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WATER AND SANITATION AGENCY (LDA) 59-F GULSHAN-E-RAVI LAHORE Technical Bid TENDER NO.P&S/25.01/6133 – REPLACEMENT OF 2CFS CAPACITY TUBEWELL AT JEVAN HANA PIND USMAN BLOCK GARDEN TOWN, LAHORE NAME OF FIRM ADDRESS COMPLETION PERIOD 90-DAYS _________ DCR NO. DATED RS. ISSUED BY Name of Branch __________________________ INSTRUCTIONS FOR BIDDERS 1. The bidder should quote rate after careful study of bid document. 2. The rates should be quoted both in figures as well as in words. Similarly the total amount of the individual items should also be mentioned both in figures as well as in words. 3. The bid must accompany NTN certificate from concerned Income Tax Office without which the bid will not be entertained. 4. Any rebate on tendered rates of item/whole bid cost shall not be accepted. 5. Bid will be valid for the 120 days. 6. No tender will be received telegraphically or by post. 7. Conditional tender will not be accepted. 8. The bidder must provide PRA Certificate along with bid. 9. In case the total tendered amount is less than 5% (Five) of the approved estimated (DNIT) amount, the lowest bidder will have to deposit additional performance security from the Scheduled Bank ranging from 5.01% to 10%. RECEIPT NO. ___________________ DATED _________________________ OPENING DATE _______________ (FOR OFFICE USE ONLY)

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Page 1: WATER AND SANITATION AGENCY (LDA) - Punjab, Pakistan · water and sanitation agency (lda) 59-f gulshan-e-ravi lahore technical bid tender no.p&s/25.01/6133 – replacement of 2cfs

WATER AND SANITATION AGENCY (LDA)

59-F GULSHAN-E-RAVI LAHORE

Technical Bid

TENDER NO.P&S/25.01/6133 – REPLACEMENT OF 2CFS CAPACITY TUBEWELL AT JEVAN HANA PIND USMAN BLOCK GARDEN TOWN, LAHORE

‘ NAME OF FIRM

ADDRESS

COMPLETION PERIOD 90-DAYS _________

DCR NO. DATED RS.

ISSUED BY Name of Branch __________________________

INSTRUCTIONS FOR BIDDERS

1. The bidder should quote rate after careful study of bid document. 2. The rates should be quoted both in figures as well as in words. Similarly the total

amount of the individual items should also be mentioned both in figures as well as in words.

3. The bid must accompany NTN certificate from concerned Income Tax Office without which the bid will not be entertained.

4. Any rebate on tendered rates of item/whole bid cost shall not be accepted. 5. Bid will be valid for the 120 days. 6. No tender will be received telegraphically or by post. 7. Conditional tender will not be accepted. 8. The bidder must provide PRA Certificate along with bid. 9. In case the total tendered amount is less than 5% (Five) of the approved estimated

(DNIT) amount, the lowest bidder will have to deposit additional performance security from the Scheduled Bank ranging from 5.01% to 10%.

RECEIPT NO. ___________________

DATED _________________________

OPENING DATE _______________

(FOR OFFICE USE ONLY)

Page 2: WATER AND SANITATION AGENCY (LDA) - Punjab, Pakistan · water and sanitation agency (lda) 59-f gulshan-e-ravi lahore technical bid tender no.p&s/25.01/6133 – replacement of 2cfs

SPECIAL CONDITIONS

1. The replacement of materials shall be in accordance with the specified requirements and compatible to the existing Tubewell machinery.

2. The Contractor shall attach relevant documents as a support which is required in technical evaluation criteria duly signed and stamped by bidder otherwise bidder shall not be qualified / responsive.

3. The decision of Technical Evaluation committee shall be final and acceptable by the bidders.

4. Bid security in the shape of CDR amounting to Rs.193,406.00 must be attached with technical bid failing which the bid shall be rejected.

5. CDR must be on account of firm /company/Joint Venture in favour of Deputy Director Procurement failing which the bid shall be rejected.

6. Each page of technical bid and attached documents must be signed and stamped by the bidder failing which the bid shall be rejected.

7. E-stamp paper according to stamp act article No.22A(a)(iv) amounting to Rs.5,000.00 shall be provided by the bidder for execution of Contract Agreement.

8. Contractor “All Risk Policy” by WASA approved insurance company shall be provided by the bidder and shall be made a part of Contract Agreement.

9. The sub-contractor’s experience shall be considered for evaluation. 10. Only the sub-contractor share, by value, shall be considered to meet. 11. The General Experience and financial resources of sub-contractor shall not be

considered to those of the bidder for purpose of qualification of the bidder. 12. In Case of experience as sub-contractor the bidder must produce agreement

(Containing detail work/Activities performed during agreement) with prime contractor.

13. Joint Venture must comply with the following requirements:

a) Following are minimum requirements for Joint Venture: - i) In accordance with PEC Bye Laws, Foreign Firms are required to form JVs with local Firms.

ii) The lead partner shall meet not less than 40% percent of all qualifying criteria given in paras heretofore.

iii) Each of the partners shall meet not less than 25% percent of all the qualifying criteria given in paras heretofore.

iv) The joint venture must collectively satisfy the technical evaluation criteria. Heretofore, for which purpose the relevant figures for each of the partners shall be added together to arrive at the JV’s total capacity. Individual members must satisfy each of the requirements. v) The lead partner shares shall not be less than 40% and shares of each partner of JV shall not be less than 25%. vi) The JV agreement must registered with sub registrar mentioning the joint and several liabilities with respect to the contract and Joint account of the firms to whom the transactions shall be made.

b) Any change in a technically responsive/ qualified JV after evaluation, shall be subject to the written approval of the client such approval may be denied if: -

i) Partner(s) withdraw from a JV and remaining partners do not meet the qualifying / technical evaluation criteria; ii) The new partners to a JV are not stand qualified/ responsive individually or as another JV; or iii) In the opinion of the Client, a substantial reduction in competition would result.

Page 3: WATER AND SANITATION AGENCY (LDA) - Punjab, Pakistan · water and sanitation agency (lda) 59-f gulshan-e-ravi lahore technical bid tender no.p&s/25.01/6133 – replacement of 2cfs

iv)One firm shall not be partner in more than one JV.

c) Bid shall be signed by all members in the JV so as to legally bind all partners, jointly and severally, and any bid shall be submitted with a copy of the JV agreement dully registered with sub-registrar providing the joint and several liabilities with respect to the contract.

