WESTERN ZONAL OFFICE ENGINEERING DEPTT. WEST WING, FIRST FLOOR, "YOGEKSHEMA, NARIMAN POINT MUMBAI

ENROLMENT FORM FOR DATA CABLING / AUTOMATIC FIRE ALARM AND DETECTION SYSTEM WESTERN ZONAL OFFICE ENGINEERING DEPTT. WEST WING, FIRST FLOOR, "YOGEKSHEMA, NARIMAN POINT MUMBAI - 400021 FORM FOR ENROLMENT OF CONTRACTORS FOR DATA CABLING / Automatic Fire Alarm and Detection System

ENROLMENT FORM FOR DATA CABLING / AUTOMATIC FIRE ALARM AND DETECTION SYSTEM ENGINEERING DEPTT, FIRST FLOOR, WEST WING YOGEKSHEMA, NARIMAN POINT, MUMBAI-400021E-mail wz_engg@licindia.com INSTRUCTIONS FOR FILLING AND SUBMISSION OF ENROLMENT FORM The Enrolment Form along with the Annexure A1,A2 and B to I shall be completely filled in all respects along with processing fees Rs 1000/- ( for each work) non refundable by way of DD/ pay order in favour of LIC of India payable at Mumbai address to the CHIEF ENGINEER, Life Insurance corporation of India, Western Zonal Office, First Floor, West wing, Yogekshema, Nariman point Mumbai -400021 along with these instructions for filling and submission of enrolment form on or before 12.10.2015.Please not that no consideration will be given for postal delay 1. Contractors to note that all particulars required as per the form and Annexure shall be filled in completely in relevant blanks strictly as per the format. Simply enclosing copies of partnership deeds, Printed Brochures printed list of work or certificates from authorities & stating refer to such and such enclosure without filling the entries in the forms /Annexure does not meet the requirement. It is also essential to furnish full details of name of work, Location, full postal address with fax and telephone No etc of the employers and authorities under whom the work is carried out in the enrolment form and annexure. 2. The forms not submitted strictly as per the above instructions within stipulated period are liable to be rejected. 3. The eligible contractors who will be selected for issue of tenders (after scrutiny of enrolment forms) shall be informed by a letter as and when the tenders are ready for issue. Please note that no enquiries or correspondence regarding the selection for issue of tenders shall be entertained. 4. Latest Solvency Certificate from any Nationalized/Scheduled Bank (Not more than 3 Months old) should be submitted along with Enrolment Form. Notarized Xerox copy of the solvency certificate will be entertained. 5. The contractors are advised to follow the instructions given below- (a) Enrolment Form shall be filled-up in clean handwriting in capital letters or typed. (b) Full address of the site of work, owner or authority under whom the works have been carried out should be given (Please refer Annexure D & E ) (c) The Agencies should ensure to submit the satisfactory Completion Certificate giving the value of work, (d) year of completion and it should also tally with the value of final bill in Annexure D. The annual turnover should be based on latest Income-tax Returns, duly audited by CA or as per Audited balance sheet copy should be submitted. 6. Separate application must be submitted for different items of works along with non refundable amount of Rs 1000/- each towards processing fees in the form of DD/ pay order drawn in favour of Life Insurance Corporation of India payable at Mumbai 7. Please note that the submission of this enrolment form does not confer any right on you to claim issue of tenders and The Chief Engineer, LIC WZO Mumbai-21, reserve the right not to issue tender to any/all applicants without assigning any reason whatsoever. 8. LIC Working contractors also need to apply with full details however LIC working contractors shall be given relaxation up to 15% in prequalification criteria. 9. The contractors should ready to execute the work at all locations for all under jurisdictions of WZO Mumbai. If there is any reservation please mention the same in your enrolment form. Agreed and confirmed Signature of Contractor yours faithfully Chief Engineer

