CENTRAL BANK OF KENYA PREQUALIFICATION/REGISTRATION … · The Central Bank of Kenya will pre-qualify and enlist prospective bidders for provision of medical services and treatment

BANKI KUU YA KENYA

CENTRAL BANK OF KENYA

Haile Selassie Avenue

P.O. Box 60000 - 00200 Nairobi Kenya Telephone: 2861000/2863000

Fax 340192/250783

Email: [email protected]

CENTRAL BANK OF KENYA

PREQUALIFICATION/REGISTRATION OF

SUPPLIERS

FOR

SUPPLY/PROVISION OF MEDICAL SERVICES

FOR

THE YEAR 2018-2021

TENDER NUMBER CBK/56/2017-2018

(CLOSING DATE:THURSDAY 29TH MARCH 2018 AT 10:30AM

2

SECTION 1: TENDER NOTICE

REFERENCE: CBK /56/2017-2018 TENDER NAME: PRE-QUALIFICATION OF

SUPPLIERS FOR PROVISION OF MEDICAL SERVICES (DOCTORS SPECIALISED

IN VARIOUS FIELDS AND MEDICAL INSTITUTIONS- HOSPITALS, XRAY, SCAN

MRI, LASER EYE TREATMENT, LABORATORY AND AMBULANCE SERVICES)

FOR CENTRAL BANK OF KENYA HEAD OFFICE, BRANCHES & CURRENCY

CENTRES (KISUMU, ELDORET, MOMBASA, NAKURU, NYERI & MERU)

SECTION A – INVITATION FOR PREQUALIFICATION

Tender Ref. CBK/56/2017-2018

The Central Bank of Kenya (CBK) invites sealed applications from eligible candidates for

purposes of prequalifying Doctors and Hospital institutions from 1st May, 2018 to 30th April

2021

1. A complete set of pre-qualification documents containing detailed information may be

obtained from Central Bank of Kenya, Head Office, along Haile Selassie Avenue,

Procurement and Logistics Services Department on 5th Floor at no cost OR be downloaded

from the Central Bank website www.centralbank.go.ke for free. Bidders who download the

tender document are advised to email their contact address using the email:

[email protected] before the tender closing date.

2. Further information as pertains to these tenders may be obtained during working hours

(Monday to Friday) between 9:00 am and 5:00 pm using the following address: The Ag.

Director, Procurement and Logistics Services, Tel: +254 20 2861000/2860000,Fax: +254

20 2863497/020 310604, 6th Floor, Central Bank of Kenya, Haile Selassie Avenue,

Nairobi, Email: [email protected]

3. Pre-qualification documents duly completed in sealed envelopes clearly marked with the

tender number and title should be deposited in the Green Tender Box (Marked Tender

Box No.3) located at the Front Entrance to the CBK Building situated along Haile Selassie

Avenue, Nairobi so as to be received on or before THURSDAY 29TH MARCH, 2018 at

10.30 a.m. Late bids will not be accepted and will be returned unopened.

4. Tenders will be opened immediately thereafter in the presence of the tenderers

representatives who may choose to attend the opening at DPLS Conference Room on 5th

Floor.

Ag. DIRECTOR,

DEPARTMENT PROCUREMENT AND LOGISTICS SERVICES

http://www.centralbank.go.ke/

mailto:[email protected]

mailto:[email protected]

3

Table of Contents Page

SECTION 1 : INVITATION TO TENDER…………………………………2

GUIDE LINES IN PREPARATION OF BID DOCUMENT...3

SECTION I1 : PRE-QUALIFICATIONS CATEGORIES…………………...9

SECTION II1 : INSTRUCTIONS TO TENDERERS………………………...9

SECTION IV : APPENDIX TO INSTRUCTIONS TO TENDERERS………13

SECTION V : EVALUATION CRITERIA……………………………. ……14

SECTION VI : PRICE SCHEDULE …………………………………………..17

SECTION VII : STANDARD FORMS…………………………………………18

4

GUIDELINES IN PREPARATION OF BID DOCUMENT

In preparing the bid document in response to the tender, bidders are advised to note the

following:

Section I – Invitation to Tender. This section gives guidelines on how and where to seek

further clarification pertaining to the tender document; Whether Tender Security is required

or not; where and when the tenders should be submitted; and place where tenders will be

opened.

Section II – Prequalification Categories – This section provides a List of categories for

which the Doctor/Medical Institutions are being prequalified. Please indicate the services

you provide.

Section III – Instruction to Tenderers. This section guides tenderers basically on how to

prepare their bid and how the tendering process will be carried out upto the award stage

including notification of award to the successful bidder. “Appendix to Instruction to

Tenderers” customizes clauses under Section III. Wherever there is a conflict between the

provisions of the Instructions to Tenderers under Section III and the provisions of the

appendix, the provisions of the appendix prevail.

Evaluation Criteria: This gives information on how the tender will be evaluated. Tenderers

should be able to evaluate their bids before submission to determine in advance whether they

meet the requirement of the bid or not. Through the evaluation criteria bidders will be able to

note all the required documents that should be attached to the bid document. Checklist of Document Forming the Bid Document:

No. Documents forming part of the bid Remarks

1 The main sections of the tender document that includes

Section I – Invitation to Tender;

Section II – Instruction to Tenderers; and section III –

General Conditions of the Contract

2 Copy of Certificate of Incorporation or Business Registration Certificate as

per the tender requirements and items in MR1 - 7

3 Copy of tax compliance certificate valid at least up to the date of tender

opening

4 Dully filled and signed Confidential Business Questionnaire in the form or

format provided in the tender document

5 Provide ALL ITEMS detailed in T1 – T3 as appropriate for Individual

Doctors and Medical Institutions

6 Bid document to be serialized on all pages by the tenderer

7 List of services provided with charges

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SECTION II: PRE-QUALIFICATIONS CATEGORIES

NO SPECIALITY INDICATE YOUR CATEGORY

NAIROBI

1. Cardiologists

2. General Physicians

3. Dermatologists

4. Endocrinologists

5. Gastroenterologists

6. Cancer Specialists

7. Neurologists

8. Surgeons

9. E.N.T

10. Ophthalmologists

11. Psychiatrists

12. Obstetricians &

13. Gynaecologists

14. Orthopedic Surgeons

15. Neurosurgeons

16. Urologists

17. Plastic Surgeons

18. Cardiothoracic

19. Surgeons

20. Rheumatologists

21. Allergists

22. Dentists

23. Oral & Maxillofacial

24. Hospitals

25. Day Care Surgeries

26. Audiology Services

27. Nutritionists /Dieticians

28. Counselling Services

29. Physiotherapy Services

30. Chemists

31. X-rays ,Scans ,M.R.I

32. Laboratories Services

33. Ambulance Services

34. Special Outpatients

35. Clinics

36. Chest Physicians

37. Pediatricians

38. Neonatologist

39. Hematologists

40. Cancer care centre

41. Anesthesiologist

42. Interventional Radiologist

43. Gastro-entrology

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NO SPECIALITY INDICATE YOUR CATEGORY 44. Pain Specialists

