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1 THE WATER AUTHORITY OF FIJI INVITATION OF TENDER Tender Terms and Conditions (TT&C) Construction of NCC Entrance and Fire Escape Stairways, Tamavua Tender Number: WAF_13/11/01/PROD/DBSS 24 th February, 2014

THE WATER AUTHORITY OF FIJI INVITATION OF TENDER...Schedule to Condition of Tendering in Part 1 of this document. 3.2 Each Tenderer shall submit with their tender full details of the

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Page 1: THE WATER AUTHORITY OF FIJI INVITATION OF TENDER...Schedule to Condition of Tendering in Part 1 of this document. 3.2 Each Tenderer shall submit with their tender full details of the

1

THE WATER AUTHORITY OF FIJI

INVITATION OF TENDER

Tender Terms and Conditions (TT&C)

Construction of NCC Entrance and Fire Escape Stairways, Tamavua

Tender Number: WAF_13/11/01/PROD/DBSS

24th February, 2014

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Table of Contents1.0 About the Company ..................................................................................................................3

2.0 Introduction……………...............................................................................................................3

3.0 Design……………………………….............................................................................................3

4.0 Commencement of work……..................................................................................................4

5.0 Completion of component no.1 ..............................................................................................4

6.0 Completion of component no. 2..........................................................................................4

7.0 Completion of component no. 3……………………………………………………………..4

8.0 Awarding for different phases of work………………………………………………………5

9.0 Conditions for the Project……………………………………………………………………….5

10.0 Scope of work ……………………………………………………………………………………6

11.0 Attachments ……………………………………………………………………………………..7

Attachment 1…………………………………………………………………………………………..8

Attachment 2 …………………………………………………………………………………………10

Attachment 3 ………………………………………………………………………………………….25

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1

Design and Construction of WAF National Control Centre (NCC) premisesEntrance and Fire Escape Stairways, Tamavua.

1.0About the Company

Water Authority of Fiji (WAF) is dedicated to the delivery of watersupply and waste water services independently and is able to mobilisethe necessary resources to meet the demand, effectively andefficiently at required quality standards.

2.0 Introduction

The Water authority of Fiji intends to establish it’s National Control Centre(NCC) at Tamavua in Suva .The sole objective of this is to improve

its service delivery in all over Fiji with Optimization of key operationsthrough Automation and instrumentation. Towards achieving this

objective it has been planned to further improve and expand itsSupervisory control and Data acquisition system (SCADA) usingcombination of telemetry, Radio and GSM technologies to cover all thewater & waste water systems. This activity will be one of the majordrivers which will boost WAF operations over a period of three years. It isexpected that this facility will ensure better management of WAF waterand waste water assets all over the country utilizing latest state of artsmart technologies. The WAF National Control Centre (NCC) premises is to belocated in the extension of the Tamavua WTP Building which is 3rd level andabout 8.094 m from the ground level.

The project is primarily in three phases with three major components in theconstruction of the preliminaries and general, main entrance and the fireescape emergency stairways. There is an existing stairway within the premises,however it is not wide enough as we expect a sudden increase in number ofpeople who would be using this premises in the near future. As such there is aneed for proper entrance and fire escape stairway addressing safety, healthand aesthetic concerns. This project can be further divided into four mainstages as outlined in this document.

2.0 Design

Submission and approval of conceptual design and actual design to matchnicely with the existing structure of the treatment plant, treatment plantbuilding and surrounding landscape from all sides. A consulting service has

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been engaged for this purpose and a set of preliminary architectural andstructural drawings have been developed with the main phases of the workutilizing a concrete entrance staircase and a steel fire escape stairways.Different design for these phases of work must be supported with relevantdocumentations.

4.0Commencement of work

The construction would be in accordance with approved conceptual andactual design with proper supervisions and monitoring to ensure that astandard of work is identified and maintained. The work would be divided intothree major components and they would be implemented on a parallel basis.

5.0Completion of Component No. 1 – Preliminaries and General

The completion of component no. 1 would ensure that all the preliminarywork including Public Liability, Risk Insurances, Bonds, Safety and warningequipments, road management, permits and fees, drawings and otherimportant documents are organized before the construction phase getsunderway.

