10043975-1 Self-declaration on exclusion grounds and eligibility.docx

Self-declaration on exclusion grounds and eligibility in the contract award procedure 10043975-1 AgriPV-plant for Chad

General notes on filling out this form

This self-declaration must be submitted together with the bid documents. The bidder need not sign this self-declaration where indicated; it is sufficient to enter the name of the authorized representative in text form (Article 126b of the German Civil Code (BGB)). The same applies to all other documents if the bids are submitted electronically through the GIZ e-tendering marketplace, unless required otherwise elsewhere in the tender documents.

The bidder only has to fill out the fields marked red and add any annexes required.

Boxes marked in grey contain supplementary information from the contract award office.

Declaration on the absence of grounds for exclusion

Bidders/members of a bidding consortium that cannot issue this declaration without reservations, must explain such reservations in order to substantiate their eligibility for the contract being awarded despite the existence of grounds for exclusion.

For bidding consortia and subcontractors: Each member of a bidding consortium / each subcontractor must sign this form separately.

In the event of inaccurate self-declarations, the bidder or the (complete) bidding/service delivery consortium (a single inaccurate self-declaration can suffice) can be excluded from participating in the competitive procedure in accordance with Article 124 paragraph 1, number 8 and 9c) of the Act against Restraints of Competition (GWB).

The bidder/member of the bidding consortium

hereby declares that:

1. it does not meet any grounds for the exclusion according to Article 124 GWB, in particular that it is not a bidder that has undertaken an act listed in Article 124 GWB;
2. no person whose conduct is allocable to the bidder entered above (or a member of the bidding consortium) has been found guilty by judicial process of one of the acts named in § 123 GWB and no legally enforceable fines in accordance with Article 30 of the Act on Regulatory Offences (OWiG) have been imposed on the bidding company on account of the acts;
3. it does not meet any grounds for exclusion in accordance with Section 22 of the German Supply Chain Sourcing Obligations Act (LkSG). In particular it is not a bidder who has been legally sentenced for one of the offences specified in Section 24 LkSG and against whom no legally enforceable fines in accordance with Section 30 OWiG have been imposed, and
4. there is no entry in the Competition Register for public procurement according to § 2 Competition Register Act (Wettbewerbsregistergesetz, WRegG).

The signatory acknowledges that:

• if exclusion criteria exist in accordance with Articles 123 and 124 GWB, it can provide substantiation of eligibility regardless by reference to Article 125 (remedial action) and it is the bidding company’s responsibility to furnish the requisite substantiation, and
• intentionally inaccurate statements can lead to exclusion from the present and future contract award procedures.

Economic and financial capacity

Technical and professional capacity

Authorised representative of the bidder or authorised signatory of the bidding consortium

For bidding consortia: The authorised signatory of the bidding consortium indicated in the bid must be entered as authorised representative.

I have issued all declarations accurately to the best of my knowledge and in good faith.

Annexes

The bidder must complete and adjust the list of annexes.

Important note: A separate form must be filled out for each reference project. This form should be copied as needed, filled out and attached to the bid.

(Place, date) Name of authorized representative in text form (within the meaning of Article 126b of the German Civil Code (BGB))

Important note: A separate form must be filled out for each reference project. This form should be copied as needed, filled out and attached to the bid.

(Place, date) Name of authorized representative in text form (within the meaning of Article 126b of the German Civil Code (BGB))

Important note: A separate form must be filled out for each reference project. This form should be copied as needed, filled out and attached to the bid.

(Place, date) Name of authorized representative in text form (within the meaning of Article 126b of the German Civil Code (BGB))

Important note: A separate form must be filled out for each reference project. This form should be copied as needed, filled out and attached to the bid.

(Place, date) Name of authorized representative in text form (within the meaning of Article 126b of the German Civil Code (BGB))

Important note: A separate form must be filled out for each reference project. This form should be copied as needed, filled out and attached to the bid.

(Place, date) Name of authorized representative in text form (within the meaning of Article 126b of the German Civil Code (BGB))