(A Government Of India Enterprise)

PO:VINDHYANAGAR,DISTT.SINGRAULI(MP)486885

INVITATION TO BID/NOTICE INVITING TENDER

DOMESTIC COMPETITIVE BIDDING

Ref. No. VSTPP/CONTRACTS/05 -2014 Dt. 27.06.2014

1.NTPC Limited–Vindhyachal Super Thermal Power Project, in Madhya Pradesh, invites e-tender bids / tenders / proposals from eligible bidders for the following packages:

2.Brief Description of NIT

 

 

 

 

 

 

Tender Fee

Bid document

BOD part (A),

 

Sl.

 

 

 

 

Est. Cost

(including VAT) /

Completion

NIT No.

Name of Work

 

(`. In lacs)

Earnest Money

issue period

part (B), &

No.

 

period

 

 

 

 

(from - to)

partC) **

 

 

 

 

 

 

(in `)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4515-138-

Biennial job

contract for

civil

 

 

10.07.2014

 

 

 

 

 

09.08.2014

 

 

 

maintenance

in township

area

 

2363/-

 

24(twenty

01

3434

198.61

(online)

28.08.2014

for the year 2014-16 (Part-B)

398000/-

four) months

 

(40023599)

of NTPC-Vindhyachal.

 

 

 

26.07.2014

 

 

 

 

 

 

 

 

 

(offline)*

 

 

IMPORTANT NOTES:

*Bid document issue time (offline) from 10.00 am to 4.00 pm (Excluding Sunday/Closed Holiday)

**Date of opening of part (c) shall be communicated only to the bidders, who are found qualified at a later date.

-

Type Of Bidding

Single stage two envelopes bidding.( price bid

 

 

shall be submitted online)

-Last date of submission of queries by bidders, if any : 16.08.2014

-

Submission of "NO DEVIATION CERTIFICATE"

 

 

: To be submitted by bidder invariably as per

 

 

 

 

 

 

 

format enclosed with tender documents.

 

 

 

 

 

 

 

(Annexure A-2 (INB)

Note: Bids are to be submitted super-scribing the tender reference. As detailed below

 

PART

Envelope

Mode

Superscription

Remarks

 

 

 

 

 

on envelop

 

 

 

 

 

A

Envelope

Offline

EMD +

 

It shall be submitted in separate envelope

 

 

 

A

 

Letter

of

in tender Box containing

 

 

 

 

undertaking+

1.

Requisite EMD in valid form

 

 

 

 

No-deviation

2.

LETTER OF UNDERTAKING (as per

 

 

 

 

Certificate*

 

 

ANNEXURE-C, PAGE-10) on the Non-

 

 

 

 

 

 

 

Judicial Stamp paper of Rs. 10/-

 

 

 

 

 

 

3.

Duly filled , signed and Stamped “ No

 

 

 

 

 

 

 

Deviation Statement”

 

B

Envelope B

Offline

Technical

 

It shall be submitted in separate envelope

 

 

 

 

 

Bid*

 

in tender Box containing

 

 

 

 

 

 

∑

Total credential to fulfill all the criteria

 

 

 

 

 

 

 

as mentioned in qualifying requirements

 

 

 

 

 

 

 

below

 

C

_______

Online

Price Bid

 

The price bid / rate part shall be submitted

 

 

 

 

 

 

 

online in SRM

* Name of Package and NIT No are also to be super scribed Followings may kindly be noted that:-

-Offers shall be submitted online only. No financial terms including discount/premium to be quoted off-line or in c-folder.

-No deviation ,whatsoever, is permitted by NTPC, as preparation of price bids, its opening and comparative evaluations are done online

(Page:2)

Hence, the quoted amounts as per the system shall only be considered for evaluation any documents/ conditions found offline shall be treated invalid and shall not be considered for evaluation

3.Bidder can view/download the complete set of Bid documents as per the following procedure:

Login

Type of Vendor

Required documents for viewing our tender documents

password

 

 

 

 

 

 

 

status

 

 

 

 

 

 

 

A

Vendors already having SRM Vendor

Refer Clause No. 4 below.

 

code and Password

 

 

 

 

 

 

B

Vendors already having SAP vendor

The agency has to furnish dully filled, signed and stamped

 

code but does not have SRM Login

Annexure-II (format attached).

