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  • Sample Blacklisting Form

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    jomari basilio
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    The agency issued a blacklisting order against [Insert Name of Blacklisted Entity] for committing [Insert Offense Committed] related to the [Insert Name of Project] located in [Insert Location of Project]. The blacklisted entity is disqualified from participating in government procurement activities from [date] to [date] for a period of [number] years. The blacklisted entity may also forfeit its bid or performance security in the amount of [amount]. The order was signed by the Head of the Procuring Entity.

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    The agency issued a blacklisting order against [Insert Name of Blacklisted Entity] for committing [Insert Offense Committed] related to the [Insert Name of Project] located in [Insert Location of Project]. The blacklisted entity is disqualified from participating in government procurement activities from [date] to [date] for a period of [number] years. The blacklisted entity may also forfeit its bid or performance security in the amount of [amount]. The order was signed by the Head of the Procuring Entity.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    65 views1 page

    Sample Blacklisting Form

    Uploaded by

    jomari basilio
    The agency issued a blacklisting order against [Insert Name of Blacklisted Entity] for committing [Insert Offense Committed] related to the [Insert Name of Project] located in [Insert Location of Project]. The blacklisted entity is disqualified from participating in government procurement activities from [date] to [date] for a period of [number] years. The blacklisted entity may also forfeit its bid or performance security in the amount of [amount]. The order was signed by the Head of the Procuring Entity.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    LETTERHEAD & LOGO OF AGENCY

    6 August 2015

    BLACKLISTING ORDER NO. _______

    Pursuant to Section 69.1 of the Revised Implementing Rules and


    Regulations of Republic Act No. 9184 and the Uniform Guidelines for
    Blacklisting of Manufacturers, Suppliers, Distributors, Contractors and
    Consultants (Government Procurement Policy Board Resolution No. 09-2004)
    and upon recommendation of Agency BAC, the HOPE, under Resolution
    No._________ dated ___________, hereby issues this Blacklisting Order to the
    Manufacturer/Supplier/Distributor/Contractor/Consultant hereafter stated:
    1. Name and Address of the Blacklisted Entity
    [Insert Name of Blacklisted Entity]
    [Insert Address of Blacklisted Entity]
    2. Name of Project
    [Insert Name of Project]
    3. Location of Project
    [Insert Location of Project]
    4. Offense Committed
    [Insert Offense Committed]

    5. Sanctions Imposed:
    a.

    b.

    Disqualification for a period of _________ year/s from ________ to ________


    from participating in the procurement activities of all government
    projects.
    [Forfeiture of the Bid Security or Performance Security of ___________.]
    _________________________________________
    Signed by the Head of the Procuring Entity (HOPE)

    Received by:
    Designation:
    Date:

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