BHEL: PS-WR PUR-F09/01

/ FORMAT FOR
EMPANELMENT OF SUPPLIER
(INSTALLATION SERVICES) / Page 16 of 16

Application Form No. …..

EMPANELMENT NO.

(To be filled by BHEL)

BHARAT HEAVY ELETRICALS LIMITED

POWER SECTOR WESTERN REGION

345, KINGSWAY, NAGPUR 440 001

TEL: (0712) 530641 FAX: (0712) 530640, 530503

INSTRUCTIONS FOR FILLING THE FORM

·  Please read the instructions in each column and accordingly provide correct, complete and precise information in the designated column or space provided therein. In case the space provided is insufficient and you need additional space, separate sheet/s may be attached.

·  Original Application form duly filled, stamped and signed shall be sent alongwith a covering letter on your letterhead signed by a person having valid power of attorney on his name with Xerox copy of power of Attorney.

·  Please fill up the form neatly and clearly in BLOCK CAPITAL LETTERS

·  Wherever Checkbox options are given, you are to choose the option, by putting a TICK () in the most appropriate Checkbox. In case, more than one Checkbox is applicable, you may TICK () such boxes under each head.

·  Do not leave any column blank. If the particular item is not pertinent to you, please write “Not applicable” or “N.A.”

·  Incomplete, partially complete, not clearly filled forms giving in correct informations are liable to be rejected without any consideration.

·  Submission of this empanelment forms do not automatically guarantee for empanelment in BHEL. BHEL, also does not take any responsibility for loss of any Application form in transit.

·  BHEL reserves all rights to call for additional information or/and check, verify all the informations provided and statements made in the application. BHEL also reserves all the rights to inspect all premises/facilities to confirm the authenticity of information furnished/capabilities mentioned in the application.

·  BHEL reserves all the rights to reject any or all the applications without assigning any reasons whatsoever.

·  BHEL’s decision shall be final on all matters.

APPLICATION FORM FOR EMPANELMENT

OF SUPPLIER

Please read instructions given alongwith the form before you start filling the form
Whether at present registered with BHEL PSWR Yes No.
Area of work in which to be empanelled
Civil
Mechanical- TG GT BOILER/HRSG HYDRO
ELEC. C&I MM PAINTING MISC.

Name of the Company/Firm ……………………………………..

A)  GENERAL

I) Year of establishment ……………………………………..

II) Address ……………………………………..

……………………………………..

……………………………………...

III)Type of organization :

1) Central Govt.U/t 6) Public Limited Company

2) State Govt. U/t 7) Pvt.Ltd. Co.

3) Social/Charitable orgn 8) Partnership firm

4) Co.Op.Society 9) Proprietary firm

5) Joint Sector 10) Others (pl. specify)

IV) Whether small scale Industry: YES NO

If yes, Registration No. ------

(Please attach xerox copy of Registration)

ADDRESS FOR COMMUNICATION

Registered Office – Address / Telephone Nos.
Fax No.
E-mail
Mailing Address / Telephone Nos.
Fax No.
E-mail
Factory/Godown/Warehouse Address / Telephone Nos.
Fax No.
E-mail

V) Provide details of Directors/Partners/Owners/Proprietors in the following Format. You may take additional xerox copies of this sheet if you need more space.

Sl.No. / Name & Position held in organization / Address & Phone No. / Qualification / Experience (No. of years)

VI) Whether any collaboration (either financial or technical) with Foreign or indigenous

firms Yes No

If yes, following particulars of the Collaborator.

Sl.No. / Name / Address with phone nos./fax and contact person / Details of Collaboration

VII Please specify if any of your Director, Partner, Owner are ex-employee of BHEL.

YES NO.

If yes - Name ------

Designation------

Location------

VIII Please specify if any close relatives of your Owner, Partner, Director are employee of

BHEL at present.

YES NO.

If yes - Name ------

Designation------

Location------

IX Please specify, whether your company can execute the job in the states of Maharastra, Madhya Pradesh., Chhatisgarh, Gujrat and Goa .

Yes No.

If no, please indicate your preference.

SIGNATURE OF THE CONTRACTOR

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BHEL: PS-WR PUR-F09/01

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EMPANELMENT OF SUPPLIER
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(B)  TECHNICAL

(I) DETAILS OF WORKS CARRIEDOUT

Please provide details of Contract jobs carried out by you in last five years (use xerox of this sheet in case you need more space
Sr. No. / Job description in brief / W.O. No. & date / Location of work / Contract value in Rs.Lakhs / Contractual date of completion / Actual date of completion / Status / Reason for delay

*Submission of Completion certificate from respective department is must for completed work

SIGNATURE OF THE CONTRACTOR

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BHEL: PS-WR PUR-F09/01

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(INSTALLATION SERVICES) / Page 16 of 16

(II)

(a)  DETAILS OF TOOLS & PLANTS, MACHINERIES OWNED BY COMPANY

(Please attach additional sheet if necessary)

Sl. No. / Description / Capacity / Make / Year of purchase / Quantity / Remarks

(b) DETAILS OF MMD (Measuring and Monitoring devices) OWNED BY COMPANY (Please attach additional sheet if necessary)

Sl. No. / Description / Quantity / Make / Capacity / Remarks

(III) EMPANELMENT REQUIRED FOR

Code No. / Discipline / Category / Brief description / Minimum single order value executed for similar nature of work (Pl furnish the proof)
CE / Civil / Enabling / Construction of Office, stores, approach road etc.
CP / Civil / Plant work / Main Civil with minor structural work for Power plant
SP / Structural / Plant work / Major Structural work for Power plant
MB / Mechanical / Boiler / E&C of Utility Boilers/ Industrial boilers/ HRSGs/ Modular/ WHRB/ FBC
MM / Mechanical / Misc. Static equipment & Power station auxiliary / E&C of ESP, Ducts, Fans, Mills (Bowl & drum), compressor
MS / Mechanical / STG & GTG / E&C of Steam Turbine & Gas Turbine Generator sets
MH / Mechanical / HTG / E&C of Hydro Turbine & Generator sets with associated electrical and C&I
MP / Mechanical / Piping – HP & LP / E&C of Piping systems, HP/LP, Piping, Deaerator, tanks, heater, cooler, pumps etc.
EP / Electrical / Plant / E&C of Transformers, switchgears, Bus Duct, cabling, ESP electricals, illumination etc.
CP / Control & Instrumenta-tion / Plant / E&C of C&I work of Boiler/ CFBS/ HRSG/STG/GT sets & Station C&I
MM / Material handling & Management / Plant / Unloading of materials, transportation, verification, stacking, handling at site
IP / Insulation & refractory / Plant / Application of insulation and refractory in industrial & Utility Boiler including CFBC
PP / Painting / Plant / Application of paints with surface preparation
Code No. / Discipline / Category / Brief description / Minimum single order value executed for similar nature of work (Pl furnish the proof)
GP / Geo-Technical / Plant / Geo-technical investigation
EMP / Electro Mechanical package / Plant / E&C of all Mech., Elec., C&I items of Co-Gen. & CCPP
CEMP / Civil, Mech., E, C&I package / Plant / E&C of Co-Gen., CCPP including Civil, E-C&I complete.
CC / Chemical cleaning / Plant / Acid cleaning, Alkali flushing, Alkali Boil out etc. of power plants
ESPC / Electrical systems, protection & checking / Plant / Service for providing of integrated interlock/protection including dynamic testing of electrical systems in co-ordination with Gen. /Bus-duct/ Transformer & switch gear during commissioning & post commissioning stage.

(IV)  Please provide details of Govt. organization viz. Central/State/PSUs/State Electricity Boards and any other Multi National Companies with which you are registered. (Please take xerox copies of the following if required more space.)

Name & Address of Orgn. And contact person for any query on performance / Registered for (please specify job items) / Registered since how many years / Empanelment No.
V (a) Whether acquired ISO Certification Yes No

(b)  If no, whether proceeding for the same in Yes No

near future.

VI. Whether approved by or regularly visited by any third party Inspection agency

Please attach relevant certificate to this effect.

