Pre-Qualification Form: RISK ASSESSMENT STUDY Consultants

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1 PRE-QUALIFICATION FORM RA CONSULTANTS Pre-Qualificatin Frm: RISK ASSESSMENT STUDY Cnsultants Name and Address f Cnsultants: Date: Revisin: 00 April 2008 Page 1 f 11

2 Ntes t Applicants Please type r print yur replies legibly. Enter the date n which yu cmplete the questinnaire at the bttm f each page. Please answer all questins. If the questin des nt apply t yu, please put NA (Nt Applicable). Please include all attachments (additinal pages) in the related sectins e.g. Sectin D attachments shall be D1, D2 r D3, etc. The fllwing are guidelines fr cnsultants seeking t perfrm cnsultancy services fr Trakhees-EHS Jurisdictin. General: 1. Registratin with Trakhees-EHS is required fr all Envirnment, Health & Safety cnsultants wh intend t wrk fr Trakhees-EHS jurisdictinal areas. EHS will maintain infrmatin n the qualificatins and capabilities f registered cnsultants in its infrmatin system. 2. Cnsultants wh are seeking registratin with EHS shall submit the applicatin with fllwing dcuments : 2.1 Intrductin letter addressed t the COO, Envirnment Health & Safety- Prts, Custms & Free Zne Crpratin, prviding a general brief n yur firm. 2.2 One cpy f the attached questinnaire fully cmpleted and signed by an Authrized representative. 2.3 Cpy f the supprting dcuments. Agencies t cmplete the frmat cvering all details and submit fr apprval. 3. The prcessing fee f AED 10,000/- fr New Applicatin payable by cash r cheque addressed t PCFC-Trakhees will be required t be paid fr the Registratin, which will be valid fr ne year. Fr Renewable f Registratin, every year a fees f AED 5,000/- will be required t be paid. 4. Cpy f valid Trade License issued frm Chamber f Cmmerce shuld be attached. 5. Cpy f ISO/quality certificatin shuld be submitted. 6. Premises/ffice culd be inspected by EHS at any time during the year. 7. The cmpany persn shuld have an insurance cverage fr the prfessinal liability. Please prvide details and attach a cpy f the plicy. 8. CVs f all lcally available engineers/ cnsultants whse names are required t be listed in the apprved list and passprt cpy with evidence f UAE residence (passprt cpy with visa page). 9. Attested cpies f academic and prfessinal qualificatin/certificatins. 10. Apprval frm ther authrities. 11. Prven track recrd summary fr majr relevant studies. Revisin: 00 April 2008 Page 2 f 11

3 Table f Cntents Please list belw any additinal pages attached with the Applicatin Frm. List Page N. 1.0 General Infrmatin Page Range f Engineering Specialties Page Operating Resurces Page Human Resurces Page Resume Frmat Page Experience/Past Perfrmance Page Organizatin & Management Page Quality Page 11 Revisin: 00 April 2008 Page 3 f 11

4 1.0 General Infrmatin 1. Name f the Cmpany : Address : Telephne Numbers : Fax Number : 2. Cntact Persn Name : Designatin : Mbile Telephne N. : 3. Curier Address : 4. Lcatin Plan : Please attach lcatin plan t shw existing ffice. 5. Bank Infrmatin : Bank Name Address Cntact Name Telephne N. Revisin: 00 April 2008 Page 4 f 11

5 2.0 Range f Engineering Specialties Please mark dwn n the table the type f services ffered with respect t each discipline which best describes yur Cnsultancy services in accrdance with yur cmmercial registratin license/certificate. Please indicate ONLY thse services f which yu have apprpriate experience and expertise, which can be verified by EHS. Type f activities Prvided: SL. Discipline Planning Design Supervisin Audits 2.1 Cmmercial Facilities 2.2 Residential Facilities 2.3 Industrial Facilities 2.4 General Warehusing Facilities 2.5 Dangerus Gds Warehusing 2.6 Petrchemical Industries 2.7 Oil Refinery 2.8 LP Gas Man/Strage/filling 2.9 Chemical Strage Tanks 2.10 Tbacc Industries 2.11 Htel Industries 2.12 Institutinal Facilities 2.13 Radiactive 2.14 Rail Rads Prts & Marine Industries 2.16 Cntainer Terminal 2.17 Cnstructin Industries 2.18 Pwer Statins/Sub Statins 2.19 Textile Industries Cement Industries 2.21 Steel Industries 2.22 Occupatinal Health Revisin: 00 April 2008 Page 5 f 11