45. Diabetology/

46. Endocrinology

47. Paediatric Cardiac Clinic

48. Adult Cardiac Clinic

49. Paediatric Surgery

50. Paediatric Neurology

51. Psychiatry

52. Neuro-Surgery

53. Maxillo-facial Surgery

54. Paediatric Gastroetrology

55. Paediatric Nephrology

56. Paediatric Endocinologist

57. Paediatric Pulmonologist

58. Asthma Specialist

59. Cardiothoracic Surgeons

60. Breast Specialist

ELDORET COUNTY 61. Physicians

62. Opthalmolgists

63. General Surgery

64. Urologists

65. Gyneacologists

66. Dermatologists

67. Orthopaedics Surgeons

68. Paediatricians

69. Dentists

70. Psychiatrics

71. E.N.T

72. Oncologists

73. Counselling

74. Neuro Surgeon

75. Nutritionist

76. Gastroenterolgists

77. Diabetologist

78. Cardio thoracic surgeons

79. Occupational Therapists

80. Physiotherapy

81. X-ray ,M.R.I ,Scans

82. Laboratory Services

83. Hospitals 84. Chemists


86. Nephrologists

87. Paediatric Pulmilogist

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88. Dialysis Clinic

89. Rehabilitation Centres

90. Athroscopic Surgeon

KISUMU COUNTY

91. Physicians

92. Neurologists

93. Uro-logist

94. General Surgeons

95. Gynaecologists

96. Dermatologist

97. E. N T

98. Psychiatric

99. Paediatricians

100. Paeditric Surgeion

101. Orthopeadic Surgeons

102. Dentists

103. Hospitals

104. Laboratory

105. X-ray Scan ,MRI

106. Couselling services

107. Physiotherapy

108. Ambulances

109. Chemists

MOMBASA COUNTY

110. Physicians

111. Urologists

112. Gastroenterologists



115. Opthalmologists

116. Gynaecologists

117. Dermatologists

118. E.N.T

119. Psychiatrics

120. Paediatricians

121. Oncologists

122. Dentists

123. Maxillofacial

124. Neuro -Surgeons

125. Neuro Physician

126. Rheumatologists

127. Nutritionists / Dieticians

128. Cardilogists

129. Hospitals

130. Cardiology Services

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131. Laboratory Services

132. X-ray, Scan, MRI

133. Dialysis Services

134. Nephrologists

135. Chemists 136. Ambulance Services

137. Neurology Services

138. Counselling Services

139. Laparascope Gastroenterologists

140. Anaesthesists

NAKURU COUNTY 141. Out Patients Clinic

142. Physicians

143. Urologists

144. Pediatricians



147. Oral &Maxillofacial Surgeon

148. Opthalmolgist

149. Dermatologist

150. ENT Surgeon

151. Obstretic & Gynaecologist

152. Cardiologists

153. Oncologists

154. Trauma Surgeon

155. Psychiatrist


157. Radiologist MERU COUNTY

158. Outpatients Clinic

159. Paediatrician

160. E.N.T

161. Gynaecologist

162. Dentist

163. Radiologist

164. Wananchi Health Services

NYERI COUNTY 165. Outpatient Clinics 166. Obstretic & Gynaecologist

167. General Physicians

168. E.N.T 169. Trauma Surgeons 170. Dentists

171. Paediatrician 172. Opthalmologist

173. Pyschatric

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SECTION III: INSTRUCTIONS TO TENDERERS

1.1. The Central Bank of Kenya will pre-qualify and enlist prospective bidders for provision

of medical services and treatment under the CBK Medical Benefit Scheme.

1.2. The Doctors and Hospitals (Institutions) that have in the past been pre-qualified as

suppliers by CBK are also required to update their records through participation in this

pre-qualification process. Only the suppliers that respond to this advertisement will

be enlisted in the CBK data bank.

1.3. Both individual doctors and Hospital institutions are invited to submit a pre-qualification

tender for the provision of the advertised services listed in Section A of this pre-

qualification document.

1.4. The Pre-Qualification Tender document and the Tenderers response thereof shall be the

basis for pre-qualification. Tenderers must familiarize themselves with the requirements

described in this document and take them into account while preparing the response.

1.5. Tenderers will meet all costs associated with preparation and submission of their

applications.

1.6. It is the Bank’s policy to require that Tenderers observe the highest standard of ethics

during the selection and execution of such contracts. In pursuance of this policy, The

Bank:

a) defines, for the purpose of this provision, the terms set forth below as follows:

(i) "Corrupt practice" means the offering, giving, receiving or soliciting of

anything of value to influence the action of an officer of the

Purchaser/Employer in the pre-qualification process; and

(ii) “Fraudulent practice” means a misrepresentation of facts in order to

influence the pre-qualification process to the detriment of the

Purchaser/Employer, and includes collusive practices among Tenderers

(prior to or after submission of Tenders) designed to establish prices at

artificial, non-competitive levels and to deprive the Purchaser of the

benefits of free and open competition.

(b) Will reject a Tender for pre-qualification if it determines that a Tenderer

has engaged in corrupt or fraudulent activities in competing for the

contract in question;

(c) Will declare a Tender ineligible, for pre-qualification if at any time it

determines that Tenderer has engaged in corrupt or fraudulent practices in

competing for, or in executing, a similar contract; and

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(d) Will have the right to examine financial records relating to the

performance of such services to determine capability.

(e) Will have the right to inspect the business premises of the tenderer.

1.8 Tenderers shall furnish information as described in the pre-qualification tender document.

1.9 Tenderers shall be aware of the provisions on fraud and corruption stated in the standard

contract under the clauses indicated in the Data Sheet.

2. DOCUMENTS COMPRISING THE REQUEST FOR PRE-QUALIFICATION

2.1 Tenderers may request a clarification on the Tender Pre-qualification document up to

three (3) days before the Tender submission date. Any request for clarification must be

sent in writing by mail, facsimile, or electronic mail to the Purchaser's/Employer’s

address. The Purchaser/Employer will respond in writing by normal postal mail,

facsimile, or electronic mail to such requests and will send copies of the response to all

Tenderers who intend to submit tenders.

3 PREPARATION OF TENDER DOCUMENTS

3.1 Tenderers are requested to submit a Tender written in English language.

3.2 Tenderers are expected to examine the documents comprising this Request for pre-

qualification in detail. Material deficiencies in providing the information requested may

result in rejection of a Tender.

3.3 Tenderers are required to meet the qualification criteria stipulated in Section 2. Those

who do not meet the requirements need not submit tenders. Only tenders, which fulfill

these requirements, will be considered for detailed evaluation.

3.4 The pre-qualification documents shall not include any financial proposal information

other than audited accounts for the last 2 years.

3.5 Period of Validity

The request for pre-qualification must remain valid for not less than 120 days from the

date of submission.

4 SUBMISSION, RECEIPT, AND OPENING OF TENDERS

4.1 The original Tender Document shall be prepared in indelible ink. It shall contain no

interlineations or overwriting, except as necessary to correct errors made by the Tenderer.

Any such corrections must be initialed by the person or persons who sign(s) the Tender

Document.

4.2 The Tender should be prepared and submitted in 1 (one) copy in a plain sealed envelope

marked;

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“PRE-QUALIFICATION OF SUPPLIERS FOR PROVISION OF MEDICAL SERVICES

(DOCTORS SPECIALISED IN VARIOUS FIELDS AND MEDICAL INSTITUTIONS-

HOSPITALS, XRAY, SCAN MRI, LASER EYE TREATMENT, LABORATORY AND

AMBULANCE SERVICES) FOR CENTRAL BANK OF KENYA HEAD OFFICE AND

BRANCHES AND CURRENCY CENTRES (KISUMU, ELDORET & MOMBASA,

NYERI, NAKURU & MERU) (Indicating the field of specialization as in the categories

above)

and addressed to:

The Ag. Director, Procurement and Logistics Services,

Central Bank of Kenya

P.O. Box 60000-00200

Nairobi

4.3 Deadline for Submission

The closing time for the Tender shall be Thursday 29th March, 2018 at 10.30 a.m. and

shall be sent to the above address. Tenders shall be marked on top "DO NOT OPEN

BEFORE THURSDAY 29TH MARCH, 2018 at 10.30 a.m.

4.4 Late Tender

Any Tender received after the deadline pursuant to clause 4.3 shall be rejected.

4.5 Tender Opening And Evaluation

4.5.1 A committee of officials from the Bank shall open the Tender immediately after the

closing time for submission of the Tender.

