REGISTRATION OF SUPPLIES FOR GOODS, WORKS AND SERVICES FOR 2019/2020 & 2020/2021
Please indicate the item applied for as follows:
NAME OF THE SUPPLIER:………………………………………………………
ITEM REF. No………………………………..
ITEM DESCRIPTION………………………………….…………………………………
GROUP (OPEN / YWPD) …………………………………………………
TABLE OF CONTENTS
PAGE NUMBER
TENDER NOTICE ……………………………………………………………………………….. 5
1. REGISTRATION INSTRUCTIONS …………………………………………………….. 7
2. BRIEF CONTRACT REGULATIONS/GUIDELINES …………………………….. 8
3. REGISTRATION DATA INSTRUCTIONS …………………………………………… 9
4. REGISTRATION EVALUATION CRITERIA ……………………………………….. 12
PART I: REGISTRATION REGISTRATION DOCUMENTATION …………………. 14
PART ll: SUPPLIER DETAILS ……………………………………………………………. 15
PART III : COMPANY DETAILS …………………………………………………………. 15
PART VII: PERFORMANCE STANDARDS & FACILITIES ………………………… 19
PART VIII: MANPOWER …………………………………………………………………… 20
PART IX: GENERAL INFORMATION …………………………………………………… 21
PART X: BUSINESS PROBITY AND LITIGATION HISTORY …………………….. 23
PART XI: SWORN STATEMENT ………………………………………………………… 24
REGISTRATION OF SUPPLIERS
The Insurance Regulatory Authority (IRA) is a government agency established under the Insurance (Amendment) Act, 2006, Cap 487 of the Laws of Kenya to regulate, supervise and promote the development of the Insurance Industry in Kenya.
The Authority wishes to invite all eligible, competent and qualified firms to submit applications for purposes of registration for supply of goods, works and Services for the period 2019/2020 and 2020/2021 financial year. Suppliers that are currently registered by IRA are required to register a fresh if they wish to participate. The categories for consideration are listed below: –
CATEGORY A – SUPPLY OF GOODS TARGET GROUP
NO. ITEM DESCIPTION
IRA/A/1 Supply of General Office Supplies YWPD
IRA/A/2 Supply of Office Equipment Open
IRA/A/3 Supply Office Furniture, Furnishings and Fittings Open
IRA/A/4 Supply, Printing and Embroidery of Promotional Materials and Services YWPD
IRA/A/5 Design, Printing and Supply of Printed Paper Materials E.g. Calendars, Diaries, Annual Reports and other Printed Stationery/Materials. YWPD
IRA/A/6 Supply and Maintenance of Fresh Office Flowers and Indoor Potted Plants YWPD
IRA/A/7 Supply of Printer Toners and Computer Accessories YWPD
IRA/A/8 Supply of Library Books Open
IRA/A/9 Supply of Newspapers, Magazines and Periodicals YWPD
IRA/A/10 Supply of Corporate Uniform and Protective
Clothing/Gear YWPD
IRA/A/11 Supply of Softwares and Associated licenses (Windows,
Microsoft Office, SPSS, Antivirus, DMS, Adobe, Pastel, Memory Soft, etc.) YWPD
IRA/A/12 Supply of Motor Vehicle Tyres, Batteries and Accessories Open
CATEGORY B- PROVISION OF SERVICES
IRA/B/1 Provision of Courier Services YWPD
IRA/B/2 Provision of Maintenance of Office Equipment YWPD
IRA/B/3 Provision of Maintenance of Office Furniture, Furnishings and Fittings YWPD
IRA/B/4 Provision of Repair and Maintenance of CCTV & TV
Installation and Accessories YWPD
IRA/B/5 Provision of Photography and Video Coverage Services YWPD
IRA/B/6 Provision of Air Ticketing Services/Air Travel Agency (IATA registered only) YWPD
IRA/B/7 Provision of Event Management Services (DJ, Bands, Comedy, Dancers, Musicians, Models and MC’s etc.) YWPD
IRA/B/8 Provision of Media Monitoring, Analysis and Reporting Services Open
IRA/B/9 Translation and Editorial Services (English to Kiswahili and vernacular languages) Open
IRA/B/10 Provision of Auctioneering Services Open
IRA/B/11 Provision of Legal Services Open
IRA/B/12 Provision of Legal Audit Services Open
IRA/B/13 Provision of Governance Audit Services Open
IRA/B/14 Provision of Asset Tagging, Verification and Reconciliation Services YWPD
IRA/B/15 Provision of Public Relations Agency/External Communication Services YWPD