 

ID and Password

It shall be submitted up to

26.07.2014

at 4:00 pm at the

 

 

address given below at Cl 10.

 

 

After obtaining SRM login ID and password , the agency shall

 

 

follow as per login password status “A” above. .

C

New Vendor neither having any

The agency has to furnish the followings duly filled, signed and

 

vendor code in SAP nor any SRM

stamped

 

 

 

 

 

 

Login ID and Password

a)

Duly filled Annexure-I (format attached)

 

 

b)

Partnership deed/affidavit for proprietorship/certificate of

 

 

 

incorporation.

 

 

c) PAN Card scanned/Photo Copy (self attested)

 

 

d)

Address proof with postal Pin code

 

 

e)

Copy of PF Documents

 

 

f)

Service Tax Registration

 

 

g)

EFT form duly filled in signed and certified by Bank as per

 

 

 

Annexure-V.

 

 

All these documents shall be submitted up to

26.07.2014

at

 

 

4:00 pm at the address given below at Cl 10.

 

 

After obtaining SRM login ID and password , the agency shall

 

 

follow as per login password status “A” above. .

 

 

 

 

 

Note: Digital certificate (Class-III category is required) is a must for vendors to participate in e-tender. For further details

please visit “Guidelines to Bidders” in SRM Login screen.

 

 

 

 

 

4.Mode of payment for purchase of tender documents:

a)On-line:

Bidders can view/download the tender documents after logging in our e-tender site:

i)By clicking on “e-tender” in home page of www.ntpctender.com

ii)In the Internet browserdirectly type the URL

https://etender.ntpclakshya.co.in/sap/bc/gui/sap/its/bbpstart

After logging to our e-tender site as mentioned above, the bidder shall pay the requisite tender fee through payment gateway by clicking “pay tender fee” as mentioned in the “Bidder’s Manual” and also in Guidelines to Bidders” which are available on the SRM Login screen.

In case of any difficulty, please contact help desk no. 0120-2952319

b)Off-line: Tender fee shall be made in form of Pay order / demand draft / Bankers cheque in favor of NTPC Limited, from any of the list of Nationalized or Scheduled Bank enclosed at ANNEX- III, payable at Vindhyanagr/

Singrauli/ Waidhan of MP, and the same should reach NTPC Vindhyachal in the communication address given at S.No.10. on or before offline last date as mentioned i.e upto 26.07.2014 at 4:00 pm along with the requisite

documents mentioned as per clause 3 “B” & “C” above. Whichever is applicable for the respective status of vendor. If the vendor at 3 “A” desirers for tender documents may also request offline for tender documents. .

c)Exemptions of cost of tender documents : Refer clause No. 05 (iii) (c)

Request for tender documents received after the offline last date as mentioned i.e upto 26.07.2014 at 4:00 shall not be entertained.

5.Bid Security (EMD): Bidder has to submit earnest money deposit (EMD) of requisite value in a separate envelope offline super scribing “EMD Envelope” containing (Requisite EMD in valid form ,”LETTER OF UNDERTAKING” and “ No Deviation Statement”) as detailed above , the same must reach to the office at the address mentioned below before the bid submission deadline as mentioned in the e-tender of our SRM system.

(Page:3)

i)“EMD Envelope” should contain the EMD of requisite value, strictly in valid form as mentioned below at Sl.No.

iii)a)/b) as per applicability or valid supporting document in support of seeking exemption of EMD as iii) c).

ii)If Bid security (EMD), in original, of any agency is not received in a sealed envelope, their bid shall not be opened. If the EMD amount submitted by any agency is less than the stipulated EMD amount their offer shall be rejected.

iii)EMD may be furnishedin any of the following forms.

a)For EMD amount of any value : Pay order / demand draft / Bankers cheque in favor of NTPC Limited, from any of the list of Nationalized or Scheduled Bank enclosed at ANNEX- III, payable at Vindhyanagr/ Singrauli/ Waidhan of MP,

b)Unconditional and irrevocable Bank Guarantee from a nationalized bank/ scheduled bank . the bid security shall remain valid for a period of 45 days beyond the bid original bid validity period (180 days) or beyond any extension in the period of bid security . The Bank Guarantee verification check list duly filled in as per format attached as has to be submitted in this regard. Bidder shall ensure that all the points of check list are replied in “Yes”.