EIL DCL Lloyds TATA Any other

C)  FINANCIAL

I / Total capital employed (Rs. In lakhs)
II / Annual turnover
Net profit ( after tax depreciation and interest)
Assets
Reserves
III / Whether at any time company has been referred to BIFR / Yes/No
IV / Maximum value of jobs which can be handled at a time / Lakhs
Maximum value of single job which you can handle at a time
Maximum value of indemnity bond which can provide at a time
Maximum value of bank guarantee which you can provide at a time (BG only from Nationalized Banks to be considered)

DETAILS OF REGISTRATION WITH STATUTORY AUTHORITIES

V / Name of statutory authority / Registration/Licence No. / States
Central sales tax
State Sales Tax
Works Contract tax
EPF for contract labour
Labour license
Electrical license
IBR Empanelment
Any other

SIGNATURE OF THE CONTRACTOR

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(INSTALLATION SERVICES) / Page 16 of 16

(VI)  SOME IMPORTANT FINANCIAL - FEED BACK TO BE FURNISHED BY COMPANY:

(a)

PERTICULARS OF THE EXISTING AND PROPOSED LIMITS FROM THE BANKING SYSTEM

Rs. Lakhs

Sl. No. / Nature of facility / Sanctioning Bank/Financial Institute / Existing Limits / Extent to which limits were utilised during the last 12 months / Balance outstanding as on 31.03…. / Limits now requested
Maximum / Minimum
1 / Term Loans
2 / Fund based limits
a / Cash credit
b / Bills Discountting
3 / Non-Fund based limits
a / Letters of Credit
b / Bank-Guarantee limits

(b)

IMPORTANT DETAILS OF FIRM/COMPANY – PAST & ESTIMATED
Sl. No. / Particulars / Year … / Year…. / Year….
1 / Share Capital
2 / Fixed Assests
3 / Current Assets
Sundry debtors
Inventory
Other Assets
Sub-Total
4 / Current Liabilities
Advance from Customer
Sundry creditors
Other Liabilities
Sub-Total
5 / Net working Capital (3 – 4)
6 / PROFIT

SIGNATURE OF THE CONTRACTOR

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BHEL: PS-WR PUR-F09/01

/ FORMAT FOR
EMPANELMENT OF SUPPLIER
(INSTALLATION SERVICES) / Page 16 of 16

NAME & ADDRESS OF YOUR BANKERS

1) / 2)
3) / 4)

PLEASE ATTACH THE FOLLOWING DOCUMENTS:

Put ( Ö ) against each item if attached
Sl.No. / Document required (In three copies) / Attached / Not attached
1 / Audited Profit and Loss account and balance sheet for last three years
2 / Latest Income-tax clearance certificate
3 / Certificate regarding approved Bank Guarantee limits from your Bankers & outstanding liabilities.
4 / Copy of Sale-Tax Registration certificate
5 / Copy of EPF Registration number for contract labour
6 / Electrical Contractors license (for Electrical & C&I)
7 / Certificate of Registration with IBR
8 / Completion Certificates from Customers for completed works
9 / Proof of owning T&P, MMD etc.

Any other documents which has not been covered above but required to be attached in support of the information furnished may also be submitted alongwith this application.

REFERENCE – Whether registered with other Regions/Units of BHEL : Yes No.

If yes, please give the details as below:-
Location / Year of Empanelment / Empanelment Number
BHEL – Eastern Region
BHEL – Northern Region
BHEL – Southern Region
BHEL Units
(Please specify)

(E)  Any other information

1)  Please give below any other information which is relevant, useful and has not been covered anywhere in this proforma.

2)  DECLARATION

I/We do hereby declare that the entries made in this application form and enclosed attachments are true to the best of my/our knowledge.

Signature of authorised signatory

(With rubber stamp of organization)

Name:

Designation:

Date

Place

FOR OFFICIAL USE ONLY

Do not write anything in the columns mentioned below on this page.

Verification Verified by - Signature------

Name------

Contractor------Empanelment Number------

Code------Discipline------

Category------Financial limit------

For Period From------To------

COMMENTS

·  Type of job

·  Area of Operation

·  Financial Capability

PURCHASE FINANCE SMX/TSX.

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