PREQUALIFICATION OF SUPPLIERS FOR GOODS AND SERVICES FOR THE YEAR

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1 PREQUALIFICATION OF SUPPLIERS FOR GOODS AND SERVICES FOR THE YEAR INVITATION FOR PREQUALIFICATION TO TENDER FOR THE SUPPLY OF GOODS & SERVICES. (One application form can only be used to apply for ONE category of goods / services) CATEGORY NO: ITEM DESCRIPTION: RECEIPT NO. (Attach copy) Credit Bank Ltd is in the process of updating its register of Suppliers for various Goods & Services for the Year 2015/2017. Interested and existing suppliers are invited to apply for pre-qualification, indicating the Goods and/or services they wish to supply. Pre-qualification documents with detailed information can be obtained from The Head Office, Credit Bank Ltd, Mercantile House, Koinange Street, or your nearest Credit Bank Branch upon payment of a non-refundable fee of Kshs 3,500 per category payable in banker s cheque or cash to TENDER A/C NO KES CBL Prequalification Application Document 2 Duly completed Pre-qualification documents in plain sealed envelopes MUST Indicate the Category No. and Item Description and clearly marked Prequalification of Suppliers-2015/2017 and should be deposited in the Prequalification Tender Box at Credit Bank Ltd, Mercantile House, Koinange Street, Nairobi or posted to: The Chairman, Tender Committee

2 Credit Bank Ltd P. O. Box NAIROBI. The closing date for the submission of applications will be 19 th October, APPLICATION SUBMISSION SHEET We, the undersigned, apply to be pre-qualified for the provision of goods and Services to Credit Bank Ltd for the 2015/2017 financial years and declare that: (a) We have examined and have no reservations to the Pre-qualification Document and Instructions. (b) We, including any subcontractors or suppliers for any part of the contract Subject to this pre-qualification process, have the technical and financial Capabilities to undertake the provision of the required goods and services. (c) We, including any subcontractors or suppliers for any part of the contract Subject to this pre-qualification do not have any conflict of interest, in Accordance with the Credit Bank s Policy for Procurement and Disposal and the Public Procurement & Disposal Act. (d) We, including any subcontractors or suppliers for any part of the contract Subject to this pre-qualification, have not been declared ineligible to supply Goods and services under the Kenyan laws or official regulations or by an Act of compliance with a decision of the United Nations Security Council. CBL Prequalification Application Document 3 (e) We understand that you may cancel the prequalification process at any time and that you are neither bound to accept any application that you may receive nor to invite the prequalified applicants to bid for the contract subject of this prequalification, without incurring any liability to the applicants. Signed Name In the Capacity of Duly authorized to sign the application for and on behalf of: Applicant s Legal Name (Organization) Address

3 Date Official Stamp CBL Prequalification Application Document CONFIDENTIAL BUSINESS QUESTIONNAIRE PART A - BACKGROUND INFORMATION 1. Name of Organization: 2. Address for all Correspondence: 3. Principal Contact Person/s: 4. Position: 5. Telephone Numbers: Landline/s: Mobile/s: Fax Numbers: 6. Addresses: 7. Physical Location of Business: Premises (Note that a visit to your Office may be made to confirm Information provided as part of tender Evaluation) Town: LR. No:

4 Street: Building: Floor: 8. Nature of Organization (Ltd, Plc, Partnership, Sole proprietorship, etc.) 9. Names of Proprietor/ Partners/Directors NAME NATIONALITY Geographical Areas of Operations 11. Business Operations Year established.. Duration of business operation..(years) 12. Company Registration No. (Attach copy) No 13. VAT Registration No. (Attach copy) No

5 14. Valid Tax Compliance Certificate (Attach copy) 15. Current Trade License No. No 16. Brief description of goods /services that you offer Please attach copy of organizational structure and profile of key personnel of the Organization PART B - FINANCIAL STATUS Name of Bank & Branch (from which a financial reference may be sought) Bank: Branch: (Indicate Bank name & branch) Bank address: Bank Telephone Number: Bank Contact Name & Position: State Annual Turnover (Attach certified copies of bank statements for the past one year) Annual Turn Over in KShs: State Profit for the past 3 years (Attach copies of audited accounts)

6 Profit in KSh. Year. Year.. Year.. PART C - REFERENCES Provide contact details for 3 referees for previous / current work that is similar or the same to the one now applied for. The referees may be contacted at any given time. A) How many references are you indicating? (Tick one) B) Is CREDIT Bank one of your references? Yes.. No. C) Other Organization.. Contact Name... Position.. Telephone No.... address... Signature of referee & Official Stamp Organization.. Contact Name...

7 Position.. Telephone Nos address... Signature of referee & Official Stamp Organization.. Contact Name... Position.. Telephone No.... address... Signature of referee & Official Stamp Please attach copies of LPOs, award letters or any other approved document from each of the above showing works done and their values. PART D PROJECT / SUPPLIES HISTORY List information on public or private major projects/supplies completed over

8 The last 5 years and most recent /ongoing. (Attach copies of LPOs, award letters or any other approved document from each of the above showing works done and their values). (i) Completed Client Project title / Supplies Duration/Period Value (ii) Current / On-going Client Project title / Supplies Duration/Period Value (iii) Maximum value of business handled at any one time KSh...

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