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ISO-aligned ICC Project Evaluation Forms 1-7
NEDA evaluation forms for ICC project
Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: QF-ICC-CS-01-07
ICC-PE FORM NO. 1
GENERAL INFORMATION
1. Project Title
2. Description of Project
3. Project Location
ICC-PE FORM NO. 1
GENERAL INFORMATION (continued)
4. Total Project Cost*
a. Foreign Funding
______________
ICC PE Forms
_____________
Exchange rate:
_______________
QF-ICC-CS-01-07
- Foreign Source*
- Local Source
b. Local Funding
- Foreign Source*
- Local Source
5. Summary of Implementation and Cost Schedule
Year 1
Activity/Component
TOTAL
______________
ICC PE Forms
Foreign Source
Foreign Cost*
Local Cost
Local Source
Foreign Cost*
Local Cost
Year N
…
…
…
TOTAL
QF-ICC-CS-01-07
6. Implementing Agency (s) / Firm (s) ___________________________________________________________________________
Prepared by
:
____________________________
Telephone Number
:
____________________________
Office Address
:
____________________________
Date Prepared
:
____________________________
*Expressed in foreign currency and peso equivalent
Prepared by
Reviewed by
Approved by
CALIXTO M. MANGILIN
HAZEL S. BALIATAN
OIC Assistant Director and
Concurrent Division Chief, ICC
Core Division
JONATHAN L. UY
Director IV, Public Investment
Staff and Head, ICC Core
Secretariat Head
Chief Economic Development
Specialist
______________
ICC PE Forms
QF-ICC-CS-01-08
ICC-PE FORM NO. 2
SOURCE OF FINANCING
SOURCES OF FINANCING
YEAR 0
YEAR 1
YEAR 2
I. LOCAL SOURCE
1. Budget Appropriation
2. Equity1
3. Bonds and Notes
4. Direct Borrowing
a) Deposit Money Banks
b) Specialized Banks (DBP, LBP,
PNB)
c) Thrift Banks
d) Other financial Institutions
i) Those regulated by or under
supervision of the Central
Bank
e) Ii) Those not regulated by or
under supervision of BSP (e.g.
private insurance companies)
ICC-PE FORM NO. 2
SOURCE OF FINANCING (continued)
1
For government corporations equity should exclude contributions derived from budgetary appropriations.
______________
ICC PE Forms
YEAR 3
YEAR 5
YEAR N
QF-ICC-CS-01-08
YEAR 0
YEAR 1
II.
FOREIGN SOURCE
1. Foreign Loans*
a) Direct Obligation of
proponent2
i) Concessional Loans*
ii) Commercial Loans*
b) From Relending Lines*
i) Concessional Loans*
ii) Commercial Loans*
c) Bonds and Notes*
2. Equity*
3. Others*
TOTAL
*Expressed in foreign currency and peso equivalent
2
Indicate whether already approved or yet to be approved by the Central Bank.
______________
ICC PE Forms
YEAR 2
YEAR 3
YEAR 5
YEAR N
QF-ICC-CS-01-08
Prepared by
Reviewed by
Approved by
CALIXTO M. MANGILIN
HAZEL S. BALIATAN
OIC Assistant Director and
Concurrent Division Chief, ICC
Core Division
JONATHAN L. UY
Director IV, Public Investment
Staff and Head, ICC Core
Secretariat Head
Chief Economic Development
Specialist
______________
ICC PE Forms
QF-ICC-CS-01-09
ICC-PE FORM NO. 3
ESTIMATED PROJECT COST
INVESTMENT PHASE
All cost are expressed in constant prices __________ (indicate year) In ___________ Units
YEAR 0
I. Civil Works
a. Equipment / Machinery
Foreign Exchange Costs
Local Costs
b. Materials / Supplies
Foreign Exchange Costs
Local Costs
c. Labor Costs
c.1 Supervision and
Consultancy Fees
Foreign Exchange Costs
Local Costs
c.2 Laborers
Local Costs (skilled)
Local Costs (unskilled)
______________
ICC PE Forms
$
P
$
P
$
P
P
P
YEAR 1
YEAR 2
YEAR 3
YEAR 5
YEAR N
QF-ICC-CS-01-09
ICC-PE FORM NO. 3
ESTIMATED PROJECT COST
INVESTMENT PHASE
All cost are expressed in constant prices __________ (indicate year) In ___________ Units
YEAR 0
2. Machinery / Equipment
Foreign Exchange Costs
Local Costs
3. Land Acquisition Costs
4. Other Investment Phase Costs
(specify)
Foreign Exchange Costs
Local Costs
5. Total Costs (1-4)
Total Foreign Exchange
Costs
Total Local Costs
6. Subsidies
What are the subsidized items?