4.5.2 The Bank will prepare a record of the Tender opening.

5 TENDER EVALUATION

5.1 General Requirements

(i) The Central Bank will examine the tenders to determine completeness,

general orderliness and sufficiency in responsiveness.

(ii) Tenderers shall not contact the Bank on the matter relating to their tender

from the time of opening to the time the evaluation is finalized and official

communication is sent to them. Any effort by the Tenderer to influence the

Bank in the Tender evaluation shall result in the rejection of their tender.

12

(iii) Pre-qualification will be based on meeting the minimum qualifying score of

75% in the evaluation criteria as set out in SECTION V of the tender

document.

(iv) The tenderers should have registered offices and the Bank reserves the

discretion of visiting physical premises from which the tenderer conducts

business if so desired to confirm existence and capability to deliver the said

goods/services.

(v) Tenderers who qualify according to the selection criteria may be invited to

submit their quotations for the provision of the services as and when required.

The Bank does not bind itself to assign services but shall endeavor to ensure

that Applicants are treated equitably when opportunities arise.

5.2 Litigation

Applicants must disclose any current litigation involving the firm.

5.3 Verification of Information

Central Bank of Kenya reserves the right to verify any information provided by

prospective bidder as a qualification for consideration.

13

SECTION IV: APPENDIX TO INSTRUCTIONS TO TENDERERS

The following information regarding the particulars of the tender shall complement/ supplement

or amend the provisions of the instructions to tenderers. Wherever there is a conflict between the

provision of the instructions to tenderers and the provisions of the appendix, the provisions of the

appendix herein shall prevail over those of the instructions to tenderers.

1. All the admitting hospitals must have clearly defined general ward beds, fully equipment

theatres, Radiology facilities, pharmacy, mortuaries, and physiotherapy units and lastly

they must be N.H.I.F accredited.

2. For the individual doctors, relevant qualification, experience and registration.

3. Provision of relevant Professional Indemnity Certificate

4. State charges for consultation and other charges

5. The individual doctors must all have admitting rights to the main hospitals, have

indemnity cover and must not have current malpractices against them.

6. Keeping the agreed rates as constant as possible within the contract time.

7. Offering consistent high quality services.

8. Maintain ethical practice as laid down by the Kenya Medical Practitioners and Dentists

Board Code of Conduct.

9. Adhere and to support the Bank’s policy on issuance of sick offs. Details will be provided

in the contract documents.

10. Willingness to work in close co-operation with the Staff Clinics with adequate

communication at all times.

11. State any other complimentary services provided by the medical service provider.

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SECTION V: EVALUATION CRITERIA

Evaluation of tenders will be conducted based on the tenderers response to the mandatory

requirements and the performance based technical qualification.

(I) MANDATORY REQUIREMENTS (FOR INDIVIDUAL DOCTORS)

The following mandatory requirements must be met by the individual doctors not withstanding

other requirements in the tender document:

NO REQUIREMENTS

RESPONSIVE OR NOT

RESPONSIVE

MR1. A copy of Tax Compliance Certificate issued by KRA, valid

up to and including the tender closing date.

MR2. Copy of current License from Kenya Medical Practitioners

and Dentists Board, nursing Council, laboratory regulatory

etc.

MR3. Professional Indemnity Cover- indicate the cover

MR4. Must have admitting rights to the main hospitals – proof by

providing comprehensive list of the name of hospitals where

consultant medical doctor /specialist dentists have admission

rights.

MR5. Duly filled Confidential Business Questionnaire

MR6. Duly filled Declaration form

MR 7 Services offered and a list of charges

(II) MANDATORY REQUIREMENTS (FOR HOSPITAL INSTITUTIONS)

The following mandatory requirements must be met by the Hospital institutions not withstanding

other requirements in the tender document:

NO REQUIREMENTS

RESPONSIVE OR NOT

RESPONSIVE

MR1. A copy of Tax Compliance Certificate issued by KRA, valid

up to and including the tender closing date.

