company data · web viewcontractor pre-qualification form doc. # cd-frm-009a revision # 4.2 date...

CONTRACTORPRE-QUALIFICATION FORM

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Date 12-June-2019

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Owner COMMERCIAL DEPT

GUIDELINES FOR PRE-QUALIFICATION COMPLETION AND SUBMISSION

1 All Sections must be completed in order to be considered for pre-qualification.2 An explanation must be provided when certain questions cannot be fully answered.3 Supplementary pages may be photocopied and inserted if required.4 Completed PQ Form together with your company brochure and supplementary documents are to be

submitted to EMPOWER in soft copy (scanned document in PDF format on CD), marked for the attention of the Commercial Director. Note: Soft Copy to have separate files for each Section of the PQ Document together with separate files for each supporting document. Submission in hard copy is not acceptable.


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5 Please retain a copy of your complete submission.

1. COMPANY DATA

(Completion of all Sections is Mandatory) (Score to be filled by Empower Commercial Dept.)

BENCHMARK

SCORE (by

Empower)

1.1. Company Name: Info Info

1.2. Telephone Number: Info Info

1.3. Fax Number: Info Info

1.4. Website Address: Info Info


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1. COMPANY DATA


BENCHMARK

SCORE (by

Empower)

1.5. Company E-mail: Info Info

1.6. Postal Address: Info Info

1.7. Name of Company GM No of years as GM Info Info

1.8. GM Contact No Info Info

1.9. GM Email Info Info


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1. COMPANY DATA


BENCHMARK

SCORE (by

Empower)

1.10. Main Office Location Info Info

1.11. Subsidiary Offices Location/s Info Info

1.12. UAE Commercial Licence No:1 5

1.13. Emirate of Commercial Licence: Info Info


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1. COMPANY DATA


BENCHMARK

SCORE (by

Empower)

1.14. Commercial Licence Expiry Date: Info Info

1.15. Chamber of Commerce Registration No:2 5

1.16. Date Company Established: Info Info

1 Attach Copy of UAE Commercial Licence


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1. COMPANY DATA


BENCHMARK

SCORE (by

Empower)

1.17. VAT Registration No:3 5

1.18. Status of Business: Corporation Partnership Individual LLC Other Info Info

1.19. Local Sponsor Details 5

NAME NATIONALITY PERCENTAGE OF SHARE CONTACT TELEPHONE


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1. COMPANY DATA


BENCHMARK

SCORE (by

Empower)

1.20. Name of Parent Company (if any)

1.21. Is Parent Company willing to Provide Parent Company Guarantee? Yes No 5 if applies

2 Attach Copy of Chamber of Commerce Registration Certificate


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1. COMPANY DATA


BENCHMARK

SCORE (by

Empower)

1.22. Associated / Subsidiary Companies No Yes (if “Yes” insert details below) Info Info

COMPANY NAME GENERAL MANAGER CONTACT NUMBER % STAKE HELD & RELATIONSHIP


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1. COMPANY DATA


BENCHMARK

SCORE (by

Empower)

1.23. Names of people in your company who are authorised to sign legally binding contracts with third parties4 5

NAME DESIGNATION E-MAIL ADDRESS TELEPHONE

3 Attach Copy of UAE VAT Registration Certificate


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1. COMPANY DATA


BENCHMARK

SCORE (by

Empower)

1.24 Does your company have any affiliated company or joint venture company or partnership company or any association company, which company(ies) currently providing product or services to Empower, if so please provide the following details of those Company(ies);

NAME OF THE ASSOCIATED COMPANY CONTACT DETAILS TYPE OF PRODUCT OR SERVICES Info Info


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1. COMPANY DATA


BENCHMARK

SCORE (by

Empower)

1.25 Does any person in your company have any involvement with any other company(ies), which company already providing product(s) and Service(s) to Empower, if so please provide the following information;

NAME OF PERSON NAME OF THE ASSOCIATED COMPANY

CONTACT DETAILS TYPE OF PRODUCT OR SERVICES Info Info

4 Attach copies of legally notarized and attested Powers of Attorney


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1. COMPANY DATA


BENCHMARK

SCORE (by

Empower)

1.26 Provide senior staff details of your company in the event Empower requires additional information and/or clarification on your submitted Prequalification submission.

Info Info

NAME OF PERSON DESIGNATION CONTACT NO. EMAIL


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1. COMPANY DATA


BENCHMARK

SCORE (by

Empower)

TOTAL SCORE FOR SECTION 1 [COMPANY DATA] 255


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2. INFORMATION FOR EMPOWER’S PROJECTS DEPARTMENT(Completion of all Sections is Mandatory) (Score to be filled by Empower Projects Dept.)

BENCHMARK

SCORE (by

Empower)

2.1. Number of Employees MANAGERIAL TECHNICAL ADMINISTRATIVE PRODUCTION / LABOUR

TOTAL

5

2.2. Type of Projects for Which Vendor Seeks Prequalification

VENDOR TO TICK CATEGORY OF PQ APPLICATION

ACCEPTED BY EMPOWER

REJECTED BY EMPOWER

5 Change Bench Mark Score to 25 if Clause 1.21 applies


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2. INFORMATION FOR EMPOWER’S PROJECTS DEPARTMENT

(Completion of all Sections is Mandatory) (Score to be filled by Empower Projects Dept.)

BENCHMARK

SCORE (by

Empower)

(a) District Cooling Plants Info Info

(b) Semi-Permanent Plants Info Info

(c) Chilled Water Networks Info Info

(d) ETS Rooms Info Info

(e) Plate Heat Exchangers Info Info


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BENCHMARK

SCORE (by

Empower)

(f) Cabling, Controls, Instrumentation Info Info

(g) Sub-metering Info Info

(h) Chiller Supply Info Info

(i) Pumps Info Info

(j) RO Plants Info Info


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BENCHMARK

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Empower)

(k) Transformers Info Info

(l) Switchgear Info Info

(m) Hot Tapping Info Info

(n) Flushing Info Info

(o) Civil Works Info Info


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BENCHMARK

SCORE (by

Empower)

(p) Buildings (Mixed Use Development) Info Info

(q) Other (Specify) Info Info

(r) Other (Specify) Info Info

2.3. What is the largest contract (by value)

Value in AED [Provide brief Project Description] 2


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BENCHMARK

SCORE (by

Empower)

executed by your company in the last 3 years2.7. Projects Executed for Empower in last 4 Years 5

PROJECT NAME TYPE OF WORK PROJECT VALUE YEAR AWARDED


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BENCHMARK

SCORE (by

Empower)

2.8. Projects Executed for Government of Dubai Entities in the last 4 years? 2


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BENCHMARK

SCORE (by

Empower)

GOVERNMENT ENTITY

PROJECT NAME TYPE OF WORK PROJECT VALUE YEAR AWARDED


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BENCHMARK

SCORE (by

Empower)

2.9. How many Projects have you won in the last 4 years in the value categories reflected below? Info Info

PROJECT VALUE CATEGORY MOST RECENT YEAR

YEAR 2 YEAR 3 YEAR 4


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BENCHMARK

SCORE (by

Empower)

Projects > AED 100m

Projects < AED 100m > AED 50m






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BENCHMARK

SCORE (by

Empower)

Projects < AED 1M

2.10. Please provide references from the Client in respect of the last 5 projects that you have completed [List details below and provide written references from each identified party. The reference should be on a company letterhead and should state the name of the project, the value of the project, whether the project was completed on time, whether any penalties/delay charges were applied, whether there were any contractual disputes and whether the company would use the services of your company again]


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BENCHMARK

SCORE (by

Empower)

CLIENT CONTACT PERSON NAME & DESIGNATION

CONTACT NO VALUE OF CONTRACT UNDERTAKEN

YEAR UNDERTAKEN

5

5

5

5


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BENCHMARK

SCORE (by

Empower)

5

2.11. Please include a list of all plant & equipment owned directly by your company that will be relevant to the type of works for which you are seeking prequalification. 5

EQUIPMENT MODEL CAPACITY PURCHASE DATE


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BENCHMARK

SCORE (by

Empower)


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BENCHMARK

SCORE (by

Empower)

2.12. What planning, programming and control system and software is used by your company?

3

2.13. How does your company determine work priority and work sequence when planning projects?

2


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BENCHMARK

SCORE (by

Empower)

2.14. As a rule of thumb, how frequently does your company update Project programmes?

2

2.15. Does your company produce resource and cost loaded programmes? Always Only on Client

Demand Rarely 4

2.16. Does your company have “in-house” design capability? No Yes [If yes, provide details

below] 2


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BENCHMARK

SCORE (by

Empower)

STATE TYPE OF DESIGN CAPABILITY NAME OF SENIOR PERSON WITH DESIGN CAPABILITY

QUALIFICATION EXPERIENCE (YEARS)


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BENCHMARK

SCORE (by

Empower)

