employees asked for the same, the

patient may be referred to the nearby hospital/nursing home/Govt. Hospital to obtain the

same.

27. The Doctor/Medical Officer I/c or Dispensary staff will not do medico-legal examination or

issue any Medical Legal Certificate to any patient until/unless, they are directed by the

Competent Authority.

28. The Doctor/Medical Officer I/c or Dispensary Staff shall comply all the medical ethics

strictly, as required in the profession. They will not leak any record, patient details, disease,

illness, treatment given etc to anyone otherwise it will be breach of contract. In this regards,

Govt. policies should be adopted strictly.

29. The Agency has to make their own arrangement for stay of their workforce nearby area as

the Institute is not having any such facility.

Approved Final Tender of Outsourcing of NIFTEM Dispensary

Signature of Tender

18 | A p p r o v e d T e n d e r f o r o u t s o u r c i n g o f D i s p e n s a r y 1 7 t h N o v e m b e r , 2 0 1 6

30. The agency staff shall work under supervision, direction, and overall administration of the

Agency, who will be subsequently responsible/assumable to the Institute nominated person.

31. The Agency shall not engage or appoint any sub Contractor or transfer the contract to any

other person in any manner to carry out his obligations under the contract.

32. The Agency as well as Dispensary Staff will take initiatives to maintain eco-friendly and

disease-free environment in the campus. Besides, the agency will engage adequate number

of personnel as per the requirement and high standards of campus and will also time to

initiatives for fogging, spray etc to control mosquitoes, insects etc. The Medical Officer I/c

will issue time to time cautions/awareness to save from diseases.

33. NIFTEM reserves the right to call upon the agency to remove any person employed working

in the NIFTEM Campus, if found unsuitable for services because of conduct or any other

administrative reasons. NIFTEM reserves the rights to disallow the person not having the

identity card.

34. The agency has to carry out Police verification of each worker/employee at its risk & cost.

35. The Agency will ensure the disposal of Medical waste/Biomedical Waste at designated place

at their own cost and risk.

36. The agency shall be responsible for engaging adequate number of trained/semi-trained

manpower required.

37. The employees of the agency should possess good health and should be free from any

diseases, especially contagious and frequently recurring diseases.

38. The agency will, prior to the commencement of the operation of contract, make available to

NIFTEM the particulars of all the employees who will be deployed at the Institute’s premises.

Such particulars, inter alia should include age/date of birth, Photo, fingerprint, permanent

address, police verification report and profile of the health status of the employees.

39. In the case of extension beyond one year of those workers, who does not cover under

Minimum wages, will be entitled for 10% increase in their wages annually subject to

satisfactory performance and on completion of twelve months continuous working. The

performance will be assessed by the Institute linked with their duties and performance.

40. The agency shall ensure proper discipline among his/her workers and further ensure that

they do not indulge in any unlawful activity.

Approved Final Tender of Outsourcing of NIFTEM Dispensary

Signature of Tender

19 | A p p r o v e d T e n d e r f o r o u t s o u r c i n g o f D i s p e n s a r y 1 7 t h N o v e m b e r , 2 0 1 6

41. The agency shall be personally responsible for conduct and behaviour of his staff and any

loss or damage to Institute’s movable or immovable property due to the conduct of the

agency’s staff shall be made good by the agency. If it has been found that the conduct or

efficiency of any person employed by the agency is unsatisfactory, the agency shall have to

remove the concerned worker/person and engage a substitute within 48 hours under

intimation by NIFTEM.

42. Employment of child labour is strictly prohibited under the law. Therefore, the agency will

not employ any child labour.

43. The staff shall be issued identity cards bearing photographs by NIFTEM. The agency shall

provide sufficient sets of uniforms to their workers and shall ensure that they may wear

them all times and maintain properly.

44. NIFTEM management have right to inspect the services. Any shortcomings pointed out by

such officials during their visits shall be properly attended to by the agency.

45. The agency has to extend one paid weekly off to Dispensary Staff. The wages/salaries shall

be worked out on the working of 26 days in a month. The daily rate will be worked out on

the basis of 26 days working = full wages. Each employee will be given one day paid rest

either on Sunday or any other day, as decided by NIFTEM. In case, any employee is called for

extra duty on rest day due to any exigencies, the said employee will be given rest on any

other day.

46. Each Dispensary Staff will be entitled for 8 days paid holidays including 3 national holidays.

These 8 holidays will be those days, when NIFTEM will also be closed on account of Gazetted

holiday. These gazetted holidays will be (1), Independence Day, (2) Republic Day, (3) Holi,

(4) Gandhi Jayanti, (5) Dushara (6), Deepawali, (7) Id-ul-fiter/Id and (8) Christmas.

47. The agency has to ensure 100% manpower availability on all the working days. In case of

short fall beyond 25 % or more staff continuously 3 or more days, appropriate deduction or

maximum @ Rs.250/- per person plus wages of absent employee(s) can be deducted. The

Officer I/c(Dispensary) will impose this penalty at their discretion.

48. The agency may deploy adequate work force on Saturdays/Sundays including other

holidays, according to the requirement of the Dispensary.

49. The staffs have to perform duties in shifts and therefore should be rotated on regular

intervals.

50. Timing of Dispensary:

Approved Final Tender of Outsourcing of NIFTEM Dispensary

Signature of Tender

20 | A p p r o v e d T e n d e r f o r o u t s o u r c i n g o f D i s p e n s a r y 1 7 t h N o v e m b e r , 2 0 1 6

Monday to Friday- Morning: 9.00 AM to 1.00 AM Evening: 5.00 to 8.00 PM or 4.30

7.30 PM.

Saturday : Morning 9.00 AM to 1.00 PM(5 hrs) Weekly holiday will be provided by the

agency as per Shop and Establishment. Working hours may vary including shift duties

depending upon the requirement. The agency will follow time schedule as provided by the

Officer In-charge (Dispensary).

51. No inexperienced staff shall be allowed to put on job by the Agency, if found unfit to work, he

will not be allowed to work in the Campus.

52. Storing/Supply/Sale and consumption of drugs, alcoholic drinks, cigarettes or any other

items of intoxication are strictly prohibited in the Institute’s campus. Any breach of such

restrictions by them will attract deterrent action against the agency as per statutory norms.

53. The workers employed by the agency shall be directly under the supervision, control and

employment of the agency and they shall have no connection what so ever with NIFTEM.

NIFTEM shall have no obligation to control or supervise such workers or to take any action

against them except as permissible under the law. Such workers shall also not have any

claim against NIFTEM for employment or regularization of their services by virtue of being

employed by the agency against any temporary or permanent posts in NIFTEM.

54. The Institute authorities can inspect any time the Area and if any irregularities are found,

appropriate penalty can impose upon the agency.

13. Performance Security

i) The successful agency has to submit a Performance Security @ One Lakh within 30 days of

issue of letter of work award & latest by the date of submission of 1st monthly bill. The

performance security can be submitted either in the form of DD or Bank Guarantee(in the

form of DD upto Rs5,00,000/-). The format of Bank Guarantee is available at Annexure-V.

Until submission of Performance Security, the EMD amount will retain, but in case of delay

beyond three month, the EMD amount will be forfeited. However, in this regard, decision of

the Competent Authority shall be final & binding on both the parties.

ii) Release of performance Security- On expiry of contract, the Performance Security as the

case may be, will be returned without interest, after completion of all contract obligations

within 60 days.

14. Penalty Clause

Punitive measures as delineated hereunder shall be initiated for non conformities:

Approved Final Tender of Outsourcing of NIFTEM Dispensary

Signature of Tender

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i) In case of continued/repeated non compliance of roaster, penalty of Rs.100/- shall be levied

on each exposure. Besides, the Officer I/c(Dispensary) reserves the rights to take any more

stringent action against the agency .

ii) There shall be pro-rata deduction for any wilful absence of Medical Officer & Paramedical

Staff.

iii) Oxygen Cylinder filled with Oxygen OR any other prescribed required in Ambulance/

Dispensary is not found available in good working condition, a penalty of Rs.100/- shall be

imposed on each occasion.

iv) Misbehaviour by any of the agency staff shall cause penalty as deemed appropriate by

Officer I/c(Dispensary). It can be financial/non financial /both.

v) The time schedule should be strictly followed by the agency. If the services are not made

within stipulated time/dates, penalty will be imposed as deemed fit in the circumstances.

