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BANKI KUU YA KENYA
CENTRAL BANK OF KENYA
Haile Selassie Avenue
P.O. Box 60000 - 00200 Nairobi Kenya Telephone: 2861000/2863000
Fax 340192/250783
Email: [email protected]
CENTRAL BANK OF KENYA
PREQUALIFICATION/REGISTRATION OF
SUPPLIERS
FOR
SUPPLY/PROVISION OF MEDICAL SERVICES
FOR
THE YEAR 2018-2021
TENDER NUMBER CBK/56/2017-2018
(CLOSING DATE:THURSDAY 29TH MARCH 2018 AT 10:30AM
2
SECTION 1: TENDER NOTICE
REFERENCE: CBK /56/2017-2018 TENDER NAME: PRE-QUALIFICATION OF
SUPPLIERS FOR PROVISION OF MEDICAL SERVICES (DOCTORS SPECIALISED
IN VARIOUS FIELDS AND MEDICAL INSTITUTIONS- HOSPITALS, XRAY, SCAN
MRI, LASER EYE TREATMENT, LABORATORY AND AMBULANCE SERVICES)
FOR CENTRAL BANK OF KENYA HEAD OFFICE, BRANCHES & CURRENCY
CENTRES (KISUMU, ELDORET, MOMBASA, NAKURU, NYERI & MERU)
SECTION A – INVITATION FOR PREQUALIFICATION
Tender Ref. CBK/56/2017-2018
The Central Bank of Kenya (CBK) invites sealed applications from eligible candidates for
purposes of prequalifying Doctors and Hospital institutions from 1st May, 2018 to 30th April
2021
1. A complete set of pre-qualification documents containing detailed information may be
obtained from Central Bank of Kenya, Head Office, along Haile Selassie Avenue,
Procurement and Logistics Services Department on 5th Floor at no cost OR be downloaded
from the Central Bank website www.centralbank.go.ke for free. Bidders who download the
tender document are advised to email their contact address using the email:
[email protected] before the tender closing date.
2. Further information as pertains to these tenders may be obtained during working hours
(Monday to Friday) between 9:00 am and 5:00 pm using the following address: The Ag.
Director, Procurement and Logistics Services, Tel: +254 20 2861000/2860000,Fax: +254
20 2863497/020 310604, 6th Floor, Central Bank of Kenya, Haile Selassie Avenue,
Nairobi, Email: [email protected]
3. Pre-qualification documents duly completed in sealed envelopes clearly marked with the
tender number and title should be deposited in the Green Tender Box (Marked Tender
Box No.3) located at the Front Entrance to the CBK Building situated along Haile Selassie
Avenue, Nairobi so as to be received on or before THURSDAY 29TH MARCH, 2018 at
10.30 a.m. Late bids will not be accepted and will be returned unopened.
4. Tenders will be opened immediately thereafter in the presence of the tenderers
representatives who may choose to attend the opening at DPLS Conference Room on 5th
Floor.
Ag. DIRECTOR,
DEPARTMENT PROCUREMENT AND LOGISTICS SERVICES
3
Table of Contents Page
SECTION 1 : INVITATION TO TENDER…………………………………2
GUIDE LINES IN PREPARATION OF BID DOCUMENT...3
SECTION I1 : PRE-QUALIFICATIONS CATEGORIES…………………...9
SECTION II1 : INSTRUCTIONS TO TENDERERS………………………...9
SECTION IV : APPENDIX TO INSTRUCTIONS TO TENDERERS………13
SECTION V : EVALUATION CRITERIA……………………………. ……14
SECTION VI : PRICE SCHEDULE …………………………………………..17
SECTION VII : STANDARD FORMS…………………………………………18
4
GUIDELINES IN PREPARATION OF BID DOCUMENT
In preparing the bid document in response to the tender, bidders are advised to note the
following:
Section I – Invitation to Tender. This section gives guidelines on how and where to seek
further clarification pertaining to the tender document; Whether Tender Security is required
or not; where and when the tenders should be submitted; and place where tenders will be
opened.
Section II – Prequalification Categories – This section provides a List of categories for
which the Doctor/Medical Institutions are being prequalified. Please indicate the services
you provide.
Section III – Instruction to Tenderers. This section guides tenderers basically on how to
prepare their bid and how the tendering process will be carried out upto the award stage
including notification of award to the successful bidder. “Appendix to Instruction to
Tenderers” customizes clauses under Section III. Wherever there is a conflict between the
provisions of the Instructions to Tenderers under Section III and the provisions of the
appendix, the provisions of the appendix prevail.
Evaluation Criteria: This gives information on how the tender will be evaluated. Tenderers
should be able to evaluate their bids before submission to determine in advance whether they
meet the requirement of the bid or not. Through the evaluation criteria bidders will be able to
note all the required documents that should be attached to the bid document. Checklist of Document Forming the Bid Document:
No. Documents forming part of the bid Remarks
1 The main sections of the tender document that includes
Section I – Invitation to Tender;
Section II – Instruction to Tenderers; and section III –
General Conditions of the Contract
2 Copy of Certificate of Incorporation or Business Registration Certificate as
per the tender requirements and items in MR1 - 7
3 Copy of tax compliance certificate valid at least up to the date of tender
opening
4 Dully filled and signed Confidential Business Questionnaire in the form or
format provided in the tender document
5 Provide ALL ITEMS detailed in T1 – T3 as appropriate for Individual
Doctors and Medical Institutions
6 Bid document to be serialized on all pages by the tenderer
7 List of services provided with charges
5
SECTION II: PRE-QUALIFICATIONS CATEGORIES
NO SPECIALITY INDICATE YOUR CATEGORY
NAIROBI
1. Cardiologists
2. General Physicians
3. Dermatologists
4. Endocrinologists
5. Gastroenterologists
6. Cancer Specialists
7. Neurologists
8. Surgeons
9. E.N.T
10. Ophthalmologists
11. Psychiatrists
12. Obstetricians &
13. Gynaecologists
14. Orthopedic Surgeons
15. Neurosurgeons
16. Urologists
17. Plastic Surgeons
18. Cardiothoracic
19. Surgeons
20. Rheumatologists
21. Allergists
22. Dentists
23. Oral & Maxillofacial
24. Hospitals
25. Day Care Surgeries
26. Audiology Services
27. Nutritionists /Dieticians
28. Counselling Services
29. Physiotherapy Services
30. Chemists
31. X-rays ,Scans ,M.R.I
32. Laboratories Services
33. Ambulance Services
34. Special Outpatients
35. Clinics
36. Chest Physicians
37. Pediatricians
38. Neonatologist
39. Hematologists
40. Cancer care centre
41. Anesthesiologist
42. Interventional Radiologist
43. Gastro-entrology
6
NO SPECIALITY INDICATE YOUR CATEGORY 44. Pain Specialists
45. Diabetology/
46. Endocrinology
47. Paediatric Cardiac Clinic
48. Adult Cardiac Clinic
49. Paediatric Surgery
50. Paediatric Neurology
51. Psychiatry
52. Neuro-Surgery
53. Maxillo-facial Surgery
54. Paediatric Gastroetrology
55. Paediatric Nephrology
56. Paediatric Endocinologist
57. Paediatric Pulmonologist
58. Asthma Specialist
59. Cardiothoracic Surgeons
60. Breast Specialist
ELDORET COUNTY 61. Physicians
62. Opthalmolgists
63. General Surgery
64. Urologists
65. Gyneacologists
66. Dermatologists
67. Orthopaedics Surgeons
68. Paediatricians
69. Dentists
70. Psychiatrics
71. E.N.T
72. Oncologists
73. Counselling
74. Neuro Surgeon
75. Nutritionist
76. Gastroenterolgists
77. Diabetologist
78. Cardio thoracic surgeons
79. Occupational Therapists
80. Physiotherapy
81. X-ray ,M.R.I ,Scans
82. Laboratory Services
83. Hospitals 84. Chemists
85. Ambulance Services
86. Nephrologists
87. Paediatric Pulmilogist
7