2.17. For elements of Works undertaken by your company that typically require contractor’s design, provide details of companies to whom you typically outsource this design work if you DO NOT have the capability for “in house” design

3


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BENCHMARK

SCORE (by

Empower)

NAME OF DESIGN COMPANY TYPE OF WORKS DESIGNED NUMBER OF DESIGN CONTRACTS AWARDED

IN LAST 3 YEARS


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BENCHMARK

SCORE (by

Empower)

TOTAL SCORE FOR SECTION 2 [INFORMATION FOR EMPOWER’S PROJECTS DEPARTMENT] 60


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3. INFORMATION REQUIRED BY EMPOWER’S COMMERCIAL DEPARTMENT


BENCHMARK

SCORE (by

Empower)

3.1. Under which of which of the following methods of Contracting has your company undertaken Projects

(a) Construct Only (With Client / Consultant Design) Yes No 3

(b) Design & Construct (With Contractor Design) Yes No 3

(c) Construct with Partial Contractor Design Yes No 3

(d) Engineer, Procure and Construct (Development of Client’s FEED) Yes No 3


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BENCHMARK

SCORE (by

Empower)

(e) Contracts where quantities are re-measurable Yes No 3

(f) Lump Sum Contracts Yes No 3

3.2. Under which of the following forms of Contract has your company executed Projects [Please specify any other in the space provided]

FORM OF CONTRACT EDITION YEAR

(a) FIDIC RED BOOK 1987 4th Edition 1987 5


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BENCHMARK

SCORE (by

Empower)

(b) FIDIC RED BOOK 1999 1st Edition 1999 5

(c) FIDIC GREEN BOOK Info Info

(d) FIDIC YELLOW BOOK Info Info

(e) FIDIC SILVER Info Info

(f) Info Info


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BENCHMARK

SCORE (by

Empower)

(g) Info Info

3.3. Please confirm your Company’s ability to obtain the following PROJECT SPECIFIC insurance

TYPE OF POLICY OBTAINED IN PAST ABILITY TO OBTAIN MAX LEVEL OF COVER THAT CAN BE PROVIDEDYES NO YES NO

(a) Professional Indemnity 3

(b) Contractor’s All Risk 3


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BENCHMARK

SCORE (by

Empower)

(c) Third Party Liability 3

(d) Open Marine Cargo 3

(e) Contractor’s Equipment 3

(f) Employer’s Liability & Workmen’s Comp. 3

3.4. Please provide details of the last 5 insurance claims raised by your company


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BENCHMARK

SCORE (by

Empower)

TYPE OF POLICY AGAINST WHICH CLAIM WAS MADE

AMOUNT OF CLAIM YEAR OF CLAIM CLAIM SETTLED BY INSURANCE COMPANY

No Yes Info Info

No Yes Info Info

No Yes Info Info

No Yes Info Info


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BENCHMARK

SCORE (by

Empower)

No Yes Info Info

3.5. Please provide information on the number of formal contractual disputes that your company has had in the previous 4 years [Provide numbers of disputes and the number that were settled successfully in your company’s favour]

5

PERIOD COURT CASES ARBITRATION CASES SETTLED AMICABLY

NR OF CASES

NR. CASES SUCCESSFUL

NR OF CASES


NR OF CASES



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BENCHMARK

SCORE (by

Empower)

(a) Most recent year

(b) Year 2

(c) Year 3

(d) Year 4

3.8. List any contracts entered into by your company that have been suspended or terminated by your Clients in the last 5 years 5


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BENCHMARK

SCORE (by

Empower)

PROJECT NAME CLIENT’S NAME SUSPENSION TERMINATION

DEFAULT BY CONTRACTOR

NON CONTRACTOR

RELATED

DEFAULT BY CONTRACTOR

CLIENT’S CONVENIENC

E


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BENCHMARK

SCORE (by

Empower)

TOTAL SCORE FOR SECTION 3 [INFORMATION FOR EMPOWER’S COMMERCIAL DEPARTMENT] 56


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4. INFORMATION REQUIRED FOR EMPOWER’S FINANCE DEPARTMENT

(Completion of all Sections is Mandatory) (Score to be filled by Empower Finance Dept.)

