Attachments_7_-_9.pdf

Attachment J-2: Partner Information for Vetting

Appendix B: USAID Information Form

Part I: Information About Proposed Activities (all parts mandatory)

1. Name of the proposed awardee of USAID contract or assistance (Firms must include a copy of applicable, currently valid licenses to do business in Afghanistan)

2. Type of proposed award or other assistance (check one):

Contract or Subcontract Grant or Subgrant Training Equipment Other

3. US$ amount and estimated start/end date of proposed award or assistance:

Dollar amount: $ Start: End:

4. Purpose of proposed award or assistance:

5. Organization proposed to receive award or other assistance:

a. Name:

b. Address (include village/town/city, state/county/province, and country):

c. Telephone: d. Fax: e. Email:

6. Information on Key Individuals associated with the organization named in 5 above who are not U.S. citizens or permanent legal residents, or, if no organization is listed, information on each individual to receive cash or in-kind assistance (including technical assistance). Use continuation sheets as necessary.

** = mandatory information.

A. Name (As in passport or other government-issued photo

ID):**

Government-issued photo ID number, type of ID and country of issuance:**

Place of birth** village/town/city:

state/county/province:

country:

Date of birth:** (Example:

3 May, 1979)

Title in organization (Example: President/Vice President/CFO):

Other names used (may include nicknames, pseudonyms not listed under “Name”):**

Gender:**

Current employer and job title:

Occupation:

Address of residence** village/town/city:

Citizenship(s):** (Afghans: Tribal Affiliations, Father’s Name and Grandfather’s Name)

Email:

Phone:

Is the individual a U.S. citizen or legal permanent resident?** Yes No

Part II: Contractor/Grantee/Recipient Certification: (to be completed by Prime Awardee chief of party, program director or their designee)

Potential Awardee certifies in submitting this form that it has taken reasonable steps (in accordance with sound business practices) to verify the information contained in this form. Contractor/Grantee/Recipient understands that the U.S.

Government may rely on the accuracy of such information in processing this vetting request.

Name: Signature:

Title/Organization: Date:

Part III: Submission details (to be completed by USG vetting official)

Vetting request number

Staff member who initiated request

Project name

Date submitted for screening

USAID Information Form Continuation Sheet for Part I, Section 6: List of Individuals (Use additional continuation sheets as necessary):

B. Name (As in passport or other government-issued photo

ID):**

Government-issued photo ID number, type of ID and country of issuance:**

Place of birth** village/town/city:

village/town/city:

Is the individual a U.S. citizen or legal permanent resident?**

Yes No

C. Name (As in passport or other government-issued photo

ID):**

Government-issued photo ID number, type of ID and country of issuance:**

Place of birth** village/town/city:

village/town/city:

Is the individual a U.S. citizen or legal permanent resident?**

Yes No D. Name (As in passport or other government-issued photo

ID):**

Government-issued photo ID number, type of ID and country of issuance:**

Place of birth** village/town/city:

Title in organization (Example: President/Vice President/CFO):

village/town/city:

Is the individual a U.S. citizen or legal permanent resident?**

Yes No

INFORMATION FORM INSTRUCTIONS

Please provide information for key individuals of all organizations receiving funds from USAID, including grantees, sub-grantees, contractors, and vendors, who work in Afghanistan.

Part I

Question 1 – Self-explanatory Question 2- Indicate the proposed type of mechanism to be utilized by placing a check mark on the line in front of the appropriate term Question 3 – Enter the amount of award or assistance (or sub-award) in U.S. dollars and indicate the start and end date of the award (or sub-award) using a mm/dd/yyyy format Question 4 – Indicate the purpose of the award or assistance. Use additional sheets and attach to page one of the vetting form if necessary Question 5 a-i – Self-explanatory.

Attach a copy of the relevant, currently valid Afghan business license.

