Application For Enlistment/Up-Gradation of Enlistment in All Classes

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ANNEXURE-I (Refer Rule 7.

1)

PUBLIC WORKS DEPARTMENT, GOVT. OF TRIPURA


APPLICATION FOR ENLISTMENT/UP-GRADATION OF ENLISTMENT IN ALL CLASSES

[The applicant should study carefully the Rules of Enlistment and the list of documents
to be annexed with the application form before filling the form. Applications found
deficient in any respect are liable to be rejected without any further correspondence]

Supporting Documents annexed with the application form should be listed in


Annexure-II

CLASS: --------------------------------------------

JURISDICTION: ---------------------------------------------------

1. (a) Name of applicant …………………………………


(b) Nature of Entity (Individual/ Sole Proprietorship Firm/Partnership Firm Firm/LLP
Firm/ Company) ………….…………………………………
(c) Registration No. For Firm/LLPIN for LLP /CIN for Company ………………….

2. Nationality ..................................
3. Address
(a) Regd. Office .................................................................................................................
…………………………………………………………………………………………
…………………………………………………………………………………………

(ii) Head Office (if different from registered office)

…………………………………………………………………………………………

………………………………………………………………………………………….

4. Contact Details:
(i) Telephone Number .........................................................
(ii) Fax No. ..............................................................
(iii) Mobile Number .............................................................
(iv) Email Id ............................................................
(v) Website URL (if any) ...................................................................................

5. PAN Number (Individual / Firm / LLP/ Company).................................................

6. Name, scanned passport size photo and signature of the Individual(s)/ Partner(s) /
Director(s) (Size of photo should be 2.5 X 3.5 cm having white background and printed
name at bottom)

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1. 2. 3. 4.
Paste photo Paste photo Paste photo Paste photo

Name Name Name Name

7. Is the individual/sole proprietor/any partner/directors of company:

(a) Dismissed Government Servant Yes No


(b) Removed from approved list of contractors Yes No
(c) Demoted to a lower class of contractors Yes No
(d) Having business banned/suspended by
any Government in the past Yes No

(e) Convicted by Court of Law Yes No


(f) Retired Engineer/official from Engineering
Department of Govt. of Tripura within last
two years Yes No

(g) Director or partner of any other company/firm


enlisted with PWD or any other department Yes No
(h) Member of Parliament or any State
Legislative Assembly Yes No

If answer to any of the above is ‘Yes’, furnish details on a separate sheet


8. a) Name of person holding power of attorney (if any): .................................................
b) Nationality: .................................................
c) Liabilities (if any): .................................................

9. Name of the Banker with full address, Banks Official E-mail Id and phone number
……………………………………………………….......................................

10. (a) Whether you or any partner/Director already enlisted with PWD or any other

department /Organisation Yes No

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(b) If yes, give details in table below:

Sl. Class & Name of Enlistment Enlistment Date of Tendering


No Category Department authority & Number & Validity Limit
address Date (in lakhs)

11. (a) Is any person working with the applicant is a near relative of the officer/official of

PWD [As per Enlistment Rules 16] If yes, give details Yes No

(b) If Yes, give details (Name, Designation, Employee ID)

12. Full time technical staff in applicant’s employment: Nos. ..........

(a) Graduate engineers


(b) Diploma engineers
13. Enlistment Processing fee Enclosed Details:

Draft No. Date Amount Issuing Bank & Branch drawn Executive
Branch upon Engineer in
whose favour
drawn

14. Does the applicant have sufficient T&P, Machinery, Equipment and

workshop as per requirements mentioned in the Enlistment Rules


for the class applied for Yes No
[Attach details on separate sheet]
15. Details of works completed, in progress and secured during the last 5 years to be filled
in the Proforma as given in Annexure-III (1 &2). This list should include all the works
whose gross amount of works done including enhancement if any is more than the
lowest required magnitude for the class in which registration is required.

16. Number of Certificates from clients in original or self-attested copy as per proforma
given in Annexure-IV for works selected for evaluation of contractor’s performance

17. Certificates (Strike out whichever is not applicable):

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(i) I/We (including all partners) certify that I/We have read the Rules of Enlistment of
Contractors in PWD as amended up to date and shall abide by them.

(ii) I/We certify that I/We will not get myself/ourselves registered as contractor(s) in
the Department under more than one name.

(iii) I/We certify that the information given above is true to the best of our knowledge.
I/We understand that if any information is found incorrect, our enlistment is liable
to be cancelled.

(iv) I/We certify that


(a) The constituents of the Firm/LLP /Company reflected in Sl. No. 1(b) and 7
above are as applicable on the date of this application which tallies with the
record of the registering authority. I/none of the partners/Directors retired
as an Engineer of Gazetted rank or as any Gazetted Officer employed on
Engineering or Administrative duties in last two years.

(b) That we have neither under our employment any such person nor shall we
employ any person within two years of his retirement except with the prior
permission of the Government

(v) I/We undertake that I/We will (if we do not own), hire or otherwise arrange the
Mini Batching plant/Hot mix Plant/Wet mix plant required for the particular work as
a result of this enlistment.

vi) I/We undertake that, if we do not possess in my/ our name a valid electrical license
as required, I/we shall associate with an agency having such a license for execution
of work which requires such a license.

vii) I/We have attached Annexure-II duly completed and signed.

