Form CON 3. – Environmental, Social, Health, and Safety Performance Declaration [This form should be used only if the information submitted at the time of initial selection requires updating. The following table shall be filled in for the Proposer and for JVs, each member of the Joint Venture and each Specialized Subcontractor] Proposer’s Name: [insert full name] Date: [insert day, month, year] Joint Venture Member’s or Specialized Subcontractor’s Name: [insert full name] RFP No. and title: [insert RFP number and title] Page of pages [insert page number] [insert total number] Environmental, Social, Health, and Safety Performance Declaration in accordance with Section III, Qualification Criteria, and Requirements of the Initial Selection document No suspension or termination of contract: An employer has not suspended or terminated a contract and/or called the performance security for a contract for reasons related to Environmental, Social, Health, or Safety (ESHS) performance the date specified in Section III, Qualification Criteria, and Requirements, Sub-Factor 2.5. Declaration of suspension or termination of contract: The following contract(s) has/have been suspended or terminated and/or Performance Security called by an employer(s) for reasons related to Environmental, Social, Health, or Safety (ESHS) performance since the date specified in Section III, Qualification Criteria, and Requirements, Sub-Factor 2.5. Details are described below: Year Suspended Contract Identification Total Contract or Amount (current terminated value, currency, portion of exchange rate contract and US$ equivalent) Contract Identification: [insert [insert amount [indicate complete [insert amount] year] and contract name/ number, and any other percentage] identification]
Form CON – 3. Environmental, Social, Health, and Safety Performance Declaration [This form should be used only if the information submitted at the time of initial selection requires updating. The following table shall be filled in for the Proposer and for JVs, each member of the Joint Venture and each Specialized Subcontractor] Proposer’s Name: [insert full name] Date: [insert day, month, year] Joint Venture Member’s or Specialized Subcontractor’s Name: [insert full name] RFP No. and title: [insert RFP number and title] Page [insert page number] of [insert total number] pages Environmental, Social, Health, and Safety Performance Declaration in accordance with Section III, Qualification Criteria, and Requirements of the Initial Selection document No suspension or termination of contract: An employer has not suspended or terminated a contract and/or called the performance security for a contract for reasons related to Environmental, Social, Health, or Safety (ESHS) performance the date specified in Section III, Qualification Criteria, and Requirements, Sub-Factor 2.5. Declaration of suspension or termination of contract: The following contract(s) has/have been suspended or terminated and/or Performance Security called by an employer(s) for reasons related to Environmental, Social, Health, or Safety (ESHS) performance since the date specified in Section III, Qualification Criteria, and Requirements, Sub-Factor 2.5. Details are described below: Year Suspended or terminated portion of contract Contract Identification Total Contract Amount (current value, currency, exchange rate and US$ equivalent) [insert year] [insert amount and percentage] Contract Identification: [indicate complete contract name/ number, and any other identification] [insert amount]
SPD-Request-for-Proposal-DesignBuildOperate-WTP-WWTP-OCT-2017.docx