vi) No employee of Agency will use drugs, alcohol or any other toxic substance, cigarette, Bidis,

Pan, Masala etc, if found, appropriate penalty will be imposed on the agency.

vii) The agency will ensure the statutory compliance of Minimum Wages Act, Haryana, Contract

act, Labour Act and any other act, which are applicable in the business strictly.

viii) No employee of Agency should be found without uniform etc failing which appropriate

penalty will be imposed upon the Agency.

ix) If any complaint, lapses, irregularity etc found, appropriate penalty will be imposed upon

the agency. The agency will ensure appropriate disposal of Medical Waste.

x) If agency or their employee found quarrelling, misbehaving with any officer, employee,

students, visitors or involved in any anti social activity, besides penalty, appropriate action

will be also taken against the agency.

xi) The agency will ensure that their employees do not shout/ abuse /play loudly

music/movie/news on mobile or tape or radio or FM, failing which attract penalty

provisions.

xii) In the case of repetition of any act, misconduct, heavy penalty and any other action as

deemed proper will be taken against the Agency or guilty.

Approved Final Tender of Outsourcing of NIFTEM Dispensary

Signature of Tender

22 | A p p r o v e d T e n d e r f o r o u t s o u r c i n g o f D i s p e n s a r y 1 7 t h N o v e m b e r , 2 0 1 6

xiii) If the agency fails to carry out the maintenance work as per requirements or despite of

verbal cautions, notices, reminders, suitable penalty for the same, as deemed proper in each

occasion will be imposed.

xiv) If the agency’s staff absents beyond 25% or more continuously 3 or more working days, a

penalty of maximum Rs.250/- per staff will be imposed besides deduction of wages of the

concerned manpower for absent days. However, before imposing, the agency will be

warned. The agency can also be panelised, if the absenteeism is frequent.

Penalty Chart

S.No. Reasons of Penalty Penalty details 01 Late coming on

duty 1ST time-Verbal caution. 2nd time –Verbal Caution. 3rd time – penalty of Rs. 50/- + extra working. 4th time – penalty of Rs. 250/- Frequently- discontinue from duty/campus

02. Without Uniform New employee will be allowed to come on duty without uniform, failing which a fine of Rs. 50/- will be imposed on each occasion.

03. Indiscipline case In case of quarrelling, abusing, using non-parliamentary language, shouting, misbehaving, disobeying the instruction, threatening, etc. 1st occasion- verbal warning or penalty of Rs. 500/- on the gravity of incident. 2nd occasion- Written Warning + Rs.1000/- 3rd occasion- Dismissal from the services/campus.

04. Smoking and intoxication

a. Tobacco chewing, bidis, cigarette, pan masala chewing etc. – Rs. 100/- for each occasion.

b. Under influence of liquer, drugs, ganja, afeem etc. While duty – dismissal from duty/campus.

05. Carelessness in the work

c. Unwilling to work/absent from duty place/ Playing cards or any other such activity -Rs. 50/- or more upto Rs. 500/-, as the case may be, will be fined for each occasion.

Note: the above chart is only indicative.

15. The Payment of wages and salaries:

1. The Agency will pay the wages & salaries to Dispensary Staff on or before 7th of the following

month as per approved rates but not less than minimum wages at prevailing rates.

2. There is no linkage between payment of wages & salaries and payment of bills. Therefore, agency will be make payment first to Dispensary Staff and then only submit their bills for payment alongwith required supportive documents. In case delay payment of their bills from NIFTEM, the agency has to pay wages timely.

Approved Final Tender of Outsourcing of NIFTEM Dispensary

Signature of Tender

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3. The payment of wages shall be made through online or account payee cheques only. Direct payment in the form of cash should be in very exceptional.

16. Compliance of Minimum Wages Act/Insurance Act/EPF Act Etc:

1. The agency shall be wholly responsible to provide all the benefits viz PF, ESI, Bonus,

Gratuity, Leaves etc, to eligible personnel engaged and deployed by the Contractor.

2. The Agency shall give an undertaking that the minimum wages has been paid to their staff,

besides timely deduction/submission of ESI, EPF etc. contributions to the respective

authority and will produce a copy of documentary proof alongwith claiming their monthly

bills.

3. The agency shall be responsible for timely payment of wages to his/her workers as per

Minimum Wages Act of Govt. of Haryana and fulfil all other statutory obligations, such as

revision of wages, Provident fund, ESI, /Bonus/ Fatal Accident Act, Personal injuries etc., as

applicable. In case of deficiency or dispute, the agency will be solely responsible &

appropriately punished.

4. Strict adherence of various applicable labour laws like Minimum Wages Act, Labour Act, ESI

Act, EPF Act, Payment of Wages Act, The Workman Compensation Act, Contract

Labour(Regulation and Abolition) Act 1970 or any other application Acts/Rules and all other

statutory requirements as amended from time to time to the entire satisfaction of

Central/State Govt. Authorities, shall be the responsibility of the Agency and he shall have to

good loss, if any, suffered by NIFTEM on account of default in this regard by the agency.

EPF/ESI contributions will be deposited by the agency in his EPF/ESI code No. in the

respective account of workers. The agency will submit the copy of EPF/ESI Challan/Proof of

deposit alongwith bill for payment.

5. In the event of violation of any contractual or statutory obligations by the agency, he/she

shall be responsible and liable to be penalised for the same. Further, in the event of any

action, claim, damages, suit initiated against the Institute by any individual, agency or

government authority due to the acts of the agency , he/she shall be liable to make good

/compensate such claims for damages to any individual, agency or government authority,

the agency would be required to reimburse such amount to the Institute or the Institute

reserves the right to recover such amount from the payment due to the agency while

settling agencies bills or from the amount of Security Deposit of the agency lying with the

Institute.

17. Insurance of workers: The agency will be solely responsible for any liability for his manpower in respect of any accident, injury arising out and in course of firm’s deployment. To meet his aforesaid

Approved Final Tender of Outsourcing of NIFTEM Dispensary

Signature of Tender

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obligation under the workmen Compensation Act, the agency may obtain W.C. Policy from the Insurance Company for the person employed by him for carrying out the work. The premium payable for the foresaid insurance policy shall be borne by the agency.

18. Safety Rules: a. The agency shall have to comply with all the provisions of safety rules. The Officer I /c may

impose penalty, if any employee found working carelessly without proper protective equipment in unsafe condition. Against violation of any other clause, penalty per violation shall be levied. In case of repeated violation of serious nature resulting in various serious accident or direct loss to the NIFTEM/threatens to cause servere consequences, high penalty will be imposed including termination of contract.

b. The agency will ensure all safety measure precautions are taken while running any

electrical or mechanical equipments. The agency shall be responsible for any loss or damage due to carelessness.

c. The Agency shall be responsible for safety of their staff while on the job and the Institute shall not be responsible for payment of compensation for any accident occurring during the work. The contractor is required to equip their workman with all required safety equipment etc. The Institute will not be responsible for any injury partial or permanent, or any mis-happening or death at site due to accident or malfunctioning of the equipment or by negligence of the staff.

d. If any damage caused for public convenience/services, the same shall have to be repaired instant, failing which necessary recovery shall be made from the agency bill.

e. No compensation shall be payable to the Agency for any damage caused by natural calamity (Rains, storms, earthquakes and other calamity) during the execution of the work.

f. In case, if it is observed that the Dispensary is not being run properly with minimum standard during the period of contract, payment will be deducted for sub standard work and agency may be debarred to undertake the work.

19. Withholding of Payment:

This clause authorizes user(Institute) to withhold payment till end when service provider fails in its contractual obligation. The standard text of this clause is as under: “In the event of the Service Provider’s failure to submit the Bonds, Guarantees and Documents, supply the deliverables etc as specified in the Contract, the Buyer may at his discretion, withhold any payment until the completion of the Contract”.

20. Payment:

Approved Final Tender of Outsourcing of NIFTEM Dispensary

Signature of Tender

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i. The payment of bills for Dispensary will be made on Monthly basis after submission of bills along with previous month payment details, PF & ESIC contribution deposit proof, service tax, Attendance, Proof of wages distributions(Through bank account). If the bills are complete in all respect, the same will be paid by in 20 days.

ii. Counter conditions by the bidders/agencies shall not be acceptable.