14. The technically evaluation of a JV does not necessarily qualify any of its partners individually

or as a partner in any other JV or association. In case of dissolution of a JV, each one of the

constituent firms may be declared qualified / technically responsive if they meet all the

requirements as described in technical criteria and any partner of JV has requested/shall

request for the same and then his qualification shall be subject to the written approval of the

Client.

15. The Bidder (including all members of a JV) must not be associated, nor have been associated

in the past, with the consultants or any other entity that has prepared the design, specifications

and bidding documents for the project, or was proposed as Engineer for the contract, over the

last five (05) years. Any such association may result in disqualification/ non-responsiveness of

the Bidder.

16. A qualified firm/contractor/JV may participate only in one bid only for the contract. If a firm

submits more than one bid, singly or as a JV, all bids including that bidder will be rejected.

Page 4: WATER AND SANITATION AGENCY (LDA) - Punjab, Pakistan · water and sanitation agency (lda) 59-f gulshan-e-ravi lahore technical bid tender no.p&s/25.01/6133 – replacement of 2cfs

TECHNICAL EVALUATION CRITERIA PART-A: BASIC ELIGIBILITY

1. Registration with WASA (in Category C or above) / HUD&PHED.

2. PEC License C-6 with specialization in CE-09.

3. Registration certificate / Memorandum of Association / Article of Association /Partnership

deed registered with sub-registrar/ Affidavit of sole proprietorship.

4. Registration with FBR & PRA (NTN & PNTN).

5. No Black Listing and Litigation on Judicial stamp paper of Rs.100.

Page 5: WATER AND SANITATION AGENCY (LDA) - Punjab, Pakistan · water and sanitation agency (lda) 59-f gulshan-e-ravi lahore technical bid tender no.p&s/25.01/6133 – replacement of 2cfs

PART-B: DETAIL EVALUATION CRITERIA

Sr. No. Category 1. Experience Record 2. Personnel Capabilities 3. Equipment Capabilities 4. Financial Soundness

Detail Evaluation shall be decided on the basis of responsive / non-responsive.

EXPERIENCE RECORD

The firm / applicant / bidder must meet following requirements.

Sr.

No.

Description Required Documents

1. Any project of Installation / Construction including drilling

boring of Tubewells having 02Cfs Capacity in last 05-years.

Attach Copy of Work Order/

Contract Agreement and

completion certificates.

1. PERSONNEL CAPABILITIES

The applicant must have in his employment suitably qualified personnel with relevant

experience. The firm / applicant / bidder must meet following requirements.

Sr. No.

Description Required Documents

1 Technical Staff The Applicant shall attach

evidence of detailed CVs,

affidavit of employment on

judicial stamp paper or salary

slips of Technical staff with the

application and valid PEC

Registration certificates of the

Engineers. In case of evidence of

technical staff is not attached the

staff shall not be considered for

evaluation.

I Graduate Engineers Registered with PEC

Number of Engineers 1 @ 05 year experience

Ii Number of Diploma Engineers in the Firm 1 @ 05 year experience

Iii Driller 1 @ 10 year experience

Iv Assistant Driller 2 @ 10 year experience

V Pump Tester

Vi Electrician

Vii Mechanic

Page 6: WATER AND SANITATION AGENCY (LDA) - Punjab, Pakistan · water and sanitation agency (lda) 59-f gulshan-e-ravi lahore technical bid tender no.p&s/25.01/6133 – replacement of 2cfs

2. EQUIPMENT CAPABILITIES

The firm / applicant / bidder must meet following requirements.

3. FINANCIAL POSITION

The firm / applicant / bidder must meet following requirements.

Sr. No.

Description Required Documents

1. Average Annual turnover in last three (03) years 10 million

Authenticated audited sheets of last three years.

2. Available Bank credit line / any proof of liquid assets equal to 6.5 million or above.

Recent / Most current bank credit line certificate / bank statement.

Note:

1. WASA, the Client reserves the right to verify the originality and genuineness of the

submitted documents, in case of defective information the firm/Applicant/JV may be

disqualified/blacklisted.

Sr. No. Equipment Type and Characteristics

Required Documents

1. Direct Rotary / Reverse Rotary Rig Machine capable to drill hole size of 26” i/d upto depth of 800 ft 01 No.

Attach ownership Certificate / Transfer letter are any other

ownership proof. The bidder shall provide

undertaking on judicial stamp paper of Rs.100 that he has his own rig machine

with all necessary equipment and he will

be responsible if his statement found false

at any stage during inspection by the

department

2. Excavator 01 No

3. Development and testing unit (having pump with 200 ft column pipe) capable to D&T for Tubewell atleast 1.5 times of designed capacity till the satisfactory results as per specifications are achieved. 01 No.

4. Welding plant 01 No.

5. Water Bowser 1 No.

6. Drilling Rod 850 Rft

Page 7: WATER AND SANITATION AGENCY (LDA) - Punjab, Pakistan · water and sanitation agency (lda) 59-f gulshan-e-ravi lahore technical bid tender no.p&s/25.01/6133 – replacement of 2cfs

WATER AND SANITATION AGENCY (LDA)

59-F GULSHAN-E-RAVI LAHORE

Financial Bid

TENDER NO.P&S/25.01/6133 – REPLACEMENT OF 2CFS CAPACITY TUBEWELL AT JEVAN HANA PIND USMAN BLOCK GARDEN TOWN, LAHORE

NAME OF FIRM

ADDRESS

COMPLETION PERIOD 90-DAYS _________

DCR NO. DATED RS.

ISSUED BY Name of Branch __________________________

INSTRUCTIONS FOR BIDDERS

1. The bidder should quote rate after careful study of bid document. 2. The rates should be quoted both in figures as well as in words. Similarly the total

amount of the individual items should also be mentioned both in figures as well as in words.

3. The bid must accompany NTN certificate from concerned Income Tax Office without which the bid will not be entertained.

4. Any rebate on tendered rates of item/whole bid cost shall not be accepted. 5. Bid will be valid for the 120 days. 6. No tender will be received telegraphically or by post. 7. Conditional tender will not be accepted. 8. The bidder must provide PRA Certificate along with bid. 9. In case the total tendered amount is less than 5% (Five) of the approved estimated

(DNIT) amount, the lowest bidder will have to deposit additional performance security from the Scheduled Bank ranging from 5.01% to 10%.

RECEIPT NO. ___________________

DATED _________________________

OPENING DATE _______________

(FOR OFFICE USE ONLY)

Page 8: WATER AND SANITATION AGENCY (LDA) - Punjab, Pakistan · water and sanitation agency (lda) 59-f gulshan-e-ravi lahore technical bid tender no.p&s/25.01/6133 – replacement of 2cfs

SPECIAL CONDITIONS

1. The replacement of materials shall be in accordance with the specified requirements and compatible to the existing Tubewell machinery.

2. The Contractor shall attach relevant documents as a support which is required in technical evaluation criteria duly signed and stamped by bidder otherwise bidder shall not be qualified / responsive.

3. The decision of Technical Evaluation committee shall be final and acceptable by the bidders.

4. Bid security in the shape of CDR amounting to Rs.193,406.00 must be attached with technical bid failing which the bid shall be rejected.

5. CDR must be on account of firm /company/Joint Venture in favour of Deputy Director Procurement failing which the bid shall be rejected.

6. Each page of technical bid and attached documents must be signed and stamped by the bidder failing which the bid shall be rejected.

7. E-stamp paper according to stamp act article No.22A(a)(iv) amounting to Rs.5,000.00 shall be provided by the bidder for execution of Contract Agreement.

8. Contractor “All Risk Policy” by WASA approved insurance company shall be provided by the bidder and shall be made a part of Contract Agreement.

9. The sub-contractor’s experience shall be considered for evaluation. 10. Only the sub-contractor share, by value, shall be considered to meet. 11. The General Experience and financial resources of sub-contractor shall not be

considered to those of the bidder for purpose of qualification of the bidder. 12. Joint Venture must comply with the following requirements:

a) Following are minimum requirements for Joint Venture: -

i) In accordance with PEC Bye Laws, Foreign Firms are required to form JVs with local Firms.

ii) The lead partner shall meet not less than 40% percent of all qualifying criteria given in paras heretofore.

iii) Each of the partners shall meet not less than 25% percent of all the qualifying criteria given in paras heretofore.

iv) The joint venture must collectively satisfy the technical evaluation criteria. Heretofore, for which purpose the relevant figures for each of the partners shall be added together to arrive at the JV’s total capacity. Individual members must satisfy each of the requirements. v) The lead partner shares shall not be less than 40% and shares of each partner of JV shall not be less than 25%. vi) The JV agreement must registered with sub registrar mentioning the joint and several liabilities with respect to the contract and Joint account of the firms to whom the transactions shall be made.

b) Any change in a technically responsive/ qualified JV after evaluation, shall be subject to the written approval of the client such approval may be denied if: -

i) Partner(s) withdraw from a JV and remaining partners do not meet the qualifying / technical evaluation criteria; ii) The new partners to a JV are not stand qualified/ responsive individually or as another JV; or iii) In the opinion of the Client, a substantial reduction in competition would result. iv)One firm shall not be partner in more than one JV.

Page 9: WATER AND SANITATION AGENCY (LDA) - Punjab, Pakistan · water and sanitation agency (lda) 59-f gulshan-e-ravi lahore technical bid tender no.p&s/25.01/6133 – replacement of 2cfs

c) Bid shall be signed by all members in the JV so as to legally bind all partners, jointly and severally, and any bid shall be submitted with a copy of the JV agreement dully registered with sub-registrar providing the joint and several liabilities with respect to the contract.

13. The technically evaluation of a JV does not necessarily qualify any of its partners individually

or as a partner in any other JV or association. In case of dissolution of a JV, each one of the

constituent firms may be declared qualified / technically responsive if they meet all the

requirements as described in technical criteria and any partner of JV has requested/shall

request for the same and then his qualification shall be subject to the written approval of the

Client.

14. The Bidder (including all members of a JV) must not be associated, nor have been associated

in the past, with the consultants or any other entity that has prepared the design, specifications

and bidding documents for the project, or was proposed as Engineer for the contract, over the

last five (05) years. Any such association may result in disqualification/ non-responsiveness of

the Bidder.

15. A qualified firm/contractor/JV may participate only in one bid only for the contract. If a firm

submits more than one bid, singly or as a JV, all bids including that bidder will be rejected.

Page 10: WATER AND SANITATION AGENCY (LDA) - Punjab, Pakistan · water and sanitation agency (lda) 59-f gulshan-e-ravi lahore technical bid tender no.p&s/25.01/6133 – replacement of 2cfs

FINANCIAL BID

Bid Schedule

For

TENDER NO.P&S/25.01/6133 - REPLACEMENT OF 2-CFS CAPACITY TUBEWELL AT JEVAN HANA PIND USMAN BLOCK,GARDEN TOWN LAHORE

S.No Description Qty Unit Rate Amount (Rs.) STANDARDIZED ITEMS

1 Dismentling brick work lime or cement mortor

3.88

%Cft

2,661.40 10,326.23

MRS 1st Half 2019, Chap 4, P34, item 13

2 Dismantling cement concrete 1:2:4 Plain

9.00

%Cft

6,888.30 61,994.70

MRS 1st Half 2019, Chap 4, P35, item 19(c.)

3 Dismantling brick or flagged flooring without concrete foundation.

18.00

%Sft

532.30 9,581.40

MRS 1st Half 2019, Chap 4, P36, item 29

4 Earthwork excavation in open cutting upto 5'-0" (1.5 m) depth for storm water channels, drains, sullage drains in open areas, roads, streets, lanes, including under pinning of open areas, roads, streets, lanes, including under pinning of walls and shoring to protect existing works, shuttering and walls and shoring to protect existing works, shuttering and timbering the trenches, dressed to designed level and dimensions, trimming, removal of surface water from trenches, back filling and surplus excavated material disposed of and dressed within 50 ft. (15 m) lead:-

i) Ordinary (45' x 40' x 4')

7.20

%0Cft

5,569.00 40,096.80

MRS 1st Half 2019, Chap 3, P28, Item 7(i)

5 Pacca Brick work in foundation and plinth. i)

Ratio (1:4)

9.20 %Cft

21,370.35

196,607.22

ii) Ratio (1:6)

3.88

%Cft

21,751.75 84,396.79

MRS 1st Half 2019, Chap 7, P51, Item 4(i)

6 Cement plaster 1:3 upto 20' (6.00 m) height b)

½" (13 mm) thick

23.43 %Sft

1,968.35

46,118.44

MRS 1st Half 2019, Chap 11, P72, Item 8(b)

7 Direct rotary/reverse rotary drilling of bore for tubewells in all types of soil except shingle, gravel and rock.

a) From ground level to 250 ft. BGL 20" to 26" i/d.

