November 7, 2022

Vendor Risk Assessment

All forms on this page are for demonstration purposes only. No data will be captured or transmitted.

Instructions for completion

  1. The completed application form must be returned to the Purchasing & Materials Manager at the above address.
  2. Contractors MUST provide ALL of the information requested below by the above date. Failure to address any area may disadvantage your company with regard to the assessment process and possibly result in exclusion from any resultant tender enquiry or future works.
  3. If the Contractor is a company and is a part of a group of companies, the responses in this application must be provided by the Contractor and not by a parent or holding company on behalf of the Contractor.
  4. The Contractor shall attach, where appropriate, any supporting documents to this application marking clearly the name of the Contractor and the number of the questions in this application form to which the document refers. Please note that general company information or literature is NOT to be provided.

A Contractor details

B Contractor status

Have you submitted a pre-tender questionnaire similar to this one for the MEA in the last 12 months?

C Previous qualification

Have you submitted a pre-tender questionnaire similar to this one for the MEA in the last 12 months?
No Complete this questionnaire in its entirety.
Yes Please state which tender/contract this was for including date of submission:
Complete section E, F, H, J, K, Q, R and T
If the previous submission was incomplete or information contained within is no longer relevant or accurate please amend the relevant sections of this form and enclose any relevant documentation. Please note that in signing this form you are re-verifying the relevance and accuracy of the previous submission detailed above. Not applicable for this enquiry.

D Parent company information

If applicable, the Contractor shall provide the name of the parent or holding company together with the names of the other subsidiary companies of the parent or holding company.
Parent company
Other subsidiary companies

E Services provider

The Contractor shall list all the services provided by the company applicable to this application.
Services provided

F (i)Legal proceedings

The Contractor shall state whether they are subject to proceedings in relation to
(check all that apply):

F (ii)Failure to fulfill obligations

The Contractor shall state whether they have any outstanding obligations regarding:

G Bank details

The Contractor shall provide the name, addresses and contact name for their bank:
Contact
Name of bank
Branch address
Routing number
Account number

H Financial information

The Contractor shall provide the turnover figures (as related to the supply of similar services) for the last three trading years:
Year 1
Year 2
year 3
These figures must be entered and must be supported by a copy of full audited accounts.
Copies enclosed?

I Contractor’s offices & organization

  1. The Contractor shall provide details of the location(s) from which the services would be delivered.
  2. The Contractor shall provide a histogram or organization chart showing the company’s structure.
Details enclosed?

J Details of similar contracts

Have you carried out previous work of this type which is comparable in size and nature to the works?

The Contractor shall provide a list of such contracts awarded during the last three years with the values, dates and names of awarding entity:

Awarding entity

Contract value

Contract dates

Services provided

On time?
On budget?
Awarding entity

Contract value

Contract dates

Services provided

On time?
On budget?
Awarding entity

Contract value

Contract dates

Services provided

On time?
On budget?
Awarding entity

Contract value

Contract dates

Services provided

On time?
On budget?
Awarding entity

Contract value

Contract dates

Services provided

On time?
On budget?
Awarding entity

Contract value

Contract dates

Services provided

On time?
On budget?

It is essential that Contractors provide adequate objective evidence of similar work performed successfully, to agreed timescales and budget on similar projects.

References

Please provide contact details for three references for whom you have conducted similar work in the last three years.

Customer name & company
Phone
Services provided

Commitments

Please provide a list of contracts / orders which you currently need to fulfill that have not been mentioned earlier in this section.

Contract value
Services to be provided
Est. completion date

K Staff qualifications & previous relevant experience

Please indicate the number of full time staff / equivalent staff you normally employ:

Management

Design

Manufacturing

Construction

Administration

Quality control

Total

Please provide details of the experience, qualifications, etc. and arrangements for continuing professional development of key staff who would be employed on the project. Please answer on a separate sheet.
Details enclosed?
What resources (staff, plant and equipment), does your company intend to allocate to
these works? Please answer on a separate sheet.
Details enclosed?
Please provide the following details for staff to be allocated to these works on a separate sheet:

  1. details of any manual handling training undertaken;
  2. details of all plant operator training conducted;
  3. details of special equipment training undertaken appropriate for these services;
  4. details of any Health & Safety Training.
Details enclosed?
Please also include copy of appropriate certificates for staff members.

Please provide levels of experience in terms of years and examples for both skilled workers and supervisory staff.

Details enclosed?

L Quality assurance

Does your company have a certified Quality System complying with the requirements of ISO 9000 or an equivalent standard?

If yes, please provide a copy of your current certificate and state what additional certification, if any, your company is working towards.

Copies enclosed?

If no:

Is your company working towards certification of a Quality System?
When do you expect to become certified?
Does your company have a written Quality Policy?
Copy enclosed?
Does your company have a Quality Manual?
Copy of the index enclosed?

M Trade affiliations

The contractor shall give full details of affiliations with any trade association or official body and confirmation of whether they have any active involvement in their activities. All Contractors need to be legally authorized to perform services the US.

Are you legally authorized to work in the US?
If no, have you submitted an application?

N Sub-contractors

The Contractor shall give an indication of the type of any work to be subcontracted and the proportion of the works (expressed as a percentage of total value) that they may sub-contract. All Contractors need to be legally authorized to perform services the US.

Are your sub-contractors authorized to work in the US?
If no, have they submitted an application?

O Electronic trading

Do you currently process order and/or payment details between your company and your customers/ suppliers by electronic means?
If yes, please provide details.
Do you currently accept payments by credit card?
If no, when do you expect to be card capable?
If yes, what level of detail are you able to provide?

P Distribution

Do you own your own delivery vehicles?
Which delivery companies do you use?
Do you currently accept payments by credit card?
Do you have a storage facility?
If yes, where is it and what storage capacity does it have?

Q Insurance

The Contractor shall provide details of the following insurance held.

Employer’s Liability Insurance

Insurer
Policy number
Extent of coverage
Excess
Expiry date
Public Liability Insurance

Insurer
Policy number
Extent of coverage
Excess
Expiry date
Professional Indemnity Insurance

Insurer
Policy number
Extent of coverage
Excess
Expiry date
Product Liability Insurance

Insurer
Policy number
Extent of coverage
Excess
Expiry date
Copies of all relevant insurance certificates shall be enclosed.

Copies enclosed?

Please notify us of any restrictions. In particular that your insurance policies allow you to work in or around power stations, electrical sub-station sites, near electricity cables or working at height or depth.

R Health & Safety (Organization & Arangements)

The Contractor shall provide a copy of their latest Health & Safety policy document.

Copy enclosed?
Who in your organization has overall responsibility for the management of Health & Safety?

Name
Position
Phone
[mask mask-440 "(___) ___-____"]
Email
Expiry date
Please provide details of the experience and qualifications of the person you have nominated.

Details enclosed?
Please provide details of your organisation’s Health and Safety management structure. Clearly identify management responsibilities, delegation of duties, how you maintain and update your health & safety awareness and explain relevant procedures.

Details enclosed?
Does your company engage specialist Health and Safety consultants to provide advice and services (eg occupational hygiene services, noise level surveys etc) as appropriate to your work?

If yes, please provide details below:

Is your company a member of any group, body, organization, Trade Association or similar which promotes or has an involvement in Health and Safety matters?

If yes, give the name of the group etc and what involvement employees of your company have with it:

Does your company have a recognized Safety Representative(s)?

If yes, please provide details below:

Does your company have any up-to-date trained first-aiders who would be available on-site on a day-to-day basis?

If yes, please provide details below:

Does your company have any up-to-date trained first-aiders who would be available on-site on a day-to-day basis?

Health & Safety (Training)

Have all the Directors and Managers within your Company
attended a Health and Safety Course within the last five years?
Have all Site Supervisors within your Company attended Health and Safety courses within the last five years?
Have all your site workers received Health & Safety training that is appropriate for their type of work including specialist plant & equipment training?
Please provide evidence of the above-mentioned safety training.

Details enclosed?
Do you carry out safety induction training for all new employees?

Health & Safety (Performance)

Does your company prepare summaries, statistics and reports of all accidents and incidents at work at regular intervals?
If yes, please provide evidence of such reports compiled over the last three years.

Evidence enclosed?
Please provide accident statistics for the past three years on the following:

Fatal accidents
Major injuries
Over three-day injuries
Dangerous occurrences
Total number of lost days due to accidents
Average number of employees
Total number of days worked by employees
Has your company, or individuals employed by your company, been prosecuted for any breaches of Health and Safety legislation within the past five years?
If yes, please provide details and any action that was taken to prevent reoccurrences.

Details enclosed?
Have any Prohibition, Improvement or other Enforcement Notices been issued against your company within the past five years?
If yes, enclose a copy and give details of actions taken by your company following the issue of such notices.

Details enclosed?
Has your company ever received an award for accident prevention or good Health and Safety performance?
If yes, give the name of any award and provide evidence.

Details enclosed?
Are you able to provide references that verify/support your company’s good Health & Safety practice with regard to previous projects?
If yes, please provide details.

Details enclosed?

Health & Safety (Communications)

Please provide details of your systems for communicating safety information to your work force and clients.

Details enclosed?
Please provide details of the structure and frequency of safety meetings held with members of staff and site representatives.

Details enclosed?

Health & Safety (Safe systems of work)

Please provide three samples of any laid – down safety procedures or permit to work systems that you have developed.

Details enclosed?
Please provide three examples of substances used in your operations that are classified as hazardous to health and attach copies of all assessment records.

Details enclosed?
Please provide details of your formal system for monitoring and auditing the safety of your systems of work at site.

Details enclosed?

Health & Safety (Plant & equipment maintenance and inspection)

Please provide details of the procedures to ensure that plant, equipment and personal protective equipment for use on site is issued, maintained and kept in a safe condition.

Details enclosed?

S Environmental policy

Does your company have a certified Environmental Management System in compliance with US regulations?

If Yes, please provide a copy of your current certificate and state what additional certification, if any, your company is working towards.

Copies enclosed?
If No, is your company working towards certification of an Environmental Management System?
When do you expect to become certified?
Does your company have a written Environmental Management Policy?

If yes, please provide a copy.

Copy enclosed?

How does your company manage environmental matters and in particular the disposal of waste and the prevention of land contamination?

T Comments

Please feel free to make any other comments in support of your application.

U Confirmation

I confirm that the information contained within this document and attached are accurate.
Authorized signature
Printed name
Title
For and on behalf of
Authorized signature

This must be signed by the Contractor or a partner or authorized representative in his/ her own name and on behalf of the company/organisation making this application.