Government of West Bengal

Office of the Commissioner of Police, Kolkata

Administrative (Tender) Branch, 18, Lalbazar Street, Kolkata-1

Sub-Corrigendum to No. WBKP/CP/EOI-105/KOLPOL RAP/TEN DATED : 09.12.2021

Memo No. 18285/TEN Dated. 23.12.2021

In partial modification of the NIT No. WBKP/CP/EOI-105/KOLPOL RAP/TEN DATED : 09.12.2021 published in www.kolkatapolice.gov.in; the following changes has been done in the above
said EOI document.
Sl. Pg. Clause No., if
Clause Corrigendum
No. No. any
1 3 NOTICE
INVITING
EXPRESSION OF Last Date of Submission of Bid 24.12.2021 up to 15.00 hrs. Last Date of Submission of Bid 28.12.2021 up to 15.00 hrs.
INTEREST (EOI)

Note : All others terms and conditions in the EOI remain same and unchanged.

Sd/-
for Commissioner of Police
Kolkata
Notice Inviting Expression of Interest P a g e |1

EOI
[ EXPRESSION OF INTEREST ]

NO. WBKP/CP/EOI-105/KOLPOL RAP/TEN DATED : 09.12.2021

REQUEST FOR
EXPRESSION OF INTEREST (EOI)
FOR
SELECTION OF EVENT MANAGEMENT ORGANIZATION
TO ORGANIZE RAP MUSIC COMPETITION NAMED
“KOL-POL RAP”
ON SOCIAL MEDIA PLATFORMS
TO GENERATE AWARNESS & SENSITIZATION
AMONGST THE PUBLIC ON THE ISSUE
WOMEN SAFETY, CRIMES AGAINST WOMEN,
GENDER BIAS/SENSITIZATION ETC.
UNDER NIRBHAYA PROJECT
OF KOLKATA POLICE

KOLKATA POLICE DIRECTORATE

Tender Section, 18, Lalbazar Street, Kolkata – 700 001.
Ph. : (033) 2250 5275
e-Mail : tendersection@kolkatapolice.gov.in
2|P a g e Notice Inviting Expression of Interest

TABLE OF CONTENTS
NOTICE INVITING EXPRESSION OF INTEREST (EOI) ............................................................................... 3
I. INTRODUCTION : ......................................................................................................... 4
II. SCOPE OF WORK : ....................................................................................................... 4
III. ELIGIBILITY CRITERIA FOR ORGANIZATION : .................................................................. 5
IV. GUIDELINES : ............................................................................................................... 6
V. BID EVALUATION PROCESS :......................................................................................... 6
1. Evaluation Process : ............................................................................................................................ 6
2. Technical Evaluation : ......................................................................................................................... 6
3. Evaluation of Financial Bids :.............................................................................................................. 7
VI. ACCEPTANCE OF BID : .................................................................................................. 7
VII. Security Deposit (SD) : ................................................................................................. 7
VIII. Payment : ................................................................................................................... 7
IX. VALIDITY OF EOI : ........................................................................................................ 7
X. GENERAL CONDITIONS OF THE CONTRACT : .................................................................. 7
ANNEXURE – I ................................................................................................................................... 9
COVERING LETTER (ON THE BIDDER’S LETTER HEAD) ............................................................................... 9
ANNEXURE – II ................................................................................................................................ 10
TECHNICAL BID (ON THE LETTERHEAD OF THE ORGANIZATION) ............................................................ 10
ANNEXURE – III ............................................................................................................................... 11
FINANCIAL BID............................................................................................................................................. 11
ANNEXURE – IV ............................................................................................................................... 12
Format for REP/TOR suggestion ................................................................................................................ 12
ANNEXURE – V ................................................................................................................................ 13
Format for Curriculum Vitae of key Professionals of Organization ............................. ......................... 13
ANNEXURE – VI ............................................................................................................................... 14
LETTER OF UNDERTAKING FOR CONFLICT OF INTEREST.......................................................................... 14
ANNEXURE – VII .............................................................................................................................. 15
UNDERTAKING REGARDING BLACKLISTING .............................................................................................. 15
Notice Inviting Expression of Interest P a g e |3

KOLKATA POLICE DIRECTORATE

Tender Section, 18, Lalbazar Street, Kolkata – 700 001.
e-Mail : tendersection@kolkatapolice.gov.in
Ph. : (033) 2250 5275

NOTICE INVITING EXPRESSION OF INTEREST (EOI)

Commissioner of Police, Kolkata under invites sealed Expression of Interest [EOI] for engagement of Event
Management Organizations/agencies, based in and around Kolkata to generate awareness on the issue of Women
Safety, Crimes against Women, Gender Bias/Sensitization etc. through Rap Music named ‘KOL-POL RAP’ on social
media platforms.
The detailed RFP document can be downloaded from the website www.kolkatapolice.gov.in.

