General Pre-qualification Questionnai

1 General

1.1 Qualification and Selection Procedure

1. The qualification and selection of applicants shall be effected on the basis of the response by the applicants to a
questionnaire and the information which the applicants provide in accordance with the questionnaire
.
2. Applicants shall be selected by an evaluation team on the basis of objective criteria.

3. Based on the selection criteria, the number of applicants who shall be invited to tender shall be kept to a pre-
defined level which is in keeping with the consideration of the specific characteristics of the work and the
capability of the applicants to execute the work.


Sections 1 to 8 of the questionnaire shall be as follows in this selection system:
Section Description:
1.
General information
2. License and Certificate
3. Experience
4. Contracting and Procurement
5. Quality Assurance
6.
Health, Environment, Safety
7. Financial
8. Interview / site visit
1.2 Selection of applicants

We reserve the right, if an applicant fails to meet minimum requirements to execute the scope of work, to disqualify
that applicant.

1.3 Confidentiality
The information provided by the applicants shall be treated with the appropriate confidentiality.

1.4 Acknowledgement
Applicant shall complete, sign and return the attached acknowledgement form upon receipt of the prequalification
questionnaire package by e-mail.

Works: Package1: Stone Preparation and Limestone Stockyard
Addressee acknowledges:
1. The receipt of above-mentioned document.
ACKNOWLEDGEMENT OF RECEIPT OF THE PREQUALIFICATION DOCUMENT

2. That the due date will be met.
3. That the statements made and the information provided in the duly completed application are complete, true
and correct in every detail.
Addressee's contact person will be ..........................................................................................
Telephone number ..............................................................................
Email address: ..............................................................................
Date : ..............................................................................
Signature / Stamp ..............................................................................
OUTLINE SCOPE OF WORK
2
This scope of works consist of requirements for the engineering, design, supply of materials, fabrication, assembly,
inspection, factory testing, shipment to the job site, erection/construction, start-up, training of operators, acceptance
test, quality assurance for Stone Preparation Area and Limestone Stockyard.
Details of deliverables are laid in Requisition for Package 1 document no. 2190 001 rev.: A.
3 QUESTIONNAIRE
This questionnaire is developed with the aim to arrive at a fair and correct qualification and selection in an efficient
way.
It is therefore mandatory that your response is structured in accordance with the following instructions:
Complete the questionnaire in one fold. Do not send information not requested, do not retype the questionnaire.
Answer YES or NO in all section.
Complete the attached Forms substantiating your responses to the questionnaire.
Each sheet of information and each annex should carry a date, name, signature and company stamp.
If the questionnaire is not completed, is not completed in full or is completed incorrectly, the applicant may be
excluded from consideration.
Index of sections
Section 1: General Information Section 2: License and Certificate Section 3: Experience Section 4: Contracting and
Procurement Section 5: Quality Assurance Section 6: Health, Environment, Safety Section 7: Financial Section 8:
Interview/site visit
1.1 Company name ............................................
Company address ......................................................................
SECTION 1. GENERAL INFORMATION

Telephone number ......................................................................
Telefax number ......................................................................
Contact person ......................................................................
Position ......................................................................
Mobile Phone Number ......................................................................
Email address ......................................................................
Owner and Managing Director names:
1 ....................................................................................................................................
2 .......................................................................................................................
3 ......................................................................................................................
4 ......................................................................................................................
5 ......................................................................................................................
1.2 Main lines of business
1.3 Please add to the questionnaire general information (brochures and such) of your company.
2.1 Has your company the following License and certificate (Please attach a copy if have)
Business License ....................................................................
Construction License ..............................................................
Safety certificate .....................................................................
..................................................................................................................................................................... Other
certificate(please indicate) ............................................................................................................................
2.2 Do your workers hold required certificate? (If yes please attach a copy)
SECTION 3. EXPERIENCE
3.1 Please indicate the civil works (= n) completed by your Company as a percentage of your Company's total
turnover for the last three years?
n
n > 90% ..............................................
70% < n < 90% ..............................................
SECTION 2. LICENSE AND CERTIFICATE

n < 70% ..............................................
Please provide similar references (5 - 7), stating year, Employer, project, short description and value in RM, projects
in state of XXXX, Malaysia are preferred.
3.2 Has your Company successfully completed in the last three years the following number (= n) of similar works?
n > 10 : YES/NO
5 < n < 10 : YES/NO
2 < n < 5 : YES/NO
n < 2 : YES/NO
Please provide several running projects references, stating Employer, project, short description and value in RM,
Employers contact person and contact method.
3.3 Has your company involved in legal actions for violation of Malaysia Law? If yes, who involved, your company,
any employee or director?
YES/NO
Have your company ever been prosecuted or involved in legal proceedings following accidents?
YES/NO
SECTION 4. CONTRACTING AND PROCUREMENT