IRA/B/16 Production of Radio and Television
Infomercials/Documentaries YWPD
IRA/B/17 Provision of Management Consultancy Services (HR, Recruitment, Selection and Training) YWPD
IRA/B/18 Provision of Hotel Accommodation and Conference
Facilities YWPD
IRA/B/19 Provision of Repair and Maintenance of Electrical Accessories YWPD
IRA/B/20 Provision of Repair and Maintenance of Plumping Systems YWPD
IRA/B/21 Provision of Repair and Maintenance of Air Conditioning Units Open
IRA/B/22 Provision of Occupational Health and Safety Services Open
IRA/B/23 Provision of Consultancy Services for Performance Contract Related Surveys Open
IRA/B/24 Provision of Design, Mounting of Trade Fairs (shows), Exhibitions YWPD
IRA/B/25 Provision of Risk Management, Internal Audit, ICT Audit and penetration testing Services Open
IRA/B/26 Provision of Asset Valuation Services Open
IRA/B/27 Provision of Graphic Design / Creative Services YWPD
CATEGORY C- SMALL WORKS CONTRACTS
IRA/C/1 Office Partitioning, Repair and Maintenance of Building Works, Interior Design and related services. Open
Interested bidders may view and download the above registration documents from Public Procurement Information Portal website and IRA website (www.ira.go.ke) or at IRA Procurement Office on 10th Floor, Zep-Re Place, Longonot Road, Upperhill, Nairobi. Interested and eligible applicants are required to download the registration documents from the website free of charge.
Completed Registration documents MUST be submitted in plain sealed envelopes clearly marked: –
“IRA/236/2018-2019 FOR REGISTRATION OF SUPPLIERS FOR GOODS, WORKS AND SERVICES FOR THE PERIOD 2019/2020 & 2020/2021’’.
CATEGORY ………………………………… ITEM NO………………………………..
ITEM DESCRIPTION………………………………….…………………………………
GROUP (OPEN/ YWPD) ………………………………………………………………..
and addressed to:
Chief Executive Officer Insurance Regulatory Authority
10th Floor Zep-Re Place, Longonot Road, Upperhill P.O Box 43505-00100 Nairobi, Kenya.
Telephone +254-20-4996000 E: mail: procurement@ira.go.ke
Website: http//www.ira.go.ke
and deposited in the tender box located on 10th floor Zep-Re Place, Longonot Road Upper Hill, Nairobi so as to be received on or before 9th July, 2019 at 11:00 a.m.
Registration documents will be opened immediately thereafter in the presence of the bidders’ representatives who may choose to attend at the Training Room located on 10th floor, Zep-Re Place, Longonot Road, Upperhill, Nairobi. Late tenders will not be accepted.
COMMISSIONER OF INSURANCE & CHIEF EXECUTIVE OFFICER
GENERAL INSTRUCTIONS
1) You are requested to provide particulars as indicated in part II, III, IV, V, VI of this form as accurately as possible and where space provided is not sufficient, please use a separate sheet of paper and attach to this form.
2) IRA attaches great importance to correct information given. If the information given is found to be incorrect in any respect, the applicant shall be rendered ineligible for registration/deregistered.
3) IRA reserves the right to visit and inspect business premises of all the applicants to verify information provided.
4) All the information provided would be treated as confidential.
5) This Registration Document is eligible for one Item Ref No. which should be clearly written at the top of the form.
6) Your Registration documents should be submitted properly book bound or (spiral/velo), filled and page numbered. IRA shall not be responsible for Loss of documents not bound (loose).
1. REGISTRATION INSTRUCTIONS
1.1 Introduction
The Insurance Regulatory Authority (IRA) would like to invite interested candidates who must qualify by meeting the set criteria as provided by the IRA to perform the contract of supply and delivery or provision of goods and services to IRA.
1.2 Registration Objective
The main objective is to supply and deliver assorted items and also provide services/ works under relevant tenders/quotations to IRA on as and when required during the stated period.
1.3 Invitation of Registration
Suppliers registered with Registrar of Companies under the Laws of Kenya in respective merchandise or services are invited to submit their Registration documents to The Chief Executive Officer IRA, so that they may be registered for submission of tenders. Bids will be submitted in complete lots singly or in combination. The prospective suppliers are required to supply mandatory information for Registration.
1.4 Experience
Prospective suppliers and contractors must have carried out successful supply and delivery of similar items/services to Government/Corporation/ institutions of similar size. Potential suppliers/contractors must demonstrate the willingness and commitment to meet the Registration criteria.
1.5 Registration Document
This document includes questionnaire forms and documents required of prospective suppliers.
1.6 In order to be considered for Registration, prospective suppliers must submit all the information herein requested.
1.7 Distribution of Registration Documents
A copy of the completed Registration data and other requested information shall be submitted to reach:
The Chief Executive Officer,
Insurance Regulatory Authority,
10th Floor Zep-Re Place, Longonot Road, Upperhill
P.O. Box 43505 – 00100, NAIROBI, KENYA.
Tel: +254 – 20- 4996000
Email: procurement@ira.go.ke
Website: http//www.ira.go.ke
Not later than 9th July, 2019 at 11:00 a.m.
1.8 Questions Arising from Documents
Questions that may arise from the Registration documents should be directed to the following address:
Manager, Procurement
Insurance Regulatory Authority,
P.O. Box 43505 – 00100, NAIROBI.
Email: procurement@ira.go.ke
1.9 Additional Information
Insurance Regulatory Authority reserves the right to request submission of additional information from prospective bidders.
1.10 Tenders will be made available only to those bidders whose qualifications are accepted by Insurance Regulatory Authority after scoring a minimum of 70% after the completion of the registration process.
2. BRIEF CONTRACT REGULATIONS/GUIDELINES
2.1 Taxes on Imported Materials
The Supplier shall pay custom duty, VAT and all other taxes as required by the law. The firms should also have Electronic Tax Register Machines.
2.2 Customs Clearance
The contractors shall be responsible for custom clearance of their imported goods and materials.
2.3 Contract Price
The contract shall be of unit price type or cumulative of computed unit price and quantities required. Quantities may increase or decrease as determined by demand on the authority of the Chief Executive Officer .
Prices quoted should be inclusive of all delivery charges.
2.4 Payments
All local purchase shall be on credit of a minimum of thirty (30) days or as may be stipulated in the Contract Agreement.
3. REGISTRATION DATA INSTRUCTIONS
3.1 Registration data forms
The attached questionnaire forms described as part II, III, IV, V, VI, VII, are to be completed by prospective suppliers/contractors who wish to be registered for submission of tender for the specific tender.
3.1.1 The registered application forms which are not filled out completely and submitted in the prescribed manner will not be considered. All the documents that form part of the proposal must be written in English and indelible ink.
3.2 Qualification
3.2.1 It is understood and agreed that the Registration data on prospective bidders is to be used by Insurance Regulatory Authority in determining, according to its sole judgment and discretion, the qualifications of prospective bidders to perform in respect to each tender item/category as described by the client.
3.2.2 Prospective bidders will not be considered qualified unless in the judgment of Insurance Regulatory Authority they posses capability, experience, qualified personnel available and suitability of equipment and net current assets or working capital sufficient to satisfactorily execute the contract for goods/services.
3.3 Essential Criteria for Registration
3.3.1 (a) Experience: Prospective bidders shall have at least 2 years’
experience in the supply of goods, and 5 years in the case of Consultancy services and allied items in case of potential supplier/contractor should show competence, willingness and capacity to service the contract. Consultants shall be required to have indemnity cover with reputable insurance Company.
(b) Prospective supplier requires special experience and capability to organize supply and delivery of items, or services at short notice.
(c) IRA reserves to request for additional qualification information as the tender/quotation stage to suit particular procurement.
