Supplier : __________________________

Address: ___________________________

Eligibility and Technical Components (Goods)
A. Eligibility Documents
Class A Documents:

I. Registration certificate from the Securities and Exchange Commission (SEC),
Department of Trade and Industry (DTI) for sole proprietorship, or
Cooperative Development Authority (CDA) for cooperatives, or
Any proof of such registration as stated in the BDS;

II. Mayors/ Business permit issued by the city or municipality where the principal place of business of the prospective
bidder is located;

III. Statement of the prospective bidder of all its on going and completed government and private contracts, including
contracts awarded but not yet started, if any, whether similar or not similar in nature and complexity to the contract to
be bid, within the relevant period as provided in the bidding documents. The statement shall include all information
required in the PBDs prescribed by the GPPB.

IV. Audited financial statements, showing among others, the prospective total and current assets and liabilities, stamped
received by the BIR or its duly accredited and authorized institutions, for the preceding calendar year which should not
be earlier than two (2) years from the date of bid submission;

V. NFCC computation or CLC in accordance with ITB Clause 5.5; and

Class B Document:

VI. If applicable, valid Joint Venture Agreement (JVA) or, in lieu thereof, duly notarized statements from all the potential joint
venture partners stating that they will enter into and abide by the provisions of the JVA in the instance that the bid is
successful shall be included in the bid.

A. Technical Documents

VII. Bid security as prescribed in ITB Clause 18
2% of ABC if cash
5% of ABC if surety bond


VIII. Technical Specifications which may include production/delivery schedule, manpower requirements, and or after sales
service/part, if applicable; and



IX. Sworn statement in accordance with Section 25.2 (b) (iv) of the IRR of RA 9184 and using the form prescribed in Section
IX. Bidding Forms

Financial Component

a. Financial Bid Form in accordance with the form prescribed in Section IX. Bidding Forms; and

b. Any other document required in the BDS.

Checked by:
______________________________
TWG



Omnibus Sworn Statement

Republic of the Philippines
City/Municipality of Cabadbaran

AFFIDAVIT

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:

a. I am the sole proprietor of __________________________ with office address at ______________________ (address of Bidder).

b. As the owner and sole proprietor of ______________________ (Name of Bidder), I have full power and authority to do, execute and
perform any and all acts necessary to represent it in the bidding for ________ (Name of Project) of the (Name of the Procuring
Entity).

c. (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 institutions whose blacklisting rules
have been recognized by the Government Procurement Policy Board;

d. 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;

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

f. I am 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;

g. (Name of the Bidder) complies with existing labor laws and standards; and

h. (Name of the 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 Project).

IN WITNESS WHEREOF, I have hereunto set my hands this _____ day of ________ 2014 at __________________________.


__________________________________________
Bidders Representative/Authorized Signatory





Standard Form Number : SF GOOD- 14

NET FINANCIAL CONTRACTING CAPACITY (NFCC)

A. Summary of the Applicant Suppliers / Distributors/ Manufacturers assets and liabilities on the basis of the attached income tax return
and audited financial statement, stamped RECEIVED by the Bureau of Internal Revenue or BIR authorized collecting agent, for the
immediately preceding year and a certified copy of Schedule of Fixed Assets particularly the list of construction equipment.

Year 20 _____
1. Total Assets
2. Current Assets
3. Total Liabilities
4. Current Liabilities
5. Net Worth (1-3
6. Net Working Capital (2-4)

B. The Net Financial Contracting Capacity (NFCC) based on the above data is computed as follows:
NFCC = K (Current asset- current liabilities) minus value of all outstanding works under ongoing contracts including awarded contracts yet
to be started
NFCC = P ___________________________________
K = 10 for a contract duration of one year or less, 15 for more than one year up to two years and 20 for more than two years
Or:
Commitment from a licensed bank to extend to it a credit line if awarded the contract or a cash deposit certificate in the amount of at least 10%
of the proposed project to be bid.
Name of Bank : _______________________ Amount: ________________________
Herewith attached are certified true copies of the income tax return and audited financial statement; stamped RECEIVED by the BIR or BIR
authorized collecting agent for the immediately preceding year or certificate of commitment from a licensed bank to extend a credit line.
Submitted by:
___________________________________
Name of Supplier/Distributor/Manufacturer
__________________________________
Signature









Standard Form # SF Good-13b


STATEMENT OF ALL GOVERNMENT & PRIVATE CONTRACTS COMPLETED WHICH ARE SIMILAR IN
NATURE


Business Name:

Address:


Name of Contract a. Owner's Name Nature of Work Bidder's Role a. Amount at Award a. Date Awarded
b. Address

Description % b. amount at Completion b. Contract Effectivity
c. Telephone Nos. c. Duration c. Date Completed

Government:





























Private:





















Note: This statement shall be supported with:

1. Contract

2. Certificate of Completion

3. Certificate of Acceptance



Submitted by:


Printed
Name/Signature

Designation

Date






Standard Form # SF Good 13a

LIST OF ALL ON GOING GOVERNMENT & PRIVATE CONTRACTS INCLUDING CONTRACTS AWARDED BUT
NOT YET STARTED

Business:
Name:

Address:



Name of Contract/ a. Owner's Name Nature of Work Bidder's Role a. Date Awarded % of Accomplishment Value of
Project Cost b. Address

Description % b. Date Started Planned Actual Outstanding Works/
c. Telephone Nos.
c. Date of
Completion Undelivered Portion

Government:









































Private:






















Total Cost
Note: This statement shall be supported with:
1. Notice of Award
and or/ contract.

2. Notice to Proceed issued by the owner.

3. Certificate of Accomplishments signed by the owner or authorized
representative





Submitted by:



Printed Name &
Signature





Designation

Date






Technical Specifications



Item Quantity Unit of Issue Description Statement of Compliance

















































I hereby commit to comply with all the above technical specifications




Name of Company/ Signature over Printed Name Date

Bidder