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1 Delhi Electricity Regulatory Commission Terms and Conditions for Appointment of CAG Empanelled Auditors for Certification of subsidy disbursed to JJ Cluster Consumers on Account of One Time Settlement Scheme (Bijli Bill Vivad Samadhan Scheme) of GoNCTD 26 th December, 2017 Bid Document No. DERC Fin/JJ Cluster subsidy/2017/001 Important Milestones Notice Inviting Tender : 26/12/2017 Pre-Bid Meeting : 08/01/2018 at 1500 hours Last Date and Time of Submission of Bid Proposals : 16/01/2018 till 1300 hours Opening of Bids : 16/01/2018 at 1500 hours

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Delhi Electricity Regulatory Commission

Terms and Conditions

for

Appointment of CAG Empanelled Auditors for Certification of subsidy disbursed to JJ Cluster Consumers on Account of One Time Settlement

Scheme (Bijli Bill Vivad Samadhan Scheme) of GoNCTD

26th December, 2017

Bid Document No. DERC Fin/JJ Cluster subsidy/2017/001

Important Milestones

Notice Inviting Tender

: 26/12/2017

Pre-Bid Meeting : 08/01/2018 at 1500 hours

Last Date and Time of Submission of Bid Proposals : 16/01/2018 till 1300 hours

Opening of Bids : 16/01/2018 at 1500 hours

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Appointment of CAG Empanelled Auditors for Certification of subsidy disbursed to JJ Cluster Consumers on Account of One Time Settlement Scheme (Bijli Bill Vivad Samadhan Scheme) of GoNCTD

BACKGROUND NOTE

1. GoNCTD had formulated a One Time Settlement Scheme (Bijli Bill Vivad Samadhan Scheme) with an aim to minimize power theft, bring consumers into the billing net, reduce litigation and offer a one time opportunity to the class of consumers of Delhi to settle and pay their enforcement/energy dues. On this line, GoNCTD had issued a Letter No. F11(31/2015/Power/Pt./2552 dated 13/08/2015 in respect of One Time Settlement Scheme which covers direct theft bill settlement, meter tempering bill settlement, misuse/unauthorized use of electricity, scheme for voluntary disclosure of tempered meters, scheme for disconnected consumers, scheme for JJ clusters (Annexure 1). Initially the One Time Settlement Scheme had validity of one month i.e. from 30/08/2015 to 30/09/2015 and which was subsequently extended upto 31/03/2016 (Annexure 2) and then upto 31/05/2016 (Annexure 3) vide Letter No. F.11(31)/2015/Power/ Pt./3880 dated 09/12/2015 and Letter No. F.11(31)/2015/Power/Pt.I/1170 dated 30/03/2016 of GoNCTD respectively.

2. GoNCTD had issued a Letter No. F.11(31)/2015/Power/Pt.II/990 dated 07/04/2017 to DERC to appoint external auditors for verification of the subsidy extended by DISCOMs to JJ Cluster Consumers under One Time Settlement Scheme (Bijli Bill Vivad Samadhan Scheme) for the period from 30/08/2015 to 31/05/2016.(Annexure 4)

3. Delhi Electricity Regulatory Commission, Viniyamak Bhawan, C-Block, Shivalik, Malviya Nagar, New Delhi (hereinafter referred to as “DERC” or “The Commission”) intends to appoint CAG empanelled Auditors (hereinafter referred to as “Consultant”) for Certification of subsidy disbursed to JJ Cluster Consumers on Account of One Time Settlement Scheme (Bijli Bill Vivad Samadhan Scheme) of GoNCTD. The successful bidder shall hereinafter be referred to as "Consultant".

4. The brief about JJ cluster subsidy scheme and main scope of work in certification and reconciliation of subsidy granted to JJ Cluster Consumers on Account of One Time Settlement Scheme (Bijli Bill Vivad Samadhan Scheme) of GoNCTD is enclosed as (Annexure 5). The said list of activities is purely for the purpose of guidance and is not exhaustive.

5. The Consultant is expected to get itself fully aware of applicable laws/Orders and Regulations. An indicative list of applicable laws/ regulations is enclosed as (Annexure 6).

6. The Consultant is also expected to critically examine the eligibility of consumers covered under the scheme with the applicable Orders of GoNCTD and Regulations, directives and policies issued by the Commission.

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7. The consultant shall be required to collect any additional information/data that may be felt necessary for completion of the task from DISCOMs. The Consultant shall depute its officers to the offices of the DISCOMs with Authorization Letter of the Commission.

8. The Consultant shall make presentations to the Commission, for demonstrating the progress and better understanding of the task on fortnightly basis.

General Terms and Conditions 9. No Bidder shall submit more than one Bid for the Assignment. Any Bidder bidding individually

or as a member of a Consortium shall not be entitled to submit another bid either individually or as a member of any other Consortium, as the case may be.

10. The bidder shall submit the duly signed copy of Certificate of Empanelment with CAG for FY 2017-18.

11. No change in consortium shall be permitted after submission of bid.

12. In case the Bidder is a Consortium, then the term Bidder shall include each Member of such Consortium, shall furnish a Power of Attorney in favour of the Lead Member to represent the bidder in the format enclosed as (Annexure 7).

13. A Bidder shall not have conflict of interest (the “Conflict of Interest”) that affects the Bidding Process. Any Bidder found to have Conflict of Interest shall be disqualified.

14. A Bidder shall be deemed to have a Conflict of Interest affecting the Bidding Process, if:

i) The Bidder, its Consortium member or Associate (or any constituent thereof) of any other Bidder, its constituent member or any Associate thereof (or any constituent thereof) have common controlling shareholders or other ownership interest; Provided that this disqualification shall not apply in cases where the direct or indirect shareholding or ownership interest of a Bidder, its Consortium member or an Associate thereof in the other Bidder, is less than 5% (five percent) of the subscribed and paid up equity share capital thereof; Provided further that this disqualification shall not apply to such member for any ownership in a bank, insurance company, pension fund or a public financial institution referred to in sub- section (72) of section 2 of the Companies Act, 2013. For the purposes of this Clause, indirect shareholding held through one or more intermediate persons shall be computed as follows:

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(a) Where any intermediary is controlled by a person through management control or otherwise, the entire shareholding held by such controlled intermediary in any other person (the “Subject Person”) shall be taken into account for computing the shareholding of such controlling person in the Subject Person; and