Take (Preliminary and General) Cost = X

6.0Completion of Component No. 2 - Steel

The completion of the fire escape stairway structure is anticipated earlier thanthe main entrance stairway due to the less complexity of work involved andtherefore takes lesser time since they are implemented on a parallel basis. ‘I’cross-section beam and column are recommended for any steel structure tobe used and rectangular section beam and column for any reinforcedconcrete structure to be used.

Take (Steel Fire Escape) Cost = Y

7.0Completion of Component No. 3 - Reinforced Concrete

The completion of the main entrance stairway is anticipated to completeafter 2 months which is the actual duration of the project commencing frompreliminary work and design.

Take (Entrance Staircase) Cost = Z

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8.0Awarding for different phases of work or proportionately awarding

There is a possibility that WAF will only award for certain phases of workmeaning that the work has been proportionately awarded and therefore thefollowing estimate formulae could be used:

1. Awarding for Preliminaries and General (X) and Fire Escape (Z):

Formula for Estimate = X+Z

Y+Z

2. Awarding for Preliminaries and General (X) and Entrance Staircase (Y):

Formula for Estimate = X+Y

Y+Z

9.0 Conditions for the Project

1. Hurricane proof for both works2. Structurally sound for both works3. Design load and actual detailed design are formulated from either NZ

or Australian code for structural design of steel and reinforced concrete4. Aesthetically, the structure should match nicely with the existing

building and the surrounding landscape of the treatment plant.5. OHS requirements must be met

10.0 Scope of work

No. Item Description Quantity Specifications

01. New Stairway for entrance andemergency exit.

1 No. New stairway about 8.094 m height and1.40 m width to be built externally to theexisting WTP Building, as per drawing.

02. A new two-storey structure toprovide strength, security, safetyand shelter

1 No A new two-storey structure fromfoundation level to roof level with dim.(5.019m x 7.0m) with 375 mm x 375 mmconcrete column & 150mm thick blockwall and 250x375mm reinforced concretebeam for first and second floor as perengineers design and as per drawing.

03. Ground Floor 1 No Foundation structure with dim. (5.019m x7.0m) with 375mm x 375mm & 150 mm

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thick blockwall and reinforced concretefooting as per Engineers design and as perdrawing.

04. First Floor 1 No. First Floor Structure about 3.695m aboveground level with a slab supported by a375mmx375mm column and a 250x375mmreinforced concrete beam as perengineers design and as per drawing.

05. Second Floor 1 No. Second Floor Structure about 8.094mabove ground floor level with a slabsupported by a 375mmx375mm columnand a 250x375mm reinforced beam as perengineers design and as per drawing.

06. Roofing & Roof 1 No. 0.48 BMT colorbond roofing screw fixed asper manufacturers specifications andother details as per drawing.

07. Steps, Steps Railings & Railings 1 No. As per drawing

08. Canopy 1 No. Canopy with 150x50mm timber purlins @600mm crs. bolted to MS angle bracketswith 10mm dia. Bolts complete with nuts &washers;

Tension Rods fixed to concrete column &300x150mm Universal Beam as perengineers design and other details as perdrawing

09. Doors 4 Nos. 2nd floor entry, fire exit, ground floor rearentry and ground floor store room door asper drawing

10. Proposed Fire Escape 1 No. Fire Escape ladder and pipe to wall fixingas per drawing.

11. Openable and Fixed Windows 6 Nos. 5 Nos. openable and 1No. fixed as perdrawing

12. Electrical Works As per specification and electricaldrawings

13. Plastering As per specification and drawings

14. Painting As per specification and drawings

15. Civil Works As per specification and drawings

16. Structural Works As per specification and drawings

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17. Steel and Metal works As per specification and drawings

18. Preliminary Works As per specification and drawings

19. Roofing and ceiling works As per specification and drawings

20. Plumbing and drainage works As per specification and drawings

11.0 AttachmentsThe following attachments are provided for the information of Tenderers. ThePrincipal neither warrants nor guarantees the accuracy of the informationpresented in the attachments.

ATTACHMENT 1 – Locality Maps and Building Layout

ATTACHMENT 2 – Tender Evaluation Criteria

ATTACHMENT 3 – Specimen Memorandum ofAgreement

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ATTACHMENTS 2 – TENDER EVALUATIONS CRITERIA

3.0 Tender Evaluation

3.1 Tenders will generally be evaluated with the method specified in theSchedule to Condition of Tendering in Part 1 of this document.

