volume 1 rfp - request for proposals tender forms forms.pdf · h price proposal i professional...

Tender for In-Situ Ground Water Remediation and Construction of Ground Water Pumping System in IMI "Magen" compound

-Tender Forms-

Volume 1

RFP - Request for Proposals

Tender Forms

Tender Forms, February 2019

of 66

For In-Situ Ground Water

Remediation and Construction of

Ground Water Pumping System in

IMI "Magen" compound

Tender no. 8/2019


-Tender Forms-


of 66

Tender Form Title

A Letter of Acknowledgement and Application to Attend Mandatory

Tenderers’ Conference and Tenderers’ Conference and Site Visit

B Tenderer's Letter;

Attachment 1: Authorized Representative

C Remedial Investigation Program

D

Affidavit as per the Public Entities Transactions Law, 5736 – 1976

(*) Approvals as per the Public Entities Transactions Law, 5736 -

1976 shall be attached to the Affidavit

E Parent Company Undertaking

F In-Situ Subcontractor’s Undertaking

G Financial Robustness

H Price Proposal

I Professional Threshold Requirements - Demonstration Information

J Tenderer's Information for Technical Score (TS)

K Industrial Cooperation Undertaking and Implementation Plan

L

Municipality’s Advisor’s and Tenderer’s No Conflict of Interests

Declaration

M Confirmation of Merging Company


-Tender Forms-

Tender Form A


of 66

Letter of Acknowledgement and Application to Attend Mandatory Tenderers’

Conference and Site Visit

[Pursuant to Section 5 of Volume 1 (Request for Proposals). To be completed by the any entity

and submitted to the Municipality at least one week prior to the Mandatory Tenderers’

Conference and Site Visit]

To

The Municipality of Tel-Aviv - Jafo

c/o Mr. Moshe Kidron (Municipality’s P.O.C)

69 Even Gvirol Street. 8th floor, Tel Aviv-Yafo Israel 6416201

Tel: 972-(0)3-7241456

Fax: 972-(0)3-5216419

Municipality’s POC’s E-mail Address: [email protected]

Date: ___________________

Dear Sirs

1. We the undersigned, _____________________________________[Name of the Entity to

be complete], No. __________________ [Incorporation number to be completed] (the

“Entity”), acknowledge issuance of the Tender Documents for the selection and

appointment of Contractor for In-Situ Ground Water Remediation and Construction of

Ground Water Pumping System in IMI "Magen" compound and wish to participate in the

Mandatory Tenderers’ Conference and Site Visit scheduled on the Entity’s behalf on

st_________________ [indicate whether the Entity wishes to participate in the 1 Visit

1 ndand/or 2 Visit as provided under Section 2.1 of the RFP], as provided under Volume 1

(Request for Proposals).

1 Participation in at least one of the two Tenderers’ Conference and Site Visits is mandatory and constitutes one of

the Threshold Requirements per Section 7.1.2 of the RFP.


-Tender Forms-

2. We, hereby appoint, empower and authorize____________________ [insert name of the

2Authorized Representative of the Entity] to be the our Authorized Representative in

connection with the above Tender until the Submission Date, and to perform and to sign on

our behalf, all or any actions, matters, and documents set forth hereinafter:

2.1. To receive, on behalf of us, all communications and all other documents and

material which may be issued by the Tender Committee, save for notices of legal

proceedings and judicial documents, which shall be served directly to the Entity.

Our contact details for this purpose shall be __________________________

(Address) and __________________ (e-mail).

2.2. To submit, on behalf of us, to the Tender Committee, all queries and requests for

clarifications and other inputs which the Tender Committee may require from us

from time to time.

2.3. We hereby undertake to confirm and uphold all and any act and matter which

the Authorized Representative under this authorization shall do, cause or purport

to do by virtue of this authorization. All such acts and matters caused by the

Authorized Representative shall be deemed as acts and matters caused by us.

2.4. We hereby undertake not to change this authorization in any way. In the event

of cancellation of this authorization, we shall nominate a substitute Authorized

Representative prior to such cancellation, and if not possible, promptly after the

cancellation of this authorization. We hereby acknowledge that such cancellation

or substitution shall not give cause to any delay in the conduct of the Tender by

the Tender Committee.


of 66

2 The Authorized Representative does not have to be the person representing the Entity in the Mandatory Tenderers’

Conference and Site Visit.


-Tender Forms-

Yours respectfully,

Name of Entity:


of 66

Point of contact and contact details:

Name of Authorized Representative participating:

Name of represented Tenderer (if known at this stage):


-Tender Forms-

Tender Form B

The Tenderer's Letter


of 66

[To be completed and signed by the Tenderer and all Members of the Tenderer, on a separate Form, if necessary.

To be included in Part 1 . Shall be reviewed with the framework of Stage 1.]

To:

The Municipality of Tel-Aviv-Jafo

c/o Mr. Moshe Kidron (Municipality’s P.O.C)

69 Even Gvirol Street. 8th floor, Tel Aviv-Yafo Israel 6416201

Tel: 972-(0)3-7241456

Fax: 972-(0)3-5216419

Municipality’s POC’s E-mail Address: [email protected]

Dear Sir,

Re: Tender for the design and execution of the In-Situ Ground Water Remediation and

Construction of Ground Water Pumping System in IMI "Magen" compound (the "Project

")

In response to the Tender Documents issued on _______,2019, we, the undersigned,

_____________________________________(Name of Tenderer / Member to be completed), No.

__________________ (Incorporation number of Tenderer / Members to be completed) are pleased to submit

our Proposal as defined in the Tender Documents and hereby warrant and represent as follows:

1. The Members' holdings in the Tenderer are as follows:

Member Holdings in the Tenderer (%)

%

%

2. The signature rights in the Tenderer (or in the Member, as applicable) are as follows:

Name I.D. Number Or Foreign

Passport Number and

Nationality (as applicable)

Signature

Signatory 1:

Signatory 2:

3. The Contact info of the Tenderer (or in the Member, as applicable) is as follows:

Address Phone Number Fax Number E-Mail


-Tender Forms-

4. After having thoroughly and carefully read the Tender Documents, we hereby acknowledges

and declares to have studied and satisfied ourselves as to all relevant matters and details which

can affect the execution of the Project by us in accordance with the provisions of the Tender

Documents, including, without limitation, the scope of works and their completion periods, all

risks related therein (financial and technical), and the conditions of the Site including soil and

groundwater conditions, and, fully understand the substance of the Project and required works,

equipment, services and risks, are pleased to submit our Proposal as defined in the Tender

Documents. We execute this document as part of the materials comprising the Proposal for the

Project;

5. We agree to all of the provisions of the Tender Documents and we submit our Proposal in

accordance with the terms and provisions contained therein;

6. We represent and warrant that we have no claims with regard to misunderstandings, confusion,

or conflict of provisions with regard to any of the provisions of the Tender Documents or with

regard to the evaluation criteria and procedures for selecting the Preferred Tenderer, and that

to the extent that we had such claims we submitted such claims prior to the Submission Date.

Where we have not made such claims by the Submission Date we shall be deemed to have

waived any such claims;

7. We have diligently reviewed all of the terms and provisions governing the performance of our

obligations pursuant to the Tender Documents. We hereby warrant and represent that we

possess the requisite financial strength, expertise, knowledge and know-how required to

perform all of our obligations in accordance with the Tender Documents;

8. We accept and agree that our obligations as set forth in the Tender Documents include all terms

and provisions expressly set forth therein as well as any obligations, works, or other

requirements which are not expressly set forth and which are directly or indirectly related to

the full performance of our obligations in full compliance with all provisions of the Tender

Documents;

9. We are legally entitled to use and transfer all information and intellectual property contained

in the Proposal;

10. The Proposal is accurate, complete and up-to-date at the time of the Submission Date, in

accordance with the requirements of the Tender Documents;

11. The Proposal is not made in the interest of, or on behalf of, any undisclosed person,

corporation, company, voluntary association, partnership, trust, or unincorporated association;

12. The Proposal is genuine and not collusive or sham;

13. We undertake to keep confidential all information, whether written or oral, concerning the

Project which we receive or obtain as a result of the information supplied in the Tender

Documents, or in discussions relating thereto;

14. The Tenderer and either of its Member(s), and Parent Company/ies thereof [as applicable]

have not, directly or indirectly, induced or solicited any other Tenderer or Member(s) of a


of 66


-Tender Forms-

Tenderer, the related entity/ies or the Parent Company/ies thereof to put in a false or sham

Proposal, and has not by itself, directly or indirectly, colluded, arranged or agreed with any

Tenderer or Member(s) of a Tenderer, the related entity/ies or the Parent Company/ies thereof

to secure any advantage against any other Tenderer, or to secure any advantage against the

Tender Committee or the Municipality or anyone interested in the Project;

15. The Tenderer and either of its Members and Parent Company/ies thereof participate in this

Tender only within this Proposal;

16. Any incorporated entity which exercises Control over the Tenderer and either of its Member(s)

(including, if applicable, any related entity and Parent Company), any incorporated entity

under the common Control thereof, and any incorporated entity Controlled thereby, does not

participate in this Tender, except within this Proposal;

17. We understand that the submission of our Proposal shall not be deemed in any way to create

an obligation on the part of the Tender Committee to award the Tenderer with the Contract;

that the Tender Committee has the right to reject, at its sole discretion, the Proposal submitted

by the Tenderer; and that the Tender Committee has the right, at its sole discretion, to annul

the Tender and to reject all Proposals at any time; and to request additional information from

the Tenderer or other parties; and, to cancel or modify the Tender Documents at any time;

18. Incorporated hereto, and made an integral part of the Proposal, are all Tender Forms,

attachments and annexes thereto, and other annexes attached to the Proposal as described

herein:


of 66

Tender Form Title

A Letter of Acknowledgement and Application to Attend Mandatory

Tenderers’ Conference and Site Visit

B Tenderer's Letter;

Attachment 1: Authorized Representative

C Remedial Investigation Program

D

Affidavit as per the Public Entities Transactions Law, 5736 – 1976

(*) Approvals as per the Public Entities Transactions Law, 5736 -

1976 shall be attached to the Affidavit

E Parent Company Undertaking

F In-Situ Subcontractor’s Undertaking

G Financial Robustness

H Price Proposal


-Tender Forms-

In addition to the above, our Proposal includes reference certificates and additional documents,

in accordance with the provisions set forth in the Tender Documents.

