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REQUEST FOR PROPOSAL FOR

SELECTION OF OPERATOR FOR ESTABLISHMENT, OPERATION AND MAINTENANCE OF eUPHCs

IN ANDHRA PRADESH

NATIONAL HEALTH MISSION COMMISSIONARATE OF HEALTH & FAMILY WELFARE HEALTH MEDICAL & FAMILY WELFARE DEPARTMENT

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SECTION – I

Request for Proposal for selection of operator for Establishment, Operation and Maintenance of e-UPHCs in Andhra Pradesh

ADDRESS

Commissioner of Health & Family Welfare Government of Andhra Pradesh, Sulthan Bazaar, Koti, Hyderabad

URL: cfw.ap.nic.in Telephone: 040 24650365

RFP No: 08/SPMU-NUHM/Andhra Pradesh/2014, Dated: 27.02.2016

1. Commissioner of Health & Family Welfare, Government of Andhra Pradesh herein after

referred to as CH&FW, Andhra Pradesh invites Request for Proposal from eligible bidders for

identification of total service provider for establishment, operation and maintenance of Ten e-

UPHCs at Visakhapatnam (4), Vijayawada (4) and Tirupati (2) for a period of 3 years. The scope

of services required is enumerated in Section-IV of this document.

2. This document contains eight sections as follows:

1. Section I : Request for Proposal 2. Section II: Instructions to Bidder 3. Section III: Procedures for evaluations of Bids 4. Section IV: Scope of Services 5. Section V: Eligibility Criteria 6. Section VI: Terms and Conditions 7. Section VII: Formats of Appendices 8. Section VIII: Format for Service level Agreement 9. Section IX: Services and Personal required at eUPHC

3. Schedule of RFP Process:

Sl. No. Description Date

1 Date of publish of Bid Documents 27-02-2016

2 Date of Pre-bid meeting 11-03-2016

3 Closing date and time of receipt of RFP 17-03-2016 3.00pm

4 Time, Date and Venue of Opening of Technical Bid Will be

intimated later

5 Time, Date and Venue of Opening of Financial Bid Will be

intimated later

The venue for all the events is Conference hall, O/o Commissionerate of Health & Family Welfare, Govt. of Andhra Pradesh, Sultan Bazaar, Koti, Hyderabad.

5. Bidders shall ensure that their bids complete in all respects, are dropped in the Bid Box

located at NUHM Section, O/o Commissionerate of Health & Family Welfare,

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Government of Andhra Pradesh, Sultan Bazaar, Koti, Hyderabad on or before the closing

date and time indicated in the Para 3 above. Bids submitted after the prescribed time

will be treated as late bid and will not be considered. The Bids sent by post/courier

must reach the above said address on before the closing date & time indicated in Para 3

above, failing which the Bid will be treated as late bid and will not be considered.

6. In the event of Bid opening day being declared a holiday / closed day for the CH&FW,

AP, the Bids will be received/ opened on the next working day at the same time.

7. For any clarification and further enquiries bidders may contact NUHM Division,

Commissionerate of Health & Family Welfare, Government of AP, Sulthan Bazaar, Koti,

Hyderabad.

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SECTION – 2

INSTRUCTIONS TO BIDDER

1. General Instructions

a) The Bidder should prepare and submit its offer as per instructions given in this Section.

b) The Bids should be complete with all documents duly signed by Authorized personnel.

Those submitted by telex, telegram or fax or e-mail shall not be considered.

c) The Bids /bids should be for all components of the job /service. The Bids which are for

only a portion of the components of the job /service shall not be accepted.

d) The prices quoted shall be firm and shall include all taxes and duties. This shall be

quoted in the format as per attached Appendix L only.

e) The Bids (technical and financial) shall be submitted (with a covering letter as per

Appendix ‘A’) before the last date of submission. Late Bids / bids shall not be

considered.

2. Earnest Money Deposit (EMD)

a. The Bid shall be accompanied by Earnest Money Deposit (EMD) INR 2.00 lakhs. in the

form of Bank Draft / Bankers cheque from any Schedule Bank in favour of State Health

& Family Welfare Society, Commissionarate of Health & Family Welfare, Government of

AP payable at Hyderabad.

b. No Bidding entity is exempted from deposit of EMD. Bids submitted without EMD shall

be not considered.

c. The EMD of unsuccessful Bidder will be returned to them without any interest, after

conclusion of the resultant agreement. The EMD of the successful Service provider will

be returned without any interest, after receipt of performance security as per the terms

of agreement.

d. EMD of Bidder may be forfeited without prejudice to other rights of the CH&FW, AP, if

the Bidder withdraws or amends its Bid or impairs or derogates from the Bid in any

respect within the period of validity of its Bid or if it comes to notice that the

information / documents furnished in its Bid is incorrect, false, misleading or forged. In

addition to the aforesaid grounds, the successful Bidder’s EMD will also be forfeited

without prejudice to other rights bidder, if he fails to furnish the required performance

security within the specified period.

3. Preparation of Bid

The bids shall be made in TWO SEPARATE SEALED ENVELOPES. The first envelope shall

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be marked in bold letter as “TECHNO COMMERCIAL BID” which shall contain the following:

1. Covering letter as per the proforma in Appendix A

2. Bank Draft /Bankers Cheque towards E.M.D along with Appendix C

3. Checklist of submission as per the format at Appendix B

4. A declaration from the Bidder in the format given in the Appendix D to the effect

that the firm has neither been declared as defaulter or black-listed by any

competent authority of a government department, government authorities.

5. Confirmation letter for submission of performance security at Appendix E

6. Consortium agreement and power of attorney for appointing the lead member

in the format at Appendix F

7. Power of attorney for the bid signatory in the format at Appendix G

8. Statement of legal capacity in the format at Appendix H

9. Particulars of the Bidder as per the format at Appendix I

10. Experience certificate in the format at Appendix J along with the letter of

undertaking for technical bid at Appendix K

11. Copies of the certificate of registration of EPF, ESI and Service Tax, PAN & TAN

with the appropriate authority duly self attested.

12. Annual turnover certification / Annual cost of Health Care Services provide for

2012-13, 2013-14, 2014-15 duly self attested.

13. Documentary evidences in support of providing clinical services i.e operating

PHC/Hospital/MMU for not less than two years.

14. Documentary evidences in support of providing Tele Medicine services with

specialist medical officers for not less than two years

15. Original tender document duly stamped and signed by the authorized personnel

in each page

4. Bid Validity Period

The Bids shall remain valid for 180 days from the date of submission for acceptance and

the prices quoted shall remain for the duration of the agreement. . The CHFW AP may request

for further extension as deemed fit and the Bidder will send intimation of acceptance or

otherwise of request for extension with three days of issue of such request.

5. Bid Submission

The two envelopes containing both technical and the financial bid shall be put in a

bigger envelope, which shall be sealed and superscripted with “BID NO due for opening

on or after 17.03.2016 The offer shall contain no interlineations or overwriting except

as necessary to correct errors, in which cases such correction must be initialed by the

.

.

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person or persons signing the Bid. In case of discrepancy in the quoted prices, the price

written in words will be taken as valid.

6. Opening of Bids:

The technical bid will be opened at the time & date intimated to the bidder. The Service

providers may attend the bid opening if they so desire.

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SECTION – 3

PROCEDURE FOR EVALUATION OF BIDS

1. Three stage evaluation will be taken up for identification of successful bidder a. Technical Evaluation

b. Field Inspection to assess the capabilities

c. Financial Evaluation

2. Bidders who fulfill the eligibility criteria are deemed as qualified in technical

evaluation and all other bids will be considered as non responsive and will be

rejected.

3. Technical evaluation of bids will be done as per the eligibility criteria. Bidders who

fulfill the eligibility criteria are deemed as qualified for field inspection. On

successful demonstration of the technical and field level capabilities at the time of

field inspection will alone qualify the bidders as technically qualified and all other

bids will be considered as non responsive and will be rejected.

4. Financial evaluation will be done as per the L1 basis and successful bidder will be

identified.

5. Financial Bid shall be quoted for operational expenditure per month per e-UPHC.

This Operational Cost shall be inclusive of salaries, ICT Management, Capital

expenditure (Building, Equipment), Establishment costs, Laboratory Consumables,

Taxes, Insurances and other incidental expenditure.

6. The CH&FW, AP may waive minor infirmity and/or non-conformity in a Bid,

provided it does not constitute any material deviation. The decision of the CH&FW,

AP as to whether the deviation is material or not, shall be final and binding on the

Service providers.

7. Wherever necessary, the CH&FW, AP may, at its discretion, seek clarification from

the Bidders seeking response by a specified date. If no response is received by this

date, the CH&FW, AP shall evaluate the offer as per available information.

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SECTION – 4

SCOPE OF SERVICES

Government of AP Launched National Urban Health Mission in the state with an

objective to provide Primary Health Care Services to the Urban populations especially urban

poor and vulnerable population. One of the strategies in NUHM is establishment and operation

of Urban Primary Health Services for every 50000 population. Accordingly it is decided to

establish and operate 10 Urban Primary Health Centre on eUPHCs model under Public Private

Partnership in the state.