(b) Subject to sub-clause (a) above, where a person does not exercise control over an intermediary, which has shareholding in the Subject Person, the computation of indirect shareholding of such person in the Subject Person shall be undertaken on a proportionate basis;

Provided that no such shareholding shall be reckoned under this sub-clause (b) if the shareholding of such person in the intermediary is less than 26% of the subscribed and paid up equity shareholding of such intermediary;

or

ii) A constituent of such Bidder is also a constituent of another Bidder; or

iii) Such Bidder, its Consortium member or any Associate thereof receives or has received any direct or indirect subsidy, grant, concessional loan or subordinated debt from any other Bidder, its Member or any Associate thereof; or

iv) Such Bidder has same legal representative for purposes of this Bid as any other Bidder; or

v) Such Bidder, or any Associate thereof, has a relationship with another Bidder, or any Associate thereof, directly or through common third party/parties, that puts either or all of them in a position to have access to each other’s information about, or to influence the Bid of either or each other; or

vi) There is a conflict among this and other consulting assignments of the Bidder (including its personnel and sub-consultants) and any Affiliates. While providing consultancy services to the Commission for this particular assignment, the Bidder shall not take up any assignment that by its nature shall result in conflict with the present assignment.

vii) For purposes of this Bid, Associate in relation to the Bidder shall mean a person who controls, is controlled by, or is under the common control with such Bidder. As used in this definition, the expression "control" means, with respect to a person which is a company or corporation, the ownership, directly or indirectly, of more than 50 percent of the voting shares of such person, and with respect to a person which is not a company or corporation, the power to direct the management and policies of such person by operation of law or by contract.

Single stage two envelope bidding process

15. Bid shall be submitted in a sealed envelope super-scribing on the top of the outer envelope “Appointment of CAG Empanelled Auditors for Certification of subsidy disbursed to JJ Cluster Consumers on Account of One Time Settlement Scheme (Bijli Bill Vivad Samadhan Scheme) of

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GoNCTD ” containing the following two separate sealed inner envelopes, duly super-scribing its contents:

15.1 First Envelope shall contain [Marked as Envelope - 1]

(a) Earnest Money Deposit (EMD) to be submitted as per the details below;

Earnest Money Deposit (EMD) of Rs. 10,000/- (Rupees ten thousand only) through Pay Order/Demand Draft/ in favour of “The Secretary, DERC”, payable at New Delhi,

OR

Pay through RTGS/NEFT/IMPS to the Syndicate Bank and the bank details are stated below:

Bank Account No. 90941010003951

Bank Name and Branch Syndicate Bank, Malviya Nagar, New Delhi - 110017

Type of Account Saving Bank Account

IFSC Code SYNB0009094

MICR Code 110025122

In case the amount remitted towards EMD through bank under RTGS/NEFT/IMPS, bidder shall enclose duly signed copy of bank statement.

(b) The bidder shall submit the duly signed copy of Certificate of Empanelment with CAG for FY 2017-18.

(c) The bidder shall also submit an Affidavit on a stamp paper of Rs.100/- duly signed by authorized signatory as per (Annexure 8)

15.2 Second Envelope shall contain [Marked as Envelope - 2]

a) Proposal Submission Form as per the format (Annexure 9) b) Bidder’s Information as per the format (Annexure 10) c) A Power of Attorney for Authorized Signatory as indicated in Para 17 below. d) In case of consortium, Power of Attorney for Lead Member of Consultant as per the

format (Annexure 7) e) Financial Bid: Bidder shall submit financial bid as per the format of schedule of prices

for the complete scope of work (Annexure 11)

16. The envelope containing EMD, Copy of the CAG Empanelled Certificate and Affidavit shall be opened first. Any bid not accompanied by EMD, CAG Empanelled Certificate and Affidavit, in accordance with the above stipulations, shall be summarily rejected as being non-responsive and Second Envelope shall not be opened and returned to the bidder accordingly. The Second Envelope shall be opened only for those bidders whose EMD, CAG Empanelled Certificate and Affidavit are found to be in order.

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17. The Bidder shall authorize one person as Authorized Signatory through Power of Attorney

duly notarized by the Notary Public on a non judicial stamp paper of Rs. 100/- indicating that the person signing the bid has the authority to sign the bid/execute the contract with the Commission and that the bid/ contract is binding upon the Bidder during the full period of its validity. The Power of Attorney shall be issued by duly authorized Executive of organisation of bidder and shall contain attestation of signature of PoA holder. In the event of any change in the Authorized Signatory during any stage of the bid process/execution, the Bidder shall furnish a fresh Power of Attorney indicating the new Authorized Signatory for the purpose of the assignment, intimating the change, addressed to Secretary, DERC.

18. Each page of the bid shall be numbered and signed by the Authorized Signatory with the seal of the Bidder and the covering letter must indicate the details of the enclosures.

19. The Bidder shall submit the bid in duplicate, comprising one set of the Original Bid and another set marked as Duplicate.

20. Each bidder shall provide the period of validity of the bid to be not less than 180 days from the date of opening of bids.

21. The bid document can either be downloaded from the Commission’s website (http://www.derc.gov.in) or can be obtained from the Commission’s office by submission of a request letter by the CAG empanelled firm addressed to Secretary, DERC.

22. In case, any information/clarification is required in respect of the Bid, the authorized representative(s) of the prospective bidder may visit DERC Office during Pre-Bid meeting or forward their queries before the scheduled date and time of pre-bid meeting, addressed to Secretary, DERC.

23. Bids received after the scheduled date and time of Bid submission shall not be accepted and DERC shall not be responsible for any postal delay.

24. The Bidder shall quote the bid price in the format attached (Annexure 11).

a) The Bid price shall be excluding all taxes and duties and applicable taxes shall be reimbursed by DERC.

b) No TA/DA shall be admissible for any journey in connection with the assignment.

25. In case it is found that the award/appointed Consultant’s performance report are not to the satisfaction of DERC, the DERC reserves the right to re-award the job at the risk and cost of such consultant.

26. EMD of the unsuccessful bidder(s) shall be returned to them within 1 (One) month after award of the work to the successful bidder.

27. EMD of the successful bidder shall be returned within 1 (One) month after submission of the Contract Performance Bank Guarantee.

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28. The Schedule of bid submission and bid opening shall be as under:

Sl. No. Activity Date

1 Notice Inviting Tender 26/12/2017

2 Pre-Bid Meeting with Prospective Bidders 08/01/2018 at 1500 hours

3 Last Date and Time of Receipt of Bid Proposals 16/01/2018 till 1300 hours

4 Opening of Bids 16/01/2018 at 1500 hours

29. No overwriting/cutting shall be allowed in the bid proposal without authorized signature for any correction. Further, no modification in the bid shall be entertained /permitted after the submission of the bid. In case of any mismatch in the financial quotation between quotation in numbers and quotation in words, the quotation in words shall prevail.

30. The Minimum Annual Turnover for the Consultant shall be Rs.20,00,000/- (Twenty Lakh) during each of the last three financial years.

Method of Selection: Cost Based System (CBS)

31. The proposal from qualified bidder with lowest quoted price excluding taxes and duties (after

arithmetical correction, if any) shall be declared as successful bidder. The Successful Bidder shall be intimated by the Commission and the same shall also be uploaded on the website of the Commission.

32. In case of tie in the lowest quoted prices between two bidders, a snap bid shall be called from such bidders for selection of the lowest bidder within 7 days of opening of the price bid and shall be opened in the presence of representatives of such bidders. DERC’s decision in this regard of selection of the lowest bidder shall be the final.

33. Failure to provide all information or in case of concealment of any information, considered

material to award the contract, shall be at bidder’s own risk and may result into rejection of the bid or contract, as the case may be.

34. The successful bidder shall submit an Indemnity Bond on a stamp paper of Rs.100/- duly signed by authorized signatory within 7 working days from the date of letter of award as per the format at (Annexure 12).

35. The successful bidder shall also first submit the Performance Bank Guarantee (Annexure 13) within 7 working days from the date of issue of Letter of Award, and then sign and execute the Contract at the office of the Commission within 7 working days after the date of issue of Letter of Award. The “Performance Bank Guarantee” shall be equal to 10% (Ten Percent) of the value of Contract excluding taxes and duties, which shall be valid up to 3 (Three) months after the completion of the assignment. The consultant may also submit Fixed Deposit in favour of Secretary, DERC in lieu of Performance Bank Guarantee, for the same value and validity as per the requirement of the Letter of Award.

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Non fulfillment of these conditions as at Para 34 and 35 above, would constitute sufficient ground for annulment of the award and forfeiture of Earnest Money Deposit.

36. In the event of termination of contract as above, the Commission reserves the right to award the contract for carrying out the assignment through L2 Bidder and the cost differential shall be borne by the original consultant.

37. The Commission may hold a kick off meeting with the Consultant to discuss the detailed work plan.

38. The Consultant shall hand over the entire records / working papers related to the assignment

to the Commission before the expiry of the contract and shall not utilize or publish or disclose or part with any statistics, data or information collected for the purpose of assignment, in any form, without written consent of the Commission.

39. The bids shall be sent by post so as to be received in DERC upto the scheduled date and time of submission of bids at the following address duly marked:

OR

The Bidder may also submit the bid in the Tender Box available at the reception of DERC Office, upto the scheduled date and time of submission of bids at the following address duly marked.

The Secretary Delhi Electricity Regulatory Commission Viniyamak Bhawan C-Block, Shivalik, Malviya Nagar New Delhi – 110 017 Telefax: 011-26673608 E-mail: [email protected]

40. DERC reserves the right to accept or reject any or all the bids without assigning any reason.

41. The Consultant shall execute and complete the assignment as per the work plan and activity schedule mentioned herein under.

One Team Leader (Qualified Accountant) for over all co-ordination and supervision of the three DISCOMs and at least two team members (semi qualified Accountants) for each DISCOMs are to be deployed for execution.

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Work Plan and Activity Schedule:

Sl. No. Description No. of days from the date of signing of Contract Agreement

1 Submission of Draft Report to the Commission 60

2 Submission of Final Report to the Commission 90

Note: The Consultant shall make presentations to the Commission, for demonstrating the progress and better understanding of the task on fortnightly basis.

Milestones for payment shall be as follows:

Sl. No. Milestone % of contract value

1 Submission of Draft Report to the Commission in line with the duly approved interim reports

70%

2 Submission of Final Report and acceptance by the Commission

30%

42. Consultant shall be paid as follows: a) Total Contract Amount Rs. _________________ (Rupees ________________only)

Note: This total amount shall be taken from Annexure 11 after arithmetical corrections, if any.

b) Reimbursement of applicable taxes and duties based on documentary eveidence.

43. The payment of contract amount to the Consultant shall be processed by the Commission after the deduction of applicable taxes at source.

44. Consultation charges/Contract amount shall be paid to the bidder only for the actual number of JJ Cluster Consumers’ subsidy verified, reconciled with the DISCOMS and submitted to the Commission by the consultant.

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Annexure 1

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Annexure 2

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Annexure 3

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Annexure 4

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Annexure 5

Appointment of CAG Empanelled Auditors for Certification of subsidy disbursed to JJ Cluster Consumers under the One Time Settlement Scheme (Bijli Bill Vivad Samadhan Scheme) of GoNCTD

I Brief about the Scheme for JJ Cluster Consumers and main scope of work:

GoNCTD launched One Time Settlement Scheme (Bijli Bill Vivad Samadhan Scheme) for resolution of

grievances of the public of Delhi for the period from 30/08/2015 to 31/05/2016. Under the

scheme, consultants have to verify the correctness of subsidy disbursed to JJ Cluster Consumers,

by the DISCOMs.

Scheme for JJ Clusters

Details of the schemes are furnished below:

1. The subsidy shall be given to the consumers who are living in JJ cluster areas as per

criteria/notification by Delhi Urban Shelter Improvement Board (DUSIB).

2. A lump sum payment of Rs 250 per month will be charged for the period in which they haven’t

paid dues i.e. from the date of payment of last bill till July, 2015. In disconnected cases,

amount may be charged on similar basis from the date of last payment till date of

disconnection.

3. The late payment surcharge or interest (LPSC), will be fully waived and the dues can be paid in

six monthly installments.

4. If any consumer defaults in making payment of any installment on time, settlement under the

scheme will be treated as withdrawn.

5. The GoNCTD will provide subsidy to the DISCOMs on actual basis equivalent to the amount of

energy charges (excluding LPSC) so waived.

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The DISCOMs have implemented the above scheme and made claims from GoNCTD for

reimbursement of subsidy passed on by the DISCOMs to the JJ Cluster Consumers for the period

from 30/08/2015 to 31/05/2016. The details of the claims submitted by the DISCOMS to the

GoNCTD are as under:

Sl.No Name of the DISCOM

No. of JJ Cluster Consumers (approx.)