19. The Tenderer and its Members hereby warrant and covenant that the execution, delivery and

performance of their respective obligations pursuant to the Contract do not : (i) contravenes or

violates any provisions of any Law; (ii) conflicts with or violates in any material respect any

provisions of the Tenderer's or the Members' Articles of Association; or (iii) conflicts, violates

or will result in a breach, in any material respect, of any of the terms, covenants, conditions or

provisions of any agreement or instrument to which the Tenderer or the Members are party to,

or by which they or any of their properties or assets are bound or to which they are subject, or

constitutes a default under such agreement or instrument;

20. The Tenderer and its Members hereby warrant and covenant that other than specified herein

below, no events affecting the Tenderer, its Members and Parent Company/ies thereof

(including any changes in legal status, financial status and contingent liabilities), which could

influence the Tenderer's ability to execute the Project in accordance with the provisions of the

Contract, have occurred; and

21. Our Authorized Representative authorization attached hereto as Attachment 1, is valid and in

full force and effect.

22. Indicate whether the Copy no. 2 of the Proposal includes information marked as commercially

sensitive or secret nature per the provisions of Section 17.9 (Confidentiality of Parts of the

Proposal) of Volume 1 (Request for Proposals):


of 66

I Professional Threshold Requirements - Demonstration Information

J Tenderer's Information for Technical Score (TS)

K Industrial Cooperation Undertaking and Implementation Plan

L

Municipality’s Advisor’s and Tenderer’s No Conflict of Interests

Declaration

M Confirmation of Merging Company


-Tender Forms-

23. The undersigned acknowledges receipt, understanding and full consideration of the following

Addenda to the Tender Documents issued following the Publication Date of the Tender:

Addenda No. _____ Date Received: _____



...

[to be completed]

24. Our Proposal including all associated documents and Tender Forms, is irrevocable and

unconditional and shall be valid for the Validity Period as defined in Section 19.1 of the

Request for Proposals, as extended from time to time by the Municipality.

Faithfully yours,

Stamp and


of 66

Signature

Date

Attorney's

Confirmation of (*) signatory rights

Date

The Tenderer

Member

Member

(*) In his signature the attorney attests and confirms that the signatory(ies) on behalf of the Tenderer or the Member

(as the case may be) appeared before him and signed this form and are authorized to sign on behalf of the Tenderer

or the Member (as the case may be) and to commit such Entity for all purposes and intents of the above stated Tender

Form.

Tender for In-Situ Ground Water Remediation and Construction of Ground Water Pumping System in IMI "Magen"

compound

-Tender Forms-

Tender No. 8/2019

Tender Form B

Attachment 1

AUTHORIZED REPRESENTATIVE


of 66

(To be completed by the Tenderer and each Members of the Tenderer)

To:

The Municipality of Tel-Aviv-Jafo

c/o Mr. Moshe Kidron

Address: 69 Even Gvirol Street. 8th floor, Tel Aviv-Yafo, Israel 6416201

Tel: 972-(0)3-7241456

Fax: 972-(0)3-5216419

Municipality’s POC’s E-mail Address: [email protected].

Dear Sir,

Re: for the design and execution of the In-Situ Ground Water Remediation and

Construction of Ground Water Pumping System in IMI "Magen" compound (the

"Project ")

We the undersigned, _____________________________________[Name of Tenderer /

Member to be completed], No. __________________ [Incorporation number of

Tenderer / Members to be completed], hereby appoint, empower and

authorize____________________ [insert name of the Authorized Representative of the

Tenderer] to be the Authorized Representative of the Tenderer in connection with the

Tender for For In-Situ Ground Water Remediation and Construction of Ground

Water Pumping System in IMI "Magen" compound , and, to perform and to sign on

our behalf, throughout the Tender, all or any of the actions, matters, agreements and

documents set forth hereinafter:

1. To receive, on behalf of the Tenderer and on our behalf, all communications, all

Contract Documents and all other documents and material which may be issued by

the Tender Committee to the Tenderers, save for notices of legal proceedings and

judicial documents, which shall be served directly to the Tenderer. Our contact details

for this purpose shall be __________________________ (Address) and

__________________ (e-mail).

2. To submit, on behalf of the Tenderer and on behalf of us, to the Tender Committee,

all queries and requests for clarifications and other inputs which the Tender


compound

-Tender Forms- Committee may require from the Tenderer or from us from time to time throughout

the Tender.

3. To conduct negotiations with respect to modifications, changes and revisions of the

Proposal including any changes in the Price Proposal with the Tender Committee.

4. To appear in the name of the Tenderer, or us and on its/our behalf before the Tender

Committee and before any representative of the Tender Committee, in all matters, and

to perform all actions and matters which are required of the Authorized

Representative in accordance with the Request for Proposals, or which may be

required of the Authorized Representative by the Tender Committee.

5. We hereby undertake to confirm and uphold all and any act and matter which the

Authorized Representative under this authorization shall do, cause or purport to do by

virtue of this authorization. All such acts and matters caused by the Authorized

Representative shall be deemed as acts and matters caused by the Tenderer and its

Members.

6. We hereby undertake not to change this authorization in any way. In the event of

cancellation of this authorization, we shall make all efforts to nominate a substitute

Authorized Representative prior to such cancellation, and if not possible, promptly

after the cancellation of this authorization. We hereby acknowledge that such

cancellation or substitution shall not give cause to any delay in the conduct of the

Tender by the Tender Committee.

IN WITNESS WHEREOF, we have signed this authorization this __________ day

of __________.

Stamp and


of 66

Signature

Date

Attorney's

Confirmation of signatory rights

Date

(*)

The Tenderer

Member

Member

(*) In his signature the attorney attests and confirms that the signatory(ies) on behalf of the Tenderer or

the Member (as the case may be)appeared before him and signed this form and are authorized to sign on

behalf of the Tenderer or the Member (as the case may be) and to commit such Entity for all purposes and

intents of the above stated authorization.


compound

-Tender Forms-

Tender Form C

Remedial Investigation Program


of 66

[Pursuant to Section 4 (Mandatory Sampling and Analyses) of Volume 1 (Request for Proposals). To be

included in Part 1. Shall be reviewed with the framework of Review and Evaluation of Stage 2 per

Section 10.3 (Quality Evaluation). See in this Regard Tender Annex C (Technical Score Evaluation

Criteria) Section 2 (EPS) Item (1)]

Date: ____________

To:

1. The Municipality of Tel-Aviv-Jafo

c/o Mr. Moshe Kidron

Address: 69 Even Gvirol Street. 8th floor, Tel Aviv-Yafo, Israel 6416201

Tel: 972-(0)3-7241456

Fax: 972-(0)3-5216419

Municipality’s POC’s E-mail Address: [email protected]. 2. The Israeli Governmental Authority for Water and Sewage (hereinafter: the "WA")

Mrs. Sharon Sagi Ben Moshe

Hamasger St. No 14 P.O.B 20365 Tel Aviv

E-mail: [email protected]

Fax: 03-6369761

Dear Mrs.,

Re: Request for preforming of RI Program

The undersigned _____________ [name of the entity to be completed] (the “Company”),

hereby request your approval to perform RI Program and Inspections of the Site, as

follows:

3A. Information regarding Sampling of the WA's Wells (Mandatory )

No. Name of WA

Well

Sampling

method

Parameters

to be

analyzed

Analyzing

Laboratory

Analysis

method

Sampler

name

A B C D E F G

1 M 5 נת

תע"ש מגן ת"א 1 2

3 At least one WA must be sampled.


compound

-Tender Forms-


of 66

No. Name of WA

Well

Sampling

method

Parameters

to be

analyzed

Analyzing

Laboratory

Analysis

method

Sampler

name

A B C D E F G

3 BH C1

4 BH C2

5 BH C3

6 BH C4

7 BH C6

Shallow - נת

8 m15 מגן

Deep - נת מגן

9 m15

10 M6 נת מגן

11 M8 נת מגן

12 M6-A נת מגן

13 M6-B נת מגן

14 M7 נת מגן

For each Well (of the 14 Wells) the Tenderer wishes to investigate – the Tenderer shall

fill all information relating to each of the Wells in columns C – G (inclusive).

The Tenderer shall elaborate in detail per the reasons for which it has chosen the specific

WA Wells indicated in the table of Clause A above including WA Wells:

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

B. Information regarding Sampling Wells installed by the Tenderer (Voluntary)

The table below shall be completed by the Tenderer in the event it wishes to

investigate Sampling Wells beyond the WA Well/s indicated in the table of Clause

A above. Such Sampling Wells shall be drilled by the Tenderer.

Parameters Well 1 Well 2 … Well n

Well's coordinates

Parameters to be analyzed

Sampling method

Analyzing Laboratory

Analysis method


compound

-Tender Forms- Sampler name


of 66

Diameter of the drill

Depth of sampling

Placement and depth of the screens

Level of groundwater

Geological section

Type of drill (fixed/temporary)

The Tenderer shall elaborate in detail per the reasons for which it has determined to

execute samplings in any of the Sampling Wells indicated in the table in Clause B

above including, inter alia, their locations, depths, drilling method, groundwater level,

drill diameter:

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

__________________________________________________________________.

C. Information regarding Drilling for Soil Sampling (Voluntary)

Sampled soil

point 1

Sampled soil

point 2

Sampled soil

point n

Sampled soil's coordinates

Parameters to be analyzed

Sampling method

Analyzing Laboratory

Analysis method

Sampler name

Diameter of the drill

Depth of sampling

Geological section

The reason for selecting the chosen locations and depths:

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

__________________________________________________________________.

Faithfully yours,

________________ ________________________________

Date Stamp and Signature


compound

-Tender Forms-

Tender Form D

4Affidavit According to Public Bodies Transactions Law, 5736-1976


of 66

[Pursuant to Section 7.1.3 of Volume 1 (Request for Proposals). To be completed and

signed by the Tenderer, and in the event of a Joint Venture by each one of its Members,

which is a legal entity incorporated in Israel or registered as Foreign Company as defined

under the Corporation Law 5759-1999. To be included in Part 1. Shall be reviewed with

the framework of Stage 1[

תצהיר

אני הח"מ, , נושא ת.ז. מס' , לאחר שהוזהרתי, כי עליי

לומר את האמת וכי אם לא אעשה כן אהיה צפוי לעונשים הקבועים בחוק, מצהיר בזה בכתב כדלקמן:

1. אני עושה תצהירי זה במסגרת הצעת _____________ )להלן: "המציע"( ]*יש לנקוב בשמו

המלא של המציע כפי הוא מופיע בתעודת ההתאגדות/תעודת עוסק מורשה[, מכרז מס' _____

]מס' מכרז[ של ____________________________ ]שם עורך המכרז[.

2. הנני משמש כ___________ במציע ]*יש לנקוב בתפקיד אותו ממלא המצהיר בתאגיד[ ונותן

תצהירי זה מכוח היותי מורשה לעשות כן מטעמו, ומכוח היכרותי את העובדות מושא התצהיר.

