Contractor Prequalification Form

Revision Control No. - R0

Date :
Document No- FM-CON-019
Details to be filled by Contractor
1 Name of Company

i Head Office address

ii Phone

iii Fax no

iv Website

v Regional Offices, if any.

vi Phone

vii Fax

2 Type of company (Proprietrship/ Pvt Ltd/LTD)

3 Type of works performed

Geographical zones/ States where in works can

4
be carried out

5 Years in business

6 Associated companies if any

Page 1 of 9
 Contractor Prequalification Form
Revision Control No. - R0

Date :
Document No- FM-CON-019

Whether Associated with RIL in the past

7
(If Yes , please give Vendor Code)

8 Plant & Equipment(List to be attached)

9 Quality System (ISO Certification)

10 Legal

i Has your firm ever failed to complete the contract?

Are there any judgments, claims, arbitration

ii proceedings or suits pending or outstanding against
the company or its Officers?
Have the firm filed any law suits or requested
iii arbitration with regard to construction contracts in the
last (5) five years?
Are you now, or have you ever been, involved in any
iv
bankruptcy or reorganization proceedings?

12 Present Work load Details

Total Work Order Value under Execution (in Rupees

i
lakhs)
ii Value of Unexecuted Work (in Rupees lakhs)

Page 2 of 9
 Contractor Prequalification Form
Revision Control No. - R0

Date :
Document No- FM-CON-019
13 Financials

i. Turnover (Income) (in Rupees lakhs)

2020-2021

2019-2020

2018-2019

Highest Value of Wo executed so far (Rs)- Copy of

ii
WO to be given by Contractor

Certified Copy of Balance Sheet for last 2 years

iii
(To be attached)

iv Statutory Tax Registration Numbers

State & GST NO

PAN No.

Service Tax No.

ESIC NO

PF No

14 Contractor Organogram of HO & Site

15 Safety System (ISO Certification)-If Any

16 Quality Assurance Plan of Firm

17 Corporate Safety Plan-if Any

18 List of Major Projects(Completed)

A Name of Project
Location
Contract Sum (In Lacs)
Contract Period (In Months)
Year Of Completition
Contact person (Name, Designation, Email id and
Mobile Number)

B Name of Project
Location

Page 3 of 9
 Contractor Prequalification Form
Revision Control No. - R0

Date :
Document No- FM-CON-019
Contract Sum (In Lacs)
Contract Period (In Months)
Year Of Completition
Contact person (Name, Designation, Email id and
Mobile Number)

C Name of Project
Location
Contract Sum (In Lacs)
Contract Period (In Months)
Year Of Completition
Contact person (Name, Designation, Email id and
Mobile Number)

List of Work performed to be filled for entering more de

Contract Engineer
Prepared by

Page 4 of 9
 CHECK LIST FOR REGISTRATION

Tick Mark to Ensure

Sr. No. Description the submission of
following attachments

A Contractor Registration Form( Attachment)

1 Form-1 : List of Plant & equipment

2 Form-2 : List of technical personnel

3 Form-3 : List of Works in hand including certificates.

4 Form-4 : List of Works completed including certificates

Copy of Company's System Procedure being followed
5
(Quality/Safety/Environment issues)
6 Bank Solvency certificate

7 Credit limit certificate of Bank

8 Income tax clearance certificate

9 Sales tax registration certificate

10 Organisation chart of company

COVERING CHECKLIST
 Attachment to Contractor Registration Form - 01

Name of the Organization : Sheet ______ of ________

List of Plant and Equipments Owned

Deployment (Tick as Depreciated Value

Sl.No Type of Machinery Make/ Capacity Year of Manufacture Quantity in Units
applicable) as on date

Available Engaged

Signature of Contractor
Company Seal
Attachment 01
 Attachment to Contractor Registration Form - 02

Sheet ___ of ___

Name of the Organization :
List of Technical Personnel
Total Experience in
Sl.No Name Qualification Designation
years

Technicians & Skilled Workers

Available in Company's Roll (In Deployment Strength (In Total Deployment (In
Sl.No Category
Nos.) Nos.) Nos.)
A B A+B
1 Carpenters
2 Bar Benders
3 Mason
4 Plumber
5 Welders
6 Gas Cutters
7 Fitter
8 Forman
9 Electrician
10 Mechanic
11 Operators
12 Divers
13 Drivers
Other Categories (if applicable)

Signature of Contractor
Company Seal
Attachment 02
 Attachment to Contractor Registration Form - 3

Sheet _____ of _______

Name of the Organization :

List of Works In Hand

Period Working As

Total Value of % of Completion

Contact Telephone Scheduled Finish Contractor directly Subcontractor of (Financial)
Sl.No Name of the Project Name of the Client Major Items of work your Work in Rs. Start Date
Numbers of the Client Date under Client Main Contractor
Lacs

(Tick as applicable)

Signature of Contractor
Company Seal
Attachment 03
 Attachment to Contractor Registration Form - 4

Sheet ______ of _________

Name of the Organisation:

List of Works Completed in the Last 3 Years

Contact Telephone Value of Work in Rs. Scheduled Finish Actual Finish

Sl.No Name of the Project Name of the Client Major Items of work* Start Date
Numbers of the Client Lacs Date Date

Note : 1. If Actual finish date is beyond the Schedule Finish Date, please give reasons for the delay

Note : 2. Attach relevant completion certicates document for works in previous 3 years.
* Indicate Activity Carriedout Type( viz : Nature of Work Executed Excavation, Concreting,Reinforcement, Shuttering,Structural, Plumbi

Signature of Contractor
Company Seal
Attachment 04