Assumptions:
YEAR 1
YEAR 2
$
P
P
$
P
$
P
P
Prepared by
Telephone Number
Office Address
Date Prepared
______________
ICC PE Forms
:
:
:
:
YEAR 3
YEAR 5
YEAR N
QF-ICC-CS-01-09
Prepared by
Reviewed by
Approved by
CALIXTO M. MANGILIN
HAZEL S. BALIATAN
OIC Assistant Director and
Concurrent Division Chief, ICC
Core Division
JONATHAN L. UY
Director IV, Public Investment
Staff and Head, ICC Core
Secretariat Head
Chief Economic Development
Specialist
______________
ICC PE Forms
QF-ICC-CS-01-10
ICC-PE FORM NO. 4
ANNUAL OPERATIONS AND MAINTENANCE COST
OPERATIONS PHASE
Indicate the year when the Project starts operation ____________________________
ITEM
1. Equipment / Machinery
Foreign Exchange Costs
Local Costs
2. Materials / Supplies
Foreign Exchange Costs
Local Costs
3. Labor Costs
c.1 Supervision and
Consultancy
Foreign Exchange Costs
Local Costs
c.2 Laborers
Local Costs (skilled)
Local Costs (unskilled)
4. Utilities (Electricity, Water, etc.)
Foreign Exchange Costs
Local Costs
5. Oil Costs
Foreign Exchange Costs
Local Costs
______________
ICC PE Forms
YEAR 1
$
P
$
P
$
P
P
P
$
P
$
P
YEAR 2
YEAR 3
YEAR 4
YEAR N
QF-ICC-CS-01-10
ICC-PE FORM NO. 4
ANNUAL OPERATIONS AND MAINTENANCE COST (continued)
OPERATIONAL PHASE
ITEM
6. Other O & M Costs (Specify)
Foreign Exchange Costs
Local Costs
7. Total O&M Costs
Foreign Exchange Costs
Local Costs
YEAR 1
YEAR 2
YEAR 3
$
P
$
P
What are the subsidized items?
Assumptions:
Prepared by
Telephone Number
Office Address
Date Prepared
______________
ICC PE Forms
:
:
:
:
YEAR 4
YEAR N
QF-ICC-CS-01-10
Prepared by
Reviewed by
Approved by
CALIXTO M. MANGILIN
HAZEL S. BALIATAN
OIC Assistant Director and
Concurrent Division Chief, ICC
Core Division
JONATHAN L. UY
Director IV, Public Investment
Staff and Head, ICC Core
Secretariat Head
Chief Economic Development
Specialist
______________
ICC PE Forms
QF-ICC-CS-01-11
ICC-PE FORM NO. 5
ESTIMATED PROJECT BENEFITS
Source of Project Benefits
YEAR
1
2
3
4
5
6
7
8
9
…
VALUE OF BENEFITS
YEAR
VALUE OF BENEFITS
Assumptions:
Prepared by
Telephone Number
Office Address
Date Prepared
______________
ICC PE Forms
:
:
:
:
QF-ICC-CS-01-11
Prepared by
Approved by
CALIXTO M. MANGILIN
HAZEL S. BALIATAN
JONATHAN L. UY
Chief Economic Development
Specialist
______________
ICC PE Forms
Reviewed by
OIC Assistant Director and
Concurrent Division Chief, ICC
Core Division
Director IV, Public Investment
Staff and Head, ICC Core
Secretariat Head
ICC-PE FORM NO. 6
LOGICAL FRAMEWORK1
QF-ICC-CS-01-03
Source of Project Benefits
Indicators/Targets
Means of Verification2
Key Assumptions/Risks
1. Goal
2. Purpose
3. Outputs
Assumptions:
1
Information may be abstracted from the Project’s logical framework, where available.
2
Please attach an expanded description of the Monitoring and Evaluation System that would be adopted to meet the Results Monitoring and Evaluation requirements.
______________
ICC PE Forms
Prepared by
Reviewed by
Approved by
CALIXTO M. MANGILIN
HAZEL S. BALIATAN
OIC Assistant Director and
Concurrent Division Chief, ICC
Core Division
JONATHAN L. UY
Director IV, Public Investment
Staff and Head, ICC Core
Secretariat Head
Chief Economic Development
Specialist
______________
ICC PE Forms
QF-ICC-CS-01-13
ICC-PE FORM NO. 7a.
PROJECT AND FINANCING MILESTONES
Project Title : ________________________________
Agency
: ________________________________
A. Project concept/identification
Activity
1. Project concept/identification
2. Inclusion in PIP/CIIP
3. Project definition or preparation
4. Project Approval
GOP Approval
a. Submission
of
requirements
by
Implementing Agency (including respective
mother
agency/department
level
endorsement or bureaus/attached agencies)
i. Feasibility
Study ii.
