(Stationery of Company/Firm) (Date of Issuance)

Ms. D. D. AGUDA Head Procurement Management Department National Grid Corporation of the Philippines Ground Floor, NGCP Main Building Quezon Avenue corner BIR Road Diliman, Quezon City 1104 PHILIPPINES Gentlemen: In response to your letter of invitation, the undersigned respectfully submits our application for the following NGCP procurement requirements: a) ______________________ b) ______________________ c) ______________________ We enclose herewith the duly filled-up Accreditation Forms, statements, and documents for your evaluation and we attest that these documents are true and correct. Also attached for your reference is my authority to sign this application and for NGCP to verify all our submitted documents. In the event of changes in our legal, financial conditions, etc., we shall submit the corresponding documentation to update our application. Should you need any clarification on our application, please feel free to contact us. Very truly yours,

Signature: Name: Designation/Position: Telephone: Date:

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Accreditation Form
Registered Name of Firm Date Established

Address

Country
Note: All communications shall be sent to the above address.

Postcode

Telephone number/s E-mail Address/es

Facsimile number/s Web Site/s

Share in Ownership (%)

Majority Owner Minority Owner 1 Minority Owner 2 Minority Owner 3 Minority Owner 4

Nationality

Percentage Ownership (%)

Members of the Board/Top Officials

Nationality

Position

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CONTACTS
Name 1. Administration Position Contact Details
Tel no. Mobile no. E-mail Tel no.

2. Finance

Mobile no. E-mail Tel no.

3. Technical

Mobile no. E-mail

Company Details
1. Parent Company Name Address & Country
Number of Employees

2. 2a

Subsidiary Company Names

Address & Country

Number of Employees

2b

2c

Note: Please provide a copy of the corporate structure or indicate N/A if not applicable.

TRADE ORGANIZATIONS (membership/s)

1. Organization Expiry Date 2. Organization Expiry Date
3. Organization Expiry Date

Note: Please give details of any trade memberships/affiliations that your company holds, if any.

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Please provide the following documentary requirements: 1. Copy of Department of Trade and Industry (DTI) business name registration or SEC registration certificate issued by the Philippine Government, whichever may be appropriate, or the equivalent in the country of a foreign applicant. 2. Copy of valid and current mayors permit/municipal license issued by the Philippine Government or its equivalent in the country of a foreign applicant. 3. Copy of articles of incorporation, partnership or cooperation, whichever is applicable, including amendments thereto, if any. 4. Copy of Philippine Contractors Accreditation Board (PCAB) License of Filipino contractors and other appropriate licenses, whenever applicable. 5. Valid joint venture agreement (if applicant is a joint venture) or other similar agreements 6. Letter authorizing NGCP to verify all submitted documents

REPRESENTATIVE OFFICE IN THE PHILIPPINES (if any, for foreign company) Name of the Firm/Company

Address

Note: The facilitating contact address for communications.

Telephone number/s E-mail Address/es

Facsimile number/s Web Site/s

LIAISON COMPANY (if any) Name of the Firm/Company

Address

Telephone number/s E-mail Address/es

Facsimile number/s Web Site/s

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FINANCIAL INFORMATION
Applicant Year 1 a. Total Assets b. Total Liabilities Net Equity c. Current Assets d. Inventories e. Current Liabilities
Note: Please provide the following documentary requirements: 1. Copies of the audited financial statements of the applicant and the parent company for the last three (3) years, if applicable. If no parent company, please state N/A. 2. Copy of Taxpayers Identification Number (TIN) issued by the Bureau of Internal Revenue, Philippines for Filipino applicants.

Parent Company (if applicable) Year 3 Year 1 Year 2 Year 3

Year 2

BANK INFORMATION
Name of the Bank: Address & Tel. No.: Name of the Bank: Address & Tel. No.:

INSURANCE INFORMATION
Employers Liability Insurance All Risk Marine Cargo Insurance (Ocean and Inland) Contractors All Risk Insurance Third Party Liability Insurance Workmens Compensation Insurance

INSURANCE COMPANY

TAXPAYER CLASSIFICATION
VAT-registered contractor/supplier Non-VAT contractor/supplier Tax Exempt

Please indicate and submit proof

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COMPLETED & ON-GOING CONTRACTS SIMILAR IN NATURE FOR THE LAST 10 YEARS (FOR PROJECTS/MAJOR EQUIPMENT)
Title of Contract
1. TRANSMISSION LINES 2. SUBSTATION 3. OTHERS Notes: 1. For Transmission Lines, indicate the scope of work, the voltage level, the circuit-km., the number of steel towers and steel poles, etc. 2. For Substation, indicate the scope of work, the voltage level, the number of power circuit breakers, power transformers, associated equipment (disconnect switches, instrument transformers and surge arresters), other substation equipment, etc. 3. Use additional sheets if necessary.

Owner & Address

Date Awarded

Date Completed

Percentage Completed

Contract Amount

COMPLETED & ON-GOING CONTRACTS SIMILAR IN NATURE SUPPLIERS PRODUCT LINE FOR THE LAST 10 YEARS (FOR MRO)
Title of Contract Owner & Address Date Awarded Date Completed Percentage Completed

TO

THE

Contract Amount

1. 2. 3. OTHERS

Please provide the following documentary requirements: 1. Copies of Contracts/Purchase Orders 2. Copies of Certificates of Completion/Acceptance issued by the client 3. In case of major equipment, copies of three (3) Certificates of Satisfactory Operation for at least three (3) years issued by the client/s

Has your company had any contracts terminated in the last 3 years?

Yes / No (If yes, please give details)

Has your company suffered a deduction for liquidated and ascertained damages in respect of any contract in the last 3 years?

Yes / No (If yes, please give details)

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Has your company been blacklisted by any government agency, office or corporation (including LGUs), or has been included in the Consolidated Blacklisting Report issued by the Government Procurement & Policy Board (GPPB)?

Yes / No (If yes, please give details)

Do you have any claim/s or litigation against your organization including those that are outstanding, which relate to contracts performed?

Yes / No (If yes, please give details)

EQUIPMENT RESOURCES
Construction Equipment For Transmission Line Projects 1. Puller and Tensioner 2. Truck Trailer 3. Flat Truck 4. Dump Truck 5. 6. For Substation Projects 1. 2. 3. 4. 5. 6. 7. Equipment for other Projects Capacity Owned Leased Fabricated

Note: Please indicate the quantity of equipment in the respective boxes and provide registration or proof of ownership/contract to lease

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MANPOWER RESOURCES
Permanent Full-time Temporary/Agency/ Casual/Contractual Part-time Full-time Part-time

Management Supervisors Sales personnel Production/Technical/Engineering personnel QA/QC personnel Administrative/Support personnel Others
Note: Please state the number of staff currently directly employed by your company.

Names of Personnel available for Engineering Project (if applicable)

Designation Project Manager Electrical Engineer Civil Engineer QA/QC Engineer Safety Engineer Others Name Years of Experience Education/License

Names of safety/environment personnel

Safety personnel Environment personnel Are your officers related to any employee of NGCP within the third degree of consanguinity or affinity? Yes / No (If yes, please give details)

Do you provide training programs for your employees?

Yes / No (If yes, please give details)

Note: Please provide the resum of your technical staff including copies of professional licenses

SUB-CONTRACTOR APPRAISAL (if applicable)

Do you use Sub-Contractors? Please give details of how you assess the technical competence of the companies/individuals with whom you place contracts. How do you communicate clients requirements and instructions? Does your insurance include sub-contractors liabilities?

Please encircle
Yes No

Separate Sheet

Yes

No

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QUALITY MANAGEMENT (Please submit the following)

1. ISO 9000/9002 QMS or equivalent Quality Management 2. ISO 18000 or equivalent/health and safety programs 3. ISO 14000 or equivalent/environment programs 4. DENR permits/certifications 5. OHSAS/OSHA certificate

TRADING AND EMPLOYMENT COURT ACTIONS

1. Are there any court actions and/or industrial tribunal hearings outstanding against your organization? 2. Has your organization been involved in any court action in relation to trade with third parties or with employees and/or involved in industrial tribunals over the last 3 years? Yes / No (If yes, please give details) Yes / No (If yes, please give details)

OTHER REQUIREMENTS
1. Warranty Policy/After sales service policies and procedures Yes / No (If yes, please give details) Yes / No (If yes, please give details)

2. Insurance Policy against losses or damages

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