250.00

P/Rft. 744.15

186,037.50

b) Exceeding from 250 ft. to 300 depth BGL with 26"dia bit

50.00

P/Rft. 744.15

37,207.50

c) Exceeding 300ft. depth below ground level 20"to 26" i/d

455.00

P/Rft. 744.15

338,588.25

MRS 1st Half 2019, Chap 23, P129 Item 5 (a-ii & b-ii).

MRS 1st Half 2019, Chap 23, P129, Item No. 7

Page 11: WATER AND SANITATION AGENCY (LDA) - Punjab, Pakistan · water and sanitation agency (lda) 59-f gulshan-e-ravi lahore technical bid tender no.p&s/25.01/6133 – replacement of 2cfs

8 Providing and installing M.S blind pipe socketed/welded joint, M.S. reducer in tubewells bore hole including jointing/welding with strainer, etc.

18" i/d 1/4" (450 mm i/d 6 mm) thick.

303.00

P/Rft 3,514.85

1,064,999.55

MRS 1st Half 2019, Chap 23, P131, Item 14 (l)

9 Shrouding with gravel around 10'' i/d fiber glass pipes

760.18

P/Cft 114.15

86,774.55

MRS 1st Half 2019, Chap 23, P132, Item No. 18

10 Transportation of earth all types when the total distance, including the lead coverd in the item of work, is more than 1000ft (300m) ( drilled earth from bore hole) upto 5mile (8km) lead

2.10

%0Cft 6,086.60

12,781.86

MRS 1st Half 2018, Chap 3, P29 Item 17 (a,b,c)

11 Cement concrete plain including placing, compacting, finishing and curing complete (including screening and washing of stone aggregate)

f) 1:2:4

9.00

%Cft 22,550.60

202,955.40

MRS 1st Half 2019, Chap 6, P42, item 5(f)

12 Flat brick flooring laid in 1:6 cement mortar, over a bed of 3/4" (20 mm) thick cement mortar, 1:6

18.00

%Sft 6,399.80

115,196.40

MRS 1st Half 2019, Chap 10, P66, item 8

Total for STANDARDIZED ITEMS Rs.

2,493,662.59

% Above / Below on MRS 1st Half 2019 _________

NON STANDARDIZED ITEMS

1 Providing and installing, Fiber Glass blank pipe in blank pipe in the tubewell borehole including jointing with the Fiber Glass blank pipe / strainer pipe. 10" i/d 0.22" thick.

330.00

P/Rft

2 Providing and installing,Fiber Glass strainer in tubewell bore hole including sockets,special socket etc. including jointing complete in all respect. 10"i/d 0.25" thick with 10% open area.

140.00

P/Rft

3 Providing and installing, Fiber Glass Bail plug in tubewell bore hole. 10" i/d 0.22" thick 10 ft. long.

1.00

Each

4 Providing/fixing M.S centerlizers 10.00

Each

5 Taking sample one number at every 5 ft. or from each stratum as per direction of Engineer including submission construction charts etc. and results of strata analysis.

151.00

Each

6 Providing and sealing with puddle clay between shrouding and grouting etc.

1.00

Job

7 Sealing of annular space around 18" mild steel housing pipe with 1:1 cement sand slurry including all sorts of materials.

296.00

P/Rft

8 Development testing and disinfecting of complete well in accordance with the tendered specifications including disposal arrangement of water as pumped.

1.00

P/Job

9 Chemical, physical and arsenic analysis of water from Aproved Lab.

1.00

P/Job

Page 12: WATER AND SANITATION AGENCY (LDA) - Punjab, Pakistan · water and sanitation agency (lda) 59-f gulshan-e-ravi lahore technical bid tender no.p&s/25.01/6133 – replacement of 2cfs

10 Providing and fixing M.S. cap to cover the pump house casing upto 18.5" dia 1/4" thick including welding.

1.00

Each

11 Providing/laying cement concrete block size as per drawing with RCC ratio 1:2:4 to house casing complete i/c screening of aggregate shuttering M.S Bars size 1/2" i/d & 2 Nos. clamps at right angle 1/2" thick 6" wide 5 ft long for holding down bolts with nuts complete.

1.00

P/Job

12 Installation of supply well 1.00

P/Job

13 Providing/Installation of MS stand casing 3/8" thick with 38" i/d

24.00

P/Rft

14 Geophysical bore hole logging 1.00

P/Job

15 Dismentling/Refixing of M.S Fence. 1.00

P/Job

16 Providing/fixing Carrugated Sheet (8'x4') i/c Joints etc around Working Area of the site for Safety Arrangments Complete

300.00

Rft

Total for NON STANDARDIZED ITEMS Total for STANDARD ITEMS Total for Sub Head-I Note:

1 Quantities of blank pipes and strainers given in the BOQ are only the average quantities for 2-Cfs tubewellls, as per past experience.

2 Placement of blind pipes and the strainer to be decided at site after careful examination of Hydrogeological conditions and grain size analysis of strata after drilling. Hence, quantities of useable strainer and blind pipe and depth of drilled hole may vary from site to site.

3 Dismentling of Pacca brick work, restoration of pacca brick work & transportation of earth etc will be paid as per actual & where necessary.

POWER WIRING FOR 2CFS CAPACITY (SUB HEAD-II)

STANDARDIZED ITEMS.

1 Supply and erection of single core PVC

insulated PVC sheathed copper conductor,

660/1100 volts grade cable in prelaid G.I. pipe

M.S conduits/PVC pipe/G.I. wire/trenches etc.

(rate for cable only).

19/2.11 mm (19/0.083") 60 P/Mtr.

1,085.05

65,103.00

37/2.11 mm (37/0.083") 80 P/Mtr.

1,895.10

151,608.00

MRS 1st Half 2019, Chap 24, page 143 item 12 (iv, vii).

2 Supply and erection of 3 pin switch and plug

combined recessed type 10/15 Amp. 1 Each

97.00

97.00

MRS 1st Half 2019, Chap 24, page 147 item 36 (ii).

3 Supply and erection of street light pole (30 mm) 1 1/4 G.I Pipe

complete with 2 No pole clumps

MRS 1st Half 2019, Chap 24, 150/63. 4 Each 1,319.80

5,279.20

4 Supply and erection of pole mounted street light, holders

Page 13: WATER AND SANITATION AGENCY (LDA) - Punjab, Pakistan · water and sanitation agency (lda) 59-f gulshan-e-ravi lahore technical bid tender no.p&s/25.01/6133 – replacement of 2cfs

shads and glass for fitting 125/250 watts murcry vapor

excluding cost lamps Philips designe

MRS 1st Half 2019, Chap 24, 64/150 (i). 4 Each 3,363.65

13,454.60

5 Supply and erection of G.I. flexible pipe for wiring, i/c

welding of sockets, nipples and check nuts, etc,

complete. 80 mm i/d.

MRS 1st Half 2019, Chap 24, page 141 item 5 (vii). 10 P/Mtr

1,166.45

11,664.50

6 Supply and erection of PVC Pipe for on surface wiring

(main and sub main), including clamps, inspection

boxes, pull boxes, bends, etc. complete with all

specials. 80 mm i/d.

MRS 1st Half 2019, Chap 24, page 141 item 7 (ii). 10 P/Mtr

320.15

3,201.50

7 Supply and erection of PVC Pipe for

recessed wiring (main and sub main)

purposes i/c bends, specials, in floor

wall or trenches.

80 mm i/d. 10 P/Mtr

354.60

3,546.00

MRS 1st Half 2019, Chap 24, 6 (ii).

8 Supply and fitting of mercury vapour lamp, complete

with choke set.125 Watt B295 Lamp 4 Each

1,140.75

4,563.00

MRS 1st Half 2019, Chap 24, page 147 item 65 (i).

9 Supply and erection of tubelight i/c rod, choke ,

starter frame, flexible wire, i/c connection from ceiling

rose etc. complete. single road (40 watts) with one

choke and one starter. 4 P/Set

695.55

2,782.20

MRS 1st Half 2019, Chap 24, page 148 item 43 (ii).

Total for STANDARDIZED ITEMS. Rs. 261,299.00 % Above / Below on MRS 1st Half 2019 _________ NON STANDARDIZED ITEMS.

1 Supply and erection of 200 Amps 500-V tripple pole

moulded case circuit breaker with built in over current

and short circuiting system within a metal enclosure

with top and bottom removable glands plates to

IP-54. 1 Each

2 Supply and erection of distribution board alongwith 32

Amps. T.P. main C.B. and alongwith 8 Nos. single

pole circuit breaker for branch distribution circuits of

light and fan arrangements i/c PVC pipes pull boxes

inspection boxes bends, tees, recessed type for light

wiring purposes etc. complete in all respects as per

site conforming to specifications E-01. 1 P/Job

3 Wiring light and fan points in recess with 3/.029 PVC

insulated wire in PVC pipe including switch board

size as per site requirement bulb including of making

Page 14: WATER AND SANITATION AGENCY (LDA) - Punjab, Pakistan · water and sanitation agency (lda) 59-f gulshan-e-ravi lahore technical bid tender no.p&s/25.01/6133 – replacement of 2cfs

good the damage etc. (as required). 20 P/Pnt.

4 Providing/fixing wall bracket low noise fan with

regulator oscillation type sweep 18"/20" including of

foundation bolts and making good the damages (as

approved). 1 Each

5 P/fixing low noise exhaust fan 18" size

with lauver and other fittings on the wall

as per instructions of Engineer. 3 Each

6 P/fixing shock treatment chart under

electricity act with glass and frame etc. 1 Each

7 P/fixing danger plate size 8"x4" (enamel 1 Each

coated as approved by Engineer).

8 Postal Order 40 Each

9 7/29 wire, PVC tape, samad bond, Nut bolt etc

complete in all respect for installation of energy meter 1 1Job

10 Meter Testing fee 2 Each

Total for Non Standardized Items. Total for Standared Itmes

Total for Part A

PART - B EARTHING.

STANDARDIZED ITEMS.

Providing and installation of special earthing

with distribution copper busbar and 4 SWG

wire copper conductor i/c copper plate

2'x2'x1/4" thick charcoal, salt and lime (1:2:4),

G.I. Pipe, i/c excavation of pit and other items

etc. upto permanent water table having a

resistance of 0.5-1.0 ohms and each electrical

and metalling components will be connected

at two points with earth strip of 3x25mm fitted

throughout inside the wall at 1 feet height

connected with main earthing strip at

main earthing pit by solid copper conductor at

minimum three points as per standard

specifications. This item also includes supply

and erection of PVC pipe above the ground

and construction of 18x18 inches chamber on

base of 3 inches RCC 1:4:8 with 4-1/2 inches

thick slab of 1:2:4 complete in all respect for

earthing purposes.

1 Direct rotary/reverse rotary drilling of bore for tubewells

in all types of soil except shingle, gravel and rock.

a) From ground level to 250ft. Below ground level 26" i/d. 20 P/Rft.

744.15

14,883.00

Page 15: WATER AND SANITATION AGENCY (LDA) - Punjab, Pakistan · water and sanitation agency (lda) 59-f gulshan-e-ravi lahore technical bid tender no.p&s/25.01/6133 – replacement of 2cfs

MRS 1st Half 2019, Chap 23, page 129 item 5 (a-ii).

2 Providing, laying, cutting, jointing G.I. pipe lines with

socket joints, using GI pipes of BSS 1387-1967

complete in all respects, with specials and valves.

(Medium Quality) 1/2" i/d. 25 P/Rft.

85.10

2,127.50

MRS 1st Half 2019, Chap 23, page 133 item 22 (ii-a).

3 Supply and erection of PVC pipe for wiring on surface

including clamps inspection boxes, pull boxed, bends,

tees, repairing surface etc. complete with all

specials:- 12mm i/d. 20 P/Rft.

18.85

377.00

MRS 1st Half 2019, Chap 24, page 141 item 4 (i).

4 Cement concrete brick or stone ballast 1.5" to 2"

gauge in foundation and plinth. Ratio 1:4:8

(2.75 x 2.75 x 0.25 = 1.89 Cft) 0.0189 %Cft.

13,414.85

253.54

MRS 1st Half 2019, Chap 6, page 41 item 3 (b).

5 RCC in roof slab 1:2:4

(2.25 x 2.25 x 0.25 = 1.27 Cft) 1.27

Per

Cft.

360.80

458.22

MRS 1st Half 2019, Chap 6, 6 (a-i-3) Type C.

