TENDER NO.

: PR1200002611
PROVISION OF FSO TANK THICKNESS GAUGING AND INSPECTION SERVICES
ATTACHMENT C

ATTACHMENT-C

BIDDER’S QUESTIONNAIRES

TENDER DOCUMENT

TENDER NO: PR1200002611

PROVISION OF FSO TANK THICKNESS GAUGING AND

INSPECTION SERVICES

CARIGALI HESS OPERATING COMPANY SDN. BHD.

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 TENDER NO.: PR1200002611
PROVISION OF FSO TANK THICKNESS GAUGING AND INSPECTION SERVICES
ATTACHMENT C

ATTACHMENT C
BIDDER'S QUESTIONNAIRE

This form MUST be completely filled by BIDDER. Write ‘NIL’ or ‘NOT APPLICABLE’ where
appropriate)
PRIVATE & CONFIDENTIAL
Section 1 - BIDDER's particulars
Section 2 - Particulars for the principal, parent company or affiliates
Section 3 - BIDDER’s Safety Pre-Qualification Form
________________________________________________________________________

SECTION 1.0: PARTICULARS OF BIDDING COMPANY

PROSCAN SDN. BHD

1.1 Full Company Name :
Registered Address :

Business Address : NO. 27 JALAN SIAKAP 3,

TAMAN PASIR PUTIH
81700 PASIR GUDANG
JOHOR DARUL TAKZIM

Telephone No : +607 2555245

Fax No : +607 2555246

Contact Person for this tender : NORLIZA BINTI ALI

Telephone No : 011 13175542

1.2 Nature of company: Private Ltd/Public/Corporation/Proprietorship/Partnership/

Others

1.3 11/05/2009
Date of company registration / incorporation: ______________________________
856340X
File Registration Number (Registrar of Companies): ________________________
MALAYSIA
Country of Registration: ______________________________________________
11/05/2009
1.4 Date of commencement of business operations: ___________________________

1.5 Is your company a tax resident in Malaysia? Thailand? Or Other Country: Yes / No
Yes- Malaysia
(Please specify) ____________________

Please attach a copy of the confirmation letter by your country’s Tax Authority.

C2094846803 NIL
Tax Reg. No. in Malaysia ________________; Thailand: ___________________
NIL
Other Country __________________
Does your company have any branch and/or office in Malaysia? Yes / No; NO
Thailand? Yes / No NO

If yes, please list and provide evidence of its existence as follows:-

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(i) Tax return for the branch / office

and/or
(ii) Application for registration to the Ministry of Commerce of Thailand
NIL
__________________________________________________
__________________________________________________

If yes, does your company branch and/or office in Malaysia or Thailand involve in this
NO
Contract? ___________________________

1.6 To which Income Tax Branch/Office did you submit your last Income Tax return in Malaysia?
LHDN, MALAYSIA
__________________________; NIL
Thailand? _____________________

1.7 Capital : Authorized Paid-up Working

Structure
RM 500,000.00 RM 350,000.00

1.8 Bankers:

Name Address
BANK ISLAM MALAYSIA BERHAD Cawangan Pasir Gudang, Tingkat Bawah & 1,
Lot 112719, No. 11 Pusat Perdagangan Pasir Gudang,
Jalan Bandar 81700 Pasir Gudang, Johor

Bank Account Number 01087010034351

1.9 Company Profile: Equity participation in the company.

Country %

Malaysia ______
Thailand ______
Others i)
(By Countries) ii)
iii)

1.10 Principal Officers legally empowered to act and sign on behalf of company:

No Name Title

i) ZAIDI BIN ABUZAR MANAGING DIRECTOR

ii) MOHD RAZNAN BIN RAMLI OPERATION MANAGER

iii)
iv)

1.11
Principal owners of company %

i) ZAIDI BIN ABUZAR 40 %

ii) NURUL'AIN BINTI MOHD ZIN 60 %

iii)

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1.12 Details of No. of No. of No. of %

Employees Malaysian Thai Others

Professional
Semi-Professional
Non Professional
Total

1.13 Is your company an Affiliate of an overseas parent company involved in similar nature of work
as the tender? Yes / No? NO.

If yes, give particulars of the parent company and how long has the parent company been in
this nature of business? ___________________________________________

If no, is your company registered as a foreign company doing business in Malaysia? Yes / No; NO
Thailand? Yes / No NO

1.14 Who in particular will guarantee the operational and financial performance of the company?
__________________________________________________________________
MANAGING DIRECTOR
__________________________________________________________________

1.15 Does your company have permission of Bank Negara / Bank of Thailand to operate bank
accounts in foreign currencies with banks outside of Malaysia / Thailand? Yes / No? NO . If
yes, please attach documentary proof of this permission.

1.16 For the WORK being tendered, will your company be performing the major portion of the job?
YES
Yes/No __________

If no, state the name of the company who will perform the major portion of the WORK in
Section 2 and state below the relationship with the company who will be performing the WORK
NOT APPLICABLE’
________________________________________________________

Please attach a copy of your agreement with the said Company.

1.17 Are you eligible for exemptions from customs duties and sales tax on any materials, which are
YES
required to be imported into Malaysia / Thailand for the WORK? __________

If not, do you have any specific plans to apply to the Malaysia / Thailand / Thai Treasury for
exempt status?

1.18 Has and will any litigation, suits or court action be taken against your company? Yes / No?
NO If yes please give detail.
____.
________________________________________________________________

1.19 Who is authorised to sign this CONTRACT on behalf of the company?

ZAIDI BIN ABUZAR -MANAGING DIRECTOR
__________________________________

1.20 As both Malaysian and Thai withholding taxes may apply to goods or services under this
contract, it is necessary for CARIGALI HESS to understand the legal structure and operating
environment of the BIDDER. Therefore, please provide a narrative describing the structure of
the BIDDER’s organization. This should include but not limited to the following:

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1.20.1 Describe the legal structure of BIDDER and related entities to be utilized in
performance of this contract. Are you a corporation, branch or partnership?
Registered in what country(ies)?
____________________________________________________________

1.20.2 Do you maintain an office in Malaysia? __________ Thailand? _________

1.20.3 Do you have any employee in Malaysia? __________ Thailand? ________

1.20.4 Do you file a corporate tax return in Malaysia? _______ Thailand? _______

1.20.5 How and where do you do business? : ______________________

Will you be invoicing from Malaysia or Thailand? ______________

1.20.6 Remittance will be to which country? _________________________

1.20.7 What are your expectations as to taxes, especially Malaysian and Thai withholding
and income taxes? Do you expect to also be taxed in a country with a Double Taxation
Agreement with Thailand or Malaysia?
____________________________________________________________
____________________________________________________________

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SECTION 2.0: PARTICULARS OF PRINCIPAL, PARENT COMPANY OR AFFILIATES

PROSCAN SDN. BHD
Full Company Name :

Registered Address :

Business Address : NO. 27 JALAN SIAKAP 3

TAMAN PASIR PUTIH
81700 PASIR GUDANG
JOHOR DARUL TAKZIZM

Telephone No : +607 2555245

Fax No : +607 2555245

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SECTION 3.0: BIDDER’S SAFETY PRE-QUALIFICATION FORM

3.1 CARIGALI HESS is continually improving safe and healthy place for employees, contractors,
and neighbors. Only those contractors who have demonstrated management leadership and
systems resulting in good safety and health performance are added to the approved
contractors list.

3.2 Please complete the pre-qualification form (PQF): APPENDIX I and return it as instructed if
you wish to be included on our approved contractor list.

3.3 CARIGALI HESS expects that the Contractor to:

3.3.1 Have a documented health and safety program that meets CARIGALI HESS
standard requirements applicable to your work.
3.3.2 Have a program for compliance with Process Safety Management
requirements of contracts. (Note: Only for covered processes)
3.3.3 Agree that any subcontractors utilized will meet the requirements listed
above

3.4 CARIGALI HESS hereby reserves the right to inspect and interview any of your key
personnel. Any misrepresentation of facts will result in rejection / disqualification of your
company as CARIGALI HESS approved contractors.

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ATTACHMENT C

APPENDIX 1 OF ATTACHMENT C
BIDDER’S HSE PRE-QUALIFICATION FORM
(PQF)

GENERAL INFORMATION
1. Company Name: PROSCAN SDN BHD Telephone: 07 2555245
Street address: NO. 27 JALAN SIAKAP 3 Mailing Address:
TAMAN PASIR PUTIH
81700 PASIR GUDANG

2. Officers Name Years With Company

President
Vice President
Treasurer

3. How many years has your organization been in business under your present firm name?

4. A. Parent Company name:

City: State: Zip:
Subsidiaries:

B. Principal Company name:

City: State: Zip:

5. Under Current Management Since (Date):

6. Contact for Insurance Information:
Tittle: Telephone: Fax:

7. Insurance Carrier(s):
Name Type of Coverage Telephone

8. Are you self insured for Worker’s Compensation Insurance? Yes No

9. Contact for Requesting Bids:
Tittle: Telephone: Fax:

10. PQF Completed By:*)

*) This PQF Form must be completed and signed by the Company’s authorized first level
Management
Title: Telephone: Fax:

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ORGANIZATION
11. Form of Business:
12. List other types of work within the services you normally perform that you subcontract to others:
___________________________________________________________________________
___________________________________________________________________________

COMPANY WORK HISTORY

13. Major jobs in progress:*)
*) Use additional paper as necessary
Customer/Location Type of Work USD Customer Contact Telephone

14. Major jobs completed in the past three years:

Customer/Location Type of Work USD Customer Contact Telephone

15. Are there any judgements, claims or suits pending or outstanding against your company?

If Yes, please attach details. Yes No

16. Are you now or have you ever been involved in any bankruptcy or reorganization proceedings?

If Yes, please attach details Yes No

HSE MANAGEMENT POLICY
17. POLICY STATEMENT
a) Do you have a written statement of your Environmental, Health and Safety policy?
(Please provide a copy.)
b) How is the safety policy communicated to employees?
c) Is management accountable for environmental, health and safety performance? If so,
give details how this is practised.

