Department of Public Works and Highways (DPWH)

CONTRACT ID : 22GEG0013
CONTRACT NAME : Supply/Delivery of Spare Parts for use in various Maintenance Equipment,

LOCATION OF THE CONTRACT : DPWH - Palawan 3rd DEO, Puerto Princesa City, Palawan

CHECKLIST OF ELIGIBILITY AND TECHNICAL COMPONENT FOR THE BAC

PROJECT :
DATE :
BIDDER :
ALBINO D. SOCRATES, JR.
BENJAMIN Q. MAULEON
DELMARE G. RAMISO

ARTHUR A. TORILLO
DPWH - PPCITY

ROY D. VALDEZ

1. PhilGEPS Certificate of Registration- in lieu of Documents 2,3, 5 and 7 below.

Class “A” Legal Documents
2. DTI Business Name registration or SEC Registration Certificate or CDA for
Cooperatives.

3. Valid and current Mayor’s permit/municipal license.

4. Statement of on-going and similar completed government and private contracts

5. Audited Financial statements, stamped “received” by the BIR.

6. Computation of NFCC or Committed Line of Credit

7. Tax Clearance per Executive Order No. 398 series of 2005.

Class “B” Documents, (if applicable)

1. Valid Joint Venture Agreement (JVA) in case the JV is already in existence. In the absence
of a JVA, duly notarized statements from all the potential JV partners stating that they will
enter into a abide by the provisions of the JVA in the instance that the bid is successful
shall be included in the bid, and information provided therein are true and correct.

TECHNICAL:
REQUIRED BID SECURITY/FORM
a. Cash, Certified Check, Cashier’s Check, Manager’s Checks, Bank Draft Irrevocable Letter or Credit,
confirmed by a Universal or Commercial Bank
b. Surety Bond ( callable upon demand)
Validity Period 120 Calendar days upon Opening of bids
Form of Bid Security
Company
Number
Official Receipt No.
Validity Period
Callable on Demand
Bid Security Amount
Certification from Insurance Commission ( )
Bid Securing Declaration
 Department of Public Works and Highways (DPWH)

CONTRACT ID : 22GEG0013
CONTRACT NAME : Supply/Delivery of Spare Parts for use in various Maintenance Equipment,

LOCATION OF THE CONTRACT : DPWH - Palawan 3rd DEO, Puerto Princesa City, Palawan

CHECKLIST OF ELIGIBILITY AND TECHNICAL COMPONENT FOR THE BAC

DPWH-G&S-21: The Eligibility and Technical Checklist for the BAC is issued to keep track of the Eligibility, Technical and Financial Proposals submitted by
bidders using a non-discretionary “pass/fail criterion. This form may also used by the BAC Secretariat as a reference in writing up the minutes of the Opening
of Eligibility and Bid Requirements.

1. Bid Securing Declaration

or Bid Securing ( ) Sufficient ( ) Insufficient

2. Statement of SLCC

3. Technical Specifications Proposal

4. Production/Delivery Schedule

5. Manpower Requirement, if applicable

6. After Sales Service/Parts, if applicable

7. Omnibus Sworn Statement

Note: Any missing documents in the above-mentioned checklist is a ground for outright rejection of the bid.

Remarks : ( )Pass ( ) Fail

DPWH-G&S-21: The Eligibility and Technical Checklist for the BAC is issued to keep track of the Eligibility, Technical and Financial Proposals submitted by
bidders using a non-discretionary “pass/fail criterion. This form may also used by the BAC Secretariat as a reference in writing up the minutes of the Opening
of Eligibility and Bid Requirements.
 Department of Public Works and Highways (DPWH)

CONTRACT ID : 22GEG0013
CONTRACT NAME : Supply/Delivery of Spare Parts for use in various Maintenance Equipment,

LOCATION OF THE CONTRACT : DPWH - Palawan 3rd DEO, Puerto Princesa City, Palawan

CHECKLIST OF ELIGIBILITY AND TECHNICAL COMPONENT FOR THE BAC

Checklist of Eligibility, Technical and Financial Requirement for Bidders

The Eligibility Component shall contain the following:

1. Certification in lieu of Class “A” Documents.

Note : This document certifies that the Class “A” Documents are complete, current and updated.
Presence of this document shall forego the checking of Class “A” Document

OR ALL REQUIREMENTS LISTED UNDER Class A” and “B” Documents

2. CLASS “A” DOCUMENTS

1. Registration Certificate from SEC, Department of Trade and Industry (DTI) for sole proprietorship, CDA for
cooperatives, or any proof of such registration as stated in the Bidding Documents.

