invitation for pre-qualification for the participation … · pre -qualification form “2”...
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Pre-Qualification Forms 247903.doc Page 1 of 58
INVITATION FOR PRE-QUALIFICATION
FOR THE PARTICIPATION IN A TENDER
FOR THE LIGHT RAILWAY PROJECT BETWEEN
HAIFA AND NAZARETH
June 2nd
, 2020
PRE-QUALIFICATION FORMS
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Table of Contents
A. Information and Undertakings
1. The Pre-Qualification Submission Letter
2. Participation Fee Proof of Payment
3. The Members of the Participant
4. The Participating Entity
5. Experience Provider Undertaking
6. Confirmation of Merging Company
B. Professional Thresholds
7. Systems Experience
8. Signaling Experience
9. Track Experience
10. Rolling Stock Experience
11. Project Execution, Management and Organization Experience
12. Maintenance Experience
13. Operating Experience
C. Financial Thresholds
14. Financial Robustness
15. Participant’s Weighted Turnover
16. Securing External Finance for Infrastructure Projects
17. No Going Concern
D. Financial Entities
18. Private Investment Funds
19. Institutional Investors
20. Investment Entities
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PRE-QUALIFICATION FORM “1”
THE PRE-QUALIFICATION SUBMISSION LETTER
(To be completed by the Authorized Representative of the Participant (if incorporated as of the Pre-Qualification
Submission Date) or by the Authorized Representative of each Member, each on a separate form (if the Participant
is not incorporated as of the Pre-Qualification Submission Date)
(Capitalized terms shall have the meaning ascribed to them in the Invitation)
To:
The Tender Committee
Trans Israel Company
Re: Invitation for Pre-Qualification for Participation in a Tender for the Light Railway Project
between Haifa and Nazareth
(the “Invitation”)
I, _____________, the undersigned, make this affidavit on behalf of _____________, the Participant (if
the Participant is incorporated as of the Pre-Qualification Submission Date)/ the Member of the
Participant (circle the relevant option):
In response to the Invitation issued on 7 April 2020, extending an invitation to submit a Pre-Qualification
Submission, after careful review of the Invitation, declare, warranty, and represent as follows:
1. The Pre-Qualification Submission is submitted in accordance and in agreement with the terms and
provisions contained in the Invitation, after careful review thereof.
2. The Pre-Qualification Submission is accurate, complete, and up to date as of the Pre-Qualification
Submission Date, in accordance with the requirements of the Invitation.
3. The provisions of Section 9.10 (Reservation of Rights) of the Invitation are acknowledged and
accepted, and without derogating from the generality of the provisions thereof, understand that the
submission of the Pre-Qualification Submission shall not be deemed in any way to create an
obligation on the part of the Tender Committee to announce its compliance with the Pre-Qualification
Requirements; that the Tender Committee has the right to reject, as it deems appropriate, the Pre-
Qualification Submission submitted by the Participant; and that the Tender Committee has the right,
as it deems appropriate, to annul the Pre-Qualification Process and to reject all Pre-Qualification
Submissions at any time, all, in accordance with the provisions of the Invitation.
4. Incorporated hereto, and constituting an integral part of the Pre-Qualification Submission, are all Pre-
Qualification Forms, attachments, and annexes thereto, and other annexes attached to the Pre-
Qualification Submission as described herein:
Pre-Qualification Form “1” The Pre-Qualification Submission Letter
Pre-Qualification Form “2” Participation Fee Proof of Payment
Pre-Qualification Form “3” The Members of the Participant
Pre-Qualification Form “4” The Participating Entity
Pre-Qualification Form “5” Experience Provider Undertaking
Pre-Qualification Form “6” Confirmation of Merging Companies
Pre-Qualification Form “7” Systems Experience
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Pre-Qualification Form “8” Signaling Experience
Pre-Qualification Form “9” Track Experience
Pre-Qualification Form “10” Rolling Stock Experience
Pre-Qualification Form "11" Project Execution, Management and Organization Experience
Pre-Qualification Form “12” Maintenance Experience
Pre-Qualification Form “13” Operating Experience
Pre-Qualification Form “14” Financial Robustness
Pre-Qualification Form “15” Participant’s Weighted Turnover
Pre-Qualification Form “16” Securing External Finance for an Infrastructure Project
Pre-Qualification Form “17” No Going Concern
Pre-Qualification Form “18” Private Investment Fund Statement
Pre-Qualification Form “19” Institutional Investors
Pre-Qualification Form “20” Investment Entities
5. Detailed herein is information which the Participant/Member considers to be of a commercially
sensitive or confidential nature concerning the Pre-Qualification Submission [to be completed in
accordance with the provisions of Section 7.4 (Identification of Sensitive or Classified Information) of the
Invitation]:
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
6. The following Addenda and Letters of Clarification to the Pre-Qualification Documents, issued
before the Pre-Qualification Submission Date have been received and are integral parts of the Pre-
Qualification Documents:
Addendum No. _____________ Date Issued: _____________
Addendum No. _____________ Date Issued: _____________
Addendum No. _____________ Date Issued: _____________
Addendum No. _____________ Date Issued: _____________
Addendum No. _____________ Date Issued: _____________
Letter of Clarification No. _____________ Date Issued: _____________
Letter of Clarification No. _____________ Date Issued: _____________
Letter of Clarification No. _____________ Date Issued: _____________
Letter of Clarification No. _____________ Date Issued: _____________
Letter of Clarification No. _____________ Date Issued: _____________
...
[to be completed]
7. Authorized Representative(*): _________________ e-mail:_______________ address: _________
telephone number:_____________ fax number:____________.
8. The Participant/Member hereby warrants and represents that, to the best of its knowledge and after
conducting a due investigation, each of the Experience Providers complies with all applicable
requirements of the Invitation pertaining to such Experience Provider.
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(*) All Members shall appoint one Member as Authorized Representative for the Participant, in
accordance with the provisions of Section 3.7 of the Invitation.
I, ____________, the undersigned, hereby confirm that on ____________ [date], ____________[name],
Israeli I.D. number / _______[country] Passport number ____________, who is authorized to sign on
behalf of ____________, and to commit it for purposes of the above stated Pre-Qualification Form, for all
purposes and intents, appeared before me, and after being cautioned that he/she is required to state the
truth, and that if he/she fails to do so he/she shall be liable to the punishments prescribed by Law, signed
this statement in my presence.
Name: ____________
Stamp and Signature: ____________
Date: ____________
____________________
Attorney-at-Law
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PRE-QUALIFICATION FORM “2”
PARTICIPATION FEE PROOF OF PAYMENT
(The Participant is to attach a copy of the receipt for the payment of the participation fee, in accordance with
Section 2.5.6 of the Invitation)
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PRE-QUALIFICATION FORM “3”
THE MEMBERS OF THE PARTICIPANT
(To be completed by the Participant)
(Capitalized terms shall have the meaning ascribed to them in the Invitation) I, _____________, the undersigned, am making this affidavit on behalf of _____________ (name of
Participant):
The following entities shall form / have formed [circle the relevant option] the SPC constituting the
Participant which submits this Pre-Qualification Submission:
Name [Anticipated]
Holdings in
the
Participant
Relying on a
Guarantor
Serving as
Guarantor for
another Member
Financial Entity Demonstrating
Professional
Threshold
Experience
____% ☐ Yes:
___________
☐ No
☐Yes: ___________
☐ No ☐ Yes: _______
☐ No ☐ Yes: _______
☐ No
____% ☐ Yes:
___________
☐ No
☐Yes: ___________
☐ No ☐ Yes:_______
☐ No ☐ Yes: _______
☐ No
____% ☐ Yes:
___________
☐ No
☐Yes: ___________
☐ No ☐ Yes: _______
☐ No ☐ Yes: _______
☐ No
____% ☐ Yes:
___________
☐ No
☐Yes: ___________
☐ No ☐ Yes: _______
☐ No ☐ Yes: _______
☐ No
____% ☐ Yes:
___________
☐ No
☐Yes: ___________
☐ No ☐ Yes: _______
☐ No ☐ Yes: _______
☐ No
____% ☐ Yes:
___________
☐ No
☐Yes: ___________
☐ No
☐ Yes: _______
☐ No
☐ Yes: _______
☐ No
Please check as applicable:
☐ The Members listed above have already formed a legally incorporated SPC for the Participant, whose
certificate of incorporation is attached to Annex A of Pre-Qualification Form “4”.
☐ The Members listed above have not yet formed a legally incorporated SPC for the Participant but
undertake to do so by no later than the Bid Submission Date, as shall be determined in the Tender
Selection Stage Documents, should the Participant be declared an Eligible Bidder.
________________________ ________________________ Date
Stamp and Signature
I, ____________, the undersigned, hereby confirm that on ____________ [date], ____________[name],
Israeli I.D. number / _______[country] Passport number ____________, who is authorized to sign on
behalf of ____________, and to commit it for purposes of the above stated Pre-Qualification Form, for all
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purposes and intents, appeared before me, and after being cautioned that he/she is required to state the
truth, and that if he/she fails to do so he/she shall be liable to the punishments prescribed by Law, signed
this statement in my presence.
Name: ____________
Stamp and Signature: ____________
Date: ____________
____________________
Attorney-at-Law
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PRE-QUALIFICATION FORM “4”
THE PARTICIPATING ENTITY
(To be completed by each Participating Entity, each on a separate form)
(Capitalized terms shall have the meaning ascribed to them in the Invitation)
I, _____________, the undersigned, am making this affidavit on behalf of _____________ (name of
Participating Entity):
1. Name of Participating
Entity:
____________________________________________
Business Address: ____________________________________________
Phone: ____________________________________________
Facsimile: ____________________________________________
E-mail: ____________________________________________
2. Role of the Participating Entity
[check as applicable, including if
more than one role]
☐ The Participant
☐ Member of the Participant [Anticipated] Holdings in the Participant: ____%
☐ Experience Provider Relevant Pre-Qualification Requirements:
☐ Section 4.1 (Experience in the Design and Installation of
Systems)
☐ Section 4.2 (Experience in the Design and Installation of
Signaling Systems)
☐ Section 4.3 (Experience in the Design and Construction
of Track-Way)
☐ Section 4.4 (Rolling Stock Experience)
☐ Section 4.5 (Project Execution, Management and
Organization Experience)
☐ Section 4.6 (Maintenance Experience)
☐ Section 4.7 (Operation Experience)
☐ Guarantor Names of Member(s) relying on Guarantor (if applicable)
(please indicate if the Guarantor holds Means of Control in
the Member*):
1. _________________________________________
2. _________________________________________
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3. _________________________________________
4. _________________________________________
5. _________________________________________
* Please attach to Annex E hereunder, appropriate
explanation, attested to by an attorney, demonstrated by
applicable documentation, of such Control.
☐ Financial Entity Type of Financial Entity:
☐ Private Investment Fund (Section 5.6.1)
☐ Institutional Investor (Section 5.6.2)
☐ Investment Entity (Section 5.6.3)
3. Authorized Signatory
Name Title Email & Phone
_________ _________ _____________
4. Legal Status:
(check applicable)
Limited
Partnership
☐
Limited
Liability
Company
☐
General
Partnership
☐
Other
(explain)
☐
_________________________________
_________________________________
_____________________
5. Place of Incorporation
Please check as applicable:
☐ The Participating Entity is an entity incorporated under the laws of the state of Israel.
☐ The Participating Entity is a foreign entity incorporated under the laws of its domicile,
which is: ____________. Attached hereunder to Annex A of this Pre-Qualification Form are
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authenticated copies of the Participating Entity’s certificate of incorporation and articles of
association, or their equivalent within its domicile.1
☐ The Participating Entity is a foreign entity incorporated under the laws of its domicile, which
is: _________, and is registered in Israel as a Foreign Company / Foreign Partnership [circle
applicable category]. Authenticated copies of the Participating Entity’s certification of such
registration is attached hereunder to Annex B of this Pre-Qualification Form in addition to its
certificate of incorporation and articles of incorporation, attached hereunder to Annex A of this
Pre-Qualification Form, in accordance with Section 3.5.8 of the Invitation.
In accordance with Section 3.5.6 of the Invitation:
☐ If the Participating Entity is incorporated in the State of Israel or registered in Israel as a
Foreign Company as defined under the Companies Law 1999, it shall fill out the Affidavit
required pursuant to the provisions of the Public Entities Transactions Law, 1976, attached to
Annex C of this Pre-Qualification Form, and shall attach to said Annex C of this Pre-Qualification
Form, an ascertainment of regular reports of revenues to the tax assessor and the director of
V.A.T. in transactions that are taxable under the Value Added Tax Law 1975.
☐ If the Participating Entity is a Foreign Company registered in the State of Israel but which
has not conducted any activity in Israel, or if it is a Foreign Company not registered with the
Israeli Tax authorities and cannot provide such tax approvals, it shall attach to Annex D of this
Pre-Qualification Form, hereunder (1) a declaration by an independent auditor; and (2) an
affidavit of a representative of its management, testifying to its status as such and to its
consequential inability to provide such tax approvals.
6. Guarantor
If the Participating Entity is a Guarantor, it hereby requests that its own financial information, which
is included in the Pre-Qualification Submission submitted by the Participant, will be taken into
account in determination of the Participant’s compliance with the Financial Pre-Qualification
Requirements set forth in Sections 5.1 (Turnover), 5.2 (Weighted Average Operating Cash Flow) and
5.3 (Minimal Equity Required) of the Invitation, instead of the financial information of the Members
relying on the Guarantor as detailed in Section 2 above. The Guarantor shall attach to Annex E to this
Pre-Qualification Form, its proof of Guarantor Control.
7. Registration Number: ____________________________________________
Place of Registration: ____________________________________________
Date of Registration: ____________________________________________
8. Interested Parties in the
Participating Entity (as
defined in the Invitation):
____________________________________________
____________________________________________
1 Except for official and authenticated certificates of Israeli corporations submitted in Hebrew, certificates of incorporation and minutes of incorporation provided by a Participating Entity in any language other than English shall be accompanied by a translation to English and a notarized statement of translation.
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9. The Participating Entity hereby declares, warrants and represents the following:
9.1. The Participating Entity has thoroughly and carefully read the Invitation, and agrees to all of
the applicable provisions in the Invitation, and in particular to its obligations thereunder.
9.2. The information provided by the Participating Entity in this Pre-Qualification Submission is
accurate, complete and up to date as of the Pre-Qualification Submission Date, in accordance
with the requirements of the Invitation.
9.3. The Participating Entity acknowledges and accepts the provisions of Section 9.10 (Reservation
of Rights) of the Invitation, and without derogating from the generality of the provisions
thereof, understands that the submission of this Pre-Qualification Submission shall not be
deemed in any way to create an obligation on the part of the Tender Committee to announce
the Participant’s compliance (or the compliance of any of its Members, Guarantors or
Experience Providers) with the Pre-Qualification Requirements; that the Tender Committee
has the right to reject, as it deems appropriate, the Pre-Qualification Submission submitted by
the Participant; and that the Tender Committee has the right, as it deems appropriate, to annul
the Pre-Qualification Process and to reject all Pre-Qualification Submissions at any time, all in
accordance with the provisions of the Invitation.
9.4. The Participating Entity hereby warrants and represents that it complies with and satisfies all
the requirements stipulated in Sections 3.5.1-3.5.5 and Section 3.5.7 of the Invitation;
9.5. Criminal Proceedings with respect to Offences (as defined in the Invitation) [check
applicable]:
☐ The Participating Entity hereby warrants and represents that it complies with and satisfies
all of the requirements stipulated in Sections 3.5.5 of the Invitation;
☐ The Participating Entity does not comply with or satisfy the requirements stipulated in
Sections 3.5.5 of the Invitation; [describe Offences in which the Participating Entity or any
Interested Party thereof (including individuals) was convicted or indicted]
___________________________________________________________________________
___________________________________________________________________________
______________________________________________________
9.6. The Participating Entity has not, directly or indirectly, induced or solicited any other
Participating Entity to put in a false or misleading Pre-Qualification Submission, and has not
by itself, either directly or indirectly, colluded, arranged or agreed with any other Participating
Entity to secure any advantage against any other Participant, or to secure any advantage
against the Tender Committee or GoI or anyone interested in the HN LRT Project;
9.7. The Participating Entity is participating in the Pre-Qualification Process only within the Pre-
Qualification Submission to which this Pre-Qualification Form “2” is attached; and none of the
Participating Entity’s Affiliated Entities are participating in the Pre-Qualification Process other
than within the Pre-Qualification Submission to which this Pre-Qualification Form “2” is
attached;
9.8. To the best of the Participating Entity’s knowledge, and with respect to those parts of the Pre-
Qualification Submission concerned with the Participating Entity:
9.8.1. The Pre-Qualification Submission submitted by the Participant is not made in the
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interest of, or on behalf of, any undisclosed person, corporation, company, voluntary
association, partnership, trust, or unincorporated association;
9.8.2. The Pre-Qualification Submission is genuine and not collusive or misleading; and
9.8.3. All the information contained in the Pre-Qualification Submission is true, accurate,
complete and current as of the Pre-Qualification Submission Date.
I, ____________, the undersigned, hereby confirm that on ____________ [date], ____________[name],
Israeli I.D. number / _______[country] Passport number ____________, who is authorized to sign on
behalf of ____________, and to commit it for purposes of the above stated Pre-Qualification Form, for all
purposes and intents, appeared before me, and after being cautioned that he/she is required to state the
truth, and that if he/she fails to do so he/she shall be liable to the punishments prescribed by Law, signed
this statement in my presence.
Name: ____________
Stamp and Signature: ____________
Date: ____________
____________________
Attorney-at-Law
________________________ ________________________
Date Stamp and Signature
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PRE-QUALIFICATION FORM “4” - ANNEX A
Each Participating Entity shall attach hereunder authenticated copies of its Certificate of Incorporation
and of its Articles of Association hereunder.
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PRE-QUALIFICATION FORM “4” - ANNEX B
Each Participating Entity which is a foreign entity registered in Israel as a Foreign Company / Foreign
Partnership, shall attach hereunder authenticated copies of its certification of registration as such.
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PRE-QUALIFICATION FORM “4” - ANNEX C
Each Participating Entity who is incorporated in the State of Israel or registered in the State of Israel as
a Foreign Company, as defined under the Companies Law 1999, shall complete the following Affidavit,
as required pursuant to the Public Entities Transactions Law 1976, and shall attach hereto an
ascertainment of regular reports or revenues to the tax assessor and the director of V.A.T. in transactions
that are taxable under the Value Added Tax Law 1975.
Affidavit
In accordance with the Public Entities Transactions Law, 5736-1976 (hereinafter: "Public
Entities Transactions Law"):
I, the undersigned______________ [Affiant's Full Name], bearer of __________ [Country]
passport/Israeli I.D. no. ____________, having been forewarned that I am to declare the truth
and that I will be subject to the penalties imposed by law if I do not do so, hereby affirm in
writing as follows:
1. I am authorized to make this Affidavit on behalf of _______________ [Name of the
Participating Entity/ Affiliates*] (hereinafter: the "Company") by the authorization of
the Company; (*Affiliate for the purpose of this Affidavit, shall have the meaning
ascribed thereto in the Public Entities Transactions Law).
2. Neither the Company, nor its Affiliates, (as applicable) have been convicted prior to the
Pre-Qualification Submission Date, of more than two (2) peremptory judgments for
felonies as they are defined under the Foreign Workers (Prohibition of Unlawful
Employments and Assurance of Fair Conditions) Law, 5751-1991; and if convicted
in peremptory judgments of more than two felonies under such law - the last conviction
was not within one (1) year prior to the Bid Submission Date;
3. Neither the Company, nor its affiliates, (as applicable) have been convicted prior to the
Pre-Qualification Submission Date, of more than two (2) peremptory judgments for
felonies as they are defined under the Minimum Wage Law, 5747-1987; and if
convicted in a peremptory judgment of more than two (2) felonies under such law - the
last conviction was not within one (1) year prior to the Pre-Qualification Submission
Date.
4. As of the Pre-Qualification Submission Date, the Company, either:
a. is not subject to the stipulations of Section 9 to the Equal Rights for People
with Disabilities Law, 5758-1998; or
b. (i) is subject to the stipulations of Section 9 to the Equal Rights for People
with Disabilities Law, 5758-1998 and fully complies with such Law.
(ii) In the event the Company employs at least 100 employees, the Company
undertakes to refer to the general manager of the Ministry of Labor,
Welfare and Social Services for the purpose of affirming its compliance
with Section 9 to the Equal Rights for People with Disabilities Law,
5758-1998, and obtaining any applicable instructions therefrom.
(iii) If the Company has made the commitment under Section 4(b)(ii) with
respect to previous engagements, the Company declares that it has
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referred to the general manager of the Ministry of Labor, Welfare and
Social Services as required and has complied with all instructions
received accordingly therefrom, if such were given.
(iv) The Company undertakes to deliver a copy of this affidavit to the general
manager of the Ministry of Labor, Welfare and Social Services within 30
days of the Signature Date of the Agreement, should such be made.
5. This is my name, this is my signature and the content of the Affidavit above is true.
________________________ ________________________
Date
Stamp and Signature
I, ____________, the undersigned, hereby confirm that on ____________ [date], ____________[name], Israeli
I.D. number / _______[country] Passport number ____________, who is authorized to sign on behalf of
____________, and to commit it for purposes of the above stated Pre-Qualification Form, for all purposes and
intents, appeared before me, and after being cautioned that he/she is required to state the truth, and that if he/she
fails to do so he/she shall be liable to the punishments prescribed by Law, signed this statement in my presence.
Name: ____________
Stamp and Signature: ____________
Date: ____________
____________________
Attorney-at-Law
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PRE-QUALIFICATION FORM “4” - ANNEX D Each Participating Entity who is either a Foreign Company registered in the State of Israel but
has not conducted any activity in Israel, or a Foreign Company not registered with the Israeli
Tax authorities and thus cannot provide tax approvals, shall attach hereto:
1. A declaration by an independent auditor; and
2. An affidavit of a representative of its management, testifying to its status as a Foreign
Company and to its consequential inability to provide tax approvals pursuant to Israeli
Law.
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PRE-QUALIFICATION FORM “4” - ANNEX E
PROOF OF GUARANTOR CONTROL
Each Guarantor shall attach appropriate explanation, attested to by an attorney, demonstrated by
applicable documentation, e.g. reports issued by the Registrar of Companies, organizational
charts, articles of association, etc. which prove and demonstrate its Control of the Member(s)
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PRE-QUALIFICATION FORM “5”
EXPERIENCE PROVIDER UNDERTAKING
(To be completed by the Experience Provider for the demonstration of compliance with the Professional
Pre-Qualification Requirements in Section 4 of the Invitation (to be filled out separately by each
Experience Provider))
(Capitalized terms shall have the meaning ascribed to them in the Invitation)
I, the undersigned, hereby issue this Undertaking on behalf of __ regarding its role as
Experience Provider (the “Experience Provider”) in its performance of ________ (the
“Project”) presented in demonstration of compliance with the Professional Pre-Qualification
Requirements in Section 4.__, as part of the Pre-Qualification Submission submitted by (the
“Participant”).
If relying on a Supporting Entity, please complete :
The Experience Provider relied on ___________ (the “Supporting Entity”) in demonstrating
experience on the following project, as listed in the relevant Pre-Qualification Form:
_______________.
☐ The Supporting Entity is an SPV that is not a limited liability company, in which:
(i) The Experience Provider had Effective Holdings of ___% (at least 24%) of all Means
of Control; and
(ii) All Entities which directly held the Means of Control in the SPV were responsible,
jointly and severally, for the execution of the Project.
☐ The Supporting Entity is an SPV that is a limited liability company, in which the
Experience Provider had Effective Holdings of ___% (at least 24%) of all Means of
Control.
☐ The Supporting Entity is a Subsidiary, as defined in Section 1.1 of the Invitation, of the
Experience Provider.
☐ The Supporting Entity is a second-tier Subsidiary of the Experience Provider in which
the Experience Provider has Effective Holdings of ___% (at least 50%) of all Means of
Control.
☐ The Supporting Entity is held by the Experience Provider such that:
(iii) The Experience Provider has Effective Holdings of one hundred percent (100%) of
all Means of Control in an intermediate Entity(ies), “Entity-1”; and
(iv) Entity-1 directly holds ___% (at least 75%) of all Means of Control in the
Supporting Entity.
1. JOINT AND SEVERAL UNDERTAKING
1.1. This Undertaking is irrevocable and binding upon the Experience Provider.
1.2. This Undertaking is a direct undertaking issued by the Experience Provider towards
TRI.
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1.3. The Experience Provider has demonstrated compliance with the professional threshold
requirements set forth in Section 4.__ [fill in the applicable section number] of the
Invitation. The Experience Provider hereby warrants and undertakes that it will be
responsible, jointly and severally with the Participant, for the execution of the
respective works in the HN LRT Project, should the Participant be declared the
successful bidder.
1.4. TRI shall not be required to pursue any remedy it may be entitled to from the
Participant and/or any other person/entity prior to making any demand of the
Experience Provider, and the Experience Provider shall not have any claim with
respect thereto, nor be released from any obligations as a consequence thereof.
1.5. The validity of the obligations and liabilities of the Experience Provider and/or their
extent shall not be affected and/or prejudiced, even if the Pre-Qualification Documents,
or any part thereof, are changed and/or amended from time to time. The Experience
Provider hereby confirms its consent to any change and/or amendment and shall
remain responsible for all of the Experience Provider’s undertakings, jointly and
severally with the Participant, as changed and/or amended.
1.6. The Experience Provider’s obligations pursuant to this Undertaking are unconditional
and shall not be voided, waived, reduced or otherwise affected, irrespective of:
1.6.1. Any lack of validity or enforceability of, or any ineffectiveness of, any provision
of the Pre-Qualification Documents or any other agreement, guarantee or
instrument relating thereto;
1.6.2. Any amendment to, waiver of or consent to depart from, or failure to exercise or
enforce any right, remedy, power or privilege under or in respect of the Pre-
Qualification Documents or any right of action, guarantee, indemnity or other
contingent obligation;
1.6.3. Any compromise or settlement of any dispute with the Participant and TRI or any
failure of supervision by TRI to detect or prevent any default of the Participant;
1.6.4. The insolvency of the Participant or the Experience Provider, or any proceeding,
voluntary or involuntary, involving the winding-up, bankruptcy, insolvency,
receivership, administration, reorganization, arrangement, dissolution or
liquidation of, or affecting, the Participant or the Experience Provider, or any
defense which the Participant or the Experience Provider may have by reason of
the order, decree or decision of any court or Governmental Authority resulting
from any such proceeding;
1.6.5. Any acceptance of any new or additional undertaking, security or any other
instrument, document, agreement, or obligation in connection with all or a part of
the obligations of the Participant under the Pre-Qualification Documents;
1.6.6. Any assignment of this Undertaking by TRI, in accordance with the provisions of
the Pre-Qualification Documents;
1.6.7. Any other circumstance, act or matter of a similar or different nature which might
otherwise constitute a defense available to the Experience Provider or release
from any or all of its obligations hereunder.
1.6.8. The Experience Provider further expressly waives, to the fullest extent permitted
by Law, any right or defense available to it due to, or as a result of, the above.
1.7. Notwithstanding anything contained herein to the contrary, the Experience Provider
expressly and irrevocable waives, to the fullest extent permitted, the provisions of any
laws which exonerate or limit the liability of the Experience Provider, including
section 8, 9 and 15 of the Guarantee Law, 5727-1967, or sureties and any defenses
provided by such applicable laws.
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1.8. Nothing herein shall be construed as imposing greater obligations and liabilities on the
Experience Provider than are imposed on the Participant with respect to the relevant
Professional Pre-Qualification Requirements under the Pre-Qualification Documents.
The Experience Provider shall be entitled to all defenses, limitations and exclusions
available to the Participant under the Pre-Qualification Documents.
2. Without derogating from the provisions of Section 1, if the Experience Provider has
demonstrated compliance with the Professional Threshold Requirements stipulated in
Section 4.5 (Project Execution, Management and Organization Experience) of the
Invitation, the Experience Provider undertakes to either serve as the EPC Contractor itself,
or to hold 20% or more of all Means of Control in the EPC Contractor, should the
Participant be deemed the Successful Bidder, all in accordance with Annex 2 Section 2 of
the Invitation, and as will be specified in the Tender Selection Stage Documents.
3. Without derogating from the provisions of Section 1, if the Experience Provider has
demonstrated compliance with the Professional Threshold Requirements stipulated in
Section 4.7 (Operation Experience) of the Invitation, the Experience Provider undertakes to
either serve as the O&M Contractor itself, or to hold 50% or more of all Means of Control
in the O&M Contractor, should the Participant be deemed the Successful Bidder, all in
accordance with Annex 2 Section 3 of the Invitation, and as will be specified in the Tender
Selection Stage Documents.
4. Additional Undertakings
4.1. The Experience Provider shall not assign or transfer any of its obligations pursuant to
this Undertaking without the prior written approval of TRI.
4.2. The Experience Provider shall provide TRI such information as TRI may reasonably
require from time to time with respect to the performance of its obligations pursuant to
this Undertaking.
4.3. The Experience Provider shall notify TRI of any legal or technical changes, and any
unusual events which affect its ability to perform its obligations pursuant to this
Undertaking.
5. Representations and Warranties
5.1. The Experience Provider makes each of the representations and warranties set out in
this section to TRI.
5.2. The Experience Provider is duly incorporated and validly existing under the laws of its
domicile.
5.3. The Experience Provider has the corporate power to execute and perform this
Undertaking and has taken all necessary action to authorize the execution and
performance of this Undertaking. Neither the execution nor the performance of the
obligations pursuant to this Undertaking:
(i) Violates any provisions of any law by which it is bound; nor
(ii) Conflicts with or violates any provisions of its Articles of Association;
nor
(iii) Violates any of the terms or provisions of any agreement or instrument to
which it is party, or by which any of its assets are bound or to which it is
subject or constitutes a default under such agreement or instrument.
5.4. The Experience Provider, including any of its interested parties, directors or managers,
are not residents or citizens of a hostile state which does not have diplomatic relations
with the State of Israel, or of a state which does not have full trade relations with the
State of Israel.
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5.5. This Undertaking has been duly executed and delivered by the Experience Provider
and constitutes its legal, valid and binding obligation, enforceable against it according
to its terms.
5.6. There are no pending proceedings against the Experience Provider that may reasonably
be expected to have the effect of preventing, delaying or otherwise interfering with the
performance of any of its obligations under this Undertaking.
6. Notices
6.1. All notices, demands, requests, approvals and other communications under, or in
connection with, this Undertaking shall be made in writing and may be sent by
registered mail or facsimile.
A notice shall be deemed to have been served (i) if sent by registered mail: seventy two
(72) hours following the time of its posting; or (ii) if sent by facsimile: twenty four (24)
hours following the time of its transmission.
6.2. The mailing address and facsimile number for all notices shall be in Israel, and are as
follows: _______________________________________________________________
7. No Waiver: Remedies
7.1. No failure by TRI to exercise, and no forbearance or delay in exercising any right
under this Undertaking will operate as a waiver thereof. No partial exercise by TRI of
any right will preclude any other or further exercise of that right or any other right. No
waiver of any breach or default under a provision of this Undertaking will constitute a
waiver of any subsequent breach or default under that or any other provision of this
Undertaking.
7.2. Each of the rights and remedies of TRI under this Undertaking is cumulative and not
exclusive of any other right or remedy existing by agreement, under any applicable
Law or at equity.
8. Governing Law
This Undertaking shall be exclusively governed by and construed in accordance with the
Laws of the State of Israel, without regard to the conflict of laws rules thereof.
9. Consent to Jurisdiction
The Experience Provider irrevocably submits to the sole jurisdiction of the applicable courts
in Tel-Aviv, in any proceeding arising out of or relating to this Undertaking.
10. Severability
Any part of this Undertaking which is found to be invalid or unenforceable, shall not affect
the validity or enforceability of any other parts thereof. Such invalid or unenforceable part
shall be deemed severed from the Undertaking which shall be construed and enforced
without reference to such invalid or unenforceable part.
Where provisions of any applicable Law resulting in such invalidity or unenforceability
may be waived, they are hereby waived by the Supporting Entity to the full extent permitted
by applicable Law so that this Undertaking shall be deemed valid, binding and enforceable
in accordance with its terms.
11. Entry into Force and Validity
This Undertaking shall remain in force throughout the Tender Selection Stage, should the
Participant be deemed an Eligible Participant, and until all of the Participant’s obligations
for the HN LRT Project for which the Experience Provider demonstrated Experience have
been discharged in full, should the Participant be deemed the Successful Bidder and if
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chosen by the Participant to assume responsibility in accordance with Section 3.3.7 of the
Invitation.
IN WITNESS WHEREOF, the Experience Provider has executed this Undertaking.
________________________ ________________________
Date
Stamp and Signature
I, ____________, the undersigned, hereby confirm that on ____________ [date],
____________[name], Israeli I.D. number / _______[country] Passport number ____________, who
is authorized to sign on behalf of ____________, and to commit it for purposes of the above stated
Pre-Qualification Form, for all purposes and intents, appeared before me, and after being cautioned
that he/she is required to state the truth, and that if he/she fails to do so he/she shall be liable to the
punishments prescribed by Law, signed this statement in my presence.
Name: ____________
Stamp and Signature: ____________
Date: ____________
____________________
Attorney-at-Law
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PRE-QUALIFICATION FORM “6”
CONFIRMATION OF MERGING COMPANIES
(Each Experience Provider relying on a Supporting Entity, in accordance with Section 9.11.3.4 of the
Invitation, shall complete this form and attach the documents listed in Section 2, below.)
(Capitalized terms shall have the meaning ascribed to them in the Invitation)
I, __________, the undersigned, am making this affidavit on behalf of _______ (the Experience
Provider).
1. In demonstrating compliance with the Professional Pre-Qualification Requirements of
Section 4._ of the Invitation, the Experience Provider relied on the experience of
_____________ (the Supporting Entity), in accordance with the provisions of Section
9.11.3.4 of the Invitation:
☐ Following a Merger between the Experience Provider and the Supporting Entity, as
such term is defined under the Companies Law 1999, which was completed prior to the
Pre-Qualification Submission Date (“Merger”); or following the applicable
jurisdiction’s equivalent of a Merger between the foreign Experience Provider and a
foreign Supporting Entity, which was completed prior to the Pre-Qualification
Submission Date, as stipulated in Section 9.11.3.4 (a) of the Invitation.
☐ Following the acquisition of 100% of all Means of Control of the Supporting Entity
prior to the Pre-Qualification Submission Date (“Acquisition”), as stipulated in Section
9.11.3.4 (b) of the Invitation.
☐ Following the transfer of some or all assets of a Supporting Entity, or a business or a
division thereof, as part of a corporate reorganization, to the Experience Provider,
provided that (i) the Supporting Entity no longer holds any of the transferred assets,
business or division (as applicable), and (ii) the transfer was completed prior to the Pre-
Qualification Submission Date (“Transfer”) as stipulated in Section 9.11.3.4 (c) of the
Invitation.
2. Attached to Annex A hereto are (1) a confirmation by an Israeli lawyer / a formal
certificate of the applicable statutory authority under the laws of the applicable
jurisdiction, testifying to the date and results of the Merger/Acquisition/Transfer
between the Experience Provider and the Supporting Entity; and (2) a description of the
main features of the Merger/Acquisition/Transfer, issues by the Experience Provider’s
external auditor or legal advisor.
I, ____________, the undersigned, hereby confirm that on ____________ [date], ____________[name], Israeli
I.D. number / _______[country] Passport number ____________, who is authorized to sign on behalf of
____________, and to commit it for purposes of the above stated Pre-Qualification Form, for all purposes and
intents, appeared before me, and after being cautioned that he/she is required to state the truth, and that if he/she
fails to do so he/she shall be liable to the punishments prescribed by Law, signed this statement in my presence.
Name: ____________
Stamp and Signature: ____________
Date: ____________
____________________
Attorney-at-Law
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PRE-QUALIFICATION FORM “6” - ANNEX A
1. A confirmation by an Israeli lawyer / a formal certificate of the applicable statutory authority
under the laws of the applicable jurisdiction, testifying to the date and results of the
Merger/Acquisition/Transfer between the Experience Provider and the Supporting Entity; and
2. A description of the main features of the Merger/Acquisition/Transfer, issues by the
Experience Provider’s external auditor or legal advisor.
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PRE-QUALIFICATION FORM “7”
SYSTEMS EXPERIENCE
(To be completed by each Entity demonstrating compliance with the Pre-Qualification Requirement
specified in Section 4.1 (Experience in the Design and Installation of Systems) of the Invitation)
(Capitalized terms shall have the meaning ascribed to them in the Invitation)
I, _____________, the undersigned, am making this affidavit on behalf of _____________
(name of Experience Provider):
Project Details Rail Project (at least 3) [add additional columns as necessary]
“1” “2” “3” “4”
Name of project
Type of Rail Project
☐ LRT
☐ Metro
☐ Heavy Rail
☐ LRT
☐ Metro
☐ Heavy Rail
☐ LRT
☐ Metro
☐ Heavy Rail
☐ LRT
☐ Metro
☐ Heavy Rail
Location of project (city
and country)
Description of Project
Experience as Lead
Contractor
☐ Yes
☐ No
☐ Yes
☐ No
☐ Yes
☐ No
☐ Yes
☐ No
Role included Design of
Systems, as defined in
the Invitation
☐ Yes
☐ No
☐ Yes
☐ No
☐ Yes
☐ No
☐ Yes
☐ No
Role included
Installation of Systems,
as defined in the
Invitation
☐ Yes
☐ No
☐ Yes
☐ No
☐ Yes
☐ No
☐ Yes
☐ No
Systems Designed and
Installed:
Refer to all of the
following:
1. Power supply and
distribution
2. Overhead catenary
systems
3. Low voltage systems
including at least one of
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Project Details Rail Project (at least 3) [add additional columns as necessary]
the following, in each
case that supports the rail
operation:
a. Operational control
center; or
b. SCADA; or
b. Dedicated fiber optic /
radio / WiFi
communication network
Routes consisting of
Twin Track or greater
☐ Yes
☐ No
☐ Yes
☐ No
☐ Yes
☐ No
☐ Yes
☐ No
Length of Project Route
(km)
Date of Commencement
of Commercial
Operation
[MM/YYYY]
Date of Delivery to
Client
[MM/YYYY]
Commercial Operation
of at least two
consecutive years since
Completion
☐Yes
☐No
☐Yes
☐No
☐Yes
☐No
☐Yes
☐No
Client Details and
Contact Person
Information
Executed by Supporting
Entity [refer to Pre-
Qualification Form
“17”]
☐Yes:________
☐No
☐Yes:________
☐No
☐Yes:________
☐No
☐Yes:________
☐No
________________________ ________________________ Date Stamp and Signature
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I, ____________, the undersigned, hereby confirm that on ____________ [date],
____________[name], Israeli I.D. number / _______[country] Passport number ____________, who
is authorized to sign on behalf of ____________, and to commit it for purposes of the above stated
Pre-Qualification Form, for all purposes and intents, appeared before me, and after being cautioned
that he/she is required to state the truth, and that if he/she fails to do so he/she shall be liable to the
punishments prescribed by Law, signed this statement in my presence.
Name: ____________
Stamp and Signature: ____________
Date: ____________
____________________
Attorney-at-Law
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PRE-QUALIFICATION FORM “8”
SIGNALING EXPERIENCE
(To be completed by each Entity demonstrating compliance with the Pre-Qualification Requirement
specified in Section 4.2 (Experience in the Design and Installation of Signaling Systems) of the Invitation)
(Capitalized terms shall have the meaning ascribed to them in the Invitation)
I, _____________, the undersigned, am making this affidavit on behalf of _____________
(name of Experience Provider):
Project Details Rail Project (at least 3) [add additional columns as necessary]
“1” “2” “3” “4”
Name of project
Type of Rail Project
☐ LRT
☐ Metro
☐ Heavy Rail
☐ LRT
☐ Metro
☐ Heavy Rail
☐ LRT
☐ Metro
☐ Heavy Rail
☐ LRT
☐ Metro
☐ Heavy Rail
Location of project (city
and country)
Description of project
Experience as Lead
Contractor
☐ Yes
☐ No
☐ Yes
☐ No
☐ Yes
☐ No
☐ Yes
☐ No
Role Included Design of
Signaling Systems
☐ Yes
☐ No
☐ Yes
☐ No
☐ Yes
☐ No
☐ Yes
☐ No
Role Included
Installation of Signaling
Systems
☐ Yes
☐ No
☐ Yes
☐ No
☐ Yes
☐ No
☐ Yes
☐ No
Including Signaling
Subsystems: ☐ LOSD
☐ ATP
☐ Other: _____
☐ LOSD
☐ ATP
☐ Other: _____
☐ LOSD
☐ ATP
☐ Other: _____
☐ LOSD
☐ ATP
☐ Other: _____
Routes consisting of
Twin Track or greater
☐ Yes
☐ No
☐ Yes
☐ No
☐ Yes
☐ No
☐ Yes
☐ No
Length of consecutive
Route (km)
Date of Commencement
of Commercial
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Project Details Rail Project (at least 3) [add additional columns as necessary]
Operation
[MM/YYYY]
Date of Delivery to
Client
[MM/YYYY]
Commercial Operation
of at least two
consecutive years since
Completion
☐Yes
☐No
☐Yes
☐No
☐Yes
☐No
☐Yes
☐No
Client Details and
Contact Person
Information
Executed by Supporting
Entity [refer to Pre-
Qualification Form
“17”]
☐Yes:________
☐No
☐Yes:________
☐No
☐Yes:________
☐No
☐Yes:________
☐No
________________________ ________________________
Date Stamp and Signature
I, ____________, the undersigned, hereby confirm that on ____________ [date],
____________[name], Israeli I.D. number / _______[country] Passport number ____________, who
is authorized to sign on behalf of ____________, and to commit it for purposes of the above stated
Pre-Qualification Form, for all purposes and intents, appeared before me, and after being cautioned
that he/she is required to state the truth, and that if he/she fails to do so he/she shall be liable to the
punishments prescribed by Law, signed this statement in my presence.
Name: ____________
Stamp and Signature: ____________
Date: ____________
____________________
Attorney-at-Law
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PRE-QUALIFICATION FORM “9”
TRACK EXPERIENCE
(To be completed by each Entity demonstrating compliance with the Pre-Qualification Requirement
specified in Section 4.3 (Experience in the Design and Construction of Track-Way) of the Invitation)
(Capitalized terms shall have the meaning ascribed to them in the Invitation)
I, _____________, the undersigned, am making this affidavit on behalf of _____________
(name of Experience Provider):
Project Details Rail Project (at least 3) [add additional columns as necessary]
“1” “2” “3” “4”
Name of project
Type of Rail project
☐ LRT
☐ Metro
☐ Heavy Rail
☐ LRT
☐ Metro
☐ Heavy Rail
☐ LRT
☐ Metro
☐ Heavy Rail
☐ LRT
☐ Metro
☐ Heavy Rail
Location of project (city
and country)
Description of project
Experience as Lead
Contractor
☐ Yes
☐ No
☐ Yes
☐ No
☐ Yes
☐ No
☐ Yes
☐ No
Role included Design of
Track
☐ Yes
☐ No
☐ Yes
☐ No
☐ Yes
☐ No
☐ Yes
☐ No
Role included
Construction of Track
☐ Yes
☐ No
☐ Yes
☐ No
☐ Yes
☐ No
☐ Yes
☐ No
Type of Track ☐ double
☐single
☐ double
☐single
☐ double
☐single
☐ double
☐single
Length of Consecutive
Track-Way (km) *
Length of Ballastless
Track-way (km) *
Date of Commencement
of Commercial
Operation [MM/YYYY]
Date of Delivery to
Client
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Project Details Rail Project (at least 3) [add additional columns as necessary]
[MM/YYYY]
Commercial Operation
of at least two
consecutive years since
Completion
☐Yes
☐No
☐Yes
☐No
☐Yes
☐No
☐Yes
☐No
Client Details and
Contact Person
Information
Executed by Supporting
Entity [see Pre-
Qualification Form
“17”]
☐Yes:________
☐No
☐Yes:________
☐No
☐Yes:________
☐No
☐Yes:________
☐No
* If double track, please indicate the track-way length of one track. If single track, please indicate 100% of the
track-way length. However, note that for the purpose of the PQ Threshold, only 50% of length will be
considered.
________________________ ________________________
Date Stamp and Signature
I, ____________, the undersigned, hereby confirm that on ____________ [date], ____________[name], Israeli
I.D. number / _______[country] Passport number ____________, who is authorized to sign on behalf of
____________, and to commit it for purposes of the above stated Pre-Qualification Form, for all purposes and
intents, appeared before me, and after being cautioned that he/she is required to state the truth, and that if he/she
fails to do so he/she shall be liable to the punishments prescribed by Law, signed this statement in my presence.
Name: ____________
Stamp and Signature: ____________
Date: ____________
____________________
Attorney-at-Law
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PRE-QUALIFICATION FORM “10”
ROLLING STOCK EXPERIENCE
(To be completed by each Entity demonstrating compliance with the Pre-Qualification Requirement
specified in Section 4.4 (Rolling Stock Experience) of the Invitation)
(Capitalized terms shall have the meaning ascribed to them in the Invitation) I, _____________, the undersigned, am making this affidavit on behalf of _____________
(name of the Experience Provider):
Project Details Project (no minimum number of Projects) [add additional columns as
necessary]
“1” “2” “3” “4”
Name of project
Description of project
Location of project (city
and country)
Total Number of
Vehicles Manufactured
for this Project
Number of Low Floor
or Partial Low Floor
LRT Vehicles (as such
are defined in the
Invitation)
Date of Delivery to
Client [MM/YYYY]
Date of Commencement
of Commercial
Operation [MM/YYYY]
Commercial Operation
for at least two
consecutive years
☐ Yes
☐ No
☐ Yes
☐ No
☐ Yes
☐ No
☐ Yes
☐ No
Client Details and
Contact Person
Information
Executed by Supporting
Entity [refer to Pre-
Qualification Form
“17”]
☐Yes:________
☐No
☐Yes:________
☐No
☐Yes:________
☐No
☐Yes:________
☐No
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I hereby declare, in accordance with Section 4.4.1 of the Invitation, that ______________ (name of the
Experience Provider) will be capable of executing the Design and manufacture of the rolling stock
in compliance with all the Applicable EU Standards, should the Participant be awarded the HN LRT
Project.
________________________ ________________________
Date
Stamp and Signature
I, ____________, the undersigned, hereby confirm that on ____________ [date],
____________[name], Israeli I.D. number / _______[country] Passport number ____________, who
is authorized to sign on behalf of ____________, and to commit it for purposes of the above stated
Pre-Qualification Form, for all purposes and intents, appeared before me, and after being cautioned
that he/she is required to state the truth, and that if he/she fails to do so he/she shall be liable to the
punishments prescribed by Law, signed this statement in my presence.
Name: ____________
Stamp and Signature: ____________
Date: ____________
____________________
Attorney-at-Law
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PRE-QUALIFICATION FORM “11”
PROJECT EXECUTION, MANAGEMENT AND ORGANIZATION
EXPERIENCE
(To be completed by each Entity demonstrating compliance with the Pre-Qualification Requirement
specified in Section 4.5 (Project Execution, Management and Organization Experience) of the Invitation)
(Capitalized terms shall have the meaning ascribed to them in the Invitation)
I, _____________, the undersigned, am making this affidavit on behalf of _____________
(name of Experience Provider):
Project Details Infrastructure Project (at least 2) [add additional columns as necessary]
“1” “2” “3” “4”
Name of project
Type of Infrastructure
Project
(please refer to such
definition within the
Invitation)
Role included
Execution, Management
and Organization of the
Project
☐ Yes
☐ No
☐ Yes
☐ No
☐ Yes
☐ No
☐ Yes
☐ No
Contract Value (in
NIS)*
Currency Exchange
Rate
Contract Value (in
original currency)
[name the currency]
Location of project (city
and country)
Experience as Lead
Contractor
☐ Yes
☐ No
☐ Yes
☐ No
☐ Yes
☐ No
☐ Yes
☐ No
Date of Commencement
of Commercial
Operation [MM/YYYY]
Date of Delivery to
Client [MM/YYYY]
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Project Details Infrastructure Project (at least 2) [add additional columns as necessary]
Client Details and
Contact Person
Information
Executed by Supporting
Entity [refer to Pre-
Qualification Form
“17”]
☐Yes:________
☐No
☐Yes:________
☐No
☐Yes:________
☐No
☐Yes:________
☐No
* Currency conversion (to the extent required) shall be made in accordance with the provisions of
Section 6.3 (Currency Conversion) of the Invitation.
________________________ ________________________
Date Stamp and Signature
I, ____________, the undersigned, hereby confirm that on ____________ [date],
____________[name], Israeli I.D. number / _______[country] Passport number
____________, who is authorized to sign on behalf of ____________, and to commit it for
purposes of the above stated Pre-Qualification Form, for all purposes and intents, appeared
before me, and after being cautioned that he/she is required to state the truth, and that if he/she
fails to do so he/she shall be liable to the punishments prescribed by Law, signed this
statement in my presence.
Name: ____________
Stamp and Signature: ____________
Date: ____________
____________________
Attorney-at-Law
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PRE-QUALIFICATION FORM “12”
MAINTENANCE EXPERIENCE
(To be completed by each Entity demonstrating compliance with the Pre-Qualification Requirement
specified in Section 4.6 (Maintenance Experience) of the Invitation)
(Capitalized terms shall have the meaning ascribed to them in the Invitation)
I, _____________, the undersigned, am making this affidavit on behalf of _____________
(name of Experience Provider):
Project Details Project (no more than 3)
“1” “2” “3”
Name of project
Type of Rail Project
☐ LRT
☐ Metro
☐ LRT
☐ Metro
☐ LRT
☐ Metro
Location of project (city
and country)
Description of project
Experience as Lead
Contractor
☐ Yes
☐ No
☐ Yes
☐ No
☐ Yes
☐ No
Routes consisting of
Twin Track or greater
☐ Yes
☐ No
☐ Yes
☐ No
☐ Yes
☐ No
Date of Commencement
of Maintenance Services
[MM/YYYY]
Number of consecutive
years of Maintenance
since Commencement
Date indicated above
Total Length Project
Route (km)
Role included
Maintenance of:
☐ Track-Way
☐ Systems
☐ Vehicles
(number:__)
☐ Track-Way
☐ Systems
☐Vehicles
(number:__)
☐ Track-Way
☐ Systems
☐Vehicles
(number:__)
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Project Details Project (no more than 3)
☐ Depot ☐ Depot ☐ Depot
Client Details and
Contact Person
Information
Executed by Supporting
Entity [refer to Pre-
Qualification Form
“17”]
☐Yes:________
☐No
☐Yes:________
☐No
☐Yes:________
☐No
________________________ ________________________
Date Stamp and Signature
I, ____________, the undersigned, hereby confirm that on ____________ [date],
____________[name], Israeli I.D. number / _______[country] Passport number ____________, who
is authorized to sign on behalf of ____________, and to commit it for purposes of the above stated
Pre-Qualification Form, for all purposes and intents, appeared before me, and after being cautioned
that he/she is required to state the truth, and that if he/she fails to do so he/she shall be liable to the
punishments prescribed by Law, signed this statement in my presence.
Name: ____________
Stamp and Signature: ____________
Date: ____________
____________________
Attorney-at-Law
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PRE-QUALIFICATION FORM “13”
OPERATING EXPERIENCE
(To be completed by each Entity demonstrating compliance with the Pre-Qualification Requirement
specified in Section 4.7 (Operation Experience) of the Invitation)
(Capitalized terms shall have the meaning ascribed to them in the Invitation)
I, _____________, the undersigned, am making this affidavit on behalf of _____________
(name of Experience Provider):
Please indicate the chosen Alternative below:
☐ The Experience Provider will serve as the O&M Contractor for the HN LRT Project, should
the Participant be deemed the Successful Bidder (Alternative 1 in Section 4.7 of the Invitation).
☐ The Experience Provider will enter into a service agreement with a local Bus Operator who
will serve as the O&M Contractor for the HN LRT Project should the Participant be deemed the
Successful Bidder, and whose details and experience shall be listed in the Participant’s Bid
(Alternative 2 in Section 4.7 of the Invitation).
Project Details Project [add additional columns as necessary]
“1” “2” “3” “4”
Name of project
Type of Rail Project
☐ LRT
☐ Metro
☐ LRT
☐ Metro
☐ LRT
☐ Metro
☐ LRT
☐ Metro
Location of project (city
and country)
Description of project
Experience as Lead
Contractor
☐ Yes
☐ No
☐ Yes
☐ No
☐ Yes
☐ No
☐ Yes
☐ No
Date of Commencement
of Operation Services
[MM/YYYY]
Number of consecutive
years of Operation since
Commencement Date as
indicated above
Routes consisting of
Twin Track or greater
☐ Yes
☐ No
☐ Yes
☐ No
☐ Yes
☐ No
☐ Yes
☐ No
Total Length of Service
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________________________ ________________________
Date Stamp and Signature
I, ____________, the undersigned, hereby confirm that on ____________ [date],
____________[name], Israeli I.D. number / _______[country] Passport number ____________, who
is authorized to sign on behalf of ____________, and to commit it for purposes of the above stated
Pre-Qualification Form, for all purposes and intents, appeared before me, and after being cautioned
that he/she is required to state the truth, and that if he/she fails to do so he/she shall be liable to the
punishments prescribed by Law, signed this statement in my presence.
Name: ____________
Stamp and Signature: ____________
Date: ____________
____________________
Attorney-at-Law
Line Route (km)
Operated project
included:
☐ at least 15 km
of Routes in
aggregate
☐ at least 20
Stops in
aggregate
☐ number of
Vehicles:_____
☐ LOSD
operation at At-
Grade (not
exclusively at
Depot)
☐ Ridership for
each 12-month
period: _______
☐ at least 15 km
of Routes in
aggregate
☐ at least 20
Stops in
aggregate
☐ number of
Vehicles:_____
☐ LOSD
operation at At-
Grade (not
exclusively at
Depot)
☐ Ridership for
each 12-month
period: _______
☐ at least 15 km
of Routes in
aggregate
☐ at least 20
Stops in
aggregate
☐ number of
Vehicles:_____
☐ LOSD
operation at At-
Grade (not
exclusively at
Depot)
☐ Ridership for
each 12-month
period: _______
☐ at least 15 km
of Routes in
aggregate
☐ at least 20
Stops in
aggregate
☐ number of
Vehicles:_____
☐ LOSD
operation at At-
Grade (not
exclusively at
Depot)
☐ Ridership for
each 12-month
period: _______
Client Details and
Contact Person
Information
Executed by Supporting
Entity [refer to Pre-
Qualification Form
“17”]
☐Yes:________
☐No
☐Yes:________
☐No
☐Yes:________
☐No
☐Yes:________
☐No
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PRE-QUALIFICATION FORM “14”
FINANCIAL ROBUSTNESS
(To be completed by each Member (which is not a Financial Entity) or Guarantor (as applicable), each
on a separate Pre-Qualification Form)
(Capitalized terms shall have the meaning ascribed to them in the Invitation)
I, _____________, the undersigned, am making this affidavit on behalf of _____________
(name of Member and/or Guarantor (as applicable)):
☐ (to be completed if this Pre-Qualification Form is submitted by a Member who is not a
Guarantor)
Name Anticipated Holdings
(“Total Anticipated
Holdings”)
Member: ___________________________________ ___%
☐ (to be completed if this Pre-Qualification Form is submitted by a Guarantor who is also a
Member)
Name Anticipated Holdings
Guarantor (in its
capacity as a
Member): __________________________________
___%
Member(s) relying
on the Guarantor:
__________________________________ ___%
__________________________________ ___%
__________________________________ ___%
Total Anticipated Holdings of the Guarantor and the Member(s)
relying on the Guarantor (“Total Anticipated Holdings”):
___%
☐ (to be completed if this Pre-Qualification Form is submitted by a Guarantor who is not a
Member)
Name Anticipated Holdings
Guarantor (which is
not a Member): __________________________________
Member(s) relying
on the Guarantor:
__________________________________ ___%
__________________________________ ___%
__________________________________ ___%
Total Anticipated Holdings of the Member(s) relying on the
Guarantor (“Total Anticipated Holdings”):
___%
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To be completed by all:
1. Financial Data of _____________ (name of Member or Guarantor (as applicable)): (**)
1.1. Turnover
Year 𝑐 − 2 𝑐 − 1 𝑐
Turnover (TO) –
Original Currency
[name the currency]
Currency Exchange
Rate
Turnover (TO) – NIS
Member’s Weighted
Average Turnover
(NIS)
Member′s Weighted Average Turnover =3 ∗ 𝑇𝑂𝑐 + 2 ∗ 𝑇𝑂𝑐−1 + 1 ∗ 𝑇𝑂𝑐−2
6
𝑇𝑂𝑡 = Member (i)’s annual Turnover for year ”c”.
c = most recent annual Financial Statement, which is not earlier than 2019.
1.2. Operating Cash Flow
Year 𝑡 − 2 𝑡 − 1 𝑡
Operating Cash Flow (CF) –
Original Currency [name the
currency]
Currency Exchange Rate
Operating Cash Flow (CF) –
NIS
Weighted Average Operating
Cash Flow (NIS)
Weighted Average Operating Cash Flow =3 ∗ 𝐶𝐹𝑡 + 2 ∗ (𝐶𝐹𝑡−1) + 1 ∗ (𝐶𝐹𝑡−2)
6
𝐶𝐹𝑡 = Operating Cash Flow for year “t”.
t = the most recent Financial Statement, which is not earlier than 2019.
1.2.1. The undersigned’s Weighted Average Operating Cash Flow: [check
applicable]
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☐ is not negative.
☐ is negative, and the ratio between:
(a) the absolute value of [check applicable] ☐ The undersigned’s
Weighted Average Operating Cash Flow or ☐ The undersigned’s
Operating Cash Flow based on its most recent annual Financial
Statements (not earlier than for the year 2019), and
(b) the undersigned’s equity based on its most recent annual Financial
Statements (not earlier than for the year 2019),
is less than 25%.
1.3. Minimal Equity
Year Most recent annual
Financial Statement
Equity (on the last day of the most recent annual Financial
Statements (not earlier than for the year 2019) – Original
Currency [name the currency]
Currency Exchange Rate
Equity (on the last day of the most recent annual Financial
Statements (not earlier than for the year 2019) – NIS
☐ The Total Anticipated Holdings of the undersigned are _____%, and the
undersigned’s equity as stated above is not less than NIS 4 million for each one
percent (1%) of its Total Anticipated Holdings in the Participant.
(**) All data in this Pre-Qualification Form is to be presented in NIS, in accordance with
the provisions of Section 6.3 (Currency Conversion)of the Invitation.
2. Attached to this Pre-Qualification Form “14” are the Financial Statements of
_____________ for the years _____,_____,______ (to be completed as applicable).
________________________ ________________________
Date Stamp and Signature
I, ____________, the undersigned, hereby confirm that on ____________ [date],
____________[name], Israeli I.D. number / _______[country] Passport number ____________, who
is authorized to sign on behalf of ____________, and to commit it for purposes of the above stated
Pre-Qualification Form, for all purposes and intents, appeared before me, and after being cautioned
that he/she is required to state the truth, and that if he/she fails to do so he/she shall be liable to the
punishments prescribed by Law, signed this statement in my presence.
Name: ____________
Stamp and Signature: ____________
Date: ____________
____________________
Attorney-at-Law
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PRE-QUALIFICATION FORM “14” - ANNEX A
FINANCIAL STATEMENTS
Each Member (which is not a Financial Entity) or Guarantor (as applicable) is to attach its three
(3) latest audited Financial Statements in accordance with Section 5.8 (Submission of Financial
Statements) of the Invitation.
Each other Participating Entity shall attach hereto their most recent audited Financial Statement.
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PRE-QUALIFICATION FORM “15”
PARTICIPANT'S WEIGHTED TURNOVER
(To be completed by the Participant)
(Capitalized terms shall have the meaning ascribed to them in the Invitation)
I, _____________, the undersigned, am making this affidavit on behalf of _____________ (the
“Participant”):
Based on all Pre-Qualification Forms “14” submitted by each Member or Guarantor (as
applicable), the Participant’s Weighted Turnover is not lower than the Minimal Turnover
Required, as demonstrated below.
1. Minimal Turnover Required
The Minimal Turnover Required is _____________, calculated as the product of NIS 1,200
million multiplied by the Anticipated Holdings of all Members who are not Financial
Entities, as specified below:
Member who is not a
Financial Entity
Member’s Anticipated
Holdings
___%
___%
___%
___%
Anticipated Holdings of all Members
which are not Financial Entities ___%
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2. Participant’s Weighted Turnover
The Participant’s Weighted Turnover is _____________, calculated as follows:
Member or
Guarantor (*)
A B
Product of A and
B
Member’s
Weighted
Average
Turnover
Total Anticipated
Holdings (**)
___%
___%
___%
___%
Participant’s
Weighted Turnover
(*) Member who is not a Financial Entity and whose Anticipated Holdings are 10% or more, or
Guarantor for such Member (as applicable) as demonstrated pursuant to Pre-Qualification
Form “14”.
(**) as demonstrated pursuant to Pre-Qualification Form “14” for the relevant Member or
Guarantor.
________________________ ________________________
Date Stamp and Signature
I, ____________, the undersigned, hereby confirm that on ____________ [date],
____________[name], Israeli I.D. number / _______[country] Passport number ____________, who
is authorized to sign on behalf of ____________, and to commit it for purposes of the above stated
Pre-Qualification Form, for all purposes and intents, appeared before me, and after being cautioned
that he/she is required to state the truth, and that if he/she fails to do so he/she shall be liable to the
punishments prescribed by Law, signed this statement in my presence.
Name: ____________
Stamp and Signature: ____________
Date: ____________
____________________
Attorney-at-Law
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PRE-QUALIFICATION FORM “16” SECURING EXTERNAL FINANCE FOR AN INFRASTRUCTURE PROJECT
(To be completed by the Member or Guarantor (as applicable) demonstrating compliance with the
requirements of Section 5.4 (Securing External Financing for Infrastructure Projects) of the Invitation)
(Capitalized terms shall have the meaning ascribed to them in the Invitation)
I, _____________, the undersigned, am making this affidavit on behalf of _____________
(name of Member or Guarantor (as applicable)):
Project Details Projects (at least 2) [add additional columns as necessary]
“1”* “2”* “3” “4”
Name of project
Description of Project:
Description of
Infrastructure Project
in accordance with the
definition of such term
in the Invitation
Location of project (city
and country)
Amount of External
Financing (in NIS)*
Currency exchange rate
Amount of External
Financing (in original
currency) [specify]
Date on which the
financing agreement
was executed (signed)
[DD/MM/YYYY]
Date on which the first
drawdown, pursuant to
the financing
agreement, was made
[DD/MM/YYYY]
Limited Recourse Loan ☐ Yes
☐ No
☐ Yes
☐ No
☐ Yes
☐ No
☐ Yes
☐ No
Arranger(s) of the
loan(s) (which are not
an Affiliated Entity of
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Project Details Projects (at least 2) [add additional columns as necessary]
the Member)
Arranger(s) Details and
Contact Person
Information
The External Financing
was obtained by a Private
Investment Fund which
has the same General
Partner or Fund Manager
as the Member
demonstrating
compliance with the Pre-
Qualification
Requirement (which is
also a Private Investment
Fund)
☐ Yes: ______
☐ No
☐ Yes: ______
☐ No
☐ Yes: ______
☐ No
☐ Yes: ______
☐ No
The External Financing
was obtained by a
Supporting Entity SPV in
which the Member (or
Guarantor thereof) had
Effective Holdings of at
least twenty percent
(20%) of all Means of
Control
☐ Yes
-
Name:________
_
-Effective
Holdings:______
%
☐ No
☐ Yes
-
Name:________
_
-Effective
Holdings:______
%
☐ No
☐ Yes
-
Name:________
_
-Effective
Holdings:______
%
☐ No
☐ Yes
-
Name:________
_
-Effective
Holdings:______
%
☐ No
* Currency conversion (to the extent required) shall be made in accordance with the provisions of
Section 6.3 (Currency Conversion) of the Invitation.
________________________ ________________________
Date Stamp and Signature
I, ____________, the undersigned, hereby confirm that on ____________ [date],
____________[name], Israeli I.D. number / _______[country] Passport number ____________, who
is authorized to sign on behalf of ____________, and to commit it for purposes of the above stated
Pre-Qualification Form, for all purposes and intents, appeared before me, and after being cautioned
that he/she is required to state the truth, and that if he/she fails to do so he/she shall be liable to the
punishments prescribed by Law, signed this statement in my presence.
Name: ____________
Stamp and Signature: ____________
Date: ____________
____________________
Attorney-at-Law
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PRE-QUALIFICATION FORM “17”
NO GOING CONCERN
(To be completed by the CEO or CFO of each Participating Entity in accordance with Section 5.5 (No
Going Concern) of the Invitation)
(Capitalized terms shall have the meaning ascribed to them in the Invitation)
I, _____________, the undersigned, am making this affidavit on behalf of _____________
(name of Participating Entity):
I confirm that the Participating Entity is not under any voluntary or involuntary bankruptcy
process (liquidation or reorganization), or receivership or commencement of a similar
insolvency proceeding, and that the Participating Entity’s most recent Financial Statement does
not include any going concern notice or an equivalent thereof under the applicable accounting
rules.
☐ The Participating Entity is a Member (which is not a Financial Entity) of the Participant and
has attached its three most recent Financial Statements Annex A of Pre-Qualification Form “14”
above.
☐ The Participating Entity is a Guarantor and has attached its three most recent Financial
Statements to Annex A of Pre-Qualification Form “14” above.
☐ The Participating Entity is not a Member of the Participant and has attached its most recent
Financial Statement to Annex A of Pre-Qualification Form “14” above.
☐ The Participating Entity is a Financial Entity and has attached its most recent Financial
Statement to Annex A of this Pre-Qualification Form “14” above.
________________________ ________________________
Date Stamp and Signature
I, ____________, the undersigned, hereby confirm that on ____________ [date],
____________[name], Israeli I.D. number / _______[country] Passport number
____________, who is authorized to sign on behalf of ____________, and to commit it for
purposes of the above stated Pre-Qualification Form, for all purposes and intents, appeared
before me, and after being cautioned that he/she is required to state the truth, and that if he/she
fails to do so he/she shall be liable to the punishments prescribed by Law, signed this statement
in my presence.
Name: ____________
Stamp and Signature: ____________
Date: ____________
____________________
Attorney-at-Law
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PRE-QUALIFICATION FORM “18”
PRIVATE INVESTMENT FUND
(To be completed by the General Partner or Fund Manager of the Private Investment Fund, in accordance with the
provisions of Section 5.6.1 (Private Investment Fund) of the Invitation)
(Capitalized terms shall have the meaning ascribed to them in the Invitation)
I, _____________, the undersigned, am making this affidavit on behalf of _____________, the
General Partner/Fund Manager of the Private Investment Fund, _____________:
The Assets Under Management, managed by the General Partner or Fund Manager of the Private
Investment Fund as of the last day of its most recent Financial Statements (not earlier than for the
year 2019) are: ______________________.*
Most recent Financial Statement
Assets Under Management – original currency
[name the currency]
Currency exchange rate
Assets Under Management – NIS
* All data in this Pre-Qualification Form is to be presented in NIS, in accordance with the provisions
of Section 6.3 (Currency Conversion) of the Invitation.
In the event that the Private Investment Fund was incorporated in 2020, it shall submit its most recent
Financial Statement in order to demonstrate the above requirements with respect to Assets under
Management, even if said Financial Statement relates to only part of a year.
The undersigned hereby confirms that: (i) at least 60% of the Private Investment Fund’s capital, at any
given time, is provided by Institutional Investors; and (ii) at least 60% of the financial investments it
actually made, at any given time, were made by Institutional Investors; and (iii) its General Partner or
Fund Manager has successfully managed ___________ funds.**
**Please provide details as to the identity of the Entities which raised the applicable funds (including
the connection between such Entities and the General Partner/Fund Manager (to the extent
applicable):
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Attached to Annex A hereto is a statement, signed by the General Partner/Fund Manager of the Private
Investment Fund, detailing the amount of Assets under Management managed by the General Partner
or Fund Manager under each of its funds which were accounted for in the total amount of Assets under
Management specified by the Member, in accordance with the provisions of Section 5.6.1 of the
Invitation.
Attached to Annex B hereto is an authenticated copy of the Private Investment Fund’s Partnership
Agreement, in accordance with the provisions of Section 3.5.8 of the Invitation.
Attached to Annex A of Pre-Qualification Form “14” above is the Private Investment Fund’s most
recent annual Financial Statement (not earlier than for the year 2019).
________________________ ________________________
Date Stamp and Signature
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I, ____________, the undersigned, hereby confirm that on ____________ [date],
____________[name], Israeli I.D. number / _______[country] Passport number ____________, who
is authorized to sign on behalf of ____________, and to commit it for purposes of the above stated
Pre-Qualification Form, for all purposes and intents, appeared before me, and after being cautioned
that he/she is required to state the truth, and that if he/she fails to do so he/she shall be liable to the
punishments prescribed by Law, signed this statement in my presence.
Name: ____________
Stamp and Signature: ____________
Date: ____________
____________________
Attorney-at-Law
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PRE-QUALIFICATION FORM “18” - ANNEX A
Each Member who is a Private Investment Fund shall attach a statement detailing the amount of
Assets under Management managed by the General Partner or Fund Manager under each of its
funds which were accounted for in the total amount of Assets under Management specified by
the Member. The statement shall be signed by its General Partner or Fund Manager.
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PRE-QUALIFICATION FORM “18” - ANNEX B
Each Member who is a Private Investment Fund shall attach an authenticated copy of their
Partnership Agreement hereto.
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PRE-QUALIFICATION FORM “19”
INSTITUTIONAL INVESTORS
(To be completed by each Member who is an Institutional Investor on a separate Pre-Qualification Form,
in accordance with the provisions of Section 5.6.2 (Institutional Investors) of the Invitation)
(Capitalized terms shall have the meaning ascribed to them in the Invitation)
I, _____________, the undersigned, am making this affidavit on behalf of _____________
(name of Institutional Investor):
A. Anticipated Holdings in the Participant
___________ (name of Institutional Investor) will hold ___% of Anticipated Holdings in the
Participant, _________________.
B. Financial Data of _______________ (name of Institutional Investor): *
1. Equity
Year t
Equity (excluding minimal equity required by law, to the extent
relevant) – Original Currency [name the currency]
Currency Exchange Rate
Equity (excluding minimal equity required by law, to the extent
relevant) – NIS
The Institutional Investor’s Equity is equivalent to not less than NIS four million (4,000,000)
for each one percent (1%) of its Anticipated Holdings in the Participant, as stipulated in Section
A above.*
2. Assets Managed
Year t
Managed assets– Original Currency [name the currency]
Currency Exchange Rate
Managed assets– NIS
The total net worth of the assets that the Institutional Investor manages is equivalent to not less
than NIS one hundred and twenty five million (125,000,000) for each one percent (1%) of its
Anticipated Holdings in the Participant, as stipulated in Section A, above.*
t = the year of the most recent annual Financial Statement (not earlier than for the year 2019)
* The data in this Pre-Qualification Form that is presented in NIS, should be calculated in
accordance with the provisions of Section 6.3 (Currency Conversion) of the Invitation.
Attached to Annex A of Pre-Qualification Form “14” above is the Institutional Investor’s most
recent annual Financial Statement (not earlier than for the year 2019).
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_____________________ ________________________
Date
Stamp and Signature
I, ____________, the undersigned, hereby confirm that on ____________ [date],
____________[name], Israeli I.D. number / _______[country] Passport number ____________, who
is authorized to sign on behalf of ____________, and to commit it for purposes of the above stated
Pre-Qualification Form, for all purposes and intents, appeared before me, and after being cautioned
that he/she is required to state the truth, and that if he/she fails to do so he/she shall be liable to the
punishments prescribed by Law, signed this statement in my presence.
Name: ____________
Stamp and Signature: ____________
Date: ____________
____________________
Attorney-at-Law
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PRE-QUALIFICATION FORM “20”
INVESTMENT ENTITIES
(To be completed by each Member who is an Investment Entity on a separate Pre-Qualification Form, in
accordance with the provisions of Section 5.6.3 (Investment Entities) of the Invitation)
(Capitalized terms shall have the meaning ascribed to them in the Invitation)
I, _____________, the undersigned, am making this affidavit on behalf of _____________
(name of Investment Entity):
A. Anticipated Holdings in the Participant
___________ (name of Investment Entity) will hold ___% of Anticipated Holdings in the
Participant, _________________.
B. Equity
Most recent annual
Financial
Statement
Equity (based on the most recent annual Financial Statements (not earlier
than for the year 2019) - Original Currency [name the currency]
Currency exchange rate*
Equity (based on the most recent annual Financial Statements (not earlier
than for the year 2019) - NIS
The Investment Entity’s Equity is equivalent to not less than NIS twelve million (12,000,000) for each
one percent (1%) of its Anticipated Holdings in the Participant, as stipulated in Section A, above.
C. Investments in Infrastructure Projects or companies / initiatives in the infrastructure
sector
Investment Details Infrastructure Project / Company / Initiative (at least 2) [add additional
columns as necessary]
“1” “2” “3” “4”
Name of Infrastructure
Project/ company/
initiative
Description of Infrastructure Project / Company / Initiative:
Type of Infrastructure
Project (if applicable) as
defined within the
Invitation
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Investment Details Infrastructure Project / Company / Initiative (at least 2) [add additional
columns as necessary]
Type of company/
initiative (as applicable)
and description thereof
Amount of investment
(in NIS)*
Currency exchange rate
Amount of investment
(in original currency)
[name the currency]
Date on which the
investment was
executed (signed)
[MM/YYYY]
Client Details and
Contact Person
Information
* All data in this Pre-Qualification Form is to be presented in NIS, in accordance with the provisions
of Section 6.3 (Currency Conversion) of the Invitation.
Attached to Annex A of Pre-Qualification Form “14”, above, is the Investment Entity’s most recent
annual Financial Statement (not earlier than for the year 2019).
_____________________ ________________________
Date
Stamp and Signature
I, ____________, the undersigned, hereby confirm that on ____________ [date],
____________[name], Israeli I.D. number / _______[country] Passport number ____________, who
is authorized to sign on behalf of ____________, and to commit it for purposes of the above stated
Pre-Qualification Form, for all purposes and intents, appeared before me, and after being cautioned
that he/she is required to state the truth, and that if he/she fails to do so he/she shall be liable to the
punishments prescribed by Law, signed this statement in my presence.
Name: ____________
Stamp and Signature: ____________
Date: ____________
____________________
Attorney-at-Law