3.3.2 Personnel
The Suppliers/Contractors/Consultants shall provide pertinent information to demonstrate that they have qualified staff to carry out the assignment. CVs’ of the key personnel for individual or group to execute the contract must be indicated in part VIII.
3.3.3 Financial Condition
The Supplier’s financial condition will be determined by latest financial statement submitted with the Registration documents as well as letters of reference from their bankers regarding suppliers/contractors’ credit position. Potential suppliers/contractors will be Registered on the satisfactory information given.
3.3.4Special consideration will be given to the financial resources available as working capital, taking into account the amount of uncompleted orders on contract and now in progress. Data to be filled/ provided on Part II.
However, potential bidders should provide evidence of financial capability to execute the contract.
3.3.5 Past Performance
Past performance will be given due consideration in registering bidders.
Letter of reference from past customers should be included in part V.
3.4 Statement
Application must include a sworn statement on part VII by the Tenderer ensuring the accuracy of the information given.
3.5 Withdrawal of Registration.
Should a condition arise between the time the firm is registered to bid and the bid opening date which could substantially change the performance and qualification of the bidder or the ability to perform such as but not limited to bankruptcy, change in ownership or new commitments, the IRA reserves the right to reject the tender from such a bidder even though they have been initially registered.
3.6 The firm must have a fixed Business Premise and must be registered in Kenya, with certificate of Registration, Incorporation copies of which must be attached.
3.6.1 The firm must show proof that it has paid all its statutory obligations and have Valid Tax Compliance Certificate from the Kenya Revenue Authority (KRA).
3.6 Invitation to Tender.
The successful firms that will be registered with the Authority will be issued with tender/RFP/Quotation documents and all firms invited are expected to quote. Those wishing not to participate are required to indicate reasons for non-participation on the tender/quotation form/email failing which the firm may be deleted from IRA panel of suppliers.
All invitation to tender documents will be sent by email. All suppliers MUST have a valid email address and any change must be communicated to the Authority.
4. REGISTRATION EVALUATION CRITERIA
A: OPEN CATEGORY:
PRELIMINARY EVALUATION (MANDATORY REQUIREMENTS)
Requirements Score
1 Copy of Certificate of Registration/Incorporation Mandatory
2 Copy of PIN Registration Certificate Mandatory
3 Copy of Valid Tax Compliance Certificate from Kenya Revenue Authority Mandatory
4 Valid Single Business Permit from a County Government Mandatory
5 Evidence of physical registered office – Attach utility bill e.g. Electricity/water bill etc or tenancy agreements Mandatory
6 A Copy of CR 12 for companies Mandatory
7 Audited Accounts for the last two years for companies or Certified bank statements for 6 months Mandatory
8 Letters of recommendation from four (4) clients. Mandatory
9 Certificates from affiliated Professional Bodies/Associations, where the nature of supply or service is applicable/specific to your line of business e.g. NCA, IATA, EPRA, CA, LSK, ISPAK, PCB etc. Mandatory
TECHNICAL EVALUATION
Requirements (submit evidence) PART No. Score (%)
1 Registration Documentation I 25
2 Supplier Registration Data II 5
3 Financial Position III 20
4 Manpower/Key personnel V 20
5 Past Performance & Experience VI 25
6 Litigation History VII 5
Total 100
The minimum score to qualify for Registration shall be 70%. Applicants who will not meet this minimum score shall be disqualified at this stage.
B. DISADVATAGED GROUP: YOUTH, WOMEN & PERSONS WITH DISABILITY
PRELIMINARY EVALUATION (MANDATORY REQUIREMENTS
Requirements Score
1 Copy of Certificate of Registration/Incorporation Mandatory
2 Copy of PIN Registration Certificate Mandatory
3 Copy of Valid Tax Compliance Certificate from Kenya Revenue Authority Mandatory
4 A Copy of CR 12 for companies Mandatory
5 Certified copy of the latest bank statement Mandatory
6 Certificates from affiliated Professional Bodies/Associations, where the nature of supply or service is applicable/specific to your line of business e.g. NCA, IATA, ERC, CA, LSK, ISPAK, Pest Control Board etc. Mandatory
7 Valid Registration Certificate from The National Treasury (Applicable for firms owned by Youth, Women and Persons with Disability) Mandatory
TECHNICAL EVALUATION.
Requirements (submit evidence) PART No. Score (%)
1 Registration Documentation I 35
2 Supplier Registration Data II 5
3 Financial Position III 20
4 Manpower/Key personnel V 20
5 Past Performance & Experience VI 10
6 Litigation History VII 10
Total 100
The minimum score to qualify for Registration shall be 50%. Applicants who will not meet this minimum score shall be disqualified at this stage.
PART I: REGISTRATION DOCUMENTATION
Firms must provide copies of the following applicable to Open & YWPD: – 1. Copies of Certificate of Incorporation/Partnership deed/Business registration
2. Copy of Valid Registration Certificate from The National Treasury (Applicable for firms owned by Youth, Women and Persons with Disability)
3. Valid Tax Compliance Certificate from Kenya Revenue Authority
4. Copies of PIN Certificate of firm/company/individual
5. Copy of valid Single Business Permit from County Government
6. Copies of relevant registration certificates/permits/licenses specific to your line of business from applicable bodies’ e.g. Ministry of Public Works, IATA, EPRA, CCK, AAK, MISK, CA, LSK, ACPAK, ACPSK, ISPAK, PCB etc.
7. Current letters of recommendation from previous organizations served (provide at least four).
8. Copies of current practicing Certificates for all professionals where applicable from relevant/applicable bodies.
9. Where registration for service provision is mandatory, the firm must attach evidence of valid registration certificate with relevant Professional bodies/Authorities.
10. CVs for Senior Staff for Consultancy Services
11. Evidence of physical registered office – Attach utility bill e.g. Electricity/water bill etc or tenancy agreements
PART II:
1. SUPPLIER REGISTRATION DATA
A. Business Name
………………………………………………………………………………………………
Pin No. ……………………………………………………
VAT Reg. No ……………………………………………
(Attach copy registration certificate)
B. Address
P.O. Box………………………..Postal Code………………..
City/Town…………………………………………….
Telephone Nos ………………………………………………………………………….
Mobile Nos…………………………………………………………………………….
Fax No………………………………………………………………………………..
Email Address:……………………………………………………………………….
Website address (If any)……………………………………………………………….
C. Physical Address
Business Location……………………………………………………………………
Name of building …………………………………………………….
Plot No. ………………………………
Road/Street Name ………………………………………………………………
Floor No. ………………………………………………… Room No. ………………………………………..
2. COMPANY DETAILS
A Sole Proprietor
Your name in full…………………………………………………………………………
Age………….…….
Nationality…………………………………………………………….
Country of origin……………………………….
*Citizenship details…………………………………………………….……………….….
B Partnership
Given details of partners as follows:
Name Nationality Citizenship Details Shares
…………………………………………………………………………………………………..
……………………………………………………………………………………………………
…………………………………………………………………………………………………….
……………………………………………………………………………………………………..
C Registered Company:
Private or Public………………………………………………………………………
State the nominal and issued capital of company- Nominal Kshs.………………………………..
Issued Kshs.…………………………………..
Given details of all directors as follows:-
Name Nationality Citizenship Details Shares
1.………………………………………………………………………………………………..
……………………………………………………………………………………………………..
2.………………………………………………………………………………………………..
…………………………………………………………………………………………………….
3.………………………………………………………………………………………………..
……………………………………………………………………………………………………..
4.………………………………………………………………………………………………..
…………………………………………………………………………………………………….
*If Kenya Citizen, indicate under “Citizenship Details” whether by Birth, Naturalization or Registration
D. Registration with Registrar of Companies
1) Date of Registration…………… Registration No. ………………………
(Attach copy/copies of registration certificate)
2) Registration with National Construction Authority (NCA)
Date of Registration………………………………………
Registration No. ……………………………
Present Category ……………………………………………………………
(Attach copy/copies of current registration certificate)
3) Registration with any other bodies/authority relevant to your line of business e.g. AAK, MISK, CCK, LSK, ERC, ACPAK, ACPSK, ISPAK, etc
Date of Registration …………………………………………
Registration No. ……………………………
Present Category ……………………………………………………………
(Attach a copy/copies of registration certificates)
4. Current Practising Certificates ((Attach copy)
3. TRADE LICENCES
Single Business Permit held – County Government
1) Licence No. ……………………………….