1 BRPL 10784

2 BYPL 3135

3 TPDDL 20882

TOTAL 34801

II The list of broad activities of the consultant are stated below:

1. Verification has to be made that all the claims against JJ Cluster Consumers submitted by the DISCOMS are as per the criteria/notification issued by Delhi Urban Shelter Improvement Board (DUSIB).

2. Verify and finalise the eligible subsidy payable/reimbursable to DISCOMS by GoNCTD based on the claims made /submitted by DISCOMS related to JJ Cluster Consumers.

3. Verify, if any JJ Cluster Consumers defaulted in making payment of any installment on time, settlement under the scheme will be treated as withdrawn.

4. Consultant shall prepare a reconciliation statement (As per Annexure 15, 16 & 17) in respect of reimbursement of claims submitted by each DISCOM and eligible subsidy in line with the above and the same shall be duly signed by both consultant and authorized officer of the DISCOM.

5. Contract amount shall be paid to the bidder only for the actual number of JJ Cluster Consumers subsidy verified and reconciled with DISCOMS.

The broad activities stated above are purely for the purpose of guidance and is not exhaustive and the Consultant shall use its own due diligence and DERC shall decide the issues, as and when needed.

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Annexure 6

Appointment of CAG Empanelled Auditors for Certification of subsidy disbursed to JJ Cluster Consumers under the One Time Settlement Scheme (Bijli Bill Vivad Samadhan Scheme) of GoNCTD

Indicative list of Applicable Act, Regulations, Policies, Judgment and Orders etc.

(a) Electricity Act, 2003

(b) DERC (Supply Code and Performance Standards) Regulations, 2007

(c) Applicable Tariff Orders issued by the Commission

(d) Specific regulatory orders issued by the Commission from time to time

(e) GoNCTD letter dated 13/08/2015 (about the scheme) (Annexure 1)

(f) GoNCTD letter dated 09/12/2015 (about extension of One Time Settlement Scheme

upto 31/03/2016) (Annexure 2)

(g) GoNCTD letter dated 30/03/2016 (about extension of One Time Settlement Scheme

upto 31/05/2016) (Annexure 3)

(h) GoNCTD letter dated 07/04/2017 (about special audit) (Annexure 4)

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Annexure 7

POWER OF ATTORNEY FOR LEAD MEMBER OF CONSORTIUM

Appointment of CAG Empanelled Auditors for Certification of subsidy disbursed to JJ Cluster

Consumers under the One Time Settlement Scheme (Bijli Bill Vivad Samadhan Scheme) of GoNCTD

POWER OF ATTORNEY FOR LEAD MEMBER OF CONSORTIUM

Whereas the ………………………………………………………(the “Commission”) has invited bids for the

……………………………………………………Assignment (the “Assignment”).

Whereas, ..……………………………………….., …….……………………………………..and ………………………………….

(collectively the “Consortium”) being Members of the Consortium, are interested in bidding for

the Assignment in accordance with the terms and conditions of the bid document and other

related documents in respect of the Assignment, and

Whereas, it is necessary for the Members of the Consortium to designate one of them as the

Lead Member with all necessary power and authority to do for and on behalf of the

Consortium, all acts, deeds and things as may be necessary in connection with the Consortium’s

bid for the Assignment and its execution.

NOW THEREFORE KNOW ALL MEN BY THESE PRESENTS

We,…………………………………………..having our registered office at …………………………………, and

M/s……………………… having our registered office at …………………………….., …… ,(hereinafter

collectively referred to as the “Principals”) do hereby irrevocably designate, nominate,

constitute, appoint and authorize M/s ………………………………………, having its registered office at

………………………………………….., (being one of the Members of the Consortium), as the Lead

Member and true and lawful attorney of the Consortium (hereinafter referred to as the

“Attorney”) and hereby irrevocably authorize the Attorney for the above referred bid (with

power to sub-delegate):

(i) In the event the Consortium is awarded the Assignment, during the execution of the

Assignment, and in this regard to do on our behalf and on behalf of the Consortium, all

or any of such acts, deeds or things as are necessary or required or incidental to the

submission of its bid for the Assignment, including but not limited to signing and

submission of all applications, documents and writing

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(ii) To pursue all activities for and on behalf of the Consortium and any one of us during the

bidding process

(iii) To accept the Letter of Award, participate in bidder’s and other conferences, respond to

queries, submit information/documents, sign and execute contracts and undertakings

consequent to acceptance of the bid of the Consortium and generally

(iv) To represent the Consortium in all its dealings with the Commission and/ or any other

Government Agency or any person, in all matters in connection with or relating to or

arising out of the Consortium bid for the Assignment and/or upon award thereof till the

Contract is executed with the Commission.

And we on behalf of consortium hereby agree to ratify and confirm all acts, deeds and things

done or caused to be done by our said Attorney pursuant to and in exercise of the powers

conferred by this power of Attorney and that all acts, deeds and things done by our said

Attorney in exercise of the power hereby conferred shall be deemed to have been done by

us/Consortium.

IN WITNESS WHEREOF WE THE ABOVE NAMED PRINCIPALs HAVE EXECUTED THIS POWER OF

ATTORNEY ON THIS…..DAY OF …………….…20….., in the presence of following witnesses:

For……………..

(Signature, Name and Title of Member-1)

For……………..

(Signature, Name and Title of Member-2)

For……………..

(Signature, Name and Title of Member-3) etc

(Executants)

(To be executed by all the members of the Consortium)

------------------------------------------------------------

(Signature of Authoried Signatory of the Lead Member of the Consortium)

Witnesses (Signature, Name and Address) :

1.

2.

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Notes:

The mode of execution of the Power of Attorney should be in accordance with the

procedure, if any, laid down by the applicable law and the charter documents of the

executants(s) and when it is required, the same should be under common seal affixed in

accordance with the required procedure.

Wherever required, the Bidder should submit for verification, the extract of the charter

documents and documents such as a board or shareholders resolution/power of

attorney in favour of the person executing this Power of Attorney for the delegation of

power hereunder on behalf of the Bidder.

Power of Attorney shall be submitted alongwith the bid and duly notarized by a Notary

Public.

