Contract ID :

Contract Name :

Location of the Contract :

Name of Bidder :
Republic of the Philippines
DEPARTMENT OF PUBLIC WORKS AND HIGHWAYS
CORDILLERA ADMINISTRATIVE REGION
Engineer's Hill, Baguio City

Date:

I. ENVELOPE A
(1) Legal Documents

Valid PhilGEPS Registration Certificate (Platinum Membership) (all pages)

(2) Technical Documents

Statement of the Prospective Bidder's of all its ongoing government and private contracts, including
(1) contracts awarded but not yet started, if any, whether similar or not similar in nature and complexity to
the contract to be bid. (Use Form DPWH-INFR-05 - J )

Statement of the Bidder's Single Largest Completed Contract (SLCC) similar to the contract to be bid
(2)
(Use Form DPWH-INFR-05 - I )

Philippine Contractors Accreditation Board (PCAB) License and/or Special PCAB License in case of
(3)
Joint Venture

Original Bid Security. If in the form of Surety Bond, submit also a certification issued by the Insurance
(4)
Commission or Original Copy of Notarized Bid Securing Declaration ( Use Form DPWH-INFR- 12)

(5) Project Requirements which shall include the following:

(a) Organizational Chart for the Contract to be bid.

List of Contractor's Key Personnel (e.g. Project Manager, Project Engineers, Materials
(b) Engineers, and Foreman) to be assigned to the contract to be bid, with their complete
qualification and experience data (Use Form DPWH-INFR-14)

List of contractor'smajor equipment units, which are owned, leased, and/or under purchase
(c) agreements supported by proof of ownership or certification of availability of equipment from
the equipment lessor/vendor for the duration of the project (Use Form DPWH-INFR-15)

Omnibus sworn statement by the prospective bidder or its duly authorized representative in the form
(6)
prescribed by the GPPB as to the following (Use Form DPWH-INFR-16):

It is not “blacklisted” or barred from bidding by the Government of the Philippines or any of its
(6.1) agencies, offices, corporations, or LGUs, including foreign government/ foreign or
international financing institution whose blacklisting rules have been recognized by the GPPB.

Each of the documents submitted in satisfaction of the bidding requirements is an authentic

(6.2) copy of the original, complete, and all statements and information provided therein are true
and correct.
Contract ID :

Contract Name :

Location of the Contract :

Name of Bidder :

It is authorizing the Head of the Procuring Entity or his duly authorized representative(s) to
(6.3)
verify all the documents submitted.

The signatory is the duly authorized representative of the prospective bidder, and granted full
power and authority to do, execute and perform any and all acts necessary and/or to
(6.4) represent the prospective bidder in the bidding, with the duly notarized Secretary’s Certificate
attesting to such fact, if the prospective bidder is a corporation, or duly notarized Special
Power of Attorney in case of sole proprietorship, partnership or joint venture.

It complies with the disclosure provision under Section 47 of RA 9184 and its IRR in relation
(6.5)
to other provisions of R.A. 3019.

It complies with the responsibilities of a prospective or eligible bidder provided in the BDs,
(6.6)
including ITB 6.

The owner, officers, members, directors and controlling stockholders was not related to the
Head of the Procuring Entity, Members of the BAC, TWG, Secretariats, the Head of the
(6.7)
Project Management Office/Implementing Unit, and the Project Consultants by consanguinity
of affinity up to the third civil degree.

(6.8) It complies with existing labor laws and standards.

It did not give or pay, directly or indirectly, any commission, amount, fee, or any form of
(6.9) consideration, pecuniary or otherwise, to any person or official, personnel or representative of
the government in relation to any procurement project or activity.

Remarks ( ) PASSED ( ) FAILED

II ENVELOPE B

1 Bid Form, using Form DPWH-INFR-09. Bid Amount: _______________________

Contract Duration: ______ Calendar Days

Bid prices in the Bill of Quantities (BOQ) in the prescribed Forms (Use Forms DPWH-INFR-17 and
2 18). The bid prices may be in terms of (a) bid unit prices for different work items under the BOQ, or (b)
fixed total lump-sum price for the entire contract, based on the type and complexity of the project.

Detailed estimates, including a summary sheet indicating the unit prices of construction materials, labor
3
rates and equipment rentals used in coming up with the Bid.

4 Cash flow by quarter (Use Form DPWH-INFR-19).

Note : Any Missing document in the abovementioned checklist is a ground for outright rejection
of the bid

Remarks : ( ) PASSED ( ) FAILED