3. אני מצהיר בזאת כי לאחר בירור ובדיקה שביצעתי, מתקיימים כל אלה במצטבר:

3.1. נכון למועד האחרון להגשת ההצעות במכרז, המציע ובעל הזיקה אליו ]המציע יסמן √

במקום הרלוונטי[

לא הורשעו ביותר משתי )2( עבירות לפי חוק עובדים זרים )איסור העסקה שלא כדין ❑

והבטחת תנאים הוגנים( )להלן: "חוק עובדים זרים"(, התשנ"א-1991 וחוק שכר

מינימום, התשמ"ז-1987 )להלן: "חוק שכר מינימום"(.

הורשעו ביותר משתי )2( עבירות לפי חוק עובדים זרים וחוק שכר מינימום, אך נכון ❑

למועד האחרון להגשת ההצעות חלפה שנה אחת )1( לפחות ממועד ההרשעה האחרונה.

הורשעו ביותר משתי )2( עבירות לפי חוק עובדים זרים וחוק שכר מינימום, על פי ❑

הפירוט דלהלן, ונכון למועד האחרון להגשת ההצעות טרם חלפה שנה אחת )1( לפחות

ממועד ההרשעה האחרונה.

4 Approvals testifying of Proper Bookkeeping Practices, in accordance with the Income Tax Ordinance

and the Value Added Tax Law, 5736 – 1975, shall be attached to this Affidavit. Approval are to be

submitted by the entities identified in this Tender Form D above.


compound

-Tender Forms-


of 66

פירוט העבירה

]מספר סעיף ושם חוק[

תאריך ההרשעה

]חודש ושנה[

.1

.2

.3

.4

*מספר השורות הנו להמחשה בלבד

לצורך סעיף 3.1 זה: "הורשע" ו - "בעל זיקה" – כמשמעותם בחוק עסקאות גופים

ציבוריים, תשל"ו-1976.

3.2. נכון למועד האחרון להגשת ההצעות במכרז ]המציע יסמן √ במקום הרלוונטי[

הוראות סעיף 9 לחוק שוויון זכויות לאנשים עם מוגבלות, התשנ"ח-1998 )להלן: ❑

"חוק שוויון זכויות"( לא חלות על המציע.

הוראות סעיף 9 לחוק שוויון זכויות חלות על המציע והוא מקיים אותן, ובמידה והוא ❑

מעסיק יותר מ – 100 עובדים, נכון למועד האחרון להגשת ההצעות, המציע מצהיר

ומתחייב, גם כדלקמן: )i( כי יפנה למנהל הכללי של משרד העבודה הרווחה והשירותים

החברתיים לשם בחינת יישום חובותיו לפי סעיף 9 לחוק שוויון זכויות ובמידת הצורך –

לשם קבלת הנחיות בקשר ליישומן; או לחילופין )ii( כי פנה בעבר למנהל הכללי של

משרד העבודה הרווחה והשירותים החברתיים לשם בחינת יישום חובותיו לפי סעיף 9

לחוק שוויון זכויות בהתאם להוראות סעיף )ii( לעיל, קיבל ממנו הנחיות בעניין ופעל

ליישומן.

לצורך סעיף 3.2 זה: "מעסיק" – כמשמעותו בחוק שיווין זכויות.

המציע מצהיר ומתחייב בזאת, כי יעביר העתק מהתצהיר לפי סעיף 3.2 זה לעיל, למנכ"ל

משרד העבודה הרווחה והשירותים החברתיים, בתוך 30 ימים מהמועד האחרון להגשת

ההצעות במכרז.

4. זה שמי, זו חתימתי ותוכן תצהירי דלעיל אמת.

תאריך חתימת וחותמת עו"ד תאריך חתימת המצהיר


compound

-Tender Forms-

Attachment A


of 66

Approvals as per the Public Entities Transactions Law, 5736-1976

1. אישור תקף מפקיד שומה או רו"ח בדבר ניהול ספרים כדין בהתאם להוראות פקודת מס

הכנסה )נוסח חדש( וחוק מס ערך מוסף התשל"ו-1975.

2. אישור תקף מפקיד שומה או רו"ח בדבר דיווח לפקיד השומה על הכנסותיו ולמנהל

מע"מ על עסקאות שמוטל עליהן מס לפי חוק מס ערך מוסף התשל"ו-1975.


compound

-Tender Forms-

Tender Form E – Parent Company Undertaking


of 66

[Pursuant to Section 7.2(b) of Volume 1 (Request for Proposals). To be completed and

signed by the Parent Company of the Tenderer or of a Member(s) (as applicable). To be

included in Part 1. Shall be reviewed with the framework of Stage 1.]

The undersigned _____________ [name of the Parent Company to be completed] (the "Parent

Company" or the “Company”), hereby confirms and warrants t as follows:

51. The Company is the Parent Company of ______________________ [name of

Tenderer or Member(s) as applicable - to be completed] (the “Tenderer” or "Member")

by means of _______________________________[please provide appropriate

explanation, attested to by an attorney, demonstrating by applicable documentation, e.g. reports

issued by the Registrar of Companies - for a Parent Company which is a Local Company or foreign

official companies’ registrar - for a Parent Company who is a Foreign Company, organizational

charts, articles of association, etc.].

2. The Tenderer or Member (as applicable) has informed the Parent Company of the

Request for Proposals and the submission of a Proposal on its behalf within its

framework.

3. The Parent Company hereby requests that its own financial information, which is

included in (i) Tender Form G (Financial Robustness); and (ii) 3 most recent

Financial Statements (the earliest being 2015) submitted within the Proposal, will

be taken into account in determination of the Tenderer's compliance with the

Financial Pre-Qualification Requirements set forth in Sections 7.2.1 (Turnover),

7.2.2 (Operating Cash Flow) and 7.2.3 (Equity) of the Request for Proposals

(instead of the Tenderer’s or Member's financial information).

4. The Parent Company confirms and acknowledges it must comply with all

Financial Threshold Requirements (Sections 7.2.1 (Turnover), 7.2.2 (Operating

Cash Flow), 7.2.3 (Equity) and 7.2.4 (Going Concern) – while compliance with

the Section 7.2.4 (Going Concern) shall be complied with by the Parent Company

and by the Tenderer or Member (as applicable).

5. The Parent Company confirms that all information which is included by it or on

its behalf in Tender Form G and Financial Statements is true, accurate, complete

and correct as of the Submission Date.

6. The Parent Company shall provide the Municipality with any information

(including any financial information), which may be required by it at any stage of

the Proposals evaluation stage in order to carry out its examination and evaluation

of the Proposal.

7. The Parent Company has read the Request for Proposals and is familiar with the

provisions thereof and in particular those which apply directly to it.

8. In the event the Municipality determines that the Proposal submitted by the

5 Note definition of “Parent Company” as provided under Section 7.2 (Financial Threshold Requirements)

sub-section (a) of Volume 1 (Request for Proposals).


compound

-Tender Forms- Tenderer complied with the requirements of the Request for Proposals, and that

the Tenderer, its Members (as applicable) or In-Situ Subcontractor (as applicable)

comply with the RFP’s requirements, and following thereof the Tenderer shall be

declared, per the provisions of Section 20.1 of Volume 1 (RFP) and the

Municipality shall thereafter sign the Contract with the Preferred Tenderer (who

shall thereafter be referred to as the Contractor)it - the Parent Company shall

guarantee, ensure and be liable towards the Municipality for the financial

robustness of the Tenderer or member (as applicable) until the elapse of the

Warranty Period defined under Section 18.1 (Warranty) of Volume 2 (Contract).

The Parent Company’s signature and submission of this Tender Form E shall

constitute its complete and irrevocable responsibility and undertaking for the

Tenderer’s or Member’s financial robustness, as provided above, and its

commitment (towards the Tenderer or Member and Municipality) to ensure such

robustness including by way of providing it with adequate finance.

9. The Parent Company is a company duly incorporated, duly organized and validly

existing under the laws of ____________ [insert Parent Company's applicable

jurisdiction] and the execution, delivery and performance by the Parent Company

of this Tender Form E and Tender Form G submitted by it in connection with

the Proposal within its corporate powers, have been duly authorized by all

necessary corporate and other actions and do not contravene: (i) the organizational

documents of the Parent Company; (ii) any law, rule or regulation having the force

of law in ___________________ [insert applicable jurisdiction]; (iii) to the best of the

undersigned’s knowledge, any judgment, writ, injunction, decree or ruling of any

_______________ [insert applicable jurisdiction] court or other governmental body

applicable to the Parent Company; or (iv) any agreement, contract or other

instrument known to the undersigned to which the Parent Company is a party or

to which it is subject.

10. Unless otherwise defined herein, all terms shall have the same meaning ascribed

to them in the Invitation.

Faithfully yours,

________________ ________________________________


I, (Attorney’s Name) attorney-at-law, hereby do attest and


of 66

confirm that _ (Signatory’s Name) appeared before me and signed this

Tender Form E and is authorized to sign on behalf of (Parent

Company’s name), and to commit it for all purposes and intents of the above stated

form.

Attorney-at-Law


compound

-Tender Forms-

Tender Form F – In-Situ Subcontractor Undertaking


of 66

[Applicable in the event of a Tenderer who is a single company and who has presented the experience of an In-Situ

Subcontractor for the purpose of demonstrating compliance with the Professional Threshold Requirement set forth

under Section 7.3 of the RFP.

[Pursuant to Section 7.3.1.3(a)(ii) of Volume 1 (Request for Proposals). To be

completed and signed by the In-Situ Subcontractor. To be included in Part 1. Shall be

reviewed with the framework of Stage 1.]

To:

The Municipality of Tel-Aviv-Yafo.

Re: Tender for In-Situ Ground Water Remediation and Construction of Ground

Water Pumping System in IMI "Magen" compound - (the “Project”)

We, the undersigned, ________________________(the “In-Situ Subcontractor”),

hereby issue this Undertaking, as part of the Proposal submitted

by________________________________ (the “Tenderer”), pursuant to the Tender

Documents.

1. We are duly organized and validly existing under the laws of the jurisdiction

in which we were organized.

2. We have the corporate power to execute and perform this Undertaking and

have taken all necessary action to authorize the execution and performance

of this Undertaking. This Undertaking has been duly executed and delivered

by us and constitutes our legal, valid and binding obligation enforceable

against us according to its terms.

3. We (including any of our interested parties, directors or managers) are not

residents or nationals of a hostile state which does not maintain diplomatic

relations with the State of Israel or of a state which does not maintain full

trade relations with the State of Israel.