Important Dates & Information :

Earnest Money Deposit Rs. 2,00,000/- (Rupees two lakh only) only in the form of
Demand Draft in favour of “Commissioner of Police, Kolkata”
payable at Kolkata.
Date of Publishing 10.12.2021 at 15.00 hrs.
Last Date of Submission of Bid 24.12.2021 up to 15.00 hrs.
Bid opening Date & Time To be intimated later.
The Commissioner of Police, Kolkata.
BID Addressed to
18, Lalbazar Street, Kolkata – 700 001
Tender Section,
BID Submission Location 18, Lalbazar street, Ground Floor,
Kolkata - 700 001.
Office of the Commissioner of Police, Kolkata.
BID Opening Location
18, Lalbazar Street, Kolkata – 700 001.
• Tender Section –
Contact Details – 18, Lalbazar Street, Ground Floor,
Respective Offices on any working day during Kolkata - 700 001.
office hours (10:00 hrs. to 17:30 hrs.) Phone – (033) 2250-5275.
e-Mail – tendersection@kolkatapolice.gov.in

Sd/-
for Commissioner of Police,
Kolkata
 4|P a g e Notice Inviting Expression of Interest

I. INTRODUCTION :
Violence and abuse against women and girls is frequent on streets, in public transportation and in other
public places. Such occurrences restrict women’s right to mobility, discouraging their freedom to walk freely
and move in public spaces of their choice. Such violence also limits their access to essential services and
adversely impact their health and wellbeing.
In this context, and following the tragedy of December 2012, the Government has set up a dedicated fund –
Nirbhaya Fund – which can be utilized for projects specifically designed to improve the safety and security of
women. The projects envisaged under the Nirbhaya Fund scheme have the primary aim of creating an
environment where women safety is promoted and ensured. These diverse projects not only aim towards
creating physical infrastructures to forward this objective but also target the minds/attitudes/behaviour of
the general public – male and female to question the adverse patriarchal norms that lie at the very
foundations of all forms of crimes against women.
In this context, the Commissioner of Police, Kolkata, has taken up a series of such initiatives as a part of
Women safety project under Nirbhaya fund that aim to bring about mass behavioural change by reaching
out to each and every member of the society through all forms of electronic, print and digital media.
This specific component of the project named as “KOL-POL RAP” – a rap competition with the theme of
Women Safety, Crimes Against Women, Gender Bias/Sensitization is targeted towards engaging members of
the community physically so that they feel more connected to the aim of the project and are contributors in
the project rather than mere spectators. Expression of Interest [EOI] from bonafide, resourceful
organizations/agencies based in and around Kolkata have been invited to execute the plan effectively.
The selected organization is expected to have necessary infrastructure and adequate manpower including
experienced personnel with adequate knowledge in the field of rap music, song writing and singing for short
listing of the audio clips. Selected organizations are expected to short list audio clips with a strong message
based on the issue of Women Safety, Crimes against Women, Gender Bias/Sensitization so that the thought
can be imparted into the minds of the adolescent boys and girls and also to the society at large.

II. SCOPE OF WORK :

A. The selected organizations/agencies are expected to discharge the following duties :
1. Engagement in the entire work from start to finish relating to the contest.
2. Engagement in preparing content Highlights and Terms & Conditions of the contest.
3. Engagement in arranging logistical and Technical requirements for the contest.
4. Engagement in publishing advertisement to promote the event with the objective for arranging the
same.
5. Engagement of inviting online application from the applicants according to the approved terms and
conditions.
6. Co-ordinating with the participants and ensuring a smooth process of participation.
7. Engagement of experienced experts / Judges for evaluation short listing the candidates based on
their audio clip according to the theme of the contest under the supervision of Kolkata Police
authorities.
8. Engagement of professionals / celebrities for publicity / promotion purpose of the contest under
the supervision of Kolkata Police authorities.
9. Co-ordination between the participants and judges.
10. The selected agency to ensure that the content used for publicity is approved by Kolkata Police
Authorities.
11. Constant monitoring on the progress of work so that the contest can be completed within the
stipulated period.
12. Arrangement for publicity of the programme/contest.
13. Arrangement for prize distribution ceremony.
14. Keeping close liaison with the Kolkata Police officials to render all sorts of assistance to make the
project successful.
15. Prompt submission of report as and when asked for by the Kolkata Police officials.
Notice Inviting Expression of Interest Page |5