c)Small Scale Industries registered with the National Small Scale Industries Corporation (NSIC) under single

point registration scheme and SSI units registered with MPSSIDC for the said item/ services shall be exempted from payment of Tender Fee and EMD. Exemptions of EMD and other benefits to MICRO AND

SMALL ENTERPRISES (MSEs) shall be governed as per enclosed ANNEX-IV.. Bidders seeking exemption should enclose a self certified legible copy of valid registration certificate giving details such as items/ services for which registered, validity, monetary limit etc. along with their request of Tender Document. If the validity of the certificate has expired or the stores items are not matching with the tendered items such requests run the risk of their request being passed over as disqualified for this concession/exemption. In case of any doubt on eligibility of such exemption/ concession bidder may get clarification from NTPC Official before submission of their bid.

d)The bid security of all the unsuccessful bidders will be returned as promptly as possible as per terms of bidding documents.

e)No interest shall be payable by NTPC on the Bid Security.

f)Any Bid not accompanied by a Bid Security (EMD) , Letter of undertaking and NO DEVIATION CERTIFICATE in a separate sealed envelope, may be rejected on-line by the owner as being non-responsive and the technical bid envelop shall be returned to the bidder without being opened.

6.No Deviation Certificate: Duly filled signed and stamped “NO DEVIATION STATEMENT” shall be submitted as stated in point f ) and also note PART-A of Sl No 2 above .

7.Clarification on Bidding documents: Bidder may seek clarification through e-mail or in hard copy (offline) upto the time specified as mentioned in the bidding document. The queries will be answered by NTPC and posted in the c-folder. The bidders can view all queries and all answers once they are posted in the c-folder.

8.Qualifying Requirements:

8.1The average annual turnover of the bidder during the preceding three financial years as on the date of bid opening should not be less than ` 99.31 lakh.

8.2The agency should have executed the work(s) of “Civil Maintenance/ Civil Construction” in any industry, during the last seven(07) years ending with bid opening date.

8.3The bidder should have executed the work(s) as mentioned at (8.2) above, directly under “PSU”/ “ Joint venture of PSU”/ “Govt. Department”/ “Quasi –Govt. Department”/ “Public limited company” , during last seven years ending with bid opening date , with following executed values (s) of contracts.

ÿSingle order of value not less than Rs. 79.44 lakhs

OR

ÿ Two orders each of value not less than Rs. 49.65 lakhs

ÿThree orders each of value not less than Rs. 39.72 lakhs

(Page:4)

Remarks:-

a)Executed means the value of work that has been progressively done till the specified date.

b)In case of job contract/maintenance contract with contract period of two years, the executed amount shall be evaluated for a continuous period of one year

9.General Conditions: (For submission of bid)

a)Sealed tenders signed in all pages should be submitted in two (02) parts, ( as per Sl No -2 Note-2 above)

1. Part (A) for NO DEVIATION CERTIFICATE, EMD and Letter of Undertaking,

2. Part (B) for Technical Bid containing total credential to fulfill all the criteria as mentioned in

qualifying requirements in the tender Box However the Price part must be quoted in SRM

b)The bids shall be received upto 10:30 Hrs. on date of Technical Bid Opening (PART-A and PART B in offline and PRICE IN SRM) , and PART A and PART B shall be opened at 11.00 Hrs. on the same date as stipulated above in the presence of bidder, who wish to be present.

c)In case, the date of Bid opening coincides with HOLIDAY, the shifted to next working day at the same time.

d)In the evaluation and comparison of bids, NTPC Limited reserves the right to allow purchase preference to Central Public Sector Enterprises (CPSEs) and Joint ventures with CPSEs as admissible under the existing policy of the Govt. of India.

e)All credentials pertaining to this NIT must be before the date of Bid Opening as mentioned in the NIT.

f)For any postal/communication delay, NTPC Limited will not be held responsible.

g)Details of the work to be executed and terms & conditions of the tender are stipulated in the tender documents.

h)Notwithstanding anything stated above, NTPC reserves the right to assess bidder’s capability & capacity to perform

the contract,should the circumstances warrant such assessment in overall interests of the Owner.

i)NTPC reserves the right to issue, reject any or all bids or cancel/withdraw the invitation for bids without assigning any reason whatsoever thereof and in such case no bidder/intending bidder shall have claim arising out of such action.

j)Tender document is not transferable.

k)Package Coordinators of NTPC Vindhyachal :

i.Sh Ramlal Paikara, DGM(C&M)

Mobile No.: 9425823427, email id: ramlalpaikra@ntpc.co.in

ii.Sh M.A. Siddiqui , Manager (CS)

Mobile No.: 9425178278, email id: masiddiqui01@ntpc.co.in

10.Address for Communication:

AGM(C&M)-I/c

NTPC Limited

VINDHYACHAL SUPER THERMAL POWER PROJECT

PO.VINDHYANAGAR, DIST. SINGRAULI(M.P) 486885.

Phone/fax : 07805-247921

ADDL. GENERAL MANAGER(C&M)-I/c

Annexure-I

REQUEST FOR LOGIN ID ON NTPC e-TENDER

If you are not a supplier/Contractor of NTPC, and interested in participating in e-tenders in NTPC, please fill the following.

Form-A:

For New Vender (Prospective)

Name

:

_________________________________________________________

Address

:

_________________________________________________________

 

 

_________________________________________________________

 

 

_________________________________________________________

State

:

________________________

City : _____________________

Country

:

________________________

Pin: _____________________

Telephone No.

:

________________________

Extn.: _____________________

Fax No.

:

______________________________

Email ID

:

_________________________________________________________

Your Company’s Bank Name

: __________________________________________________

Account No. :

___________________________________________

Branch

:

___________________________________________

Address

:

_____________________________________________________

 

 

_____________________________________________________

PAN Number

:

______________________________________________________

CST Number:

______________________________________________________

Excise Regn. Number: _____________________________________________________

SSI No.

:

_______________________________________________________

Contact Person’s Name:

_________________________________________________

Designation :

_______________________________________________________

Bid Invitation Number interested in:

___________________________________________

DD details as tender fee: Issuing Bank: _____________________________________

No. : ___________________________ Date of Issue: ________________________

Amount: ________________________ DD Valid till : ________________________

Note: Please download print and fill this form. Submit it to the Package Incharge/Contact Person as mentioned in the Bid invitation along with the DD of required amount.

DD should be in favor of “NTPC Limited” payable at the ordering location mentioned the Bid invitation.

Annexure-II

REQUEST FOR LOGIN ID ON NTPC e-TENDER

If you are already a supplier/Contractor of NTPC, and interested in participating in e-tenders in NTPC, please fill the following.

Form-B:

For Existing Venders

Existing Vender Code with NTPC : ______________________________ Pre ERP

 

 

 

 

Post ERP

Telephone No. :

________________________

Extn.: _____________________

Email ID

:

_________________________________________________________

Contact Person’s Name:

___________________________________________________

Designation

:

_________________________________________________________

Bid Invitation Number interested in: _____________________________________________

DD details as tender fee: Issuing Bank: _____________________________________

No. : ___________________________ Date of Issue: ________________________

Amount: ________________________ DD Valid till : ________________________

Address and other details (Only in case of change):

Name

:

_________________________________________________________

Address

:

_________________________________________________________

 

 

_________________________________________________________

 

 

_________________________________________________________

State

:

________________________

City : _____________________

Country

:

________________________

Pin: _____________________

Telephone No. :

________________________

Extn.: _____________________

Fax No.

:

______________________________

Email ID

:

_________________________________________________________

Your Company’s Bank Name

: __________________________________________________

Account No. :

_____________________________________________________

Branch

:

_____________________________________________________

Address

:

_____________________________________________________

 

 

_____________________________________________________

Note: Please tick the approximate box in front of vendor code to indicate whether the vendor code given is Pre-ERP or Post- ERP.Tender fee payment can be given through DD or Payment Gateway. In case the Option of DD is opted should be in favor of “NTPC Limited” payable at ordering location mentioned in the Bid invitation.

Request for login may be sent through E-mail or manually sent to Package in charge/control person as mention in the Bid Invitation.