4. We have received and diligently reviewed all of the Tender Documents, to

the extent that they are relevant to us, in their entirety, including all forms,

annexes, appendices, volumes and other attachments relevant to us and

consent to all of the terms and conditions set forth therein. We have

understood the contents of such Tender Documents in their entirety, we are

fully familiar with all the provisions thereof, and have executed this Tender


compound

-Tender Forms- Form in accordance with the provisions of the Tender Documents. We

further declare that we agree to all of the provisions in the Tender

Documents pertaining to the In-Situ Subcontractor, we confirm that each of

the undertakings set forth therein should be deemed to have been given by

us, insofar as such undertakings directly pertain to us and undertake to be

bound by all the operative provisions contained therein.

5. We have demonstrated compliance with the professional threshold

requirement set forth in Section 7.3.1 (In-Situ Design and Remediation

Experience) to the Tender, through Tenderer’s Technical-Engineering

Proposal [Tender Form I (Professional Threshold Requirements -

Demonstration Information) and Tender Form J (Tenderer's Information

for Technical Score)], and hereby warrant and undertake that the respective

works in the Project will be executed directly by us.

6. We warrant that: (i) the part in the Proposal pertaining to us is accurate,

complete and up-to-date at time of submission, in accordance with the

requirements of the Tender Documents all attachments thereto and in the

our best professional judgment; and (ii) that the Proposal parts pertaining to

us are fully compliant with all terms and provisions of the Tender

Documents.

7. We understand that the submission of this Proposal shall not be deemed in

any way to create an obligation on the part of the Municipality to declare

the Tenderer “Preferred Tenderer”; that the Municipality has the unfettered

right to reject any or all Proposals; to request additional information from

the Tenderer or other parties including from us; to cancel or modify the

Tender Documents at any time and to negotiate with any or all Tenderers.

8. The validity of our Undertaking and/or its extent, shall not be affected

and/or prejudiced even if the Tender Documents or the Proposal (or any part

thereof) is changed and/or amended, from time to time. We hereby confirm

our consent to any change and/or amendment and shall remain responsible

for all of our undertakings.

9. We undertake to be directly liable towards the Municipality, to any loss or

damage whatsoever suffered as a result of our performance of the In-Situ

works or as a result of act or omission of the In-Situ Subcontractor.

10. We acknowledge and agree that our signatures on the Tender Forms

pertaining to us shall fully bind us with regard thereto.

11. The Laws of the State of Israel shall apply to this undertaking, its

interpretation and any matter relating thereto or deriving therefrom.

12. The address of the undersigned shall be the Tenderer and the Tenderer shall

be authorized to accept notices and legal documents for us and on our behalf.


of 66


compound

-Tender Forms- 13. The Proposal has not been prepared in collusion with any other tenderer

participating in the Tender, or with any affiliate thereof.

14. We are legally entitled to use and transfer all information, know-how, trade

secrets, patents and other intellectual property contained in our part of the

Proposal.

15. We undertake to keep confidential all information, whether written or oral,

concerning the Tender which we receive or obtain as a result of the

information supplied in the Tender Documents, or in discussions relating

thereto.

16. We acknowledge that we are aware of and acquainted with all other entities

that are, or could be, connected with or affect, the performance of our

obligations, and have fully taken into account such entities in the

preparation of our part of the Proposal. We shall not make or submit any

claim, suit, or action based on or arising out of, whether directly or

indirectly, any misunderstanding or lack of knowledge with regard to any

term or provision of the Tender Documents, and we hereby, irrevocably and

without exception, waive any such claim, suit or action.

17. There are no conflicts of interest between our participation in the Proposal

and any of our prior or current engagements or activities.

18. We acknowledge and agree that all costs arising from or related to the

submission of our part of the Bid including, without limitation, our review

of all the relevant Tender Documents, shall be borne solely and entirely by

us and by the Tenderer and that we shall have no claim, suit or cause of

action with regard to any such costs.

19. We undertake that we shall refrain from requesting any changes,

clarifications, amendments, or easements from any entity other than the

Municipality.

20. A breach of any of the undertakings, agreements or representations in part

or entirety will constitute a cause for the disqualification of the Proposal.

IN WITNESS WHEREOF, the parties hereto have executed this undertaking.

The Subcontractor Signature

1.

2.

3.

The Tenderer Signature


of 66


compound

-Tender Forms- 1.

2.

3.

I, (Attorney’s Name) attorney-at-law, hereby do attest and confirm that


of 66

_ (Signatory’s Name) appeared before me and signed this Tender

Form F and is authorized to sign on behalf of (In-Situ Subcontractor’s

name), and to commit it for all purposes and intents of the above stated form.

Attorney-at-Law


compound

-Tender Forms-

Tender Form G – Financial Robustness


of 66

[Pursuant to Section 8.2.7.1 of Volume 1 (Request for Proposals). To be completed

and signed by the chief executive officer or chief financial officer of the Tenderer and

each Member and Parent Company (as applicable) on a separate Form. To be included

in Part 1. Shall be reviewed with the framework of Stage 1.]

Name of Tenderer, Member or

___________________________________________Parent Company (as applicable):

(a) In the event the Tenderer is a

_____________% (Complete) JV – the Member’s holdings in

the Tenderer:

(b) In the of a Single Company 100%

Tenderer

Name of signatory and its position in Name: _____________________________

Position in the Tenderer, Member or Parent Company the Tenderer, Member or Parent (as applicable): CEO CFO

Company (as applicable): [check the applicable]

1. Turnover

Year t - 2

t - 1 t Average

Annual

Turnover

for the last

three (3)

years**

Weighted

Average

Annual

Turnover of

the

Member***

Turnover (NIS) *

Where:

t - The year of the most recent available Financial Statements.

* Based on the Tenderer’s / each Member’s or Parent Company's (as applicable) most


compound

-Tender Forms- recent available Financial Statements (for the removal of doubt, which is not earlier than


of 66

2015).

** The average annual Turnover shall be calculated in accordance with the formula set forth

is Section 7.2.1 of Volume 1 (Request for Proposals).

*** The weighted average annual Turnover for the Tenderer / each Member (as applicable)

shall be calculated in accordance with the formula set forth is Section 7.2.1 ("Turnover")

of the Volume 1 (Request for Proposals).

2. Operating Cash Flow

The Tenderer / each Member or Parent Company (as applicable) is required to

complete one of the following Sections 2.1 (Average Operating Cash Flow) or

2.2 (Financial Ratio):

2.1 Average Operating Cash Flow:

Year t - 2

t - 1

T Average

Annual

Operating Cash

Flow during the

last three (3)

years**

Operating Cash

Flow (NIS) *

Where:

t - The year of the most recent available Financial Statements.

* Based on the Tenderer’s / each Member’s or Parent Company’s most recent available

Financial Statements (for the removal of doubt, which is not earlier than 2015)


compound

-Tender Forms- ** The Average Annual Operating Cash Flow shall be calculated in accordance with the

formula set forth in Section 7.2.2.1 of Volume 1 (Request for Proposals).

2.2. Financial Ratio

The Financial Ratio is ____% (in words: ______________________

percent) ***.

*** The Financial Ratio shall be calculated in accordance with Section 7.2.2.2 of Volume 1

(Request for Proposals).

3. Equity

The equity of the Tenderer / each Member or Parent Company (as applicable) at

the last day of the year of the most recent available Financial Statement is

_______________ NIS.

4. Going Concern

I hereby confirm that the Tenderer, each Member and Parent Company [delete as

applicable] is not under any voluntary or involuntary bankruptcy process

(liquidation or reorganization), or receivership or commencement of a similar

insolvency proceeding, and the Tenderer / each Member and Parent Company’s

most recent available Financial Statement does not include any Going Concern

notice.

[This Threshold Requirement (Section 7.2.4 – Going Concern) applies to the Tenderer and

Member regardless of the fact whether or not they have relied upon a Parent Company.

Accordingly, in the event a Tenderer or Member relied upon a Parent Company all (Tenderer and

its Parent Company or Member(s) and its / their Parent Company shall comply with this Threshold

Requirement].


of 66


compound

-Tender Forms- Notes:


of 66

- All data should be presented in NIS, in accordance with the provisions of Section

8.2.7.5 (Currencies Conversion) of Volume 1 (RFP).

- The Tenderer / each Member and Parent Company (as the case may be), should

complete this Tender Form G (Financial Robustness) in accordance with its

contents and per Section 8.2.7.1 (Financial Threshold Requirements -

Demonstration) of Volume 1 (Request for Proposals).

- A Tenderer or Member which relies on a Parent Company for the purpose of the

Financial Threshold Requirements as set forth in Section 7.2 (Financial Threshold

Requirements) sub-section (a) of Volume 1 (Request for Proposals), must rely on

such Parent Company for the purpose of demonstration all Financial Threshold

Requirements. The Financial Threshold Requirement provided under Section

7.2.4 (Going Concern) shall be complied with by the Tenderer or Members (as

applicable) in addition the Parent Company’s compliance with this Financial

Threshold Requirement (in addition to the Parent Company’s compliance with the

Financial Threshold Requirements provided under Sections 7.2.1 – 7.2.3 of

Volume 1 (RFP) (inclusive)).

- Attached are the Tenderer’s, Members’ (as applicable) or Parent Company’s 3

most recent Financial Statements (the earliest being 2015).

✓

Faithfully yours,

I, ______________, (Name of Attorney) attorney-at-law, hereby do attest and confirm

that __________ (Name of Signatory) has been identified by me and has signed the above

statement and that he/she/they serve as the chief executive officer / chief financial officer

of _______________ (name of Tenderer / Member / Parent Company) and is/are

authorized to sign on its behalf, and to commit it for purposes of the above stated Tender

Form, for all purposes and intents.

____________________

Attorney-at-Law


compound

-Tender Forms-


of 66


compound

-Tender Forms-

Tender Form H – Price Proposal


of 66

[Pursuant to Section 9 of Volume 1 (Request for Proposals). To be completed and

signed by the Tenderer. To be included in Part 3. Shall be reviewed with the framework

of Stage 3]

The Tenderer’s proposed Fixed Lump Sum Price Proposal:

In numbers: [____________________] NIS.

In words: [________________________________________________] New

Israeli Shekels.

Sums excluding VAT.

Faithfully yours,

________________

Tenderer's Name

________________ ________________________________


I, ______________, attorney-at-law, hereby do attest and confirm that __________

appeared before me and signed this form and is authorized to sign on behalf of

_______________, and to commit it for all purposes and intents of the above stated

form.

____________________

Attorney-at-Law


-Tender Forms-

Tender No. 8/2019

Tender Form I - Professional Threshold Requirements - Demonstration Information

Tender Forms, February 2019 of 66

[Pursuant to Section 7.3 and 8.2.8 of Volume 1 (Request for Proposals). To be included in Part 1. Shall be reviewed with the framework of

Stage 1 – Examination of Tenderer’s Composition and Threshold Requirements.]

