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LE PROJET USAID / KENEYA JEMU KAN

LE PROJET USAID / KENEYA JEMU KAN

18 juillet, 2018

ANNEXES

 

Certification of Source and Nationality Specifications

Source Verification

For Commodities (Packaging materials)

 

Tick the option that applies and provide documentation to support that option:

 

_____The commodities are available for purchase in my store/shop located in Mali and did not come from a prohibited country or source.

 

_____I received the commodities from a free port or bonded warehouse from an area or country that is not a prohibited country or source AND the commodities have a valid warranty.

 

NATIONALITY VERIFICATION

ONLY individual suppliers tick if the following statement is true and provide documentation to support this statement:

 

______I am a citizen or lawful permanent resident of Mali or another country that is not a prohibited country AND I am not an employee or agent of a foreign (non-US) government or any of its agencies.

 

 

 

ONLY organizations/companies/firms tick if the following statement is true and provide documentation to support this statement:

 

_____The organization is:  (1) incorporated or legally organized under the laws of Mali or another country that is not a prohibited country; (2) is a going concern in an area or country in Mali or another country that is not a prohibited country; (3) is managed by a governing body, the majority of whom are citizens or legal permanent residents of Mali or another country that is not a prohibited country; and (4) in more than half of its permanent positions and more than half of its principal management positions, employs citizens or lawful permanent residents of Mali or another country that is not a prohibited country.  Additionally, no foreign (non-US) government or its agents or agencies have controlling interest in the commercial company, organization, enterprise or non-government organization.

 

 

 

 

 

 

ANNEX B

VENDOR PROFILE AND REFERENCE SHEET

 

All bidders are required to fill out the form below and provide it as part of the consultation package.

 

VENDOR PROFILE

Name of the company:  
Telephone numbers of the company & countries:  
Physical address of the company:  
E-mail address of the company:  
Person(s) of contact for this offer:  
Name & first name:  
Email address:  
Phone & fax numbers:  

 

REFERENCES COMMERCIAL (FOR SIMILAR SUPPLIES)

 

REFERENCE 1

Project name/Agency Client:  
Phone numbers:  
Physical address:  
E-mail Address:  
Amount of supply:  
Year of execution:  
Execution time:  
Contact phone and email of the contact person:  

 

REFERENCE 2

Project name/Agency Client:  
Phone numbers:  
Physical address:  
E-mail Address:  
Amount of supply:  
Year of execution:  
Execution time:  
Contact phone and email of the contact person:  

 

REFERENCE 3

Project name/Agency Client:  
Phone numbers:  
Physical address:  
E-mail Address:  
Amount of supply:  
Year of execution:  
Execution time:  
Contact phone and email of the contact person:  

 

 

 

 

 

 

ANNEX D Artwork

Protector Condom

Wallet – instructions printed on inside of packaging

3 foiled condoms in a wallet

Dispenser will be similar design without instructions

20 wallets in a dispenser

 

 

 

 

 

CONFIANCE

 

 

 

 

 

IUD consumer pack & leaflet

 

 

 

 

 

PILPLAN

 

 

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