Annex A Omnibus Sworn Statement

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Annex A

Omnibus Sworn Statement

REPUBLIC OF THE PHILIPPINES ) CITY/MUNICIPALITY OF ______ ) S.S.

A F F I D A V I T

I, [Name of Affiant], of legal age, [Civil Status], [Nationality], and residing at [Address of Affiant], after having been duly sworn in accordance with law, do hereby depose and state that:

1. Select one, delete the other: If a sole proprietorship: I am the sole proprietor or authorized representative of [Name of Bidder] with office address at [address of Bidder]; If a partnership, corporation, cooperative, or joint venture: I am the duly authorized and designated representative of [Name of Bidder] with office address at [address of Bidder];

2. Select one, delete the other: If a sole proprietorship: As the owner and sole proprietor, or authorized representative of [Name of Bidder], I have full power and authority to do, execute and perform any and all acts necessary to participate, submit the bid, and to sign and execute the ensuing contract for [Name of the Project] of the [Name of the Procuring Entity], as shown in the attached duly notarized Special Power of Attorney; If a partnership, corporation, cooperative, or joint venture: I am granted full power and authority to do, execute and perform any and all acts necessary to participate, submit the bid, and to sign and execute the ensuing contract for [Name of the Project] of the [Name of the Procuring Entity], as shown in the attached [state title of attached document showing proof of authorization (e.g., duly notarized Secretary’s Certificate, Board/Partnership Resolution, or Special Power of Attorney, whichever is applicable;)];

3. [Name of Bidder] is not “blacklisted” or barred from bidding by the Government of the Philippines or any of its agencies, offices, corporations, or Local Government Units, foreign government/foreign or international financing institution whose blacklisting rules have been recognized by the Government Procurement Policy Board;

4. Each of the documents submitted in satisfaction of the bidding requirements is an authentic copy of the original, complete, and all statements and information provided therein are true and correct;

5. [Name of Bidder] is authorizing the Head of the Procuring Entity or its duly authorized representative(s) to verify all the documents submitted;

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6. Select one, delete the rest: If a sole proprietorship: The owner or sole proprietor is not related to the Head of the Procuring Entity, members of the Bids and Awards Committee (BAC), the Technical Working Group, and the BAC Secretariat, the head of the Project Management Office or the end-user unit, and the project consultants by consanguinity or affinity up to the third civil degree; If a partnership or cooperative: None of the officers and members of [Name of Bidder] is related to the Head of the Procuring Entity, members of the Bids and Awards Committee (BAC), the Technical Working Group, and the BAC Secretariat, the head of the Project Management Office or the end-user unit, and the project consultants by consanguinity or affinity up to the third civil degree; If a corporation or joint venture: None of the officers, directors, and controlling stockholders of [Name of Bidder] is related to the Head of the Procuring Entity, members of the Bids and Awards Committee (BAC), the Technical Working Group, and the BAC Secretariat, the head of the Project Management Office or the end-user unit, and the project consultants by consanguinity or affinity up to the third civil degree;

7. [Name of Bidder] complies with existing labor laws and standards; and

8. [Name of Bidder] is aware of and has undertaken the following responsibilities as a Bidder: a) Carefully examine all of the Bidding Documents;

b) Acknowledge all conditions, local or otherwise, affecting the implementation of the

Contract;

c) Made an estimate of the facilities available and needed for the contract to be bid, if any; and

d) Inquire or secure Supplemental/Bid Bulletin(s) issued for the [Name of the Project].

9. [Name of Bidder] did not give or pay directly or indirectly, any commission, amount, fee, or any form of consideration, pecuniary or otherwise, to any person or official, personnel or representative of the government in relation to any procurement project or activity.

IN WITNESS WHEREOF, I have hereunto set my hand this __ day of ___, 20__ at ____________, Philippines. _____________________________________ Bidder’s Representative/Authorized Signatory

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SUBSCRIBED AND SWORN to before me this ___ day of [month] [year] at [place of execution], Philippines. Affiant/s is/are personally known to me and was/were identified by me through competent evidence of identity as defined in the 2004 Rules on Notarial Practice (A.M. No. 02-8-13-SC). Affiant/s exhibited to me his/her [insert type of government identification card used], with his/her photograph and signature appearing thereon, with no. ________ and his/her Community Tax Certificate No. _______ issued on ____ at ______. Witness my hand and seal this ___ day of [month] [year]. NAME OF NOTARY PUBLIC Serial No. of Commission _______________ Notary Public for _______ until __________ Roll of Attorneys No. __________________ PTR No. ______ [date issued], [place issued] IBP No. ______ [date issued], [place issued] Doc. No. _____ Page No. _____ Book No. _____ Series of _____

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Republic of the Philippines

NATIONAL FOOD AUTHORITY

CARAGA REGION

BIDS AND AWARDS COMMITTEE

Butuan City

INVITATION TO SUBMIT QUOTATION

PROCUREMENT OF CONSTRUCTION OF WATER TANK BASE SUPPORT IN

LIBERTAD GID COMPOUND, BUTUAN CITY THRU SMALL VALUE

PROCUREMENT PER SECTION 53.9 OF THE 2016 REVISED IRR OF RA 9184

(REBIDDING)

The NATIONAL FOOD AUTHORITY, through its RMT Budget for 2019, intends to

apply the sum of ONE HUNDRED FIFTY SEVEN THOUSAND ONE HUNDRED

TWENTY NINE AND 28/100 PESOS ONLY (Php 157,129.28) being the

APPROVED BUDGET FOR THE CONTRACT (ABC) to payment for the

Procurement of Construction of Water Tank Base Support in GID Compound,

Butuan City Thru Small Value Procurement Per Section 53.9 of the 2016 Revised

IRR of RA 9184.

LOT

NO. PARTICULARS

sub-ABC

(in Php)

1 Construction Materials #1 4,863.04




5 Labor Services 52,734.65

TOTAL ABC 157,129.28

Those interested can secure copies of the REQUEST FOR QUOTATION form from NFA Caraga Regional Office, NFA Compound, Brgy. Libertad, Butuan City on October 12 – 17, 2019 8:00 AM TO 5:00 PM (Working Days Only) until October 18, 2019 not later than 12:00 NN. The Request for Quotation form must be submitted to the NFA Caraga Regional Office on October 18, 2019 at 1:00 PM. Late quotations shall not be accepted. Opening of the Quotations shall immediately follow at 2:00 PM at same venue and shall be opened in the presence of the Offerors or Offerors’ authorized representatives.

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The NATIONAL FOOD AUTHORITY CARAGA reserves the right to accept or reject any quotation, to annul the negotiated procurement, and to reject all quotation at any time prior to contract award without thereby incurring any liability to the affected Offeror or Offerors. For further information, please refer to:

Ms. BEVERLYN P. PERALTA Acting Asst. Regional Manager and RBAC Chairperson National Food Authority NFA Compound, Libertad, Butuan City Tel. No. (085) 817-9311 Fax No. (085) 816-3786 Email: [email protected]

Ms. AMIELOU JANE G. MENDOZA Regional Information Officer BAC Secretariat Head National Food Authority NFA Compound Libertad, Butuan City Tel. No. (085) 817-9311 Email: [email protected]

Ms. BEVERLYN P. PERALTA Acting Asst. Regional Manager and RBAC Chairperson

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Revised on: May 24, 2004

Standard Form Title: Request for Quotation

Date: October 12, 2019

Quotation No. 04-2019

_____________________________ (Company Name)

________________________________ (Address)

Please quote your lowest price on the item/s listed below, subject to the particulars below

and other terms. Submit your quotation duly signed by you or your authorized representative not later than October 18, 2019 1:00 PM in the return envelope attached herewith.

BEVERLYN P. PERALTA, Ph. D. Acting Assistant Regional Director

Chairperson, BAC

NOTE: 1. ALL ENTRIES MUST BE TYPEWRITTEN; 2. PRICE VALIDITY MUST BE WITHIN THIRTY (30) CALENDAR DAYS; 3. PRICE MUST BE VAT INCLUSIVE; 4. PLEASE SUBMIT THE FOLLOWING BEFORE THE OPENING OF THE SEALED QUOTATION IN ONE (1)

ORIGINAL COPY AND THREE (3) DULY CERTIFIED PHOTOCOPIES BY THE BIDDER: A. PLATINUM MEMBERSHIP (PhilGEPS) B. INCOME/BUSINESS TAX RETURN FOR 1

ST AND 2

ND QTR OF 2019;

C. NOTARIZED OMNIBUS SWORN STATEMENT; AND D. BID SECURITY IN ANY FORM AS PRESCRIBED BY RA 9184

LOT

NO. PARTICULARS

Sub-ABC

(in Php)

Offer

(Inclusive VAT)





5 Labor Services 52,734.65

TOTAL ABC 157,129.28

After having carefully read and accepted your Conditions, I/We quote you on the item at prices noted above.