Annexure – A2(INB)

NO DEVIATION CERTIFICATE

NAME OF PACKAGE& PROJECT:

BIENNIAL JOB CONTRACT FOR CIVIL MAINTENANCE IN TOWNSHIP AREA FOR THE YEAR 2014-16 (PART-B) OF NTPC VINDHYACHAL

BIDDING DOCUMENT NO : 40023599 (NIT NO 4515-138-3434 Dt 27.06.2014)

Bidders Name and Address

 

 

 

 

 

M/s

To, AGM (C&M)-I/c

 

 

 

 

NTPC Vindhyachal

 

 

Dear sir ,

 

 

 

 

 

With reference to our Bid proposal No .-**

-

 

 

Dt…

for “BIENNIAL

 

 

 

 

 

 

 

JOB CONTRACT FOR CIVIL MAINTENANCE IN TOWNSHIP AREA FOR THE YEAR 2014-16 (PART-B) OF NTPC VINDHYACHAL

1.0” bid document no : 40023599 (NIT NO 4515-138-3434 Dt 27.06.2014) We here by confirm that we comply with all terms . conditions and specification of the bidding Documents read in conjunction with Amendment (s) /Clarifications(s)/Addenda/ Errata (if any) issued by the Employer prior to opening of Techno – Commercial Bids and the same has been taken into consideration while making our Techno- Commercial Bids & Price Bid and we declare that we have not taken any deviation in this regard.

2.0We further confirm that any deviation, variation or additional condition etc, or any mention contrary to Bidding Documents and its Amendment (s)/ clarification(s)/ Addenda/ Errata (if any) as mentioned at 1.0 above found anywhere in our Techno- commercial Bid and/ or Price Bid, implicit or explicit, shall stand unconditionally with drawn, without any cost implication whatsoever to Employer failing with the bid security shall be forfeited.

Date-

(Signature)____________________

Place : vindhyanagar

(Name

)____________________

 

(Designation

)____________________

 

(Common Seal )____________________

** Agency’s forwarding letter ref No and date , if any, may be entered

Note :. This NO DEVIATION FORMAT must be submitted duly Filled, Signed and Stamped along with BID

Annexure – III

LIST OF BANKS

(FOR DEMAND DRAFT / BANKERS CHEQUE / PAY ORDER )

It shall be Payable at Vindhyanagar / Singrauli / Waidhan (M. P.) only

1- UNION BANK OF INDIA

2- STATE BANK OF INDIA

3- AXIS BANK LTD

4- ALLAHABAD BANK

5- BANK OF BARODA

6- CENTRAL BANK OF INDIA

7- DENA BANK

8- ORIENTAL BANK OF COMMERCE

9- PUNJAB NATIONAL BANK

10- ICICI BANK

11- HDFC BANK LTD.

12- IDBI BANK LTD

Annexure – IV

BENEFITS TO MICRO AND SMALL ENTERPRISES (MSEs)

1- EXEMPTION FROM PAYING TENDER FEES & EARNEST MONEY DEPOSIT:

MICRO AND SMALL E NTERPRISES (MSEs) registered with District Industries centres or Khadi and village industries commission or khadi and village industries Board or Coir Board or National small Industries Corporation or Directorate of handicraft and handloom or any other body specified by ministry of micro, small and medium enterprises as MSMED Act2006 ,for goods produced and services rendered, shall be issued the bidding document free of cost and shall be exempted from paying earnest money Deposit.

2- PRICE PREFERENCE:

Further, in tender, participating MSEs quoting price within price band of L1 +15 percent shall also be allowed to supply a portion of requirement by bringing down their prices to L1 price in a situation where L1 price is from someone other than a Micro and small enterprises and such Micro and small enterprises shall be allowed to supply upto 20 percent of total tendered value. In case of more than ONE such MSES, the supply will be shared proportionately (to tendered quantity).However, for procurement of services or supplies where splitting of quantity is not possible, the award shall be given to L1 bidder only.

NOTE:

The benefit as above to MSEs shall be available only for goods/services produced and provided by MSEs for which they are registered.

MSEs seeking exemption and benefits should enclose a attested /self certified copy of valid registration certificate, giving details such as validity, stores/services etc. failing which they run the risk of their bid being passed over as ineligible for the benefits applicable to MSEs.

