CONTINUATION OF ANNEX III DOCUMENTATION – DESCRIPTION OF THE WARRANTY AND OF THE MANUFACTURED AUTHORISED LOCAL SERVICE SUPPORT IN MONTENEGRO ANNEX IV : Budget breakdown (Model financial offer) TENDER REFERENCE: EuropeAid/133-339/L/ACT/ME – 2013/335-263/08 NAME OF TENDERER: A B C D E Item number Quantity specifications offered (incl brand/model) Unit costs with delivery DDP without VAT TIVAT, Montenegro EUROS total EUROS 1.1 1 compl. 1.2. 1 1.3 1 pcs. 1.4 1 pcs. 1.5 1 pcs. 1 pcs.
1.6.1 8 pcs. 1.6.2 4 pcs. 1.7. 2 pcs. 1.8 1 pcs. 1.9 40 m 1.10 8 m2 1.11 40 m 1.12 flat rate 1.13 1 pcs.
ADMINISTRATIVE COMPLIANCE GRID Project : Improvement of Energy Efficiency through an Management Network – Supply of the Equipment and installation in the pilot project in Tivat (refurbishment of heating-cooling system by installation of energy efficiency pumps in the “House of GracijaPetković” - Center for Culture) Tender reference : EuropeAid/133-339/L/ACT/ME – Tender envelope number Name of Tenderer Is tenderer (consortium) nationality eligible? (Y/N) Is documentation complete? (Y/N) Is language as required? (Y/N) Is tender submission form complete? (Y/N) Is tenderer's declaration signed (by all consortium members if a consortium)? (Yes/No/ Not Applicable) administrative requirements of the tender dossier? (Yes/No/Not applicable) Overall decision? (Accept / Reject) 1 2 3 Chairperson's name Chairperson's signature Date
EVALUATION GRID Project title : Improvement of Energy Efficiency through an Management Network – Supply of the Equipment and installation in thepilot project in Tivat ( refurbishment of heating-cooling system by installation of energy efficiency pumps in the “House of GracijaPetković” - Center for Culture) Publication reference : EuropeAid/133-339/L/ACT/ME – 2013/335-263/08 Tender envelope No Name of Tenderer Rules of origin (Y/N) Economic & financial capacity? (OK/a/b/…) Professional capacity? (OK/a/b/…) Technical capacity? (OK/a/b/…) Compliance with technical specifications? (OK/a/b/…) Ancillary services as required? (OK/a/b/…/NA) Subcontracting statement in accordance with art 6 of the General Conditions? (Y/N) Other technical requirements in tender dossier? (Yes/No/Not applicable) Technically compliant? Y/N) Notes: Voting member (Evaluator)'s name Evaluator's signature Date
If this declaration is being completed by a consortium member: The following contains our financial data as included in the consortium’s tender form. These data are based on our annual certified accounts according to the legislation of the registration country and our latest projections. Estimated figures (ie, those not included in annual audited accounts) are given in italics. Figures in all columns have been provided on the same basis to allow a direct, year-on-year comparison to be made <except as explained in the footnote to the table>. Financial data 2 years before last5 € Year before last year € Last year € Average6 € This year € Annual turnover 7, excluding this contract Cash and cash equivalents8 at beginning of year Net cash from / (used in) operating, investing & financing activities9 excluding future contracts Net forecast cash from/ (used in) future contracts, excluding this contract Cash and cash equivalents8 at end of year (ie, the sum of the above three rows) The following table contains our personnel statistics as included in the consortium’s tender form: Average manpower Previous year Last year This year Overall Total for fields related to this contract 11 Overall Total for fields related to this contract 11 Overall Total for fields related to this contract 11 Permanent staff 12 Other staff 13