________________________________

Printed Name / Signature

________________________________

Tel. No. / Cellphone No.

E-mail address ________________________________

Date

Republic of the Philippines


CARAGA REGION

BIDS AWARDS COMMITTEE Butuan City

Project Reference Number: RXV-2019-CAR-J-001

Name of the Project: Procurement of

Construction of Water Tank Base Support in Libertad GID Compound, Butuan City Thru Small Value

Procurement per Section 53.9 of the 2016 Revised

IRR of RA 9184 (Rebidding)

Location of the Project: Butuan City

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Schedule of Requirements

Item

No. Description Quantity Total

Delivered,

Weeks/Months

Lot No. 1 - Construction Materials #1 Delivery of Goods shall

not exceed fifteen (15) calendar days upon

Supplier’s receipt of

the Notice to Proceed.

1. 1”x 2” x 10’ Sarik Lumber 5 bundles

2. 3/16” x 4’ x 8’ Ordinary Plywood 2 sheets

3. Common Nails #3 5 kgs

Lot No. 2 - Construction Materials #2 Delivery of Goods shall not exceed fifteen (15)

calendar days upon

Supplier’s receipt of the Notice to Proceed.

1. Portland Cement 12 bags

2. Sand 2 cu.m.

3. Gravel 3 cu.m.


not exceed fifteen (15)

calendar days upon Supplier’s receipt of


1. 16mm dia. x 6.0m – Deformed Bars 16 lengths

2. 10mm dia. x 6.0m – Deformed Bars 12 lengths

3. Tie Wire #16 5 kgs


not exceed fifteen (15) calendar days upon

Supplier’s receipt of


1. ¼” x 4” x 6.0m –Angle Bar 4 lengths

2. ¼” 2” x 2” x 6.0m – Angle Bar 6 lengths

3. 3/16” 1 ½” x 1 ½” x 6.0m – Angle Bar 2 lengths

4. ¼” 1 ½” x 1 ½” x 6.0m – Flat Bar 5 lengths

5. 0.25m x 0.25m x 10mm thk. – Base Plate 4 pcs

6. 0.12m x 0.12m x 6mm thk. – Gusset Plate 40 pcs

7. Cutting Disk 30 pcs

8. 0.5m x 1” dia. – Anchor Bolt 4 lengths

9. 16mm dia. x 6.0m – Round Bar 3 lengths

10. 10mm dia. x 6.0m – Round Bar 12 lengths

Lot No. 5 – Labor Services

1. Concrete Chipping Works

2. Formworks

3. Concrete Works

4. Reinforcing Works

5. Steel Works

I. Technical Specification

Item Number/

Description

Statement of

Compliance

Indicate here the brand name, model

and detailed

specification, if any

Lot No. 1 - Construction Materials #1

1. 1”x 2” x 10’ Sarik Lumber

2. 3/16” x 4’ x 8’ Ordinary Plywood

3. Common Nails #3


1. Portland Cement

2. Sand

3. Gravel


1. 16mm dia. x 6.0m – Deformed Bars

2. 10mm dia. x 6.0m – Deformed Bars

3. Tie Wire #16

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1. ¼” x 4” x 6.0m –Angle Bar

2. ¼” 2” x 2” x 6.0m – Angle Bar

3. 3/16” 1 ½” x 1 ½” x 6.0m – Angle Bar

4. ¼” 1 ½” x 1 ½” x 6.0m – Flat Bar

5. 0.25m x 0.25m x 10mm thk. – Base Plate

6. 0.12m x 0.12m x 6mm thk. – Gusset Plate

7. Cutting Disk

8. 0.5m x 1” dia. – Anchor Bolt

9. 16mm dia. x 6.0m – Round Bar

10. 10mm dia. x 6.0m – Round Bar

Lot No. 5 – Labor Services

1. Concrete Chipping Works

2. Formworks

3. Concrete Works

4. Reinforcing Works

5. Steel Works

Submitted by:

_________________________________________________________

Signature over printed name of the Bidder’s authorized representative

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Caraga Regional Office

__________________________________________________________________________________ NFA Compound, Brgy. Libertad, Butuan City, Contact Nos.+6332-886-4236/(085)817-9311/ Website www.nfa.gov.ph

September 23, 2019

FOR : DIOCANO D. ALOJADO, JR. Acting Regional Director National Food Authority Caraga Region Butuan City THRU : The Regional Bids and Awards Committee (RBAC) FROM : The Technical Working Group (TWG)

SUBJECT : TERMS OF REFERENCE (TOR) FOR THE CONSTRUCTION OF

WATER TANK BASE SUPPORT IN LIBERTAD GID COMPOUND,

BUTUAN CITY

I. PROJECT DESCRIPTION AND PURPOSE

Application of Water Tank Base Support, Tapping of Concrete and Installation of Reinforced Steel Bars / Angle Bars for 2600 Cubic Liters Water Tank.

II. SUBMISSION OF SEALED QUOTATION:

1. Date and Time of Submission : On or before October 18, 2019; 1:00 PM 2. Form of Submission : Thru sealed envelope/Personalized Delivery or thru waybill (DHL, LBC, etc.) 3. Authorized person to receive quotation : RBAC Secretariat. c/o Ms. Amielou Jane G. Mendoza

III. OPENING OF QUOTATIONS 1. Date and Time of Opening : October 18, 2019; 2:00 PM onward 2. Place : NFA-Regional Office, Butuan City 3. Parties to be present

a) RBAC d) Service Provider/Authorized Representative b) TWG e) Observer c) Secretariat

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IV. SCHEDULE OF REQUIREMENTS

Description

Location

ABC

( Php)

Cost of Bidding

Documents ( Php)

Contract Duration

( Calendar Days)

Construction of Water Tank Base Support in Libertad GID Compound, Butuan City

GID Libertad, Butuan City

157,129.28

500.00

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V. ELIGIBILITY DOCUMENTS

Prospective bidders shall submit one (1) certified photocopy of the following documents during submission of sealed quotation :

Legal Documents

1. PhilGEPS Certificate of Registration ( Platinum); or

The following Class “A” eligibility documents provided that the PhilGEPS Certificate of Registration (Platinum) be submitted during the post-qualification stage: a. 2019 Mayor’s/ Business permit issued by the city or municipality where the

principal place of business of the prospective bidder is located, or the equivalent document for Exclusive Economic Zones or Area.

b. DTI Business Name Registration or SEC Registration Certificate or CDA

Registration Certificate

c. 2019 1st and 2

nd quarter Business Tax Returns

2. Omnibus Sworn Statement (Annex A)

VI. HOW TO BID

All bids that exceed the ABC shall be rejected outright.

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VII. CONDITIONS IN THE DETERMINATION OF THE LOWEST CALCULATED BID

In case of a tie in the Lowest Calculated Bid (LCB) between two bidders, this shall be resolved through toss coin. In case of multiple ties, it shall be resolved through draw lots.

VIII. PERFORMANCE SECURITY

The Performance Security shall be in amount not less than the required percentage of the total contract price in accordance with the following schedule:

Form of Performance Security

Amount of Performance Security ( not less than the required

percentage of the Total Contract Price)

a. Cash or cashier’s/manager’s check issued by a Universal or Commercial Bank

Five Percent (5%)

b. Bank draft/guarantee or irrevocable letter of credit issued by a universal or commercial bank: provided, however, that it shall be confirmed or authenticated by a universal or commercial bank, if issued by a foreign bank.

c. Surety bond callable on demand issued by a surety or insurance company duly certified by the Insurance Commission as authorized to issue such security.

Thirty Percent ( 30%)

IX. WARRANTY

To ensure that defects shall be corrected by the contractor, the project shall be covered by a warranty of a minimum of one (1) year after the completion of the project.

The obligation of the warranty shall be covered by either retention money or a special bank guarantee in an amount equivalent to at least ten percent (10%) of the total contract price. The said amounts shall only be released after the lapse of the warranty period and after all the conditions imposed under the contract have been fully met.

X. OBLIGATIONS OF THE CONTRACTOR

1. To conduct site inspection on the roof deck to be repaired prior to the submission of sealed quotation.

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2. To provide all labor, tools, equipment, materials, supplies and vehicle necessary to satisfactorily perform the project.

3. To ensure smooth and safe working environment and will not interrupt the daily business activities of the National Food Authority.

4. To display safety signs at the vicinity of the work site.

5. To inform NFA Caraga Region on the delivery of materials for inspection in

order to check the materials’ compliance to specifications.

6. The contractor shall maintain an updated Logbook and weather chart that will be available at the project site.

7. To complete the project within thirty (30) calendar days reckoning from the

receipt of the Notice to Proceed.

8. To provide NFA with all the construction records. And upon completion of the project, to provide NFA a built plan/drawing of the project.

9. Contractor shall bill NFA upon completion of the works and after the

complete submission of the required documents as mentioned in item XI.4.

XI. OBLIGATIONS OF THE NFA

1. To issue a Notice of Award

2. To serve the Notice to Proceed indicating therein the contract duration which is thirty (30) calendar days. Failure to complete the project within thirty (30) calendar days for any cause not attributable to NFA shall make the contractor liable to liquidated damages as specified in item XII.

3. The NFA Inspection Team shall validate the accomplishment/completion of

the project for purpose of payment. The Team shall be composed of the following:

Team Leader : Regional Engineer Members : Regional Operations Officer : Regional Accountant

: Regional Administrative Officer

4. The NFA shall pay the supplier upon the presentation of the following documents:

a. Accomplished Voucher

b. Notice of Award

c. Contract

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d. Notice to Proceed

e. Certificate of Inspection by the NFA

f. Certificate of Completion by the NFA

Cheque payment shall be made upon submission of complete documents as enumerated above subject to usual NFA accounting and auditing rules and regulations.

XII. LIQUIDATED DAMAGES

The Contractor shall pay liquidated damages to the Procuring Entity for each day that the Completion Date is later than the Intended Completion Date. The applicable liquidated damages is at least one-tenth (1/10) of a percent of the cost of the unperformed portion for every day of delay. The Procuring Entity shall deduct liquidated damages from payments due to the Contractor. Payment of liquidated damages shall not affect the Contractor’s liabilities. Once the cumulative amount of liquidated damages reaches ten percent (10%) of the amount of this Contract, the Procuring Entity may rescind or terminate this Contract, without prejudice to the other courses of action and remedies available under the circumstances. If the Intended Completion Date is extended after liquidated damages have been paid, the Engineer of the Procuring Entity shall correct any overpayment of liquidated damages by the Contractor by adjusting the next payment certificate.

XIII. SPECIAL PROVISION

In case of litigation arising from this contract, the contractor agrees to pay liquidated damages in the amount of not less than Php 50,000 and cost of suit.

XIV.VENUE OF ACTIONS

Actions arising out of or relating to this Contract shall be filed only with any of the competent courts of Butuan City, Agusan Del Norte.

PREPARED BY: TECHNICAL WORKING GROUP (TWG):

ART D. OCADO ALEX A. TELARMA Supvg. GOO (RE) Supvg. GOO (ROO)

HAILEE C. ATIBAGOS ROBERT P. BACANGGOY Acting Regional Calibrator GOO II

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Recommending Approval: REGIONAL BIDS AND AWARDS COMMITTEE (RBAC)

JOSE B. BALANQUIT Provincial Manager, NFA-AGN Vice-Chairperson, BAC

MAY SARA A. ATOMAR Provincial Manager, NFA-SDS Member, BAC

DAISY M. LUNA Provincial Manager, NFA- SUN Member, BAC

ROLANDO C. SINDO Officer-In-Charge, NFA-ADS Member, BAC

BEVERLYN P. PERALTA, Ph.D. Acting Assistant Regional Director

Chairperson, BAC

APPROVED:

DIOCANO D. ALOJADO, JR. Regional Director and Head of the Procuring Entity (HOPE)

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