MR2. Registration by relevant body e.g. Kenya Medical

Practitioners and Dentists Board.

MR3. Professional Indemnity Cover- indicate the cover

MR4. Audited accounts for last two years

MR5. Duly filled Confidential Business Questionnaire

MR6. Duly filled Declaration form

MR7 Services offered and a list of charges

15

III) EVALUATION CRITERIA

(A) Technical evaluation for the Individual Doctors

Evaluation Attribute Weighting Score Max Score

%

Tenderer’s

Response

Response

T1 Provide C.V with Master’s

degree in relevant speciality

Additional sub speciality

30 %

5%

35%

T2 Number of years in the

Medical speciality

5 Years and above: 40%

Others prorated at:

Number of years x 40

5

40%

T3 Provide a list of at least 3

reputable institutions where

similar services have been

provided in the recent past.

3 or more clients: 25%

Others prorated at:

Number of clients x 25

3

25%

(B) Technical evaluation for the Hospitals


%

Tenderer’s

Response

Response T1 Number of years in the

business of provision of

medical care services

15 Years and above: 30%

Others prorated at:

Number of years x 30

15

30

T2 Provide a list of all prime

clients/references to which

the company has made

similar supplies

10 or more clients: 30%

Others prorated at:

Number of clients x 30

10

30

T3. Financial strength (40

marks)

a) Profitability Margin –

A margin above 20%

10-19 %

5-9%

1-4 %

Below 1% 0 marks.

20

15

10

4

20

16


%

Tenderer’s

Response

Response b) Liquidity Ratio

2:1 – 20 Marks;

1:1 –15 marks;

0.5 :1- 10 Marks;

less than 0.5>0 5 marks

NB: (Attach Audited

financial accounts for the

last two years to assist in

the calculation).

20

15

10

5

20

Total 100

NB 1: Debt Equity Ratio (Net worth) = Total Debt

Net Worth

Profitability (Margin) = EBIT

Total sales (Income)

EBIT - Earnings before Interest and Taxes

Current Ratio (Liquidity) = Current Assets

Current Liabilities

SHORTLIST

Tenderers should note that only tenders that score 75% and above on the Technical

Evaluation will qualify to be shortlisted and retained as a standby list of suppliers for an

initial period of three (3) years from 1st May 2018 – 30th April, 2021 for the provision of

Medical Services for the Central Bank of Kenya for services offered as per list of charges

provided The contract may be renewed for an additional three (3) years by mutual consent of

both parties subject to satisfactory performance.

RECOMMENDATION OF AWARD

All technically responsive bids shall be recommended for award of the contract to provide

medical services.

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SECTION VI - PRICE SCHEDULE

Minimum (Kshs.) Maximum (Kshs.)

Consultations

Consultation

House Visits - NB (Consultations only. Incidentals

to be agreed upon by the parties)

Day Time

Night Time

Hospital Visits

Day Time

Night Time

Institutional Locum Fees per hour -Daytime

Institutional Locum Fees per hour – Night time

B: SPECIALISTS

Consultations

First visit

House Visits NB (Consultations only. Incidentals to

be agreed upon by the parties)

Day Time

Night Time

Hospital Visits

Day Time

Emergency Night visits

Emergency Day visits

ICU Visit (Daily charges)

HDU Visit (Daily charges)

Institutional Locum Fees per hour - Daytime

Institutional Locum Fees per hour – Night-time

All Other services offered and charges

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SECTION VII: STANDARD FORMS

1. CONFIDENTIAL BUSINESS QUESTIONNAIRE

You are requested to give particulars indicated in part 1 and part 2 (a), 2(b) or 2(c)

whichever applies to your type of business.

You are advised that it is a serious offence to give false information on this Form.

Part 1 General

Business Name……………………………………………………………………..