4.1 Shall your Company be sub-contracting approximately the following percentage of the work?
- None : YES/NO
- < 5% : YES/NO
- between 5-20% : YES/NO
- > 20% : YES/NO
4.2 In case your Company shall be sub-contracting, please indicate in a separate list which Part of the Work your
Company will sub-contract.
4.3 Does your Company have and maintain lists of preferred/approved vendors and sub-contractors?
YES/NO
4.4 How to ensure sub-contractors are capable of the assigned work?
5.1 Does your Company maintain a documented quality system based on:
- ISO-9001 series or equal : YES/NO
- Other standard (standard to be stated) : YES/NO
In case of such other standard, does your Company maintain a formalised quality assurance policy which clearly
emphasises a commitment to quality? Provide a copy of this policy only. Do not provide a copy of your quality
assurance document.
5.2 Has your Company a separate Quality Management/Quality Assurance department? Please provide
organisation scheme of this department.
5.3 Has your Company experience with project specific quality plans prepared for similar projects? Provide typical
of a project specific quality plan.
5.4 On similar projects does your Company perform internal quality audits at site with qualified auditors? Provide
evidence of such audits.
6.1 Does the company have a safety policy and HSE management system? If so, enclose a copy.
YES/NO
6.2 Do you have official HSE training program or procedures? Is Safety Emergency procedure included?
YES/NO
6.3 Is there any HSE accident reporting procedure and any accident tracing or investigation procedures to prevent
accidents from happening again? if yes, please provide accident report or procedure template.
YES/NO
6.4 Do you have procedure for handling hazardous material?
YES/NO
6.5 What kind of PPE is available in your company and how do you make sure PPE is in good condition?
6.6 Do your employee understand how to use special PPE? How can your company ensure they understand and
how to ensure proper PPE is used?
6.7 How many accidents resulted in a company death happened in the past three years?
6.8 Please provide your average Lost Time Injury Frequency (LTIF) value by completing following table.
LTIF = Number of lost time injuries (LTh x 1,000,000 Exposure hours
Whereas:
LTI Lost Time Injuries are the sum of Fatalities, Permanent Total Disabilities, Permanent
Partial Disabilities and Lost Work Day Cases (LWC).
LWC : Lost Work day Case is any Work Injury other than a Permanent Partial Disability which
renders the injured person temporarily unable to perform any Regular Job or Restricted Work on any day after the
day on which the injury was received. In this case "any day includes rest day, weekend, scheduled holiday, public
holiday or subsequent day after ceasing employment.
Please provide your LTIF value by completing the following table:
Lost Time Injury Frequency

YEAR 2011 2012 2013 Average
Number of lost time injuries

Exposure hours

LTIF

6.9 Has a safety officer been assigned within the company?
Name of safety officer : ________________________________________________
Date of employment : _________________________________________________
Please supply Curriculum Vitae for the proposed Safety officer.
7.1 Please provide with this questionnaire a copy of your Company's latest (2010, 2011 and 2012) audited (by third
party) financial statements.
SECTION 8. INTERVIEW I SITE VISIT
After having received your duly filled in Questionnaire, Employer will consider to have a personal interview with your
management and/or project people at your premises. Also a site visit to one of your works will be inspected. During
these interview(s) - among others - above mentioned items will be discussed, after which Tebodin and Employer will
value this section.
Statement: (for all employees and sub contractors):
Herewith I assure that all provided information is accurate and authentic.
Note: if there is any change on provided information, shall inform Employer immediately. Contract with Employer will
base on all provided information is accurate and authentic.
Name :
Position :
Date :
Signature: