Pre-Qualification of Suppliers

Pre-Qualification entity applied for:

National Security Institute Abu DhabiNational Security Institute Ajman

Mandatory Attachments:

• Trade License:

• VAT Certificate:

• Bank Details:

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GENERAL INFORMATION

Category applied for:
Travel Agent /Provision of Air Ticketing ServicesProvision of Vehicle Insurance & RegistrationRepair and Maintenance of Motor Vehicles and GeneratorsSupply of IT and Related EquipmentSupply of Pantry SuppliesSupply of Stationery and Office SuppliesSupply of Training MaterialsRepair and Maintenance of Computers and Printers & IT Related EquipmentSupply of Office Furniture and EquipmentProvision of General Renovation and / RepairsProvision of General Renovation and / RepairsProvision of Pest control and Sanitary ServicesProvision of Waste Material DisposalRepair and Maintenance of Network Equipment, DataCommunication, Website and Web Portal MaintenanceProvision of Hotel Services and Catering ServicesTranslation Services for Technical DocumentsMultimedia: Photography and/ or VideographySupply of Branding and Promotional MaterialTraining & Certification ServicesInsurance Services (Medical, WC, PL, Building, Equipment, Vehicle etc.)Professional Services (Consultancy, Accreditation, Security etc.)If others, please specify:

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NUMBER OF STAFF EMPLOYED

Please provide the organization chart/employee list from immigration or any other relevant document.

MANAGEMENT STRUCTURE

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SPECIFIC REQUIREMENTS

All firms must provide (Tick appropriate box)

Copies of Certificate of Registration / Trade License
YESNO

Copy of V.A.T Registration Certificate
YESNO

Membership to professional body for Applied category
YESNONA

FINANCIAL POSITION

All firms must provide (Tick appropriate box):

Audited financial statement (previous year)
YESNO

Provide copy of the company’s bank statement for the last 3 months
YESNO
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PAST EXPERIENCE

Provide a list of 5 current clients/customers that you have transacted business with and value (for the past 5 years) and attach the document proof i.e., Awarding letter, purchase order, agreement etc.

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HEALTH & SAFETY

You must provide details of your health and safety staff, process and policies implemented in your organization.

Does the company have any health and safety officer (or other HSE staff)?
YESNO

Does the company is health and safety ISO certified?
YESNO

Does the company have any health and safety policy?
YESNO

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BANK DETAILS

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APPENDIX 1 – DECLARATION

Having studied the tender information for pre-qualification we/I hereby state:

• a) The information furnished in our application is accurate to the best of my/our knowledge.

• b) Have read and understood the terms and condition.

• c) That in case of being qualified we acknowledge that this grants me/us the right to participate in due time in the submission of a tender or quotation on the basis of provisions in the tender or quotation documents to follow.

• d) If the legal, technical, financial conditions or the contractual capacity of the firm changes when the call for Tenders/Quotations is issued, we commit ourselves to inform you and acknowledge your right to review the tender made.

• e) We enclose all the required documents and information required for the prequalification evaluation.

Date

Applicant’s name

Represented by

Signature
[signature signature-336 color:#000000 background:#ffffff]

Designation

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Optional Attachment:

If provided, will get points accordingly and will be registered as pre-qualified supplier for all future RFQ’s and tenders.

• Bank Statement (Last 3 Months):

• Organization chart/employee list from Immigration:

• Health and Safety Policy and ISO certificate:

• Financial Statement (Last Audited):

• 5 Projects (Awarding Letter/PO/Contract/agreement):[file 5-projects]

• Professional certificate for applied category:

• ICV (In-Country Value) Certificate:

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Conflict of Interest Declaration Form

Are you aware of any conflict of interest, which might have an impact on your ability to offer / deliver the services in question to National Security Institute?

YESNO

If Yes, please provide details:

I hereby declare that the above is an accurate and complete Declaration of all Conflicts of Interest on the part of my (company/organization) in relation to this framework of which I am aware. I undertake to inform NSI of any changes to this declaration or of any other conflicts of interest which may arise during the lifetime of the framework.

I accept that NSI may take appropriate action in relation to conflicts of interest, and that my (company/organization) may be excluded for tendering for a specific contract where the effect of the conflict of interest has not been dealt with to the satisfaction of NSI.

This acknowledgment aims at supporting transparency, meeting the public interest, safeguarding NSI reputation, and protecting NSI employees and contractors from any differences that may arise.

Name (Block Capitals):

Signature: [signature sgnature-last* color:#000000 background:#ffffff]

Date:

Position:

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