Application for Empanelment (On the Letter Head of the Contractor)

Name of the Contractor/ Vendor

Area of specialization (Please Specify)Category of works Undertaken (Please Mark)

Civil Plumbing Electrical HVAC Lift Road Landscaping

WP Glazing Modular Kitchen

STP BMS DG RWH

Registered address of the Company

E-mail

Website

Fax No.Name of the Contact Person

Designation of Contact PersonEmail Id of Contact Person

Mobile no. of Contact Person

PAN Card No. (To Be Enclosed)Service Tax No. (To Be Enclosed)Service Tax Category. (To Be Enclosed)CST/ WCT / VAT / TIN No (To Be Enclosed)Provident Fund No. (To Be Enclosed)ESIC No. (To Be Enclosed)Whether Contractor belongs to SC/ST Category?

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A. Details of Works Completed in last 5 years: (Construction only )(Provide Completion certificate)

Name of the Project

Location Work Duration

Value of

work carried

out

Worked as Contractor/

Sub Contractor

References Remarks if anyName of

Contact Person

Designation Contact no.

                                                   

B. Details of Works in Hand: (Provide Work Order Copy)

Name of the Project

Location Work Duration

Value Worked as Contractor/

Sub Contractor

References Remarks if anyName of

Contact Person

Designation Contact no.

                                                   

C. Details of Turnover (Last 3 Financial Years) (Provide Copy of Audited Balance Sheet):

D. i) Maximum value of work done (in Rupees): _____________

ii) Minimum Value of work done (in Rupees): _____________

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Year Turnover in Lakh

iii) Adequacy of Working Capital:

Sr.No. Source of Credit limit Amount Remarks 1    

Provide Documentary Evidence 

2    3    4    5    

Total     

E. List of Technical Person Employed:

F. List of Plant and Machinery Owned:

G. Details of Work Carried Directly for UDA ( Provide Details, If Any )

H. Project Executed on Design & Build basis ( Provide Details, If Any )

I. Expertise in Design :

I.1 In-House

Sr. No. Name Qualification Project Executed Experience (in years)                           

I.2 Details of Designers Associated with: (Provide a copy of Agreement & list of projects completed on Design & Build Basis)

J. State Whether Registered with any Following Organization:(Please Mark & Provide Copy of Registration) C.P.W.D State P.W.D Any PSU Metropolitan Development Authority/ Housing board

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ICTAD ( If Associated, Please Provide Details As Under ):

Description Information Remarks ICTAD Registration   Registration Number   

Provide Certified Copies and label them as attachment to clause 3.1 

Grade   Speciality   Expiry Date   

K. Legal Status

If a Joint Venture, Name & addresses of JV partners 

1).

Provide Certified Copy of JV Agreement 2). 

If a Joint Venture, give name of Lead Partner    

For JV, Each JV partner shall furnish Legal Status Separately Name ( Lead Partner )  

Provide Certified Copies and label them as attachmentLegal Status   

Place of Registration   Principal Place of Business    

Written Power of Attorney of the Signatory to the Bid   

Provide original or Certified Copy of Power of Attorney attested by a Notary and label them as attachment to clause 4.1 (a)

VAT registration Number     Name (Partner 2 )  

Provide Certified Copies and label them as attachment to clause 4.1 (a)Legal Status   

Place of Registration   Principal Place of Business    

Written Power of Attorney of the Signatory to the Bid   

Provide original or Certified Copy of Power of Attorney attested by a Notary and label them as attachment to clause 4.1 (a)

VAT registration Number     

L. Any Locational Preference: ________________ M. Details of Disputes/ Arbitration or Projects on Hold/ Abandoned (Provide List):

N. Details of Site for Quality & EHS Visit ( if required, based on following parameters & Provide Details as per table) :

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i. Site should in Construction Stage ii. Project Size should be Approx. 6,00,000 Sqftiii. Project on Design & Build ( Preferably )

Sr. No. Project Name & Details Value of Work Total Area Type of contract                           

Note: All columns to be filled in by the Company and submitted along with all necessary documents/ credentials/ copies of the certificates, etc. Any other relevant information in support of empanelment may be volunteered by the applicant. All pages may be signed in ink with stamp by the authorized representative of the company along with declaration that document/ information furnished is true and valid. During the duration of the empanelment and in case there are any changes/ variation, the same shall be immediately brought to the notice of THDCL.

Signature and Seal of the Authorized Signatory

Place: Signature:

Date: Name & Designation:

Company Seal:

For Tata Housing Internal use only:Initiation Date Source

P&C Clearance Date (Evaluation)

Recommendation (Attach questionnaire also)

Quality Clearance Date (Evaluation)

Recommendation(Attach questionnaire also)

EHS Clearance Date (Evaluation)

Recommendation(Attach questionnaire also)

Over all RecommendationRemarks (P&C)

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