2. Valid and current Mayor’s permit/municipal license issued by the city or municipality where the principal place
of business of the prospective bidder is located.

3. Statement of on-going and similar completed government and private contracts within the period specified in
the ITB, including contract awarded but not yet started, if any, the statement shall include, for each contract,
the following (Form No. 1&2):

a. Name of the Contract

b. Date and Status of the Contract
c. Kind of Goods Sold
d. Amount of Contract and Value of Outstanding Contracts
e. Date of Delivery
f. End-User Acceptance, if completed

4. Statement of the bidder’s Single Largest Completed Contract similar to the contract to be bid.

5. The prospective bidder’s audited financial statements, showing among others, the prospective bidder’s total
and current asset and liabilities, stamps “received” by the BIR or its duly accredited and authorized
institutions, for the preceding calendar year which should not be earlier than two (2) years from the date of
bid submission.

6. The prospective bidder’s computation for its net Financial Capacity (NFCC) (Form No. 3)

7. Tax Clearance per Executive Order No. 398 series of 2005, as finally reviewed and approved by the BIR.

3. CLASS “B” DOCUMENTS

1. Valid Joint Venture Agreement (JVA) in case the joint venture is already in existence, in the absence of a JVA,
a duly notarized statement from all the potential joint venture partners stating that they will enter into and
abide by the provisions of the JVA if the bid is successful. Failure to enter into a joint venture in the event of a
contract award shall be ground for the forfeiture of the Bid security. Each partner of the joint venture shall
submit the legal eligibility documents. The submission of technical and Financial eligibility documents by any of
the joint venture partners constitutes compliance.
 Department of Public Works and Highways (DPWH)

CONTRACT ID : 22GEG0013
CONTRACT NAME : Supply/Delivery of Spare Parts for use in various Maintenance Equipment,

LOCATION OF THE CONTRACT : DPWH - Palawan 3rd DEO, Puerto Princesa City, Palawan

CHECKLIST OF ELIGIBILITY AND TECHNICAL COMPONENT FOR THE BAC

The Technical Component shall contain the following:

1. PhilGEPS Certificate or Registration

2. NFCC Computation or Committed Line of Credit

3. Bid Security in accordance with ITB Claus 18. A Bid Securing Declation or any of the following.

Amount of Bid Security (Equal to

Form of Bid Security
Percentage of the ABC)

a. Cash or cashier/s’manager’s check issued by Universal or Two percent (2%)

Commercial Bank

b. Bank draft/guarantee or irrevocable letter of credit issued by a

Universal of Commercial Bank. Provided, however, that it shall be
confirmed or authenticated by a Universal or Commercial Bank, if
issued by foreign bank, or
c. Surety bond callable upon demand issued by a surety or Five percent (5%)
insurance company duly certified by the insurance Commission as
authorized to issue such security; or

4. Technical specifications proposal

5. Schedule or\f requirements/delivery
6. Manpower requirements, if applicable
7. After-sales service/Parts, if applicable
8. Omnibus Sworn Statement

CHECKLIST OF FINANCIAL COMPONENT FOR BIDDERS

The Financial Component shall contain the following:

1. Bid Form which includes Bid Prices

2. Bill of Quantities which includes Unit Bid Price and Total Bid Prices for each item
3. Recurring or maintenance costs, if applicable

DPWH-G&S-15: The Checklist of Eligibility, Technical and Financial Requirements for Bidders is provided for bidders a part of the Bidding Documents to
organized the submission of requirements with regards to their eligibility, technical and financial proposal.
 DEPARTMENT OF PUBLIC WORKS AND HIGHWAYS (DPWH)

Name of Office : DPWH PALAWAN 3RD DISTRICT ENGINEERING OFFICE

STATEMENT OF ALL GOVERNMENT AND PRIVATE CONTRACTS COMPLETED WHICH ARE SIMILAR TO THE CONTRACT TO BE BID

Business Name:
Business Address:

a. Owner’s Name a. Amount at Award a. Date Awarded

Bidder’s Role
Name of Contract Nature of Work
b. Address b. Amt at Completion b. Contract Effectivity
c. Telephone No. Description % c. Duration c. Date Completed
Government

Private

Attachments: 1. Copy of Contract

2. Certificate of Completion
3. Certificate of Acceptance

Submitted by:
(Printed Name and Signature
Designation:
Date:

DPWH-G&S-13: Statement of all Government and Private Contracts Completed Which are Similar in Nature: The prospective bidder shall list down all the government and private contracts completed which are similar
in nature to the procurement at hand. The BAC shall use the form to determine whether it has completed within the period specified in the Invitation to Bid, a single contract that is similar to the contract to be bid,
and whose value, adjusted to current prices using the National Statistics Office (NSO) consumer price indices, must be at least fifty percent (50%) of the ABC. In the case of Expendable Supplies, said single contract
must be at least twenty five percent (25%) of the ABC.
 DEPARTMENT OF PUBLIC WORKS AND HIGHWAYS (DPWH)

Name of Office : DPWH PALAWAN 3RD DISTRICT ENGINEERING OFFICE

LIST OF ALL ONGOING GOVERNMENT AND PRIVATE CONTRACTS INCLUDING CONTRACTS AWARDED BUT NOT YET STARTED

Business Name:
Business Address:

a. Owner’s Name a. Date Awarded % of a. Date Awarded

Bidder’s Role
Name of Contract Nature of Work
b. Address b. Date Started Accomplishment b. Contract Effectivity
c. Telephone No. Description % c. Date of Completion Planned Actual c. Date Completed
Government

Private

Attachments: 1. Notice of Award and/or Contract

2. Notice to Proceed issued by owner
3. Certificate of Accomplishment signed by the owner or authorized representative

Submitted by:
(Printed Name and Signature
Designation:
Date:

DPWH-G&S-14: List of all On-going Government and Private Contracts Including Contracts Awarded but not yet Started: The prospective bidder shall list down all the government and private contracts completed which are similar in
nature to the procurement at hand. The BAC shall use the form to determine whether it has completed within the period specified in the Invitation to Bid, a single contract that is similar to the contract to be bid, and whose value,
adjusted to current prices using the National Statistics Office (NSO) consumer price indices, must be at least fifty percent (50%) of the ABC. In the case of Expendable Supplies, said single contract must be at least twenty five percent
(25%) of the ABC.
 DEPARTMENT OF PUBLIC WORKS AND HIGHWAYS (DPWH)

CONTRACT ID : 22GEG0013
CONTRACT NAME : Supply/Delivery of Spare Parts for use in various Maintenance
Equipment,
CONTRACT LOCATION : DPWH - Palawan 3rd DEO, Puerto Princesa City, Palawan

FINANCIAL DOCUMENTS FOR ELIGIBILITY CHECK

Summary of the Applicant Supplier’s/Distributor’s/Manufacturer’s assets and liabilities on the basis of
the attached income tax return and audited statement, stamped “RECEIVED” by the Bureau of
Internal Revenue of BIR authorized collecting agent, for immediately preceding year and a certified
copy Schedule of Fund Assets particularly the list of construction equipments.

Year 20____
1 Total Assets
2 Current Asset
3 Total Liabilities
4 Current Liabilities
5 Net Worth (1-3)
6 Net Working Capital (2-4)

The Net Financial contracting (NFCC) based on the above data is computed as follows:

NFCC = k (Current Asset – Current Liabilities) minus value of all outstanding works under ongoing
contract including awarded contracts yet to be started.

NFCC = Php___________________

K = 10 for a contract duration of one year or less, 15 for more one year up to two years and 20 for
more than two years.

Or

Commitment from a licensed bank extend to it a credit if awarded the contract in the amount of at
least 10% of the proposed project to bid.

Name of bank : _____________________________ Amount : ______________________

Herewith attached are certified true copies of the Income tax return and audited financial statement:
Stamped “RECEIVED” by the BIR authorized collecting agent for the Immediately preceding year and
certificate of commitment from a licensed bank to extend a credit line.

Submitted by:

Name of firm/contractor/supplier

Signature of Authorized Representative

Date: ______________

Note:
If partnership or Joint Venture, each partner or Member Firm of Joint Venture shall submit the above requirements. The
above information are among the financial documents required for Eligibility Check. Together with the legal and Technical
required, the financial documents shall be placed inside the Eligibility Envelope and submitted to the BAC on or before the
deadline for the submission and receipt of Eligibility Envelope.
 DEPARTMENT OF PUBLIC WORKS AND HIGHWAYS

REPUBLIC OF THE PHILIPPINES)

CITY OF PUERTO PRINCESA ) S. S.

CONTRACT ID : 22GEG0013
CONTRACT NAME : Supply/Delivery of Spare Parts for use in various Maintenance
Equipment,
CONTRACT LOCATION : DPWH - Palawan 3rd DEO, Puerto Princesa City, Palawan

BID SECURING DECLARATION

AMELIA B. FAJARDO
District Engineer
DPWH-Palawan 3rd District Engineering Office
Puerto Princesa City

I/We, the undersigned, declare that:

1. I/We undersigned that, according to your conditions, bids must be supported by a Bid
Security, which may be in the form of a Bid-Securing Declaration.

2. I/We accept that: (a) I/we will be automatically disqualified from bidding for any contract
with any procuring entity for a period of two (2) years upon receipt of your Blacklisting
Order; and (b) I/we will pay the applicable fine provided under Section 6 of the Guideline
on the Use of Bid Securing Declaration, within fifteen (15) days from receipt of the written
demand by the procuring entity for the commission of acts resulting to the enforcement of
the bid securing declaration under Section 23. 1(b), 34.2, 40.1 and 69,1, except 69.1 (f),
of the IRR of RA 9184; without prejudice to other legal action the government may
undertake.

3. If I/we understand that this Bid-Securing Declaration shall cease to be valid on the
following circumstances:

a. Upon expiration of the bid validity period, or any extension thereof pursuant to your
request;

b. I am/we declared ineligible or post-disqualified upon receipt of your notice such effect,
and (i) I/we failed to timely file a request for reconsideration or (ii) I/we filed a waiver
to avail of said right;

c. I am/we are declared as the bidder with the Lowest Calculated and Responsive Bid.
I/we have furnished the performance security and signed the Contract.

IN WITNESS WHEREOF, I/we have hereunto set my/our hand/s this _______________ day of
__________________________ at ________________________________.

Affiant
 DEPARTMENT OF PUBLIC WORKS AND HIGHWAYS

REPUBLIC OF THE PHILIPPINES)

CITY OF PUERTO PRINCESA ) S. S.

CONTRACT ID : 22GEG0013
CONTRACT NAME : Supply/Delivery of Spare Parts for use in various Maintenance
Equipment,
CONTRACT LOCATION : DPWH - Palawan 3rd DEO, Puerto Princesa City, Palawan

SUBSCRIBED AND SWORN to before me this _____ day of _________________2022, at

__________________________, Philippines, Affiant/s is/are personally known to me and was/were identified
by me through competent evidence of identify as defined in the 2004 Rules on Notarial Practice (A.M. No, 02-
8-13-SC). Affiant/s exhibited to me his/her Tax Identification No. _________________________, with his/her
photograph and signature appearing thereon, with No. ____________________ an his/her Community Tax
Certificate No. _______________ Issued on __________________________ at
______________________________.

Witness my hand and seal this ________ day of ____________________________, 2022.

