1 – Qualification Criteria and Requirements [Note to Employer: Only applications that are substantially responsive to the qualification criteria and requirements in Table 1 are to be assessed against Table 2, Rated Criteria and Requirements.] Eligibility Criteria Single Entity Requirements Joint Venture Documentation No. Subject Requirement All Members Combined Each Member One Member Submission Requirements 1.1 Nationality Nationality in accordance with ITA 4.5 Must meet requirement Must meet requirement Must meet requirement N/A Forms ELI – 1.1 and 1.2, with attachments 1.2 Conflict of Interest No conflicts of interest in accordance with ITA 4.6 Must meet requirement Must meet requirement Must meet requirement N/A Application Submission Letter 1.3 Bank Eligibility Not having been declared ineligible by the Bank, as described in ITA 4.7 and 5.1 Must meet requirement Must meet requirement Must meet requirement N/A Application Submission Letter 1.4 United Nations resolution or Borrower’s country law Not having been excluded as a result of prohibition in the Borrower’s country laws or official regulations against commercial relations with the Applicant’s country, or by an act of compliance with UN Security Council resolution, both in accordance with ITA 5.1 and Section V. Must meet requirement Must meet requirement Must meet requirement N/A Forms ELI – 1.1 and 1.2, with attachments Historical Contract Non-Performance
Criteria Single Entity Requirements Joint Venture Documentation No. Subject Requirement All Members Combined Each Member One Member Submission Requirements 2.1 History of Contracts Non-performance of a contract did not occur as a result of contractor’s default since 1st January [insert year]. Must meet requirement Must meet requirements Must meet requirement N/A Form CON-2 2.2 Suspension Based on Execution of Bid or Proposal Securing Declaration by the Employer Not under suspension based on execution of Bid or Proposal Securing Declaration pursuant to ITA 4.10. Must meet requirement Must meet requirement Must meet requirement N/A Application Submission Letter 2.3 Pending Litigation Applicant’s financial position and prospective long term profitability sound according to criteria established in 3.1 below and assuming that all pending litigation will be resolved against the Applicant Must meet requirement N/A Must meet requirement N/A Form CON – 2 2.4 Litigation History No consistent history of court/arbitral award decisions against the Applicant since 1st January [insert year] Must meet requirement Must meet requirement Must meet requirement N/A Form CON – 2 2.5 Declaration: Social, Health, and Safety (ESHS) past performance Declare any civil work contracts that have been suspended or terminated and/or performance security called by an employer for reasons related to the of any environmental, or social, or health or safety requirements or safeguard in the past five years. Must make the declaration. Where there is Specialized such N/A Each must make the declaration. Where there is Specialized N/A Form CON-3 ESHS Performance Declaration Non-
Table 2 – Rated Criteria and Requirements [Note to Employer: The criteria, requirements, maximum scores, weightings and scoring methodology contained in the table below is an example only and may be modified to suit the nature and complexity of the contract. Only applications that are substantially responsive to the qualification criteria and requirements in Table 1 are to be assessed against Table 2, Rated Criteria and Requirements] Past Experience Scoring Documentation Requirement Maximum score Remark Submission Requirement Number of similar contracts [Number of satisfactory contracts that exceed the number specified in 1, Sub-Factor 4 (where this number is z) that are: similar to the Requirements (Reference Table 1, 4); and completed during the past___ years. [insert number equal or more than the number of years specified in Table 1, Sub-Factor 4] ] Scoring methodology: [Select a maximum In case of JV, the experience be provided by the member or members indicated in Table 1. Form EXP 4.1 – 4.4