ENROLMENT FORM FOR DATA CABLING / AUTOMATIC FIRE ALARM AND DETECTION SYSTEM Encl Enrolment Form with Annexure A1,A2 B to I The separate application for following works is to be submitted 1. Data cabling etc. up to Rs 5.00 Lac 2. Automatic Fire alarm/ detection system financial limit up to Rs 5.00 Lac. Signature of the contractor PRIMARY REQUIRMENTS The primary technical and financial requirements of the applicants are as follows TECHNICAL REQUIRMENT Data cabling Adequate experience in the field of Data centers and office premises. Automatic Fire alarm/ detection The agencies should have adequate experience in this field. System Agreed and confirmed Signature of Contractor Chief Engineer FINANCIAL REQUIRMENT Financial limit for the selection of contractor for the limit up to Rs 5 lac 1) Average annual turn over for Last 4 years Rs 2.00 Lacs 2) Minimum solvency Rs 1.00 Lac 3) Minimum value of similar nature Building (residential& non residential) completed in last 7 years Total value of maintenance work done in a year Rs 2 Lac. Note A)The contractors already enrolled with LIC of India /LIC s working contractors also have to apply against this notice with full details B)For working contractors of LIC of India the above criteria may be relaxed by 15% provided they have executed similar nature of works else where also. C) Working Contractor of LIC of India means the contractors who have executed similar nature of Jobs in LIC during last four year prior to date of Publication of this advertisement and fulfilling all the eligibility criteria. Agreed and confirmed Signature of Contractor Chief Engineer Blank Enrolment form is to be downloaded from our website www.licindia.in or can be collected from the office of Executive Engineer on any working day in working hours till 12.10.2015.The enrolment form is to be submitted along with the processing fees of Rs 1000/- for each trade. The filled in enrolment form should be submitted latest by 12.10.2015 along with application processing fee of Rs 1000/- (for each job mentioned at SR No 1 to 2 shall be SUBMITTED separately.) in the form of DD in favour of LIC of India Payable at Mumbai on any nationalized bank to The Chief Engineer Life Insurance corporation of India, Western Zonal Office, First Floor, West wing, Yogekshema, Nariman point Mumbai -400021, The minimum documents to be attached with the enrolment form shall be as follows

ENROLMENT FORM FOR DATA CABLING / AUTOMATIC FIRE ALARM AND DETECTION SYSTEM 1) Bankers Solvency Certificate Not be more than three months old as on the date of submission of enrolment form ( Original or duly Notarized colour photocopy ). 2) Work completion certificates of qualifying works executed during last seven years ( Notarized colour photocopy) 3) Works in hand- Notarized copies of work orders 4) Annual turn over figures of last four years notarized copy of Income tax return ( saral form ) /copy of profit and loss balance sheet Duly certified by Chartered Accountant / Chartered Accountant. 5) In case of specialized agencies /contractors / authorized dealers Noterised authorisaton / certificate of dealership / certification as approved applicator / installer 6) Pan NO, Service Tax No, Vat No, MST No, along with supporting documents. Please note that the enrollment form received without enrolment fee and above mentioned supporting documents shall be summarily rejected. The Chief Engineer reserves the right to reject / issue tender to any/all applicants at his sole discretion without assigning any reason whatsoever. Note Any Agencies applied and fulfilling the above criteria may not be considered for enlistment if unsatisfactory performance reports are received for the completed projects/works from their previous employers. Chief Engineer

ENROLMENT FORM FOR DATA CABLING / AUTOMATIC FIRE ALARM AND DETECTION SYSTEM Enrolment Form No. (To be filled by office) LIFE INSURANCE CORPORATION OF INDIA Engg. Deptt., Western Zonal Office, First Floor, West Wing, yogekshema Nariman Point, Mumbai-400021 FORM FOR ENROLMENT OF CONTRACTORS NAME OF WORK Enrolment as tenderer for SITC & CAMC of UPS & Batteries for all residential and non residential properties situated in the states of Maharastra, Gujrat & Goa Under Juridication of LIC s Zonal office Mumbai-400021. I/We am/are desirous of being enrolled on the list of contractors for the following work and hereby apply for the same. The separate application for following works is to be submitted 1. Data cabling / ETC up to Rs 5.00 Lac 2. Automatic Fire alarm/ detection works up to Rs 5 Lac I/We give the following details for your consideration Sl. No. Query Answer 1. Name of the firm 2. Address Please mention the works for which applied 3 Pan No Tin No Vat Registration No Service Tax Registration No Sl. No. Query Answer 4 Contact Details TelephoneNumber Office