21. LIQUIDATED DAMAGES (LD)

In the event of the Service Provider's failure to submit the Bonds/Guarantees/ Documents or/and supply/perform the items/services as per Delivery schedule specified in the contract, the User may, at his discretion, withhold any payment until the completion of the contract. The User may also deduct LD to the sum of 0.5% of the contract price of the delayed/undelivered stores/ services mentioned above for every week of delay or part of a week, subject to the maximum value of the Liquidated Damages being not higher than 10% of the value of delayed stores / services.

22. NO CONDITIONAL BIDS SHALL BE ACCEPTED. 23. Right of Acceptance of Offer

a) The User reserves the right to accept partly or reject any offer without assigning any reason

thereof. The User does not pledge itself to accept the lowest or any other tender and reserves to itself the right of acceptance of the whole or any part of the tender or portion of the quantity offered and the Service Provider shall supply the same at the rate quoted.

(b) In respect of enquiries, which call for procurement of more than one item the User reserves the right to consider and accept the offer for any of the items in the enquiry reserving the right to utilize the offer for balance items at a later stage within the validity of offer.

24. Cancellation/Termination of Contract

1. NIFTEM reserves the right to terminate the contract at any time without assigning any

reason or prior notice.

2. The contract can be terminated either side by serving three months notice. However, the

Institute can serve notice less than three month in the case of continuous unsatisfactory

performance, negligence, misbehaviour, misconduct, untoward incidence, gross violation of

terms & conditions of tender/agreement or instruction passed by the Institute. In such

cases, the notice period shall be 30 days.

3. The Institute shall have the right to terminate the Contract, arising out of finalisation of this

tender, in part or in full in any of the following cases :-

Approved Final Tender of Outsourcing of NIFTEM Dispensary

Signature of Tender

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(a) The delivery of the material/services is delayed for causes not attributable to Force Majeure for more than 15 days after the scheduled date of delivery. (b) The Service Provider is declared bankrupt or becomes insolvent.

(c) The delivery of material/delayed is delayed due to cause of Force Majeure by more than Sixty Days provided Force Majeure clause is included in contract.

(d) As per decision of Arbitration/Tribunal.

(e) When both parties mutually agree to terminate the contract.

4. If the contractor fails to complete the work or any portion thereof as agreed upon or restrict

to comply with any direction given to him, shall terminate the contract and forfeit the security deposit. The contractor shall also be liable for any expenses, loss or damage which Institute may incur or sustain by reasons due to contractors fault. If it exceeds the amount of security deposit, the same shall be recovered from the dues payable to the contractor.

5. The Institute reserves the right to cancel/short close the contract at any time, in case of unsatisfactory performance, without assigning any reasons.

6. In case of unsatisfactory performance/services, the contract will be liable to be terminated at any time giving 15 days Notice.

25. FORCE MAJEURE

a. Should any force majeure circumstances arise, each of the contracting party shall be

excused for the non-fulfillment or for the delayed fulfillment of any of its contractual obligations, if the affected party within 14 days of its occurrence informs in a written form the other party.

b. Force majeure shall mean fires, floods, natural disasters or other acts such as war, turmoil,

strikes, sabotage, explosions, and quarantine restriction beyond the control of either party. 26. STATUORY DEDUCTIONS

Statutory deductions on account of Income Tax, Work, Tax etc. including surcharge shall be made at source from the bills of the agency at prevailing rates.

27. RISK & COST:

In case of the agency fails to full fill the contractual obligations, the work shall be got done from some other agency at the risk and cost of the agency. It shall be without prejudice to the right of NIFTEM to recover any further amount or any liquidated and/or other damages.

28. PENALTY FOR USE OF UNDUE INFLUENCE

The Service Provider undertakes that he has not given, offered or promised to give, directly or indirectly any gift, consideration, reward, commission, fees brokerage or inducement to