Responsibilities of Service Provider:

1. Establishment, Operation and maintenance of e-UPHCs at 10 locations in the state of AP.

List of locations are is at annexure

2. Provide the building with not less than 2000 sft carpet area and suitable for patient

examination, conducting laboratory investigations, Dispensing drugs , staff room

waiting hall for the patients and hygienic surroundings.

3. Establishing laboratory in every eUPHC for providing the laboratory investigations

mentioned at annexure.

4. Providing clinical services at eUPHCs for not less than 8 Hours per day from 8 AM to 12

Noon and 4 PM to 8 PM for 6 days a week with the staff mentioned at annexure.

5. Providing MCH clinics @ Twice in a week with OBG specialist for 4 hours per day.

6. Establishment of Telemedicine facility at every eUPHC by centralised Hub to be located

in AP. Though Telemedicine facility specialist services mentioned in the annexure shall

be provided. Timings of Telemedicine facility shall be coterminous with eUPHC timings

7. Developing and maintenance of electronic medical records of every patient / beneficiary

visited the e-UPHC. Every component of eUPHC shall be IT enabled and information of

every service provided at eUPHC has to be digitised. Maintenance of EMR and

Telemedicine shall be interrelated such that the laboratory investigations and other

examinations conducted to patient can be accessed by the specialist over the

Desktop/laptop instantaneously and tele consultation given to the patient has to be the

part of patient EMR

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8. Dispensing the drugs, medicines to the patients / dispensaries

9. Maintenance of e-UPHC i.e. Civil Infrastructure, Medical equipment and IT equipment

and Furniture, recurring cost such as Electricity, Water, Medical consumables, Bio-

medical waste management.

10. Conducting community process in the service area, which includes conducting Urban

Health and Nutrition Days, monitoring activities of Mahila Arogya Samithi, ASHAs and

ANMs. Monitoring of implementation of National and State Health Programmes.

11. Establishing and maintenance of effective referral mechanism to secondary and tertiary

care.

12. Designing and implementing MIS system for the services provided at e-UPHC and also

the services provided at service area of e-UPHC.

13. The feedback of Tele-consultation and other services provided at e-UPHCs and in

community process will be recorded electronically by the service provider.

14. Maintenance of dedicated website for Monitoring and also displaying the services

provided at the e-UPHCs. Services provided at the e-UPHCs shall be linked to CM

Dashboard on real time basis.

Responsibilities of Service Purchaser (CHFW, AP):

1. Provides the drugs medicines, consumables and laboratory reagents.

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SECTION – 5

ELIGIBILITY CRITERIA

1. The Bidder shall be a sole provider (Company/Society/Trust) or a group of companies

(maximum3) coming together as Consortium to implement the Project. The Lead

Member should have at least 51% stake of the consortium and must also have all legal

liabilities. The bidder cannot be an individual or group of individuals. The Service

provider should be registered as a legal entity such as company registered under

Companies Act, Societies Registration Act, Trust Act or an equivalent law applicable in

the region/ state/country. A bidder cannot bid as a sole provider as well as a partner in

a consortium. No bidder can place more than one bid in any form. In support of this, the

bidder’s letter shall be submitted as per proforma in Appendix ‘B’. The bidder, In case of

consortium the lead member shall have all the eligibility conditions mentioned below

2. Providing clinical services for not less than 2 years. Clinical services means PHCs or

Hospitals or MMUs, where Medical Officer (MBBS or above) and Paramedical Staff

provide the services.

3. Presently bidder must be providing Telemedicine services in Hub spoke model for at

least one year. Bidder shall have dedicated hub with medical specialists.

4. Bidder shall have not less than Rs 50 lakhs annual turnover during last financial year in

providing clinical services.

5. The bidder and in case of a consortium all the participants shall be registered for Service

Tax, IT , PF, ESI and other statutory requirements.

6. The bidder should not be presently blacklisted or terminated prematurely due to

default by any State Government / Central Government agencies/local bodies.

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SECTION - 6

TERMS AND CONDITIONS

1. Signing of Agreement

1. The successful bidder shall furnish a performance security in the shape of a

Demand Draft/Bank Guarantee issued by a Nationalised Bank in favour of Tender

Inviting Authority for an amount equal to 5% of the total agreement value. The

Bank guarantee shall be as per proforma at Appendix E and remain valid for a

period, which is three months beyond the date of expiry of the agreement. This

shall be submitted within 15 days (minimum) of receiving of Notice for Award of

Agreement and before signing of the agreement failing which the EMD may be

forfeited.

2. If the agreement is cancelled at any time during the validity period of the

agreement in terms of para 1 above the Performance Security shall be forfeited

3. The CH&FW, AP will release the Performance Security without any interest to the

firm / contractor on successful completion of contractual obligations.

4. The total cost of tender would be the basis to calculate non operative cost per e-

UPHC per day. For all days when a certain number of e-UPHC has not been

functional, cost deducted would be

= Operational cost of e-UPHC per month x number of days non operative

Number of days per the current month

5. Compliance of Minimum Wages Act and other statutory requirements

1. The Service provider shall comply with all the provisions of Minimum Wages Act/

Rates of Government (Finance Department) in case of outsourcing employees and

other applicable labor laws. The Service provider shall also comply with all other

statutory provision including but not limited to provisions regarding medical

education and eligibility criteria of human resources used by the Service provider

for providing the services, biomedical waste management, bio safety, occupational

and environmental safety.

2. The overall legal responsibility of provision of medical care lies with the

Authority/public health facility. The Service provider shall maintain confidentiality

of medical records and shall make adequate arrangement for cyber security.

6. Income Tax Deduction at Source

1. Income tax deduction at source shall be made at the prescribed rates from the

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Service provider’s bills. The deducted amount will be reflected in the requisite

Form, which will be issued at the end of the financial year.

7. Periodicity of Payment

1. The payment will be made on monthly basis. The Service provider will raise its

invoice on completion of services during this period duly accompanied by

evidences of services provided. The payment will be subject to TDS as per Income

Tax Rules and other statutory deductions as per applicable laws.

8. Damages for Mishap/Injury

1. The CH&FW, AP shall not be responsible for damages of any kind or for any

mishap/injury/accident caused to any personnel/property of the Service provider

while performing duty in the CH&FW, AP / consignee’s premises. All liabilities, legal

or monetary, arising in that eventuality shall be borne by firm/ contractor.

2. The service provider is the sole custodian of the Government properties handed

over to him. Service provider shall attend the damages to the government property

handed over to him with his own funds).

9. Termination of Agreement:

1. The CHFW AP may terminate the agreement, if the successful Bidder withdraws its

Bid after its acceptance or fails to submit the required Performance Securities for

the initial agreement and or fails to fulfill any other contractual obligations. In that

event, the CH&FW, AP will have the right to purchase the same goods/ equipment

from next eligible Service provider and the extra expenditure on this account shall

be recoverable from the defaulter. The earnest money and the performance

security deposited by the defaulter shall also be recovered to pay the balance

amount of extra expenditure incurred by the CHFW AP. After completion of the

tenure of Bid, the Service provider will be allowed to vacate the space within a

period of 15 days, in all the facilities where provider was providing the services.

10. Arbitration

1. If dispute or difference of any kind shall arise between the CHFW AP and the

firm/contractor in connection with or relating to the agreement, the parties shall

make every effort to resolve the same amicably by mutual consultations.

2. If the parties fail to resolve their dispute or difference by such mutual consultations

within thirty days of commencement of consultations, then either the CH&FW, AP

or the firm /contractor may give notice to the other party of its intention to

commence arbitration, as hereinafter provided. The applicable arbitration

procedure will be as per the Arbitration and Conciliation Act, 1996 of India. In that

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event, the dispute or difference shall be referred to the sole arbitration of an officer

to be appointed by the CHFW, AP as the arbitrator. If the arbitrator to whom the

matter is initially referred is transferred or vacates his office or is unable to act for

any reason, he / she shall be replaced by another person appointed by CHFW, AP to

act as Arbitrator.

3. Work under the agreement shall, notwithstanding the existence of any such dispute

or difference, continue during arbitration proceedings and no payment due or

payable by the CH&FW, AP or the firm / contractor shall be withheld on account of

such proceedings unless such payments are the direct subject of the arbitration.

4. Reference to arbitration shall be a condition precedent to any other action at law.

5. Venue of Arbitration: The venue of arbitration shall be the place from where the

agreement has been issued.

11. General Terms and Conditions:

1. The Service provider shall establish and operate the ten e UPHCs as per defined in

RFP document within the 30 days of signing the agreement.

2. The Authority shall finalize the Standard Operating Procedures (SOPs) for each of

the services to be followed by the Service provider.

3. All payments should be made within 30 days of submission of necessary bills/

invoices. Patient Feedback/Suggestions/Grievance Redressal- Periodic feedback

from patients are to be taken on structured questionnaire. Result would be

analyzed by the state government for further improvement of services and

feedback to the service provider. Telephone numbers where patients can lodge

their complaints will be displayed on e-UPHC.

12. Applicable Law and Jurisdiction of Court:

The agreement shall be governed by and interpreted in accordance with the laws of India

for the time being in force. The Court located at the place of issue of agreement shall have

jurisdiction to decide any dispute arising out of in respect of the agreement. It is specifically

agreed that no other Court shall have jurisdiction in the matter.

