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CONTRACTOR REGISTRATION & PRE-QUALIFICATION QUESTIONNAIRE FOR CONTRACTOR Company Name Collected By (Name & Title) Date: ____/____/____ Authorized By - 1 -

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Page 1: Registration Pre-qualification Questionnaire for Contractor (2)

CONTRACTOR REGISTRATION &

PRE-QUALIFICATIONQUESTIONNAIRE

FOR

CONTRACTOR

Company Name

Collected By(Name & Title)

Date: ____/____/____

Authorized By

Submitted By(Name & Title)

Date: ____/____/____Received By

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Page 2: Registration Pre-qualification Questionnaire for Contractor (2)

Data Entered By Date: ____/____/____

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I N D E X

PREQUALIFICATION QUESTIONNAIREPage:

Contractor’s Name ................................................................................................ 3

Guidelines .............................................................................................................. 4

Check List .............................................................................................................. 5

Section 1 – General Information .......................................................................... 6

1.1 Company Information ............................................................................ 7

1.2 Ownership, Authorized Person(s) .......................................................... 8

1.3 Certificates and Licenses ...................................................................... 9

1.4 Associated Companies .......................................................................... 9

1.5 Financial Information ............................................................................. 10

Section 2 – Work Experience ............................................................................... 11

2.1 Instructions for Completing Section 2 .................................................... 12

2.2 Work Groups ......................................................................................... 13

2.3 Work Experiences ................................................................................. 14

Section 3 – Company Resources ........................................................................ 15

3.1 Plant and Equipment ............................................................................. 16

3.2 Infrastructure/Office Facilities ................................................................ 17

3.3 Technical Resources ............................................................................. 18

Section 4 – Organization/Human Resources ...................................................... 19

4.1 Organization Chart ................................................................................ 20

4.2 Human Resources ................................................................................. 20

Section 5 – Quality, Health, Safety & Environment Management Systems ..... 21

5.1 Quality Management Systems ............................................................... 22

5.2 Quality Assurance / Quality Control Questionnaire................................ 23

5.3 HSE Management Systems 255.4 HSE Pre-Qualification Questionnaire (Groups 1-3) 265.5 HSE Pre-Qualification Questionnaire (Groups 4-9) 27

Section 6 – Pre-Qualified With ADNOC Group of Companies........................... 29

Section 7 – Company Declaration ....................................................................... 31

Note: Please refer the ADNOC “Work Groups List” to complete the above Questionnaire.

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Page 5: Registration Pre-qualification Questionnaire for Contractor (2)

ADNOCCONTRACTORS REGISTRATION &

PREQUALIFICATION QUESTIONNAIRE FOR CONTRACTOR

CONTRACTOR’S NAME

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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ADNOCCONTRACTORS REGISTRATION &

PREQUALIFICATION QUESTIONNAIRE FOR CONTRACTOR

GUIDELINES

This document is considered by the Company to be a very important one for evaluating suitability of an organization as a prospective Contractor. Hence you are kindly requested to follow these guidelines for completing the Questionnaire:

1. Additional guidelines have been provided at the beginning of Section (2). A check list is also provided on the next page 5 for you to ensure completeness of submittal.

2. The term “Contractor” used in this document denotes both Contractors and Consultants.

3. All information shall preferably be typewritten and should be supported with appropriate documentation. Companies are requested to regularly update the information provided in this document.This information is required to be updated by you every two to three years by submitting a fresh Pre-qualification Questionnaire.

4. Please attach additional sheets if the space provided for any information is insufficient. Write your Company’s ‘Short’ Name on each additional sheet, marking it with a reference number which should be entered in the Check List.

5. Every year copies of all renewed licenceslicenses and certificates (as per Sub-Section 1.3) must be submitted, without which your registration shall stand automatically cancelled.

6. The Questionnaire, duly completed, may be couriered /shall be hand deliveredpresented by a technical person to:

PROCUREMENT SUPPORT DEPARTMENT

ADNOC HQ BUILDING, 5TH FLOOR, ROOM NO. 502, CORNICHE STREET ROAD ABU DHABI – U.A.E.

All correspondence shall be addressed to Head, Procurement Support Department.

7. In case of difficulty in filling up the Questionnaire, please contact:

HEAD, PROCUREMENT SUPPORT DEPARTMENT

PHONE : 02-6023081, FAX : 02-6024264

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ADNOCCONTRACTORS REGISTRATION &

PREQUALIFICATION QUESTIONNAIRE FOR CONTRACTOR

8. 8. There are 7 Sections to in this Questionnaire,:

as under:

Section 1 : General Information Section 2 : Work Experience Section 3 : Company Resources Section 4 : Organization & Human Resources Section 5 : Quality, Health, Safety & Environment Management Systems Section 6 : Pre-Qualified with ADNOC group of companies Section 7 : Company Declaration

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ADNOCCONTRACTORS REGISTRATION &

PREQUALIFICATION QUESTIONNAIRE FOR CONTRACTOR

C H E C K L I S T

S.NO. DESCRIPTIONCONTRACTOR’S CONFIRMATION

COMPULSORY ATTACHMENTS/CONFIRMATION

1. Covering letter (Request for Registration) from Local Contractor along with copy of:- of their

Abu Dhabi Department of Planning & Economy LicenseEconomic Development

Abu Dhabi Chamber of Commerce & Industry (ADCC&I) Membership Registration Certificate.

(Above Certificates must contain Activity: On-Shore & Off-Shore Oil & Gas Fields Services)

Ministry of LabourLabour Company Employee List of Employees

“To Whom It May Concern Certificate” from ADCC&I stating % of ownership.

Note: Attach copy of above LicenceLicenses/Certificates and their Official English Translations.

Official Authorization /Power of Attorney from the owner of authorised signatories.

2. Latest audited Balance Sheets/Annual Reports for last 3 years, duly certified by chartered accountants.

3. World Wide Customer List including Name of Client, Scope of Work, Value and Year of Project.

4. Company Profile outlining key areas (1 or 2 pages).

5. Confirm that Section 2 has been fully completed i.e. including Work Groups and Work Experience.CV of Key Staff (maximum 5)

ADDITIONAL ATTACHMENTS, IF APPLICABLE TO YOUR ACTIVITIES

6. Contractor Classification from Abu Dhabi Department of Economic DevelopmentAbu Dhabi Department of Planning & Economy

7. Copy of QAMS Certificate for ISO 9001:2000 2008 series from an international certifying Agency.Quality Management System Manual (soft copy if possible)HSE Manual (soft copy if possible)Procedures Manual (soft copy if possible)

8. Company Organization charts and brief write-up as per Section 4.

9. Company catalogues/brochures, if any.

OPTIONAL DOCUMENTS

10. Banker’s reference letter(s).

11. Customer reference letters.

12. Any other documents which you wish to enclose in support of this pre-qualification (Please list below):

Confirm that all Sections / Sub-sections applicable to you have been filled.

NOTES: – Item Nos. 1 to 5 are compulsory for Contractors.– Item Nos. 6 to 9 are compulsory for Contractors, if applicable.

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ADNOCCONTRACTORS REGISTRATION &

PREQUALIFICATION QUESTIONNAIRE FOR CONTRACTOR

– Item No. 10 onwards – optionally provide useful additional information for this pre-qualification.

AUTHORISED SIGNATURES

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ADNOCCONTRACTORS REGISTRATION &

PREQUALIFICATION QUESTIONNAIRE FOR CONTRACTOR

SECTION 1

GENERAL INFORMATION

1.1 COMPANY INFORMATION

1.2 OWNERSHIP, AUTHORIZED PERSON(S)

1.3 CERTIFICATES AND LICENSES

1.4 ASSOCIATED COMPANIES

1.5 FINANCIAL INFORMATION

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ADNOCCONTRACTORS REGISTRATION &

PREQUALIFICATION QUESTIONNAIRE FOR CONTRACTOR

SECTION 1PAGE 1 OF 4

SECTION 1 – GENERAL INFORMATION

SUB-SECTION 1.1 – COMPANY INFORMATION

FULL NAME

SHORT NAME (IF ANY)

DATE ESTABLISHED

NATIONALITY

INCORPORATED IN ABU DHABI OTHER EMIRATE WITHIN U.A.E.

AGCC COUNTRY OTHER COUNTRY

(AGCC = Arab Gulf Cooperation Council)

ADDRESSES STREET

MAIN OFFICE

IN ABU DHABI

P.O. BOX

TEL. NO.

FAX NO. E-MAIL:PARENT COMPANY HEADQUARTERS

STREET

P.O. BOX

TEL. NO.

FAX NO. E-MAIL:OTHER OFFICES STREET

P.O. BOX

TEL. NO.

FAX NO. E-MAIL:

HOME OFFICE STREET

(ONLY FOR ?????? CONSULTANTS/ ENGINEERS)

P.O. BOX

TEL. NO.

FAX NO. E-MAIL:

CONTACT PERSONS: (Please include name of Chief Executive of the Company)

NAME DESIGNATION TEL.NO. FAX. NO. E-MAIL

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ADNOCCONTRACTORS REGISTRATION &

PREQUALIFICATION QUESTIONNAIRE FOR CONTRACTOR

SECTION 1PAGE 2 OF 4

SUB-SECTION 1.2 – OWNERSHIP, AUTHORIZED PERSON(S)

(A) LOCAL COMPANY

100% OWNED BY U.A.E. NATIONAL 51% OWNED BY U.A.E. NATIONAL

NAME OF OWNER(S) NATIONALITY % OF OWNERSHIP

(B) FOREIGN COMPANY

IS IT A BRANCH IN ABU DHABI? YES NO

IF YES, PROVIDE THE COMPOSITION OF BOARD OF DIRECTORS OF PARENT COMPANY:

NAME POSITION NATIONALITY

OR, IS IT A SPONSORED COMPANY IN ABU DHABI? YES NO

IF YES, PLEASE PROVIDE DETAILS OF YOUR COMPANY’S SPONSOR IN ABU DHABI:

NAME(S) OF SPONSOR(S) ADDRESS TEL.NO. FAX. NO. E-MAIL

(C) AUTHORISED SIGNATORIES AS PER STATUTES/ARTICLES OF ASSOCIATION

NAME(S) DESIGNATION SPECIMEN SIGNATURE

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ADNOCCONTRACTORS REGISTRATION &

PREQUALIFICATION QUESTIONNAIRE FOR CONTRACTOR

SECTION 1PAGE 3 OF 4

SUB-SECTION 1.3 – CERTIFICATES AND LICENSES

(Please attach copies of Certificates/Licenses and their official English Translation)

CLASSIFIED FOR OIL AND GAS FIELD SERVICES? YES NO

(The above classification is necessary for registration as a ‘Contractor’)

TRADE LICENSE FROM ABU DHABI Department of Planning & EconomyDepartment of Economic Development

REGISTRATION NO. DATE OF REGISTRATION REGISTRATION EXPIRY DATE

TRADE REGISTRATION CERTIFICATE FROM ABU DHABI Department of Planning & Economy

REGISTRATION NO. DATE OF REGISTRATION REGISTRATION EXPIRY DATE

MEMBERSHIP REGN. CERTIFICATE FROM ABU DHABI CHAMBER OF COMMERCE & INDUSTRY

REGISTRATION NO. DATE OF REGISTRATION REGISTRATION EXPIRY DATE

OTHER LICENSES, IF ANYDATE OF

REGISTRATION

REGISTRATION EXPIRY DATE

SECURITY CO. LICENSE ISSUED BY ABU DHABI POLICE

ENVIRONMENTAL LICENSE ISSUED BY EPA ENVIRONMENTAL PROTECTION AGENCY

COMPANY CLASSIFICATION WITH Department of Economic DevelopmentPLANNING DEPARTMENT, ABU DHABI , IF AVAILABLE

CLASSIFIED FOR CATEGORY OF CLASSIFICATION DATE ISSUED

SUB-SECTION 1.4 – ASSOCIATED COMPANIES

NAME OF COMPANY ADDRESS TYPE OF ASSOCIATION* FOR ADNOC USE ONLY

* TYPES OF ASSOCIATION: W Wholly-Owned Subsidiary Co.P Partially Owned Subsidiary Co.

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ADNOCCONTRACTORS REGISTRATION &

PREQUALIFICATION QUESTIONNAIRE FOR CONTRACTOR

I Independent Co., but under same management

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ADNOCCONTRACTORS REGISTRATION &

PREQUALIFICATION QUESTIONNAIRE FOR CONTRACTOR

SECTION 1PAGE 4 OF 4

SUB-SECTION 1.5 – FINANCIAL INFORMATION

(All figures in Thousand Dirham)

FULL NAME OF COMPANY

YEAR

CURRENT ASSETS

CURRENT LIABILITIES

FIXED ASSETS

GROSS INCOME

LONG TERM LIABILITIES

NET INCOME

PAID UP CAPITAL

COMPANY’S AUDITORS

NAME ADDRESS

COMPANY’S BANKERS

Provide Main Banker’s Name, Address & Credit Facilities

BANK/INSTITUTION NAME ADDRESSCREDIT FACILITIES

AMOUNT DETAILS/CONDITIONS

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ADNOCCONTRACTORS REGISTRATION &

PREQUALIFICATION QUESTIONNAIRE FOR CONTRACTOR

SECTION 2

WORK EXPERIENCE

2.1 INSTRUCTIONS FOR COMPLETING SECTION 2

2.2 LIST OF WORK GROUPS INCLUDED IN SUBMISSION

2.3 WORK EXPERIENCE

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ADNOCCONTRACTORS REGISTRATION &

PREQUALIFICATION QUESTIONNAIRE FOR CONTRACTOR

SECTION 2PAGE 1 OF 3

SECTION 2 – WORK EXPERIENCE

SUB-SECTION 2.1 – INSTRUCTIONS FOR COMPLETING SECTION 2

The additional guidelines given below should be strictly followed in order to detail the information about your Company’s and it’s Associates’ experiences:

1. 1.Please refer to the ADNOC “Work Groups” listWORK GROUPS LIST” booklet provided. covering current areas of ADNOC’s interest. Please sSelect those Work Groups which are relevant to your Company’s work experience & included in your Abu Dhabi Trade License.

Attach supporting documents to prove and provide your work experiences for the selected Work Group(s).

Note: You may also include a specialized service offered by you which is not covered in the list but, in your opinion, may be of interest to ADNOC.

2. List the Work Groups which you have included/selected as per item (1) above, in Sub-section 2.2

3. Record each of your work experiences in a separate form. A specimen form is provided in Sub-section 2.3. Use photocopies of this form and give these copies serial numbers which should be entered in the column provided in Sub-section 2.2 in order to link your supporting experiences to the relevant Work Group(s).In case if you listed more thaen one Wwork gGroups, please use photocopies of the form which provided in Sub-section 2.3

4. First record the jobs directly handled by your Company.

5. Record your Work Experiences only for 3 most recent and major contracts for each ‘Work Group’, preferably from Oil & Gas Industry, will be considered as the minimum requirement. JobsIndustry Jobs with ADNOC/ADNOC Group of companies followed by those undertaken in Abu Dhabi/U.A.E. should be priority listed.

6. The description of Work Experience must identify the key areas of the work executed by your Company and extent of your direct involvement such as:

Turnkey Projects including Engineering Design, Supply, Erection and Supervision

Maintenance/Installation/Commissioning works including Supply of Manpower

Consultancy Services, i.e. Engineering Design, Study and Reports

Or, Construction work only.

7. Under ‘Contract Value’, specify the value of works executed directly by your Company including your sub-contractors.

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ADNOCCONTRACTORS REGISTRATION &

PREQUALIFICATION QUESTIONNAIRE FOR CONTRACTOR

SECTION 2PAGE 2 OF 3

SUB-SECTION 2.2 – LIST OF WORK GROUPS INCLUDED IN SUBMISSION

Please list the Work Groups in the following table, which shall be included in this submission in the WORK EXPERIENCE (SUB-SECTION 2.3) :

S.NO. WORK GROUP NO. NAME OF WORK GROUPSWORK EXPERIENCE

FORM NO.

Record any other specialized services offered, which are not included in the above List:

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SUB-SECTION 2.3 – WORK EXPERIENCE SECTION 2PAGE 3 OF 3

A D N O C - S S D / P S D / P R O C U R E M E N T S U P P O R T D E P A R T M E N T

L I S T O F 3 M A J O R E X P E R I E N C E S F O R T H E L A S T 5 Y E A R S

CONTRACTOR ‘S NAME CONTRACTOR REGISTRATION NUMBER

WORK GROUP NO. WORK GROUP DESCRIPTION

SL. NO.