NO SPECIALITY INDICATE YOUR CATEGORY
88. Dialysis Clinic
89. Rehabilitation Centres
90. Athroscopic Surgeon
KISUMU COUNTY
91. Physicians
92. Neurologists
93. Uro-logist
94. General Surgeons
95. Gynaecologists
96. Dermatologist
97. E. N T
98. Psychiatric
99. Paediatricians
100. Paeditric Surgeion
101. Orthopeadic Surgeons
102. Dentists
103. Hospitals
104. Laboratory
105. X-ray Scan ,MRI
106. Couselling services
107. Physiotherapy
108. Ambulances
109. Chemists
MOMBASA COUNTY
110. Physicians
111. Urologists
112. Gastroenterologists
113. General Surgeons
114. Orthopedic Surgeons
115. Opthalmologists
116. Gynaecologists
117. Dermatologists
118. E.N.T
119. Psychiatrics
120. Paediatricians
121. Oncologists
122. Dentists
123. Maxillofacial
124. Neuro -Surgeons
125. Neuro Physician
126. Rheumatologists
127. Nutritionists / Dieticians
128. Cardilogists
129. Hospitals
130. Cardiology Services
8
NO SPECIALITY INDICATE YOUR CATEGORY
131. Laboratory Services
132. X-ray, Scan, MRI
133. Dialysis Services
134. Nephrologists
135. Chemists 136. Ambulance Services
137. Neurology Services
138. Counselling Services
139. Laparascope Gastroenterologists
140. Anaesthesists
NAKURU COUNTY 141. Out Patients Clinic
142. Physicians
143. Urologists
144. Pediatricians
145. Orthopedic Surgeons
146. General Surgeons
147. Oral &Maxillofacial Surgeon
148. Opthalmolgist
149. Dermatologist
150. ENT Surgeon
151. Obstretic & Gynaecologist
152. Cardiologists
153. Oncologists
154. Trauma Surgeon
155. Psychiatrist
156. Ambulance Services
157. Radiologist MERU COUNTY
158. Outpatients Clinic
159. Paediatrician
160. E.N.T
161. Gynaecologist
162. Dentist
163. Radiologist
164. Wananchi Health Services
NYERI COUNTY 165. Outpatient Clinics 166. Obstretic & Gynaecologist
167. General Physicians
168. E.N.T 169. Trauma Surgeons 170. Dentists
171. Paediatrician 172. Opthalmologist
173. Pyschatric
9
SECTION III: INSTRUCTIONS TO TENDERERS
1.1. The Central Bank of Kenya will pre-qualify and enlist prospective bidders for provision
of medical services and treatment under the CBK Medical Benefit Scheme.
1.2. The Doctors and Hospitals (Institutions) that have in the past been pre-qualified as
suppliers by CBK are also required to update their records through participation in this
pre-qualification process. Only the suppliers that respond to this advertisement will
be enlisted in the CBK data bank.
1.3. Both individual doctors and Hospital institutions are invited to submit a pre-qualification
tender for the provision of the advertised services listed in Section A of this pre-
qualification document.
1.4. The Pre-Qualification Tender document and the Tenderers response thereof shall be the
basis for pre-qualification. Tenderers must familiarize themselves with the requirements
described in this document and take them into account while preparing the response.
1.5. Tenderers will meet all costs associated with preparation and submission of their
applications.
1.6. It is the Bank’s policy to require that Tenderers observe the highest standard of ethics
during the selection and execution of such contracts. In pursuance of this policy, The
Bank:
a) defines, for the purpose of this provision, the terms set forth below as follows:
(i) "Corrupt practice" means the offering, giving, receiving or soliciting of
anything of value to influence the action of an officer of the
Purchaser/Employer in the pre-qualification process; and
(ii) “Fraudulent practice” means a misrepresentation of facts in order to
influence the pre-qualification process to the detriment of the
Purchaser/Employer, and includes collusive practices among Tenderers
(prior to or after submission of Tenders) designed to establish prices at
artificial, non-competitive levels and to deprive the Purchaser of the
benefits of free and open competition.