18. EMERGENCY RESPONSE PROCEDURES

Do you have an emergency response plan? (Please provide a list of procedures.) Describe
how emergency preparedness is maintained and the command structure in case of emergency.
19. BASIC SAFETY RULES (SAFETY MANUAL)
a) List your EH&S procedure manuals (Please submit current copies.
b) Do you have written working practices and safety instructions such as those covering
scaffolding,
lifting, heavy equipment, chemical handling or excavation? (Please provide a copy, if
available).
20. ACCIDENT REPORTING PROCEDURE.
Please attach your Accident Reporting Procedure
21. EMPLOYEE ORIENTATION PROGRAM
a) Do you have a EH&S Orientation Program for new hires & newly hired or promoted
Supervisors?
b) State the instruction of the program and the length of the orientation program?
22. SAFETY MEETING PROGRAM
a) Do you organize in-house safety meetings? Please describe the frequency, attendance
and topics.
b) Do you organize campaigns to stimulate safe working practices? (If so, please give
details).

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23. SAFETY TRAINING PROGRAM

a) What safety training is given to your employees? (Please provide details and examples).
b) Have the personnel who will undertake specific work received formal training in safe
working practices and in the use of protective equipment relating to the potential hazards
of the work? (Please provide details).

24. SAFETY INSPECTION PROGRAM

a) Do you conduct safety inspections/audits of your operations? If so, at what frequency
and how are unsafe acts and/or conditions resolved/
b) Please provide details of any OSHA, EPA or other enforcement authority’s inspection,
citation or penalties levied during the last three (3) years. Were any proposed citations
contested? If so, explain.

25. PROFESSIONAL SAFETY SUPPORT

a) Do you have a safety organization? (Please provide an organization chart and a
description of responsibilities.)
b) Who is the most senior person for coordinating safety matters and what is his/her
experience?
c) What type of safety qualifications does your staff have? Describe.

26. INDUSTRIAL HYGIENE

a) Do you have an industrial hygiene program? If so, what does it include?
b) Do you have a risk assessment, or similar type method, for identifying work place
hazards?
Please descibe this process.
c) If you introduce hazardous materials/substances into the work site, describe the
Process you will use to document and control these.

27. PERSONAL PROTECTIVE EQUIPMENT

a) Do you provide appropriate personal protective equipment (PPE) for your employees?
Please provide a list of the PPE for the scope of this work.
b) Do you provide training on how to use PPE? Explain the content of the training and any
follow up.
c) Do you have a program to ensure that PPE is used and maintained?

28. ENVIRONMENTAL
a) Please provide the number of accidents resulting in environmental damage in the amount
greater than $50,000 for the last 24 months. Attach copies of any governmental reports
submitted.
b) Do you have procedures for waste disposal?
c) Do you have procedure for spill reporting?
d) Do you have procedures for spill clean up?
e) Please provide details of any of your equipment related to environmental matters.
f) Who is the person in charge of coordinating environment matter and what is his
experience.

29. EQUIPMENT AND MATERIALS MANAGEMENT

a) Do you conduct inspections on operating equipment (e.g. cranes, forklifts) in compliance
with regulatory requirements?
b) Do you maintain the appropriate inspection and maintenance certification records for
operating equipment?

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30. STATISTICAL INJURY & ILLNESS DATA

a) What type of safety records do you maintain, e.g.
- fatalities
- injuries
- dangerous occurrences
- environmental damage costs
- property and/or vehicle damage costs
b) Please provide the details of your annual safety record for the last three (3) years. (If a
U.S. employer, please submit OSHA 200 logs for sites worked in for the last 3 years).
- number of fatalities
- number of lost work day case injuries
- number of total recordable injuries
- number of days lost
- number of relevant exposure hours
c) If a U.S. employer, do you have Worker’s Compensation Experience Modification Rates
(EMR’s) established as a part of your insurance premiums? If so, please provide your
EMR number.
d) Please provide the incidence rate of your company over the last three (3) years using the
following formula:
Incident Rate= (N/H ) (200,000)
Where:
N= number of injuries and /or illnesses or lost workdays
H= total hours worked by all employees during a year
(if the hours are unknown, 173.3 hours per employee-month should be
used)

31. INCIDENT INVESTIGATION

a) Do you have a procedure for the investigation, reporting and follow-up of accidents,
dangerous occurrences or occupational illnesses?
b) Are the results of accident investigations communicated to the employees? (Please give
examples).
c) Please provide the names of major sub-contractors if known at this time.
32. SUB-CONTRACTORS
a) What safety requirement do you, the Contractor, specify for your sub-contractors?
b) Do you have procedures for the control of the safety performance of a sub-
contractor? (If so, please give details).
c) Please provide the names of major sub-contractors if known at this time.
33. OTHER
a) Do your employees read, write and understand English such that they can perform their
job tasks safely without an interpreter? If no, provide a description of your plan to assure
that they can safely perform their jobs.
b) Please provide the details of any significant safety achievements or awards.

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