Location of business premises; Country/Town……………………………

…………………………………………………………………………………………

Plot No……………………Street/Road…………………………………………

Postal Address………………………Tel No……………………………………

Fax No………………………………………………………………………………

E-mail………………………………………………………………………………

Nature of Business…………………………………………………………………

Current Trade License No…………………Expiring date…………………

Maximum value of business, which you can handle at any time:

Kshs…………………………………………………………………………………

Name of your bankers……………………………………………………………

Branch………………………………………………………………………………..

Part 2(a) – Sole Proprietor

Your name in full…………………………………………………Age…………

Nationality……………………………………Country of Origin………………

*Citizenship details……………………………………………………………….

Part 2(b) – Partnership

Give details of partners as follows:

Name in full, Nationality, Citizenship Details and Shares

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1 ……………………………………………………………………………………

2 ……………………………………………………………………………………

3 ……………………………………………………………………………………

4 ……………………………………………………………………………………

5 ……………………………………………………………………………………

Part 2(c) - Registered Company

Private or Public……………………………………………………………………

State the nominal and issued capital of the company –

Nominal Kshs……………………………………………………………………...

Issued Kshs…………………………………………………………………………

Give details of all directors as follows:

Name in full, Nationality, Citizenship Details and Shares

1 ……………………………………………………………………………………

2 ……………………………………………………………………………………

3 ……………………………………………………………………………………

4 ……………………………………………………………………………………

5 ……………………………………………………………………………………

Date…………………………Signature of Applicant………………………

*If Kenyan Citizen, indicate under “Citizenship Details” whether by Birth, Naturalization

or Registration.

Interested eligible bidders may obtain information and inspect pre-qualification documents during

working hours Monday to Friday at the office of:

20

2. CLIENT REFERENCE FORMAT: NAMES OF THE APPLICANTS CLIENTS IN

THE LAST TWO YEARS.

1. Name of Client (organization) …………………………………………………………

Address of Client (organization) ………………………………………………………

Name of Contact Person at the client (organization) …………………………..

Telephone No. of Client ……………………………………………………………………

Value of Contract

…………………………………………………………………………….

Duration of Contract (date) ……………………………………………………………..

(Attach documental evidence of existence of contract)

2. Name of 2nd Client (organization)

Name of Client (organization) …………………………………………………………

Address of Client (organization) ………………………………………………………



Value of Contract

…………………………………………………………………………….

Duration of Contract (date) ……………………………………………………………..


3. Name of 3rd Client (organization)

Name of Client (organization) …………………………………………………….……

Address of Client (organization) ………………………………………………….……



Value of Contract

……………………………………………………………………….…….

Duration of Contract (date) ………………………………………………………….…..


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4. Name of 3rd Client (organization)

Name of Client (organization) …………………………………………………….……

Address of Client (organization) ………………………………………………….……



Value of Contract

……………………………………………………………………….…….

Duration of Contract (date) ………………………………………………………….…..


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3.0 DECLARATION FORM

I/We………………………………………………………………. hereby declare

That the information given above is true and further state that I/We also understand the

purchase of this form does not guarantee registration.

That I/We are not insolvent/in receivership, bankrupt or being wound up, business

activities not suspended/not subject to legal proceedings.

That I/We have legal capacity to enter into contract.

That I/We have fulfilled obligations to pay taxes/social security contributions.

That if the legal, technical, financial position, or the contractual capacity of the firm

changes, we commit ourselves to inform you and acknowledge your sole right to

review the pre-qualification made.

That I/We understand that I/We shall be disqualified should the information submitted

here for purpose of seeking qualification be materially inaccurate or materially

incomplete.

That I/We give Central Bank of Kenya, authority to seek any other references

concerning my/Our Company from whatever sources deemed relevant.

That if pre-qualified, I/we undertake to participate in submission of a tender or

quotation when called upon to do so.

Name………………………………………………………………………………...

Designation…………………………………………………………………………

Signature……………………………………………………………………………

Official rubber Stamp………………………………………………………………

Date………………………………………………………………………………….