(b) Will reject a Tender for pre-qualification if it determines that a Tenderer
has engaged in corrupt or fraudulent activities in competing for the
contract in question;
(c) Will declare a Tender ineligible, for pre-qualification if at any time it
determines that Tenderer has engaged in corrupt or fraudulent practices in
competing for, or in executing, a similar contract; and
10
(d) Will have the right to examine financial records relating to the
performance of such services to determine capability.
(e) Will have the right to inspect the business premises of the tenderer.
1.8 Tenderers shall furnish information as described in the pre-qualification tender document.
1.9 Tenderers shall be aware of the provisions on fraud and corruption stated in the standard
contract under the clauses indicated in the Data Sheet.
2. DOCUMENTS COMPRISING THE REQUEST FOR PRE-QUALIFICATION
2.1 Tenderers may request a clarification on the Tender Pre-qualification document up to
three (3) days before the Tender submission date. Any request for clarification must be
sent in writing by mail, facsimile, or electronic mail to the Purchaser's/Employer’s
address. The Purchaser/Employer will respond in writing by normal postal mail,
facsimile, or electronic mail to such requests and will send copies of the response to all
Tenderers who intend to submit tenders.
3 PREPARATION OF TENDER DOCUMENTS
3.1 Tenderers are requested to submit a Tender written in English language.
3.2 Tenderers are expected to examine the documents comprising this Request for pre-
qualification in detail. Material deficiencies in providing the information requested may
result in rejection of a Tender.
3.3 Tenderers are required to meet the qualification criteria stipulated in Section 2. Those
who do not meet the requirements need not submit tenders. Only tenders, which fulfill
these requirements, will be considered for detailed evaluation.
3.4 The pre-qualification documents shall not include any financial proposal information
other than audited accounts for the last 2 years.
3.5 Period of Validity
The request for pre-qualification must remain valid for not less than 120 days from the
date of submission.
4 SUBMISSION, RECEIPT, AND OPENING OF TENDERS
4.1 The original Tender Document shall be prepared in indelible ink. It shall contain no
interlineations or overwriting, except as necessary to correct errors made by the Tenderer.
Any such corrections must be initialed by the person or persons who sign(s) the Tender
Document.
4.2 The Tender should be prepared and submitted in 1 (one) copy in a plain sealed envelope
marked;
11
“PRE-QUALIFICATION OF SUPPLIERS FOR PROVISION OF MEDICAL SERVICES
(DOCTORS SPECIALISED IN VARIOUS FIELDS AND MEDICAL INSTITUTIONS-
HOSPITALS, XRAY, SCAN MRI, LASER EYE TREATMENT, LABORATORY AND
AMBULANCE SERVICES) FOR CENTRAL BANK OF KENYA HEAD OFFICE AND
BRANCHES AND CURRENCY CENTRES (KISUMU, ELDORET & MOMBASA,
NYERI, NAKURU & MERU) (Indicating the field of specialization as in the categories
above)
and addressed to:
The Ag. Director, Procurement and Logistics Services,
Central Bank of Kenya
P.O. Box 60000-00200
Nairobi
4.3 Deadline for Submission
The closing time for the Tender shall be Thursday 29th March, 2018 at 10.30 a.m. and
shall be sent to the above address. Tenders shall be marked on top "DO NOT OPEN
BEFORE THURSDAY 29TH MARCH, 2018 at 10.30 a.m.
4.4 Late Tender
Any Tender received after the deadline pursuant to clause 4.3 shall be rejected.
4.5 Tender Opening And Evaluation
4.5.1 A committee of officials from the Bank shall open the Tender immediately after the
closing time for submission of the Tender.
4.5.2 The Bank will prepare a record of the Tender opening.
5 TENDER EVALUATION
5.1 General Requirements
(i) The Central Bank will examine the tenders to determine completeness,
general orderliness and sufficiency in responsiveness.