NAME OF NOTARY PUBLIC

Doc. No. _________

Page No. _________

Book No. _________
Series of _________

DPWH – G&S-04 – The Bid Securing Declaration (BSD) is an undertaking which sate that the bidder shall enter into contract with the
DPWH and furnish the require Performance Security which ten (10) calendar days, or less from receipt of the Notice of Award,
committing to pay the corresponding fine and the suspended for a period of time from being qualified to participate in any government
procurement activity in the event it violates any of the conditions required in the guidelines issued by the GPPB. BSD must be notarized,
dry sealed with documentary stamps. The BSD shall be submitted to the DPWH as a form of bid security and shall be enforced when the
bidder commits any act resulting to the forfeiture of Bid Security.
 DEPARTMENT OF PUBLIC WORKS AND HIGHWAYS (DPWH)

CONTRACT ID : 22GEG0013
CONTRACT NAME : Supply/Delivery of Spare Parts for use in various Maintenance
Equipment,
CONTRACT LOCATION : DPWH - Palawan 3rd DEO, Puerto Princesa City, Palawan

DELIVERY SCHEDULE OF REQUIREMENTS

Delivered,
Description Quantity Unit
Weeks/Months

SPARE PARTS FOR USE IN

SPCL 1 VARIOUS MAINTENANCE
EQUIPMENTS
I.A Hino Dump Truck, DPWH No. H3 - 6613

Tires 11x22.50 Tubeless 6.00 pcs

Battery, 3SMF, 12V, Heavy Duty 2.00 pcs
Oil Filter, C-1314 2.00 pcs
I.B Hino Dump Truck, DPWH No. H3 - 6696

Tires 11x22.50 Tubeless 6.00 pcs

Battery, 3SMF, 12V, Heavy Duty 2.00 pcs
Oil Filter, C-1314 2.00 pcs
I.C MITSUBISHI L-300 DPWH No. H1-6348

Tires 185 R14 Tubeless 4.00 pcs

Battery, 3SMF, 12V, Heavy Duty 1.00 pcs

I.D MITSUBISHI Pick-up, DPWH No. H1-7630

Compressor 1.00 assy

Condenser 1.00 assy

Brake Pad 1.00 set

Brake Shoe 1.00 set

Oil Filter 1.00 pc

Fuel Filter 1.00 pc

Alternator 1.00 assy

I.E MITSUBISHI Pick-up, DPWH No. H1-7631

Tires 245/65 R17 Tubeless 4.00 pcs

Battery, 3SMF, 12V, Heavy Duty 1.00 pcs

Oil Filter, C-1312 2.00 pcs

I.F TOYOTA Prado, DPWH No. H1-4376

Tires 205 R16 4.00 pcs

Battery, 3SMF, 12V, Heavy Duty 1.00 pcs

I.G Marking Remover, DPWH No. Z15R-19

Tires 16x6.5-8 4.00 pcs

 DEPARTMENT OF PUBLIC WORKS AND HIGHWAYS (DPWH)

CONTRACT ID : 22GEG0013
CONTRACT NAME : Supply/Delivery of Spare Parts for use in various Maintenance
Equipment,
CONTRACT LOCATION : DPWH - Palawan 3rd DEO, Puerto Princesa City, Palawan

DELIVERY SCHEDULE OF REQUIREMENTS

Delivered,
Description Quantity Unit
Weeks/Months

I.H GRASS CUTTER (15 UNITS) KAWASAKI TD40

Carburator 15.00 pcs

Piston 15.00 pcs

Piston Ring 15.00 pcs

Clutch Lining 15.00 pcs

Spark Plug 30.00 pcs

Recoil Starter Assy 10.00 pcs

Block 5.00 pcs

I.I MITSUBISHI Pick-up, DPWH No. H1-7627

Tires 245/65 R17 Tubeless 4.00 pcs

Battery, 3SMF, 12V, Heavy Duty 1.00 pcs

(Signature over Printed Name of Authorized Representative)

(Designation)

(Name of Bidder)

DPWH –G&S-17 – The Schedule of Requirements shall indicate the delivery date of the goods and services to the project site expressed as
weeks/months and shall be consistent with the dates specified in the Bidding Documents.
 DEPARTMENT OF PUBLIC WORKS AND HIGHWAYS (DPWH)

CONTRACT ID : 22GEG0013
CONTRACT NAME : Supply/Delivery of Spare Parts for use in various Maintenance
Equipment,
CONTRACT LOCATION : DPWH - Palawan 3rd DEO, Puerto Princesa City, Palawan

TECHNICAL SPECIFICATIONS PROPOSAL

Bidder’s Specification/Statement of Compliance
Item Specification (Specify Brand Name of Offered Product/s)

[Bidders must state here either “ Comply” or “ Not Comply” against

each of the individual parameters of each Specification stating the
corresponding performance parameter of the equipment offered.
Statements of “Comply” or “Not Comply” must be supported by evidence in
a Bidders Bid and cross-referenced to that evidence. Evidence shall be in
the form of manufacturer’s un-amended sales literature, unconditional
statements of specification and compliance issued by the manufacturer,
samples, independent test data etc., as appropriate. A statement that is
not supported by evidence or is subsequently found to be contradicted by
the evidence presented will render the Bid under evaluation liable for
rejection. A statement either in the Bidder's statement of compliance or
the supporting evidence that is found to be false either during Bid
evaluation, post-qualification or the execution of the Contract may be
regarded as fraudulent and render the Bidder or supplier liable for
prosecution subject to the applicable laws and issuances.]

SPARE PARTS FOR USE IN VARIOUS

SPCL 1
MAINTENANCE EQUIPMENTS

I.A Hino Dump Truck, DPWH No. H3 - 6613

Tires 11x22.50 Tubeless
Battery, 3SMF, 12V, Heavy Duty
Oil Filter, C-1314

I.B Hino Dump Truck, DPWH No. H3 - 6696

Tires 11x22.50 Tubeless
Battery, 3SMF, 12V, Heavy Duty
Oil Filter, C-1314
I.C MITSUBISHI L-300 DPWH No. H1-6348
Tires 185 R14 Tubeless
Battery, 3SMF, 12V, Heavy Duty

I.D MITSUBISHI Pick-up, DPWH No. H1-7630

Compressor
Condenser
Brake Pad
Brake Shoe
Oil Filter
Fuel Filter
Alternator
I.E MITSUBISHI Pick-up, DPWH No. H1-7631
Tires 245/65 R17 Tubeless
 DEPARTMENT OF PUBLIC WORKS AND HIGHWAYS (DPWH)

CONTRACT ID : 22GEG0013
CONTRACT NAME : Supply/Delivery of Spare Parts for use in various Maintenance
Equipment,
CONTRACT LOCATION : DPWH - Palawan 3rd DEO, Puerto Princesa City, Palawan

TECHNICAL SPECIFICATIONS PROPOSAL

Bidder’s Specification/Statement of Compliance
Item Specification (Specify Brand Name of Offered Product/s)

Battery, 3SMF, 12V, Heavy Duty

Oil Filter, C-1312
I.F TOYOTA Prado, DPWH No. H1-4376
Tires 205 R16
Battery, 3SMF, 12V, Heavy Duty
I.G Marking Remover, DPWH No. Z15R-19
Tires 16x6.5-8

I.H GRASS CUTTER (15 UNITS) KAWASAKI TD40

Carburator
Piston
Piston Ring
Clutch Lining
Spark Plug
Recoil Starter Assy
Block

I.I MITSUBISHI Pick-up, DPWH No. H1-7627

Tires 245/65 R17 Tubeless
Battery, 3SMF, 12V, Heavy Duty

(Name of Bidder)

(Signature over Printed Name of Authorized Representative)

(Designation)

PWH –G&S-16 – The Technical Specification Proposal shall contain the minimum requirements or specifications to meet the needs of the
DPWH. The bidder must state his/her own specifications and statement of compliance specifying the brand name of the offered product/s
and supported by evidence in the form of manufacturer’s un-amended sales literature, unconditional statements of specification and
compliance issued by the manufacturer, samples, Independent test data, etc, as appropriate. A statement that is not supported by evidence
or is subsequently found to be contradicted by the evidence presented will render the Bid under evaluation liable for rejection.
 Omnibus Sworn Statement

REPUBLIC OF THE PHILIPPINES )

CITY/MUNICIPALITY OF ______ ) S.S.