ENROLMENT FORM FOR DATA CABLING / AUTOMATIC FIRE ALARM AND DETECTION SYSTEM Residence Mobile Fax No., if any E-Mail, if any 5 Telegraphic Address If any 6. Month and year in which the firm was established in present name 7. Particulars of old firm(if present firm is new), if main partners of the present firm were working as construction contractors, in some other name in the past (The partnership deed of old firm be enclosed) 8. Particulars of sister construction firms if any 9. i) What is the constitution of firm viz. Sole Proprietor, Partnership, Pvt. Ltd., Public Ltd., etc. ii) Enclose copy of partnership deed, Articles of Association or Affidavit in case of sole proprietorship as per Annexure A-1 iii) Fill-in enclosed Annexure A-2 10. Fill and enclose Annexure-B giving details of enrolment with LIC of India in the past and with other Organisation 11. Has the applicant or his partners or Directors been black listed in the past by any Central or State Government Deptt./ Organisation Sl. No. Query Answer 12. i) Annual Turn Over for last Four Year Rs. in Lacs

ENROLMENT FORM FOR DATA CABLING / AUTOMATIC FIRE ALARM AND DETECTION SYSTEM years (enclose documentary evidence or proof to support figures) i)2011-12 ii)2012-13 iii) 2013-14 iv) 2014-15 ii) iii) What evidence of proof is enclosed to support the amounts of yearly turnover Enclose for the latest income tax clearance certificate Certificate enclosed for Assessment years.. 13. i) Name and complete postal address of bankers ii) Enclose solvency certificate indicating amount ( Certificate should not be more than three Months Old) iii) Bank Guarantee limit with various banks i) Rs lacs with. ii) with. Rs lacs iii) Rs lacs with. Total Rs. 14. i) Enclose list of immovable properties with complete postal addresses, full description & reasonable market value of property duly supported by certificate of DM/Collector/First Class Magistrate/Approved valuer ii) Whose supporting certificate is enclosed Rs of Date

ENROLMENT FORM FOR DATA CABLING / AUTOMATIC FIRE ALARM AND DETECTION SYSTEM Sl. No. Query Answer 15. i) Particulars of movable properties along with Banker's reference Value of tools & plants Rs. Other Assets Rs. Total Rs. ii) Whose reference is enclosed 16. Fill in and enclose list of tools & plants as per Annexure-C enclosed 17. Fill in enclosed Annexure D giving full particulars about major works completed during the past Four years Note List of only those works which are carried out by the firm requesting for enrolment is to be given. Work completion certificate for qualified works must be notarized with the address and contract no of issuing authority) 18. Work in progress i) Whether full details of major work on hand given in Annexure-E. the details must be noterised ii) Are copies of work orders for such large works enclosed 19. Whether full information regarding permanent technical staff employed given in Annexure-F 20 i) How do you normally carry out works of water supply, sanitary and plumbing installations ii) Who is the licence holder and what his experience of this work is

ENROLMENT FORM FOR DATA CABLING / AUTOMATIC FIRE ALARM AND DETECTION SYSTEM Sl.No. Query Answer 21 i) How do you normally get work of electrical installation carried out ii) Who is the licence holder and what his experience of this work is 22. Whether check list submitted as per Annexure-I 23. Any other information the applicant might like to give DECLARATION I/We agree to notify the officer accepting this application and registering my/our names on list of contractors of Life Insurance Corporation of India, of any changes in the foregoing particulars as and when they occur and to verify and confirm these annually on 1 st January. I/We, understand and agree that the appropriate Life Insurance Corporation of India Authority has the right as he may decide, not to issue tender form in any particular case and also to suspend, remove or blacklist my/our name from Life Insurance Corporation of India list of contractors in the event of my/our furnishing false particulars in the enrolment forms or submitting non-bonafide tenders or for technical or other delinquency in regard to which the decision of appropriate Life Insurance Corporation of India Authority shall be final and conclusive. I/We, certify that the particulars furnished in the enrolment forms are correct and that should it be found that,i/we have given a false certificate or that if I/We fail to notify the fact of my/our subsequent amalgamation with another contractor or firm, the Life Insurance Corporation of India may remove my/our name from the list of contractors and any contract that I/We may be holding at the time may be rescinded. PLACE DATE SIGNATURE OF CONTRACTOR ---------------------------------------------------------------------------------------------------------------------- FOR OFFICE USE ONLY ENROLMENTFORM NO SUBMITTED BY.. FOR JOB NO--------------------------------------------------------------------------------------- NAME OF WORK ------------------------------------------------------------------------ ---------------------------------------------------------------------------------------------------- NOTE THE FILLED IN ENROLMENT FORM SHOULD REACH IN THE OFFICE ON OR BEFORE 12/09/2015. SIGNATURE OF RECEIVING OFFICER

