S Karnataka H,*+htl$, Office Circle Kankanady Mangalore -5750O2 Regd. & Head P. B. No.599, Mahaveera Phone :0824-2228222Fax:0824-2225589 E-mail :[email protected] Web site:www.karnatakabank.com CIN :185110KA1924PLC001128 TREASURY & ACCOUNTS DEPARTMENT November 24,2014 Application no.LBL,/BNG/0'L/201.4-15 (No. of Pages 5) DD (for Rs.1500/- non-refundable favouring Karnataka Bank Ltd.,drawn on Mangalore) NO. With date:. DD issued Bank & Piace... APPLICATION FORM FOR EMPANELMENT OF CIVI CONTRACTORS FOR CONSTRUCTION OF BANK'S ONA{ COMMERCIAL BUILDING IN BANGALORE. {The proposed building to be constructed is at Bull Temple Road,Bangalore comprising of Basement(Car parking) +Ground + 3 Upper floors with an approximate cost of Rs.7 to 8 crore with total area of around 28,800 Sft on vacantLand of size 70 feetx 130 feet) SL DESCRIPTION PARTICULARS NO. 1 Name of the Organisation 2 Name of the Head of the Orsanisation Address J 4 5 6 7 Telephone Number Fax Number Cell number Year of Establishment Status/constitution of the firm (whether comnanv / Partnershin / oroprietarv) Name of the Directors/ Partners/ Proprietor i) ii) iii) it) v) vi) with the registrar of 8 \zVhether registered 9 companies/the registrar of Firms If yes-Registration number and date (Enclose relevant copies as proof). a) Name and address of Bankers: 0 i0 iii) ir) v) 10 11 b) Enclose solvency certiJicate from the Bankers Whether registered for sales tax purposes. If yes, number and date (Enclose relevant copies as proof). V\rhether an assessee of Income taxes? If yes, furnish Permanent Account No. (Enclose relevant copies as proof). Pagel of SIGNATURE OF THE CONTRACTOR WITH SEAL 5 DESCRIPTION SL PARTICULARS NO. 12 13 Furnish copies of-Audited Balance sheet -Audited profit & Loss account (audited) for the last 3 years. (Enclose relevant copies as proof). If you are registered in the panel of other organizattons/Statutory bodies such as CPWD.PWD, MES, Banks etc, furnish their names, category and date of 14 15 1.6 17 registration with copies. (Enclose relevant copies as proof). Detailed description and value of works executed in the past. -For Banks -For others (Enclose relevant copies as proof). Specify the maximum value of work executed in a year (enclose relevant copies as proofl. Furnish the names of three responsible i) persons who will be in a position to ii) certify about the quality as well as past iii) performance of Organisation along with contact numbers Furnish additional information in Annexure L,2 and 3 Note: 1) Where copies are required to be furnished, they are to be certified copies by the concerned agencies or a Government officer. 2) Filied above application in seaied cover super scribing " Applications for empanelment of Civil Contractors" shall be submitted to the under signed on or before 15/12/2014 durrng office hours. 3) The right to reject any or all the application without assigning any reasons is reserved with the undersigned & Bank reserves the right to accept, negotiate, reject or to relax the qualifying requirement, if necessary ,in its own interest and the decision of the Bank in this regard is final. Place: Date: SIGNATURE OF THE CONTRACTOR WITH SEAL -sdDEPUTY GENERAL MANAGER THE KARNATAKA BANK LIMITED TREASURY & ACCOUNTS DEPARTMENT HEAD OFFICE, P.B.NO.599, MAHAVEERA CIRCLE, KANKANADY, MANGALORE-575002 Page 2 of 5 ANNEXURE.l PARTICULARS Proiect-1 Proiect-2 Proiect-3 Proiect-4 Short description of works executed Value of project each Woks carried out (plumbing & Electrical works rt ar y to be shown in the separately same column) Rs. Commencement & Finishing date of Proiect work Name of the consultants Note: For more No. of projects separate sheet in the above format may be enclosed SIGNATURE OF THE CONTRACTOR WITH SEAL Page 3 of 5 ANNEXURE -2 KEY PERSONNEL PERMANENTLY EMPLOYED SL Name Designation Qualification Experience NO. Years Any other with the Information firm not included 1 2 a J 4 5 6 7 8 9 10 SIGNATURE OF THE CONTRACTOR WITH SEAL Page 4 of 5 ANNEXURE -3 OTHER RELEVANT INFORMATION Name SL NO. 1 Carpenters 2 Helpers J Masons 4 Electricians 5 Plumbers 6 Others No. Of Years with the firm Any other Information not included WORKSHOP FACILITIES: SI No Type Of Structure Land Area and Place Type of Facilities Total Value of Whether Owned/Leas e/Rent Workshop Rs. 1. 2 List Of Major Equipments Possession Of The Firm A) B) c) D) E) F) G) H) D r) SIGNATURE OF THE CONTRACTOR WITH SEAL Page 5 of 5
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