Project
Proposal
iii. Accomplished ICC Project Evaluation
Forms
(1-7)
iv. ICC Project Evaluation Matrix
v. Project context in the Department’s
overall national strategy and programs1
vi. DBM-certified budget strategy
vii. RDC endorsements
viii. Environmental
Compliance
Certificate/Certificate of Non-Coverage
ix. ROW acquisition and resettlement
action plan with budget cover
x. DOF-CAG review (for GOCC and
GFI
projects)
xi. NCC review for relending programs
xii. Information on job creation/employment
impact of the project
xiii. Endorsements from other concerned
agencies xiv. Location Map
xv. Advance Procurement Activities 2
Consulting Services
1
Target Schedule
Yes/No
Yes/No
Consulting Services
Refers to the overview of the concerned Department’s national strategy and programs, including overall
development outcomes, timelines, and investment requirements and the specific link of the proposed project outputs,
timelines and investment requirements to achieve the Department’s national strategy and programs.
2 Advance procurement is the conduct of procurement activities starting from procurement planning up to conduct of
bidding (short of notice of award), prior to effectiveness of the project financing agreement. APAs for ODA-assisted
projects may be initiated immediately after project appraisal by the development partner in accordance with the
procedures agreed between the development partner and the government. Per DBM Circular Letter No. 2010-9
December 30, 2010, “procuring entities, even without the receipt of allotment issued by DBM should proceed with
the procurement processes, starting from procurement planning up to the conduct of bidding” (paragraph 5.5)
______________
ICC PE Forms
QF-ICC-CS-01-13
Contract 1
• Preparation of TOR and cost-estimates
• Advertising
• Completion of the consultant short-list and
RFP
• Issuance of RFP
• Receipt of proposals
• Evaluation of technical and financial
proposals
Goods/Civil Works
Contract 2
Contract 3
Contract 4
Contract 5
Contract 3
Contract 4
Contract 5
Goods/Civil Works
Contract 1
Contract 2
• Preparation of technical specifications and
bidding documents
• Advertising
• Pre-qualification of bidders
• Issuance of Bidding documents
• Bid opening
• Evaluation of technical and financial
proposals
b. ICC Secretariat
review/evaluation c. ICC
Technical Board review
d. ICC Cabinet Committee review
e. NEDA Board confirmation of ICC approval
Development Partner Activities
a. Development Partner review of
proposals b. Appraisal Mission
c. Development Partner review of Appraisal
Mission report
d. Development Partner issuance of pledge
e. Acceptance by Philippine Government of
pledge
f. Development Partner Approval of the
Project
Financing
Project Financing
a. Monetary Board Approval in Principle
b. DBM Issuance of Forward Obligational
Authority
c. Technical Discussion/Loan Negotiations
(DOF- IFG/BSP-ID/DOJ)
d. Issuance of Full Powers
e. Signing of Loan Agreement and
Exchange of
Notes
f. Monetary Board Final Approval (DOFIFG/BSP-ID)
g. DOJInvestment Phase
B. Legal Opinion
A
c
5. Detailed engineering/design
t
6. Procurement Milestones
i
Consulting
v
i
______________ t
ICC PE Forms
y
Target
Schedule
Consulting Services
QF-ICC-CS-01-13
Services
• Preparation of TOR and cost-estimates
• Advertising
• Completion of the consultant short-list
and RFP
• Issuance of RFP
• Receipt of proposals
• Evaluation of technical and financial
proposals
• Contract award
• Issuance of Notice to Proceed
Contract 1
Contract 2
Contract 3
Contract 4
Contract 5
Goods/Civil Works
Contract 1 Contract 2
Contract 3
Contract 4
Contract 5
Goods/Civil
Works
7.
• Preparation of technical
specifications and bidding documents
• Advertising
• Pre-qualification of bidders
• Issuance of Bidding documents
• Bid opening
Project• Evaluation of technical and financial
implementation
proposals
a. Loan/Grant award
• Contract
• Effectivity DateNotice to Proceed
Issuance of the
• Closing Date
b. Physical
Implementation
• Start Date
• Closing Date
c. Post-Investment Phase
Activity
8. Preparation of Project Completion Report
9. Start of O&M
10. Conduct of Ex-Post Evaluation
Target
Schedule
Prepared by: ______________________
(Signature over printed name)
Date: ______________
Approved by: ______________________
(Signature over printed name)
Date: ______________
______________
ICC PE Forms
QF-ICC-CS-01-13
Prepared by
Reviewed by
Approved by
CALIXTO M. MANGILIN
HAZEL S. BALIATAN
OIC Assistant Director and
Concurrent Division Chief, ICC
Core Division
JONATHAN L. UY
Director IV, Public Investment
Staff and Head, ICC Core
Secretariat Head
Chief Economic Development
Specialist
______________
ICC PE Forms
