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G) Appendix G-SubcontractorRequestAuthorization Form

This document is a request form for subcontract authorization from a contractor to an oil company. It includes: 1) Details of the proposed subcontractor, scope of work, value, and timeline. 2) Representations from the contractor that the subcontractor meets requirements, there is no conflict of interest, and the subcontractor's financial statements show no issues. 3) An authorization section for the oil company to approve or deny the subcontract request based on vetting of the subcontractor.

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Cesar Augusto Arias Castro
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222 views2 pages

G) Appendix G-SubcontractorRequestAuthorization Form

This document is a request form for subcontract authorization from a contractor to an oil company. It includes: 1) Details of the proposed subcontractor, scope of work, value, and timeline. 2) Representations from the contractor that the subcontractor meets requirements, there is no conflict of interest, and the subcontractor's financial statements show no issues. 3) An authorization section for the oil company to approve or deny the subcontract request based on vetting of the subcontractor.

Uploaded by

Cesar Augusto Arias Castro
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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“REQUEST FOR SUBCONTRACT AUTHORISATION” FORM

TENDER/CONTRACT NUMBER:
SCOPE OF WORK:

Kind attention to: Eni COMPANY’s name

The undersigned Enterprise (CONTRACTOR)


____________________________________________________
with registered office and fiscal domicile in ________________________________________________
Registration in the Companies Register and tax code ________________________________________
VAT number ________________________________________________________________________

REQUESTS

authorization to subcontract the activities described herein below to the following subcontractor [or
enclosed such information with an Annex “List of subcontractors”]:

Subcontractor Name: __________________________________________________________________


Registered Office: _____________________________________________________________________
Tax Code/VAT Number:_________________________________________________________________
Number of Registration with CCIAA:________________________________________________________
Description of activities to be subcontracted:_________________________________________________
____________________________________________________________________________________
Value:_______________________________________________________________________________
Activities Commencement/Completion Dates: _______________________________________________

AND TO THIS END REPRESENTS

a) that the subcontractor meets the requirements under the CONTRACT and it is not included in the
“Reference List” 1 for the activities which entail the risk of commitment of transnational crimes and/or
crimes for purposes of terrorism or subvention of the democratic order, as well as in the lists imposing
limits or prohibitions to the performance of the subcontractor’s activities;

1 Reference Lists: means the lists posted on the following websites listed below and any other similar list which may be applicable
locally:
https://www.un.org/sc/suborg/en/sanctions/un-sc-consolidated-list
http://eeas.europa.eu/cfsp/sanctions/consol-list/index_en.htm
http://www.treasury.gov/resource-center/sanctions/SDN-List/Pages/default.aspx

b) that no form of mutual control exists between undersigned Enterprise and the subcontractor;
or, alternatively,
that a form of mutual control exists between undersigned Enterprise and the subcontractor (specify
the subcontractor and the type of control);

c) that no conflict of interest, even a potential one, exists between the subcontractor and the COMPANY
or, alternatively,
that the following situation of conflict of interest exists (specify the exact situation of conflict of
interest, even a potential one, between the subcontractor and the COMPANY)
________________________________________________________________________________
________________________________________________________________________________

d) that the subcontractor’s financial statements for the last three (3) financial years show no criticality in
terms of financial standing of the subcontractor.

We understand and acknowledge that:

 the submission of a declaration resulting to be irregular, false or incomplete, in relation to points above
will be grounds for (i) termination of the CONTRACT and/or (ii) exclusion from the qualification and/or
tender process, subject to any other sanction and legal consequences;
 we undertake to communicate in due time any change or update to the representations provided above;

ANNEXES:

Request for subcontract authorization Form_ English Law


1) the “Compliance Form” attached to the Invitation To Tenderers, signed by subcontractor
2) A document issued by an authorized official body/agency certifying that subcontractor fulfils its
obligations relating to the payment of social security contributions in accordance with the legislation of
the state in which subcontractor is established.
3) Draft copy of the subcontract agreement (if requested by COMPANY)
4) Health and Safety documentation indicated in the CONTRACT 6) (If the Enterprise is not included in
the Vendor List qualified by Eni)
Health and Safety documentation, issued on headed paper of the Enterprise and signed by the Employer,
having the following content:
a) General data (company details, organization, number of employees and production units);
b) Assessment of the risks, and relevant assessment criteria, for all activities carried out (and with
details regarding the assessment of risks connected with the activities concerned), in compliance
with the provisions of the applicable legislation on protection of health and safety in the workplace;
c) Plan or evidence that training and information on the health and safety aspects is being given to
the personnel (with details for that relating to the activities concerned);
d) Statistical data on accidents occurring over the last five years (number and seriousness index).
5) (If the Enterprise is not included in the Vendor List qualified by Eni)
List of references regarding the specialization/product group concerned
6) Other documents (to be specified)

Place and date………………………………………………………..

………………………………………………………………
(stamp and signature of the Enterprise (CONTRACTOR))

---------------------------------------------------------------------------------------------------------------------

AUTHORISATION TO SUBCONTRACT BY COMPANY

With reference to Your request for subcontract authorization as above and Your enclosed representations
dated…………..., having verified the subcontractor’s representations that the subcontractor [or those
subcontractors as listed and approved in the Annex “List of subcontractors”] (i) meets general
requirements, the ethical requirements, the obligations relating to the payment of social security
contributions, financial stability requirements, (ii) has the technical and professional capability required
under the Contract and applicable law, and (iii) meets the requirements for subcontract authorization
provided in the Contract (including, where applicable, the requirements laid down by the Antimafia
legislation in force),

WE AUTHORISE

the subcontract requested as aforesaid, according to the terms and characteristics indicated therein.

…………………………………………date, …………………….………………………………..place

(signature and stamp of the COMPANY’s Contract Administrator or other authorized officer)

Request for subcontract authorization Form_ English Law

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