6 Fabrication of mild steel reinforcement for cement

concrete, including cutting, blending, laying in position

making joints and fastening, including cost of binding

wire of steel reinforcement (also includes removal of

rust from bars). Deformed Bars. 3/8" dia @ 6" c/c

(2 x 5 x 2 = 20 x 0.376/2.204 = 3.412 Kg) (40-Grade) 0.0341 % Kg.

13,126.30

447.61

MRS 1st Half 2019, Chap 6, page 43 item 9(b).

7 Pacca brick work in foundation and plinth in cement

sand mortar. Ratio 1:5.

(2 x (2.25+1.5) x 0.375 x 1.5 = 4.22 Cft) 0.42 %Cft.

20,848.35

8,756.31

MRS 1st Half 2019, Chap 7, page 51 item 14 (i).

8

Rehandling of Earthwork 0.074 %oCft.

1,565.50

115.85

MRS 1st Half 2019, Chap 3, page 29 item 13 (a).

Total for Standardized Items

27,419.02

% Above / Below on MRS 1st Half 2019 _________

NON STANDARDIZED ITEMS.

1 Providing and fixing of copper plate size 2' x 2' x 1/4" 19.46 P/Kg.

2 Providing and fixing of copper strip size 1" x 1/8" and 35.5 P/Kg.

copper wire 4 SWG.

Page 16: WATER AND SANITATION AGENCY (LDA) - Punjab, Pakistan · water and sanitation agency (lda) 59-f gulshan-e-ravi lahore technical bid tender no.p&s/25.01/6133 – replacement of 2cfs

3 Providing & fixing of Salt, Charcoal & Lime and testing

& commissioning of 4SWG Earthing complete in all

respects including the cost of any additional material

required to complete the job as required in the

description above the item No. 1 of part-B, Sub

Head-IV. 1 Job

Total for Non Standardized Items

Total for Standared Itmes

Total for 1-Nos earthing

Total for Part B (2-Nos Earthing)

Total for Part-A

Total for Sub Head-II

SUB HEAD-III

CONSTRUCTION OF TUBEWELL CHAMBER.

STANDARDIZED ITEMS.

1 Excavation in foundation of building, bridges & other

structures, including dag belling, dressing, refilling

around structure with excavated earth, watering and

ramming lead upto one chain and lift upto 5 ft.

Ordinary soil. 1 %oCft

6,614.80

6,614.80

MRS 1st Half 2019, Chap 3, page 30 item 21 (b).

2 Cement concrete brick or stone ballast

1.5" to 2" gauge in foundation and plinth.

Ratio 1:6:12 2.55 %Cft

11,382.05

29,024.23

MRS 1st Half 2019, Chap 6, page 41 item 3 (d).

3 Pacca brick work in foundation and plinth in cement

sand mortar. Ratio 1:4. 6.60 %Cft

21,370.35

141,044.31

MRS 1st Half 2019, Chap 7, page 51 item 4 (i).

4 P/laying damp proof course of cement

concrete 1:2:4 (using cement, sand &

shingle) i/c bitumen and one coat

polythene sheet 500 gauge 1.5" thick. 0.62 %Sft

4,775.45

2,960.78

MRS 1st Half 2019, Chap 6, 8/33 (a-i).

5

Pacca brick work in ground floor. Ratio 1:4 6.66 %Cft

22,666.05

150,955.89

MRS 1st Half 2019, Chap 7, page 52 item 5 (i).

6 P/laying reinforced cement concrete (including

prestressed concrete) using course sand and

screened graded and washed aggregates in required

shape and design including forms, moulds,

shuttering, lifting, compacting curing, rendering and

finishing exposed surface, complete (but excluding

the cost of steel reinforcement its fabrication and

Page 17: WATER AND SANITATION AGENCY (LDA) - Punjab, Pakistan · water and sanitation agency (lda) 59-f gulshan-e-ravi lahore technical bid tender no.p&s/25.01/6133 – replacement of 2cfs

placing in position etc).

a-i) Reinforced cement in roof slab, beams, lintels,

girders and other structural members laid in situ or

precast laid in position, or prestressed members cast

in situ, complete in all respects.

Type C Nominal Mix 1:2:4 200 P/Cft

360.80

72,160.00

MRS 1st Half 2019, Chap 6, page 42 item 6 (a-i) Type C.

7 P/Laying cutting jointing testing and disinfecting PVC

pipe line of BSS with B class working pressure pipe

in trenches complte in all respect 3" i/d 75mm)

MRS 1st Half 2019, Chap 23 i-26 39 P/Rft

111.00

4,329.00

8 Fabrication of mild steel reinforcement for cement

concrete, including cutting, bending, laying in

position making joints, and fastening, including cost

of binding wire of steel reinforcement (also includes

removal of rust from bars). Deformed Bars. 40-Grade 7.9 %Kg

13,126.30

103,697.77

MRS 1st Half 2019, Chap 6, page 43 item 9 (b).

9 Cement plaster 1:4 upto 20 ft.

height 1/2" thick. 11.61 %Sft

1,870.70

21,718.83

MRS 1st Half 2019, Chap 11, page 72 item 9 (b).

10 Cement pointing struck joints, on

walls, upto 20' height, Ratio 1:2 16.09 %Sft

2,014.10

32,406.87

MRS 1st Half 2019, Chap 11, page 73 item18 (a).

11 Khassi parnalas in cement sand mortar

1:2 12" outside width finished smooth

with floating coat of neat cement. 33.00 P/Rft

103.20

3,405.60

MRS 1st Half 2019, Chap 9, page 72 item 14.

12

Khuras on roof 2'x2'x6". 3.00 Each

499.65

1,498.95

MRS 1st Half 2019, Chap 9, page 62 item 15.

13 Bottom khuras of brick masonry in

cement mortar 1:6 4'x2'x4.5" over 3"

cement concrete 1:4:8. 3.00 Each

887.25

2,661.75

MRS 1st Half 2019, Chap 9, page 62 item 16.

14

Dry rammed brick or stone ballast 1.5" to 2" gauge. 1.16 %Cft

4,262.30

4,944.27

MRS 1st Half 2019, Chap 6, page 41 item 2.

15 P/L conglomerated floor (two coat work) with top

layer of 1/2" thick wearing surface consisting of one

part of cement two parts of stone chips passing 3/16"

sieve over bottom layer of cement concrete 1:3:6 i/c

surface finishing and dividing in panel 1.5" thick. 2.58 %Sft

4,205.80

10,850.96

MRS 1st Half 2019, Chap 10, page 67 item 16(a).

