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Application for Accreditation (2)

This document is an application form for accreditation from the Bids & Awards Committee of Calatrava, Negros Occidental, Philippines. It outlines the required eligibility documents and information needed from the applicant, including business registration, permits, financial statements, and declarations regarding relationships with local government officials. The form concludes with a declaration by the applicant affirming the truthfulness of the provided information.

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8 views2 pages

Application for Accreditation (2)

This document is an application form for accreditation from the Bids & Awards Committee of Calatrava, Negros Occidental, Philippines. It outlines the required eligibility documents and information needed from the applicant, including business registration, permits, financial statements, and declarations regarding relationships with local government officials. The form concludes with a declaration by the applicant affirming the truthfulness of the provided information.

Uploaded by

tina88.artnextdoor
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOCX, PDF, TXT or read online on Scribd
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Republic of the Philippines

Province of Negros Occidental


Municipality of Calatrava
BIDS & AWARDS COMMITTEE
Tel. No. (034) 727-9486
e-mail: [email protected]

APPLICATION FOR ACCREDITATION

New ( ) Renewal ( )

1. Name of Applicant Designation


Address

2. Name of Establishment
3. Business Address
Telephone Numbers _____ ______________
e-mail address

4. Nature of Business

5. Form of Ownership _______


6. Authorized Representative _______

NAME POSITION SPECIMEN


SIGNATURE

ELIGIBILITY REQUIREMENTS:

 DTI Business Name or SEC Registration Certificate, whichever is appropriate;


 Valid & Current mayor’s Permit/Business License (place of business);
 Tax Clearance issued by the BIR Main Office & Income or Business Tax Returns pursuant
to BIR Revenue Regulations (RR) No. 3-2005 (Sec. 3.4; 4.4; and 4.5);
 BIR Registration Certification which contains the Taxpayer’s Identification Number (TIN);
 Statement of the Prospective Bidder that it is not “blacklisted” or barred from any
bidding by the Government or any if its agencies, offices, corporations or LGU’s;
 Sworn affidavit of the Bidder that it is not related to the Municipal Mayor, Members of the
BAC, TWG and Secretariat, by consanguinity or affinity up to the third civil degree;
 Letter authorizing the BAC or its duly-authorized representative to verify any or all of the
documents submitted for eligibility check;
 Certification under oath that each of the documents submitted in satisfaction of the
eligibility requirements is an authentic and original copy or is a true and faithful
reproduction of the original, complete and that all statements and information provided
therein are true and correct;
 Statement of completed government projects and/or private contracts within the
specified period including contracts awarded but not yet started;
 Statement of ongoing government projects and/or private contracts within the specified
period including contracts awarded but not yet started;
 Specification of whether or not the prospective bidder is a manufacturer, supplier or
distributor;
 Audited Financial Statements stamped “received” by the BIR or its duly-accredited and
authorized institutions for the immediate preceding calendar year showing among others
the Total Assets & Liabilities;
 Company and or business profile;
 Annual Fee of Php500.00 & Accreditation Fee of Php500.00 (Official Receipts issued by
the office of the Municipal Treasurer of Calatrava);
 Articles of Incorporation, Partnership or Cooperation, whichever is applicable, including
amendments thereto if any;
 Current/Updated License To Operate (LTO) issued by the BFAD (for suppliers of
Medicines/Medical/Dental/Laboratory supplies & equipment);
 Current DENR/PCA Permit for suppliers of rough and coco lumbers
 Current Governor’s Permit for suppliers/contractors of sand & gravel;
 Fertilizers & Pesticides Authority Permit for Fertilizers, Pesticides & Termite Control
Items;
 Bureau of Plant (for suppliers of seedlings);
 NFA License (for rice, corn, & other grain supplies);
 NTC License (for radio sets, transmitters & the likes);
 Certificate of Exclusive Distributorship (if applicable);
 Manufacturer’s Certificate (if applicable);
 Valid PCAB License Registration for the type and cost of contract to be bid;
 PHILGEPS Certification;
 NFCC Computation K =15
 Sworn Statement – Declaration of Business Interest; Letter of Intent
 Others – (Certificate of Site Inspection)

I HEREBY declare that the data furnished by me in this Application Form are true and
correct to the best of my knowledge and belief that the same have been given voluntarily
and without any fraudulent or deceitful purpose whatsoever and that I am aware that any
false statement given by me will be a ground for revocation/cancellation of my
accreditation.

Applicant’s Signature

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