VENDOR PRE-QUALIFICATION FORM

If you are providing installation service, when required, does you company have insurance policies in place?*

Rows	YES	NO	NOT APPLICABLE
WORKMEN COMPENSATION INSURANCE
EMPLOYER'S LIABILITY INSURANCE

YESNO
Please upload all international approved quality certificates *

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Showcase projects: describe 3 ongoing and/or completed projects in the last 12 months*

Rows	PROJECT 1	PROJECT 2	PROJECT 3
PROJECT NAME
LOCATION
CLIENT NAME
CLIENT CONTACT INFO
CONTRACT VALUE
SCOPE OF WORK
PERCENTAGE (%) OF CONTRACT COMPLETION
COMPLETION DATE

YESNO
Please describe which previous (or pending) judgments, claims or arbitration proceedings against the company within the last 5 years
YESNO
Please describe lawsuits or requested arbitration, with regard to contracts, which company filed within the last 5 years

Please upload a copy of the most recently audited accounts for your company covering the last two years. (Otherwise for the period that is available if trading is less than two years)*

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Please upload a statement of the company’s turnover, Profit and Loss and cash flow for the most recent full year of trading. (Otherwise for the period that is available if trading is less than two years)*

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YesNo

Bank details*

Rows	Provide required information
NAME OF BANK
BANK ADDRESS
NAME OF CONTACT PERSON IN YOUR BANK
TELEPHONE NUMBER OF CONTACT PERSON IN YOUR BANK
EMAIL ID OF CONTACT PERSON IN YOUR BANK
ACCOUNT NAME
ACCOUNT NUMBER
IBAN NUMBER
SWIFT/ BIC

YESNOONLY CSRONLY SUSTAINABILITY
What environmental management systems and certification systems are you using? Please indicate whether they are consistent with international standards.
What local environmental regulations are you required to comply with?

How likely are you to implement new initiatives or policies within the next year to reduce your environmental impacts and support a green strategy?*

	1	2	3	4	5	6	7	8	9	10

1 is Not at all likely, 10 is Extremely likely

What are your 'green' and sustainable product trends? (E.g. Bamboo toothbrush, recycled plastic coat hangers)*

Please rate the following statements based on the extent to which they are implemented at your company.*

Rows	NEVER	RARELY	SOMETIMES	FREQUENTLY	ALWAYS
Final products are packaged using RECYCLE materials
Final products are packaged using RECYCLABLE materials
We track, report and manage our use of energy, chemicals and water
We recycle our inputs (energy, chemicals, water)
Our facilities use renewable energy

YESNONOT SURE
Organic MaterialsRecycled MaterialsVirgin MaterialsRecyclable MaterialsBiodegradable MaterialsCompostable MaterialsRenewable Materials/ResourcesNon-Renewable Materials/ResourcesOther
General WasteCompost WasteRecyclable WasteOther
YESNO
Do you have in place any guidelines or procedures for managing end of life cycle for your product

Form Completed By:*

Rows	Provide Required Information
NAME
POSITION
DATE
TELEPHONE NUMBER
EMAIL ADDRESS

The information contained in this questionnaire will be held in confidence by Orsini SPI and it's clients and used for the purpose of determining your suitability for meeting our general requirements. Further assessment and selection may be required before and indication can be given on the success of your application for inclusion on our preferred tender list.
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Vendor Pre-Qualification Form