Anne) Annexure-1 PRE-QUALIFICATION PERFORMA Tender 1D: 2021_AAL_71994_1 ;E UPLOADED BY ‘ANTS ALONG WITH TI Te APPLICATION IN PRE-QUALIFICATION BID (Envelope-I). Name of Work: Augmentation of fire station hard standing including approach road towards runway at Imphal Airport. (2° call) 1 2 3 4 Ss. Qualifying criterion Supporting Document must have the | Enclosure No. following salient information which Checklist AAI would like to note 10 | General LT [Name “and “registered office | 7Vl Md: Calzrn Kiank trrethe address of the Applicant ee Mrsler~ Mara letxad Contractor / Firm Name, Address, Telephone no., | Name: Mol. Salam Johan Mobile No., Fax No., e-mail : nasil address of the authorized contact | Address: [Ayana =: person of the agency for further Moyer Ael Jeo | Communication Ph. No.: Mobile No: 4434500 > Fax No.: th tom. Eemail 1D: Gala mnlehare FYB) ¢ amep'l €0 4 T2_| Authorized Signatory (Name & I Tam Koo Designation) Ma. Sel Mawagins Pardw 2.0 | Tender processing fee & EMD : = 2.1. | Tender Processing Fee, Rs.1680/- (Ve GST), non-refundable | will be required to be paid online on| Yes/No CPP portal only. 2.2 | Eamest Money Deposit (EMD) | EMD Declaration as per Annexure A | = Yes /No Env —1 includ 30 | ich shall conta oft 3.1 | Undertaking regarding unconditional acceptance (as per Annexure -2) & | Copy enclosed: scanned copy of payment receipts for tender fees and EMD. Yes /N 32 | Scanned copy of Permanent Account Number (PAN) and GST Registration | Copy epelosed: ‘Number and Undertaking for Registered under GST and compliance forGST | Yes/No provision (As per Annexure-4). | [33 | “Undertaking” regarding Blacklisting? Debarment on Company's Letter] Copy enclosed: Head (As per Annexure-5). Ye / No AAL Covvaasa at ites gue4 | Tenderer should deploy sufficient plant and machinery as per the requirement of work in consultation with the Engineer-in-Charge (EIC) to & Sat achieve the milestones/targets and overall completion with the time period, | C°PY enclosed: Tenderer shall submit scanned copy of ‘Undertaking’ on Company's Letter| Y¢/No Head (Annexure-7). 3.5 | Companies other than propriety firm shall submit, scanned copy of] Copy enclosed: Authorization Letter/Power of Attomey along with copy of Certificate of| Yes/No Incorporation of the Company under Companies Act showing CIN/LLPINName of Directors of the Company & Copy of Board Resolution regarding Authority to assign Power of Attorney. 3.6 | Proprietary firm shall submit scanned copy of Authorization Letter/Power of | Copy enclosed: Attorney only if the tender is processed by a person other than proprietor. Yes / No 3.7 | Registration with ESIC, EPF from concerned authori Copy enclosed: Yes/No 3.8 | Digitally signed tender document should be submitted. Copy enclosed: Yes/No 3.9 | Under taking for non-relative working in AAT (As per clause 40 on page ‘Copy enclosed: GCC -68) (Annexure-9). Yes /No 3.10 | Under taking for Minimum wage (As per Annexure-3). Copy enclosed; Yes/No 3.11 | Scanned copy of duly signed Integrity Pact. Page No. 118 of GCC Copy enclosed: Yes/No 4.0 | Part B which shall contain scanned copy of : 4.1 | Should have satisfactorily | A) Certificate of completion of the Three completed the work of similar|/ Two / One work(s) for meeting nature, eligibility criteria as applicable i) Three works of Rs. 272.152 | Work No.1 Copy of | Lakhs each in single contract of | -Name of work : certificate similar nature of work during | -Nature of work done: enclosed : last seven years ending on | -Value of woi Yes/No 31/01/2021, -Date of start: -Date of Completion as per agreement: ~Actual Date of Completion : ~Satisfactory completion of work: -EOY granted (if any) up to with/ without levy of compensation. Work No.2 Copy of lame of work : certificate -Nature of work done: enclosed : -Value of work: Yes/No -Date of start: -Date of Completion as per agreement: ~Actual Date of Completion : Satisfactory completion of work: -EOT granted (if any) up to with/ without levy of compensation. AA.ee fame of work : certificate -Nature of work done: enclosed : =Value of work: Yes/No -Date of start: -Date of Completion as per agreement: -Actual Date of Completion : “Satisfactory completion of work: -BOT granted (if any) up to ... ‘with’ without levy of compensation. Tp Two works of Rs. 340.190 | Work No. 1 Copy of Lakhs each in single contract of | -Name of work = certificate similar nature of work during | -Nature of work done: enclosed : last seven years ending on | -Value of work: Yes/No 31/01/2021. -Date of start: -Date of Completion as per agreement: -Actual Date of Completion : Satisfactory completion of wor -EOT granted (if any) up to a wwith/ without levy of compensation. ‘Work No.2 Copy of =Name of work : certificate -Nature of work done: enclosed : -Value of work: Yes / No -Date of start: “Date of Completion as per agreement: Actual Date of Completion : Satisfactory completion of work: -EOT granted (if any) up to . with/ without levy of compensation. Ti) One work of Rs, 544.304 | Work No.1 Copy of Lalkhs each in single contract of | -Name of work = certificate similar nature of work during last | -Nature of work done: enclosed : seven years ending —_ on | -Value of work: Yes/No 31/01/2021. -Date of start: -Date of Completion as per agreement: -Actual Date of Completion : Satisfactory completion of work: -EOT granted (if any) up to with/ without levy of compensation. ZI | Whether experience ‘fom Govt. | Govt. Organization / Pvt. Clients. (Tick | TDS certificate organizations or private clients? whichever is applicable). TDS certificate enclosed: from client to be enclosed. Yes/No 43 | TURNOVER, ‘Annualized average financial | Year Tumower (in Lakhs) Proof of turn tumover of not less than Rs. 777 over BOLILA Tabhis agoet tues [eee 431. 68 enclosed executed during last three financial 918-19) (Abridged years. As.a proof, copy of Abridged | 698.5! balance sheet & Balance Sheet of the firm with 575-35 profit & loss profit and loss account shall be 626-25 AIC) submitted along with the Copy enclosed: ication. Average: GO2Z-1 ‘Yes/No AAL c. I 9. 6 Aa oa‘Note: - In case the Income Tax Return for the financial year 2019-20 has not been submitted by the tenderer, the agency can submit average Balancesheet and Profit & Loss Account Statements for the financial year 2016-17, 2017-18 & 2018-19 due to issue of guidelines regarding last date for filing the return by the Govt, for the financial year 2019-20. 4a | Net worth “The tenderer should have @ minimum net worth of Rs. 102,057 lakhs issued by certfied ‘Chartered Accountants (Annexure-8). $0 | Envelope-II shall submit the financial e-bid through CPP portal. Financial bid through CPP portal. ne 6.0 | Any other information 7.0 | Remarks Place: SIGNATURE WITH STAMP Authorized signatory of the Firm [a ‘Brothers: ws Naseem On go. Class Coie’ M/S Md. Salam Khan & Brothers Address Special Class Contractor Kiyamgel Muslim Mayal_ Leikal Se PO Canchint PS -ting egd. No. : 2W.0). Regd. No. MANIDCOIIDCICE2/2016(Pt/65 ee espn abn a BP Rogd. No. Electrical Licence No. 381 (MV) mail: calamkhan?4@g Rogd. No.224/AC/MOBEDS/2019(Civil & Electrical). @ +91 9436235003 . GSTIN : 44ABCFM1770C1Z8 Ref. No. MSKB/2020- 2} Date To, Annexure -5 KLISTING / DEBARRING OF FIRM The Senior Manager (Engg.-Civil), Airport Authority of India Civil Engineering wing, Imphal Airport Name of Work: Augmentation of fire station hard standing including approach road towards runway at Imphal Airport. Tender ID: 2021_AAI_71994_1 Sir, 1. | hereby undertake that our firm or its partners or its directors have not been black listed / debarred and neither any case or complaint is pending nor contemplated against the firm or its partners regarding irregularities, in India or abroad, by any Indian State/Central Governments Departments or Public Sector Undertaking of India or global international body like World Bank/International Monetary Fund/ World health Organization etc. | further undertake