Works 1-4 Application Form - National Contracts Commission

NATIONAL CONTRACTS COMMISSION
REGISTER OF PUBLIC SECTOR CONTRACTORS
GRADES 1-4
APPLICATION FORM
NATIONAL CONTRACTS COMMISSION
THE CONTRACTS SECRETARIAT
OFFICE OF THE CONTRACTOR-GENERAL
1ST FLOOR, PIOJ BUILDING
16 OXFORD ROAD KINGSTON 5
Telephone: 929-8560/6466/6460
Fax: 929-7335/920-8104
Website: www.ncc.gov.jm
Type of Application: (please indicate)
[ ] New
[ ] Annual Registration
[ ] Upgrade
[ ] Additional Category(ies)
NCC Registration No.
NATIONAL CONTRACTS COMMISSION
REGISTRATION OF CONTRACTORS GRADES 1-4
GENERAL INFORMATION
1.
CONTRACTORS MAY APPLY TO BE PLACED IN ONE OR MORE OF THE CATEGORIES/GRADES LISTED IN THE APPENDIX TO THIS FORM.
(THE MAXIMUM NUMBER OF CATEGORIES FOR START UP FIRMS IS (4) FOUR)
2.
THE SYSTEM OF CONTRACTOR REGISTRATION COMPRISES FOUR (4) GRADES (1 TO 4) OF CONTRACTORS AND THIRTY-FOUR (34) CATEGORIES OF WORKS
3.
CONTRACTORS WILL BE ASSIGNED TO CATEGORIES AND GRADES DETERMINED BY THE EXTENT TO WHICH THE INFORMATION PROVIDED IN THEIR
APPLICATIONS SATISFY THE CRITERIA SET OUT IN THE APPENDIX FOR PLACEMENT IN PARTICULAR CATEGORIES AND GRADES.
4.
CONTRACTORS WHO WISH TO BE INCLUDED ON THE REGISTER MUST SUBMIT THE FOLLOWING DOCUMENTS:
A.
ONE COPY OF THE COMPLETED APPLICATION FORM.
B.
ONE CERTIFIED COPY OF THE COMPANY REGISTRATION DOCUMENT, I.E. CERTIFICATE OF INCORPORATION, OR CERTIFICATE
OF REGISTRATION, WHERE APPLICABLE.
C.
ONE COPY OF THE AUDITED FINANCIAL REPORTS FOR THE LAST THREE YEARS AND CURRENT IN-HOUSE FINANCIAL
STATEMENTS.
D.
ONE CERTIFIED COPY OF A CURRENT TAX COMPLIANCE CERTIFICATE IN THE NAME OF THE APPLICANT
E.
EVIDENCE OF ACADEMIC AND OTHER QUALIFICATION OF PROFESSIONAL, TECHNICAL AND SUPERVISORY STAFF; I.E. RESUME
AND COPIES OF DEGREES, DIPLOMAS, CERTIFICATES ETC.
F.
5.
REFER TO THE ATTACHED NCC SUPPLEMETARY REGISTRATION REQUIREMENTS FOR ADDITIONAL INFORMATION.
APPLICATIONS FOR THE SPECIALIST CATEGORIES OF BLASTING (# 1) AND ELECTRICAL WORKS (# 7) WILL ONLY BE CONSIDERED IF A COPY OF THE
RELEVANT LICENCE IS SUBMITTED WITH THE APPLICATION.
6.
MONETARY LIMITS: THE FOLLOWING RESTRICTIONS WILL APPLY:
A.
CONTRACTORS WILL NOT BE AWARDED CONTRACTS THAT EXCEED THE MONETARY LIMIT OF THEIR GRADE
B.
CONTRACTORS WILL NOT BE AWARDED A GOVERNMENT CONTRACT IF THE NET VALUE OF OUTSTANDING WORK ON CURRENT
CONTRACTS PLUS THE VALUE OF THE NEW CONTRACT EXCEEDS THREE TIMES THE MONETARY LIMIT OF THE GRADE.
7.
THE POLICY OF THE NCC IS TO ENCOURAGE FULL AND OPEN COMPETITION. ACCORDINGLY, ALL REGISTERED PUBLIC SECTOR CONTRACTORS IN THE
APPROPRIATE CATEGORY AND GRADE WILL BE AFFORDED THE OPPORTUNITY TO TENDER ON PUBLIC SECTOR CONTRACTS. THERE WILL BE PUBLIC
ADVERTISEMENTS OF INVITATIONS TO TENDER WHICH WILL INCLUDE DETAILS OF PROJECTS AS WELL AS THE CATEGORIES AND GRADES OF
CONTRACTORS ELIGIBLE TO TENDER.
8.
THE ANNUAL REGISTRATION FEES FOR CONTRACTORS ARE AS FOLLOWS.
GRADES 1 & 2
-
$60,000.00
GRADE 3
-
$30,000.00
GRADE 4
-
$5,000.00
9.
THE ABOVE FEES ARE PAYABLE AT ANY BRANCH OF THE BANK OF NOVA SCOTIA USING BANK DEPOSIT VOUCHERS SENT TO SUCCESSFUL APPLICANTS.
10.
REGARDLESS OF THE NUMBER OF CATEGORIES IN WHICH A CONTRACTOR IS REGISTERED, ONLY ONE ANNUAL FEE WILL BE PAYABLE CORRESPONDING
TO THE HIGHEST GRADE IN WHICH HE IS REGISTERED.
11.
APPLICANTS WHO ARE FOUND ELIGIBLE FOR REGISTRATION WILL BE INVITED TO BECOME FULLY REGISTERED. THIS INVITATION WILL BE VALID FOR
ONE YEAR.
12.
COMPLETED APPLICATION FORMS ARE TO BE RETURNED TO THE FOLLOWING ADDRESS:
NATIONAL CONTRACTS COMMISSION
CONTRACTS SECRETARIAT
OFFICE OF THE CONTRACTOR GENERAL
1ST FLOOR P.I.O.J. BUILDING, 16 OXFORD ROAD
KINGSTON 5
13.
EACH APPLICANT WILL BE ADVISED AS SOON AS POSSIBLE OF THE OUTCOME OF HIS APPLICATION. SUCCESSFUL APPLICANTS WILL BE ISSUED WITH A
CERTIFICATE OF REGISTRATION FOLLOWING RECEIPT OF THE DUPLICATE BANK DEPOSIT VOUCHER INDICATING THAT THE APPROPRIATE REGISTRATION
FEE HAS BEEN PAID.
14.
ENQUIRIES RELATING TO THE REGISTRATION PROCESS SHOULD BE DIRECTED TO THE SECRETARIAT OF THE NATIONAL CONTRACTS COMMISSION
DURING WORKING HOURS OF 8:30-4:00 MONDAY TO THURSDAY & 8:30-3:00 FRIDAYS. TELEPHONE NUMBERS 929-8560, 929-7536/ 6466.
15.
IF THE INFORMATION PROVIDED BY THE APPLICANT ON WHICH EVALUATION AND AWARD(S) WERE BASED IS FOUND TO BE ERRONEOUS THEN
THE CONTRACTOR(S) SHALL NOT BE REGISTERED, OR IF ALREADY REGISTERED, THE REGISTRATION WILL BE REVOKED.
ALL INFORMATION SUPPLIED IN CONNECTION WITH THIS APPLICATION WILL BE TREATED CONFIDENTIALLY.
Application for Inclusion on the GOVERNMENT OF JAMAICA Register of Public Sector Contractors
Grades 1 – 4
(Application must be completed in black ink using block lettering or typed)
1.
What is the Registered Name of the Firm?
What is the legal structure of the Firm?: Sole Proprietorship [ ] Partnership [ ] Limited Liability Company [ ]
[ ] Copy of Certificate of Incorporation attached
What is the Registered Address of the Firm?
Street Address _______________________________________________________________________________________
Parish
Mailing Address
Does the Firm Have a Branch Office?
Address
Address
Parish
Parish
Does the firm have? [ ] Warehouse [ ] Storage [ ] Workshop (please indicate)
Please State Other Methods of Contacting the Firm
Telephone No.: 1)
2)
Fax No.
Email:
Contact Persons (Manager/Principal etc.) 1)
NATIONAL CONTRACTS COMMISSION – Contractor Application Form CR – 03/2013
2)
Page 1
PLEASE INDICATE METHOD OF RECEIVING CERTIFICATE OF REGISTRATION BY TICKING THE APPROPRIATE BOX: [
2.
] HOLD
[
] MAIL
How many years has the Firm been operating as a contractor?
Under its present name?
3.
4.
4.1
What was the Date of Registration?