(Stamp of member-1) (Stamp of member-2) (Stamp of member-3) With signature With signature With signature

------------------------------- Signature of the Notary

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Annexure 8

AFFIDAVIT

I, ………………………………………………………. Son/Daughter of Shri……………………aged ……..years do

hereby solemnly affirm and declare as follows:

That I am one of the Authorised Signatory …………………………….M/s

………………………………………………………….. having its Registered office at

…………………………………………………………………………………hereinafter referred to as Company/Firm

which expression shall include its successors in interest and permitted assigns.

That I have been duly authorized by the said Company/Firm/Consortium Bidder to affirm this Affidavit for participation in the tender for “Appointment of CAG Empanelled Auditors for Certification of subsidy disbursed to JJ Cluster Consumers on Account of One Time Settlement Scheme (Bijli Bill Vivad Samadhan Scheme) of GoNCTD” and thus competent to do so.

OR

That I am one of the Partner of M/s ……………………………………………. a Partnership Firm having its

Head Office at ………………………………………..… hereinafter referred to as the said Firm which

expression shall include its successors in interest and permitted assigns.

OR

That I am the Sole Proprietor of M/s ………………..………………………………………………. having its office

at …………………………………………………………….

(Use one of the above according to suitability)

I hereby declare on behalf of the Bidder-

That the bidder has read and understood all the terms and conditions mentioned in the bid documents and undertakes to abide by them.

That all the information given by it in connection with its participation in the current

tender is true and correct. That the bidder/consortium member has/have never been blacklisted / debarred from any tender/work in the past by any of the Department(s) / Institution(s) / Autonomous Bodies / Local Bodies / Municipalities / Public Sector Undertakings etc of State/Centre Government.

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That during the last five years the Bank Guarantee(s)/Security Deposit(s) of its Firm/Consortium member(s) have not been encashed due to termination/ non performance of contract.

Date: Place

Authorized Signatory: Name and Title of Signatory:

Name and Address of the Bidder:

Witnesses (Representatives of Separate Firms):

(Signature, Name and Designation with Firm Name)

1.

2.

3.

Note: This form shall be submitted in a stamp paper of Rs.100/- duly signed by the

authorized signatory of bidder/consortium.

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Annexure 9

PROPOSAL SUBMISSION FORM To

The Secretary Delhi Electricity Regulatory Commission Viniyamak Bhawan,C-Block, Shivalik, Malviya Nagar, New Delhi – 110 017

Subject: Appointment of CAG Empanelled Auditors for Certification of subsidy disbursed to JJ Cluster Consumers under the One Time Settlement Scheme (Bijli Bill Vivad Samadhan Scheme) of GoNCTD

Ref.: Bid Document No. DERC Fin/JJ Cluster Subsidy/2017/001 dated 26/12/2017

Sir/Madam,

We, the undersigned, offer to provide the services for undertaking the assignments relating to ____________________in accordance with your bid document No. DERC Fin/JJ Cluster subsidy/2017/001 dated 26/12/2017.

We are hereby submitting our proposal for undertaking the assignment in one Original and one copy (marked as “Original” and “Copy no.-1” respectively), in the prescribed formats, which includes the Financial Proposal submitted in the Second Envelope. Each page of the proposal has been numbered and signed by the Authorized Signatory.

A Power of Attorney duly notarized by the Notary Public, indicating that the person(s) signing the bid has the authority to sign the bid and that the bid is binding upon the Bidder during the full period of its validity is enclosed.

It is also confirmed that presently we are not handling any assignment that would be in conflict with this assignment or place us in a position of not being able to carry out this assignment timely, objectively and impartially.

It is confirmed that the bid shall remain valid for 180 days from the date of bid opening.

Demand drafts/pay orders no. _______________dated __________for Rs. 10,000/- (Rupees ten thousand only) as EMD, in favour of Secretary, DERC payable at New Delhi is enclosed herewith OR for payment through RTGS/NEFT with copy of the duly signed bank statement is enclosed.

We understand that DERC is not bound to accept any Proposal, as received from us.

Yours sincerely,

Authorized Signatory: Name and Title of Signatory: Name of the Bidder/Consortium: Encl. As above

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Annexure 10

BIDDER’S INFORMATION IN BRIEF

Appointment of CAG Empanelled Auditors for Certification of subsidy disbursed to JJ Cluster Consumers under the One Time Settlement Scheme (Bijli Bill Vivad Samadhan Scheme) of GoNCTD

Bidder’s Information

Sl. No. Particular Details

1 Name of the bidder

2 Single Firm/Consortium, details to be provided (copy to be attached)

3 Bidder Registration No. (copy to be attached)

4 Pan No. (copy to be attached)

5 GST Registration No. (copy to be attached)

6 Address of the Bidder (Head Office/Registered Office)

7 Phone No. and Email ID

8 Year of Establishment of the Bidder

9 No. of Partners

10 Name of Partners and Membership No.

11 No. of Regular Employees

12 Copy of the latest (2017-18)CAG Empanelment Certificate

13

Annual Audited Turnover of the Firm

Year (2014-15)/___ Year (2015-16)/____ Year (2016-17)/___ (Copy of

Audited

Accounts

Enclosed)

Yearly Turnover (Rs Lakhs)

Total Turnover (Rs Lakhs)

Average Turnover (Rs lakhs)

14 Name of Team Leader (Qualified Accountant) and Team Members (Semi Qualified Accountants) responsible for this assignment * (with academic qualification and experience):

[In case of consortium separate BIDDER’S INFORMATION IN BRIEF for each members of consortium

is to be submitted]

Particulars, Name, Organisation, Phone No.

Educational

Qualification

Experience Details

Team Leader

Team Member

Team Member

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15 Brief title of some assignments executed relevant for the current tender

16 Any other information

Name and Signature of the Authorized Person (of each consortium Member, if applicable)

(Stamp)

Date: Place:

* One Team Leader (Qualified Accountant) for over all co-ordination and supervision of the

three DISCOMs and at least two team members (semi qualified Accountants) for each DISCOMs are to be deployed for execution.