Signature(s) of applicant(s) as
applicable:

(Sole Proprietor OR All Partners OR Either All Directors or the Chief Managing Director if
authorised specifically by a Board Resolution)

Sl. Name Signature & Date Address

1.

2.

3.

4.

No. Of Documents attached

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ANNEXURE-II {Refer Annexure-I Sl. 17 (vii)}

List of Documents Attached for Enlistment / Up-gradation of Enlistment


For online applications, downloaded copy duly completed to be used
Document Annexure Document Description User
Code No Status
1 Proof of Constitution {Annexure-I, Sl. No-1 (b)} Yes No
(a) In case of sole proprietorship/HUF: an affidavit
executed before the Magistrate not below the
rank of Executive Magistrate, that the applicant
is the sole proprietor of the firm/Karta of HUF
(b) In case of Partnership Firm; Certificate of
Registration, Partnership Deed and prescribed
documents indicating approval of change in
address or constitution of Partnership Firm duly
self-attested.
I In case of Limited Liability Partnership,
Certificate of Incorporation, Partnership Deed
and prescribed documents indicating approval
of change in address or constitution of
Partnership duly self-attested.
(d) In case of Private/Public Limited Company,
Certificate of Incorporation, Articles of
Association and prescribed documents
indicating approval of change in address or
constitution of Board of Directors duly self-
attested.
2 Power of attorney, if any (Annexure-I SI.no.8a)
or Board Resolution, if any, self-attested
3 V-1 & (A) Banker’s Certificate from Scheduled Bank
V-2 in original (in proforma V-I)
(B) Certificate regarding Annual turnover
on works as per applicable class and
category of the firm in the last three
financial years as per Annexure V-2
4 Self-Attested copy of Enlistment order if any
{Annexure-I, Sl. No. 10 (a) & 10 (b)}.
5 List of all near relatives working in CPWD
{Annexure-I, Sl. No. 11(a) & 11 (b)} See also Rule
16.0 of Enlistment Rule.
6 Technical Staff: (Annexure-I, Sl. No-12)
(i) List of full-time technical staffs with
qualification and experience of each
(ii) Attested copies of the degrees/diplomas of
the technical staff/Designers.

(iii) Declaration from the technical staff


/Designers (those are employed with the

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applicant) countersigned by the applicant

7 III Annexure-III-1 (Completed Works) and III-2


(works under progress). (See Rule 12.2).
8 IV Original or self-attested copies of certificates for
works done, from concerned Clients, in proforma
as given in Annexure-IV (Annexure- I, Sl. No. 16)
(see also Rule 12.0)
9 III Self-Attested copies of Award Letters and Final
Bill for works included in Annexure-III-1 (See
Rule 12.2).
10 III Self-Attested copies of Award Letters and Final
Bill for works included in Annexure-III-2 (See Rule
12.2).
11 List of machineries, T&P i/c centering &
shuttering, possessed by the applicant.
(Annexure-I, Sl. No- 14)
12 IV Contractor’s performance as per prescribed
criteria and client certificate. (Annexure-IV) (Rule
12.2)

Signature(s) of applicant(s) as applicable:

(Sole Proprietor OR All Partners OR, either All Directors or the Managing Director or
Director if authorised specifically by a Board Resolution)

Sl. Name Signature & Date Address

1.

2.

3.

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ANNEXURE-III(1) (Completed Works) (Refer Rule 12.2)

(1) In case of enlistment- Works completed during the last five years or
(2) In case of revalidation- List of works completed during last enlistment/revalidation
period (It is mandatory to submit details of all the works completed irrespective of its cost)

Sl. Name of Date Date of Reasons for Tendere Total Name, Whether
No work & of completio delay & d amoun designation & any
Agreem start n compensati Amount t of the complete litigation
ent No. on levied, if compl address of the involved
any eted authority for including
Actual work whom the work arbitratio
Stipulated

was executed n

Certificate:

This is to certify that no adverse action on any of the above-mentioned works has been
taken by the concerned department against me/us. I/we understand that if any
information is found incorrect, our enlistment is liable to be cancelled.

Applicant’s Signatures (As per Annexure-

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ANNEXURE-III (2) (Work not yet Completed) (Refer Rule 12.2)
(1) In case of enlistment- Works in progress and secured during the last five years or
(2) In case of revalidation- List of works in progress and secured during last enlistment/
revalidation period.

(It is mandatory to submit details of all the works completed irrespective of its cost)

Sl Name Date Date of Reasons Tendered Total Percenta Name,


. of of start completio for Amount amoun ge designati
N work n delay t of the progress on &
o & work complete
Agree Target paid address
Stipulated

ment of the
No. authority
for
whom
the work
is being
done

Certificate:

This is to certify that no adverse action on any of the above-mentioned works has been
taken by the concerned department against me/us. I/we understand that if any
information is found incorrect, our enlistment is liable to be cancelled.

Applicant’s Signatures (As per Annexure-1)

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