Expiry Date ………………………………..
Licensed for……………………………………………………………………….
Current Trade Licence – Ministry/Statutory Commissions/Regulatory
Authorities etc
1) Licence No. ……………………………… Expiry Date ………………………………..
2) Licence No. ……………………………..
Expiry Date ………………………………..
3) Licence No. ……………………………..
Expiry Date………………………………….
(Attach copy/copies of registration certificate)
4. NATURE OF BUSINESS
A. Please list the goods or services you provide specific to item Ref. No, Item Description applied for:
1) …………………………………………………………………………………………
B. For Contractors, state your area of specialisation specific to item Ref. No,
Item Description applied for: –
1) ……………………………………………………………………………………………
2) ……………………………………………………………………………………………
3) ……………………………………………………………………………………………
_______________________________________________________________________________________________
PART III: FINANCIAL POSITION / INVESTMENT
A. Company’s Capital
1) Authorised Shares Ksh ……………………………………
2) Issued Shares Ksh. ……………………………………
B. Partnership & Sole Proprietorship:
Total Investment: Kshs. ……………………………………………………
NB: Provide and attach certified audited financial statements for the previous (latest) two years and/or bank statements for the 6 months certified by the issuing bank as proof of ability to execute the items applied for.
C. Maximum value of business which you can handle at any time
…………………………………………………..
D. State terms of payment in preference order
i) ……………………………………………………………………… ii) ……………………………………………………………………… iii) ………………………………………………………………………
Note: IRA prefers payment to be made within 30 days after delivery of goods/services.
_______________________________________________________________________________________
PART IV: PERFORMANCE STANDARDS & FACILITIES
A. Space
1) Factory: ………… Sq.ft. Owned or rented …………………
2) Godown: ……….. Sq.ft. Owned or rented……………………
3) Office …………… Sq.ft. Owned or rented……………………
B. Machinery
1) You own or lease …………………………………………………
2) Approximate value Ksh……………………………………………
(Provide and attach a list of key plant/equipment for the execution of the works)
3) State extent to which you would have to sub-contract
work………………………………………………………………………………
………………………………………………………………………………………
………………………………………………………………………………………
…………………………………………………………………………
4) Are you certified by any Quality Assurance Body? If so, give the standard and name
……………………………………………………………………………………… ……………………………………………………………………………………… ……………………………………………………………………………………… ……………
(Attach copies of the accreditation)
_________________________________________________________________________________
PART V: MANPOWER
a) Name of Chief Executive Officer/Principal Officer
………………………………………………………………………………
b) How many staff does your organization have?.…………………
c) Indicate the number in each category:
(i) Technical (Permanent……….. Temporary………….)
(ii) Semi Skilled ( Permanent………… Temporary………)
d) Please describe generally the experience and expertise your organisation posses that will generally enable you to effectively and efficiently undertake the Consultancy services that you are applying for as required by IRA
• Attach CV’s of key professional/technical personnel in the following format.
Name ………………………………………………………………… Age ……………………………………………………………………
Academic Qualification ……………………………………………………
Under graduate…………………………………………………………
Post graduate…………………………………………………………………………
Diploma…………………………………………………………………………
High School………………………………………………………………………
Professional Qualification ……………………………………………………..
…………………………………………………………………………………
(Attach Certificates if any)
Length of service with the firm
Position held …………………………….