16. To make necessary arrangement to select the appropriate visuals / advertisements as per the given
guideline / instruction by the authority of Kolkata Police.
17. Entire task of preparing and publishing the rewards to the winners which includes recording, filming
and publishing of the music videos for the winning songs.
B. Kolkata Police is expected to discharge the following duties :
1. To render all sorts of assistance to the Organizations /agencies.
2. To provide a final go ahead with respect to all stages of the program as designed and put up by the
agency.
3. Making constant liaison with the selected Agency.
C. Timeline for rolling out the project :
Sl.
Event Particulars Time Schedule
No.
1 Advertisement inviting entries Audio-Video
FM
Social Media pages
e-Books
Traffic Kiosks
Letters to Colleges
2 Selection of Judges Rapper
Music Composer
Lyricist / Poet / Writer
3 Receipt of Entries In pre-determined
format
4 Short-listing of Entries
5 Final Selection & Announcement of the
Winner
6 Video Shooting & Recording
7 Launch of the final A/V and the Song

**Note : The project will have to be completed within 45 days.

III. ELIGIBILITY CRITERIA FOR ORGANIZATION :

1. The Organization should have been registered in India under any Act.
2. The organization should have its registered office in or around Kolkata with telephone/fax facility,
office bearers and staff.
3. The organization should have valid Trade Licence, if applicable issued by the competent authority for
similar type of works and also valid Professional Tax Certificate & Income Tax Clearance Certificate.
4. The bidder should have in its name PAN (Permanent Account Number) with Income Tax authority in
India.
5. The bidder should have Goods & Services Tax Identification Number (GSTIN) in India in its name.
6. The organization should not have been blacklisted by any Central/State Government. An undertaking in
this regard should be submitted in the form of affidavit.
7. The organization should be financially solvent to carry out the program entrusted upon them. A
certificate from Chartered Accountant should be attached stating the annual turnover.
8. The organization should be of repute and working experience in the relevant field.
9. The organization should have skilled manpower in the relevant fields for managing such
events/programs/contests.
10. The organization should have various statutory clearances as are applicable for running its various
functions.
11. The organization should have a pucca/permanent office with telephone/fax facility and staff to
respond to any emergency call or report etc.
6|P a g e Notice Inviting Expression of Interest

12. Earnest Money Deposit (EMD) :

i) Intending bidder has to deposit the Earnest Money (EMD) Rs.2,00,000/- (Rupees two lakh) only
through Demand Draft (DD) drawn in favour of Commissioner of Police, Kolkata payable at
Kolkata. Original Bank Draft is to be submitted along with the tender. No alternative will be
accepted.
ii) Earnest Money in respect of the finally selected organization will be discharged upon the Bidder
signing the Contract and furnishing the Performance Guarantee.

IV. GUIDELINES :
1. While submitting bid by any organization, it shall authorize the person signing the RFP document on
behalf of the organization. The person signing the bid document shall sign all changes, alterations,
corrections in the bid document. No eraser or overwriting without authentication would be permissible.
2. The authorised signatory of the organization shall submit the bid in two parts namely Part-I will have
technical bid [As enclosed as Annex-II] and Part-II will have Financial bid [As enclosed as Annex-III] in
separate envelops.
3. Technical and Financial bid shall be submitted on the organization’s letter head.
4. Bid submitted shall be in the prescribed format as given in Annexure and shall also have the relevant
documents including documentary evidences.
5. Authorized signatory must submit the original ‘Technical’ and ‘Financial Bid’ in separate sealed
envelopes and put again in a sealed envelope, superscribed with BID FOR ENGAGEMENT OF
ORGANIZATION FOR Selection of Event Management Organization to generate awareness and
sensitization amongst the public against Crime Against Women (CAW); Gender Bias; Adolescent Drug
Abuse etc. through Rap Music on social media platforms.
6. The Bids completed in all respects as specified in this RFP shall be sent/submitted by hand/post/courier
to : The Commissioner of Police, Kolkata, 18, Lalbazar Street, Kolkata – 700 001.
7. The complete bid document should be submitted before due date and time as mentioned above. Bid
received after the stated time and date will not be considered and is liable for rejection.
8. Commissioner of Police, Kolkata reserves the right to accept or reject any/all the bid(s) including the
lowest bid without assigning any reason and no correspondence in this regard shall be entertained.
Commissioner of Police, Kolkata takes no responsibility for delay, loss, or non-receipt of response to this
RFP.
9. The applicant shall carefully examine and understand the requirements/conditions of RFP and seek
written clarifications, if required, to ensure that they have understood all requirements/conditions of
RFP.
10. The Organization should have THE capability to provide the services as described in the RFP document.
11. The successful Organization shall be required to enter into an agreement with the Commissioner of
Police, Kolkata within seven (7) days from the date of issue of letter of Intent (LoI) or within such
extended period, as may be specified by the Commissioner of Police, Kolkata in this regard.
12. Submission of illegible documents shall lead to disqualification of the Organization concerned.
13. No enquiry shall be made by any Organization during the course of evaluation of the tender, after
opening of bid, till final decision is conveyed to the successful Organizations. However Commissioner of
Police, Kolkata can make any enquiry / seek clarification from Organization may be rejected.

V. BID EVALUATION PROCESS :

1. Evaluation Process :
Response to this RFP will be evaluated in two phases. Initially technical bids will be opened and
evaluated. Those bids who satisfy the technical requirements, as per the requirements/specifications
and the terms and conditions of this RFP, shall be short-listed. Financial bids shall be opened only for
the short-listed Organizations who have qualified in the technical bid.
2. Technical Evaluation :
The bids will be technically evaluated on various components. Each response to the RFP from each
bidder will be judged on its own merit. Evaluation of Technical proposal will be on the following
Notice Inviting Expression of Interest Page |7

technical parameters carrying total 100 marks and each technical parameter has been assigned
maximum score as given in the table below :
Sl. Maximum
Parameter Supporting Documents
No. Marks
1Experience of the Organization To be submitted by the bidder 10
Methodology, work plan and understanding
2 To be submitted by the bidder 20
of the Terms of Reference (TOR)
3 Profile of the team for the assignment To be submitted by the bidder 30
4 Submission of the concept note and script To be submitted by the bidder 40
TOTAL 100
** Organizations scoring at least 65 percent will qualify for opening of financial bid.
3. Evaluation of Financial Bids :
1. Financial bids of only the Organizations who have cleared the technical evaluation benchmark will
be opened and evaluated.
2. If there are arithmetic errors in the Bid, the bid shall be treated as cancelled.

VI. ACCEPTANCE OF BID :

Lowest bid shall be accepted. Such bid should contain the basic rate and applicable tax & duties, if any.

VII. SECURITY DEPOSIT (SD) :

i) The contractor shall have to deposit a sum equivalent to 3% of the total value of the Work Order
(excluding admissible Taxes/GST) as Security Deposit in the form of Bank Guarantee (BG)/FDR issued by
any Bank in favour of Commissioner of Police, Kolkata valid up to completion of completion of
work/project.
ii) The Security Deposit will be released after completion of the whole project. Security Deposit will not
carry any interest.

VIII. PAYMENT :
• Advertisement & finalization of entries – 25%.
• Adjudication, final prize giving function/audition etc. - on completion – 50%.
• Launching of video albums of wining participants & completion of the project – 25%.

IX. VALIDITY OF EOI :

The bids shall be valid for a period of 6 months from the closing date for submission of the Bid

X. GENERAL CONDITIONS OF THE CONTRACT :

1. Applications : These general conditions shall apply to the extent that provisions in other parts of the
RFP do not supersede them. For interpretation of any clause in the RFP or Contract, the
interpretation/clarification of the Commissioner of Police, Kolkata shall be final and binding upon the
Organization/Bidder.
2. RFP Clarifications : During technical evaluation of the bids, Commissioner of Police, Kolkata may at its
sole discretion, ask Organizations for clarification on their bids.
3. Amendments in RFT: At any time prior to deadline for submission of bid, Commissioner of Police,
Kolkata may for any reason, modify the RFP. The RFP shall be notified with the amendments by posting
the same at the Kolkata Police website : www.kolkatapolice.gov.in and such latest amendments shall be
binding upon all the Organizations.
4. Disqualifications : The Commissioner of Police, Kolkata may at its sole discretion and at any time during
the evaluation of Bid, disqualify any Organization/bidder, if the Bid documents were submitted after
the deadline; made misleading or false representations in the forms, statements and attachments
submitted in proof of the eligibility requirements; Exhibited a record of poor performance such as
abandoning works, not properly completing the contractual obligations, inordinately delaying
completion or financial failures, etc. In any project in the preceding three years; submitted bid that is
8|P a g e Notice Inviting Expression of Interest