Question 6 - A “Key Individual” means (i) Any person who exercises effective control of the organization; (ii) a principal officer of the organization's governing body (e.g., chairman, vice chairman, treasurer or secretary of the board of directors or board of trustees); (iii) the principal officer and deputy principal officer of the organization (e.g., executive director, deputy director president or vice president); (iv) the program manager or chief of party for the USAID-financed program; (v) any person receiving significant commissions (defined as a sum, either fixed or a set percentage of the value involved, paid to an agent or person acting in a similar role in the activity involved) or similar earnings from the Award in an amount exceeding $25,000; and (vi) any other person with significant responsibilities for administration of USAID-financed activities or resources (while a comprehensive list is not possible, this would include any person acting in a role substantially similar to those outlined in (i)-(v). For Private Security Services, this would include leadership roles down to the level of field commanders). Complete for each of these six categories or indicate “N/A” if a category does not apply. Use additional pages as needed. Only Key Individuals who are not U.S. citizens or permanent legal residents need to be submitted. Attach copies of photo ID for each non-U.S. “Key Individual”. In addition, for all non-U.S. Key Individuals in possession of passports, passport copies must be attached.

Note: If a “Key Individual” is a U.S. citizen or permanent legal resident, proof of citizenship or residency must be attached.

Part II The representative of the prime Awardee (chief of party, program director or their designee) must fill out the form, read the certification and print their name where indicated, sign where indicated, print their title and the name of their organization where indicated, and print the date where indicated.

Part III This section will be completed by the USG vetting official.

Attachment J-3 Vendor Information

Please Respond to the Following Questionnaires

1. State whether the offeror firm filed bankruptcy in the past seven years. If so, provide a summary of the proceedings, including under which chapter the bankruptcy was originally filed and the final disposition of the proceedings

2. State whether the offeror firm ever failed to complete any work awarded under a contract. If

“yes,” note when, where, why, the owner’s name, and phone number.

3. State whether there any judgments, claims, arbitration proceedings, or suits pending or outstanding against the offeror firm.

4. State whether the offeror firm has any pending/outstanding actions against the U.S. government, other suppliers, and subcontractors or contractors. If so, describe such actions.

ATTACHMENT 9 – Proposal Checklist

The following checklist is provided as guidance to assist Offerors ensure that all required documents are submitted with their proposal. It is the Offeror’s responsibility to ensure that it has fully complied with the instructions set forth in Section L.

TECHNICAL PROPOSAL

Cover Letter

Section 1: Verification of Local Entity Status

AISA License

Ministry of Commerce License

Entity Formation Documents (i.e., Articles of Incorporation or similar)

Majority Owner’s Tazkira (national ID card)

Section 2: Part Experience

Completed Attachment 3 (Past Project Information Sheet)

Copies of contracts evidencing the Past Projects identified in Attachment 3

Certifications of Completion for Past identified in Attachment 3

GPS Coordinates/Location of project sites for Project Projects identified in Attachment 3.

Any additional documentation to demonstrate satisfaction of the requirements set forth in Section L.

Section 3: Technical Capability

Site Supervisor

Proof of work experience (e.g., Curriculum Vitae or Resume)

Proof of education qualification (e.g., copy of diploma or other similar documentation)

Name, email address and phone number of a reference that can verify work experience.

Completed Attachment 5 (Machinery Details)

Proof of Equipment Ownership (for owned machinery)

Written evidence from the lessor that such equipment will be available for lease, including lease price, for machinery that will be leased.

Implementation Plan Regarding Machinery

Security Plan

Section 4: Financial Capability

Bank Statements OR Income and Balance Sheets

Section 5: Past Performance

Completed Attachment 3 with all reference information

**Remember that Attachment 5 Forms must be sent to all references identified in Attachment 3**

BUSINESS PROPOSAL

Section 1: Completed SF 1442 Standard Form

Section 2: Completed Attachment J-6 of Unit Price Proposal

Section 3: Completed and signed RFP Section K Reprsentations and Certifications

Section 4: Completed Partner Information Forms

All required documentation in support of PIF, including Tashkira or Government Identification Card for all named Key Personnel

Section 5 All documentation in support of demonstrating to USAID an affirmative determination of responsibility based on Section L.

Completed Attachment J-7