3.2 Each Tenderer shall submit with their tender full details of the non priceattributes as described in the Attributes Submission Schedule included withthese conditions. Failure to submit these documents may deem the tender to benon-conforming.

3.3 Selection Process: Tenders will be evaluated by the evaluation team usingthe “Two Envelope Weighted Attribute” method outlined as further detailed in theclauses below. Where only one conforming tender is received WAF maynegotiate with the tenderer, but shall not accept a negotiated price thatexceeds the tender price.

Tenderers who are unfamiliar with this evaluation method should contact theProject Manager for clarifications.

3.4 Tender Evaluation- Two envelope Weighted Attribute Tender Method TenderEvaluation shall be conducted in two stages as follows:

1st Stage

The first stage shall consist of determination of tender acceptability and gradingagainst each of the attributes. This shall be done using the procedure outlinedbelow.

Each non-price attribute shall be graded to a 65 marks, All tenders that score 45marks will be qualify for the second stage, And those below will not beconsidered.

2nd Stage

The second stage consists of opening the tender price information. The highestmark will be allocated to the lowest bidder.

The Principal shall not be bound to acceptany tender.

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3.5 Attribute Marks

The Marks for each attribute (W) shall be shown below;

EVALUATION CRITERIA MARKSFIRST STAGE

1 Relevant Experience 10abc

Experience in FijiExperience in construction buildings

Experience in construction of steelfabricated staircases

2 Track Record 25Proven track record inFiji in constructionor fabrication ofbuildings / buildingcomponents/Steelstructures

3 Proposed Personnel 5ab

Key staff experience in FijiProject Managers experience in

managingContracts

4 Construction Methodology 25abcde

Project ProgrammeConstructionMethodologyResourcesManagement SkillsSafety and Quality systems

SECOND STAGE1 Price 35

3.6 Canvassing of WAF Employees

3.6.1 Any attempt made by the Tenderer to influence the outcome of thetendering process by canvassing, lobbying or otherwise seeking support ofthe WAF employees shall be deemed valid grounds for the exclusion of thattender from the evaluation process

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3.7 Attribute Submission Requirements & Schedules

Tenders should be structured and is mandatory to include the information as setout in this section.

Non-price attribute should not exceed a total of 20 single sided pages ofstandard font 11 prints.

Each Tenderer shall submit with their tender, full detail of the non-priced attributesas described in these Conditions. Failure to submit these details may deem thetender to be non-conforming and lead to failure on the attribute and rejection ofthe tender.

Tenderers should be aware that Contractors performance has been reviewed onthe past WAFcontractors and will be reviewed on thiscontract.

3.8 General-Introduction

The introduction to the tender should state that the Tenderer has read andunderstood all the terms and conditions contained in this tender and that theyhave been complied with and will continue to be complied with throughoutthe duration of the tender period and contract period.

3.9 Relevant Experiences

Each Tenderer will supply a record of the relevant experiences, which wouldindicate its suitability for the works described in the scope of works andtechnical specifications. The relevant experience of proposed subcontractorsor other named personnel will also be supplied. Total contracting experienceand the local knowledge of each Tenderer will be considered, as this willreflect organization abilities.

Information on each project shall include the name of the project, theclients’ year and duration of the project which demonstrates the relevanceof this contract. Where the Tenderers’ input was as part of a larger project,this information shall be detailed for the Tenderers’ input only.

3.10 Track Record

The track record shall include a minimum of five (5) relevant projects in Fiji, whichdemonstrate the ability of the Tenderer to undertake this contract. The followingitems shall be provided in tabular form:

Name of Project Client (include clients name, name of key persons and phone numbers) Location Durations and Dates

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Final certification from the respective client on satisfactory completion Construction Cost (Both whole project and Tenderer’s input) Completed within Time (Y/N) Completed within budget (Y/N)

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Completed to target performance levels (Y/N)

(If “NO” then a supporting statement maybe made) Supporting InformationRequired:

Details of Quality Management Systems employed by the Tenderer Compliance with the Health and Safety at Work Act 1996/2003 (HSWA).

Tenderers are advised that their record of compliance with Quality ManagementSystems will be given particular attention during the tender evaluation process.

3.11 Proposed Personnel

Details including curricula vitae (CV) or summary CV’s, (detailed CV’s maybe contained in Appendices) of the key personnel offered by the Tendererto work on this contract, with particular regard to the skills and experience ofstaff in the particular technical areas, job co- ordination, traffic control, qualityassurance and testing, public and contractual relations and communications. Within

the contractors workforce there should be an appropriatelytrained safety representative, as well as the other key personnel listed in theSchedule IV of Section 2.5.Where the use of subcontractors is proposed, the tenderer shall complete TenderInformation Schedule in Section 2.5 by stating the name and address of eachsubcontractor together with a statement of relevant technical skills of keysubcontractors staff, and the type and extent of work for which thesubcontractors staff, and the type and extent of work for which the subcontractorwill be used. Particular regard will be paid to the relevance of the technical skillsand experience of the staff offered.NOTE: If awarded, the offer of personnel (own staff and subcontractors)constitutes an obligation for those people to be employed as part of the projectteam, and in the role for the level of commitment nominated in section 2.5,Schedule IV, Personnel Schedule for the duration of the contract period. Removalor replacement of personnel from the contract must have the prior writtenapproval of the Principal.

3.12 Proposed Subcontractors

Details of proposed subcontractors shall be included for earth working, civilconstruction, mechanical fabrication and installation and electrical contractorsfor the delivery of this construction contract. However the experience of thesubcontractors will not be considered for evaluation.

Details of the proposed subcontractors should include relevant experience (refersection 2.3.2)track record (refer section 2.3.3) and proposed personnel (refersection 2.3.4).The Tenderer shall complete Tender Information Schedule in Section 2.5 bystating the name and the address of each subcontractor, and the type andextent of work for which the subcontractor shall be used.

Particular regard will be given to the proposed subcontractors and their relevant

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experience, track record and proposed personnel.Note, if awarded, the offer of subcontractors constitutes anobligation as part of the Tender.

Removal or replacement from the contractor must have the prior andwritten approval of the principal.

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3.13 Construction MethodologyThis section should set out the procedures Tenderers propose to implementthis contract, achieve the specified standards, minimum inputs, specified endresults, along with all the contracts requirements.Methodology shall demonstrate the Tenderers approach in carrying out thespecified work.

The methodology willinclude:

The division of work (own forces or subcontractors) and how the labor resource areallocated

to each work activity (scheduleitem)

A tender programme of works showing start and finish dates of major activities. The means of planning and programming (computer based) The means of communication within the site between staff and the engineer. The implementation of a specific Quality plan for this project. Means of recording, reporting and invoicing. Identification of hazards The Tender shall demonstrate their understanding of the project, the contractrequirements,

the client needs and the specific needs of the Water Authority of Fiji, as well as themeans and methods required to achieve the desired results in the most efficientmanner.

3.14 Resources

Each Tenderer will list the main items of the plant and equipment (including thoseof subcontractors), facilities, intellectual property and other physical resources tobe used in the contract works and available as required to fulfill all aspects of thecontracts works.

The successful Tenderer will not be limited to using only the plant andequipment listed provided that any replacement item is considered by theEngineer to be suitable for the intended task. Acceptance of the tenderdoes not necessarily imply acceptance of all the Tenderer’s proposed plantand equipment. The Tenderer shall indicate whether he/she currently has theequipment available.

Details of major plant identification and commitment shall be submitted inSection 2.5, Schedule V: Plant and Equipment.

NOTE: If awarded, the offer of resources (own and subcontractors) constitutes anobligation for those resources to be used for the level of commitmentnominated in Section 2.5, Schedule V, Plant and Equipment for the duration of theContract period. Removal or replacement of resources from the contract withoutthe written approval of the Principal may result in a breach of contract.

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3.14.1 Work Commitments,Conflicts and Impacts

Tenderers should also indicate whether they or any proposed keysubcontractors have any existing or anticipated conflicts of interest of other workcommitments which might impact on the performance of the workscontemplated by this Tender. (Use Tender Information Schedule in Section 2.5 andaccompany with any explanation.)

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3.14.2 Management Skills

Description of the management system and management skills of both thetendering company and the nominated personnel who will be applied in order tosuccessfully carry out the contract works.

The description of the management system willshow:

The System used and proposed to control this contract in particular, time, Quality,Cost,

Environment, health andsafety.

The management contract hierarchy in the form of a tree diagram. The system used for communication between staff with the Engineer. A commitment of the management to the electronic data processing systemsdeveloped for

recording, reporting andinvoicing.