ENROLMENT FORM FOR DATA CABLING / AUTOMATIC FIRE ALARM AND DETECTION SYSTEM ANNEXURE-A1 LIFE INSURANCE CORPORATION OF INDIA A F F I D A V I T (On Non Judicial Stamp Paper of appropriate value in case the individual who is the sole proprietor of the firm) I,. S/o.. Age years, occupation business R/o..... do hereby state on oath as under That I am residing in... locality of District since last..years. That I am the sole proprietor of a proprietary concern name and style as ". " having it's office at.... District. dealing in business of Government, civil contracts and ancillary works attached therefore. Hence this affidavit. Note This Affidavit should be notarized. Deponent.

ENROLMENT FORM FOR DATA CABLING / AUTOMATIC FIRE ALARM AND DETECTION SYSTEM LIFE INSURANCE CORPORATION OF INDIA ANNEXURE-A2 CONSTITUTION OF FIRM - SOLE PROPRIETORSHIP/PARTNERSHIP/LTD.CO./OTHER DETAILS OF CONSTITUENTS Sl.No. Name of sole partner or Director/ other High Officials Age Share Technical Experience Year to year As Employee As Contractor (1) (2) (3) (4) (5) (6) (7) (8) Whether power of attorney Holder

ENROLMENT FORM FOR DATA CABLING / AUTOMATIC FIRE ALARM AND DETECTION SYSTEM SIGNATURE OF CONTRACTOR ANNEXURE-B I. ENROLMENT WITH LIC LIFE INSURANCE CORPORATION OF INDIA PARTICULARS OF ENROLMENT WITH LIC AND OTHER ORGANSIATION Name of works for 1) 3) Which enroled by 2) 4) LIC in the past Sr. Nos. for which tenders were submitted Sr. Nos. for which work order was received II. ENROLMENT WITH OTHER ORGANISATIONS Sl. No. Name and address of Authority with whom you are enrolled FIRST TIME ENROLMENT Year to year Is copy of letter enclosed Year to year LAST RENEWAL OR ENROLMENT Class or Category Limit (Rs. in lacs) Is copy of letter enclosed (1) (2) (3) (4) (5) (6) (7) (8)

ENROLMENT FORM FOR DATA CABLING / AUTOMATIC FIRE ALARM AND DETECTION SYSTEM SIGNATURE OF CONTRACTOR

ANNEXURE- C LIFE INSURANCE CORPORATION OF INDIA PARTICULARS OF TOOLS AND PLANT Sl.No. Item Specification Quantity Estimated Value Remarks (1) (2) (3) (4) (5) (6) SIGNATURE OF CONTRACTOR

ENROLMENT FORM FOR DATA CABLING / AUTOMATIC FIRE ALARM AND DETECTION SYSTEM LIFE INSURANCE CORPORATION OF INDIA ANNEXURE-D LIST OF MAJOR SIMILAR NATURE WORKS COMPLETED DURING LAST SEVEN YEARS Sl. No. Name and Complete Postal Address of Place of work & Nature of work Owner Authority under whom work was carried out Ref. No. & Date Order Contract Amount (Rs. in Lacs) Is copy enclosed? Value of work as per final bill Rs. in Lacs Commencement of work month & year Completion of work month & year Penalty levied for delay of completion, if any (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) NOTE To enable us to process your application quickly, please ensure that complete Postal Address including Pin Code and Telephone Numbers / Fax Numbers / E-mail Address etc. are furnished under Column No.s.2, 3 & 4 above