that at any stage of evaluation of PQQ submissions or in later stage also, if it is found that | (the bidder firm) have given wrong or misleading information then our bid/contract can be summarily rejected/terminated contract, if any. Also legal action may be initiated against me. Yours = Signature : z Paring... it ws. wassazn foan & Brothers ‘ Sy ces Conkaces Got Nenu Name : Md. Salam Khan Designation : Managing Partner Name of Agency : M/S Md. Salam Khan & Brothers Thanking you.M/S Md. Salam Khan & Brothers Address Special Class Contractor Kiyamgei Muslim Mayai Leikai PwW.D. EEC Meese, P.0.-Canchipur, P.S.-Irilbung Regd. No, SAN 7/a14-W ww Imphal East, Manipur-795003 Sead he: MADE oi a one Email: salamkhan74@gmail com a > Regd. No. Electrical Licence No. 381 (MV) Regd. No.221/ACIMOBEDS/2019(Civil& Electrical), @ +91 9436235003 GSTIN : 14ABCFMATTOCIZS Ref. No, MSKB/2020- A) , Date LR-22°R0A) Annexure -7 UNDERTAKING FOR DEPLOYMENT OF T&P Name of work: Augmentation of fire station hard ‘standing including approach road towards runway at Imphal Airport. Tender ID: 2021_AAI_71994_1 ‘Name of Contractor / Firm: M/S Md Salam Khan & Brothers '/ we have applied for issue of tender for the work of ‘Augmentation of fire station hard standing including approach road towards runway at Imphal Airport’'and hereby undertake that: - !/ we have gone through the tender documents and drawings in its entirety, visited the site and have understood the nature of work to be executed, |/ we will deploy adequate T&P in working condition with adequate standby arrangement for efficient / timely execution of the work. |/ we have submitted the details of T&P owned by us and undertake to procure or take on lease the balance T&P for the work as per requirement of the work matching with the work program. | / we will abide by any instructions by AAI for such Procurement / arrangement of T&P on lease as is considered necessary for efficient / timely execution of work. Place: |mp hal. Date: |2-02°R0a1 Signatire of Contractor With Rubber Stamp janaging Partner reson ten € BobetIPUR 567270 POWER OF ATTORNEY Know all men by these presents that I, Md, Abdul Wahab, aged about 39 years., Partner of the firm M/S Md. Salam Khan & Brothers (Special Class Contractor, P.W.D., Govt. of Manipur), situated at Kiyamgei Muslim Mayai Leikai, P.O. - Canchipur, P.S. - Irilbung, Imphal East District, Manipur- 795003, S/o (L) Md. Abdul Gani, a resident of Kiyamgei Muslim Mayai Leiksi, P.O.-Canchipur, P.S. - Irilbung, Imphal East District, Manipur do hereby appoint my brother Md. Salam Khan, aged about 47 years., Managing Partner of the said firm, M/S Md. Salam Khan & Brothers (Special Class Contractor, P.W.D., Govt. of Manipur), S/o (L) Md. Abdul Gani; « resident of Kiyamgei Muslim Mayai Leikai, P.O.-Canchipur, P.S. Irilbung, Imphal East District, Manipur, as my true and lawful Attorney to do the following things and acts on my behalf as he thinks proper and expedient within the ambit of law. That, the said Attorney is authorised to execute any central and state works on my behalf as and when the said work is awarded to the said firm. ‘That, the said Attorney is empowered to sign, receive, collect etc. of all the necessary documents in connection with the said contract work on my behalf. That, the said Attorney is empowered to transact bill, cheque etc. from the financial institutions/Banks in connection with the said contract work on my behalf. ‘That, the said Power of Attorney shall remain irrevocable till the completion of the said contract work. In witness whereof I have executed this power of Attomey on this 8 day of February, 2021, Witnesses Signature of Executants foi Mot : Kh. Aodek aatis. Nn (iicAndab Waban & Brothers 2, Oh Gieay Ancwer- Set hibit Gf kehac Matsig _ jignature of Atorney Holder By: Adiovate?™* | (Ma. Salam Khan) ‘ourt oy Manupus 68 ‘Managing Partner ws mad Salam Khan & Brothers Spi Class Contac Got ot Manip —, Spl. Class Contractor, Govt. of Manis