Date: 06th /06/2023

ANNEX A: FORM A1 APPLICATION SUBMISSION SHEET

Secretary Contracts Committee

Yumbe district local government
P.O.Box 1 Yumbe

REF NO. WORKS/02

We, the undersigned declare that:

a. We have examined and have no reservations to the Bidding document,
including addenda No. N/A
We offer to execute in conformity with the Biding Document and in accordance
with, the completion schedule specified in the statement of the Bidding document,
the following work for prequalification for works (construction of VIP latrine)

B The total price of our Bid, excluding any discounts offered in.item (e) below,
is:N/A
.The advance payment (which shall be paid in the same currencies and percentages
as the contract price) required is:
Bid ,address to Secretary Contracts Committee
Yumbe district local government
P.O.Box 1 Yumbe

Date of Bid: 06/06/2023

Reference No. WORKS/02

Subject of
procurement prequalification for works (construction of VIP latrine)
a. The discounts offered and the methodologies for their application are:
Unconditional discounts if our Bid is accepted, the following discounts shall
apply Methodology of application of the unconditional discounts. The
unconditional discount shall be applied using the following methods:
Conditional discounts. If our Bids for more than one lot are accept, the
following discounts shall apply methodology of application of the following
discounts.
b. Our Bid shall be valid for a period of 90 working days from the date fixed
for the submission deadline in accordance with the Bidding Document, ant it
expiration of that period;
c. If our Bid is accepted, we commit to obtain a performance security .in
accordance with the Bidding Document in the amount 0f 10% for the due
performance of the contract;
d. We, including any subcontractors or providers for any part of the contact
resulting from this procurement process, are eligible to participate in public
procurement in accordance with ITB Clause 4.1;
e. We, including any subcontractors or providers for any part of the contact, has
nationals from eligible countries Uganda
f. We, undertake to abide by the code of ethical conduct for Bidders and
resulting contact.
g. We, accept the appointment of be N/A as the adjudicator, and propose
instead that N/A be appointed as adjudicator, whose daily fees and
biographical data are attached.
h. We are not participating, as Bidder, in more than one Bid in this bidding
process, other than alternative Bids in accordance with the Bidding
Document;
i. We do not have any conflict of interest not participated in the preparation of
the original statement of requirements for the procurement and Disposal
Entity;
a. We, our affiliates or subsidiaries, including any subcontractors for any
part of the contact, has not been suspended by the public procurement
and Disposal of Public Assets Authority in Uganda from participating in
public procurement;
j. The following commissions, gratuities, or fees have been paid or are to be
with respect to the biding processes or execution of the contact:

Name of recipient Address Reason Amount/

Currency
Yumbe District P.O.Box 1 Yumbe Bid fee 60,000
Local Government

k. We understand that this Bid, together with your written acceptance thereof
included in your letter of Bid acceptance, shall constitute a binding contact
between us, until a formal contact if prepared and executed.
l. We understand that you are not bound to accept the lowest bid or any other
bid that you may receive.

Signed: ...........................................
Name: Mr. Ocile Patrick
In the Capacity of: Managing Director
 Date: 06th /06/2023

ANNEX A: FORM A1 APPLICATION SUBMISSION SHEET

Secretary Contracts Committee

Yumbe district local government
P.O.Box 1 Yumbe

REF NO. D. FRAMEWORK CONTRACTS

We, the undersigned declare that:

b. We have examined and have no reservations to the Bidding document,
including addenda No. N/A
We offer to execute in conformity with the Biding Document and in accordance
with, the completion schedule specified in the statement of the Bidding document,
the following work for prequalification for framework contracts (supply of
office stationery and consumables)

B The total price of our Bid, excluding any discounts offered in.item (e) below,
is:N/A
.The advance payment (which shall be paid in the same currencies and percentages
as the contract price) required is:
Bid ,address to Secretary Contracts Committee
Yumbe district local government
P.O.Box 1 Yumbe

Date of Bid: 06/06/2023

Reference No.
D.FRAMEWORK CONTRACTS
Subject of prequalification for framework contracts (supply of
procurement office stationery and consumables)
m. The discounts offered and the methodologies for their application are:
Unconditional discounts if our Bid is accepted, the following discounts shall
apply Methodology of application of the unconditional discounts. The
unconditional discount shall be applied using the following methods:
Conditional discounts. If our Bids for more than one lot are accept, the
following discounts shall apply methodology of application of the following
discounts.
n. Our Bid shall be valid for a period of 90 working days from the date fixed
for the submission deadline in accordance with the Bidding Document, ant it
expiration of that period;
o. If our Bid is accepted, we commit to obtain a performance security .in
accordance with the Bidding Document in the amount 0f 10% for the due
performance of the contract;
p. We, including any subcontractors or providers for any part of the contact
resulting from this procurement process, are eligible to participate in public
procurement in accordance with ITB Clause 4.1;
q. We, including any subcontractors or providers for any part of the contact, has
nationals from eligible countries Uganda
r. We, undertake to abide by the code of ethical conduct for Bidders and
resulting contact.
s. We, accept the appointment of be N/A as the adjudicator, and propose
instead that N/A be appointed as adjudicator, whose daily fees and
biographical data are attached.
t. We are not participating, as Bidder, in more than one Bid in this bidding
process, other than alternative Bids in accordance with the Bidding
Document;
u. We do not have any conflict of interest not participated in the preparation of
the original statement of requirements for the procurement and Disposal
Entity;
a. We, our affiliates or subsidiaries, including any subcontractors for any
part of the contact, has not been suspended by the public procurement
and Disposal of Public Assets Authority in Uganda from participating in
public procurement;
v. The following commissions, gratuities, or fees have been paid or are to be
with respect to the biding processes or execution of the contact:

Name of recipient Address Reason Amount/

Currency
Yumbe District Local P.O.Box 1 yumbe Bid fee 100,000
Government

w. We understand that this Bid, together with your written acceptance thereof
included in your letter of Bid acceptance, shall constitute a binding contact
between us, until a formal contact if prepared and executed.
x. We understand that you are not bound to accept the lowest bid or any other
bid that you may receive.

Signed: ...........................................
Name: Mr. Ocile Patrick
In the Capacity of: Managing Director