[The following table shall be filled in for the Applicant, each member of a Joint Venture and each Specialized Subcontractor] Applicant’s Name: [insert full name] Date: [insert day, month, year] Joint Venture Member’s or Specialized Subcontractor’s Name: [insert full name] RFP No. and title: [insert RFP number and title] Page [insert page number] of [insert total number] pages Environmental, Social, Health, and Safety Performance Declaration in accordance with Section III, Qualification Criteria, and Requirements No suspension or termination of contract: An employer has not suspended or terminated a contract and/or called the performance security for a contract for reasons related to Environmental, Social, Health, or Safety (ESHS) performance the date specified in Section III, Qualification Criteria, and Requirements, Sub-Factor 2.5. Declaration of suspension or termination of contract: The following contract(s) has/have been suspended or terminated and/or Performance Security called by an employer(s) for reasons related to Environmental, Social, Health, or Safety (ESHS) performance since the date specified in Section III, Qualification Criteria, and Requirements, Sub-Factor 2.5. Details are described below: Year Suspended or terminated portion of contract Contract Identification Total Contract Amount (current value, currency, exchange rate and US$ equivalent) [insert year] [insert amount and percentage] Contract Identification: [indicate complete contract name/ number, and any other identification] Name of Employer: [insert full name] Address of Employer: [insert street/city/country] Reason(s) for suspension or termination: [indicate main reason(s)] [insert amount] [insert year] [insert amount and percentage] Contract Identification: [indicate complete contract name/ number, and any identification] Name of Employer: [insert full name] Address of Employer: [insert street/city/country] Reason(s) for suspension or termination: [indicate main reason(s)] [insert amount] … … [list all applicable contracts] …
* Refer ITA 14 for date and source of exchange rate. ** Total USD equivalent for all years divided by the total number of years. See Section III, Table 1 Qualification Criteria, and Requirements, 3.2. Form EXP - 4.1 Specific DBO Experience (Table 1, 4.1 and Table 2) [The following table shall be filled in for contracts performed by the Applicant, each member of a Joint Venture, and Specialized Sub-contractors] Applicant’s Name: [insert full name] Date: [insert day, month, year] Joint Venture Member Name:[insert full name] RFP No. and title: [insert RFP number and title] Page [insert page number] of [insert total number] pages Similar Contract No. [insert number] of [insert number of similar contracts required] Information Contract Identification [insert contract name and number, if applicable] Award date [insert day, month, year, e.g., 15 June, 2014] Design-Build Commissioning Date [insert day, month, year, e.g., 15 June, 2015] Operations period completion date (actual or expected) [insert day, month, year, e.g. 03 October, 2030] Role in Contract the appropriate box] Prime Contractor Member in JV Management Contractor Sub-contractor Total Contract Amount [insert contract amount in local currency] US$ [insert Exchange rate and total contract amount in US$ equivalent]* If member in a JV or sub-contractor, specify share in value in total Contract amount and roles and [insert a percentage amount] [insert total contract amount in local currency] [insert exchange rate and total contract amount in US$ equivalent]*
Role in Contract [check the appropriate boxes] Lead design Process design Detailed design Other Total Contract Amount [insert total contract amount in local currency] US$ [insert Exchange rate and total contract amount in US$ equivalent]* If member in a JV or sub-contractor, specify share in value in total Contract amount and roles and responsibilities [insert a percentage amount] [insert contract amount in local currency] [insert exchange rate and total contract amount in US$ equivalent]* [insert roles and responsibilities] Description of the similarity in accordance with Section III Table 1, 4.2 Physical size of required contracts items [insert physical size of Complexity [insert description of complexity] Methods/Technology [insert specific aspects of the methods/technology involved in the contract] Other Characteristics [insert other characteristics as described in Section VII, Scope of Employer’s Requirements] Employer's Name: [insert full name] Address: Telephone/fax number E-mail: [indicate street / number / town or city / country] [insert telephone/fax numbers, including country and city area [insert e-mail address, if available] * Refer ITA 14 for date and source of exchange rate. Form EXP - 4.3 Specific Construction Experience 1, 4.3 and Table 2) [The following table shall be filled in for contracts performed by the Applicant, each member of a Joint Venture, and Specialized Sub-contractors] Applicant’s Name: [insert full name]