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SECTION - VII

Appendix A

Format for COVERING LETTER

Date:

To,

The Commissioner

Commissioner Health & Family Welfare

DM&HS Compound

Sultan Bazaar, Koti

Hyderabad - 500095

Tel:

Dear Sir:

Sub: Submission of Bid Comprising of Technical and Price Bids for Establishment, Operation

& Maintenance of e-UPHCs in Vijayawada (4), Visakhapatnam (4) & Tirupati (2), Andhra

Pradesh on Public Private Partnership (PPP) Basis.

1. We _____________________________________are submitting this Bid on our own.

2. Having examined the RFP Documents, for the execution of the Contract Agreement for the captioned project, we the undersigned offer to Establishment, Operation & Maintenance of e-UPHCs in Vijayawada (4), Visakhapatnam (4) & Tirupati (2), Andhra Pradesh on Public Private Partnership (PPP) Basis for the Contract Period in conformity with the RFP.

3. This Bid and our written acceptance of it shall form part of the Contract Agreement to be

signed between the Preferred Bidder and CH&FW. If selected as Contractor, we understand that it is on the basis of the technical, financial & organizational capabilities and experience of the Bidder taken together. We understand that the basis for our qualification will be complete Bid documents submitted along with this letter, and that any circumstance affecting our continued eligibility as per RFP, or any circumstance which would lead or have led to our disqualification, shall result in our disqualification under this Bidding process.

4. We agree that

(a) If we fail to permit CH&FW or its Authorised Representative for carrying out the inspection of works/ facilities during Contract Period

Or

(b) If we fail to meet the Technical Specifications and/or the Performance Standards according to the conditions/ stipulations of the RFP/ Contract Agreement, CH&FW shall be at liberty to take action in accordance with the RFP/ Contract Agreement.

5. We undertake, if our Bid is accepted, to complete the Project, commence operations and manage as per the RFP/ Contract Agreement.

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6. We agree to abide by this Bid for a period of 180 (one hundred and eighty) days from the Due Date fixed for submitting the same and it shall remain binding upon us and may be accepted at any time before the expiry of that period.

7. In the event of our Bid being accepted, we agree to enter into a formal Contract Agreement

with you incorporating the conditions of the Bid including the draft Contract Agreement thereto annexed and written acceptance thereof.

8. We agree, if our Bid is accepted, to furnish Performance Security Bank Guarantee for. 5% of Project Cost to CH&FW in the form as specified in the RFP as a precondition for signing of Contract Agreement.

9. We agree that if we fail to fulfill the condition mentioned at para 8 above, CH&FW has the right to forfeit the Bid Security being furnished by us along with this Bid and any other payments made till such date.

10. We understand that CH&FW is not bound to accept any or all Bids it may receive.

11. We declare that we have disclosed all material information, facts and circumstances, which would be relevant to and have a bearing on the evaluation of our Bid and selection as Contractor.

12. We do, also, certify that all the statements made and/or any information provided in our proposal are true and correct and complete in all aspects.

13. We declare that in the event that CH&FW discovers anything contrary to our above declarations, it is empowered to forthwith disqualify us and our Bid from further participation in the Bid evaluation process and forfeit our Bid Security.

Dated this __________________day of_______________________ 2015

___________________________ (Signature) ___________________________ (Name of the person) ___________________________ (In the capacity of) Company Seal ___________________________ (Name of firm) Duly authorized to sign Proposal for and on behalf of (Fill in block capitals)

______________________________________________________________

______________________________________________________________

______________________________________________________________

Witness

Signature _______________________

Name _______________________ Address _______________________

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Appendix B

Format for

CHECKLIST OF SUBMISSIONS

Enclosures to the

Outer Envelope, Technical & Price Bid

Status (Submitted/Not

Submitted)

Page Numbers

1 Covering letter as per the proforma in Appendix A

2 Bank Draft /Bankers Cheque towards E.M.D along with Appendix C

3 Checklist of submission as per the format at Appendix B

4 A declaration from the Bidder in the format given in the Appendix D

5 Confirmation letter for submission of performance security at Appendix E

6 Consortium agreement and power of attorney for appointing

the lead member in the format at Appendix F

7 Power of attorney for the bid signatory in the format at

Appendix G

8 Statement of legal capacity in the format at Appendix H

9 Particulars of the Bidder as per the format at Appendix I

10 Experience certificate in the format at Appendix J along with

the letter of undertaking for technical bid at Appendix K

11 Copies of the certificate of registration of EPF, ESI and Service Tax, PAN & TAN with the appropriate authority duly self attested.

12 Annual turnover certification / Annual cost of Health Care Services provide for 2012-13, 2013-14, 2014-15 duly self attested.

13 Documentary evidences in support of providing clinical services i.e operating PHC/Hospital/MMU for not less than two years.

14 Documentary evidences in support of providing Tele Medicine services with specialist medical officers for not less than two years

15 Original tender document duly stamped and signed by the authorized personnel in each page

Signature of Bidder

.

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Appendix C

Format for

COVERING LETTER FOR SUBMITTING BID SECURITY

To, Date:

The Commissioner

Commissioner Health & Family Welfare

DM&HS Compound

Sultan Bazaar, Koti

Hyderabad – 500095

Tel:

Dear Sir,

Sub: Establishment, Operation & Maintenance of e- - Covering Letter for Bid Security.

As a part of the Bid for Establishment, Operation & Maintenance of e-UPHCs in Vijayawada,

Visakhapatnam & Tirupati, Andhra Pradesh on Public Private Partnership (PPP) Basis, we

hereby submit the Bid Security for Rs. ....... (Rupees ........ Only) in the form Demand Draft from

______________ Bank (which is a Nationalised/ Scheduled Bank) in favour of “Commissioner Health

& Family Welfare” and operable at Hyderabad. This Bid Security shall be independent of the

validity of the Bid and Contract Agreement between CH&FW and the Contractor and shall be

honoured by the issuing banks irrevocably.We agree that in the event of any breach or non-

performance of the following terms and conditions contained in the RFP document:

(1) if we withdraw our Bid during the period of Bid Validity as specified in the RFP; or

(2) if we refuse to accept the correction of errors in our Bid; or

(3) if we submit a conditional Bid which would affect unfairly the competitive provision of

other Bidders who submitted substantially responsive Bids and/or is not accepted by

CH&FW, or

(4) if we, having been notified of the acceptance of our Bid by the CH&FW during the period

of Bid validity;

(a) fail or refuse to execute the Contract Agreement in accordance with the RFP

documents; or

(b) fail or refuse to submit Performance Security Bank Guarantee, in accordance

with the RFP documents;

CH&FW is empowered to forthwith disqualify us and our Bid from further participation

in the Bid evaluation process and forfeit our Bid Security.

Yours faithfully,

_________________________

(Signature of Authorised Signatory)

(Name, Title, Address, Date)

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Appendix D

Format for

LETTER OF UNDERTAKING

[To be furnished by the Bidder, in case of Consortium to be given separately for members on

their letterheads]

Date:

To,

The Commissioner

Commissioner Health & Family Welfare

DM&HS Compound

Sultan Bazaar, Koti

Hyderabad – 500095

Tel:

Dear Sir,

Sub: Establishment, Operation & Maintenance of e-UPHCs in Vijayawada, Visakhapatnam &

Tirupati, Andhra Pradesh on Public Private Partnership (PPP) Basis – Letter of Undertaking.

We confirm that we are not blacklisted by Government of Andhra Pradesh (GoAP), any

other State Government in India (SG) or Government of India (GoI), or any of the agencies of

GoAP/SG/GoI from participating in any category of projects as on ________________ (Bid Due

Date).We also confirm that Government of Andhra Pradesh (GoAP), any other State Government

in India (SG) or Government of India (GoI), or any of the agencies of GoAP/SG/GoI have not

terminated the service agreement due to default in providing services.

Yours faithfully,

__________________________

(Signature of Authorised Signatory)

(Name, Title, Address, Date)

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Appendix E

Format For

COMMITMENT FOR SUBMISSION OF PERFORMANCE SECURITY

[On the Letterhead of the Bidder]

Date:

To,

The Commissioner

Commissioner Health & Family Welfare

DM&HS Compound

Sultan Bazaar, Koti

Hyderabad – 500095

Dear Sir,

Sub: Establishment, Operation & Maintenance of e-UPHCs in Vijayawada, Visakhapatnam &

Tirupati, Andhra Pradesh on Public Private Partnership (PPP) Basis – Commitment for

Submission of Performance Security.

Dear Sir,

We _______________________ have submitted our bid for the development of “Establishment,

Operation & Maintenance of e-UPHCs in Vijayawada, Visakhapatnam & Tirupati, Andhra

Pradesh on Public Private Partnership (PPP) Basis”.

We hereby write to inform you that if we are selected as the Preferred Bidder for implementing

the project, we shall submit a Performance Security in the form of unconditional and irrevocable

Bank Guarantee for rupees equivalent to 5% of project cost per annum favouring

“Commissioner Health & Family Welfare” within 15 days from the date of issue of Letter of

Intent.

SIGNATURE _________________

NAME _________________

DESIGNATION _________________

COMPANY SEAL COMPANY _________________

DATE ...............................................................................................................................................................................