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Annexure 11

(SCHEDULE OF PRICES (Consultancy Charge) FOR THE COMPLETE SCOPE OF WORK)

Appointment of CAG Empanelled Auditors for Certification of subsidy disbursed to JJ Cluster Consumers under the One Time Settlement Scheme (Bijli Bill Vivad Samadhan Scheme) of GoNCTD

All Prices are in Indian Rupees

Sl. No. Price Components Qty. Unit Price Total Price

Nos. Rs Rs

1 2 3 4 5 = (3x4)

1 Consultancy Charges for Certification and reconciliation of disbursed subsidy to JJ Cluster Consumers on Account of One Time Settlement Scheme (Bijli Bill Vivad Samadhan Scheme) of GoNCTD for the Complete Scope of the work.

i) BRPL 10784

ii) BYPL 3135

iii) TPDDL 20882 ______ Total - 34801

34801

2 Total Amount 34801

3 Total amount in word: (Rupees …………………………………………. only)

4 Taxes and Duties ………………………. (Rupees ………………………………………)

NOTE a) The Bid price shall be excluding applicable taxes and duties and applicable taxes shall be

reimbursed by DERC, based on documentary evidence. b) The payment to the Consultant shall be processed by the Commission after the

deduction of applicable taxes at source. c) No TA/DA shall be admissible for any journey in connection with the assignment. d) Arithmetical corrections: In case of amounts in Nos and in words, the amount in words

shall prevail. e) Consultation charges shall be released to the consultant only for the actual number of JJ

Cluster Consumers subsidy verified and submitted to the Commission after reconcilation with DISCOMS.

Date: Place

Authorized Signatory: Name and Title of Signatory:

Name and Address of the Bidder:

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Annexure 12

INDEMNITY BOND

Appointment of CAG Empanelled Auditors for Certification of subsidy disbursed to JJ Cluster Consumers under the One Time Settlement Scheme (Bijli Bill Vivad Samadhan Scheme) of GoNCTD

- The Contractor hereby indemnifies DERC from:

(a) Any third party claims, civil or criminal complaints /liabilities, site mishaps, fire hazards and other accidents including death of any person(s) or dispute and /or damages occurring, or arising out of any mishaps at site due any fault or negligence of the contractor or any of its employees or other persons engaged/associated with the job or otherwise.

(b) All claims, demands, actions, proceedings, losses, damages, liabilities, cost, charges, expenses or obligations which occur or generate as a result of nonpayment of any statutory dues levies/Taxes e.g. leviable on the Contractor

OR, the Contractor committing breach of any of the rules, regulations, orders, directives, instructions that may be issued by any authority under the Central Government/State Govt. or any statute or laws in force.

(c) Any damages, losses, injury, death or expenses due to or resulting from any negligence or breach of duty on its part or on the part of any of its employee(s)/ representative(s).

Date: Place:

Authorized Signatory: Name and Title of Signatory:

Name and Address of the Bidder:

Note: This form shall be submitted in a stamp paper of Rs.100/- duly signed by the authorized signatory of bidder/consortium.

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Annexure 13

BANK GUARANTEE FOR PERFORMANCE SECURITY (To be stamped in accordance with Stamp Act)

Ref……………………… Bank Guarantee No.………….

Date …………………….............

To Delhi Electricity Regulatory Commission Viniyamak Bhavan C Block, Shivalik Malviya Nagar New Delhi - 110017

Dear Sir,

In consideration of the DERC (hereinafter referred to as the ‘Commission’, which expression shall unless repugnant to the context or meaning thereof include its successors, administrators and assigns) having awarded to M/s _____________________ (Consultant Name) with its Registered/Head Office at __________________ (hereinafter referred to as the consultant, which expression shall unless repugnant to the context or meaning thereof, include its successors, administrators, executors and assigns), a Contract, by issue of Commission’s Letter of Award No.__________________________ dated __________ and the same having been unequivocally accepted by the Consultant, resulting into a Contract valued at Rs. _________ (excluding taxes) for Appointment of CAG Empanelled Auditors for Certification of disbursed subsidy to JJ Cluster Consumers under the One Time Settlement Scheme (Bijli Bill Vivad Samadhan Scheme) of GoNCTD (Scope of Contract) and the Consultant having agreed to provide a Contract Performance Guarantee for the faithful performance of the entire Contract equivalent to 10% (ten percent) of the said value of the Contract to the Commission.

We___________________________(Name and Address of the Bank), having its Head Office at ___________________ (hereinafter referred to as the ‘Bank’, which expression shall, unless repugnant to the context or meaning thereof, include its successors, administrators, executors and assigns) do hereby guarantee and undertake to pay the Commission, on demand any and all monies payable by the Consultant to the extent of _________________ as aforesaid at any time upto _____@(days/month/year)________ without any demur, reservation, contest, recourse or protest and/or without any reference to the Consultant. Any such demand made by the Commission on the Bank shall be conclusive and binding notwithstanding any difference in claims between the Commission and the Consultant or any dispute pending before any Court, Tribunal, Arbitrator or any other authority. The Bank undertakes not to revoke this guarantee during its currency without previous consent of the Commission and further agrees that the guarantee herein contained shall continue to be enforceable till the Commission discharges this guarantee.

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The Commission shall have the fullest liberty without affecting in any way the liability of the Bank under this guarantee from time to time to extend the time for performance of the Contract by the Consultant. The Commission shall have the fullest liberty, without affecting this guarantee, to postpone from time to time the exercise of any powers vested in them or of any right which they might have against the Consultant and to exercise the same at any time in any manner, and either to enforce or to forbear to enforce any covenants, contained or implied, in the Contract between the Commission and the Consultant or any other course or remedy or security available to the Commission. The Bank shall not be relived of its obligations under these presents by any exercise by the Commission of its liberty with reference to the matters aforesaid or any of them or by reason of any other act or forbearance or other acts of omission or commission on the part of the Commission or any other indulgence shown by the Commission or by any other matters or thing whatsoever which under law would, but for this provision, have the effect of relieving the Bank.

The Bank also agrees that the Commission at its option shall be entitled to enforce this Guarantee against the Bank as a principal debtor, in the first instance without proceeding against the Consultant and notwithstanding any security or other guarantee that the Commission may have in relation to the Consultant’s liabilities. Notwithstanding anything contained hereinabove our liability under this guarantee is restricted to________* _______ and it shall remain in force upto ___(days/month/year)_____ and shall be extended from time to time for such period (not exceeding one year), as may be desired by M/s___________________ (Consultant Name) on whose behalf this guarantee has been given.

In witness whereof the Bank, through its authorized Officer, has set its hand and stamp on this ______ day of ___________201_____ at ____________.

Witness:

(Signature) (Signature) (Name) (Name) (Official Address) (Designation with Bank stamp) (Attorney as per Power of Attorney) No. _____________ Dated_________

Note: 1. * This sum shall be ten percent (10%) of the Contract Price excluding Taxes and Duties. @ The date will be 3 (three) months beyond the completion date of the assignment.