16 Supply and filling sand under floors or

Page 18: WATER AND SANITATION AGENCY (LDA) - Punjab, Pakistan · water and sanitation agency (lda) 59-f gulshan-e-ravi lahore technical bid tender no.p&s/25.01/6133 – replacement of 2cfs

plugging in wells. 1.00 %Cft

1,820.90

1,820.90

MRS 1st Half 2019, Chap 7, page 56 item 30.

17 Single layer of tiles 9"x4.5"x1.5" laid over 4" earth &

plaster without bhoosa grouted with cement sand 1:3

on top of RCC roof slab provided with 34 lbs bitumen

coating sand blinded. 2.50 %Sft

6,810.90

17,027.25

MRS 1st Half 2019, Chap 9, 1/5.

18 Making and fixing steel grated doors with 1/16" thick

sheeting i/c angle iron frame 2"x2"x3/8" and 3/4"

square bars 4" C/C with locking arrangement. 80.00 P/Sft

1,033.60

82,688.00

MRS 1st Half 2019, Chap 25, 3/31.

19 P/fixing steel windows with openable glazed panels,

using beams section for frame 1.5" to 1"x5/8"x1/8"

Z-section for leaves 3/4"x1"x3/4"x1/8" T-section

sashes 1"x1"x1/8" glass panes, wooden screed for

glazing embedded over a thin layer of putty duly

screwed with leaves, brass fittings, holdfast duly

painted complete in all respects, including all cost of

material and labour etc. as per approved design as

directed by the Engineer Incharge. (22-SWG)

b) Fixed with wire gauze glass pane

5mm thick 22 SWG 60 P/Sft

471.25

28,275.00

MRS 1st Half 2019, Chap 25, page 156 item 41 (b-v).

20 Distampring of new surface.

New surface

3-Coats. (Rate for 3 Coats) 15 %Sft

395.40

5,931.00

MRS 1st Half 2019, Chap 11, page 73 item 23.

21 Painting new surface (Preparing surface and

painting of doors and windows, any type i/c

edges). Priming coat.

Each subsequent coat of paint. Two Coats 2.19 %Sft

1,177.90

2,579.60

MRS 1st Half 2019, Chap 13, page 153 item 5 (c-i,ii).

22 Fabrication of heavy steel work with

angle, tees, flat iron, round iron and

sheet iron for making trusses, girders,

tanks, etc. i/c cutting drilling, reveting

handling, assembling and fixing but

excluding erection in position.

For Roof Canopy as per drawing. 0.677 %Kg

14,728.15

9,970.96

MRS 1st Half 2019, Chap 25, page 153 item 10.

23 Erection and fitting in position iron

trusses, staging of water tanks, etc.

For Roof Canopy as per drawing. 0.677 %Kg

732.20

495.70

Page 19: WATER AND SANITATION AGENCY (LDA) - Punjab, Pakistan · water and sanitation agency (lda) 59-f gulshan-e-ravi lahore technical bid tender no.p&s/25.01/6133 – replacement of 2cfs

MRS 1st Half 2019, Chap 25, 153 item 11.

24 Preparing of surface and painting of doors and

windows any type i/c edges. (3-coats)

For Canopy. 0.50 %Sft

1,589.40

794.70

MRS 1st Half 2019, Chap 13, i/5(c).

25 Filling, watering and ramming earth under floors.

i) with surplus earth from foundation. 1.80 %oCft

3,170.65

5,707.17

MRS 1st Half 2019, Chap 3, page 29 item 15 (i).

26 P/fixing floor trap of cast iron including

concrete chamber, all round, and C.I. grating:

(4"x3") 3 Each

413.25

1,239.75

MRS 1st Half 2019, Chap 19, page 115 item 33 (ii).

27 Providing, laying, cutting, jointing, testing and disinfecting

G.I. pipeline in trenches, with socket joints, using G.I

pipes of B.S.S. 1387-1967 complete in all respects, with

specials and valves. (Medium quality)

¾" i/d (20 mm) 2.35mm thick

ch. 23 page 133 item 22-ii 50 P/Rft

107.80

5,390.00

28 Providing and fixing chromium plated bib cock:-

i) 2 cm (¾")

ch. 19 page 114/26-i 2 Each

353.70

707.40

29 Providing and fitting glazed earthen ware water closet

European type, excluding seat and cover:-

i) white

ch. 19 page 112/1-i 1 Each

2,191.50

2,191.50

30 Providing and fitting plastic made low down flushing

cistern

1363 litre (3 gallons) capacity, including bracket set, copper

connection, etc. complete.

i) white

ch. 19 page 113/12-i 1 each

1,208.80

1,208.80

31 Providing and fitting "P" trap:-

ii) 10 cm (4") glazed.

ch. 19 page 115/34 1 Each

143.25

143.25

Total of STANDARDIZED ITEMS. 754,444.99

% Above / Below on MRS 1st Half 2019 _________

NON STANDARDIZED ITEMS.

1 Providing, erecting and fixing in position

R.S. Joist size 5"x10"x1/2" & 15 ft long

Page 20: WATER AND SANITATION AGENCY (LDA) - Punjab, Pakistan · water and sanitation agency (lda) 59-f gulshan-e-ravi lahore technical bid tender no.p&s/25.01/6133 – replacement of 2cfs

having sufficient weight duly painted with

3 coats of approved paint. 1 Each

2 Providing and fixing deodar wall mounted

rack 2' x 1' size duly polished including

fixing of frame. 1 Each

3 P/fixing marble plate 1.5'x1' including

the engraving of letters as required as

per satisfaction of Engineer Incharge. 1 Each

4 Writing of WASA monogram as per

satisfaction of Engineer Incharge. 1 Each

5 Providing wooden benches 1.5'x4' long

16" high of good quality wood. 1 Each

6 Making water supply connection i/c M.S clump Drilling

hole

rubber sheet and net and bolt e.t.c. 1 each

7 Making sewer connection 6" dia 1 each

Total of NON STANDARDIZED ITEMS. Total for Standard Items Total for Sub Head-III

SUB HEAD-IV

PROVIDING & FIXING OF C.I. SPECIALS.

STANDARDIZED ITEMS.