ENROLMENT FORM FOR DATA CABLING / AUTOMATIC FIRE ALARM AND DETECTION SYSTEM SIGNATURE OF CONTRACTOR

ENROLMENT FORM FOR DATA CABLING / AUTOMATIC FIRE ALARM AND DETECTION SYSTEM ANNEXURE-E Sl. No. LIFE INSURANCE CORPORATION OF INDIA LIST OF WORKS IN HAND Name and Complete Postal Address of Order Date of Place of work & Nature of work Owner Authority under whom work was carried out Ref. No. & Date Amount (Rs. in Lacs) Is copy enclosed? commencement of work Scheduled date of completion of work Progress and expected date of completion and reasons for delay, if any (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) NOTE To enable us to process your application quickly, please ensure that complete Postal Address including Pin Code and Telephone Numbers / Fax Numbers / E-mail Address etc. are furnished under Column No.s.2, 3 & 4 above

ENROLMENT FORM FOR DATA CABLING / AUTOMATIC FIRE ALARM AND DETECTION SYSTEM SIGNATURE OF CONTRACTOR ANNEXURE-F Sl. No. LIFE INSURANCE CORPORATION OF INDIA PARTICULARS OF PERMANENT TECHNICAL STAFF Name Designation Age Academic Qualification Service with the firm Details of Experience year to year (1) (2) (3) (4) (5) (6) (7)

ENROLMENT FORM FOR DATA CABLING / AUTOMATIC FIRE ALARM AND DETECTION SYSTEM SIGNATURE OF CONTRACTOR ANNEXURE-G Sl. No. Financial Year Total contract amount received LIFE INSURANCE CORPORATION OF INDIA ANNUAL TURNOVER FOR THE LAST FIVE YEARS IT Certificate enclosed Yes/No Audited Balance sheet copy enclosed Yes/No Remarks (1) (2) (3) (4) (5) (6) 1. 2011-2012 2. 2012-2013 3. 2013-2014 4 2014-2015

ENROLMENT FORM FOR DATA CABLING / AUTOMATIC FIRE ALARM AND DETECTION SYSTEM SIGNATURE OF CONTRACTOR

ENROLMENT FORM FOR DATA CABLING / AUTOMATIC FIRE ALARM AND DETECTION SYSTEM ANNEXURE-H AFFIDAVIT (On Non Judicial Stamp Paper of appropriate value for the contractors applying for Builders work) I/We, agree to notify the officer accepting this application and registering my/our names on list of contractors for Works as mentioned in the PQN for which I applied for Life Insurance Corporation of India, I/We agree to execute the all type of jobs required for the respective trade for which I/We applied for the as per list of works mentioned in PQN at a time as per instructions received from time to time. If, I/We fail to Execute any jobs as mentioned above, the Life Insurance Corporation of India may remove my/our name from the list of contractors and any contract that I/We may be holding at the time may be rescinded and in addition to this forfeiture of deposit amount, no payment for incomplete work etc. PLACE DATE SIGNATURE OF CONTRACTOR

ENROLMENT FORM FOR DATA CABLING / AUTOMATIC FIRE ALARM AND DETECTION SYSTEM LIFE INSURANCE CORPORATION OF INDIA ENROLMENT CHECKLIST CHECKLIST FOR ENROLMENT ANNEXURE - I Sl.No. Description of Enclosure Refer item of form Enclosed/Not Enclosed 1. Partnership deed / Articles of Association / Affidavit(Annexure A-1) 9 (ii) 2. Annexure(A-2) as enclosed 9(iii) (particulars of partners) 3. Annexure B (as enclosed) 10 (particulars of enrolment in LIC and other Organisation) 4. Proof of turnover 12(ii) 5. Latest I.T.C.C. 12(iii) 6. Solvency Certificate 13(ii) 7. Certificate of Bank Guarantee 13(iii) 8. Immovable properties certificate 14(ii) 9. Movable properties reference 15(ii) 10. Annexure C (as enclosed) 16 (particulars of tools and plant) 11. Annexure D (as enclosed) 17 (List of major works completed during last 3 years) 12. Annexure E (as enclosed) 18 i(list of work in hand) 13. Copies of work order 18(ii) 14. Annexure F (as enclosed) 19 (particulars of permanent technical staff) 15 Annexure H ( as enclosed on Rs 100 Bond)

ENROLMENT FORM FOR DATA CABLING / AUTOMATIC FIRE ALARM AND DETECTION SYSTEM