Download Application form for expression of interest 2016

REPUBLIC OF KENYA
MINISTRY OF TRANSPORT, INFRASTRUCTURE, HOUSING AND
URBAN DEVELOPMENT
STATE DEPARTMENT FOR HOUSING AND URBAN DEVELOPMENT
ARDHI HOUSE
1ST NGONG AVENUE
P.O BOX 30119 - 00100
NAIROBI
TEL: (020) 2718050/2716040
EXPRESSION OF INTEREST
APPLICATION FORM FOR EXPRESSION OF INTEREST FOR ARCHITECTURAL AND QUANTITY SURVEYING SERVICES,
STRUCTURAL, CIVIL, MECHANICAL AND ELECTRICAL ENGINEERING SERVICES, LAND SURVEYING AND
ENVIRONMENTAL IMPACT ASSESSMENT SERVICES
FINANCIAL YEAR 2016/2017 AND 2017/2018
NOTE
Each firm in a consortium is required to fill this application form. Where a firm is registered and licensed to
provide different services e.g. mechanical and electrical services, then one application form is applicable.
A. COMPANY DETAILS
(i) Name……………………………………………………………………………………………………………………………………………………………
Location………………………………………………………………………………………………………………………………………………...
Name of building & floor No………………………………………………………………………………………………………………….
Road/Street……………………………………………………………………………………………………………………………………………
(ii) Address
Postal Address………………………………………………………………………………………………………………………………………
Telephone number(s)…………………………………………………………………………………………………………………………….
Mobile Number(s)………………………………………………………………………………………………………………………………….
E-mail……………………………………………………………………………………………………………………………………………………
Sample of Headed Paper (attach copy)
(iii) Enclose firm’s CV
B. LEGAL STATUS
(i)
(ii)
(iii)
(iv)
Company
Partnership
Sole Proprietorship
Other
(Attach Certificate of Registration)
C. TRADE LICENCE
(i) Local Authority…………………………………………………………………………………………………………………………………………….
(ii) Licence Number…………………………………………………………………..Expiry Date……………………………………………………
(iii) Valid Tax Compliance Certificate
(Attach copies)
D. REGISTRATION WITH RELEVANT PROFESSIONAL BODIES
(i) Board of Registration of Architects and Quantity Surveyors , Engineers Registration Board, National
Environment Management Authority and other relevant bodies
Date of Registration…………………………………………………………………………………………………………………………………….
Registration number…………………………………………………………………………………………………………………………………….
Category (where relevant)……………………………………………………………………………………………………………………………
(ii) Provide valid practicing licence
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(iii) Registration with any other relevant bodies
(Attach copies of certificates)
S/NO
RELEVANT BODY
DATE OF REGISTRATION
REGISTRATION NUMBER
(Attach relevant registration certificates)
E. PARTNERS, DIRECTORS AND ASSOCIATES
(Please attach CVs and certificates for each on separate sheets including)
(i) Names
(ii) Qualifications
(iii) Experience
(iv) Registration number under CAP.525 or other respective Acts
(v) Valid practicing licence
(vi) Resident in Kenya or abroad
(vii) If resident abroad state Country of residence
F. EMPLOYED PERSONNEL, PROFESSIONAL AND SUB-PROFESSIONAL
(Attach separate CVs and certificates for relevant employees)
(i) Names and positions
(ii) Qualifications
(iii) Experience
(iv) Registration number under CAP.525 or other respective Acts
(v) Valid practicing licence
(vi) Resident in Kenya or abroad
(vii) If resident abroad state Country of residence
G. PROJECTS/WORKS
Name of project/works undertaken by the firm with the Government of Kenya or any other Government Body
over the last fifteen years and any other projects done over the mentioned period.
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Project/Works
Status
Client
Year undertaken
Value (Kshs.)
H. CLAIMS
(i) State if you have had any claim/pending bills with the Government or any Government body
…………………………………………………………………………………………………………………………………………………………………..
(ii) Nature of the claim (if any)………………………………………………………………………………………………………………………….
…………………………………………………………………………………………………………………………………………………………………….
I.
LITIGATION
(i) State any litigation you have had with the Government or any Government body
…………………………………………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………………………………………...
(ii) State the nature of the litigation (if any)
…………………………………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………………………………
(iii) State the ruling of the litigation
…………………………………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………………………………
Company Name……………………………………………………………………………………………………………………………………………………………
Address
…………………………………………………………………………………………………………………………………………………………….
Signature
…………………………………………………………………in the capacity of……………………………………………………………..
Official Stamp …………………………………………………………………………………………………………………………………………………………...
Date
…………………………………………………………………………………………………………………………………………………………….
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