VOC Port Authority

MEE Department

SECTION VIII – ANNEXURES AND FORMS

ANNEXURE A

QUALIFICATION AND RESPONSIVENESS INFORMATION: LIST OF DOCUMENTS TO

BE ENCLOSED

All bidders shall include the following information with their bids by scanning the relevant documents
after being filled, signed with seal and serially numbered by the Bidder. The above shall be uploaded
using their user-id and password in the E-tender portal on or before the last date of submission of
tender mentioned in the NIT towards Cover A – Techno-commercial bid.

PART I (COVER A) – TECHNO-COMMERCIAL BID

Uploaded
Sl.No Qualification Documents to be uploaded
Page Ref No.
1. Form I – Bid cover letter (as per Section II, clause 16.2.14 a)
Form II – Transaction details for remittance of Earnest Money Deposit
2.
(as per Section II, clause 16.2.1)
Form III – Financial capability (as per Section II, clause 16.2.3)
3. Copies of the Income tax return, Profit & Loss statement and Balance
sheet duly certified by the Chartered Accountant
Form IV Similar Work Experience [as per Section II, clause 16.2.2]
Copies of Work order and completion certificate issued by any Central
4.
/ State Government / Autonomous bodies / PSEs/PSUs / Public
Limited or Private Limited Companies, etc., as provided in NIT
Form IV A – Experience / Completion / Performance certificate (as
5.
per Section II, clause 16.2.2.b)
Form IV B – Details of TDS certificate (if applicable) (as per Section
6.
II, clause 16.2.2.c)
Form V – Declaration of Authorised Representative of the bid (as per Not
7.
Section II, clause 16.2.7) Applicable
Form VI – Declaration of litigation and Blacklisting (as per Section
8.
II, clause 16.2.14.b)
Form VII – Certificate of no deviation in the Tender Conditions (as
9.
per Section II, clause 16.2.8)
Form VIII Declaration by the Bidder (as per Section II, clause Not
10.
16.2.14.f) Applicable
11. Form IX – Bank Mandate Form (as per Section II, clause 16.2.14.c)
Form X -Tender Acceptance letter (as per Section II, clause 16.2.14.
12.
d)
Copies of original registration certificate documents incorporating the
legal entity and defining the constitution or legal status, place of
13.
registration and principal place of business - (as per Section II, clause
16.2.6)
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14. Copy of GST registration certificate - (as per Section II, clause 16.2.5)
15. Copy of PAN (as per Section II, clause 16.2.4)
Copies of
16. 1. EPF registration certificate-(as per Section II, clause 16.2.5)
2. ESI registration certificate, (as per Section II, clause 16.2.5)
Form- XI - Local Content declaration & Self Certification (as per
17.
Section II, clause 16.2.9 & clause 29 )
Scanned copy of NEMA 4 rating test certificate with test report of
18.
thermal camera
Scanned copy of IP66 test report test certificate with test report of
19.
thermal camera
20. Scanned copy of Data Sheets for all products offered in the tender
21. Scanned copy of Manufacturer Authorization Letter (MAL)
Scanned copy of “No Malicious Code Certificate” from the OEM for
22.
CCTV Camera and Network Video Management Software (NVMS)
Undertaking from Offered OEM of CCTV Cameras and Network
23. Video Management Software (NVMS) that these products are ONVIF
compliant
Signed Declaration on letterhead from offered OEM of CCTV camera
24. that MAC addresses of proposed CCTV Cameras are registered in the
name of OEM supplying the cameras
An ‘Undertaking from OEMs of camera and Network Video
Management Software (NVMS)’ having its service and support centre
in India. This Service and support centre should have facility of
25.
repair/trouble shooting of offered Camera and NVMS software. Also
mention address of the Service centre in the undertaking duly signed
and stamped.
NVMS (Centralized Software) should have capability of being
26. scalable and can add up to 300 Cameras (For Viewing and recording).
An undertaking by Bidder in this regard is to be submitted.
Undertaking shall comply the latest guidelines issued by Government
of India under Make in India policy for public procurements as per
DPIIT Orders No. P-45021/2/2017-B.E.-II dated 15.06.2017 & No. P-
45021/2/2017-PP (BE-II) dated 28.05.2018 and OM No.P-
45021/2/2017-PP(BE-II) dated 4th Jun, 2020 & 16th Sep, 2020,
27. Department of Public Enterprise OM No: DPE-7(4)/2017-Fin-(Part-
I) dated 30.09.2020, MeitY Notification No. W-43/4/2019-IPHW-
MeitY dated 7th Sep, 2020) and Department of Telecommunications
Gazette Notification no.18-10/2017-IP dated 29.08.2018 while
procuring IP based network components/services required for
commissioning of the CCTV Surveillance system.

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Cameras shall have quality system compliance and shall be

‘STQC/TEC/BIS or any Indian standards’ as applicable to the
28.
equipment. All supportive documents should be attached with the
technical bid.
All OEMs of Servers, Storage, Cameras, Network equipment,
Workstations, Software Application system, NVR etc. should give
29.
an undertaking that all licenses supplied by them would be registered
in favor of VOCPA.
Total number of the pages uploaded by the bidder (mention the page
no. starting from to end)
30. 1. Starting page no.
2. Ending page no.
3. Total number of pages

(Fill the page numbers where the documents have been uploaded in the table provided above)

(Signature of Authorized Person)

Place: ……………………. Name ……………………………………………….
Date: …………………….. Designation ………………………………………..
Business Address: …………………………………
…………………………………………………………
Seal …………………………………………………….

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FORM I - BID COVER LETTER

(To be in the Firm’s letter head)

Date:…………………
1. Registered Business Name :
2. Registered Business Address :
3. Name, Designation & address of the Contact
person to whom all references shall be made :
regarding this tender
4. Telephone / Mobile No. :
5. Fax :
6. E-Mail :

To
The Chief Mechanical Engineer,
Mechainical &Electrical Engineering Department,
V.O.Chidambaranar Port Authority,
Tuticorin – 628 004
Sir,
1. We hereby apply to be qualified for the tender invited by the V.O.Chidambaranar Port
Authority, Tuticorin as a bidder for the work “______________________________”
2. We hereby give our consent to the Port or its authorized Representative(s) to conduct any
investigations to verify the statements, documents and information submitted and to clarify the
financial and technical aspects of this application. For this, we hereby authorize (any Public
Official, Engineer, Bank, Depository, Manufacturer, Distributor, etc.) or any other person or
firm to furnish pertinent information deemed necessary and requested by the Port to verify
statements and information provided in this application or regarding our competence and
standing.
3. We the undersigned have read and examined in detail the Bid document in respect of work
intended and do hereby express our interest to execute the intended work.
4. We certify that goods & services offered shall be of best quality and the manpower who shall
be deployed for the work are competent enough and have necessary qualifications for taking
up this assignment.

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5. The names and positions of persons who may be contacted for further information, if required,
are as follows
a) For Technical: Shri/Smt …… (Name, position, Address, contact number and email id)
b) For Financial: Shri/Smt …… (Name, position, Address, contact number and email id)
c) For Personnel: Shri/Smt …… (Name, position, Address, contact number and email id)
6. We declare that the statements made and the information provided in the application are
complete, true and correct in every detail.
7. We understand that V.O.Chidambaranar Port Authority reserves the right to reject any
application without assigning any reasons.

Thanking you,
Yours faithfully,

(Signature of Authorized Person)

Place: ……………………. Name ……………………………………………….
Date: …………………….. Designation ………………………………………..
Business Address: …………………………………
…………………………………………………………
Seal …………………………………………………….

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FORM IIA
(To be in the Firm’s letter head)
Date:…………………

Transaction details for remittance of Earnest Money Deposit (EMD)

The bidder shall upload system generated proof towards successful payment of EMD along with
following fillied in form in the bid document as follows

Date of Amount Uploaded page No.

Sl. No Beneficiary reference No.
Payment (in INR) reference

(Signature of Authorized Person)

Place: ……………………. Name ……………………………………………….
Date: …………………….. Designation ………………………………………..
Business Address: …………………………………
…………………………………………………………
Seal …………………………………………………….

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FORM IIB
(To be in the Company letter head)
Date:…………………

Exemption of EMD by the Micro and Small Enterprises (MSEs)

The bidder shall upload the requisite certificate of registration under MSEs along with following fillied
in form in the bid document as follows

Sl. Name of Udyam Registration Uploaded page No.

Enterprise type
No Enterprise Number reference

(Signature of Authorized Person)

Place: ……………………. Name ……………………………………………….
Date: …………………….. Designation ………………………………………..
Business Address: …………………………………
…………………………………………………………
Seal …………………………………………………….

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FORM III
(To be in the Firm’s letter head)
Date:…………………

FINANCIAL CAPABILITY

The details of Summary of Annual Turnover of the Bidder on the basis of the Audited Balance Sheet
for the last three financial years shall be given as under

Sl.No. Financial year Total Turnover Uploaded page no. reference

01 Year 20.... – ...... Rs...................

02 Year 20..... – ...... Rs....................

03 Year 20...... – ...... Rs...................

Note: The Profit & Loss statement and Balance sheet to be uploaded shall be duly certified by the
Chartered Accountant.

(Signature of Authorized Person)

Place: ……………………. Name ……………………………………………….
Date: …………………….. Designation ………………………………………..
Business Address:
…………………………………………………………
Seal …………………………………………………….

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FORM – IV
(To be in the Firm’s letter head)
Date:…………………
SIMILAR WORK EXPERIENCE
The Bidders experience in similar work carried out each in any Central / State Government /
Autonomous bodies / PSEs/PSUs / Nationalised Banks / Public Limited or Private Limited Companies,
etc., for evaluating the Eligibility Criteria for pre-qualification to be provided using the format as
below:
Details of Similar Work Experience

Sl. Name Value of Work order Contract period Date of Name Uploaded
No of work reference No. completion and page no.
work executed Commencement completion certificate address reference
of the
(in Rs.)
Client

Note:
1. The copies of the documents containing above information like work order and completion
certificate in the at attached Form IV (A) have to be uploaded duly self-attested.
2. In case of experience other than Central / State Government / Autonomous bodies / PSEs/PSUs/
Public Limited Companies, the bidder has to submit TDS certificate for the past experience to be
uploaded, as provided in form IV (B), only then the experience will be considered.
Yours faithfully,
(Signature of Authorized Person)
Place: ……………………. Name ……………………………………………….
Date: …………………….. Designation ………………………………………..
Business Address: …………………………………
…………………………………………………………
Seal …………………………………………………….

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FORM – IV (A)
EXPERIENCE / COMPLETION / PERFORMANCE CERTIFICATE
(To be issued in the Company’s official letter head, sealed and signed by the Official who had
issued the work order / his equivalent or his superiors)

This is to certify that M/s --------------------- awarded the contract ---------------------------------- and
executed in this organization as per the details furnished below

1. Name of the work :

2. Work order number/ agreement number and date :
3. Work order value :
4. Date of commencement :
5. Date of completion :
6. Executed value :
7. Performance of the Contractor : Satisfactory/ Not Satisfactory

(Signature)
Place: ……………………. Name ……………………………………………….
Date: …………………….. Designation ………………………………………..
Organizationwith Address...………………………
………………………………………………………
Seal ………………………………………………….
Note:-
(i) Furnishing the information in the format is preferable.
(ii) Certificate(s) in any other format containing all the required information as in Form - IV may
also be furnished.

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FORM – IV (B)
(To be in the Firm’s letter head)
Date:…………………

DETAILS OF TDS CERTIFICATE

In case of experience other than Central / State Government / Autonomous bodies / PSEs/PSUs/
Nationalized Banks / Public Limited Companies, the bidder has to provide the details of the TDS
certificate in the form provided below and shall submit TDS certificate for the past experience to be
uploaded, only then the experience will be considered.

Sl. Name Value of Work order TDS Certificate Name and Uploaded
No of work work reference No. address of page no.
executed No. Amount the Client reference
(in Rs.)

(Signature of Authorized Person)

Place: ……………………. Name ……………………………………………….
Date: …………………….. Designation ………………………………………..
Business Address: …………………………………
…………………………………………………………
Seal …………………………………………………….

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FORM V
DECLARATION OF AUTHORISED REPRESENTATIVE
(Separate Forms to be submitted for each Signatory with details of Proprietor or Partner or Managing
Director)
I/We,......................... (Name)being the (Partners/Karta/Managing Directors and whole
time Director/Members of Managing Committee of Associations /Board of Trustees etc.) of
............................... (Name of the Bidder), hereby solemnly affirm and declare that the ..........................
(Authorised Signatory) is hereby authorized, vide resolution No. (Resolution Number)
dated..................... (Resolution Date) (copy submitted herewith), to act as an authorized signatory for
the business....................... (Name of the Bidder) for which submission of bid is being filed under the
tender. All his actions in relation to this tender will be binding on me/us.

Signature of the person competent to sign

Name:...................................................................................
Description:..........................................................................
Name of the Business Entity:.................................................

Acceptance as an Authorized Signatory

I (Authorised Signatory)hereby solemnly accord my acceptance to act as authorized signatory

for the above referred business and all my acts shall be binding on the business.

Signature of Authorised Signatory

Name:................................................................................
Description:.......................................................................
Place:..................................................................................
Date:...................................................................................
Note:
1. For the purpose of this tender and the Agreement, the tender, forms, Agreement and other
documents shall be signed only by the persons, who are themselves in a position to undertake
the work and possessing all other resources required for the purpose. The tender shall contain
the name, residence and place of business of the person or persons submitting the tender and
shall be signed by the Bidder with his usual authorized representatives followed by the name

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and Description of the person signing the document along with a copy of the partnership deed.
A copy of the constitution of the firm with the names and addresses of all the partners shall be
furnished.
2. Tender by a corporation shall be signed in the name of the corporation by a duly authorized
representative, and a power of attorney in that behalf shall accompany the tender. In the case
of company, a copy of the Memorandum and Articles of Association shall be furnished.
3. Tenders may be submitted by agents on behalf of their principals, but in such cases the Board
reserves the right to enter into contract with the principals, Director, with the principals and
agents jointly as deemed appropriate.

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FORM VI
DECLARATION ON LITIGATION AND BLACK LISTING

Declaration to be issued on the official letter head stating the following that
WE DECLARE THAT:
1. We have/ have not been involved in any litigation for the past five years that may have an impact
of affecting or compromising the delivery of service as required under this tender.
2. Information regarding any litigation and arbitration against the Port during the past five years
prior to the date of publication of NIT, the parties concerned and disputed amount is as given
below
1.---------------
2.---------------
3. We are not black listed or debarred in the last three years from providing service by any Central
/ State Government / Autonomous bodies / PSEs/PSUs / Nationalised Banks / Public Limited or
Private Limited Companies, etc., in India.

Yours faithfully,

(Signature of Authorized Person)

Place: ……………………. Name ……………………………………………….
Date: …………………….. Description ………………………………………..
Business Address: …………………………………
…………………………………………………………
Seal …………………………………………………….
Witness with signature
1) Name & Address 2) Name & Address
........................................ ........................................
........................................ ........................................
........................................ ........................................

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FORM VII
SCHEDULE OF NO DEVIATION
This is with reference to Tender No.…………………………………., for
“…………………………………………………………….”
I/We,................................ (Name of the Bidder / Authorised Representative of the Bidder) of
M/s........................................ (Name of the organisation), hereby certify that there is no deviation from
the Tender conditions either technical or commercial or tender enquiry and I/We am/are agreeing to all
the terms and conditions mentioned and comprised in relation to the above mentioned Tender.
Yours faithfully,

(Signature of Authorized Person)

Place: ……………………. Name ……………………………………………….

Date: …………………….. Description ………………………………………..
Business Address: …………………………………
…………………………………………………………
Seal …………………………………………………….
Witness with signature
1) Name & Address 2) Name & Address
........................................ ........................................
........................................ ........................................
........................................ ........................................

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FORM VIII
DECLARATION BY THE BIDDER
(To be provided in 100 Rs Stamp Paper)
To
The Head of the Department.
I/We M/s.represented by its Proprietor / Managing Partner / Managing Director having its Registered
Office at and do declare that I/We have carefully read all the conditions of tender with NIT No……,
dated ………., Basis In ……………………(Name Of The Department) Department At
V.O.Chidambaranar Port Authority for a period of -------------------------------,(including extension if
any), if needed and accepts all conditions of the tender including amendments/corrigendum
subsequently issued by the tender inviting authority, if any. Further I/we confirm our eligibility for this
tender and quoted as per the tender condition and Governing laws of India, in case of typographical
error found in submitted documents/affidavits/declarations, in this case we accept all the Terms and
conditions of bid documents and hereby confirm as under.
1. I/We have not made any counter conditions stipulation and conditions and I/We agree that in the
event of any such counter conditions my/our tender will be summarily rejected and such offer
will not be evaluated and considered at all by you.
2. I/We do hereby declare that we have not been blacklisted/ debarred by any Central / State
Government / Autonomous bodies / PSEs/PSUs / Nationalised Banks / Public Limited or Private
Limited Companies, etc., from taking part in the tendering process.
3. I/We have not made any payment or illegal gratification to any person/authority connected with
the tendering process so as to influence the tendering process and have not committed any offence
under the Prevention of Corruption Act in connection with the tender.
4. I/We hereby declare that, all information furnished by me/us with this tender is true to best of
my/our knowledge, belief and in case, if it is found that, the information furnished is not true or
partially true or incorrect, I/We agree that my/our tender shall be summarily rejected without
prejudice to the right of the board of Trustees of Port of V.O.Chidambaranar Port Authority to
take further action in to the matter.

Witness’s Bidder’s
Signature: ___________________ Signature:___________________
Name: ___________________ Name: ___________________
Address: __________________ Address: ___________________
Tel. No: ___________________ Tel. No: ___________________
Mobile no.:__________________ Mobile No:__________________
Date:___________________ Date:___________________

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FORM IX

FORM IX
BANK MANDATE FORM
1. Name of the company :
2. Status :
3. Bank Name, Address & Branch :
4. IFSC Code :
5. MICR Code :
6. Branch Code :
7. Name of the Authorised Person :
8. Signature of the authorised person
as per Bank :
9. E-Mail ID of Authorised Person :
10. Contact No. Landline/Mobile :

Copy of cancelled cheque may be enclosed if Bank signature not obtained.

Name & Seal of the

Bank with Date

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FORM X
TENDER ACCEPTANCE LETTER
(To be printed on company letterhead and filled, signed, and uploaded)
To
The Chief Mechanical Engineer
V.O.Chidambaranar Port Authority
Tuticorin-4
Sir,
Subject: “---------------------------------------------------------------------------------
Tender reference No. ------------------------------------------------
1. I/We have downloaded/obtained the tender document(s) for the above-mentioned tender/work
from the website, namely https://etenders.gov.in/eprocure/app, as per your advertisement given
in the above-mentioned website(s).
2. I/We hereby certify that I/We have read the entire terms and conditions of the tender documents
from Page No. to (including all documents like annexure(s), schedules(s), etc., which form
part of the contract agreement and I /we shall abide hereby and agree the terms /conditions
/clauses contained therein.
3. The corrigendum(s) issued from time to time by V.O.Chidambaranar Port Authority for the
above subject work has also been taken into consideration while submitting this acceptance
letter.
4. I/We hereby unconditionally accept the tender conditions of above mentioned tender
document(s)/ corrigendum (s) in its totality /entirety.
5. I/We do hereby declare that our firms have not been blacklisted/ debarred by any Govt.
Department/ Public sector undertaking.
6. I / We certify that all information furnished by me/ us is true & correct and in the event that the
information is found to be incorrect/untrue or found violated, then V.O.Chidambaranar Port
Authority shall without giving any notice or reason therefore, summarily reject the bid or
terminate the contract, without prejudice to any other rights or remedy including the forfeiture
of the full earnest money deposit absolutely
Yours faithfully,
(Signature of the bidder with official seal)
Note: If the firm has been blacklisted or debarred or banned or delisted by any Government or
Quasi-Government Agencies or Public Sector Undertaking in India, then the same should be
declared properly after modifying the sentence, suitably.
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Form XI
Local content Declaration & Self Certification as per the Government of India Order towards
Public Procurement (preference to Make in India) vide Letter No. P-45021/2/2017-PP(BE-II),
(revised) Dated.16.9.2020)

(TO BE PROVIDED ON Rs.100/- NON- JUDICIAL STAMP PAPER)

I___________________(Name of the Person(s),S/o _____________at _________(Address), working

as ______________________(Designation and name of the firm/Company/ partnership/ Joint
venture), and I have been authorized to sign the Declaration / Self- Certification on behalf of firm /
Company/partnership/ Joint venture do hereby solemnly affirm and declare as under:
That I will agree to abide by the terms and conditions of the policy of Government towards Public
Procurement (preference to Make in India) vide Letter No. P- 45021/2/2017-PP(BE-II), (revised)
Dated.16.9.2020. That the information furnished hereinafter is correct to be of my knowledge and
belief and I undertake to produce relevant records before the procuring entity or any
authority so nominated for the purpose of assessing the Local Content. That the local content for all
inputs which constitute the said equipment has been verified by me and I am responsible for the
correctness of the claims made therein. That in the event of the domestic value addition of the product
mentioned herein is found to be incorrect and not meeting the prescribed value addition norms based
on the assessment of an authority so nominated for the purpose of assessing the Local Content, action
will be taken against me as per the notification P-45021/2/2017- PP(BE-II), (revised) Dated.16.9.2020.
I agree to maintain the following information in the company’s record for a period of 8 years and shall
make this available for verification to my statutory authority. The Details of the location(s) at which
the local value addition is made
i. Name and details of the Domestic manufacture
ii. Date on which this certificate is issued
iii. Product for which the certificate is produced
iv. Percentage of local content. (% to be mentioned)
Signed by me at ______________on___________
Authorized signatory
(Name of the Firm entity)
Note: Required particulars are to be filled properly for acceptance.

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