............................................................................................................................................................. _________________

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Appendix F

Format For

CONSORTIUM AGREEMENT

(In case the Bidder being a Consortium)

On a Non-Judicial Stamp Paper of Rs. 100 duly attested by notary public

THIS CONSORTIUM AGREEMENT is entered into on this the ………… day of ………… 20…

AMONGST

1. ………… Limited, a company incorporated under the Companies Act, 1956 and having its

registered office at ………… (hereinafter referred to as the “First Part” which expression

shall, unless repugnant to the context include its successors and permitted assigns)

AND

2. ………… Limited, a company incorporated under the Companies Act, 1956 and having its

registered office at ………… (hereinafter referred to as the “Second Part” which

expression shall, unless repugnant to the context include its successors and permitted

assigns)

AND

AND

3. ………… Limited, a company incorporated under the Companies Act, 1956 and having its

registered office at ………… (hereinafter referred to as the “Third Part” which expression

shall, unless repugnant to the context include its successors and permitted assigns)

The above mentioned parties of the FIRST, SECOND and THIRD PART are collectively referred

to as the “Parties” and each is individually referred to as a “Party”

WHEREAS,

THE COMMISSIONER HEALTH & FAMILY WELFARE (CH&FW)., represented by the ___________,

and having its Principal Office at “______________________” (hereinafter referred to as the

“Authority” which expression shall, unless repugnant to the context or meaning thereof,

include its administrators, successors and assigns) has invited Proposals (the “Bids”) by its

Request for Proposal No. ………… dated ………… (the “RFP”) for short-listing of bidders for

Establishment, Operation & Maintenance of e-UPHCs at Vijayawada, Visakhapatnam & Tirupati,

Andhra Pradesh on Public Private Partnership (PPP) Basis (the “Project”) through Public

Private Partnership.

21

A. The Parties are interested in jointly bidding for the Project as members of a Consortium

and in accordance with the terms and conditions of the RFP document and other bid

documents in respect of the Project, and

B. It is a necessary condition under the RFP document that the members of the Consortium

shall enter into a Consortium Agreement and furnish a copy thereof with the

Application.

NOW IT IS HEREBY AGREED as follows:

Definitions and Interpretations

In this Agreement, the capitalised terms shall, unless the context otherwise requires, have

the meaning ascribed thereto under the RFP.

Consortium

The Parties do hereby irrevocably constitute a consortium (the “Consortium”) for the

purposes of jointly participating in the Bidding Process for the Project.

The Parties hereby undertake to participate in the Bidding Process only

through this Consortium and not individually and/ or through any other

consortium constituted for this Project, either directly or indirectly or through

any of their Associates.

Covenants

The Parties hereby undertake that in the event the Consortium is declared as the

selected Bidder and awarded the Project, it shall incorporate a Special Purpose

Company (the “SPC”) under the Indian Companies Act, 2013 for entering into an

Concession Agreement with the Authority and for performing all its

obligations as the Concessionaire in terms of the Concession Agreement for

the Project.

Role of the Parties

The Parties hereby undertake to perform the roles and responsibilities as described

below:

a) Party of the First Part shall be the Lead member of the Consortium and shall have the

Power of Attorney from all Parties for conducting all business for and on behalf of

the Consortium during the Bidding Process and until the Appointed Date under the

Concession Agreement when all the obligations of the SPC shall become effective;

b) Party of the Second Part shall be the ----------------- Member of the Consortium

and

The roles and responsibilities of the Members of the Consortium shall be as follows:

a. The Party of the First Part (Lead Member) shall be responsible for:

(i)

(ii)

(iii)

22

b. The Party of the Second Part shall be responsible for:

(i)

(ii)

(iii)

c. The Party of the Third Part shall be responsible for:

(i)

(ii)

(iii)

Joint and Several Liability

The Parties do hereby undertake to be jointly and severally responsible for all

obligations and liabilities relating to the Project and in accordance with the terms

of the RFP and the Concession Agreement, till such time as the Financial Close for

the Project is achieved under and in accordance with the Concession Agreement.

Shareholding in the SPC

a. The Parties agree that the proportion of shareholding among the Parties in the SPC shall

be as follows:

First Party:

Second Party:

Third Party:

b. The Parties together shall be required to hold an equity shareholding of at least 51% of

the paid up and subscribed equity of the Concessionaire until ten years from the date of

Execution of Agreement. The Parties undertake that a minimum of 26% (twenty six per

cent) of the subscribed and paid up equity share capital of the SPC shall, at all times till the

First anniversary of the date of Execution of the Agreement, be held by the Parties of the

First, {Second} Part whose experience and net worth have been reckoned for the purposes

of qualification and short-listing of Applicants for participation in the Bid Stage for award

of the Project

c. The Parties also undertake that other member of the consortium shall hold a minimum of

10% (ten per cent) of the subscribed and paid up equity share capital of the SPC at all

times till the First anniversary of the date of Execution of Agreement.

d. In addition to the above, the Parties undertake that they shall collectively hold an equity

shareholding of at least 100% of the paid up and subscribed equity of the Concessionaire

until date of execution of the Concession Agreement and thereafter at least 51% (fifty one

per cent) of the subscribed and paid up equity share capital of the SPC at all times until the

First anniversary of the date of Execution of Agreement.

e. The Parties undertake that they shall comply with all equity lock-in requirements set

forth in the RFP and more particularly the Concession Agreement.

23

Representation of the Parties

Each Party represents to the other Parties as of the date of this Agreement that:

a) Such Party is duly organised, validly existing and in good standing under the laws of its incorporation and has all requisite power and authority to enter into this Agreement;

b) The execution, delivery and performance by such Party of this Agreement has been authorised by all necessary and appropriate corporate or governmental action and a copy of the extract of the charter documents and Board Resolution/ Power of Attorney in favour of the person executing this Agreement for the delegation of power and authority to execute this Agreement on behalf of the Consortium Member is annexed to this Agreement, and will not, to the best of its knowledge:

i. require any consent or approval not already obtained;

ii. violate any Applicable Law presently in effect and having applicability to it;

iii. violate the memorandum and articles of association, by-laws or other applicable organisational documents thereof;

iv. violate any clearance, permit, concession, grant, license or other governmental authorisation, approval, judgement, order or decree or any mortgage agreement, indenture or any other instrument to which such Party is a party or by which such Party or any of its properties or assets are bound or that is otherwise applicable to such Party; or

v. create or impose any liens, mortgages, pledges, claims, security interests, charges or Encumbrances or obligations to create a lien, charge, pledge, security interest, encumbrances or mortgage in or on the property of such Party, except for encumbrances that would not, individually or in the aggregate, have a material adverse effect on the financial condition or prospects or business of such Party so as to prevent such Party from fulfilling its obligations under this Agreement;

c) This Agreement is the legal and binding obligation of such Party, enforceable in accordance with its terms against it; and

d) There is no litigation pending or, to the best of such Party's knowledge, threatened to which it or any of its Affiliates is a party that presently affects or which would have a material adverse effect on the financial condition or prospects or business of such Party in the fulfilment of its obligations under this Agreement

Termination

This Agreement shall be effective from the date hereof and shall continue in

full force and effect until the Financial Close of the Project is achieved under

and in accordance with the Concession Agreement, in case the Project is awarded to

the Consortium. However, in case the Consortium is either not pre-

qualified for the Project or does not get selected for award of the Project, the

Agreement will stand terminated in case the Applicant is not pre-qualified or

24

upon return of the Bid Security by the Authority to the Bidder, as the case may

be.

Miscellaneous

That in case the project is awarded to the Consortium, the Consortium will carry out all

the responsibilities as the Concessionaire and will comply with all the terms and

conditions of the Concession Agreement as would be entered with the Authority.

This Consortium Agreement shall be governed by laws of India.

The Parties acknowledge and accept that this Agreement shall not be amended by the

Parties without the prior written consent of the Authority.

IN WITNESS WHEREOF THE PARTIES ABOVE NAMED HAVE EXECUTED AND DELIVERED THIS

AGREEMENT AS OF THE DATE FIRST ABOVE WRITTEN.

SIGNED, SEALED AND

DELIVERED

For and on behalf of

LEAD MEMBER:

(Signature)

(Name)

(Designation)

(Address)

SIGNED, SEALED AND

DELIVERED

For and on behalf of

SECOND PART:

(Signature)

(Name)

(Designation)

(Address)

SIGNED, SEALED AND

DELIVERED

For and on behalf of

THIRD PART:

(Signature)

(Name)

(Designation)

(Address)

Notes:

1. The mode of the execution of the Consortium Agreement should be in accordance with the

procedure, if any, laid down by the Applicable Law and the charter documents of the

executant(s) and when it is so required, the same should be under common seal affixed in

accordance with the required procedure.

2. Each Consortium Agreement should attach a copy of the extract of the charter documents

and documents such as Resolution / Power of Attorney in favour of the person executing

this Agreement for the delegation of power and authority to execute this Agreement on

behalf of the Consortium Member.

3. For a Consortium Agreement executed and issued overseas, the document shall be

legalised by the Indian Embassy and notarized in the jurisdiction where the Power of

Attorney has been executed.

25

Format For

POWER OF ATTORNEY FOR APPOINTING THE LEAD MEMBER – TO BE PROVIDED BY ALL

MEMBERS OF THE CONSORTIUM

(On a Non-Judicial Stamp Paper of Rs. 100 duly attested by notary public)

Whereas the Commissioner Health & Family Welfare (CH&FW) (“the Authority”) has invited

applications from interested parties for the Establishment, Operation & Maintenance of e-

UPHCs in Vijayawada, Visakhapatnam & Tirupati, Andhra Pradesh on Public Private Partnership

(PPP) Basis (“the Project”).

