THE CO-OPERATIVE BANK OF KENYA LIMITED

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1 1 IMPORTANT NOTES TO SUPPLIERS (a) The purpose of this document is to assist Co-operative Bank of Kenya in the identification and evaluation of potential suppliers who may subsequently be invited to tender for the equipment in a cost effective and fast way. (b) This pre-qualification does not amount to any contractual obligation on the part of Co-operative Bank of Kenya and the bank is not obliged to invite any tenders or quotations from any or all candidates that have expressed their interest by responding to this invitation. (c) Co-operative Bank of Kenya has the right to invite open tenders for goods, works or services in any of the categories as and when required in line with the bank s policy. (d) Co-operative Bank of Kenya reserves the right to authenticate information provided herein without reverting to the participants. (e) Co-operative Bank of Kenya reserves the right to accept or reject any application without assigning any reasons for the decision. (f) Completed prequalification documents should be submitted in plain sealed envelopes clearly marked thereon Pre-qualification of Supplier 2014/2015 and the Category No of the Item applied for. The envelopes should be addressed to: The Chairman Tender Committee Co-operative Bank of Kenya Ltd P.O.Box Nairobi. and should be deposited in the Tender Box on the ground floor Co-op Trust Plaza, Upper Hill, Nairobi. (g) The closing date for the submission of applications will be 28 th February, 2014 at 4.00p.m. Applications received after the deadline will be rejected. The Bank reserves the right to accept or reject any application without assigning any reason thereof.

2 2 SECTION TO BE COMPLETED IN FULL BY SUPPLIER OFFICIAL USE ONLY 1. BUSINESS NAME: 2. PHYSICAL LOCATION OF BUSINESS PREMISES (Note that a visit to your office may be made to confirm information provided as part of tender evaluation) TOWN:.. LR. NO:.. Street:. Building: Floor:.. 3. POSTAL ADDRESS: 4. AND WEBSITE ADDRESS: 5. PRINCIPAL CONTACT PERSON(S) 6. TELEPHONE NUMBERS (for the principal contact person) Landline Mobile 7. TYPE OF COMPANY: (Private limited, Partnership, Joint Venture, Sole Proprietorship, Others etc)

3 3 8. TELEPHONE: 9. FAX NO: Mobile:. Landline: DATE OF REGISTRATION: 11. REG. CERTIFICATE NO: 12. P.I.N. NO: 13. V.A.T. REG. NO: 15. LIST OF ASSOCIATED COMPANIES: 16. SIZE OF THE ORGANIZATION IN TERMS OF THE TOTAL WORK FORCE: 17. NAMES OF DIRECTORS/PARTINERS & NATIONALITY:(may be attached or included in the company profile) 16.Brief description of goods/services that you offer: BRIEF SUMMARY OF KEY RELEVANT PERSONNEL: (may be attached or included in the company profile)

4 4 17. STATE THE AREA OF SPECIALIZATION (e.g Structured cabling, Air conditioning, General stationery, Promotional materials etc) 18. YEARS IN OPERATION 19. YEARS OF SERVICE TO CO-OPERATIVE BANK: 20. FINANCIAL INFORMATION Gross Revenue Operating Profit Total Fixed Assets Total Current Assets Total Liabilities 21. BANKERS: (Indicate the following) Please indicate Bank, Branch & Account No.) Name of the Bank: Branch:. Bank Telephone number:. 22. INSURERS: 23. LIST OF CURRENT CLIENTILE: This may be attached or included in the company profile.

5 5 24. CUSTOMER REFERENCES: (Provide contact details for 3 referees for previous/current work that is similar or the same to the one now applied for. The referees may be contacted at any given time) Is Co-operative Bank one of your referees? (If yes, provide two other referees. If no, provide 3 referees) Others (A) Organization:. Contact Name:. Position:. Telephone No.: address: Signature of the referee and Official Stamp.. (B) Organization:. Contact Name:. Position:. Telephone No.: address: Signature of the referee and Official Stamp.. (C)

6 6 Organization:. Contact Name:. Position:. Telephone No.: address: Signature of the referee and Official Stamp.. Please attach copies of LPOs, award letters or any other approved document from each of the above showing works done and their values. 25. MEMBERSHIP OF INDUSTRIAL/PROFESSIONAL BODIES: 26. PROVIDE US WITH COPIES OF THE FOLLOWING DOCUMENTS: (a) Certificate of Incorporation /Registration (b) Certificate of Registration with Ministry of Roads & Public Works (where applicable) (c) Current Trade License (d) PIN & VAT Certificates (e) Tax Compliance Certificate DECLARATION I/We have completed this form(s) accurately at the time of reply and it is agreed that all responses can be substantiated, if requested to do so. Any inaccuracy in the information filled herein will be used as grounds for removal from or termination of the qualification process. NAME: SIGNATURE: DESIGNATION:

7 7 DATE: COMPANY STAMP: