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General information/030;L=0 V=D>@<0FVO:>Section 2. Information about Managers/=D>@<0FVO ?@> 48@5:FVN:Name, position, passport number, tax identification number of line manager/<'O, ?>A040, =><5@ ?0A?>@B0 B0  2V4?>2V40;L=>3> <5=5465@0Name, position, passport number, tax identification number of chief accountant/<'O, ?>A040, =><5@ ?0A?>@B0 B0  3>;>2=>3> 1CE30;B5@0Name, position, passport number, tax identification number of the person authorized to sign/<'O, ?>A040, =><5@ ?0A?>@B0 B0  02B>@87>20=>W >A>18 4;O ?V4?8ACInformation about shareholders (please state your major shareholders)/=D>@<0FVO ?@> 0:FV>=5@V2 (1C4L-;0A:0, 2:06VBL 3>;>2=8E 0:FV>=5@V2) 4Section 3. Contact information/>=B0:B=0 V=D>@<0FVO:Legal address/.@848G=0 04@5A0Postal address/$0:B8G=0 04@5A0 Phone/"5;Fax/$0:AE-mail/;.04@5A0Internet site/=B5@=5B A09BEurasia Foundation has the right to verify all the information specified in Table 1./$>=4 2@07VO <0T ?@02> ?5@52V@OB8 2AN V=D>@<0FVN, 7070=0G5=C 2 B01;8FV 1.>A040V4?8A <'O/@8728I5Question/8B0==OAnswer/V4?>2V4L7Section 1. Licenses, sertificates/VF5=7VW, A5@B8DV:0B8Question/8B0==O Notes:  SignatureEurasia Foundation has the right to verify all the information specified in Table 2./$>=4 2@07VO <0T ?@02> ?5@52V@OB8 2AN V=D>@<0FVN, 7070=0G5=C 2 B01;8FV 2.Eurasia Foundation has the right to verify all the information specified in Table 3./$>=4 2@07VO <0T ?@02> ?5@52V@OB8 2AN V=D>@<0FVN, 7070=0G5=C 2 B01;8FV 3. <'O/@V728I5vSection 2. Experience in the activity, which is the subject of the tender/>A2V4 4VO;L=>ABV, O:0 T ?@54<5B>< B5=45@C::lThe total period of work on the Ukrainian market, years/030;L=89 ?5@V>4 @>1>B8 =0 C:@0W=AL:><C @8=:C, @>:V2JThe total number of contracts, units./030;L=5 G8A;> :>=B@0:BV2, :V;L:VABLIThe total amount of contract dollars/030;L=0 AC<0 :>=B@0:BV2, 4>;0@8 !(7Section 3. Additional information/>40B:>20 V=D>@<0FVO:)The main activity/A=>2=89 284 4VO;L=>ABVYA brief description of the infrastructure of the company/>@>B:89 >?8A AB@C:BC@8 :><?0=VW_Annual turnover (last financial year), USD/ VG=89 >1>@>B (>AB0==V9 DV=0=A>289 @V:), 4>;0@V2 !(YNumber of employees employed by the company/V;L:VABL @>1VB=8:V2, O:V ?@0FNNBL 2 :><?0=VWNumber of employees who are qualified for high-quality order execution/V;L:VABL ?@0FV2=8:V2, O:V :20;VDV:>20=V 4;O 28:>=0==O 28A>:>O:VA=>3> 70<>2;5==OIAn employee, who provided information/!?V2@>1VB=8:, O:89 =0402 V=D>@<0FVNjThe presence of unfulfilled orders from judicial authority/0O2=VABL =528:>=0=8E =0:07V2 2V4 AC4>2>W 2;048iFinding a property under arrest or in the tax lien/5@51C20==O <09=0 ?V4 0@5HB>< 01> 2 ?>40B:>2V9 70AB02VFinding a company under the liquidation, reorganization or bankruptcy proceedings /><?0=VO 7=0E>48BAO C ?@>F5AV ;V:2V40FVW, @5>@30=V70FVW 01> :>=:C@A=>3> 28@>1=8FB20The presence of criminal cases and convictions unwithdrawn against leaders/0O2=VABL =57=OB8E :@8<V=0;L=8E A?@02 V 28@>:V2 ?@>B8 :5@V2=8FB20n(by type of activity that are the subject of the RFP)(70 2840<8 4VO;L=>ABV, O:V T ?@54<5B>< 70?8BC ?@>?>78FV9)Name of Client/0720 :;VT=B0Subject/@54<5BAmount, USD/!C<0Period of validity/5@V>4Contact person/>=B0:B=0 >A>10(Contact phone/><5@ :>=B0:B=>3> B5;5D>=CBData for inmates / performance of the contract/0=V I>4> :>=B@0:BC'Appendix A - Bidder s Information Form 7Information about Bidder/=D>@<0FVO ?@> CG0A=8:0 B>@3V2rBidder guarantees the accuracy of the data presented./#G0A=8: =5A5 2V4?>2V40;L=VABL 70 4>AB>2V@=VABL =040=8E 40=8EDList of main clients of the Bidder/!?8A>: >A=>2=8E :;VT=BV2 CG0A=8:08Qualification< s of Bidder's company/20;VDV:0FVO :><?0=VWPresense of license reflecting certain type of economic activity, which is the subject of the RFP (if such activities are subject to licensing in accordance with the laws of Ukraine), copies should be attached/0O2=VABL ;VF5=7V9, O:V 2V4>1@060NBL ?52=89 284 4VO;L=>ABV, O:0 T ?@54<5B>< 70?8BC ?@>?>78FV9 (O:I> B0:0 4VO;L=VABL ?V4;O30T ;VF5=7C20==N 2V4?>2V4=> 4> 70:>=>402AB20 #:@0W=8), :>?VW ?>28==V 1CB8 4>40=VCertificates required to perform work in the competitive project, copies should be attached/!5@B8DV:0B8, =5>1EV4=V 4;O 28:>=0==O @>1VB 2 :>=:C@A=><C ?@>5:BC, :>?VW ?>28==V 1CB8 4>40=VOPeriod of work on this kind of activity, years/5@V>4 @>1>B8 70 FVTN 4VO;L=VABNSection 4. The absence of complaints from the public authorities (No / Yes, if "Yes" - provide details)/V4ACB=VABL A:0@3 7 1>:C 45@602=8E >@30=V2 (5<0T / "0:, O:I> ""0:" - ?>4@>18FV):hProvide a brief overview of your projects/activities to be used as references (at least three references required). Fill in this form for each of the projects. The projects/activities should be those implemented no more than 3 years ago. 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