Whereas,_______________ and ______________ (collectively the “Consortium”) being Members of the

Consortium are interested in bidding for the Project in accordance with the terms and

conditions of the Request for Proposal document (RFP) and other connected documents in

respect of the Project, and

Whereas, it is necessary for the Members of the Consortium to designate one of them as the

Lead Member with all necessary power and authority to do for and on behalf of the Consortium,

all acts, deeds and things as may be necessary in connection with the Consortium’s bid for the

Project and its execution.

NOW THEREFORE KNOW ALL MEN BY THESE PRESENTS

I, ______________ having our registered office at ____________________ [the name and address of the

registered office] (hereinafter referred to as the “Principal”) do hereby irrevocably designate,

nominate, constitute, appoint and authorize M/s_________________________ having its registered

office at __________________, being one of the Members of the Consortium, as the Lead Member and

true and lawful attorney of the Consortium (hereinafter referred to as the “Attorney”). I hereby

irrevocably authorize the Attorney (with power to sub delegate) to conduct all business for and

on behalf of the Consortium and any one of us during the bidding process and, in the event the

Consortium is awarded the Concession/Contract, during the execution of the Project and in this

regard, to do on our behalf and on behalf of the Consortium, all or any of such acts, deeds or

things as are necessary or required or incidental to the pre-qualification of the Consortium and

submission of its bid for the Project, including but not limited to signing and submission of all

applications, bids and other documents and writings, participate in bidders and other

conferences, respond to queries, submit information/ documents, sign and execute contracts

and undertakings consequent to acceptance of bid of the Consortium and generally to represent

the Consortium in all its dealings with the Authority, and/ or any other Government Agency or

any person, in all matters in connection with or relating to or arising out of the Consortium’s bid

for the Project and/ or upon award thereof till the Concession Agreement is entered into with

the Authority.

26

AND hereby agree to ratify and confirm and do hereby ratify and confirm all acts, deeds and

things lawfully done or caused to be done by our said Attorney pursuant to and in exercise of

the powers conferred by this Power of Attorney and that all acts, deeds and things done by our

said Attorney in exercise of the powers hereby conferred shall and shall always be deemed to

have been done by us/ Consortium.

IN WITNESS WHEREOF WE THE PRINCIPALS ABOVE NAMED HAVE EXECUTED THIS POWER

OF ATTORNEY ON THIS _____ DAY OF _____20**

For ____________________

(Signature)

____________________

(Name & Title)

For ____________________

(Signature)

____________________

(Name & Title)

Witnesses:

1.

2.

_____________________________

(Executants)

(To be executed by all the Members of the Consortium)

Notes:

The mode of execution of the Power of Attorney should be in accordance with the

procedure, if any, laid down by the applicable law and the charter documents of the

executant(s) and when it is so required, the same should be under common seal affixed in

accordance with the required procedure.

Also, wherever required, the Applicant should submit for verification the extract of

the charter documents and documents such as a resolution/ power of attorney in

favor of the person executing this Power of Attorney for the delegation of power

hereunder on behalf of the Applicant.

For a Power of Attorney executed and issued overseas, the document will also have to be

legalized by the Indian Embassy and notarized in the jurisdiction where the Power of

Attorney is being issued. However, the Power of Attorney provided by Applicants from

countries that have signed the Hague Legislation Convention 1961 are not required to be

legalised by the Indian Embassy if it carries conforming Appostille certificate.

27

Appendix G

Format For

POWER OF ATTORNEY FOR THE BID SIGNATORY

(On a Non-Judicial Stamp Paper of Rs. 100 duly attested by notary public) Know all men by these presents, We___________________________________ (name of the firm and

address of the registered office) do hereby irrevocably constitute, nominate, appoint and

authorize Mr/ Ms (name), __________________ son/daughter/wife of __________________________and

presently residing at __________________, who is [presently employed with us and holding the

position of _________________________], as our true and lawful attorney (hereinafter referred to as

the “Attorney”) to do in our name and on our behalf, all such acts, deeds and things as are

necessary or required in connection with or incidental to submission of our application for

submission of our bid for the “Establishment, Operation & Maintenance of e-UPHCs in

Vijayawada, Visakhapatnam & Tirupati, Andhra Pradesh on Public Private Partnership (PPP)

Basis” proposed by the CH&FW (the “Authority”) including but not limited to signing and

submission of all applications, bids and other documents and writings, participate in Pre-bid

conferences and other conferences and providing information/ responses to the Authority,

representing us in all matters before the Authority, signing and execution of all contracts

including the Contract Agreement and undertakings consequent to acceptance of our bid, and

generally dealing with the Authority in all matters in connection with or relating to or arising

out of our bid for the said Project and/ or upon award thereof to us and/or till the entering into

of the Contract Agreement with the Authority.

AND we hereby agree to ratify and confirm and do hereby ratify and confirm all acts, deeds and

things lawfully done or caused to be done by our said Attorney pursuant to and in exercise of

the powers conferred by this Power of Attorney and that all acts, deeds and things done by our

said Attorney in exercise of the powers hereby conferred shall and shall always be deemed to

have been done by us.

IN WITNESS WHEREOF WE,____________________, THE ABOVE NAMED PRINCIPAL HAVE

EXECUTED THIS POWER OF ATTORNEY ON THIS ____ DAY OF ________, 20**

For ---------------------------

(Signature)

(Signature, name, designation and address)

Witnesses: 1. [Notarized] 2. Accepted ________________ (Signature) (Name, Title and Address of the Attorney)

28

Appendix H

STATEMENT OF LEGAL CAPACITY

(To be forwarded on the letterhead of the Applicant)

Ref. Date:

To,

To,

The Commissioner

Commissioner Health & Family Welfare

DM&HS Compound

Sultan Bazaar, Koti

Hyderabad – 500095

Tel:

Sub: Establishment, Operation & Maintenance of e-UPHCs in Vijayawada, Visakhapatnam &

Tirupati, Andhra Pradesh on Public Private Partnership (PPP) Basis – Statement of Legal

Capacity.

Dear Sir,

We hereby confirm that we satisfy the terms and conditions laid out in the RFP document.

We have agreed that ______________(insert individual’s name) will act as our representative and has

been duly authorized to submit the RFP and required submissions. Further, the authorized

signatory is vested with requisite powers to furnish such letter and authenticate the same.

Thanking you,

Yours faithfully,

Authorized Signatory

For and on behalf of

*Please strike out whichever is not applicable.

29

APPENDIX I

Format For

GENERAL INFORMATION OF THE BIDDER

1 (a) Name:

(b) Country of Incorporation:

(c) Address of the Corporate

Headquarters and its Branch

Office(s), if any, in India:

(d) Date of Incorporation and/ or

Commencement of Business:

(e) Income Tax Registration Number

(PAN)

(f) Service Tax Registration No.

2 Brief description of the Company including details of its main lines of business and

Proposed Role and Responsibilities in this Project:

3 Details of Individual(s) who will serve as the Point of Contact/ Communication for

the Authority:

(a) Name:

(b) Designation:

(c) Company:

(d) Address:

(e) Telephone Number:

(f) E-Mail Address:

(g) Fax Number:

4 Particulars of the Authorized Signatory of the Applicant:

(a) Name:

(b) Designation:

(c) Address:

(d) Phone Number:

(e) Fax Number:

5 In case of a Consortium:

(a) The information above (1-4) should be provided for all the members of the

Consortium.

30

(b) A copy of the Consortium Agreement should be attached to the Application.

(c) Information regarding role of each member should be provided as per

table below:

Sl. No.

Name of Member

Role* {Refer Sec I of RFP}

Percentage of equity in the Consortium {Refer Sec I of RFP }

1

2

3

(b) The following information shall also be provided for each member of

the Consortium:

Name of Applicant /member of Consortium

Sr. No. Criteria Yes No

1. Has the Applicant/ Constituent of the Consortium been

barred by the Central/ State Government, or any entity

controlled by them, from participating in any Project (BOT

or otherwise).

2. If the answer to 1 is yes, does the bar subsist as on the date

of Application?

3. Has the Applicant/ Constituent of the Consortium paid

liquidated damages of more than 5% of the contract value

in a contract due to delay or has been penalized due to any

other reason in relation to execution of a contract, in the

last three years?

6 A statement by the Applicant and each of the members of its Consortium (where

applicable) disclosing material non-performance or contractual noncompliance in

past projects, contractual disputes and litigation/ arbitration in the recent past is

given below (Attach extra sheets, if necessary):

SIGNATURE ___________________

NAME ___________________

DESIGNATION ___________________

COMPANY SEAL COMPANY ___________________

DATE ___________________

31

Appendix J

EXPERIENCE CERTIFICATE

(To be submitted by Bidder/Lead Bidder in case of consortium)

Sl. No.