Part A

[In the event of a Tenderer who is comprised of a single company, to be completed and signed by the entity who is demonstrating the experience

(the Tenderer or the In-Situ subcontractor). In the event of a JV, to be completed and signed by the Member who is demonstrating its

experience.]

Affidavit

I, the undersigned, _______ [name] _______ [surname] ___________ [Israeli ID no. / Foreign Passport no. – circle] acting in the position of

________ within the [Tenderer / Member / In-Situ Subcontractor – circle] (the “Company”) after having been warned that I must declare the

whole truth and that I can expect to incur the penalties prescribed by law should I not do so, hereby make the following declaration:

In-Situ Design and Remediation Experience (Section 7.3.1 of Volume 1 (Request For Proposals)

Note: Information in the table below classified under the RFP column as "General" – is requested and will be reviewed for reference purpose only

and shall not determine compliance or non-compliance with the Professional Threshold Requirement.


-Tender Forms-


6 In the event more than three projects are presented within the Proposal – the additional projects shall be presented in the same table format.

# Information requested

RFP Section Demonstrated projects

#1 #2 6#3

1. Pro ject’s location General

2. Ent ity demonstrating the experience: 7.3.1.3

(i) In the event of a single company – the

Tenderer or the In-Situ Subcontractor's

name;

(ii) In the event of a JV – the name of the

Member.

[note the provisions regarding accumulative

experience provided under sections 7.3.1.3(a) and (b)]

3. Det ail the role of the demonstrating entity (main 7.3.1.3(c)

contractor/ subcontractor.

4. C lie nt General

5. Con tact person of the Client]name, position/role, phone, General

e-mail[

6. In-S itu technology that was applied in the project.

Note: the technology applied does not have to be one

General

of the two In-Situ technologies listed in section 1.6.1 of

the RFP.

Dummy TextDummy Text


-Tender Forms-

7. Rem ediation commencement date - (dd/mm/yyyy) 7.3.1.1

[note the time frames provided under Section 7.3.1.1 of

Volume 1]

The Tenderer shall attach to this this part of Tender Form I– for each Location - the following supportive documentation:


8. Rem ediation completion date - (dd/mm/yyyy) [note that 7.3.1.1

the design and remediation of the 3 projects should be

completed by the submission date]

9. Raw water source and type General

10. Num ber of Injection Wells

Note: minimum of 7 wells in each project.

7.3.1.2

11. Det ail type of Chlorinated Solvent/Solvents (See General

definition of Chlorinated Solvent under Annex A.

(Definitions for the RFP and Contract).

12. Init ial concentrations of each Chlorinated Solvent(s) of General

concern, ppb

13. Des ignated ppb concentration of each Chlorinated General

S olvent(s) – per design.

14. Act ual ppb concentration of each Chlorinated General

S olvent(s) –after In-Situ treatment

15. P ub lic domain of the project, if applicable General


-Tender Forms-

• A detailed project description within the framework of which the experience demonstrated above was executed.

• A description of the executed scope, works and services confirmed by the respective client (relevant contractual documents signed by

the client may be submitted).

• A map presenting the injection wells.

• Laboratory reports including analysis of the relevant Chlorinated Solvent(s). The laboratory results shall reflect the findings

documented (a) prior to, (b) during; and (c) after the In-Situ treatment application. The reports shall be signed by the laboratory.

• Any additional document the Tenderer deems to submit.

Note: If a Tenderer is of the opinion it is unable to attach the above required documents in full or in part, for any reason whatsoever, it shall


- prior to Submission Date - submit a detailed RFC on the matter (see in this regard Sections 3.5.3 and 16.1 of Volume 1).

The contents of this affidavit is complete, accurate and true and as a confirmation to this statement I signed my name below

Signature _________

Date __________

Confirmation

I, ______________, attorney-at-law / legal consultant [circle as applicable], hereby attest and confirm that Mr. / Mrs. __________ has been

identified by me and has signed the above statement and that he/she/they is/are authorized to sign on behalf of _______________ [name of

Company] and to commit it for purposes of the above stated Tender Form, for all purposes and intents.

____________________ [Signature, Stamp and License no. / Registration no.]

Attorney-at-Law/legal consultant


-Tender Forms-

Part B


[In the event of a Tenderer who is a single company - to be completed and signed by the Tenderer. In the event of a JV - to be completed and

signed by one of the JV’s Member who is demonstrating the experience (which also should be a Local company as provided under 7.3.2 section).]

Affidavit


________ within the [Tenderer / Member– circle] (the “Company”) after having been warned that I must declare the whole truth and that I can

expect to incur the penalties prescribed by law should I not do so, hereby make the following declaration:

Local Company – Professional Experience (Section 7.3.2. of Volume 1 (Request for Proposals))

Notes:

1- As stipulated in Section 7.3.2, compliance with the Threshold Requirements of Section 7.3.2 can be achieved either by complying with

the requirements of section 7.3.2.1 or by complying with the requirements of section 7.3.2.2.

2- Requested Information referred as "General" are for reference purposes only.

(1) Professional Experience (Section 7.3.2.1 of the RFP):


-Tender Forms-


Information requested

RFP

Section

Details

1. D escription of the project where the treatment 7.3.2.1

was or still is executed

2. E ntity demonstrating the experience: 7.3.2

(i) In the event of a single company – the

Tenderer;

(ii) In the event of a JV – the name of the

Member.

[note the provisions regarding accumulative

experience provided under section 7.3.2

3. D etail the role of the demonstrating entity 7.3.2.

(main contractor/ subcontractor).

4. C lient General

5. C ontact person of the Client ]name, General

position/role ,phone, e-mail[

6. C onfirm treatment of ground water. 7.3.2.1

7. T ype of contaminants treated (groundwater 7.3.2.1

NO3 and/or groundwater VOC’s)

8. I nitial concentrations of each contaminants of General

c oncern, ppb

9. T echnology used (In-Situ and/or Ex-Situ) 7.3.2.1

10. C ommencement date - (dd/mm/yyyy) [note the 7.3.2.1

time frames and the minimal time period of

Dummy Text


-Tender Forms-


Information requested

RFP

Section

Details

Treatment provided under section 7.3.2.1 of

Volume 1)

11. C ompletion date - (dd/mm/yyyy) (if applicable) 7.3.2.1

12. P ublic domain of the project, if applicable General

The Tenderer shall attach to the above table the following documents in order to demonstrate the experience required for the respective

Threshold Requirement:

• Detailed project description.

• Description of the scope of works and services signed by the client.

• In the event of:

o In-Situ Treatment – a map presenting the injection wells.

o Ex-Situ Treatment – as made PFD and operational reports, at least, one year of operation.

• Laboratory reports showing analysis and presence of, at least, of NO3 and/or VOC in the raw water. The reports shall be signed by the

laboratory.



Dummy Text


-Tender Forms-

Or


(2) Professional Experience (Section 7.3.2.2 of the RFP):

Projects Details

RFP

Section

Demonstrated projects

#1 #2 #3

1. project 7.3.2.2

2. Entity demonstrating the experience: 7.3.2

(i) In the event of a single company – the Tenderer;

(ii) In the event of a JV – the name of the Member.

[note the provisions regarding accumulative experience

provided under sections 7.3.2]

3. Detail the role of the Local Company (main contractor, 7.3.2

subcontractor).

4. Client General

5. Contact person of the client ]name, position/role ,phone, e-mail[ General

6. Confirm investigation of groundwater contaminated from 7.3.2.2

industrial sources 7. Type of Industrial contaminants General

8. Concentrations of the Industrial contaminant(s), ppb General

9. N umber of Wells (minimum of 5 wells in each project) 7.3.2.2

10. Investigation commencement date - (dd/mm/yyyy) [note the 7.3.2.2

time frames provided under section 7.3.2.2 of Volume 1)

11. Completion date - (dd/mm/yyyy) 7.3.2.2

12. Public domain of the project, if applicable General

The Tenderer shall attach to the above table the following documents in order to demonstrate the experience required for the respective

Threshold Requirement (for each project):

Dummy TextDummy TextDummy Text


-Tender Forms-

• Detailed project description.

• Description of the scope of works and services signed by the client.

• A map presenting the wells.

• Laboratory reports showing analysis and presence of the industrial contaminant(s) in all presented wells. The reports shall be signed

by the laboratory.




The contents of this affidavit are complete, accurate and true and as a confirmation to this statement I signed my name below

Signature _________

Date __________

Confirmation







-Tender Forms-

Tender Form J – Tenderer's Information for Technical Score (TS)


Part A - EXPS

[Pursuant to Section 10.3 of Volume 1 (Request for Proposals) and Annex C (TS Evaluation Criteria). To be completed and signed by Tenderer.

To be included in Part 2. Shall be reviewed with the framework of Stage 2.]

Affidavit


________ within the [Tenderer / Member(s) / In-Situ Subcontractor – circle as applicable] (the “Company”) after having been warned that I

must declare the whole truth and that I can expect to incur the penalties prescribed by law should I not do so, hereby make the following

declaration:

For the purpose of determination of the Experience Proposal Score (EXPS), all Proposals shall include, in a comprehensive manner, the following

information regarding the projects demonstrating the Tenderers experience for (a) In-Situ Design and Execution and (b) Production Wells Design:

a. In-Situ Design and Execution Projects Reference List

Projects Details

Corresponding

item in Section 2

of Annex C

Project

#1 #2 #3 #4 #5

1. C lient General

2. L ocation General

3. Type of contaminant)s( 3, 8

Dummy TextDummy TextDummy TextDummy Text


-Tender Forms-


Projects Details

Corresponding

item in Section 2

of Annex C

Project

#1 #2 #3 #4 #5

4. Concentrations of each of the contaminant)s( before treatment, 3,6

ppb

5. Concentrations of each contaminants after In-Situ Treatment- 3, 6, 7

Design, ppb

6. Concentrations of each contaminants after In-Situ Treatment- 3, 6, 7

actual, ppb

7. Presence of Heavy Metals (yes/no)- type of metal and 3

concentration of each metal

8. Technology applied 1, 2

9. NOD/NRD in the site 1, 2

10. Type of material used 1, 2

11. Injected materials solution concentration 1, 2

12. Geology of the site General

13. Number of Injection Wells 4

14. A field/laboratory measured parameter that defines the ROI, as 1, 2, 4

well as the radius itself, m

15. Depth of Injection Wells (below water table), m 5

16. T ype of injection 1, 2

17. N umber of injection cycles General

18. I njection cycles' schedule General

19. T otal injected materials per cycle per well, kg General

20. N umber of Monitoring Wells General

21. D epth of Monitoring Wells, m General

22. D ate execution commenced (dd/mm/yyyy) 1, 2

23. D ate execution completed (dd/mm/yyyy) 1, 2

Dummy TextDummy TextDummy TextDummy TextDummy Text


-Tender Forms-


Projects Details

Corresponding

item in Section 2

of Annex C

Project

#1 #2 #3 #4 #5

24. Rebound Effect description including, possibility, time frame General

and ways of treatment (if applicable)

25. Description of derivatives and by product and their toxicity General

26. Contact person of the Client ]Name, Position/role ,phone, e- General

mail[ 27. P ublic domain of the project, if applicable General

b. Pumping system Design - Projects Reference List

Projects Details

Corresponding

item in Section 2 of

Annex C

Project

#1 #2 #3 #4 #5

1. C lient General

2. L ocation General

3. D epth of Production Wells (before water table), m 10

4. N umber of Production Wells 11

5. F low rate from each Production Well, m3/hr 11

6. P roject’s status 9

7. D ate Designed completed 9

8. D ate operation commenced (dd/mm/yyyy) 11

9. N umber of years of operation 11

Dummy TextDummy TextDummy TextDummy TextDummy TextDummy Text


-Tender Forms-


Projects Details

Corresponding

item in Section 2 of

Annex C

Project

#1 #2 #3 #4 #5

10. S igned and dated pumping system As-Made drawings 9, 10 11. P roduction well in a residential area 12

Confirmation






Dummy TextDummy TextDummy TextDummy TextDummy Text


-Tender Forms-

Part B - EPS

[Pursuant to Section 10.3 of Volume 1 (Request for Proposals). To be completed and signed by Tenderer. To be included in Part 2. Shall be


The Tenderer is requested, in the framework of this part of Form J, to elaborate on the technical design of the project component including

submittal requirements set in Annex G (Submittals for the EPS). Please note Annex C (TS (Technical Score) Evaluation Criteria) will be

evaluated and scored based upon the information completed by the Tenderer below (without that derogating from the Municipality’s

discretion to consider for the purpose of evaluation and score of Annex C additional information provided by the Tenderer in the other parts

of its Proposal). Notice the provisions of section 10.3.2 of the RFP (Minimum Requirements for EPS).


No. Parameter

Corresponding Item

in section 1 (EPS) of

Annex C for

reference purpose

Data given

1 Technology proposed (ISCO for all Injection Wells or ISCR for all 8, 9, 10 Circle: ISCO or ISCR

Injection Wells) and description.

The description shall demonstrate the compatibility of the chosen

method to the historical and updated contaminants concentrations

results (shall be examined based on the remedial investigation, all

models, equations and calculations attached).

Method and description to be attached

by the Tenderer to this Form J as

“Attachment 1”


-Tender Forms-


No. Parameter

Corresponding Item


Annex C for

reference purpose

Data given

2 NOD if ISCO was proposed or NRD if ISCR was proposed. Please 8, 9, 10 Fill in one of the followings:

provide information regarding the calculation and whether the NOD: _________ for ISCO

calculation was based upon the pre-proposal RI or literature NRD: _________ for ISCR

evaluation.

3 Injection Wells and Monitoring Wells: 2, 4, 6, 10, 7 Number of Injection Wells: ______

a. Number of Injection Wells; and Number of Monitoring Wells: ______

b. Number of Monitoring Wells; and Number of Drilling Machines: ______

c. Number of drilling machines; and A 1:500 scale map of the Site

d. Location of each of the wells; and indicating the location of each

e. Depth of each of the wells. Injection Wells and Monitoring Well.

f. Methods of drilling This map shall be attached by the

Tenderer to this Form J as

“Attachment 2”. Beneath the map a

table shall be added identifying each

well by designated code and indicating

its depth (meters).

4 The type and total injected material amount per Injection cycle and 9, 10 Material: __________ [type] Material:

active material concentration and amount for each Injection Well. __________ [name]

Material: _______ % [active material

concentration]

The table (to be attached as

Attachment 2) shall also show, for

each Injection Well the Injected

material amount and volume.

5 Number of Injection machines 5 ________ [number]


-Tender Forms-


No. Parameter

Corresponding Item


Annex C for

reference purpose

Data given

6 ROI value, and methodology of each determination for each of the 3, 10 The table (to be attached as

Injection Wells. Attachment 2) shall also show, for

each Injection Well the ROI value

(meters). The ROI methodology of

determination shall be included in the

aforesaid Attachment 1.

7 Description related to the toxicity of derivatives and byproducts 8, 10 The description shall be attached by the

Tenderer to this Form J as

“Attachment 3”.

8 Description of the injected material's influence on the chrome's 8 The description shall be attached by the

oxidation state- hazards and treatments Tenderer to this Form J as

“Attachment 4”.

9 • Frequency of sampling and number of Monitoring Wells to be 10 The information shall be attached by the

sampled in each partial monitoring event. Tenderer to this Form J as

• Number and type of analysis per each sample. “Attachment 5”.

• A list of all Laboratories to be used in the Project indicating for

each laboratory the type of analysis to be performed.

• On line and/or field testing description, analysis methods and

quantification levels. 10 Pumping System pump's characterization 11 Efficiency: _______ %

MOC of the wetted parts: _______

11 Underground Structure cross section and design 11


-Tender Forms-


No. Parameter

Corresponding Item


Annex C for

reference purpose

Data given

12 Pumping System’s on line instrumentations 11

13 Piping design from each well to the connection point to the terminal 11

points, including: route, material, dimeter, flow velocities, work

description, connection point design and cross section.

14 Suitability of the Pumping System and component's design, 11

execution and operation to an installation in an underground

structure

15 Suitability of the Pumping System and component's design, 11

execution and operation in highly urban populated area

16 RI program – number of sampling wells and parameters for analysis 1

Notes:

1. All sampling and lab results executed prior to the Submission Date.

2. All relevant modeling, equations and calculations used for the design of the In Situ (Injection Specific Design Using the Pre Design Data),

such as: the total injected material amount per injection cycle on 100% base for each material and each well, flow rates, Wells dispersing

throughout the Site, field/laboratory measured parameter that defines the ROI, as well as the radius itself (meters), etc.)

3. Plot plan for all systems on 1:1000 scales including:

• Injection, Monitoring, and Production Wells


-Tender Forms-

• Pumping System Pipelines up to the terminal points

• Terminal points for all relevant streams

• Working and organization areas

4. 1:500 scale map including:

• The location of the Injection and Monitoring Wells, stating clearly for each well the type (injection/monitoring), the depth, and ROI.

• The type and total injected material amount per injection cycle on 100% base for each material and each Well.

• The map should include the contamination plume background concentrations.

• The required information on the map can be presented in tables with clear index

5. Rebound effect description including:

• Possibility, time frame and ways of treatment

• Suitability of the suggested injection plan to the treatment of the Rebound Effect risk

6. 1:500 Layout of proposed Pumping system including the Production Wells, pumps, underground structure, connecting pipes and terminal

points.

7. Pumping System components drawing including: Production Wells, pumping units and piping. The drawing shall include hydraulic

characterization for each Production Well in the pump outlets and terminal points (flow and pressure).

Note: If a Tenderer is of the opinion it is unable to attach the above required documents in full or in part, for any reason whatsoever, it shall - prior


to Submission Date - submit a detailed RFC on the matter (see in this regard Sections 3.5.3 and 16.1 of Volume 1).


-Tender Forms-

Tender Form J – Part B (EPS) – Attachment A


Approved RI Program

Approved RI Program and Sampling Results

[Pursuant to Section 4 of Volume 1 (Request for Proposals). To be completed and signed by The Tenderer. To be included in Part 2. Shall be


The Tenderer is requested, in the framework of this Tender Form J– Part B – Attachment A, to submit its approved RI Program, including a

detailed description of the works and signed Laboratory results and analysis. In the event the Tenderer installed and monitored Sampling Wells at

the Site (beyond the WA Wells) as part of the RI Program, it shall submit a map indicating the location of such Sampling Wells within the Site and

drilling logs.

Tender for In-Situ Ground Water Remediation and Construction of Ground Water Pumping System in IMI

"Magen" compound

-Tender Forms-

Tender No. 8/2019

Ministry of Economy and Industry

86 Menachem Begin Rd., P.O.B 36049, Tel Aviv 6136001, Israel

[email protected]

www.ica.gov.il Tender Forms, February 2019 of 66

Tender Form k – Industrial Cooperation Undertaking

[Pursuant to Section 7.1.5 of Volume 1 (Request for Proposals). To be completed and

signed by Tenderer. To be included in Part 5. Shall be reviewed with the framework

of Stage 1.]

This Binding Undertakings Instrument ("Undertaking") is made as of [_____] [Date],

by [_______] [Name] a corporation duly incorporated and existing under the laws of

[_____] [Place of inco0rporation], company number [______] with address at

_______________________ (“Supplier”).

Whereas, according to the Israeli Mandatory Bidding Regulations (Mandatory

Industrial Cooperation) of 2007 a Foreign Supplier who participates in a

procurement process conducted by Buyer (as such term is defined below),

or otherwise engages Buyer, for the purpose of acquisition by Buyer of

goods, equipment, services or work, at a value as defined under the

Regulations, is required to engage in industrial cooperation activity in

Israel; and -

Whereas, the Supplier, is a Foreign Supplier (as such term is defined below) and

participates in a procurement process number [____] [Tender No.] issued

by [____] [Issuer of the Tender] (the “Buyer”) for the supply of

_______________________ [____] [Name of Tender] (the “Tender”) or

otherwise wishes to engage with Buyer for the supply of goods,

equipment, services or work; and -

Whereas, Supplier hereby undertakes that, should it be awarded in the framework

of the Tender (or otherwise contract with Buyer), Supplier shall conduct

such industrial cooperation in such nature and scope as set forth in this

binding Undertaking, including appendices thereof.

THEREFORE, in consideration of these premises, I, the undersigned Supplier, hereby

declare, warrant and undertake towards the State of Israel (represented for the purposes

hereof by the ICA (as such term is defined below)), as follows:

1. PREAMBLE, INTERPRETATION AND DEFINITIONS

1.1 The preamble and Schedules to this Undertaking and the Appendices attached

hereto constitute integral parts hereof.

mailto:[email protected]

http://www.ica.gov.il/


"Magen" compound

-Tender Forms-

Tender No. 8/2019



[email protected]


1.2 Section headings have been included in this Undertaking for convenience of

reference only and shall not be used for the interpretation thereof and in no

way alter, modify, amend, limit, or restrict any contractual obligations of the

Supplier hereunder.

1.3 This binding Undertaking is provided in accordance with Israeli Statute and

Regulations (as such terms are defined below) and the ICA Guidelines as

presented in the official website of the ICA.