(ii) Tenderers shall not contact the Bank on the matter relating to their tender
from the time of opening to the time the evaluation is finalized and official
communication is sent to them. Any effort by the Tenderer to influence the
Bank in the Tender evaluation shall result in the rejection of their tender.
12
(iii) Pre-qualification will be based on meeting the minimum qualifying score of
75% in the evaluation criteria as set out in SECTION V of the tender
document.
(iv) The tenderers should have registered offices and the Bank reserves the
discretion of visiting physical premises from which the tenderer conducts
business if so desired to confirm existence and capability to deliver the said
goods/services.
(v) Tenderers who qualify according to the selection criteria may be invited to
submit their quotations for the provision of the services as and when required.
The Bank does not bind itself to assign services but shall endeavor to ensure
that Applicants are treated equitably when opportunities arise.
5.2 Litigation
Applicants must disclose any current litigation involving the firm.
5.3 Verification of Information
Central Bank of Kenya reserves the right to verify any information provided by
prospective bidder as a qualification for consideration.
13
SECTION IV: APPENDIX TO INSTRUCTIONS TO TENDERERS
The following information regarding the particulars of the tender shall complement/ supplement
or amend the provisions of the instructions to tenderers. Wherever there is a conflict between the
provision of the instructions to tenderers and the provisions of the appendix, the provisions of the
appendix herein shall prevail over those of the instructions to tenderers.
1. All the admitting hospitals must have clearly defined general ward beds, fully equipment
theatres, Radiology facilities, pharmacy, mortuaries, and physiotherapy units and lastly
they must be N.H.I.F accredited.
2. For the individual doctors, relevant qualification, experience and registration.
3. Provision of relevant Professional Indemnity Certificate
4. State charges for consultation and other charges
5. The individual doctors must all have admitting rights to the main hospitals, have
indemnity cover and must not have current malpractices against them.
6. Keeping the agreed rates as constant as possible within the contract time.
7. Offering consistent high quality services.
8. Maintain ethical practice as laid down by the Kenya Medical Practitioners and Dentists
Board Code of Conduct.
9. Adhere and to support the Bank’s policy on issuance of sick offs. Details will be provided
in the contract documents.
10. Willingness to work in close co-operation with the Staff Clinics with adequate
communication at all times.
11. State any other complimentary services provided by the medical service provider.
14
SECTION V: EVALUATION CRITERIA
Evaluation of tenders will be conducted based on the tenderers response to the mandatory
requirements and the performance based technical qualification.
(I) MANDATORY REQUIREMENTS (FOR INDIVIDUAL DOCTORS)
The following mandatory requirements must be met by the individual doctors not withstanding
other requirements in the tender document:
NO REQUIREMENTS
RESPONSIVE OR NOT
RESPONSIVE
MR1. A copy of Tax Compliance Certificate issued by KRA, valid
up to and including the tender closing date.
MR2. Copy of current License from Kenya Medical Practitioners
and Dentists Board, nursing Council, laboratory regulatory
etc.
MR3. Professional Indemnity Cover- indicate the cover
MR4. Must have admitting rights to the main hospitals – proof by
providing comprehensive list of the name of hospitals where
consultant medical doctor /specialist dentists have admission
rights.
MR5. Duly filled Confidential Business Questionnaire
MR6. Duly filled Declaration form
MR 7 Services offered and a list of charges
(II) MANDATORY REQUIREMENTS (FOR HOSPITAL INSTITUTIONS)
The following mandatory requirements must be met by the Hospital institutions not withstanding
other requirements in the tender document:
NO REQUIREMENTS
RESPONSIVE OR NOT
RESPONSIVE
MR1. A copy of Tax Compliance Certificate issued by KRA, valid
up to and including the tender closing date.
MR2. Registration by relevant body e.g. Kenya Medical
Practitioners and Dentists Board.