2. The Stamp Paper of appropriate value shall be purchased in the name of guarantee issuing Bank or the Party on whose behalf the BG is being issued. The Bank Guarantee shall be issued on a stamp paper or value as application in the State in India from where BG is issued or NCT of Delhi, whichever is higher.

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Annexure 14

(Contract Agreement to be signed by Consultant with DERC)

This ARTICLES OF CONTRACT made on this ……… day of …………2017

BETWEEN:

Delhi Electricity Regulatory Commission a statutory Body set up by the Government of NCT of Delhi under the Delhi Electricity Reforms Act, 2000 and having its office at Viniyamak Bhawan, C-Block, Shivalik, Near Malviya Nagar, New Delhi – 110 017, hereinafter referred to as the “Commission’) (which expression shall unless excluded by or repugnant to the context or meaning thereof, includes its successors and permitted assigns) of the FIRST PART

AND

_________________________________Company registered under the Companies Act, 1956 and having its office at, _________________________________ consortium lead member, representing (1)________________, (2) ________________, (3) ________________ hereinafter referred to as the Consultant (which expression shall unless excluded or repugnant to the context or meaning thereof include its successors and permitted assigns) of the SECOND PART.

(The Commission and the Consultant are individually referred to as the “Party” and collectively as the “parties”).

WHEREAS the Commission has awarded the contract termed as Appointment of CAG Empanelled Auditors for Certification of subsidy disbursed to JJ Cluster Consumers on Account of One Time Settlement Scheme (Bijli Bill Vivad Samadhan Scheme) of GoNCTD, on the basis of open tender process to the party of the SECOND PART as a Consultant for appointment of CAG Empanelled Auditors for Certification of disbursed subsidy to JJ Cluster Consumers on Account of One Time Settlement Scheme (Bijli Bill Vivad Samadhan Scheme) of GoNCTD, more precisely explained in the ‘Terms of Conditions contained in the bid document No. DERC Fin/JJ Cluster subsidy/2017/001 dated 26/12/2017”.

AND M/s ______________________________have agreed to provide services to the Commission on the terms and conditions stated herein as under: NOW the Parties to these Present hereby agree as follows: 1. M/s___________________ (as a lead member of a consortium, if applicable) is hereby

appointed as the Consultant for the afore-mentioned assignment. The Consultant shall commence the assignment from zero date i.e., date of signing this contract agreement.

2. The Consultant shall execute and complete the assignment as per the work plan and activity schedule mentioned herein.

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One Team Leader (Qualified Accountant) for over all co-ordination and supervision of the three DISCOMs and at least two team members (semi qualified Accountants) for each DISCOMs are to be deployed for execution.

WORK PLAN AND ACTIVITY SCHEDULE:

Sl. No. Description No. of days from the date of signing of Contract Agreement

1 Submission of Draft Report to Commission 60

2 Submission of Final Report to the Commission 90

Note: The Consultant shall make presentations to the Commission, for demonstrating the progress and better understanding of the task on fortnightly basis.

Scope of Work:

3. The activities to be carried out shall be as per the detailed indicative list given under (Annexure 5) of the Bid document.

4. The Scope of Work shall be primarily governed by the Act, Regulations, Policies, Orders, Judgments etc. broadly indicated in (Annexure 6) of the Bid document and any or all instructions issued by Commission from time to time.

5. Any other services connected with the works rendered by the Consultant, but not referred to herein above.

6. The Consultant shall assume full responsibility for proper execution of works covered under the scope of contract. The work shall be executed with due diligence in a professional manner and with true sincerity.

Other Issues: 7. The consultant shall submit an Indemnity Bond on a stamp paper of Rs. 100/- duly signed by

authorized signatory as per the format at (Annexure 12)

8. The description of scope of work (as in Annexure 5) is purely indicative and not exhaustive. Changes/additions can be made by DERC as and when required for better understanding of the task, and also based on the feedback of the Consultant from time to time to enhance the quality of the audit, without changing its basic nature.

9. The Consultant agrees and undertakes that the respective tasks shall be performed and

completed only by the authorized personnel and that if any change in the composition of the team is necessitated, the consultant (SECOND PARTY) shall seek prior permission of the Commission to effect the changes.

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10. Consultant shall be paid as follows:

(a) Total Consultation charges/contract amount Rs. ________________________ Rupees ______________only) (A schedule of price is to be submitted separately as per Annexure 11) and as per the letter of award issued by Commission to the Consultant.

(b) Reimbursement of applicable taxes and duties Rs. _______ (Rupees__________only)

(c) The payment of Consultation charges/Contract amount to Consultant shall be processed by the Commission after the deduction of applicable taxes at source.

(d) Consultation charges/Contract amount shall be made to the bidder only for the actual number of JJ Cluster Consumers subsidy verified and submitted to the commission duly reconciled with DISCOMS by the bidder

Milestones for payment shall be as follows:

Sl. No.

Milestone % of contract

value

A. Submission of Draft Report to the Commission 70%

B Submission of Final Report and acceptance by the Commission

30%

(e) The payment of contract amount to Consultant shall be made by the Commission after

the deduction of applicable taxes at source.

(f) The Consultant has already submitted/hereby provides a performance security by way of Bank Guarantee acceptable to the Commission (Annexure 13) from a Nationalised Bank/ Scheduled Bank for an amount equal to 10% (Ten Percent) of the total contract value which shall be valid upto a period of 3 (three) months beyond the completion date. The said Bank Guarantee shall be extended suitably in case of extension of period of contract. The Consultant may also submit Fixed Deposit in favour of Secretary, DERC in lieu of Bank guarantee for the same value and validity as per the requirement of the Letter of Award.

(g) The Commission shall be entitled to evaluate the interim reports submitted by the Consultant in stages and the Consultant shall incorporate / restructure the report and finding as per the recommendations of the Commission within such reasonable time as may be prescribed by the Commission.

(h) The Commission shall make payments to the Consultant within 30 days of the date of receipt of Invoice for the individual milestone completion in all respects, in the Commission’s office subject to acceptance of deliverables wherever required unless prevented by reasons beyond its control duly notified to the consultant and in the later case, the Consultant shall not be entitled to claim any interest or damages on account of such delay.

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(i) The Consultant shall be liable to the Commission for the performance of its obligations in this Contract as a result of any default of the Consultant except the following limitations:

I. The Consultant shall not be liable for any damage or injury caused by or arising out of the act, omission, neglect or default of any person other than the Consultant.

II. The Consultant shall not be liable for any loss or damage caused by or arising out of circumstances over which the Consultant has no control.

III. The total liability of the Consultant under this clause shall be limited to 10% of the charges mentioned in Clause 10 (a) except for gross negligence or any damage on account of the Consultant, for which the Consultant shall be fully liable.

IV. It is mutually agreed between the parties that the time shall be the essence of this CONTRACT. The Consultant, (the party of the second part) shall adhere to the time schedule as prescribed in this CONTRACT and complete the work within the stipulated time frame, failing which the party of the second part would be liable for a penalty which may go upto Rs. 5000/- per day, subject to a maximum of 10% of entire value of contract, for each day of delay beyond the time stipulated in this CONTRACT, provided that each day of delay beyond time schedule is attributable solely to the CONSULTANT. The Commission’s decision in this matter shall be binding on all parties.

(j) No TA/DA shall be admissible for any journey in connection with the assignment.

(k) The Commission reserves the right to amend, foreclose, terminate or cancel the engagement of the Consultant without assigning any reasons. In such cases Consultant shall be paid consultation charges after taking into consideration the part of work completed prior to such foreclosure, termination or cancellation of the engagement as may be decided by the Commission, and the decision of the Commission shall be conclusive and binding. The consultation charges so fixed and paid shall be deemed to be the final payment in all such cases.

(l) Any information of confidential nature, which may be so marked by the Commission, which comes to the knowledge or in the possession of the Consultant or of any of its employees by virtue of their engagement on the subject matter of this contract; shall not be disclosed by the Consultant or employees or any of the audit team member to any unauthorized person in any manner. Any breach of this clause without prejudice to any other action that may be initiated as per law, shall also subject the Consultant to a liability to pay to the Commission such compensation for damages as may be decided by the Commission keeping in view the nature, manner and motive of the information disclosed and the extent of the damage caused by such unauthorized disclosure:

Provided that any information that was (a) rightfully already known to Consultant at the time of its disclosure, (b) independently developed by Consultant without referring to

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the Commission’s confidential information, (c) known to the public through a source other than Consultant, or (d) disclosed to Consultant by a third party not having an obligation of non disclosure to the proprietor of the information, shall not be deemed to be such confidential information for the purposes of this contract;

Provided further that the obligation of confidentiality on Consultant shall not apply where such confidential information is required to be disclosed under any law.

(m) The Consultant undertakes that they are not handling any assignment that would be in conflict with this assignment or place them in a position of not being able to carry out this assignment objectively and impartially.

(n) In case the Consultant fails to fulfill its obligations, the Commission would be entitled to invoke the Performance Bank Guarantee furnished by the Consultant and the amount mentioned in the Performance Bank Guarantee shall stand forfeited.

(o) In respect of any matter for which no provision has been made in this contract, the provisions contained in the Delhi Electricity Regulatory Commission (Appointment of Consultants) Regulations, 2001, shall apply.

(p) In case of any differences or disputes between the parties arising out of this CONTRACT, the matter shall be referred to the sole arbitrator nominated by the Commission, in accordance with the provisions of the Arbitration and Conciliation Act, 1996 and decision of the Commission shall be final and binding on the consultant.

IN WITNESS WHEREOF the Authorised Signatory on behalf of the Consultant and Secretary on behalf of the Commission have hereto put their signature on the day and the year first above written. ( ) ( ) Authorised Signatory Secretary Consultant DERC Stamp Stamp Witnesses: 1. 2.

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Annexure 15

Statement of reconciliation of the subsidy disbursed to JJ Cluster Consumers DISCOM: BRPL

Appointment of CAG Empanelled Auditors for Certification of subsidy disbursed to JJ Cluster Consumers under the One Time Settlement Scheme (Bijli Bill Vivad Samadhan Scheme) of GoNCTD

As per DISCOM As verified by Consultant

Sl.

No.

No. of JJ Cluster

Consumers

Amount of subsidy

disbursed

(Rs.)

No. of Eligible JJ

Cluster Consumers for subsidy disbursed

Amount of subsidy

reimbursable to DISCOM

(Rs.)

Difference Remarks

No. of not eligible

Consumer for

subsidy (2-4)

Amount between column

(3-5)

1 2 3 4 5 6 7 8

1 10784

Encl: Consumer wise details of subsidy reconciled

Authorized Signatory Name and Title of Signatory

Authorized Signatory Name and Title of Signatory

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Annexure 16

Statement of reconciliation of the subsidy disbursed to JJ Cluster Consumers DISCOM: BYPL

Appointment of CAG Empanelled Auditors for Certification of subsidy disbursed to JJ Cluster Consumers under the One Time Settlement Scheme (Bijli Bill Vivad Samadhan Scheme) of GoNCTD

As per DISCOM As verified by Consultant

Sl.

No.

No. of JJ Cluster

Consumers

Amount of subsidy

disbursed

(Rs.)

No. of Eligible JJ

Cluster Consumers for subsidy disbursed

Amount of subsidy

reimbursable to DISCOM

(Rs.)

Difference Remarks

No. of not eligible

Consumer for

subsidy (2-4)

Amount between column

(3-5)

1 2 3 4 5 6 7 8

1 3135

Encl: Consumer wise details of subsidy reconciled

Authorized Signatory Name and Title of Signatory

Authorized Signatory Name and Title of Signatory

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Annexure 17

Statement of reconciliation of the subsidy disbursed to JJ Cluster Consumers DISCOM: TPDDL

Appointment of CAG Empanelled Auditors for Certification of subsidy disbursed to JJ Cluster Consumers under the One Time Settlement Scheme (Bijli Bill Vivad Samadhan Scheme) of GoNCTD

As per DISCOM As verified by Consultant

Sl.

No.

No. of JJ Cluster

Consumers

Amount of subsidy

disbursed

(Rs.)

No. of Eligible JJ

Cluster Consumers for subsidy disbursed

Amount of subsidy

reimbursable to DISCOM

(Rs.)

Difference Remarks

No. of not eligible

Consumer for

subsidy (2-4)

Amount between column

(3-5)

1 2 3 4 5 6 7 8

1 20882

Encl: Consumer wise details of subsidy reconciled

Authorized Signatory Name and Title of Signatory

Authorized Signatory Name and Title of Signatory