not accompanied by required documentation or is non-responsive; failed to provide clarifications

related thereto, when sought for; or submitted more than one Bid; declared ineligible by the
Government or any other body for corrupt and fraudulent practices or blacklisted; or modified the
terms and conditions of RFP.
5. Termination : Either party of the agreement may terminate the contract in whole or in part by giving
thirty (30) days prior notice in writing to the other party assigning specific reason.
6. Right to Accept Bid : With regard to the RFP, the Commissioner of Police, Kolkata has the following
rights to :-
a) Accept or reject any of the bids, without assigning any reasons thereof.
b) Ask for re-submission.
c) Request clarification from Organizations.
d) To accept any Bid in whole or in part.
8. Conflict of Interest : Commissioner of Police, Kolkata requires that the Organization should provide
professional, objective, and impartial advice and all times hold the Commissioner of Police, Kolkata
interests paramount, strictly avoid conflicts with other assignments/jobs or their own business
interests.
9. Confidentiality : The selected and engaged Organizations, at all times, during the continuance of their
contract or otherwise (i) keep all Confidential Information confidential and accordingly shall not
disclose any such Confidential Information to any third party under any circumstances; (ii) not use or
cause the use of any Confidential Information for any purpose whatsoever other than that
contemplated under this contract. Commissioner of Police, Kolkata may, at his discretion, ask the
engaged Organization execute a non disclosure Agreement with him, if deemed appropriate.
10. Standard of Performance : The selected Organizations shall perform and carry out their obligations
under the contract with due diligence and efficiently. The Organizations shall always act in respect of
any matter relating to this contract as faithful advisor to the Commissioner of Police, Kolkata. The
engaged Organizations shall always support and safeguard the legitimate interest of the Commissioner
of Police, Kolkata in any dealings with the third party. The Organizations shall conform to the
standards laid down in REP in totality.
11. Assignments : The Organizations shall not assign the work to any other agency/individual, in whole or
in part, to perform its obligation under the contract, without prior written consent of the
Commissioner of Police, Kolkata.
12. Resolution of Dispute : In case of any dispute or difference arising out of or in connection with any of
the terms and conditions of RFP Document or meaning or interpretation of the contract arising there
under, in the first instance, the parties of the contract shall try to resolve the dispute amicably, failing
which the dispute shall be referred to a sole arbitrator to be appointed mutually by the parties. The
arbitration and Conciliation Act, 1996 and any statutory modification or re-enactment thereof, shall
apply to these arbitration proceedings. Arbitration proceedings shall be held at Kolkata and the
language of the arbitration proceeding and that of all documents and communications between the
parties shall be in English. The decision of the arbitrator shall be final and binding upon both the
parties. All arbitral awards shall be in writing and shall state the reasons there of. The expenses of the
arbitration as determined by the arbitrator shall be shared equally by the parties.
13. Jurisdiction : Subject to the arbitration clause herein contained, all disputes between the parties
pertaining to this contract shall be subject to the jurisdiction of the competent Courts at Kolkata only.
Notice Inviting Expression of Interest Page |9

ANNEXURE – I

COVERING LETTER (ON THE BIDDER’S LETTER HEAD)

To
The Commissioner of Police, Kolkata
18, Lalbazar Street,
Kolkata – 700 001.

Sub : BID for engagement of Organization for Selection of Event Management

Organization to generate awareness and sensitization amongst the public against
Crime Against Women (CAW); Gender Bias; Adolescent Drug Abuse etc. through
Rap Music on social media platforms.
Dear Sir,
With reference to the RFP document, I, the authorized signatory on behalf of the Organization named and
styled as .............................................. located at Address............... ................................................. offer my proposal
for the subject and the same are in full conformity with the said RFP. I declare that all the provisions of this RPF are
acceptable for me. I further certify that I am competent enough to make the declaration. I further declare that
additional conditions, variations, deviations, if any, found in our bid, shall not be given effect to.
I agree to abide by the terms and conditions of this Bid, including this letter, the technical and financial bid, and all
attachments and it shall remain binding upon me and may be enforced by you at any time before the expiry of the
validity period.
I hereby declare that all the information and statements made in this bid are true to the best of my knowledge and
belief and any misleading/false information contained in it may lead to cancellation of my candidature/proposal.
I understand that you reserve the right to accept or reject any bid.