MR3. Professional Indemnity Cover- indicate the cover
MR4. Audited accounts for last two years
MR5. Duly filled Confidential Business Questionnaire
MR6. Duly filled Declaration form
MR7 Services offered and a list of charges
15
III) EVALUATION CRITERIA
(A) Technical evaluation for the Individual Doctors
Evaluation Attribute Weighting Score Max Score
%
Tenderer’s
Response
Response
T1 Provide C.V with Master’s
degree in relevant speciality
Additional sub speciality
30 %
5%
35%
T2 Number of years in the
Medical speciality
5 Years and above: 40%
Others prorated at:
Number of years x 40
5
40%
T3 Provide a list of at least 3
reputable institutions where
similar services have been
provided in the recent past.
3 or more clients: 25%
Others prorated at:
Number of clients x 25
3
25%
(B) Technical evaluation for the Hospitals
Evaluation Attribute Weighting Score Max Score
%
Tenderer’s
Response
Response T1 Number of years in the
business of provision of
medical care services
15 Years and above: 30%
Others prorated at:
Number of years x 30
15
30
T2 Provide a list of all prime
clients/references to which
the company has made
similar supplies
10 or more clients: 30%
Others prorated at:
Number of clients x 30
10
30
T3. Financial strength (40
marks)
a) Profitability Margin –
A margin above 20%
10-19 %
5-9%
1-4 %
Below 1% 0 marks.
20
15
10
4
20
16
Evaluation Attribute Weighting Score Max Score
%
Tenderer’s
Response
Response b) Liquidity Ratio
2:1 – 20 Marks;
1:1 –15 marks;
0.5 :1- 10 Marks;
less than 0.5>0 5 marks
NB: (Attach Audited
financial accounts for the
last two years to assist in
the calculation).
20
15
10
5
20
Total 100
NB 1: Debt Equity Ratio (Net worth) = Total Debt
Net Worth
Profitability (Margin) = EBIT
Total sales (Income)
EBIT - Earnings before Interest and Taxes
Current Ratio (Liquidity) = Current Assets
Current Liabilities
SHORTLIST
Tenderers should note that only tenders that score 75% and above on the Technical
Evaluation will qualify to be shortlisted and retained as a standby list of suppliers for an
initial period of three (3) years from 1st May 2018 – 30th April, 2021 for the provision of
Medical Services for the Central Bank of Kenya for services offered as per list of charges
provided The contract may be renewed for an additional three (3) years by mutual consent of
both parties subject to satisfactory performance.
RECOMMENDATION OF AWARD
All technically responsive bids shall be recommended for award of the contract to provide
medical services.
17
SECTION VI - PRICE SCHEDULE
Minimum (Kshs.) Maximum (Kshs.)
Consultations
Consultation
House Visits - NB (Consultations only. Incidentals
to be agreed upon by the parties)
Day Time
Night Time
Hospital Visits
Day Time
Night Time
Institutional Locum Fees per hour -Daytime
Institutional Locum Fees per hour – Night time
B: SPECIALISTS
Consultations
First visit
House Visits NB (Consultations only. Incidentals to
be agreed upon by the parties)
Day Time
Night Time
Hospital Visits
Day Time
Emergency Night visits
Emergency Day visits
ICU Visit (Daily charges)
HDU Visit (Daily charges)
Institutional Locum Fees per hour - Daytime
Institutional Locum Fees per hour – Night-time
All Other services offered and charges
18
SECTION VII: STANDARD FORMS
1. CONFIDENTIAL BUSINESS QUESTIONNAIRE
You are requested to give particulars indicated in part 1 and part 2 (a), 2(b) or 2(c)
whichever applies to your type of business.
You are advised that it is a serious offence to give false information on this Form.
Part 1 General
Business Name……………………………………………………………………..
Location of business premises; Country/Town……………………………
…………………………………………………………………………………………
Plot No……………………Street/Road…………………………………………
Postal Address………………………Tel No……………………………………
Fax No………………………………………………………………………………
E-mail………………………………………………………………………………
Nature of Business…………………………………………………………………
Current Trade License No…………………Expiring date…………………
Maximum value of business, which you can handle at any time:
Kshs…………………………………………………………………………………
Name of your bankers……………………………………………………………
Branch………………………………………………………………………………..