The specific management systems appropriate to manage this specificcontract and all the contract requirements detailed in these contractdocuments.

Commitment and management of a structured Health and Safety policy. The commitment and management of Quality and demonstration of an understanding ofsuch

items as a Contract Quality Plan and Quality procedures to ensure the requiredQuality productresults. Comment on any formula QASystem.

The commitment and management of staff training.

The management skills of each key personnel and how these will beimplemented to carry out their nominated duties.Details including CV’s or Summary CV’s detailed CV’s may be contained inAppendices) of thekey personnel offered by the Tenderer to work on this contract, with particularregard to the relevant management skills and experience of the staff inmanagement positions implementing the proposed management system for thiscontract.

3.14.3 ContractQuality Plan

Where required in the Schedule to Conditions of Tendering the Tender shallprepare an outline (heading and subheading as a minimum) Contract QualityPlan (CQP) to ensure that the materials used and the workmanship employedwill achieve the minimum Quality and environmental standards specified pagelimit.NOTE: The final CQP required by the clause 5.17 of the General Conditions must bein place before works are permitted to proceed.

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3.14.4 Health and Safety Plan

The Tender shall include in its tender the first of two parts of the Health andSafety Plan. The first part is to be submitted with the tender and shall address allknown hazards identified by the Principal and listed in this section (Schedule VII).The Health and Safety Plan shall include a completed Health and Safety PlanTable in the format stated (Schedule VII).

The second part of the plan, if required by the Special Condition of Contract shallbe submitted by the successful Tenderer as required by the General Condition2.6.4.

NOTE: The second part of the plan, if required to be submitted, must be in placeprior to commencement of the Permanent Works.

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3.15 Pricing Information

Each Tenderer must submit the total price for which it is prepared to undertakethe works covered by this tender, on the Tender Form.

Each component of the works required should be costed separately on theSchedule of Prices and Rates. If a Day work rate is requested, a rate shall beincluded in the Schedule of Prices.

All prices should be stated exclusive of VAT and in Fijian dollars.

3.16 Insurance

The tender must out the following in full in respect of the Tenderers insurancepolicies as listed below. All the insurance shall satisfy the requirements of theclause 8.5 of the General Condition of Contract, except as provided below.The Principal may waive additional excepted risks and insurance conditions,which the Tenderers insurer cannot comply with and which are generally notprovided by the Insurance Industry, providing that these exceptions are listedwith the tender submission:

Type of Cover Sum Insured Excess Expiry Name of PolicyDate Insurer No.

Public LiabilityContract WorksMotor VehicleConstruction MachineryProfessional IndemnityRequest to waiveadditional excepted risksand insurance conditions

3.17 Notices to Tenderers

Please acknowledge receipt of all notices to Tenderers in the form set out on the TenderForm.

3.18 Alternative Tenders, Conditions, Endorsements

The Tender should note the WAF Amendments to Conditions of Tendering contained inPart 2Section 2.2 of this document.

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3.19 Tender Form

Tender For: Contract No. .........................................................................................

For: ...................................................................................................................................

1) .................................................................................................................................. (Hereinafter called theTenderer) having examined the site and the Tender Documents hereby offers to Water Authority ofFiji to construct, complete, deliver and maintain theabove-mentioned work in accordance with the drawings, specifications andConditions ofContract for the sum of (in words)

Tender Total $................................................................................ (VEP)................................................................................................................................................................................................................................. (Words) or such other sums as may be ascertained inaccordance with the Contract Documents.

2) This sum includes allowance for Notice(s) to Tenderers No(s).....................................

3) We undertake to complete and deliver the whole of the contract works comprised in theTender Documents within the time stated in the Special Condition of Contract, or such othertime ascertained in accordance with the Tender Documents.

4) This tender is valid for a period of 90 days from the date of closing of tenders.

5) Until a Contract Agreement is prepared and executed, this tender together with yourwritten acceptance thereof, shall constitute a binding contract between us as Contractor andWater Authority of Fiji as Principal.

6) We understand that the Principal is not bound to accept the lowest priced, highest scoringor any tender received.

7) We authorize the Principal to seek an opinion from our banker regarding our ability to undertakethis contract.

8) We understand that no legal or other obligations shall arise between the Tenderer and thePrincipal in relation to the conduct or outcome of the tender process unless and until theTenderer has received written notificationof the acceptance of its tender.

