Annexure-1. Format of Letter of Expression of Interest. [On Company’s/Firm’s letterhead]. Reference: Date: Dean (Resources and Alumni).
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Annexure – 1 Format of Letter of Expression of Interest Reference: Date: Dean (Resources and Alumni) Dean, Resources and Alumni Office Room No. FB – 270, IInd Floor , Faculty Building Indian Institute of Technology Kanpur Kanpur (UP) 208 016 SUB: SUBMISSION OF EXPRESSION OF INTEREST Dear Sir , We hereby submit our expression of interest for consultancy services as explained in the Invitation for ` Expression of Interest for the aforementioned project. In support we submit all the necessary information and relevant documents (one original and one copy) for our participation in the procedure for short listing of applicants as a part of the selection process. We her eby submit our willingness to get shortlisted for our participation in the process for identifying the Consultant by the aforementioned Design. We understand that IIT Kanpur reserves the right to reject the submission, without assigning any reason. Yours faithfully, Signature of Applicant: Name of Signatory: Designation: Name and address of firm: Contact number: Fax: Email: Enclosures: Copy of Board Resolution/ Power of Attorney or Authority letter authorizing the representative to sign on behalf of the Company/firm as the case may be.

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Annexure – 2 TO BE SWORN ON A NON – JUDICIAL STAMP PAPER OF RS.100/ – AFF I DAVIT complete address) do hereby solemnly affirm and declare as under: – Mention the name of the Act). n for Expression of Interest i.r.o. Appointment of Public Relation Service Provider for IIT Kanpur . DEPONENT VERIFICATION – named deponent do hereby verify that the contents of the aforesaid paragraphs 1 and 2 are true and correct to the best of *my/our knowledge and belief and nothing is concealed there from. 1 9 (Strike off whichever is not applicable) DEPONENT Note: Deponent will be the authorized signatory of the Applicant

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Annexure – 3 TO BE SWORN ON A NON – JUDICIAL STAMP PAPER OF RS.100/ – AFF I DAVIT organization and its complete address) do hereby solemnly affirm and declare as under: – Mention name of organization) is eligible to submit the aforesaid proposal as neither the applicant has been barred and/or blacklisted by the Central Government and/or any State Government of India at any time prior to the date of submitting this affidavit. last three years has neither failed to perform on any agreement nor was expelled from any project or agreement nor any agreement terminated for any breach by the applicants or any of its constituents. 3. That an annexure attached to this affidavit gives list of all contracts of y of its constituents with the state / central government that are in arbitration. DEPONENT VERIFICATION the aforesaid paragraphs 1 to 3 are true and correct to the best of *my/our knowledge and belief and nothing is concealed there from. 19. (Strike off whichever is not applicable) DEPONENT Note: Deponent will be the authorized signatory of the Applicant

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An nexure – 4 ORGANISATIONAL STRUCTURE (This form to be furnished not only by the Prime Agency applying for the prequalification, but also furnish separately for sub – consultants (if any) who would be associated with this project) 1 Name & Address of the applicant with Telephone No./Fax No./ Email ID 2 a. Year of Establishment b. Date & Year of commencement of practice. 3 Legal status of the applicant (attach copies of original document defining the legal status) A proprietary firm A firm in partnership A limited company or Corporation 4 Names of Directors & other executives with designation 5 Designation of individuals authorized to act for the organization 6 Total No. of professional staff (In house): – Architects: Service Consultants : Quantity Surveyors: Others: 7 Was the applicant ever required to suspend the project for a period of more than six months continuously after you commenced the planning? If so, give the name of the project and reasons of suspension of proje ct. 8 Has the applicant or any partner in case of partnership firm, ever abandoned the awarded project before its completion? If so, give name of the project and reasons for abandonment. 9 Has the applicant or any constituent partner in case of partnership firm, ever been deba rred/ black listed for competing in any organization at any time? If so, give details. 10 Has the applicant or any constituent partner in case of

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partnership firm, ever been convicted by a court of law? If so, give details. 11 In which field of Consultancy the applicant has specialization & interest 12 Any other information considered necessary but not included above. 13 Address of local office if any

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Annexure – 5 DETAILS OF IN HOUSE SERVICES AVAILABLE FOR THE ASSIGNMENTS SNo. In – house Service Availability of Services Nos. of In – house Staff with experience Experience of 10 years & above Experience of 5 – 10 years Experience of less than 5 years 1 2 3 4 5 6 7 8 9 10 11 Note: Maximum two – page CV of each main member and key expert shall be furnished as per Annexure 7 .

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Annexure – 7 Brief Bio – Data of Key Professionals (This form to be furnished not only by the Prime Consultant applying for the prequalification, but also furnish separately for sub – consultants who would be associated with this project) Name of Firm: _____________________________________________________ Professional: ______________________________________________________ Date of Birth: ______________________________________________________ Years with Firm: ____________________________________________________ Nationality: _______________________________ _________________________ Membership in Professional Societies: ___________________________________ Detailed Task Assigned: ______________________________________________ levant to responsibility in context of assignment. Describe degree of responsibility held by staff member on relevant previous assignment and give dates and location. Use up to half a page.] Education: [Summarize college/university and other specialized e ducation of staff member, giving names of schools, dates attended and degree(s) obtained. Use up to a quarter pages .] Employment Record: [Starting with present position, list in reverse order every employment held. List all positions held by staff member since graduation, giving dates, name(s) of employing organization(s), title of positions held and location of assignments. For experience in last five years, also give type of activities performed and client references, where appropriate. Use up to three q uarter of a page.] Languages: [Indicate proficiency in speaking, reading and writing of English language: excellent, good, fair, or poor.] Certification: I, the undersigned, certify that to the best of my knowledge and belief, these bio – data correctly des cribe my qualifications, my experience and myself. Annexure – 8

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DETAILS OF QUALIFYING SUCH PROJECTS HANDLED /COMPLETED DURING THE LAST FIVE YEARS. SIMILAR NATURE OF ASSIGNEMENT COMPLETED WORKS S.No . Description Work No. 1 Work No. 2 Work No. 3 1 Name of Service / Project 2 Name & Address of Employer / Organization, Telephone no. of officer to whom reference may be made. 3 Cost of work in Rs. Lakhs (Attach copy of Work Order 4 Date of commencement as per contract 5 Stipulated date of completion 6 Actual date of completion 7 Litigation / arbitration pending / in progress with details * 8 Service rendered In – house teams Associated Consultants (if any) 9 Names of Project In charge & Key staff & nos. of staff involves. 10 Any other information * Indicate gross amount claimed and amount awarded by the Arbitrator. The Applicant may provide in this annexure, details of maximum 3 projects which in his opinion best present his ability to do justice to this Design (qualifying project referring to the project ) Annexure – 9

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CLIENT WISE PERFORMANCE REPORT OF SERVICE 1 Name of Service / Project 2 Agreement No. 3 Estimated Cost 4 Tendered Cost 5 Date of start 6 Date of completion Stipulated date of completion Actual date of completion 7 Amount of compensation levied for delayed completion, if any 8 Amount of reduced rate items, if any 9 Performance Report Quality of work Very Good/Good/Fair/Poor Financial soundness Very Good / Good / Fair / Poor Technical Proficiency Very Good / Good / Fair / Poor Resourcefulness Very Good / Good / Fair / Poor General Approach & Behaviour Very Good / Good / Fair / Poor Dated: Signature & Seal of Executive engineer or equivalent Annexure – 1 0

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AVERAGE ANNUAL FINANCIAL TURN OVER (GROSS) OF LAST THREE YEARS Financial Analysis : Details to be furnished duly supported by figures in balance sheet/profit and loss account for the last three years duly certified by the Chartered Accountant, as submitted by the applicant to the Income Tax Department (copies to be attached). Particulars Financial Year Year 201 5 – 1 6 Year 2 01 6 – 1 7 Year 201 7 – 1 8 Gross Annual turnover on construction work. (In Lakhs) Profit / Loss Certified by Financial arrangements for carrying out the proposed work. The following certificates are enclosed: Current Income Tax clearance Certificate / Profit & Loss account Signature of Chartered Accountant with seal

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