Item Details

1 Name of the Form 2 Type of organization 3 Address 4 Date of Registration 5 EPF 6 ESI 7 Sales Tax 8 VAT 9 Service Tax 10 PAN

12

Annual Turn Over (Attach IT returns and Statutory audit reports)

2012-13 2013-14 2014-15

13. Experience in Providing Clinical Services

Type of Facility (PHC/Hospital/MMU)

Location and Mode operation (own or PPP or charity based

Date of

Establish

ment

Number of Medical

Officers employed

Number of

Paramedical and

Nursing staff

employed

(add additional rows if number of facilities are more than 3)

14. Experience in Providing Tele Medicine Services

Date of Establishment

Location of Hub Number of

Services Centers

Number of specialists

Medical officers employed

for Tele Medicine

Objective of

Providing Tele

Medicine

Certification:

I, undersigned, certify that to the best of my knowledge and belief, this CV correctly describes

me, my qualifications, and my experience. I understand that any wilful misstatement described

herein may lead to my disqualification or dismissal, if engaged.

Signature of Authorized

Signatory

Date:

32

Appendix K

Format For

LETTER OF UNDERTAKING FOR TECHNICAL BID

[On the Letterhead of the Bidder]

Date:

To,

The Commissioner

Commissioner Health & Family Welfare

DM&HS Compound

Sultan Bazaar, Koti

Hyderabad – 500095

Tel:

Dear Sir,

Sub: Establishment, Operation & Maintenance of e-UPHCs in Vijayawada, Visakhapatnam &

Tirupati, Andhra Pradesh on Public Private Partnership (PPP) Basis – Letter of

Undertaking for Technical Bid.

We have read and understood the Request for Proposal (RFP) document in respect of

the captioned project provided to us by CH&FW.We hereby agree and undertake as under:

Notwithstanding any qualifications of conditions, whether implied or otherwise,

contained in our Proposal we hereby represent and confirm that our Proposal is unconditional

in all respects' and we agree to the terms of the proposed Contract Agreement, a draft of which

also forms a part of the RFP document provided to us.We hereby undertake that if the Project is

awarded to us, we shall implement the project as specified in the RFP. We also undertake to

meet the statutory requirements of the laws of Local Authority, State Government and that of

the Government of India, seek all the statutory licenses from time to time as required to develop

and operate the project for the Contract Period, pay all the statutory taxes, license fees payable

to Government from time to time and any other rules and regulationsof the both State and

Central Government as applicable from time to time during the Concession period.We hereby

agree to develop and operate the Project for the Contract Period of 3 years as per the

requirements specified in the RFP. We hereby assure you and guarantee that in future, from

time to time whenever we are required to undertake or follow any specific guidelines / laws, we

shall do the needful as required to ensure that the project and the Contractor comply to the legal

requirements.

Yours faithfully,

____________________________

(Signature of Authorised Signatory)

(Name, Title, Address, Date)

33

Appendix L

Format For

PRICE BID AND LETTER

[On the Letter head of the Bidder]

Date:

To,

The Commissioner

Commissioner Health & Family Welfare

DM&HS Compound

Sultan Bazaar, Koti

Hyderabad – 500095

Tel:

Dear Sir,

Sub: Price Bid for Establishment, Operation & Maintenance of e-UPHCs in Vijayawada,

Visakhapatnam & Tirupati, Andhra Pradesh on Public Private Partnership (PPP) Basis.

Being duly authorized to represent and act on behalf of ………………, and having reviewed and

examined the bidding documents (RFP), including Addenda’s , Clarifications/Reply to Pre-Bid

queries (if any) and fully understood all the requirements of bid submission pertaining to

procurement, installation of equipments at 8 e-UPHCs and Operation & Maintenance of the e-

UPHCs for three years from the date of execution of the agreement, we the undersigned, offer to

provide building space , supply the equipments and offer Operation and Maintenance services of

10 e-UPHCs under the above named contract in full conformity with the said bidding

documents. We confirm that we meet the eligibility criteria as per the RFP document. We

undertake, that if we are selected as Preferred Bidder, upon issuance of Letter of Award or

Letter of Intent, commence the Services, and achieve completion within the respective time

stated in the bidding documents. We agree to abide by this Bid, which consist of our financial

offer hereto, for a period of 180 days from the Bid Due Date and it shall remain binding on us

and may be accepted by you any time before the expiration of that period.

We hereby submit our Financial Proposal as given in the following table for undertaking the

aforesaid Project in accordance with the Bidding Documents and the Contract. .

34

1. Operational Expenditure:

S.No Cost Head Price quoted per e-UPHC per Month in Rs

1st year 2nd year 3rd year 1 Salary component

2 Non-salary component

Total

Capital Cost:

Sl. No. Item Cost (Rs in lakhs) 1 Equipment

2 Hardware and Software and Communication equipment

3 Other Establishment cost

Total

Total Project Cost:

Sl. No. Item Cost (Rs in lakhs) 1 Total O&M Cost for 1st year

2 Total O&M Cost for 2nd year

3 Total O&M Cost for 3rd year

4 Capital Cost

Total Project Cost for three years Price quoted per month per e-UPHC is Rs ……./-( in words………..) (Operational expenditure per month per e-UPHC shall be arrived by dividing total project cost

with 36 x 10)

We agree to bind by this offer if we are the selected contractor for this project. This offer is

un conditional. In case of difference between the words and figures, words would prevail.

Signature & Stamp of Authorized person

Date:

Place:

35

SECTION - VIII Service Level Agreement

1. BACKGROUND

1.1 CHFW GOVERNMENT OF AP desirous of outsourcing the services relating to

establishment, operation and Maintenance of E-UPHCs in the State of AP had invited Request

for Proposals from eligible bidders vide TE No ________________ dated _____________. <Name of the

Service Provider> having submitted his bid in response to the tender enquiry and having been

found technically qualified as per the conditions in the same TE, has been awarded the

agreement by the competent authority in the CHFW GOVERNMENT OF AP <Name of the Service

Provider> has also performed required obligations after the award of agreement was

communicated to him.

1.2 Both CHFW GOVERNMENT OF AP and <Name of the Service Provider> hereinafter

referred to as Service Provider hereby willingly enter into this agreement and agree to abide by

all obligations enjoined on them by this agreement.

2. SERVICE DESCRIPTION AND RESPONSIBILITIES

Responsibilities of Service Provider:

1. Establishment, Operation and maintenance of e-UPHCs at 10 locations in the state of AP.

List of locations are is at annexure

2. Provide the building with not less than 2000 sft carpet area and suitable for patient

examination, conducting laboratory investigations, Dispensing drugs , staff room

waiting hall for the patients and hygienic surroundings.

3. Establishing laboratory in every eUPHC for providing the laboratory investigations

mentioned at annexure.

4. Providing clinical services at eUPHCs for not less than 8 Hours per day from 8 AM to 12

Noon and 4 PM to 8 PM for 6 days a week with the staff mentioned at annexure.

5. Providing MCH clinics @ Twice in a week with OBG specialist for 4 hours per day.

6. Establishment of Telemedicine facility at every eUPHC by centralised Hub to be located

in AP. Though Telemedicine facility specialist services mentioned in the annexure shall

be provided. Timings of Telemedicine facility shall be coterminous with eUPHC timings

36

7. Developing and maintenance of electronic medical records of every patient / beneficiary

visited the e-UPHC. Every component of eUPHC shall be IT enabled and information of

every service provided at eUPHC has to be digitised. Maintenance of EMR and

Telemedicine shall be interrelated such that the laboratory investigations and other

examinations conducted to patient can be accessed by the specialist over the

Desktop/laptop instantaneously and tele consultation given to the patient has to be the

part of patient EMR

8. Dispensing the drugs, medicines to the patients / dispensaries

9. Maintenance of e-UPHC i.e. Civil Infrastructure, Medical equipment and IT equipment

and Furniture, recurring cost such as Electricity, Water, Medical consumables, Bio-

medical waste management.

10. Conducting community process in the service area, which includes conducting Urban

Health and Nutrition Days, monitoring activities of Mahila Arogya Samithi, ASHAs and

ANMs. Monitoring of implementation of National and State Health Programmes.

11. Establishing and maintenance of effective referral mechanism to secondary and tertiary

care.

12. Designing and implementing MIS system for the services provided at e-UPHC and also

the services provided at service area of e-UPHC.

13. The feedback of Tele-consultation and other services provided at e-UPHCs and in

community process will be recorded electronically by the service provider.

14. Maintenance of dedicated website for Monitoring and also displaying the services

provided at the e-UPHCs. Services provided at the e-UPHCs shall be linked to CM

Dashboard on real time basis.

Responsibilities of Service Provider:

2. Provides the drugs medicines, consumables and laboratory reagents.

5. REFERRAL PROCESS & ELIGIBILITY

1. It will be the responsibility of CHFW GOVERNMENT OF AP to provide the Service

provider an “information matrix” for nearest facilities including their capacity in

terms of existing Laboratory services, diagnostic services, and human resources

37

available.

2. It will be the responsibility of the Service Provider to keep the Medical Officer(s) in

charge of the e-UPHC informed of the information matrix. For services not available

at the e-UPHC, patients can be referred to nearest facility in accordance with the

“information matrix“.

3. Both the parties hereby agree that no patient will be referred to any private

medical establishment either formally or informally without specific prior approval

of the CH&FW, AP

6. INFORMATION AND REPORTING REQUIREMENTS

1. The Service provider shall ensure that information, records and documentation

necessary to monitor the agreement are maintained and are available at all times to

the CHFW, GOVERNMENT OF AP or its authorised representative. The Service

Provider hereby agrees that he and all his staff shall at all times co-operate with the

reasonable processes of the Service procuring agency for the monitoring,

evaluation and carrying out quality audit and financial audit by any third party

authorised by CH&FW, AP

2. The Service provider hereby agrees to maintain all relevant data and records of all

patients treated at the e-UPHC.

3. The Service provider further agrees to maintain confidentiality of these data and

records and commits that such data and records will not be shared with any third

party for any purpose.

4. The Service provider agrees to provide data to CHFW, GOVERNMENT OF AP as per

requirement of CHFW. Failure to do so may entail cancellation of the agreement.

5. The Service provider agrees that the e-UPHC vehicles will not be used to advertise

any product or organisation including the Service provider’s own.

6. The Service provider agrees to display copies of this agreement, list of medical

equipment available with the e-UPHC, stocks of drugs and consumables at

prominent place in the e-UPHC. The names of the Medical Officer and other

personnel on duty must also be displayed during duty hours.

7. PERFORMANCE

1. An quarterly review meeting will be held and attended by appropriate levels of

officials of Service procuring agency and Service providers to consider the

performance, the anticipated outcome of the agreement and future service

developments and changes. Further meetings may be arranged at any time to

consider significant variation in the terms or conduct of the agreement and where

38

corrective action on either part is indicated.

2. Both the Service procuring agency and Service Provider agree to consider

introduction of any further service in line with any new initiative of the

government or in response to local demand which could not be anticipated earlier.

3. Both the Service procuring agency and Service Provider agree that such services

should be provided without extra cost. However, if it is felt by both the parties that

the additional services would require additional resources/manpower, the Service

procuring agency agrees to consider reasonable increases in amount disbursed to

the Service provider. It is agreed that the Service provider will be under no

obligation to introduce the additional service unless a commitment to reimburse

additional cost has been provided to him.

8. HEALTH AND SAFETY

1. The Service Provider agrees to adequately train, instruct and supervise staff to

ensure as is reasonably practicable, the health and safety of all persons who may be

affected by the services provided under the agreement.

2. The Service provider agrees that he would collect periodic feedback from the

patients through structured questionnaire at his cost. The periodicity will not be

less than once in six months. Responses to the questionnaire will be submitted in

original to the Service procuring Agency Telephone numbers where patients can

lodge their complaints to be displayed on e-UPHC.

9. DATA PROTECTION, CONFIDENTIALITY AND RECORD KEEPING

1. All Service Users have a right to privacy and therefore all information and knowledge

relating to them and their circumstances must be treated as confidential. The Service

Provider must advise all staff on the importance of maintaining confidentiality and

implement procedures which ensure that Service User’s affairs are only discussed with

relevant people and agencies.

2. The Service Provider shall comply with all legislations, which otherwise would have

been applicable had the services been run directly by the Government agencies.

10. STAFFING

1. The Service provider will ensure that, at all times, it has sufficient suitably trained

staff to ensure that services comply with all the statutory requirements and meet

patient needs.

2. The Service provider agrees that he would ensure that a adequate complement of

staff mentioned at Section IX (S.No 3) of this document Agreement would be in

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position in each e-UPHC.

3. The Service provider agrees that a record of qualifications shall be maintained by

the provider and available for inspection.

4. The Service provider hereby expresses his commitment to training and staff

development and the maintenance of professional knowledge and competence.

11. FINANCE ARRANGEMENTS

1. Both parties agree that the payment arrangements as quoted by the Service

provider in his bid against the above mentioned tender enquiry and/or

subsequent bid submitted by him as a result of negotiations shall be adhered to.

2. It is agreed that payments would be made monthly basis. To facilitate this, the

Service provider will submit invoices with all documents in support of his claims

on every last working day of the month. On the basis of such invoices, the Service

procuring agency agrees to provisionally transfer the amount electronically to the

Service provider’s bank account within fifteen days from submission of invoices.

3. The Service procuring agency or any other agency as per existing rules of the

government will have the right to examine the invoices as required under

relevant rules. If such examination reveals any extra payment already

provisionally made, the extra amount will be adjusted from the next payment due

to the Service provider under intimation to him.

4. In case the last day of the month is holiday as a result of which invoices cannot be

submitted, the Service procuring agency agrees to make payment of an equivalent

amount of the last invoice submitted. Additional amount paid if any on the basis of

actual invoices submitted later and examination thereof will be adjusted from

subsequent payments under intimation to the Service provider.

5. The Service provider hereby agrees to maintain all required books of accounts

and agrees to provide them to such audit as may be required to be carried out.

6. The Service provider hereby agrees that the Service procuring agency will

deduc0074 from all payments such amount of statutory taxes and duties as he is

required to deduct under provisions of law. The amount would be deducted if the

e-UPHC becomes non operative proportionately.

12. VARIATION

1. This Service Level Agreement may not be varied unless a variation is agreed in

writing and signed by all parties.

13. DISPUTES

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1. The agreement shall be governed by and interpreted in accordance with the laws of

India for the time being in force. The Court located at the place of issue of agreement

shall have jurisdiction to decide any dispute arising out of in respect of the

agreement. It is specifically agreed that no other Court shall have jurisdiction in the

matter.

2. Both parties agree to make their best efforts to resolve any dispute between them

by mutual consultations.

14. ARBITRATION

1. If the parties fail to resolve their dispute or difference by such mutual

consultations within thirty days of commencement of consultations, then either

the Service procuring agency or the Service provider may give notice to the other

party of its intention to commence arbitration, as hereinafter provided. The

applicable arbitration procedure will be as per the Arbitration and Conciliation

Act 1996 of India. In that event, the dispute or difference shall be referred to the

sole arbitration of an officer as the arbitrator to be appointed by the <Name of the

e-UPHCSA>. If the arbitrator to whom the matter is initially referred is transferred

or vacates his office or is unable to act for any reason, he / she shall be replaced

by another person appointed by CHFW GOVERNMENT OF AP to act as Arbitrator.

2. Work under the agreement shall, notwithstanding the existence of any such

dispute or difference, continue during arbitration proceedings and no payment

due or payable by the e-UPHCSA or the firm / contractor shall be withheld on

account of such proceedings unless such payments are the direct subject of the

arbitration.

3. Reference to arbitration shall be a condition precedent to any other action at

law.14.4 Venue of Arbitration: The venue of arbitration shall be the place from

where the agreement has been issued.

15. TERMINATION

1. Either party may terminate this agreement by giving not less than 3 months

notice in writing to the other. This notice shall include reasons as to why the

agreement is proposed to be terminated.

2. The Service Procuring agency may terminate the agreement, or terminate the

provision of any part of the Services, by written notice to the Service provider

with immediate effect if the Service Provider is in default of any obligation under

the agreement, where the default is capable of remedy the Service Provider has

not remedied the default to the satisfaction of the Service procuring agency within

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30 days of at least two written advice, or such other period as may be specified by

the Service procuring agency, after service of written notice specifying the default

and requiring it to be remedied; or b. the default is not capable of remedy; or c.

the default is a fundamental breach of the agreement

3. If the Service procuring agency terminates the agreement and then makes other

arrangements for the provision of the Services, it shall be entitled to recover from

the Service provider any loss that had to be incurred due to such sudden

termination of agreement.

4. Both the parties agree that no further payment would be made to the Service

provider, even if due till settlement of anticipated loss as a result of premature

termination of the agreement.

5. The CHFW AP reserves the right to terminate the agreement without assigning

any reason if services of the e-UPHC create serious adverse publicity in media and

prima facie evidence emerges showing negligence of the Service provider.

16. INDEMNITY

1. By this agreement, the Service provider indemnifies the Service procuring agency

against damages of any kind or for any mishap/injury/accident caused to any

personnel/property of the Service provider while performing duty.

2. The Service provider agrees that all liabilities, legal or monetary, arising in any

eventuality shall be borne by the Service provider.

17. PERIOD OF AGREEMENT

1. This Service Level Agreement shall be for a period of three years take effect on

…To…..until …. The period may be extended with the agreement of both parties

after mutual negotiations.

Signed for and on behalf of the e-UPHC Service Procuring Agency

(Commissioner of Health & family Welfare,I

Signed for and on behalf of the Service Provider:

Witnesses:

1)

2)

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SECTION – IX

SERVICES & PERSONAL REQUIRED AT eUPHC

List of Personal to be available in each eUPHC

Sl.No. Position Number

1 Medical Officer, 1

2 Staff Nurse 1

3 ANM 5

4 Lab Technician 1

5 Pharmacist 1

6 Sweeper cum Watchman 1

The list of services would be provided at static clinic and at outreach as follows:

Services at Static clinic Services at outreach 1. Maternal Health

Ante-natal and post-natal care Management of regular maternal health

conditions Intra natal care, i.e. normal deliveries,

appropriate and prompt referral of cases needing specialist care.

Nutrition & health counseling Referrals services Janani Suraksha Yojana

(JSY), Janani Shishu Suraksha Karyakram (JSSK), Medical Termination of Pregnancy (MTP) etc.

Registration ANC identification of danger signs Promotion of institutional delivery Follow-up Nutrition & health counseling Counseling and behavior promotion.

2. Family welfare

Education, motivation and counseling to patients to adopt appropriate Family Planning methods.

Counseling and referral to nearby Government hospital for couples having infertility.