BENCHMARK

SCORE(By

Empower)

4.1. No of Shares in Company 2

4.2. Value of Each Share 2

4.3. Paid-up Capital 2

4.4. Name of Principle Bank: 2

4.5. Account No: Info Info


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BENCHMARK

SCORE(By

Empower)

4.6. Branch Name: Info Info

4.7. Branch Telephone No: Info Info

4.8. Please provide details of the value of facilities that your company holds with its bankers for providing bonds and bank securities and the balance of the facility available at the date of submitting this prequalification

10

BANK NAME BONDING FACILITIES HELD WITH BANKS BALANCE OF


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BENCHMARK

SCORE(By

Empower)

FACILITY AT PQ DATE

Performance Bonds

Advance Payment Bonds

RetentionBonds

Total Bonding Facility


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BENCHMARK

SCORE(By

Empower)

4.9. Do you have any arrangements with your Bankers whereby you are under obligations to directly assign Project payments to the Bank

No Yes (provide details below) 10

Bank Name: Info Info



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BENCHMARK

SCORE(By

Empower)


4.12. Anticipated Company Turnover in Current Year: 2

4.13. Company Turnover in Last Financial Year: 2

4.14. Company Turnover in Previous Financial Year 2

4.15. Anticipated Company Profit in Current Year: 2


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BENCHMARK

SCORE(By

Empower)

4.16. Declared Profit in Last Financial Year 2

4.17. Declared Profit in Previous Financial Year 2

TOTAL SCORE FOR SECTION 3 [INFORMATION FOR EMPOWER’S FINANCE DEPARTMENT] 40


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5. INFORMATION FOR EMPOWER QHSE DEPARTMENT

(Completion of all Sections is Mandatory) (Score to be filled by Empower QHSE Dept.)

BENCHMARK

SCORE (by

Empower)

PART 1 - QUALITY

5.1. Does your Company have a signed Quality Policy Manual?

No Yes 5

Copy attached No Yes 5

5.2. Is your Company certified to ISO 9001 or equivalent?

No Yes 5



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BENCHMARK

SCORE (by

Empower)

5.3. Do you have a copy of ISO9001:2008 certificate

No Yes 5


5.4. Do you have any objection to an on-site assessment by EMPOWER Personnel? No Yes 5

5.5. Has a QA Manager/Officer been appointed in your Company No Yes [If YES, please provide name

and reporting line] 5


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BENCHMARK

SCORE (by

Empower)

Name: Info Info

Reports To: Info Info

5.6. Do you perform your own Internal Quality Appraisal Audits? No Yes [If YES, please provide

information below] 5

Frequency of Audits 3

Date of last Audit 2


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BENCHMARK

SCORE (by

Empower)

(mm/yyyy)

Copy of latest Audit Report attached No Yes 5

SUB-TOTAL [PART 1 - QUALITY SECTION] 55


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INFORMATION FOR EMPOWER QHSE DEPARTMENT


BENCHMARK

SCORE (by

Empower)

PART 2 – ENVIRONMENTAL

5.7. Is your Company certified to ISO 14000 (Environmental Management Systems)?

Yes 5

Copy of environmental manual & registration certificate attached

No yes 5

No


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BENCHMARK

SCORE (by

Empower)

If NO manual & registration certificate briefly describe your environmental protection and waste management systems on a separate signed page.

5 if applies

5.8. How do you contribute for environmental protection?

5


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BENCHMARK

SCORE (by

Empower)

[Attach a separate sheet with


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BENCHMARK

SCORE (by

Empower)

SUB-TOTAL [PART 2 – ENVIRONMENTAL SECTION] 156


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BENCHMARK

SCORE (by

Empower)

PART 3 – HEALTH AND SAFETY

5.11. Is your Company certified to OHSAS 18001 (Occupational Health & Safety Management System)?

[If YES attach copy of document describing core elements of your OHSAS & registration cert.]

Yes 5

Copy of document attached Yes No 5

OR[If NO, provide copy of your company’s occupational health & safety management system manual]

No 5

6 Change Bench Mark score to 20 if Clause 5.7 applies


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BENCHMARK

SCORE (by

Empower)


5.14. Does your Company maintain records of all accidents and injuries sustained?

[If YES, provide record of your safety performance over the last 3 years (number of Lost Time Injuries, Medical Treatment Cases, etc.)]

