Form No: CVM-Q-0001
Rev No : 2
Rev Date: 2010-11-01
INDUSTRIAL PLANT SERVICES LIMITED
CONTRACTOR/SUPPLIER PRE-QUALIFICATION FORM
INDUSTRIAL PLANT SERVICES LIMITED
THIS FORM IS APPLICABLE TO CONTRACTORS AND SUPPLIERS
ALL INFORMATION PROVIDED IN THIS DOCUMENT WILL BE
TREATED IN THE STRICTEST CONFIDENCE
1.0SECTION A:GENERAL INFORMATION
- Company Registered Name: ______Address : ______
______
- Years in operation:______
- Type of ownership
Sole Proprietorship
Partnership
Private Limited Liability Company
Public Company/Corporation
- Please state the names of the Principal Owners, all Directors, and Parties holding 10% or more cumulative voting rights.
PRINCIPAL OWNERS / DIRECTORS / OTHER PARTIES WITH INFLUENTIAL VOTING RIGHTS
SECTION B: CONTACT
- Telephone No.: ______
- Telefax No.: ______
- Contact Person(s): ______
- Cellular No.: ______
- Pager No.: ______
- E-Mail Address: ______
SECTION C: OTHER DATA
- Registered name of Parent (affiliated) Company: (if applicable) ______
- Please complete Appendix A for Contractor Services.
- Please complete Appendix B for Products and Supplies.
- PLEASE ATTACH THE FOLLOWING DOCUMENTS:
Certificate of Registration (if applicable)
Vat Certificate for Local Suppliers/Contractors (if applicable)
Recent Board Of Inland Revenue Clearance Certificate (Local Vendors)
Company Brochure (if applicable)
Product Catalog (for vendors only) (if applicable)
2.0FINANCIAL INFORMATION
2.1 Please attach the following Audited Financial Statements for the last three (3) years of operations:
- Balance Sheet
- Income Statement
- Cash Flow Statement
- Bank Letter (For companies in operation less than 3 yrs)
2.2 Please provide details of the following in AppendixC.
- Outstanding guarantees given by the company
- Outstanding bank guarantees issued on behalf of the company
- Statement of outstanding litigation charges in excess of $ 25,000 that your company is involved in as a plaintiff or as a debtor
2.3Financial facilities available to clients:
Is a credit facility available?
Yes
No
If yes, please state the number of days:
Greater than 60 days
Between 30 and 60 days
Less than 30 days
______
2.4Contact person for financial matters: ______
Telephone No: ______Telefax No: ______
Cellular No: ______E-mail Address: ______
2.5Name and Address of Banker: ______
______
______
A/CName: ______A/C No: ______ABA No: ______
3.0TECHNICAL COMPETENCE & SUPPORT INFRASTRUCTURE
3.1HUMAN RESOURCES
Please complete APPENDIX D, providing details of the technical skills which exist in your organization, that are integral to the services you expect to provide to IPSL.
3.2PROFESSIONAL ALLIANCES/ASSOCIATIONS
Please complete APPENDIX E, detailing the names of all companies and/or individuals with whom your company has formal affiliations through joint venture / official agreements and indicate their sphere of operations and expertise.
4.0COMPANY REFERENCES
4.1 Please list your six (6) major customers in APPENDIX K.
NOTE: In addition to the completion of this form(Form No;C-VM-001) and the supporting appendices, either of the following should be completed;
To become registered as an approved Contractor-
- Please complete Form No: C-VM-002 together with the attached appendices applicable to Contractors only.
To become registered as an approved Supplier-
- Please complete Form No: C-VM-003together with the attached appendices applicable to Suppliers only.
I/WE CERTIFY THAT THE ABOVE INFORMATION IS CORRECT AND THAT FALSE INFORMATION SUPPLIED WILL DISQUALIFY ME/US FROM BEING PLACED ON THE APPROVED LIST OF CONTRACTORS/VENDORS.
NAME:______
SIGNATURE:______
DATE:______
COMPANY STAMP:
PLEASE BE ADVISED THAT PLACEMENT ON THE APPROVED LIST OF CONTRACTORS/SUPPLIERS IN NO WAY GUARANTEES THE AWARD OF WORK.
Contractor/Supplier Pre-Qualification FormPage 1 of 6