Distribution of OCP/CC, IUD insertion Referral for sterilization Management of contraceptive related

complications. Female sterilization, Vasectomy, IUD

insertions, Oral contraceptives and Condoms Management of complications.

Distribution of OCP/CC, IUD insertion Referral for sterilization Management of contraceptive related

complications. Referral to e-UPHC

3. Child health and nutrition

Prenatal diagnosis on birth defects Neonatal and Infant Health Referred to Newborn Stabilization Units

(NBSU)/Special Newborn Care Units (SNCU) for further care

Post natal visits and counseling for newborn care.

Promotion of exclusive breast feeding for 6 months.

Height/weight measurement, distribution

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Infant and Young Child Feeding (IYCF) and nutrition counseling, exclusive breastfeeding, complementary feeding, micronutrient supplementation

Diagnosis and treatment of childhood illness Immunization Identification and referral of neonatal sickness Referral of acute cases/chronic illness Management of neonatal hypothermia/

jaundice. Biannual screening of children for

developmental delays, diseases through RBSK referring to DIC

Disabilities and detection of RHD, malnutrition and anemia through RBSK.

of therapeutic doses of IFA, promotion of iodised salt, nutrition supplements to identified children and pregnant/lactating women.

Immunization Identification of high risk cases, referral

and follow-up Distribution of ORS Pediatric cotrimoxazole Collaborate with the Anganwadi Workers

(AWW) under ICDS.

4. RTI/STI (including HIV/AIDS)

Symptomatic diagnosis and primary treatment and referral of complicated cases

Health education on prevention of RTI/STIs.

Symptomatic search, referral, community level follow up for ensuring adherence to treatment regime of cases undergoing treatment.

Health education on prevention of RTI/STIs.

5. Nutrition deficiency disorders

Diagnosis and treatment of seriously deficient patients

Referral of acute deficiency cases Early identification of mild and severe under

nutrition Counseling for optimal feeding practices or

referral. Identification and referral of neonatal

sickness. Referring to Nutrition Rehabilitation Center

(NRC) for nutrition supplements of malnutrition

Treatment of acute ailments Screening for congenital anomalies and other

disorders Micro-nutrient supplementation Nutritional counselling Diagnosis and treatment of seriously deficient

patients, referral of acute deficiency cases Early identification of mild and severe under nutrition, counselling for optimal feeding practices or referral.

Treatment of common ailments Nutrition supplements and management of

malnutrition Stabilization and initial management of

various traumas Diagnosis and treatment of childhood illnesses,

referral of acute cases/chronic illness

Height/weight measurement Distribution of therapeutic doses of IFA Promotion of iodised salt, nutrition

supplements to identified children and pregnant/lactating women.

Collaborate with the Anganwadi Workers (AWW) under ICDS.

Immunization, identification of high risk cases, referral, follow up, distribution of ORS, pediatric cotrimoxazole, post natal visits and counseling for newborn care.

School health programme Diagnosis and nutrition advice to

malnourished children, pregnant women, anemia, vitamin-A deficiency and others in coordination with ICDS

Referral of SAM cases to nearby GNR/DEIC under ISSNIP program in coordination with ICDS

0-18 children screening on 30 conditions and referrals to DIC or SRU.

Distribution of IFA and De-worming under WIFS

Adolescent health: life skills, peer counselling, education, De-worming, Updating School Health Cards for referral services, Hygiene, clean water, early detection of growth abnormalities,

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Identification and referral of neonatal sickness Immunization services Referral to appropriate levels

prevention of diarrhea, ARI and fever, IYCF, use of iodized salt, identification of anemia, malnutrition, follow-up for NRC for SAM after treatment at Secondary level, Nutrition Diet supplementation for Child below 5yrs by linking up with Anganwadi

Adolescent health activities through RSKS. Referral of acute deficiency cases Childhood & Adolescent Health

6. Vector borne diseases

Diagnosis and treatment, referral of terminally ill cases

9. National Programmes

Implementation of All the National/State Health Programmes like RKSK, RBSK, NMHP, NTCP, RNTCP, NOHP, IDSP, NACP, NPCB, NPCDCS, NCD, NVBDCP etc. Eye care and provision of glasses through NPCB

10. Chest infections (TB/asthma)

Diagnosis and treatment, referral of complicated cases (MDR, reactions, terminal illness).

Symptomatic search and referral Ensuring adherence to DOTS and other

treatment 11. Cardio vascular disease

Clinical diagnosis Management and referral of hypertension Follow-up referred cases

BP measurement Symptomatic research and referral Follow-up of under treatment patients

12. Diabetes

Blood/urine testing Clinical diagnosis and referral Follow-up of referred cases

Symptomatic research and referral Follow-up of under treatment patients

13. Cancer

Identification and referral Follow-up of under treatment patients

Symptomatic research and referral Follow-up of under treatment patients

16. IEC/BCC

Distribution of health education material Health camps/fairs, events in schools/with MAS groups

17. Counseling

Patient/Attendant counseling Individual/group/family counselling on

HIV/AIDS Mental disorders, stress management,

tobacco/alcohol substance abuse

Individual/group/family counselling on HIV/AIDS

Mental disorders, stress management, tobacco/alcohol substance abuse

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List of lab investigations provided in house for e-UPHC:

1 Sugar – fasting 23 RDW-SD 43 Total Billirubin

2 Sugar – post prandial 24 PLT 44 Blood group Rh type

3 Sugar – random 25 MPV 45 HIV

4 HBA1C 26 PDW 46 HBAsg

5 Typhoid 27 PCT 47 VDRL

6 Dengue 28 Total Cholesterol 48 ASO

7 Malaria 29 Triglycerides 49 RA

8 ESR 30 HDL 50 CRP

9 WBC 31 LDL 51 Pregnancy test

10 Lymph# 32 VLDL 52 Urea

11 Mid# 31 LDL 53 Creatinine

12 Gran# 32 VLDL 54 Urine colour

13 Lymph% 33 LD/HDL 55 Urine Transparency

14 Mid% 34 SGOT 56 Urine sugar

15 Gran% 35 SGPT 57 Urine Proteins

16 HGB 36 Total Protein 58 Epithelial cells

17 RBC 37 Albumin 59 Pus cells

18 HCT 38 Globulin 60 RBC cells

19 MCV 39 A/G 61 Casts

20 MCH 40 Alkaline phosphate 62 Crystals

21 MCHC 41 Direct Billirubin

22 RDW-CV 42 In Direct Billirubin

The site locations of UPHCs are as follows

S.No Name of the City Location of e-UPHC 1 Vijayawada Ambedkar Nagar

2 Vijayawada Kristurajapuram

3 Vijayawada Santhi nagar

4 Vijayawada Kotha Pet

5 Visakhapatnam Prasad Gardens

6 Visakhapatnam Maddilapalem

7 Visakhapatnam Old Gajuwaka Junction

8 Visakhapatnam Lakshmi Nagar

9 Tirupati Yerramitta

10 Tirupati Autonagar

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Telemedicine Services:

a. Virtual consultation this is a holistic concept of integrating digital health services

with Tele-medicine technology as value added. Tele-medicine is visualized to be

a combination of real-time consultation and transmission of patient’s health

records collected at on-boarding, vital captured with devises should be

accessible to the online Doctors. Tele-medicine services can be provided to

facilitate patients to access specialist consultation services through virtual clinic

with prior intimation and for second opinion on specific cases. Online specialist

consultation Communication link between the e-UPHC and the NOC could be

through wired/wireless Broadband, or any other available form of connectivity.

A dedicated minimum bandwidth of 2 Mbps (for each of uplink and downlink

channels) for videoconference and data transmission between clinic and NOC is

deemed sufficient.

b. Network Operations Centre/Service Support Center: A facility with a pool of

qualified specialist doctors to provide Video consultations as on specialized

services in the presence of physical Doctor at the center.

c. The NOC/SSC receive reading of the patients that are sent for diagnosis by

remotely situated Spokes. Spokes shall be able to send medical records of the

patients to the Doctors available in NOC/SSC and an informed patient-Doctor

interaction is established through Video conference.

d. The Tele-medicine functionality at these units must allow doctors to connect,

create, store, retrieve EMR and provide/retrieve expert opinion.

e. General Medicine, Pediatrics, Gastroenterology, Endocrinology, Dermatology,

Cardiology and Neurology services shall be provided through Telemedicine

Other Services to be provided at eUPHC:

f. Electronic Medical Record has to be made for every patient / Beneficiary

accessed the eUPHC.

g. Every patient / Beneficiary accessed the eUPHC shall be provided with the

Medical Record Book (design will be provided by the CHFW)

h. Adequate waiting room shall be available and waiting area shall be provided

with IEC Material. LCD TV (42’’) shall be positioned in the waiting room through

which awareness on DCPs, Lifestyle Diseases and others shall be provided.

i. Ensure the control of communicable disease which includes prompt response to

epidemics and effective surveillance

j. Display of the Charter of Patient’s Rights in waiting hall and focusing NUHM

component in each e-UPHC. Definitive service levels shall be stipulated for

providing a response to each grievance. Maintain a digital log-book for reported

grievances on services, facilities, shortages of medicines, quality of services, staff,

space or any other aspect relating thereto and report from time-to-time to

CPMU/DPMU/DM&HO/SPMU