1 P/fixing sluice valve BSS quality and

weight, class-B for cast iron pipe line

and asbestos cement pipe lines

(including cost of jointing material).

8" i/d. 1 Each

23,095.90

23,095.90

MRS 1st Half 2019, Chap 23, page 136 item 30 (f).

2 P/fixing cast iron special of BSS

class-B (such as bend, tee, cross

collar, reducer, tail piece flanged spigot,

cap, flanged socket, taper, angle

branch, plug etc.) for cast iron pipe line,

complete (C.I. flanged and flanged joint.

8" to 12" i/d. 240 P/Kg

105.00

25,200.00

MRS 1st Half 2019, Chap 23, page 135 item 28 (b-ii).

Total for Schedule Items Rs. 48,295.90 % Above / Below on MRS 1st Half 2019 _________ NON STANDARDIZED ITEMS.

1 Providing and fixing cast iron double

flanged pipe 8" i/d conforming to BSS

78-1961 Class-B to with stand 500 ft.

head (Hydraulic test pressure at works)

Page 21: WATER AND SANITATION AGENCY (LDA) - Punjab, Pakistan · water and sanitation agency (lda) 59-f gulshan-e-ravi lahore technical bid tender no.p&s/25.01/6133 – replacement of 2cfs

weight 53:69 lbs/ft. of variable length

varying from 1' to 6' length including

nuts and bolts rubber sheet complete in

all respects. 17 P/Rft

2 P/fixing disc type non return valve with

stainless disc and seat as per

WASA standard specifications 8" i/d

with integral flanges i/c rubber rings,

all respect. 1 Each

3 P/fixing double air release valve nominal dia

80mm (3") in cast iron construction good quality

approved by Engineer Incharge,

complet in all respects including jointing mat. 1 Each

4 Providing cement concrete/brick blocks

to support bends with ratio 1:2:4 i/c of

screening washing of stone aggregate

shuttering and curing etc. complete as

per drawing, complete job. 1 Each

5 P/fixing pressure gauge 4" i/d 0-150 PSI

capacity including gauge cock, copper

pipe, flair nut and drilling of holes in pipe

etc. complete job. 1 Each

6 Construction of brick support for tubewell

delivery pipe as per drawing complete in all

respects. 1 Job

7 Construction of RCC support for tubewell

delivery pipe and bend as per drawing

complete in all respects. 1 Job

Total for NON STANDARDIZED ITEMS. Total for Standard Item Total for Sub Head-IV

Sub Head-V

MAKING GRID CONNECTION OF TUBEWELL SUB-HEAD VI

A) Standardized Items

1 Dismantling and removing of road metalling.

100 x 2.50x 1 =250 2.50 %Cft 1252.40

3,131.00

MRS 1st Half 2019, Ch-4 i-45

2 Excavation of trenches in all kinds of soil, except

cutting rock, for water supply pipe line upto 5 ft.

depth from ground level including trimming dressing

sides, levelling the beds of trenches to correct grade

and cutting pits for joints etc. complete in all respect.

100x 2.5 x 4=1000 1.00 %0Cft 4709.75

4,709.75

MRS 1st Half 2019, Ch-3 i-44

Page 22: WATER AND SANITATION AGENCY (LDA) - Punjab, Pakistan · water and sanitation agency (lda) 59-f gulshan-e-ravi lahore technical bid tender no.p&s/25.01/6133 – replacement of 2cfs

3 Providing and fixing sluice valve of BSS quality and

weight, Class "B" for Cast Iron pipe line, and

Asbestos Cement pipe line complete (including cost

of jointing material).

8" i/d 2.00 Each 23095.90

46,191.80

MRS 1st Half 2019, Ch-23 i-30

4 P/fixing cost iron specials of BSS Class B (such as

bend, tee, cross collar reducer, tail piece flanged

socket, flanged spigot, cap, taper angle branch, plug

etc.) for Asbestos Cement pipe line with comet joint

& rubber ring complete

8" to 18" i/d. 450.00 P/Kg 105.00

47,250.00

5 Rehandling of earth work lead upto a single throw of

Kassi, phaorah or Shovel. 4.00 %oCft 1565.50

6,262.00

MRS 1st Half 2019, Ch-3 i-13(a)

6 Making connection with running main i/c excavation

of pit, backfilling excluding cost of specials etc.

8" i/d 1.00 P/ Con 2257.95

2,257.95

10" i/d 1.00 P/ Con 3185.15

3,185.15

12" i/d 1.00 P/ Con 4359.30

4,359.30

MRS 1st Half 2019, Ch-23 i-41

7 Cement concrete plan I/c placing compcting finshing

curing complete (I/c screeing and washing of

store aggregate) 1:2:4 100 x 2.25 x 0.5=112.5 0.08 %Cft 22550.60

1,804.05

8 Supply and filling sand under floors or

plugging in wells. 5.00 %Cft 1820.90

9,104.50

9 Transportation of earth all type including the lead

covered more then 1000 ft upto 5 mile (8 km) lead 1.00 %0Cft 6086.60

6,086.60

10

Providing, Laying, Jointing, Testing H.D.P.E presue pipe 50.00 P/Rft 941.65

47,082.50

PN-8, PE-100 for water supply in trenches i/c carriage at

site

conforming to iso-4427. Din 8074/75 & PS 3580: 1984 as

per satisfaction of engineer incharge (250mm)

Total of STANDARDIZED ITEMS. 181,424.60 % Above / Below on MRS 1st Half 2019 _________

Page 23: WATER AND SANITATION AGENCY (LDA) - Punjab, Pakistan · water and sanitation agency (lda) 59-f gulshan-e-ravi lahore technical bid tender no.p&s/25.01/6133 – replacement of 2cfs

B) NON Standardized Items

1 Construction of sluice valve chamber complete in all respects as per WASA standard drawing. 2.00 Each

2 P/F gibault joints i/c nut and bolts

best quality, complete in all respect.

8" i/d 4.00 Each

3 Providing, Laying, Jointing, Cutting, Testing and

disinfecting of D.I Pipe line 8" i/d. 50.00 P/Rft

4 Providing / Fixing Stub End (250mm) PN-10 4.00 each

Total of NON STANDARDIZED ITEMS. Total of Standared Items

Total for Sub Head-V

* Quantities of Grid Connection are on avarage basis. Actual Quanities will be determined as per site

Finalization.

Name of Firm _______________________________________________ Address _____________________________________________________ Signature ___________________________________________________