AFFIDAVIT

I, __________________________________________ of legal age, Married, Filipino, and residing at

___________________________________________________, after having been duly sworn in accordance
with law, do hereby depose and state that:

1. I am the sole proprietor of __________________________________________ with office address

at ____________________________________________________;

[If a partnership, corporation, cooperative, or joint venture:] I am the duly authorized and
designated representative of [Name of Bidder] with office address at [address of Bidder];

2. As the owner and sole proprietor of______________________________________, I have full

power and authority to do, execute and perform any all acts necessary to represent it in the
bidding for ____________________________________________
____________________________________________________________________
of the DPWH-Palawan 3rd District Engineering Office, Puerto Princesa City;

3. _______________________________________________ is not “blacklisted” or barred from

bidding by the Government of the Philippines or any of its agencies, offices, corporations, or Local
Government Units, foreign government/foreign or international financing institution whose
blacklisting rules have been recognized by the Government Procurement Policy Board;

4. Each of the documents submitted in satisfaction of the bidding requirements is an authentic copy of
the original, complete, and all statements and information provided therein are true and correct;

5. _____________________________________________ is authorizing the Head of the Procuring

Entity or its duly authorized representative(s) to verify all the documents submitted;

6. I am not related to the Head of the Procuring Entity. Members of the Bids and Awards Committee
(BAC), the Technical Working Group, and the BAC Secretariat, the Head of the Project Management
Office of the end-user unit, and the project consultants by consanguinity or affinity up to the third
degree;

7. ________________________________________________ complies with existing labor laws and

standard; and

8. ________________________________________________ is aware of and has undertaken the

following responsibilities as a Bidder;

a. Carefully examining all of the Bidding Documents;

b. Acknowledge all conditions, local or otherwise, affecting the implementation of the Contract;
c. Made an estimate of the facilities available and needed for the contract to be bid, if any; and
d. Inquire or secure Supplemental/Bid Bulletin(s) issued for ____________________________
_________________________________________________________________

9. ________________________________________________ did not give or pay directly or indirectly,

any commission, amount, fee or any form of consideration, pecuniary or otherwise, to any person
or official, personnel or representative of the government in relation to any procurement project or
activity.
 Omnibus Sworn Statement

IN WITHNESS WHEREOF, I have hereunto set my hand this ______ day of ____________, 2022 at
_______________________________________, Philippines.

_______________________________________
Bidder’s Representative/Authorized Signatory

SUBSCRIBED AND SWORN to before me this _____ day of ________________2022,

at_____________________________, Philippines, Affiant/s is/are personally known to me and was/were
identified by me through competent evidence of identify as defined in the 2004 Rules on Notarial Practice
(A.M. No, 02-8-13-SC). Affiant/s exhibited to me his/her Tax Identification No.
_________________________, with his/her photograph and signature appearing thereon, with No.
__________________________ an his/her Community Tax Certificate No. ___________________ issued on
_________________ at _______________________________. Witness my hand and seal this ____ day of
_____________________________,2022.

(Notary Public
Until 31 December _________
PTR No. __________________
Issued at _________________
Issued on _________________
TIN No. __________________
Doc. No. ________
Page No. ________
Book No. _______
Series of ________

DPWH –G&S-18 – The Omnibus Sworn Statement is a written undertaking issued by the prospective bidder or its duly authorized
representative that its is not “blacklisted” or barred from bidding by the government each of the documents submitted is an authentic
copy of the original, complete, and all statements provided are true and correct, it is authorizing the Head of the Procuring Entity or his
duly authorized representative(s) to verify all the documents submitted; the signatory is the duly authorized re4presentative of the
prospective bidder, it complies with the disclosure provision under Section 47 of RA 9184 in relation to the provisions of RA 3019; the
responsibilities of a bidder provided in the PBDs; existing labor laws and standards; it did not give or pay any amount of any form of
consideration, to any person or official, personnel or representative of the government in relation to any procurement or activity.