Reason for Survey (completed by...
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SUPPLIER PRE-QUALIFICATION QUESTIONNAIRE Doc. # PCD-FRM-002 Revision # 0 Date 08.12.2009 Page Page 1 of 6 Owner PCD Note : 1. All Sections must be completed in order to be considered for pre- qualification. 2. All submissions are to be delivered to Dubai World Central Corporation Office in original form and marked for the attention of the Purchasing & Contracts Department. 3. Supplementary pages may be photocopied and inserted if required. 4. Please retain a copy of your complete submission. 5. If a joint venture is proposed, all companies are to respond to all questions. document.doc
Transcript of Reason for Survey (completed by...
SUPPLIER PRE-QUALIFICATION QUESTIONNAIRE
Doc. # PCD-FRM-002
Revision # 0
Date 08.12.2009
Page Page 1 of 6
Owner PCD
Note :1. All Sections must be completed in order to be considered for pre-qualification.2. All submissions are to be delivered to Dubai World Central Corporation Office in original form and marked for the
attention of the Purchasing & Contracts Department.3. Supplementary pages may be photocopied and inserted if required.4. Please retain a copy of your complete submission.5. If a joint venture is proposed, all companies are to respond to all questions.
SECTION 1 - GENERAL
1.1 Company Name:.................................................................................................................................
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1.2 Registered Office Address:.................................................................................................................................
1.3 Post Box : ………...… 1.4 Telephone:.........................................
1.5 Fax:................................................
1.6 Type of Company: Consultant Contractor Supplier Other
1.7 Services/Products provided by Company .........................................................................................................
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......................................................................................................
...
1.8 Brochure/Catalogue attached YES / NO
1.9 Trade Licence Number (copy to be attached): .......................................................................
1.10 Company Registration number if outside UAE (Copy to be attached): .....................................................................
..
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1.11 Number of years in current business: In UAE………. …Internationally………… Total…………...
1.12 Details of Parent Company (if any): .........................................................................................................
1.13 Details of the other associated companies (if any)
......................................................................................................
...
......................................................................................................
...
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1.13 Sponsor: .........................................................................................................
1.14 Type of limited liability company: Joint venture (state %) ………….%
Partnership (state %) …………..%
Private individual
1.15 Company Organization Chart: (Must be attached)
1.16 Do you have any other Representative Offices in the UAE YES / NO
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(Please complete Page 1 of this Assessment Form for any Representative Offices in other Emirates)
SECTION 2 - FINANCIAL STATEMENT
2.1 Paid Up Capital:
……………………………………
2.2 Authorised Capital:
……………………………….
2.3 Issued:
…..……………………...
2.4 Gross turnover in previous 5 years:
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Year Year 1(most recent) Year 2 Year 3 Year 4 Year 5
U.A.E.
Internationally
Total
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2.5 Summary of auditors accounts for previous 3 years to be attached: (Balance Sheet & P&L Statement):
2.6 Company Bankers: Bank Name: ....................................................................................
Bank Contact Person: ..…………………………………………Bank Contact No: ..……………………………………………..
SECTION 3 – COMPANY RESOURCES
3.1 Name and Position of Contact Person: ............................................................................................
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...
3.2Number of Employees: Managerial
………….....
Technical
……......
Admin
………….
Production/Labour
…………..............
Total
…………....
3.3List of total Staff available by category/trade to be attached.
SECTION 4 - COMPANY EXPERIENCE (Delete as required)
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4.1 Has Company supplied products/services to Dubai World Central Corporation before?
YES / NO
If “YES”, provide details:.............................................................................................................................
4.2 Has Company provided the products/service on offer for at least the last 10 years?
If not, state how long:
YES / NO
................. years
4.3 Please provide details of all Contracts for the last 3 years (to be attached separately in the following format).
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Project Name Description Client Client Contact Person/Contact No.
Consultant Contractor Year/Duration
(Please indicate with * which of the above projects are in hand)
SECTION 5 – CONTRACTING CAPACITY & STATUS
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5.1 Up to what value of Contract can you undertake: Category A – AED 5 Million and above
Category B – AED 1 Million to AED 5 Million
Category C – AED 500,000 to AED 1 Million
Category D – AED 100,000 to AED 500,000
Category E – AED 10,000 to AED 100,000
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5.2 What is the largest single Contract (for similar works/products/services) that you have undertaken to date?
Value of Work……………………Period………………………for …..……………………. (Client Name)
5.3 Has Company had any Contracts suspended/terminated in the last five years?
YES / NO
lf “YES”, provide details: .............................................................................................................................
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………………………………………………………………………...........
5.4 Has any legal action or Court judgment been imposed on the Company in the past 5 years? YES / NO (lf “YES”, provide details)………..………………………………………………………………………………..
………………………………………………………………………………………………………………….
5.5 Are any of the processes required to produce the finished product or provide the services sub-contracted/sub-consulted by the Company to other organizations? YES / NO
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lf “YES”, provide details: .................................................................................................................................
SECTION 6 -WARRANTIES/GUARANTEES/INSURANCES
6.1 Does Company have a design capability? YES / NO
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6.2 Is the design capability covered by Professional Indemnity insurance? YES / NO
6.3 lf so, what is the maximum PI cover in place? (Copy to be attached) …………..
6.4 “Our Company will provide Contractors All Risk Insurance, if required”
Level of cover
YES / NO
6.5 “Our Company will provide Third Party Liability Insurance, if required”
Level of cover AED. …………………………………………………
YES / NO
6.6 How any insurance claims been levied by the company in the past 3 years? YES / NO
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If yes, provide details ____________________________________________ ____________________________________________ ____________________________________________
6.7 “Our products are covered by a product Insurance Policy against defects for a period of at least 10 years.”(If “YES”, provide copy of specimen policy)
YES / NO
6.8 “Our Products are suitable for use in the climate of the UAE.” YES / NO
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6.9 “Our Parent Company will provide a Parent Company guarantee to Dubai World Central Corporation.”
6.10 “Our Company agrees to be bound by the Laws of the UAE current at the time of entering into any agreement with Dubai World Central Corporation.”
YES / NO
YES / NO
SECTION 7 – PERFORMANCE BOND CAPACITY
7.1 “Our Company is able to provide on demand type Bank Performance Securities YES / NO
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for products or services provided to Dubai World Central Corporation.”
7.2 Performance Bond Securities total capacity AED Million7.3 Performance Bond Securities Value Outstanding AED MillionSECTION 8 - QUALITY CONTROL
8.1 Do you work to a current Quality Manual? (If “YES”, provide copy)
YES / NO
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8.2 Do you have established inspection procedures? YES / NO
8.3 Do you have traceability procedures? YES / NO
8.4 Are you ISO 9001 Accredited? If yes, please provide a copy of the certificate. YES / NO
8.5 Will you provide reasonable access to quality records for our company personnel? YES / NO
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SECTION 9 – HEALTH ,SAFETY & ENVIRONMENT
9.1 Does Company have formal Health & Safety Environmental Policy?(If “YES”, provide copy)
YES / NO
9.2 Name of person responsible for Health, Safety & Environmental Management ………………………………………
9.3 To whom does this person report? ………………………………………YES / NO
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9.4 Do you maintain accident statistics?
9.5 Is the Company OHSAS 18001 accredited?If yes, please provide a copy of the certificate.
YES / NO
COMPANY DECLARATION
“We confirm the particular given in this form are factual and correct and have been provided by an authorized employee of the Company. I/ We authorize and accept that Dubai World Central Corporation may verify such statements and other information in this questionnaire and further agree to furnish any additional information that may be required.
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Authorized Representative: ……………………………………………………………………………
Title: ……………………………………………………………………………
Date: ……………………………………………………………………………
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SUMMARY ASSESSMENT (completed by Dubai World Central Corporation)
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Reason for Assessment:
New Supply/Contract Re-Assessment
New Plant/Equipment Poor Quality Record
Offices/Premises visited YES / NO by ………………………………… on ……………………….
Separate visit report attached YES / NO
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Pre-qualification documents attached YES / NO
Quality Manual seen? YES / NO HSE Manual seen? YES / NO
Comments: …………………………………………………………………………………………………………
…………………………………………………………………………………………………………
…………………………………………………………………………………………………………
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Assessed by: .................................... Signature: ............................................ Date: ........................
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