Approved Final Tender of Outsourcing of NIFTEM Dispensary

Signature of Tender

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any person in service of the Buyer or otherwise in procuring the Contracts or forbearing to do or for having done or for borne to do any act in relation to the obtaining or execution of the Contract or any other Contract with the Government for showing or forbearing to show favour or disfavor to any person in relation to the Contract or any other Contract with the Government. Any breach of the aforesaid undertaking by the seller or any one employed by him or acting on his behalf (whether with or without the knowledge of the seller) or the commission of any offers by the seller or anyone employed by him or acting on his behalf, as defined in Chapter IX of the Indian Penal Code, 1860 or the Prevention of Corruption Act, 1988 or any other Act enacted for the prevention of corruption shall entitle the Buyer to cancel the contract and all or any other contracts with the seller and recover from the seller the amount of any loss arising from such cancellation. A decision of the buyer or his nominee to the effect that a breach of the undertaking had been committed shall be final and binding on the Seller. Giving or offering of any gift, bribe or inducement or any attempt at any such act on behalf of the seller towards any officer/employee of the buyer or to any other person in a position to influence any officer/employee of the User for showing any favour in relation to this or any other contract, shall render the Service Provider to such liability/ penalty as the User may deem proper, including but not limited to termination of the contract, imposition of penal damages, forfeiture of the Bank Guarantee and refund of the amounts paid by the Buyer.

29. Patent Rights. The Service Provider shall indemnify and hold the User harmless against all third party claims of infringement of patent, trade mark of industrial design rights arising from use of the stores supplied or any part thereof.

30. Right to Variation Clause

To take care of any change in the requirement during the period between issue of tender and conclusion of contract, Buyer reserves the right to increase or decrease the quantity of the required deliverables without any change in the terms & conditions and prices quoted by the Seller. While concluding the contract, the quantity can be accordingly increased or decreased at the same terms of conditions by 25%.

31. Arbitration Clause:

In case of any dispute between Agency and NIFTEM, arising out of or in relation to the

agreement, the dispute shall be referred to arbitration of a sole arbitration to be appointed

by the Hon’ble Vice Chancellor, NIFTEM. The award of the said arbitrator shall be binding on

both parties. The seat of the arbitration shall be at Sonepat & Haryana territory.

In additions to clauses above, other terms & conditions, which have not been mentioned in

the Tender, can be added and the same will be mentioned in the award of work. If the

agency is not agree with any terms, which has been included later date, may communicate in

Approved Final Tender of Outsourcing of NIFTEM Dispensary

Signature of Tender

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writing before accepting the offer. After acceptance, no protest will be considered.

(Registrar, NIFTEM)

Approved Final Tender of Outsourcing of NIFTEM Dispensary

Signature of Tender

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Annexure- I

Tender form (Technical Bid)

(To be submitted by the Agency on their letter head. All Columns should be filled. Documents

prescribed at Sl. No. 2 (a) of other term & conditions should be enclosed)

Name of the Firm/Agency......................................................................................................................................................

Address..........................................................................................................................................................................................

Sl. No.

Particulars

Status (to be filled by the Bidder)

1.

Year of Incorporation of the agency (copy to be enclosed) along with the latest registered address of corporate office

2. Type of Services applied for : Length of relevant experience in years :

3.

Registration No. of the firm/Agency registered for Medical Services (Copy to be enclosed)

4. Mobile No................................................Email ID: .....................................................

5. Name of Proprietor/Authorized Person: .......................................................... 6.

No. of Govt./ Semi Govt. Institutions/PSUs/Autonomous Orgn/Universities/Educational & Research Institute served during last three years (Work order along with list with names, designation & Telephone numbers of the authority to be enclosed)

7. Income Tax Registration No. PAN No.

8. Service Tax No.(Enclose copy also) 9. Provident Fund Account No. and authority with whom registered:

10. ESI/EPF No (with latest return challan copy) Drug License No.(Enclose copy_

11. License No. under Contract Labour (R&A) Act(Copy enclose) 12. Brief explain how the firm will carry out the work assigned by

NIFTEM (use separate sheet)

13. Annual Turnover(In lakhs) of last three years of the company (Copy to be enclosed)

a) 2013-14 b) 2014-15 c) 2015-16

14. Details of work carried out by the Bidders

Attach the proof of experience for last 03 years.

Demand drafts bearing No.…..……................. dated …....………. drawn on ............…………………for

Rs............................is enclosed with Technical bid as Tender Fee and EMD.

Signature…………………………. Date: Seal of firm……………………….

Approved Final Tender of Outsourcing of NIFTEM Dispensary

Signature of Tender

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Annexure- II

TENDER CONDITIONS ACCEPTANCE LETTER (To be given on Company Letter Head)

Date:

To, ______________________ ______________________ ______________________

Sub: Acceptance of Terms & Conditions of Tender

Tender Reference No: ________________________

Name of Tender / Work: - ___________________________________________________________________________________ ___________________________________________________________________________________

Dear Sir,

1. I/ We have downloaded / obtained the tender document(s) for the above mentioned “Tender/Work‟ from the web site(s) namely: _________________________________________________________________________________ _________________________________________________________________________________

as per your advertisement, given in the above mentioned website(s).

2. I / We hereby certify that I / we have read entire terms and conditions of the tender documents from Page No. _______ to ______ (including all documents like annexure(s), schedule(s), etc .,), which form part of the contract agreement and I / we shall abide hereby the terms / conditions / clauses contained therein.

3. The corrigendum(s) issued from time to time by your department/ organizations too have also been taken into consideration, while submitting this acceptance letter.

4. I / We hereby unconditionally accept the tender conditions of above mentioned tender document(s) / corrigendum(s) in its totality / entirety.

5. In case any provisions of this tender are found violated , your department/ organization shall be at liberty to reject this tender/bid including the forfeiture of the full said Earnest Money Deposit absolutely and we shall not have any claim/right against deptt in satisfaction of this condition.

Yours Faithfully,

(Signature of the Bidder, with Official Seal) Annexure- III

Approved Final Tender of Outsourcing of NIFTEM Dispensary

Signature of Tender

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PART-I (Mandatory)

Format of Financial Bid

(To be submitted by the Agency on their letter head. Quote only agency charges)

S. No.

Requirement of Manpower with required qualification

No. of persons

Fixed Monthly

salary(upto) Rs.

Remarks Service charges to be

quoted by the bidder in %age.

01. Physician(Male/Female) MBBS

02

75,000/- -

02. Physician(Male/Female) MD(Medicine)

1,00,000/-

03.

Staff Nurse(Male/Female) 04 30,000/-

04 Pharmacist(Male/Female) 01 25,000/-

05 Driver-cum-Attendant(Male) 02 20,000/-

06 Rate of Agency/Overhead charges on billing amount (in percentage )

07 Service Tax/GST As per Govt. rates 08 Cess (Education, Swachh Bharat, Labour Welfare As per Govt. rates

Note-

1) Service Charges and TDS(If any) will be deducted as per rules.

2) The selection of the Agency/Contractor will be made on the basis of L1 (Lowest quote) rates for Agency Charges. In case of tie between the agencies, the work will be awarded to that agency whose financial turnover is higher.

3) If any change(s) in Govt. rates, the same will be admissible to agency also.

4) The agency may visit NIFTEM Dispensary before submitting tender/bid.

5) The agency has to worked out their requirement on quarterly basis and thereafter its availability will be ensured through Officer In-charge(Dispensary).

6) In the circumstances and requirement, the agency can be asked to make arrangement for any specific requirement or material and in that case, the agency shall be bound to provide the same on market rates together with agency charges as mentioned in the tender. In such cases, no advance will be paid. In case it is found that agency has charged rates more than existing market rates, the appropriate amount will be deducted towards the same.

Name …………………………….

Signature of the contractor (Date & Stamp of the Company)

Approved Final Tender of Outsourcing of NIFTEM Dispensary

Signature of Tender

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Annexure-III(B)

PART-II(Optional)

Format of Financial Bid

(To be submitted by the Agency on their letter head. Quote only agency charges)

Those agencies, who are having valid drug license and capable to supply medicines, surgical

items, toiletries products to NIFTEM Dispensary, are required to quote discount structure on

following format.

SNo. Name of Product Minimum Order quantity at a time

Discount on MRP

Remarks

01 Branded Medicines in company packaged strips

10 Tab or one Strip

02 Generic Medicines (packed) 100 Tab/ Capsules 03 Surgical Items 01 No. of

Box/Packing

04 Toiletries products 01 No. of Box/Packing

i. VAT/GST/Sales Tax(as applicable) will be paid extra.

ii. The Item wise ARC will be made with that agency, who will offer highest discount on MRP.

iii. The Supplies are required to be made to the NIFTEM Campus, Kundli, Sonepat at their cost.