1.4 Terms used herein and not otherwise defined shall have the same meaning as

ascribed thereto in Statute or Regulations.

Without derogating from the above, in this Undertaking, the following terms

shall have the meaning ascribed thereto below:

“Buyer” as defined in the preamble to this Undertaking above.

“Contract” shall mean the procurement contract between the Buyer and the

Supplier which shall be entered into between Buyer and Supplier should the

Supplier be awarded in the framework of the Tender, or otherwise, for the

purpose of acquisition by Buyer from Supplier of goods, equipment, services or

work.

"Contract Value" – the total considerations to be paid to Supplier in the

framework of the Contract or in relation thereto, including taxes, levies, fees,

insurance and transportation costs, and - in respect of imported goods - their

CIF price in an Israeli port, including taxes, levies, fees, insurance and

transportation costs, all - without giving effect to any deductions, set-offs or

fines. Contract Value includes, without limitation – (1) any payment which,

under the Contract, the Buyer is required to pay to Supplier and Supplier is

required to transfer to another; (2) any payments which any third party is

required to pay to Supplier, by virtue of the Contract; (3) any payments,

including payments as stated in paragraphs (1) or (2) above included in any

option of Buyer under the Contract; (4) any continuation contract in excess of

USD 500,000 that is made within a period of 5 years from the date of the

Contract; and (5) any acquisition of spare parts, training activities, maintenance,

technical assistance, guarantees etc. procured in the framework of the Contract

or in relation thereto.

"Foreign supplier" – a manufacturer, supplier or importer of imported goods

or a supplier of work that is not performed in Israel, whether himself or by

means of others. For the purpose of this undertaking and subject to its terms and




"Magen" compound

-Tender Forms-

Tender No. 8/2019



[email protected]


conditions, importer of imported goods and their manufacturer are considered

jointly and severally a Foreign Supplier.

For the removal of doubt, the Foreign Supplier's Subsidiaries or affiliates shall

be considered as Foreign Supplier, For the purpose of this undertaking.

"Subsidiary" - a company in which the Foreign Supplier holds fifty percent or

more of the nominal value of its issued share capital or of the voting power

therein or is entitled to appoint fifty percent or more of its directors.

"Affiliate" – a company in which another company - which is not a parent

company thereof - holds twenty-five percent or more of the nominal value of its

issued share capital or of the voting power therein or is entitled to appoint

twenty-five percent or more of its directors;

"Israeli made Goods" - goods made in Israel or in the Area (as such term is

defined under the Statute) by a producer who is an Israeli citizen, or a permanent

resident of Israel, or a body corporate registered in Israel, on condition that the

price of their Israel content constitutes at least 35% of the proposed price, all –

as defined under the Regulations. Goods manufactured outside of the State of

Israel may only be recognized as Israeli-Made Goods at the prior written

approval of ICA and under the terms and conditions as defined under the

Regulations.

"ICA" shall mean The Foreign Investments and Industrial Cooperation

Authority operating in the Ministry of Economy and Industry.

"Industrial Cooperation" shall mean the business activities in Israel as set

forth in section 4 of the Regulation.

"Local Subcontracting" shall mean the execution of contract/s to purchase

Israeli Made Goods (as such term is defined under the Regulations), or to

procure Works or services in Israel (as such term is defined under the

Regulations), all - for the purpose of performing the Supplier's undertakings

under the Contract.

"Regulations" shall mean the Mandatory Bidding Regulations (Mandatory

Industrial Cooperation) of 2007, a curtsey translation to English thereof are

presented in the official website of the ICA.




"Magen" compound

-Tender Forms-

Tender No. 8/2019



[email protected]


For the removal of doubt, in any case of contradiction between the provisions

of the Regulations and the English translation thereof, the provisions of the

Regulations shall govern.

"Statute" shall mean the Mandatory Bidding Law of 1992.

"Work or Services in Israel" - work or services executed in Israel or in the

Area by an Israel citizen or by a permanent resident in Israel, or by a body

corporate registered in Israel.

2. GENERAL

2.1 The Supplier hereby declares, warrants and undertakes towards the State of

Israel (represented for the purposes hereof by the ICA), that subject to the

signing of the Contract, it shall perform and put into practice Industrial

Cooperation in Israel at a scope, nature and timetables as set forth in this

Undertaking and the Implementation Plan (as such term is defined below) and

shall fully comply with all of its undertakings hereunder.

2.2 This Binding Undertaking may further include special terms and conditions as

set forth in Appendix "A" hereof.

3. EXTENT OF THE INDUSTRIAL COOPERATION

The scope of Industrial Cooperation that shall be carried out by the Supplier shall be

at an amount of at least ____ % of the Contract Value ________________ US$

[Contract Value], i.e. a total amount of US$ ______________________ [The scope

of Industrial Cooperation].

The Contract Value for the purposes of calculating the scope of Industrial

Cooperation hereunder shall be adjusted, as required, in any case of a change in the

Contract Value.

4. NATURE OF INDUSTRIAL COOPERATION

4.1 Industrial Cooperation may be conducted by means of Local Subcontracting,

investments, research and development, transfer of know-how or purchase of




"Magen" compound

-Tender Forms-

Tender No. 8/2019



[email protected]


Israeli-Made Goods (as such term is defined above), or Works or services

in Israel (as such term is defined above).

Supplier undertakes to perform Local Subcontracting at a value of no less than

20% of the Contract Value.

4.2 Industrial Cooperation shall not include:

4.2.1 Expenses, including agent’s commission, incurred to promote the sales

of the Supplier in Israel;

4.2.2 The purchase of shares of companies that are subject to the Israeli

Securities Law, 5728 - 1968 ("Securities Law"), at a rate at which the

purchaser does not become an interested party as defined in the

Securities Law; and -

4.2.3 Investments, acquisition and funding of research and development

work that shall be deemed Industrial Cooperation, shall not include

grants given by the Government of Israel as part of an investment

program or funding.

5. PERIOD AND TIMETABLE

5.1 The Supplier's Industrial Cooperation undertakings hereunder shall be fully

executed within the period of the Contract (“Industrial Cooperation Period”).

Without derogating from the above, or from any right or remedy of the ICA

hereunder or at law, in any case this Undertaking shall not be terminated until

full Industrial Cooperation obligations hereunder are fully complied with by

Supplier.

5.2 The Supplier's undertakings for Industrial Cooperation hereunder shall be

fulfilled at a fixed amount every year on a linear basis, unless otherwise

approved by the ICA and included in the Implementation Plan.

6. IMPLEMENTATION PLAN

6.1 A comprehensive detailed implementation plan for the fulfillment of Supplier's

Industrial Cooperation obligations hereunder is Attached as Appendix "B"

("Implementation Plan"). Any change or adjustment of the Implementation

Plan may only be done by the prior written approval of the ICA.




"Magen" compound

-Tender Forms-

Tender No. 8/2019



[email protected]


The Implementation Plan shall apply to the whole period of the Contract.

6.2 Supplier hereby warrants and represents that the Implementation Plan reflects its

good faith estimation of the business opportunities for performance of its

Industrial Cooperation undertakings hereunder in scope and in timetable as

defined hereunder. Such Implementation Plan was established by Supplier after

thorough review and examination and in-depth survey for potential real

investments or other Industrial Cooperation activities in Israel.

6.3 Supplier hereby undertakes that it will continue to invest efforts, using

customary reasonable measures, for exploring and establishing Industrial

Cooperation in Israel in accordance with its undertakings hereunder, including

the use of consultation services, conducting a professional survey in Israel,

visiting business entities in Israel, participating in Israeli industry conferences,

etc., and shall pursue full implementation of the Industrial Cooperation as

described in the Implementation Plan.

6.4 ICA may, at any time, require Supplier to submit clarifications, additions or

modifications to the Implementation Plan, inter alia in order to reflect actual

changes in Supplier's Industrial Cooperation, or in the case of a default or a

potential default by Supplier (and without prejudicing from any right or remedy

of ICA) – in order for Supplier to cure any such default and fully comply with

its undertakings hereunder. Supplier hereby undertakes to comply with all such

requirements by ICA.

6.5 Any industrial cooperation activity to be carried out by the Supplier which is not

part of an approved Implementation Plan will be subject to ICA's prior written

approval in order for it to be credited as Industrial Cooperation.

7. REPORTS

7.1 The Supplier shall submit to the ICA an annual report regarding the fulfillment

of the undertakings for Industrial Cooperation stated in this Undertaking (the

“Progress Report”).

7.2 The Progress Report for each calendar year shall be submitted no later than stMarch 31 of the following calendar year. ICA may, at any time, require the

submission of additional Progress Reports, including in case of a default or a

potential default of the Implementation Plan.

7.3 The Progress Report shall include the following details:




"Magen" compound

-Tender Forms-

Tender No. 8/2019



[email protected]


7.3.1 Performance against anticipated Industrial Cooperation under the

Implementation Plan.

7.3.2 A summary of all the claims for Industrial Cooperation credits in a form

attached as Appendix "C" hereof approved by the Supplier's

independent auditor. For each one of the credit claims the Supplier shall

submit a confirmation of the Israeli supplier signed by an authorized

signatory, at the form included in Appendix "C1".

7.3.3 Any additional information, which may be required by the ICA,

regarding the activities carried out toward the fulfillment of the

Supplier’s undertakings.

7.4 A final report regarding the scope of the Industrial Cooperation and Local

Subcontracting as actually implemented and the nature thereof shall be

submitted by the Supplier, along with the approval of Supplier's auditor to such

report, no later than 30 days after the end of the Industrial Cooperation Period.

8. BREACH BY SUPPLIER

8.1 Breach by Supplier of the provisions of Sections 2.1, 3, 4.2, 5.1, 6.2, 6.3, 7.1 or

7.4 of this Undertaking shall be considered as fundamental breach of this

Undertaking.

8.2 Any other breach by Supplier of this Undertaking, which is not cured within 30

days of ICA's written demand (or an extended cure term as defined by the ICA,

at its sole discretion) shall become a fundamental breach.

9. LIQUDATED DAMAGES

9.1 During the Industrial Cooperation Period, the ICA will determine the following

parameters, as at the end of each calendar year ("Evaluation Date"):

9.1.1 The Supplier’s accumulated obligations for Industrial Cooperation under

this Undertaking from the commencement of the Industrial Cooperation

Period until the Evaluation Date.

9.1.2 The Supplier's accumulated volume of Industrial Cooperation performed

by Supplier and approved by ICA, from commencement of the Industrial

Cooperation Period and until the Evaluation Date.




"Magen" compound

-Tender Forms-

Tender No. 8/2019



[email protected]


9.2 In any case that the balance between section 9.1.1 minus section 9.1.2 above is

positive (“Unfulfilled Obligation”), i.e., at the relevant Evaluation Date, the

Supplier has not fully complied with its Industrial Cooperation undertakings

hereunder, Supplier agrees and undertakes to pay the State of Israel liquidated

damages, at an amount equal to 2% of the Unfulfilled Obligation.

Supplier hereby warrants and confirms that the above liquidated damages

constitutes reasonably estimated damages which will be caused to the State of

Israel in any case of breach of its undertakings hereunder.

9.3 The provisions of this Section 9 above shall not prejudice or derogate from any

right or remedy of ICA hereunder or at law.

10. INDUSTRIAL COOPERATION COORDINATOR

10.1 Supplier shall appoint one person in Israel which will serve as Supplier's liaison

person vis-à-vis ICA. As at the date of signing the Contract, the Industrial

Cooperation Coordinator is:

[Name]

[Address]

[Telephone]

[Fax]

[Email]

10.2 The Industrial Cooperation Coordinator will represent the Supplier for all

purposes hereunder and will serve as the Supplier liaison person also vis-à-vis

Israeli industry and other business entities.

10.3 In case the Industrial Cooperation Coordinator is replaced at any time in the

future, the Supplier is committed to notify the ICA of the identity of the new

Industrial Cooperation Coordinator within 7 days from the time the replacement

took place.

11. LAW AND JURISDICTION

11.1 This Undertaking shall be exclusively governed by and construed in accordance

with the substantive laws of the State of Israel without giving effect to any

choice of law or conflict of law provision or rule.




"Magen" compound

-Tender Forms-

Tender No. 8/2019



[email protected]


11.2 The competent courts of the State of Israel shall have exclusive jurisdiction over

any and all disputed arising from or related to this Undertaking, to exclude the

jurisdiction of any other competent court of any other jurisdiction.

12. MISCELLANEOUS

12.1 The records of ICA pertaining to the execution of the Supplier undertakings

hereunder shall serve as prima facie evidence to the contents thereof.

12.2 Any activity of the Supplier with the Israeli industry carried out prior to being

awarded with the Contract shall not be eligible for crediting purposes.

12.3 This binding Undertaking shall constitute an integral and inseparable part of the

Contract and is hereby signed for the benefit of the State of Israel.

12.4 This Undertaking and Appendices thereof constitute the entire understandings

and undertakings by the Supplier towards the State of Israel and replaces and

supersedes any and all previous agreements or understandings, all of which shall

be null and void.

12.5 Any amendment and/or supplement to this Undertaking shall be in writing,

signed by Supplier and approved by ICA.

IN WITNESS WHEREOF, this Undertaking has been executed by the Supplier, as

of the day and year first hereinabove written.

Signature of an authorized officer on behalf of the foreign supplier (Not the Importer):

Foreign Supplier [Company name]:

____________________________________________________________________

Name:

____________________________________________________________________

Title:

____________________________________________________________________

Signature:

________________________________Date:________________________________




"Magen" compound

-Tender Forms-

Tender No. 8/2019



[email protected]


If the Tender proposal is submitted (and/or the Contract is signed) by an importer, this

undertaking should also be signed by an authorized officer on behalf of the importer:

Importer [Company name]:

_____________________________________________________________________

Name:

_____________________________________________________________________

Title:

_____________________________________________________________________

Signature:

________________________________Date:________________________________




"Magen" compound

-Tender Forms-

Tender No. 8/2019



[email protected]


Appendix B

Implementation Plan

Related to Tender/RFP No. ………………………………

Issued by .....................…………………………………… Dated …………………….

Pursuant to clause 6 of the a.m. document, we [full company name]

…………..…….……..……………………………, hereby submit our detailed

Fulfillment Program, aimed at the satisfaction of our a.m. undertaking, as follows:

1. Our fulfillment activities will be in the fields of one or more of the following

Industrial Cooperation Categories: (*)

Local Subcontracting

Acquisition of Israeli Products, Work or Services

R&D Orders

Investments

Know-How transfer

Other ….…………………………………………………………...……..………

2. Anticipated / Approximate dates of the following mile stones implementation:

a. Conducting an Israeli industry survey …………………….....……………

b. Projects and partners selection …………………..…………………………

c. Starting date of IC activities implementation ...……………………………

d. Full program accomplishment .……………………………………………

3. Following is our prospective Fulfillment Program:




-Tender Forms-

Tender No. 8/2019

Acquisition of Israeli Estimated Products

Local Industrial Timeframe Transaction Israeli entity’s Transaction Subcontractor Names of Israeli Entities

Cooperation Site of Production Value (in Contact Person Description Involved

Category USD/EUR) info. Yes/No

Signature of an authorized officer on behalf of the foreign supplier (Not the Importer):

Name (Supplier): ……………………………… Title: ……….………………..………….

Signature (Supplier): …………………………… Date: ……….………………………..…


Start Due Country City

Date Date

Total Fulfillment Value

Total Local

Subcontracting value



-Tender Forms-

Tender No. 8/2019

Name (Importer): *………………..…..………… Title:*…………………………………

Signature (Importer): *………………………...... Date:*...………………………………

* If the Tender proposal is submitted (and/or the Contract is signed) by an importer, this undertaking should also be signed by an authorized officer on behalf

of the importer.



compound

-Tender Forms-

Tender No. 8/2019

Tender Form L – Municipality’s Advisor’s and


of 66

Tenderer’s No Conflict of Interests Declaration

[Pursuant to Section 24.10 of Volume 1 (Request for Proposals). To be completed by

the Tenderer (or by each Member of a Joint Venture) and by Parent Companies thereof

(as applicable) and by the In-Situ Subcontractor in a separate forms. To be included in

Part 1. Shall be reviewed with the framework of Stage 1.]

To:

The Municipality of Tel-Aviv-Yafo. (the "Company")

Statement and Undertaking regarding No Conflict of Interests

I the undersigned, bearer of __________________ Passport /, I.D. No. __________________,

hereby state and undertake on behalf of __ (name of Tenderer / Member / In-Situ Subcontractor /

Parent Company – the “Company”) as follows:

1. After conducting queries and investigations to the best of my ability, I declare and

undertake the Company is not involved or engaged with any of the entities listed under

Annex A hereafter with respect to the Tender or Project nor does it have any personal,

financial or other interest that may constitute a conflict of interests and/or a concern of a

conflict of interests with the interests of the Municipality or its activities, or create a

concern to such conflict of interests with regard to the aforesaid entities or any other entity.

2. As long as the engagement shall remain valid and in any matter concerning the

engagement also in the event it expires, I state and undertake as follows:

1.1. I shall notify the Municipality promptly in the event I shall hold familial and/or

business relations with any of the Municipality’s employees and/or any other

person that may have any influence on my engagement with the Company in the

framework of Tender No. 8/2019.

2.2. In any event of a concern of a conflict of interests, as specified hereinabove, I shall

immediately notify the Municipality about it and present the reasons for such

concern. Only after receiving the Municipality’s approval, to the extent such shall

be given, I shall be entitled to continue my engagement with the Company in the

framework of Tender No. 8/2019.

2.3. In the event of circumstances that may give rise to a conflict of interests, I shall

notify the Municipality immediately with no delay, provide it the relevant

information in writing and act in accordance with its instructions.


compound

-Tender Forms-

Tender No. 8/2019

3. Not to offer and/or give and/or receive, directly and/or indirectly, any benefit and/or

money and/or anything of value for the purpose of influencing directly and/or indirectly

upon any decision and/or action and/or omission of the Municipality, or any of the

Municipality’s officers and/or employees and/or any one related to such officers and/or

employees and/or anyone acting on the Municipality’s behalf, with respect to the Tender

and/or the process of engaging in a contract in accordance thereto, and/or any

agreement/order deriving there-from.

4. Not to solicit and/or cooperate, directly and/or indirectly, with an officer of the Company

and/or an employee of the Municipality and/or anyone on the Municipality’s behalf and/or

any other person for the purpose of receiving confidential/privileged information in

connection with the Tender and/or the process of engaging in contract in accordance

thereto and/or any agreement/order deriving there-from.

5. Not to solicit and/or cooperate, directly and/or indirectly, with an officer of the

Municipality and/or an employee of the Municipality and/or anyone on the Municipality’s

behalf and/or any other person for the purpose of setting prices artificially and/or in an

uncompetitive and/or unlawful manner.

6. I have not acted in contradiction to the provisions of the aforesaid sections 3 - 5, in the

framework of the Tender procedures and the contracting process of the Municipality

and/or any agreement/order deriving there-from.

7. I confirm that I have no contact or engagement with any of the entities listed under the

attached Annex A (Municipality’s Advisors) with respect to the Tender or Project.

[or; in the event such contact or engagement exists:]

I have existing contact or engagement with the following entity which is listed under the

attached Annex A (Municipality’s Advisors): _________________________________

Details and nature of such contact or engagement: ______________________________

_______________________________________________________________________

______________________________________________________________________

And in witness hereof I hereby affix my signature:

Date: ____________________

Name: ____________________

Signature: ____________________


of 66


compound

-Tender Forms-

Tender No. 8/2019

Annex A to Tender Form K


of 66

7Municipality Advisors

Specialty Name of Advisors

Hebrew English Hebrew English

Simon-Vekslar, Spierer, ,סימון-וקסלר, שפירר Legal Advisors יעוץ משפטי

Maoz מעוז, עורכי-דין

MNS consulting Ltd. מ.נ.ש. יעוץ בע"מ Financial Advisor יעוץ פיננסי

ADAN Technical and אדן טכנולוגיה ויעוץ Technical - יעוץ טכני

Economic Services Ltd. כלכלי בע"מ Advisor - General כללי

Etgar A. Engineering Ltd. - יעוץ טכניאתגר הנדסה וייעוץ Technical Advisor

תכנון בע"מ - Drillings

קידוחים

Uri Orland Risk Management אורי אורלנד – משרד

יועצים לניהול סיכונים Insurance Consultants Ltdביטוח בע''מ

7 As may be supplemented by the Municipality.



compound

-Tender Forms-

Tender No. 8/2019

Tender Form M


of 66

Confirmation of Merging Companies

[Pursuant to Section 7.3.3 of Volume 1 (Request for Proposals). To be completed and signed by the

Tenderer. To be included in Part 1. Shall be reviewed with the framework of Stage 1]

The Tenderer shall attach hereto either:

(a) a confirmation by a lawyer registered in the Israeli Bar Association; or

(b) a formal certificate of the applicable statutory authority under the applicable laws

of its jurisdiction;

testifying to the results of the merger between the Absorbed Company and the Surviving

Company, and confirming that the Absorbed Company has been fully and completely

merged into the Surviving Company, and has ceased to exist after the merger, and the

date of such merger.