Year/Month/Day:
/
Under any other name?
Please state the other name:
Who are the Owners/Principals?:
1)
2)
3)
4)
5)
6)
/
Please State the Directors/Managers of the Firm:
1) Name:
Position:
2) Name:
Position:
3) Name:
Position:
4) Name:
Position:
5) Name:
Position:
Please Provide Details of Full-Time Staff Members. Details should also be provided for all persons who provide managerial and
operational support e.g. Accountants, Secretaries, etc.
NATIONAL CONTRACTS COMMISSION – Contractor Application Form CR – 03/2013
Page 2
5.
Please indicate the Category and Grade for which registration is sought by inserting the requested grade (1, 2, 3, 4) in the
space provided for each category.
(For further information on Grades and Categories see Appendix)
No.
Categories
Grade No.
Categories
1
Blasting
18
Mechanical Works
2
Bridge Construction
19
Medical Equipment
3
Building Construction
20
Painting & Decorative Finishes
4
Building Maintenance
21
Piling
5
Civil Engineering
22
Pipe Laying
6
Drilling
23
Road Maintenance Works
7
Electrical Works
24
Road Surfacing - Asphaltic Concrete Works
8
Elevator, Escalator & Moving Walkways
25
Road Surfacing - Double Surface Dressing Works
9
Fencing
26
Road Surfacing - Micro Surfacing Works
10
General Road Works
27
Roofing
11
Heating, Ventilation, Air Conditioning & Refrigeration
28
Sandblasting
12
Industrial Maintenance
29
Security Systems
13
Information Technology Systems
30
Signage
14
Instrumentation
31
Steel Erection
15
Interior Construction Works
32
Steel Fabrication
16
Landscaping
33
System Building
17
Marine Engineering
34
Tank Erection
NATIONAL CONTRACTS COMMISSION – Contractor Application Form CR – 03/2013
Grade
Page 3
6. Please list the major items of relevant plant and equipment available to the Firm:
(This page may be copied as required)
If equipment is not supported by Audited Statement, it will not be considered and this will affect your evaluation and category awarded.
No
Item
Age
Owned
Leased/Rented
Condition
(e/g/f/p)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
Key: (e- excellent, g- good, f- fair, p- poor)
NATIONAL CONTRACTS COMMISSION – Contractor Application Form CR – 03/2013
Page 4
7.
Financial Information (Weighted 30% of Evaluation)
7.1
Please State the Total Annual Volume of Construction work performed in the past five (5) years
Year
Total Annual Volume
20
20
20
20
20
7.2
Please Provide Audited Financial Reports for the Last Three (3) Years: Balance Sheets, Profit and Loss Statements, Cash
Flow, Auditor's Reports etc. Please List below and Attach:
Note: If the Auditor's Reports' does not cover the last six months, please also provide up-to-date in-house financial statements.
(For Re-Registration, Provide Last Year Only)
Year
Items
20
20
20
NATIONAL CONTRACTS COMMISSION – Contractor Application Form CR – 03/2013
Page 5
7.3
Financial Institution Reference
Please tell us the name(s) of your banker(s) and other financial institutions who provide financial services and who may be contacted to
provide references:
a) Name of Institution:
b) Address:
c) Contact Person:
Telephone#
Position:
a) Name of Institution:
b) Address:
c) Contact Person:
Telephone#
Position:
a) Name of Institution:
b) Address:
c) Contact Person:
Telephone#
Position:
NATIONAL CONTRACTS COMMISSION – Contractor Application Form CR – 03/2013
Page 6
STAFFING (Weighted 30% of Evaluation)
(This page may be copied as required to provide information on additional staff members.)
Professional (10% of evaluation)
8.
Professional staff includes:
•
Individuals who have attained the minimum academic qualification of a first degree, or equivalent, and are either: a) registered with a professional
registration board, b) a member of a professional association, or c) both
•
Individuals who have a formal working relationship with the Contractor and/or Company in a capacity such as Consultants, Full-time or Part-time
staff.
Professional Engineer - at least one (1) staff with a valid Professional Engineers Registration Certificate from the Professional Engineers Registration
Board is required in a full-time working capacity with the Company and/or Contractor for the Grade One (1) categories with monetary limits of J$150M.
These categories are Bridge Construction, Building Construction, Civil Engineering, System Buildings General Road Works, Road Surfacing - Asphaltic
Concrete Works, Road Surfacing - Double Surface Dressing Works and Road Surfacing - Micro Surfacing Works.
Name of Individual:
Years with Firm:
a) Name of Professional Registration Board:
Year of last registration:
b) Name of Professional Association
Number of years practicing in profession:
Academic Qualifications (eg: Cert., Dip., Bsc., Ma., Msc.)
Major Discipline
Year Qualified
/
/
/
/
Accrediting Institution
/
/
Information regarding experience in each category of work for which registration is requested:
Category Applied for
(List name of category)
No. of Years Experience in this
Category of Work
Position Held
NATIONAL CONTRACTS COMMISSION – Contractor Application Form CR – 03/2013
Project Description
Page 7
STAFFING (Weighted 30% of Evaluation)
8.2
(This page may be copied as required to provide information on additional staff members.)
Technical (10% of evaluation)
Technical staff includes:
•
Individuals who have benefited from relevant tertiary-level training.
•
Individuals who have a formal working relationship with the Contractor and/or Company in a capacity such as Consultants, Full-time or Part-time
staff.
Name of Individual:
Years with Firm:
Number of years practicing in profession:
Academic Qualifications (eg: Cert., Dip., Bsc., Ma., Msc.)
Major Discipline
Year Qualified
/
/
/
/
Accrediting Institution
/
/
Information regarding experience in each category of work for which registration is requested:
Category Applied for
(List name of category)
No. of Years Experience in this
Category of Work
Position Held
NATIONAL CONTRACTS COMMISSION – Contractor Application Form CR – 03/2013
Project Description
Page 8
STAFFING (Weighted 30% of Evaluation)
8.2
(This page may be copied as required to provide information on additional staff members.)
Supervisory (10% of evaluation)
Supervisory Staff includes:
•
Individuals with considerable practical experience in the construction industry with responsibility for on-site day-to-day activities.
• Individuals who have a formal working relationship with the Contractor and/or Company in a capacity such as Consultants, Full-time or
Part-time staff.
Name of Individual:
Years with Firm:
Number of years in construction industry:
Educational Level Achieved (eg: High / Tech Sch., Cert., Dip., Bsc., Ma., Msc.)
Year Qualified
Accrediting Institution
/
/
/
/
Information regarding experience in each category of work for which registration is requested:
Category Applied for
(List name of category)
No. of Years Experience in this
Category of Work
Position Held
NATIONAL CONTRACTS COMMISSION – Contractor Application Form CR – 03/2013
Project Description
Page 9
RELATIONSHIPS
9.
Please state the following Relationships with other Organizations:
A.
If the Principal(s) and/or Director(s) of the Company are Principals and/or Directors of other organizations who also provide
goods, works, or services to the construction industry (except those stated above) please state:
(a) Name of Individual
(b) Name of Organization
(c) Position Held
B.
If the Firm is a division/subsidiary of another company, please state the name of the parent company:
C.
If the Firm is otherwise associated or attached to other organizations (Parent, Subsidiary, Associate, Joint-Venture, etc.) who
provide goods, works, or services to the construction industry, please state the organizations' names and nature of
association:
Name of Organization
Nature of Association
1.
2.
3.
4.
5.
NATIONAL CONTRACTS COMMISSION – Contractor Application Form CR – 03/2013
Page 10
Components:
PROJECTS (Weighted 30% of Evaluation) (This page may be copied as required)
10. Please provide details of the two (2) most significant projects completed within the last ten (10)
years in each category applied for. If project has multiple components, please indicate
components & approximate values in table provided.
Name of Project:
Location of Project:
Value of Work Executed $:
Original Contract Period:
Years
Months
Contract Start Date:
Weeks
Days
(Y/M/D)
Contract Completion Date (Practical Completion):
(Y/M/D)
Nature of Work Executed by Firm:
$Value:
1. Blasting
/
2. Bridge Construction
/
3. Building Construction
/
4. Building Maintenance
/
5. Civil Engineering
/
6. Drilling
/
7. Electrical Works
/
8. Elev./Escal/Moving Sidewalk
/
9. Fencing
/
10. General Road Works
/
11. Heating/Vent/Ac/Refrig.
/
12. Industrial Maintenance
/
13. Information Technology Sys.
/
14. Instrumentation
/
15. Interior Construction Works
/
16. Landscaping
/
17. Marine Engineering
/
18. Mechanical Works
/
19. Medical Equipment
/
20. Painting & Decorative Works /
21. Piling
/
22. Pipe Laying
/
23. Road Maintenance Works
/
24. Rd. Surfacing-Asphaltic Conc. /
25. Rd. Surfacing-Dbl. Surf. Dress. /
26. Rd. Surfacing-Micro Surfacing /
Name of Client
Contact Person:
Ph.#
Name of Architect/Engineer/Project Manager:
Contact Person:
Ph.#
Work was executed as: Main Contractor [ ] Sub Contractor [ ] Joint Venture Partner [ ]
27. Roofing
/
28. Sandblasting
/
29. Security Systems
/
30. Signage
/
31. Steel Erection
/
32. Steel Fabrication
/
33. System Building
/
34. Tank Erection
/
If work was performed as either a Sub-Contractor or with a Joint Venture Partner; please state the name of:
(a) Main Contractor:
(b) Joint Venture Partner(s)
Contact Person
Contact Person
NATIONAL CONTRACTS COMMISSION – Contractor Application Form CR – 03/2013
Ph#
Ph#
Page 11
PROJECTS Cont. (This page may be copied as required)
11.
If the Firm failed to complete any project within the last three years please state:
Name of Project
Name of Client:
Contact Person:
Ph.#
Name of Architect/Engineer/Project Manager in charge:
Contact Person:
Ph.#
Location of Project:
Value of Work Executed
$:
Contract Sum: $
Work was Executed as:
Main Contractor [
] Sub Contractor [
] Joint Venture Partners [
]
If work was performed as either a (a) Sub Contractor or (b) with Joint Venture Partner; Please state the name of:
(a) Main Contractor:
(b) Joint Venture Partner(s)
List briefly three main reasons why the company failed to complete the contract:
NATIONAL CONTRACTS COMMISSION – Contractor Application Form CR – 03/2013
Page 12
12. Narrative Description of Firm (Voluntary)
NATIONAL CONTRACTS COMMISSION – Contractor Application Form CR – 03/2013
Page 13
AFFIDAVIT UNDER THE VOLUNTARY DECLARATIONS ACT
IN THE MATTER of Part IIIA
of the Contractor-General Act.
AND IN THE MATTER of the
National Contracts Commission
I/We,
, being duly sworn, make oath and say
(Name(s) of owner or director)
as follows:
1.
That my/our address is at
and I am/we are
(Postal address of person(s) above)
and I am/we are duly
authorised to make this affidavit on behalf of (Description and relationship to contractor-owner or director)
(Name of Contractor / firm)
2. That the facts set forth in the National Contracts Commission Application for Inclusion on the
Register of Contractors for the Government of Jamaica are based on my/our personal knowledge or
information obtained from the files of
to which I/we
(Name of Contractor / firm)
have full access.
3. That I/we declare that I/we have carefully read the foregoing application form of
(Name of Contractor / firm)
and that to the best of my/our information, knowledge, and belief, the information provided in the said
form is true and correct
AND I make this solemn declaration conscientiously believing the same to be true and by virtue of the
provisions of the Voluntary Declarations Act.
Sworn to at
This
Before me:-
Day of
(Signature of owner or director)
)
)
)
Justice of the Peace for the Parish of:
(Date)
Page 14
National Contracts Commission
Declaration Form
REGISTRAR OF PUBLIC SECTOR CONTRACTORS GRADES 1- 4
This form may be duplicated as needed and must be completed by each Director/Owner
I ………………………………………………………………………………… Director  /Owner 
(Name of Director/Owner)
of: ..……………………………………………………………………………, solemnly declare that:
(Name of Company)
1. I am not currently employed to a Government Agency 
2. I am currently employed to a Government Agency

a. I have received written permission from the Services Commission/Permanent Secretary to
operate this establishment for which registration with the NCC is being sought and the said
permission letter explicitly indicates that there exists no conflict of interest 
b. Permission letter attached: 
c. Name of Government Agency:
d. Date of Employment:
e. Position (s) held within Agency during the last five years (All committee membership MUST be stated):
i.
ii.
iii.
3. Are you affiliated with any other company registered with the National Contracts Commission?
Yes  No
If yes, please state name of company(ies) and nature of affiliation:
Date:…………………………………….
Date: ………………………………….
Signature:………………………………..
Director/Owner
Signature:……………………………..
Justice of Peace
Page 15