9) We attach the information to be submitted with this Tender:

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10) We are a registered company in terms of Value Added Tax. Our VATregistration number is........................................................

11) A complete schedule of quantities and prices showing how the said sum isarrived at is attached.

12) Should this offer be accepted, the Tenderers undertake, within 14 days ofacceptance, to execute and have executed by the surety, a bond inaccordance with the Conditions of Contract.

Signature of authorized signatory:.............................................................................................. Name of authorizedsignatory: .................................................................................................... TelephoneNo: ...........................................Date: ........................................................................Address:......................................................................................................................................

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Section 3 - Evaluation and Qualification Criteria 3-27

3.20 Tender Information Schedules

Schedule I to IV inclusive on the following pages.In completing these schedules the Tenderer should note:

1) % Commitment is the percentage of the time the person or resources will becontractually committed to this contract. The 5% is considered adequate at tenderstage, e.g. 100% is 40 hours per week x 52 weeks per year = 2040 hours per annum(leave and training include for personnel).

2) Potential conflicts of current work or outstanding tenders to be indicated by anaccompanying explanation of impact.

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WATER AUTHORITY OF FIJICorner of Kings & Wainivula Road

Manohan Building – Level 5, Nasinu

P.O. Box 1277, Suva, Fiji Islands

MEMORANDUM OF AGREEMENT

CONSTRUCTION OF NCC ENTRANCE AND FIRE ESCAPE STAIRWAYS, TAMAVUA

CONTRACT No. ……………….

THIS AGREEMENT is made on the……..day of ……………..20….. that is the latter of two dates entered bysignatories below

BETWEEN the WATER AUTHORITY OF FIJI through the Production Business Unit located at level 4,Manohan Building, Corner of Wainivula Road, 4 miles (herein called “THE CLIENT”) of the one part

AND ……………………………………………………………..practicing as Contractors from an officeat…………………………………………………………(who and the survivors of whom are herein called “THECONTRACTORS”) of the other part.

IT IS AGREED as follows:

The contractor shall undertake and perform duties, complete and deliver as described in the Quotationprovided by the CONTRACTOR.

The Client shall pay the contractor the sum of not exceeding…………………….inclusive of VAT and alldisbursements.

Each party shall carry out and fulfil their obligations as stipulated in the Terms of Reference and the agreedContract Documents.

This Memorandum of Agreement and the following documents shall be binding and form part of thisAgreement.

a) The Terms of Reference prepared by Client dated………………..b) Letter of Acceptance by the Client dated………………….c) Acceptance of Offer by the Contractor dated……………d) Contractor’s Tender Submission dated…………………..e) General Conditions of Engagement, Model Conditions of Engagement (FIDIC, 2006)f) The Contractor’s Professional Indemnity and Public Liability Insurance Policies

Page 26: THE WATER AUTHORITY OF FIJI INVITATION OF TENDER...Schedule to Condition of Tendering in Part 1 of this document. 3.2 Each Tenderer shall submit with their tender full details of the

Tender Terms and Conditions – 01 – 25/02/2014NCC Refurbishment – Construction of NCC Entrance and Fire Escape Stairways

NOW THIS PRESENT WITNESS and it is hereby agreed and declared by and between the parties hereto:

CLIENT – WATER AUTHORITY OF FIJI

CORNER OF KINGS & WAINIVULA ROAD, LEVEL 4 – MANOHAN BLDG, NASINU.

SIGNED FOR AND ON BEHALF OF CLIENT WITNESS TO THE SIGNATURE OF CLIENT

…………………………………… ……………………………………………

SIGNED SIGNED

…………………………………….. …………………………………………….

PRINT NAME PRINT NAME

………………………………………. ………………………………………………

DESIGNATION OCCUPATION

……………………………………….

DATE

……………………………………..

COMAPANY SEAL

CONTRACTOR …………………………………………………

SIGNED FOR AND ON BEHALF OF CONTRACTOR WITNESS TO THE SIGNATURE CONTRACTOR

…………………………………………………….. ……………………………………………………

SIGNED SIGNED

……………………………………………………… ……………………………………………………..

PRINT NAME PRINT NAME

…………………………………………………….. …………………………………………………….

DESIGNATION OCCUPATION

……………………………………………………..

DATE

…………………………………………………….

COMPANY SEAL