PROJECT TITLE

LOCATION

ROLE IN PROJECT MAIN/SUB

CONTRACTOR

CLIENTBRIEF SCOPE OF WORK RELATED TO

ABOVE WORK GROUP/SERVICENO. OF

PERSONS DEPLOYED

YEAR(FROM – TO)

TOTAL CONTRACT

VALUE(AED)

VALUE FOR THIS WORK

GROUP (AED)

1 2 3 4 5 6 7 8 9 10

1

2

3

NOTES:1. List your experiences starting with Oil companies, other organisations in UAE, GCC countries & Worldwide.2. Include recently awarded contracts agreements, which should include scope of work with value.3. Please continue in additional sheets following the same format, if required. 4. Attach a list of references including contact names, addresses and telephone/fax numbers relating to each project cited above.5. Provide SSupporting dDocuments such as recently awarded contracts agreements/Purchase Orders/Works Orders, which should include scope of work and value for each contract listed in the form.(form of contract, signature pages).

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6. COLUMN 10: This value should reflect the relevant portion of the total jobvalue of the contract which relates directlyis related to the concerned work group. for which this form is being filled

e.g., iIf the total job value is AED 1 million & out of this the relevantand the portion of value for this Wworkg Group service is only AED 50,000, then write AED 50,000 in this column.

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ADNOC

CONTRACTORS REGISTRATION & PREQUALIFICATION

QUESTIONNAIRE REGISTRATION & PREQUALIFICATION QUESTIONNAIRE FOR

CONTRACTOR

SECTION 3

COMPANY RESOURCES

3.1 PLANT AND EQUIPMENT

3.2 INFRASTRUCTURE/OFFICE FACILITIES

3.3 TECHNICAL RESOURCES

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ADNOC

CONTRACTORS REGISTRATION & PREQUALIFICATION

QUESTIONNAIRE REGISTRATION & PREQUALIFICATION QUESTIONNAIRE FOR

CONTRACTOR SECTION 3PAGE 1 OF 3

SUB-SECTION 3.1 – PLANT AND EQUIPMENT

Please list thethe company’s Summarize your fixed/mobile Plants and Equipments in U.A.E. in the following table: which are in good working order and provide a similar list for Plant and Equipment outside U.A.E., as a separate attachment.

S. No.PLANT / EQUIPMENT AND

ITS MANUFACTURER/MAKEQTY. CAPACITY

YEAR OF MFR.

LOCATIONOWNED /

HIREDREMARKS

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ADNOC

CONTRACTORS REGISTRATION & PREQUALIFICATION

QUESTIONNAIRE REGISTRATION & PREQUALIFICATION QUESTIONNAIRE FOR

CONTRACTOR SECTION 3PAGE 2 OF 3

SUB-SECTION 3.2 – INFRASTRUCTURE

Please enclose the following document and tick the box to confirm:

(i) SPACE (Please specify the space occupied, in square meters)

Offices Warehouses Workshops/Plants Showrooms Laboratories Others

(ii) COMPUTERS/OFFICE AUTOMATION (Please specify the Facilities available)

No. Of Computers No. of other Hardware such as Printers/Plotters, etc.

Do you use AUTOCAD or similar program? YES NO

Please list application software used/available with you including the ones for Project Planning/ Control functions and for Engineering Design:

Please describe very briefly, communication network(s) / facilities available, such as Modems, Electronic Mail, Telefax, etc.:

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ADNOC

CONTRACTORS REGISTRATION & PREQUALIFICATION

QUESTIONNAIRE REGISTRATION & PREQUALIFICATION QUESTIONNAIRE FOR

CONTRACTOR SECTION 3PAGE 3 OF 3

SUB-SECTION 3.3 – TECHNICAL RESOURCES

(A) Please provide a brief write-up on how Planning, Procurement, Construction and Management of client projects are handled, emphasizing on Procurement, Personnel planning and their deployment, Project monitoring & control, Quality Control and Safety aspects.

(B) BACK-UP SERVICES:Please summarize all back-up services you have, to support your prime business

ENGINEERING & DESIGN WORKSHOPS & FABRICATIONTESTING, COMMISSIONING &

OTHER SPECIALIZED SERVICES

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ADNOC

CONTRACTORS REGISTRATION & PREQUALIFICATION

QUESTIONNAIRE REGISTRATION & PREQUALIFICATION QUESTIONNAIRE FOR

CONTRACTOR

SECTION 4

ORGANIZATION/HUMAN RESOURCES

4.1 ORGANIZATION CHART

4.2 HUMAN RESOURCES

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ADNOC

CONTRACTORS REGISTRATION & PREQUALIFICATION

QUESTIONNAIRE REGISTRATION & PREQUALIFICATION QUESTIONNAIRE FOR

CONTRACTOR SECTION 4PAGE 1 OF 1

SECTION 4 – HUMAN RESOURCES

SUB-SECTION 4.1 – ORGANIZATION CHART

Please encloseattache the following Organization Charts documents with this submittal:

Organization Chart for your Local Office in Abu Dhabi YES NO

Organization Chart for your Corporate Office YES NO

Organization Chart for your Home Office (if different from your Corporate Office)

YES NO

CV of Key Staff (maximum 5)included? YES NO

Ministry of Labour Company Employee List included?

Please mention the number of UAE nationals permanently employed by your company and confirm it with evidence documents issued or endorsed by the UAE Governmental Authority. which to be linked under linked documents screen:

Organization Chart for Abu Dhabi included? YES NO

Organization Chart for Head Office included? (if applicable) YES NO

Organization Chart for entire Group Operations, indicating location & business areas included? (if applicable)

YES NO

SUB-SECTION 4.2 – HUMAN RESOURCES

List below, by category of specialization, the number of personnel employed, indicating whether they represent core “permanent” employees or “hired” ones.

Please attach list of personnel under your company's visa issued by Ministry of Labour of UAE Government, Abu Dhabi.

Permanent: Under your Abu Dhabi Company's visaHired: Not under your Abu Dhabi Company’s visa in Abu Dhabi.

List below, by category of specialization, the number of personnel employed, indicating whether they represent core “permanent” employees or temporary “hired” ones.

(“Permanent” employees are those who have been with your Company for at least 3 years.)

CATEGORY OF SPECIALIZATION TOTAL NUMBER PERMANENT HIRED

Accountants/Accounts OfficerArchitectsChemical EngineersCivil Engineers & SupervisorsCoded Welders (for Pressure Welding)Commissioning EngineersContract / Project ManagementDesign / Drawing PersonnelElectrical Engineers / HVAC EngineersEstimating EngineersInstrument Engineers

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ADNOC

CONTRACTORS REGISTRATION & PREQUALIFICATION

QUESTIONNAIRE REGISTRATION & PREQUALIFICATION QUESTIONNAIRE FOR

CONTRACTOR

Machinery EngineersMechanical EngineersMetallurgistsProduction / Control EngineersPurchasing PersonnelQA / Inspection & Test PersonnelResearch & Development PersonnelSafety PersonnelSales PersonnelValves & Piping EngineersWelding Engineers / WeldersOTHERS: (Please specify)

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ADNOC

CONTRACTORS REGISTRATION & PREQUALIFICATION

QUESTIONNAIRE REGISTRATION & PREQUALIFICATION QUESTIONNAIRE FOR

CONTRACTOR

SECTION 5

QUALITY, HEALTH, SAFETY & ENVIRONMENT MANAGEMENTS SYSTEMS

5.1 QUALITY MANAGEMENT SYSTEMS

5.2 QUALITY ASSURANCE / QUALITY CONTROL QUESTIONNAIRE

5.3 HSE MANAGEMENT SYSTEMS

5.4 HSE PRE-QUALIFICATION QUESTIONNAIRE (GROUPS 1-3)

5.5 HSE PRE-QUALIFICATION QUESTIONNAIRE (GROUPS 4-9)

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ADNOC

CONTRACTORS REGISTRATION & PREQUALIFICATION

QUESTIONNAIRE REGISTRATION & PREQUALIFICATION QUESTIONNAIRE FOR

CONTRACTOR SECTION 5PAGE 1 OF 7

SUB-SECTION 5.1 – QUALITY MANAGEMENT SYSTEMS

1. Do you have an APPROVED Quality Management Systems? YES NO

2. Is it approved for your Abu Dhabi Office? YES NO

3. Name of the standard for which your QMS System is approved

4. Name of the approving authority (e.g. BV, LRQA, DNV, etc.)

5. Date of expiry of the certificate _____/_____/_____

6. Do you carry routine internal audits of your operations? YES NO

7. Is your system audited by external auditorsThird Party Auditorsbodies?

YES NO

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ADNOC

CONTRACTORS REGISTRATION & PREQUALIFICATION

QUESTIONNAIRE REGISTRATION & PREQUALIFICATION QUESTIONNAIRE FOR

CONTRACTOR SECTION 5PAGE 2 OF 7

SUB-SECTION 5.2 – QUALITY ASSURANCE / QUALITY CONTROL QUESTIONNAIRE

Please tick the appropriate box and provide required information:

1. Do you have ISO 9001 or ISO 29001 accreditation? YES NO

2. Have you executed major projects for any major international oil & gas companies such as Shell, BP, Aramco, PDO etc. If yes, attach details

YES NO

3. Is your QA System approved by any inspection / certifying agency Or by any large well-known company, viz. Lloyds, TUV, etc. or a major oil company?

YES NO

If yes, specify which ones.

4. Can youDo you have a capability to provide training facilities at site?

YES NO

If yes, please describe briefly.

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ADNOC

CONTRACTORS REGISTRATION & PREQUALIFICATION

QUESTIONNAIRE REGISTRATION & PREQUALIFICATION QUESTIONNAIRE FOR

CONTRACTOR SECTION 5PAGE 3 OF 7

SUB-SECTION 5.2 – QUALITY ASSURANCE / QUALITY CONTROL QUESTIONNAIRE

Please list allsummarize QA accreditations of your Company and its Associate companies, if any:

NAME OF COMPANY AND ITSASSOCIATE

ISO OR EQUIVALENT STANDARDS

(Please Specify)

Note:1. Please attach copies of QA QMS Certificate(s) ands, QAMS Manual(s) and Procedure

Manual(s).2. If your Company is not certified yet, but is going through the certification process, specify the

name of Agency employed, if any, and approximate certification completion time:(Please attach a letter from the Agency confirming the above).

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ADNOC

CONTRACTORS REGISTRATION & PREQUALIFICATION

QUESTIONNAIRE REGISTRATION & PREQUALIFICATION QUESTIONNAIRE FOR

CONTRACTOR SECTION 5PAGE 4 OF 7

SUB-SECTION 5.3 – HEALTH, SAFETY & ENVIRONMENT MANAGEMENT SYSTEMS

1. Did you have any deaths or LTI in the course of executing your work during the last 5 years?

YES NO

2. Do your facilities meet to Abu Dhabi Civil Defense requirements? YES NO

3. Do you have ISO 14001:1996 Environment Management System CertificationCertifications?

YES NO

4. Do you have OHSAS 18001 Certification? YES NO

5. Do you have a documented HSE Management System? YES NO

6. Do you have a dedicated HSE Engineer/HSE Officer? YES NO

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ADNOC

CONTRACTORS REGISTRATION & PREQUALIFICATION

QUESTIONNAIRE REGISTRATION & PREQUALIFICATION QUESTIONNAIRE FOR

CONTRACTOR SECTION 5PAGE 5 OF 7

SUB-SECTION 5.4 – HSE PRE-QUALIFICATION QUESTIONNAIRE (GROUPS 1-3)

TO BE COMPLETED BY THE CONTRACTOR AND VERIFIED/SCORED BY THE HSE ASSESSOR DURING THE SITE VERIFICATION:

Name of the Company :

Address

Name of the Person (Including position, title & e-mail address) completing this Checklist:

:

Nature of Business :

Telephone # :

Fax # :

Statement: I, certify that the details provided in this assessment are true and correct to the best of my knowledge.

Signature with Date :

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ADNOC

CONTRACTORS REGISTRATION & PREQUALIFICATION

QUESTIONNAIRE REGISTRATION & PREQUALIFICATION QUESTIONNAIRE FOR

CONTRACTOR SECTION 5PAGE 6 OF 7

SUB-SECTION 5.5 – HSE PRE-QUALIFICATION QUESTIONNAIRE (GROUPS 4 – 9)

Please tick the appropriate box and provide required information:

Name and address of premises to which this HSE questionnaire applies: -

Name and title of Management Representative responsible for your HSE Management System.

1. Do you have a formally documented HSE Management System?

YES NO

2. Do you have a HSE Manual / HSEMS Procedures? YES NO

If yes, provide copy of HSEMS manual & list of HSEMS procedures.

3. Since when HSEMS implemented in your company?

4. Does your HSE Management System meet the requirements of ISO 14000 Series / OHSAS 18000 series / other internationally recognized HSE System?

YES NO

If yes, specify National/International Standard to which It is developed

5. Is your HSE Management System approved by any inspection/certifying agency Or by any large well-known company, viz. Lloyds, BV, DNV, TUV, etc. or a major oil company?

YES NO

If yes, specify which one and provide last certification or surveillance audit report and copy of the certificates.

6. Can you provide training facilities at site? YES NO

If yes, please describe briefly

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ADNOC

CONTRACTORS REGISTRATION & PREQUALIFICATION

QUESTIONNAIRE REGISTRATION & PREQUALIFICATION QUESTIONNAIRE FOR

CONTRACTOR SECTION 5PAGE 7 OF 7

SUB-SECTION 5.5 – HSE PRE-QUALIFICATION QUESTIONNAIRE (GROUPS 4 – 9)

Please summarize list all HSE accreditations of your Company and its Associate companies, if any:

NAME OF COMPANY AND ITSASSOCIATED COMPANIES

ISO OR EQUIVALENT STANDARDS

(Please Specify)

Note: Please attach copies of HSEMS, HSE Certificate(s) and HSE Manual(s).

If your Company is not certified yet, but is going through the certification process, specify the name of Agency employed, if any, and approximate certification completion time:

(Please attach a letter from the Agency confirming the above).

Questionnaire completed by:-

Name:

Position:

Signature with Date:

Official Stamp

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Page 36: Registration Pre-qualification Questionnaire for Contractor (2)

ADNOC

CONTRACTORS REGISTRATION & PREQUALIFICATION

QUESTIONNAIRE REGISTRATION & PREQUALIFICATION QUESTIONNAIRE FOR

CONTRACTOR

SECTION 6

PRE-QUALIFIED WITH ADNOC GROUP OF COMPANIES

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Page 37: Registration Pre-qualification Questionnaire for Contractor (2)

ADNOC

CONTRACTORS REGISTRATION & PREQUALIFICATION

QUESTIONNAIRE REGISTRATION & PREQUALIFICATION QUESTIONNAIRE FOR

CONTRACTOR SECTION 6PAGE 1 OF 1

SECTION 6 – PRE-QUALIFIED WITH ADNOC GROUP OF COMPANIES

If your company is pre-qualified with any of ADNOC group of companies, please fill the following information and provide supporting documents:

S.No.ADNOC

COMPANY NAMEREGISTRATION No.

DETAILS OF / SERVICES PREQUALIFIED

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Page 38: Registration Pre-qualification Questionnaire for Contractor (2)

ADNOC

CONTRACTORS REGISTRATION & PREQUALIFICATION

QUESTIONNAIRE REGISTRATION & PREQUALIFICATION QUESTIONNAIRE FOR

CONTRACTOR

SECTION 7

COMPANY DECLARATION

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Page 39: Registration Pre-qualification Questionnaire for Contractor (2)

ADNOC

CONTRACTORS REGISTRATION & PREQUALIFICATION

QUESTIONNAIRE REGISTRATION & PREQUALIFICATION QUESTIONNAIRE FOR

CONTRACTOR SECTION 7PAGE 1 OF 1

SECTION 7 – COMPANY DECLARATION

We hereby declare and undertake that all the information/documents provided are under our full legal responsibility and confirm that we indemnify and hold ADNOC harmless against any claim or liability arising from the acceptance or use of such information/documentation whatever the source of such claim or liability.

We also authorize ADNOC to verify and seek any way of confirmatory of such information/documents.

We acknowledge that submission of this Questionnaire does not give us any right whatsoever to be invited to tender for any work being so tendered by ADNOC.

We undertake to inform Company of any changes and will periodically update/confirm (at least yearly) all items of supplied information.

Signature

Full Name

Designation

On Behalf Of

Date

Company stamp

Note: Official Authorization /Power of Attorney from the owner to the above signed should be attached.

We declare that the above statements and information are true to the best of our knowledge.

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Page 40: Registration Pre-qualification Questionnaire for Contractor (2)

ADNOC

CONTRACTORS REGISTRATION & PREQUALIFICATION

QUESTIONNAIRE REGISTRATION & PREQUALIFICATION QUESTIONNAIRE FOR

CONTRACTOR

We acknowledge that submission of this Questionnaire does not give us any right whatsoever to be invited to tender for any work being so tendered by ADNOC (Company).

We undertake to inform Company of any changes and will periodically update/confirm (at least yearly) all items of supplied information.

SIGNATURE

FULL NAME

DESIGNATION

ON BEHALF OF

DATE

OFFICIAL

SEAL

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