Part 2(a) – Sole Proprietor
Your name in full…………………………………………………Age…………
Nationality……………………………………Country of Origin………………
*Citizenship details……………………………………………………………….
Part 2(b) – Partnership
Give details of partners as follows:
Name in full, Nationality, Citizenship Details and Shares
19
1 ……………………………………………………………………………………
2 ……………………………………………………………………………………
3 ……………………………………………………………………………………
4 ……………………………………………………………………………………
5 ……………………………………………………………………………………
Part 2(c) - Registered Company
Private or Public……………………………………………………………………
State the nominal and issued capital of the company –
Nominal Kshs……………………………………………………………………...
Issued Kshs…………………………………………………………………………
Give details of all directors as follows:
Name in full, Nationality, Citizenship Details and Shares
1 ……………………………………………………………………………………
2 ……………………………………………………………………………………
3 ……………………………………………………………………………………
4 ……………………………………………………………………………………
5 ……………………………………………………………………………………
Date…………………………Signature of Applicant………………………
*If Kenyan Citizen, indicate under “Citizenship Details” whether by Birth, Naturalization
or Registration.
Interested eligible bidders may obtain information and inspect pre-qualification documents during
working hours Monday to Friday at the office of:
20
2. CLIENT REFERENCE FORMAT: NAMES OF THE APPLICANTS CLIENTS IN
THE LAST TWO YEARS.
1. Name of Client (organization) …………………………………………………………
Address of Client (organization) ………………………………………………………
Name of Contact Person at the client (organization) …………………………..
Telephone No. of Client ……………………………………………………………………
Value of Contract
…………………………………………………………………………….
Duration of Contract (date) ……………………………………………………………..
(Attach documental evidence of existence of contract)
2. Name of 2nd Client (organization)
Name of Client (organization) …………………………………………………………
Address of Client (organization) ………………………………………………………
Name of Contact Person at the client (organization) …………………………..
Telephone No. of Client ……………………………………………………………………
Value of Contract
…………………………………………………………………………….
Duration of Contract (date) ……………………………………………………………..
(Attach documental evidence of existence of contract)
3. Name of 3rd Client (organization)
Name of Client (organization) …………………………………………………….……
Address of Client (organization) ………………………………………………….……
Name of Contact Person at the client (organization) …………………………..
Telephone No. of Client ……………………………………………………………………
Value of Contract
……………………………………………………………………….…….
Duration of Contract (date) ………………………………………………………….…..
(Attach documental evidence of existence of contract)
21
4. Name of 3rd Client (organization)
Name of Client (organization) …………………………………………………….……
Address of Client (organization) ………………………………………………….……
Name of Contact Person at the client (organization) …………………………..
Telephone No. of Client ……………………………………………………………………
Value of Contract
……………………………………………………………………….…….
Duration of Contract (date) ………………………………………………………….…..
(Attach documental evidence of existence of contract)
22
3.0 DECLARATION FORM
I/We………………………………………………………………. hereby declare
That the information given above is true and further state that I/We also understand the
purchase of this form does not guarantee registration.
That I/We are not insolvent/in receivership, bankrupt or being wound up, business
activities not suspended/not subject to legal proceedings.
That I/We have legal capacity to enter into contract.
That I/We have fulfilled obligations to pay taxes/social security contributions.
That if the legal, technical, financial position, or the contractual capacity of the firm
changes, we commit ourselves to inform you and acknowledge your sole right to
review the pre-qualification made.
That I/We understand that I/We shall be disqualified should the information submitted
here for purpose of seeking qualification be materially inaccurate or materially
incomplete.
That I/We give Central Bank of Kenya, authority to seek any other references
concerning my/Our Company from whatever sources deemed relevant.
That if pre-qualified, I/we undertake to participate in submission of a tender or
quotation when called upon to do so.
Name………………………………………………………………………………...
Designation…………………………………………………………………………
Signature……………………………………………………………………………
Official rubber Stamp………………………………………………………………
Date………………………………………………………………………………….