Dated this (date/month/year)

Full Signature

Address :

Note : This will be enclosed in original along with both Technical & Financial Bid.
10 | P a g e Notice Inviting Expression of Interest

ANNEXURE – II

TECHNICAL BID (ON THE LETTERHEAD OF THE ORGANIZATION)

Details of Authorized Signatory :

1 Name of the organization / agency

2 Address (enclose proof)
3 Contact Details Telephone/mobile/e-mail/fax
4 Years of experience of Organization (enclose copy of certificates) ---- years
5 Trade Licence
6 Other documents as per RFP
7 PAN No. (enclose copy of PAN) & GST No

Declaration
I hereby declare that the above information furnished is true to the best of my knowledge and information and if it
is discovered at a later date that any or all of the above information is incorrect, I shall liable to be disqualified and
that if the assignment is already awarded, Commissioner of Police, Kolkata shall have the full right to cancel the
contract forthwith without assigning any reasons to me whatsoever.

Date : Yours faithfully,

(Signature of the authorized signatory)
Name...................................................................
Address................................................................
Contact No. .............................................
Notice Inviting Expression of Interest P a g e | 11

ANNEXURE – III

FINANCIAL BID
(On the Letterhead of the Organization)

The organization is required to submit bid in the following format. The consolidated rate inclusive of all
taxes/charges etc. for preparation this contest on Social Media Platform on Crime/Violence against Women to
convey a strong message to the Society about the value of women shall be quoted.

Sl. Basic Rate Total Total Amount

Description of Assignment
No. (Rs.) GST (Rs.) with GST (Rs.)
01 Selection of Event Management Organization to generate
awareness and sensitization amongst the public against
Crime Against Women (CAW); Gender Bias; Adolescent
Drug Abuse etc. through Rap Music on social media
platforms.

Signature : ......................................................
Name : .............................................................
Date : ..................................
Address : ..............................................................
Contact No. ...........................................
e-Mail address.................................................
12 | P a g e Notice Inviting Expression of Interest

ANNEXURE – IV

Format for REP/TOR suggestion

Rep/tor REFERENCE HEAD Comments/ Suggestions,

Sl. No. REP/TOR reference head
CLAUSE if any
Notice Inviting Expression of Interest P a g e | 13

ANNEXURE – V

Format for Curriculum Vitae of key Professionals of Organization .............................

Other
Designation Script Writer Director Cameraman
Technician
Name

Date of Birth

Qualifications(s)
(Specifying degree/institution/university)

Residential Address.

No. of years of experience in the field

14 | P a g e Notice Inviting Expression of Interest

ANNEXURE – VI

LETTER OF UNDERTAKING FOR CONFLICT OF INTEREST

( On the Letterhead of the Bidder)

To
The Commissioner of Police, Kolkata.
18, Lalbazar Street, Kolkata,
Pin – 700 001.

Sir,

I, ...................................... the authorised signatory on behalf of the Organization ....................................... have

already undertaken the following assignments which may conflict with the proposals assignment.
Sl. No. Name of the Assignment

I further undertake not to accept further such assignments and relinquish all such existing assignments in
commencement with contract with the Kolkata Police.

Name :
Date :
Sign. :
Address with Phone No. and E-mail ID
Notice Inviting Expression of Interest P a g e | 15

ANNEXURE – VII

UNDERTAKING REGARDING BLACKLISTING

[ To be executed on Rs.10/- non Judicial Stamp paper and duly notarized ]

I/we ____________________________________________________________________________________
Contractor/Partner or Sole Proprietor (Strike out the word which is in applicable) of (Firm of contractor)
____________________________ do hereby declare and solemnly affirm that the individual firm/
companies M/s ______________________________________________________ have not been blacklisted
during last 5 years by the Union or State Government and the individual/firm/companies blacklisted by the
Union or State Governments or any partner or shareholder thereof are not directly or indirectly connected
with or has any subsisting interest in business of my firm.

Deponent
___________________________
Dated ______________ Address _________________________

________________________________

I do hereby solemnly declare and affirm that the above declaration is true and correct to the best of my
knowledge and belief. No part of it is false and it conceals nothing.

Dated : ______________ Deponent __________________

____________