This form must be completed for EVERY EMPLOYEE who is requested to work overtime, and must be PRE-APPROVED BEFORE any overtime is worked

P.O.Box 10270, Jubail Industrial City 31961

Kingdom of Saudi Arabia

Phone: +966-13-343 7700 Fax: +966-13-341-2571

Email: purchasing@aytb.com,

www.aytb.comReference Number:FM/QA/044Revision Number02

Document Title:SUPPLIER EVALUATION QUESTIONNAIRE

COMPANY FULL NAME: INDUSTRIAL PROJECT MANAGEMENT SOLUTIONSTREET ADDRESS: P.O.BOX 5555, DAMMAM 31432, KING DOM OF SAUDI ARABIAP.O.BOX: 5555 CITY: DAMMAM ZIP CODE:31432 COUNTRY: KINGDOM OF SAUDI ARABIAPHONE: +96638316714 FAX:+96638316677 E-MAIL: prasb@ipms.com.saBRANCHES (LOCALLY & OVERSEAS): ___________________________________________________________________________________________________________________________________INTRODUCTION

The attached questionnaire will be used by AYTB Quality Assurance personnel to evaluate your Quality Assurance capabilities. Submittal of this questionnaire by itself, does not constitute an approval of your company as an approved source. AYTB may, after receipt of the completed questionnaire, conduct an on-site survey of your facility. Since Quality Assurance approval is necessary before a procurement award can be made, it is to your benefit to return this form as soon as possible.

INSTRUCTIONS:1. If you have an ISO or any recognized Quality Standard certification, it is not necessary to complete the remainder of this form. Please send a copy of the registration certificate along with the completed first and second pages of this survey.

2. All questions should be answered. Enter an X in appropriate boxes on YES-NO-N/A(Not Applicable) questions.3. If supplemental data is submitted, check with an asterisk (*) and identify the attachments by the applicable paragraph number. A supplemental data sheet is attached for your convenience.

4. Answers should reflect your current status. Do not reflect procedures or capabilities which are anticipated or proposed.

5. Questionnaire should be returned within ten (10) days.

6. Completed questionnaire should be directed to the Purchasing Department - AYTB Co. Ltd.The information contained in this questionnaire is certified to be complete and accurate.

Authorized Official:

NAME: VIGHNESHVAR BHALCHANDRA BANDEKARTITLE: OPERATION DIRECTORSIGNATURE:_________________________________Date: _____________________Section I Organization1. Key Personnel:

President/Owner(s)/Partner(s)/ C.F.O: NABIL MUSTAFA NEMER NASROperation director.: VIGHNESHVAR BHALCHANDRA BANDEKARQuality Assurance Manager: DEIVENDRAN PETHANAN 2. Contact persons:

NamePositionPhone No/Mobile No./Email Address

Prasad BandekarOperation Director0138316713/0509815111/prasb@ipms.com.sa

Deivendran PProject /QA manager0138316715/0556011337/deivp@ipms.com.sa

Mohammed Iliyas KhanLead - BD0138316714/0552672566/mikhan@ipms.com.sa

3. Company Particulars:

a) How long has company been in business as presently organized?

5 yearsb) What is your principal Product(s) and / or services?

Installation of switch gears and transformers and MCC etc.. and Testing & Commissioning of various electrical systems and FOC termination, splicing and testing & Supplying any kind of electrical (UPS & BATTERY BANK SYSTEMS) and mechanical related products and spares on LSTK basisc) Is the company an agent/sole distributor/representative for specific product(s)?