No extra payment towards cartages etc will be paid. The payment will be made within 30

days.

iv. The monthly consumption of Medicines/Surgical items/Toiletries products is above

Rs.25000/- but under 50,000/- per month.

v. The actual requirement can be increase/decrease subject to actual requirement and

increasing/decreasing of students from the Hostels.

vi. Presently, Dispensary is serving 900 students 500 employees including

regular/contractual/outsourced. The strength will increase in near future.

vii. All the items should be as per work order.

Name ……………………………. Signature of the contractor (Date & Stamp of the Company)

Approved Final Tender of Outsourcing of NIFTEM Dispensary

Signature of Tender

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Annexure-IV

UNDERTAKING

To,

Registrar, National Institute Of Food Technology Entrepreneurship and Management Plot no 97, sector-56, HSIIDC Industrial Estate, Kundli-131008, District-sonepat (haryana)

Sir,

7. I/we the undersigned, certify that I/we have gone through the terms and conditions mentioned in the Tender documents and undertake to comply with them.

2. The Contractor/Agency is not facing any legal proceedings for violation of any labour law form any agency/department/court of law so far.

3. The Contractor/Agency has not been disqualified for poor performance or for failure to adhere to labour laws by any government organisation or public sector undertaking.

4. I/we the undersigned will pay all the dues along with legal expenses, if any, if detected

for any default by any Inspector under labour laws. The Institute will not be responsible for any default made by the contractor.

5. I/we, the undersigned undertake to compensate for any loss to NIFTEM on account of any failure/negligence or lapses in discharging the duty causing the loss.

6. It is further certified that our firm has not been blacklisted by any agency in India or abroad so far. Neither, the firm/The partners/Contractor have been prosecuted/convicted for any criminal offence and nor any matter/case is pending for investigation/trial before any Civil Authority or in Court of Lawn.

Dated:

SIGNATURE OF THE BIDDER WITH SEAL

NAME OF THE BIDDER

WITH ADDRESS

Annexure-V Bank Guarantee Format For Performance-Cum- Warranty

Approved Final Tender of Outsourcing of NIFTEM Dispensary

Signature of Tender

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From : (__________________Bank)

To, The Vice Chancellor, NIFTEM. Dear Sir,

1. Whereas, Registrar, NIFTEM (hereinafter referred to as User) have entered into a Contract

No._____________________ dated _____________________ (hereinafter referred to as the said contract) with M/s (hereinafter referred to as the Service Provider) for the running the Dispensary as per contract to the said User and whereas the Service Provider/Agency/ Contractor has undertaken to produce a bank guarantee for (10%) of total contract value amounting to ______________________ to secure its obligations towards Performance-cum-Warranty to the User.

2. We the ____________________________________________ bank hereby expressly, irrevocable and unreservedly undertake and guarantee as principal obligors on behalf of the Service Provider that, in the event that the User declares to us that the amount claimed is due by way of loss or damage caused to or would be caused or suffered by the User by reason of breach/failure to perform by the said Service Provider of any of the terms and conditions in the contract related to Performance and Warranty clauses, we will pay you, on demand and without demur, all and any sum up to a maximum of ____________________________________________________________________________ Rupees only. Your written demand shall be conclusive evidence to us that such repayment is due under the terms of the said contract. We undertake to effect payment upon receipt of such written demand.

3. We shall not be discharged or released from this undertaking and guarantee by any arrangements, variations made between you and the Service Provider, indulgence to the Service Provider by you, or by any alterations in the obligations of the Service Provider or by any forbearance whether as to payment, time performance or otherwise.

4. In no case shall the amount of this guarantee be increased. 5. This Performance-cum-Warranty guarantee shall remain valid for a period until three months

beyond the warranty period as specified in the contract. 6. Unless a demand or claim under this guarantee is made on us in writing or on before the

aforesaid expiry date as provided in the above referred contract or unless this guarantee is extended by us, all your rights under this guarantee shall be forfeited and we shall be discharged from the liabilities hereunder.

7. This guarantee shall be continuing guarantee and shall not be discharged by and change in the constitution of the Bank or in the constitution of M/s _____________________________ We undertake not to revoke this guarantee during the currency except with previous consent of User in writing.

8. Dated the ___________________ day of __________________ for ______________

(Name of Bank)