6 3.0 Operating Resurces Please prvide details f the perating resurces available within yur firm. 3.1 Hardware Item N. Hardware Number Type Capacity Wrkstatin Cmputers Mnitrs Scanners Pltters/Clur Printers GPS Surveying Statins Mnitring Equipment Others * 3.2 Sftware N. Discipline Sftware Versin Fire & Explsin Index Mdeling Txicity & Dispersin Index Mdeling Cnsequence Mdeling Heat Radiatin Mdeling Drawing Planning/Scheduling Others (Specify) Revisin: 00 April 2008 Page 6 f 11

7 4.0 Human Resurces Please indicate the availability f the fllwing prfessinals. Please nte C.V. in the attached frmat is required fr all the prfessinals. N. f Technical Staff : N. f Administratin Staff : SL. Prfessinal Discipline N. 4.1 Fire Engineer Availability Yes/N Number Wrk Experience Intl. Gulf UAE 4.2 Envirnmental Engineer 4.3 Safety Engineer 4.4 Chemical Engineer 4.5 Mechanical Engineer 4.6 Marine Engineer 4.7 Structural Engineer 4.8 Civil Engineer 4.9 Draughtsman/CAD Operatr 4.10 Administratin Staff 4.11 Accuntant 4.12 Others * * T be listed ut Revisin: 00 April 2008 Page 7 f 11

8 5.0 Resume Frmat 1. POSITION : 2. NAME : 3. DATE OF BIRTH : 4. NATIONALITY : 5. EDUCATION QUALIFICATION: (State the name f the institutin, its lcatin and the year the qualificatin btained) 6. OTHER PROFESSIONAL TRAINING: 7. LANGUAGE AND DEGREE OF : PROFICIENCY 8. MEMBERSHIP OF PROFESSIONAL : SOCIETIES 9. EXPERIENCE WITH CURRENT COMPANY : 10. WORK EXPERIENCE IN THE UAE. : 11. WORK EXPERIENCE IN THE GULF : 12. WORK EXPERIENCE IN OTHER COUNTRIES : 13. CURRENT BASE ADDRESS : Revisin: 00 April 2008 Page 8 f 11

9 6.0 Experience/Past Perfrmance 6.1 Length In Business Please cnfirm the number f years experience as a Cnsultant Engineer Internatinal Gulf UAE 6.2 DETAILS OF INVOLVEMENT IN MAJOR PROJETS IN LAST 2 YEARS) SI. N Prject Name Lcatin Client Prject Value Prject Descriptin Duties Perfrmed * Additinal Sheets may be used if required. 6.3 Recrd f Claims/Arbitratin Please prvide 5 year recrd f Claims/Arbitratin with yur majr Clients. Revisin: 00 April 2008 Page 9 f 11

10 7.0 Organizatin and Management 7.1 Trade License Please prvide details f UAE Trade License (attach cpy) 7.2 Pre-qualificatins Please prvide details f Pre-qualificatins with Internatinal Gulf/UAE Organizatin. 7.3 Organizatin Chart Please indicate here r attach rganizatin chart shwing the cmpany structure shwing the psitins f directrs and all key persnnel. 7.4 Manager in-charge Please indicate here the manager in-charge f the cnsultancy ffice and attach CV in the prescribed frmat. 7.5 Sub-Cnsultants Please prvide details f any sub-cnsultants invlved by yu. Sl. N. Sub-Cnsultants Discipline 7.6 Jint Venture Please prvide details f jint venture, therwise state NOT APPLICABLE 7.7 Reference Please prvide details f the cmpanies/persnnel frm whm reference can be btained fr yur the cmpany. 7.8 Insurance Please prvide details f pssessin f PL/PI Insurance (attach plicy cpy) Revisin: 00 April 2008 Page 10 f 11

11 8.0 Quality 8.1 ISO Accreditatin Please cnfirm whether yur cmpany is ISO accredited? Prvide details. 8.2 Quality Statement Please prvide/submit yur cmpany quality statement? 8.3 Quality Assurance Manual Des yur cmpany have Quality Assurance Manual? If s, attach cpies f the cver and table f cntents pages. Revisin: 00 April 2008 Page 11 f 11

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