Yes

No

If Yes, please provide the name(s) of the manufacturer(s): # MSA / # I-TORQ / #SAMSON / # INTERVALVE d) Commercial Registration No.:2050075764 (please provide copy of your CR).4. Mandatory Documents Required for Approval a) Company Profile

b) Is your company approved by Aramco (Yes/No) (please provide a copy of approval)

c) Is your company approved by Sabic (Yes/No) (please provide a copy of approval)

d) Commercial Registration Certificate. Valid till 19-05-1438e) Chamber of Commerce Certificate. Valid till 31-12-2015f) Zakat Valid till 30-04-2015g) GOSI (Insurance) Valid till 06-07-1436h) Saudization Certificate. Valid till 20-04-20155. Financial Information:

Name and address of bank(s): Riyad Bank , Branch - Al Mazrouiah., Dammam. Section II Quality Assurance Systems and Procedures1. Are you approved under ISO or any recognized Quality Standard? Yes

No

2. If Yes, identify the standard (Attach Certificate copies): ISO 9001:2008 Other Standards _________________________________Registrars Name: ACM., Limited., U.KRegistration Number: 4301A Valid until: 22-07-20173. Is a current copy of your Quality Manual available to AYTB upon request? Yes

No

Section III Quality Control System Elements:

YES NO N/A1Quality Assurance

a) There is a Quality Assurance system that is properly implemented.

b) There is a Quality Assurance Manual.

c) There are documented procedures and detailed work instructions for all operations which effect quality.

d) The Quality Assurance Organization trains and documents employees in the application of Quality Assurance Methods

2.Measuring and Test Equipment

a) There is a calibration program for your test and measurement equipment

b) Your measuring and test equipment is identified to indicate the last calibration date, by whom, and next calibration due date

3.Procurement Control

a) There is a system for rating suppliers for quality and delivery.

b) Quality Assurance personnel review purchase orders to assure the incorporation of quality requirements

c) Quality capabilities of sources are evaluated prior to procurement.

4.Inspection

a) Inspection records and traceability are provided with each order.

b) All materials are rated upon receipt to assure conformance to all requirements

c) All of the discrepant materials are promptly and adequately identified and separated from normal work operations.

d) You have documented inspection systems for incoming, in-process and final inspection.__

5.Complaints

a) There is a system for responding to customers complaints. If so, please describe: As per our IPMS quality assurance procedureAs mentioned in the documents IPMS-QSP-002 as regards Internal audit, control of non-conformity and corrective and preventive action measures by using the following forms IPMS-FRM-006 / 007/ 008/009. We can submit our detailed quality manual and following procedure at any time upon request.

Section III Quality Control System Elements (Continued)

6.Supplemental Information

You are invited to include any additional or supplemental information which would be pertinent to this application and the evaluation of your capabilities. (Use continuation sheets or attachments as necessary).As conferred we Industrial Project Management Solutions (IPMS) an ISO 9001:2008 company and a division of Al Dammam development Holding Company is synonymous with Prompt & Quality Industrial Project supplies and services to our valuable Clients, IPMS can delivers Project oriented Professional services and technical resources with the purpose to meet our client commitments towards a successful completion of Industrial Projects and Operational & Maintenance services. IPMSalso offer great service of Installation of switch gears and transformers and MCC etc.. and Testing & Commissioning of various electrical systems and FOC termination, splicing and testing & Supplying any kind of electrical (UPS & BATTERY BANK SYSTEMS) and mechanical related products and spares on LSTK basis at a very competentpriceand have never been known to compromise on the quality of our service. We have a well-established proven track record in our Business and our services have always met with great customer satisfaction in the field.[ This page is for AYTB Corporate QA and Purchasing Department Internal Use Only ]

Section IV AYTB Corporate Quality Assurance Review

1. General Company Information and OrganizationApproved: Yes No

Comments: ________________________________________________________________________________________________________________________________________________________2. Quality Assurance System

Approved: Yes No

Comments: ________________________________________________________________________________________________________________________________________________________3. AYTB Corporate QA recommendation

Approved Supplier

Secondary Supplier

Unsatisfactory Supplier

Comments: ________________________________________________________________________________________________________________________________________________________Reviewed by AYTB Corp. Quality Assurance

_________________________ _____________________ _______________ _____________ Name Title Signature Date

Note: Please return to Purchasing Department after QA review.

Section V AYTB Purchasing Dept.

Assigned Supplier No. :______________________________

Industry Name:

______________________________

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