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i. Record of poor performance such as abandoning the works, not properlycompleting the contract, unsatisfactory quality of work, inordinate delays in

competition, claim and litigation history, or financial failures etc. in anydepartment of Govt. of Chhattisgarh or the state Govt.

organization/services/corporations/local body etc.(by whatever names these are

called) within state territory of Chhattisgarh.And/orii. Participated in the previous bidding for the same work and had quoted

unreasonably high or low bid prices and could not furnish rational justification for

it to the Chief Project Engineer.

ANNEXURE-1

5

Qualification Information

1.1 Constitution or legal

status of Bidder [attach

copy]

Place of Registration of

Firm/Company (in case

of other than individuals)

Principal place ofbusiness

Name of power of

attorney holder of

signatory of Bid (bidder)[attach copy]

1.2 Total annual volume of

civil engineering

construction workexecuted and payments

received each year in theimmediate five years inwhich tenders are invited.

(Attach certificate from

Chartered Accountant)-indexed @ 10% (tenpercent) compounded per

year.

Financial

year(Rs. in Crores)

Civil Engineering

construction work

Turn over in the year

Add for

indexing

Total

1.1 Preparatory firm, partnership firm with the certificate of registration byregister/article and Memorandum of Association with Certificate of Incorporation.

1.2 Note:-Mention and Highlights the years, which the tenderer considers forevaluation for the committee.

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ANNEXURE-5

Availability of Major items of Contractors Equipment proposed for carrying out

the works. List all information requested below.

Item ofEquipment Totalnumber

available

Description,make, and

age (Years),and capacity

Condition(new, good,

poor) andnumber

available

Nos.(i)Owned,

(ii)Leased,or (iii)to be

purchased

If these arein use in

some work,mention the

details.

No. ofequipments

proposed tobe utilised in

this work(out of total

Nos.)

1 2 3 4 5 6 7

ANNEXURE-6

Qualifications of consultants / each technical personnel proposed for the contract.

Position Name Qualifi

cation

Date from

which theyare working

in thebidders

organisation

Years of Experience Remark

Roadworks

Buildingworks

Bridgeworks

Others

1 2 3 4 5(a) 5(b) 5(c) 5(d) 6

Note:- 1. If any personal is proposed to be engaged, furnish details here under:- (if

necessary use separate sheet for eachfor C.V.)(Enclose Certificates)

2. If any technical persons are to be changed during the construction periods,Then it can be changed with the prior intimation to the Engineer in charge.

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ANNEXURE-7

Financial reports for the immediate previous five years: balance sheets, profit and

loss statements, audited auditors reports, etc., below and attach copies.

Year Income taxclearance

certificate(optional)

Balancesheet Profit &Loss

Statement

Reservebrought

forward in any

Net creditBalance if

any [for debitshow

(-)]

AuditorsReport Otherinformation

if thebidder

wished to

submit

1 2 3 4 5 6 7 8

ANNEXURE-8

Information on current claims, arbitration, litigation in which the Bidder in

involved

Sl. No. Name of

Other

Party(s)

Agt No.

date year

and Deptt.

Brief of cause of

claims,

arbitration/dispute

(give reference ofcontract details)

Where Litigation

pending (in the

department/court/arb

itration) (mentionDeptt./court/Arbitrat

ion)

Amount

involved/

claimed

1 2 3 4 5 6

Can use separate sheets for each agreements if necessary

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ANNEXURE-9

List of key plant & equipment to be deployed on Contract Work (Building/Bridge)

to be filled by the Chief Project Engineer as per their requirements

Sl Type of Equipment Maximumage as on

1.10.05(years)

Contract Package SizeFrom Rs.

3 Crores

to Rs. 10Crores

From Rs.

10 Crores

to Rs. 30Crores

From

Rs. 30

Croresto Rs. 50

Crores

From

Rs. 51

Crores&

above

1 2 3 4 5 6 7

Total

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ANNEXURE-10

List of key plant & equipment to be deployed on Contract Work (Building/Bridge)

to be filled by the Chief Project Engineer as per their requirements

Sl Type of Equipment Maximumage as on

1.10.05(years)

Contract Package SizeFrom Rs.

3 Crores

to Rs. 10Crores

From Rs.

11 Crores

to Rs. 30Crores

From

Rs. 31

Croresto Rs. 50

Crores

From

Rs. 51

Crores&

above

1 2 3 4 5 6 7

1 Motor Grader

2 Dozer

3 Front end Loader

4 Smooth Wheel Roller

5 Vibratory Roller

6 Hot Mix Plant with Electroniccontrols (Minimum 60/90 TPH

Capacity)

7 Paver finisher with Electronic

Sensor

8 Water Tanker

9 Bitumen Sprayer

10 Tandem Roller

11 Contrete Mixer with Itegral Weigh

Batching Facility

12 Concrete Batching and Mixing

Plant (Minimum Capacity

15m3/hour)

13 W.M.M. Plant

Total

Contractor shall submit the certificate of qwnership of plants and machineries as shown

above duly certified by Executive Engineer or Equivalent Officer (Certificate should notbe older than 24 months) alng with th EMD envelope, other wise tender will be

disqualified while opening.

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ANNEXURE-11

List of Technical person to be deployed on Contract Work

Sl Personnel Qualification Contract Package Size

From Rs.3 Crores

to Rs. 10

Crores

From Rs.11 Crores

to Rs. 30

Crores

FromRs. 31

Crores

to Rs. 50Crores

FromRs. 51

Crores

&above

1 2 3 4 5 6 7

1 Project manager B.E. Civil + 15 yearsExp. (5years as manager)

2 Site Manager B.E. Civil + 10 years

Exp. (5years as roadsconstruction)

3 Plant Manager B.E. Mech + 10 yearsExp. Or Dip. Mech +

15years Exp.

4 Quantity Surveyor B.E. Civil + 7 years

Exp. Or Dip Civil +10years Exp.

5 Soil & MaterialEngineer

B.E. Civil+10years Exp.

6 Survey Engineer B.E. Civil+5years Exp.Or Dip. Civil+8years

Exp.

Total

Note:- The list of the Technical persons as mentioned above are tentative. S.E. of the

circle can modified the above list of the Technical persons as per their requirements.

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ANNEXURE-12

CONTRACT PERSONS

Sl. No. Name of Executive

Engineer of theDivision

Divisional STD Code Phone No.

Office/residence

Name of

District

1 2 3 4 5 6

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Affidavit

I SMT NAEEM BEGAM W/O MOHD KASIM Aged55Years KAILASH NAGAR

DANTEWADA For and on behalf self, do here by and herewith solemnly affirm/state on

oath that :-

1. All documents and informations furnished are correct in all respects tothe best of my knowledge and belief

2. I have not suppressed or omitted any information as is required.3. I hereby authorize th C.G. Police Housing Cooperation Officials to get all

the documents verified from appropriate source(s).

Deponent

(Naseem Begam.)Authorized signatory/

Verification

I SMT NAEEM BEGAM W/O MOHD KASIM do here by affirm that the

contents stated in Para 1 to 3 above are true to the best of my knowledge and believe and

are based on my / our record.

Verified that this. Date of 200 at(Place).

Seal of attestation by public Deponent

Notary with date (Naseem Begam)Authorized signature/