No Yes 5


5.17. Has a Safety Manager/Officer been No Yes [If YES, please provide name 5


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BENCHMARK

SCORE (by

Empower)

appointed in your Company?

and reporting line]

Name: Info Info

Reports To: Info Info

5.18. Do you have project specific QHSE Objectives & Targets/KPIs?

If YES, provide the reports for QHSE Objectives & Targets / KPIs (Planned Vs Actual

No Yes 5


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BENCHMARK

SCORE (by

Empower)

achievement) for the projects executed by organization in


SUB-TOTAL [PART 3 – HEALTH & SAFETY] 45


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BENCHMARK

SCORE (by

Empower)

TOTAL FOR QHSE PARTS 1, 2 & 3 115


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CHECKLIST FOR DOCUMENTS TO BE ATTACHED [CONTRACTOR TO TICK AS APPLICABLE]

NAME OF DOCUMENT ITEM REF. IN PQ DOCUMENT ATTACHED

Company Brochure Guidelines YES NO

UAE Commercial Licence 1.12 YES NO

Chamber of Commerce Registration Certificate 1.15 YES NO



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VAT Registration Certificate 1.17 YES NO

Notarised & Attested Power of Attorney 1.23 YES NO

Written Client References 2.7 YES NO

List of Plant & Equipment (If insufficient space on form) 2.8 YES NO

Audited Financials for the last 3 years 4.1 & 4.2 YES NO



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Letter of support or good conduct issued by the Principle Bank - YES NO

Letter of support from Bank regarding commitment for providing facilities for Empower’s Projects (if available) - YES NO

Signed Quality Policy manual 5.1 YES NO

ISO 9001 Certificate 5.2 YES NO



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ISO 9001:2008 Certificate 5.3 YES NO

Environmental Manual & Registration Certificate 5.7 YES NO

Environmental Protection and Waste Management Systems (if no manual and registration certificate) 5.7 YES NO

Contribution to Environmental Management (if insufficient space on form) 5.7 YES NO



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OHSAS Document and Certificate 5.9 YES NO

OHSAS Manual (if no document & certificate) 5.9 YES NO

Accident & Injury Records 5.10 YES NO

QHSE KPI’s 5.12 YES NO



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DECLARATION BY CONTRACTOR

We confirm that the particulars given in this form are factual and correct and have been provided by an authorised representative of the Company. We authorise and accept that Empower may verify any such statements and other information in this questionnaire and further agree to furnish any additional information that may be required.Our Company agrees to be bound by the Laws of Dubai and the UAE current at the time of entering into any agreement/contract with Empower. We undertake to keep confidential all details and information relating to all transactions between Empower and the Company and shall not disclose any such information without the express written permission of an authorised representative of Empower. We also undertake to comply with the Government of Dubai’s Internal Security Regulations (ISR)



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Signature:

Name of Authorised Representative:

Title of Authorised Representative

Date:



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Company Stamp



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FOR INTERNAL USE BY EMPOWERA. EMPOWER INTERNAL ASSESSMENT OF SECTION 1 – COMPANY DATA

BENCH MARK SCORE ACHIEVED SCORE PERCENTAGE SCORE APPROVED REJECTED



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Comments:

REVIEWING DEPARTMENTS’ APPROVAL / REJECTION

DESIGNATION SIGNATURE NAME DATE



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Senior Commercial Officer

Director – Commercial

B. EMPOWER INTERNAL ASSESSMENT OF SECTION 2 – INFORMATION FOR EMPOWER PROJECTS DEPARTMENT




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Comments:





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Project Manager

Head of Projects



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C. EMPOWER INTERNAL ASSESSMENT OF SECTION 3 – INFORMATION FOR EMPOWER COMMERCIAL DEPARTMENT




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Comments:





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Senior Commercial Officer

Director – Commercial

D. EMPOWER INTERNAL ASSESSMENT OF SECTION 4 – INFORMATION FOR EMPOWER FINANCE DEPARTMENT




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Comments:





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Manager – Payables & Fixed Assets

Director – Finance



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E. EMPOWER INTERNAL ASSESSMENT OF SECTION 5 – INFORMATION FOR EMPOWER’S QHSE DEPARTMENT




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Comments:





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Senior Quality Executive

OVERALL SUMMARYSECTION BENCHMARK

SCOREACHIEVED

SCORE%

SCOREDAPPROVED REJECTED

SECTION 1 – COMPANY DATA

SECTION 2- INFORMATION FOR PROJECTS DEPT.



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SECTION 3 – INFORMATION FOR COMMERCIAL DEPT.

SECTION 4 – INFORMATION FOR FINANCE DEPT.

SECTION 5 – INFORMATION FOR QHSE DEPT.

TOTAL SCORES

EMPOWER MANAGEMENT APPROVAL7




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CHIEF COMMERCIAL OFFICER

HEAD OF PROJECTS

CHIEF FINANCE OFFICER

7APPROVAL IF GIVEN, SHALL BE VALID FOR 3 YEARS FROM THE LATEST DATE OF APPROVAL REFLECTED ABOVE



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