PART VI: PAST PERFORMANCE& EXPERIENCE
a. Please provide at least four (4) major supplies/services/projects/assignments you have undertaken relevant to the job you are applying registration performed over the last three (3) years:
1. Name of 1st Client
i) Name of Client …………………………………………………………… ii) Address of Client ………………………………………………………… iii) Name of Contact Person at the client ……………………………….. iv) Telephone Contact…………………………………………………………
v) Value of Contract …………………………………………………………… vi) Duration of Contract (date)…………………………………………….. vii) Signature and Date………………………………………………
Company Stamp…………………
(Attach documental evidence of existence of contract)
2. Name of 2nd Client
i) Name of Client …………………………………………………………… ii) Address of Client ………………………………………………………… iii) Name of Contact Person at the client ……………………………….. iv) Telephone Contact…………………………………………………………
v) Value of Contract …………………………………………………………… vi) Duration of Contract (date)…………………………………………….. vii) Signature and Date………………………………………………
Company Stamp…………………
(Attach documental evidence of existence of contract)
3. Name of 3rd Client
i) Name of Client …………………………………………………………… ii) Address of Client ………………………………………………………… iii) Name of Contact Person at the client ……………………………….. iv) Telephone Contact…………………………………………………………
v) Value of Contract ……………………………………………………………
vi) Duration of Contract (date)…………………………………………….. vii) Signature and Date………………………………………………
Company Stamp…………………
(Attach documental evidence of existence of contract)
4. Name of 4th Client
i) Name of Client …………………………………………………………… ii) Address of Client ………………………………………………………… iii) Name of Contact Person at the client ……………………………….. iv) Telephone Contact…………………………………………………………
v) Value of Contract …………………………………………………………… vi) Duration of Contract (date)…………………………………………….. vii) Signature and Date………………………………………………
Company Stamp…………………
(Attach documental evidence of existence of contract)
b. Trade References
Attach at least four (4) current letters of recommendation from reputable organisations that you have supplied goods, works/service for the last three years.
i) Name and address of your Bankers
………………………………………………………………………………………………
……………………………………………………
ii) Have you ever had an order/contract issued and cancelled in whole or part by IRA? Yes/No ……………………
If yes give reasons for cancellation
………………………………………………………………………………………………
……………………………………………………………………………………………… iii) Have you ever been issued with a tender/quotation document by IRA and you failed respond/submit? Yes/No …………………… If yes give reasons for not submitting:
……………………………………………………………………………………………… ………………………………………………………………………………………………
iv) Do you have any objection in IRA obtaining a confidential financial report from your
bankers?………………………………………………………………………………
v) Has your company ever been involved in litigation/arbitration with clients/consultants?
If yes, give details
……………………………………………………………………………………………………… ……………………………………………………………………………………………………..
PART VII: BUSINESS PROBITY AND LITIGATION HISTORY
Please confirm whether any of the following criteria applies to your organization: Note that failure to disclose information relevant to this section may result in your exclusion as a potential IRA supplier.
No. PARTICULARS RESPONSE
1 Is the organization bankrupt or being wound up, having its affairs administered by the court, or have entered into an arrangement with creditors, suspended business activities or any analogous situation arising from similar proceedings in Kenya or the country in which it is established?
2 Please provide a statement of any material pending or threatened litigation or other legal proceedings where the claim is of a value in excess of Kshs 500,000/=
3 Has any partner, director or shareholder been the subject of corruption or fraud investigations by
the police, Ethics & Anti-Corruption Commission or similar authority in the country in which your organization is established?
4 Has the organization not fulfilled obligations relating to the payment of any statutory deductions or contributions including income tax as required under Kenyan law?
5 Please state if any Director / Partner and / or Company Secretary of the Organization has a close relative who is employed by IRA and who is in a position to influence the award of any supply. For purpose of
Registration process close relative refers to parents, siblings spouse or children
PART VIII: SWORN STATEMENT
I declare that to the best of my knowledge the answers submitted in this Registration questionnaires (and any supporting documentation) are correct. I understand that any misrepresentation will render my organization ineligible to participate in any future business activities with Insurance Regulatory Authority.
Having studied the Registration information for the above provision of goods, works or services applied for I hereby state:
1. The information and answers furnished in this Registration questionnaire form (and any supporting documentation) are correct to the best of our knowledge and I understand that any misrepresentation will render my organization ineligible to participate in any future business activities with Insurance Regulatory Authority.
2. That in case of being registered we acknowledge that this grants 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.
3. We enclose all the required documents and information required for the Registration evaluation.
4. We will not engage in corrupt practices with the Authority/Members of
Staff.
5. We have not been debarred from participating in Public Procurement Proceedings.
FORM COMPLETED BY
Date:
Name:
Signature:
Stamp or seal
(Full name and designation of the person signing and affix Rubber stamp/seal)
H