Annexure – V

BANK CODE

IFSC CODE

VENDOR CODE

E.F.T. Form

(TO BE RETURNED TO THE COMPANY)

To

Vindhyachal Super Thermal Power Project

NTPC Limited , P.O. Vindhyanagar

Dist. Singrauli (MP) – 486885

Dear Sir,

REF: AUTHORISATION OF ALL OUR PAYMENTS THROUGH

ELECTRONIC FUND TRANSFER SYSTEM

We hereby authorize Vindhyachal Super Thermal Power Project, P.O. Vindhyanagar, Dist. Singrauli (MP)- 486885 to make all our payments through Electronic Fund Transfer System. The details for facilitating the payments are given below:

(TO BE FILLED IN CAPITAL LETTERS)

1.NAME OF THEBENEFICIARY

2.ADDRESS

PIN CODE

3.TELEPHONE NO. WITH STD. CODE

4.BANK PARTICULARS

A)BANK NAME

B)BANK TELEPHONE NO.

C)BRANCH ADDRESS

PIN

CODE

D) BANK FAXNO. (WITH STD CODE)

E)9 DIGIT MICR CODE OF THE BANK BRANCH (ENCLOSE COPY OF A CANCELLED CHEQUE)

F)BANK ACCOUNT NUMBER

G)BANK ACCOUNT TYPE ( TICK ONE)

SAVING

 

CURRENT

LOAN

CASH CREDIT

OTHERS

 

H) IF OTHERS, SPECIFY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5.

PERMANENT ACCOUNT NUMBER (PAN)

 

 

 

 

 

 

 

 

 

 

 

6.

E-MAIL Address for Intimation regarding release of payments

7a) IFSC CODE

b)BRANCH CODE

c)BANK CODE

I/We hereby declare that the particulars given above are correct and complete. If the transaction is delayed or credit is not effected at all for reasons of incomplete or incorrect information, I/We would not hold the Company responsible.

SIGNATURE

DATE

(AUTHORISED SIGNATORY)

Name :

OFFICIAL STAMP

---------------------------------------------------------------------------------------------------------------------

BANK CERTIFICATION

It is certified that above mentioned beneficiary holds a bank account No……………….. with our branch and the Bank particulars mentioned above are correct.

SIGNATURE

DATE

(AUTHORISED SIGNATORY)

Name:

OFFICE STAMP

Note: 1) CANCELLED MICR CHEQUE MUST BE ENCLOSED.

2)XEROX COPY OF PANCARD

3)PLEASE MENTION SAP VENDOR CODES APPLICABLE

Annexure=VI

CHECK LIST FOR QRs

NIT Qualifying Requirements

 

Details of copy of documents duly

Please mention

 

signed & stamped to be submitted

 

pages

 

 

 

 

 

 

 

 

 

 

 

8.4 The average annual turnover of the bidder

FY – 2011-12

 

 

during the preceding three financial years as

 

From : …………..

FY – 2012-13

on the date of bid opening should not be less

 

To

: …………..

FY – 2013-14

 

 

 

 

 

 

than ` 99.31 lakh.

 

 

 

 

 

 

 

 

 

8.5 The agency should have executed the

PO Details with BOQ

From : …………..

work(s) of “Civil Maintenance/ Civil

To

: …………..

Construction” in

any

industry,

during

the

 

 

 

 

From : …………..

last

seven(07)

years

ending

with

bid

Executed amount details

To

: …………..

opening date.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8.6 The

bidder should have executed the

 

 

 

work(s) as mentioned at (8.2) above,

 

 

 

directly under “PSU”/ “ Joint venture of

PO Details with BOQ

From : …………..

PSU”/ “Govt. Department”/ “Quasi –Govt.

To

: …………..

Department”/ “Public limited company” ,

 

 

 

 

during last seven years ending with bid

 

 

 

opening date , with following executed

 

 

 

values (s) of contracts.

 

 

 

 

 

 

∑

Single order of value not less than Rs.

 

 

 

 

79.44 lakhs

 

 

 

 

 

From : …………..

∑

OR

 

 

 

Executed amount details

Two orders each of value not less than

To

: …………..

 

Rs. 49.65 lakhs

 

 

 

 

 

OR

 

 

 

 

 

 

∑ Three orders

each

of value

not less

 

 

 

 

than Rs. 39.72 lakhs

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CONTRACTOR’S SIGNATURE