<p> Form No: CVM-Q-0001A Rev No: 1 Rev Date:2010.11.01</p><p>______</p><p>INDUSTRIAL PLANT SERVICES LIMITED</p><p>‘A’ To ‘E’ And ‘K’</p><p>APPLICABLE TO BOTH CONTRACTORS AND SUPPLIERS ALL INFORMATION PROVIDED IN THIS DOCUMENT WILL BE TREATED IN THE STRICTEST CONFIDENCE Form No: CVM-Q-0001A Rev No: 1 Rev Date:2010.11.01 Company name: ______</p><p>Date (YYYY/MM/DD): ______APPENDIX A CONTRACTOR SERVICES</p><p>Please tick the appropriate box(es) for which you wish to be pre-qualified/Registered*.</p><p> Accounting  Consultancy –  Air Conditioning o Engineering  Architectural o Financial  Barge and Tug Rental o Information Technology  Bicycle Service & Repairs o Legal  Building Maintenance o EAP & Psychological  Calibration & Testing Services o Other (Specify) ______ Catalyst Handling/Loading  Container Rental  Catering Services  Cooling Tower Repair  Ceramic/Epoxy Coatings  Courier Services  Chemical Cleaning o Local  Chemical Coating o International  Civil Works-  Customs Brokerage Road & Paving o  Diesel Engine Services Concrete Foundation& o  Diving Services Structures  Electrical Drainage o o Services Building Construction & o o Labour Repairs o Engineering Design  Communications  Employment Agency  Computer –ICT Services o Recruitment Services Preventative Maintenance o o Personnel Supply Hardware Equipment Repair o  Environmental Testing & Monitoring o Server Repair o Technical Services-  Networking Operating System   Equipment Rental  Business Software o Industrial Rental  Fork Lift Rental  Creep Measurement  Crane Rental Testing  Compressor  Load Testing  Welding Units  Instrumentation  Lighting Towers o Services  Pump Rentals o Labour  Man Lifts  Insulation Works o Office Rental  Janitorial  Event Management Services o Servicing of Air Refreshner units  Exchanger o Sanibins o Cleaning o Labour (Maids & Cleaners) o Re tubing  Landscaping o Manufacture  Machining Services  Fibre Glass Works o Field  Freight Forwarding o Shop  Grounds Maintenance  Mechanical  Hydraulic Bolt Torquing o Services  Hydraulic Equipment Repairs o Labour  Hydroblasting o Engineering Design  Inspection & Testing Services  Medical Services o Inspection- o Facilities  Non Destructive o Personnel Examinations o Lab  Qualified Inspection  Motor Rewinding Labour  OEM Specialists (Plant Equip. Repair &  Inspection Services) Equipment  Online Repairs  Statutory Inspections o Crimping Services o Hot Tapping o Leak Sealing o Testing-  Painting  Replica o Service Metallography o Labour  Metallurgical  Pest Control Testing  Plumbing & Sanitary Works  Refractory Works  Rotating Equipment  Testing & Analysis(Lab Services) o Repair  Training o Labour  Transportation Services  Safety  Travel Agency o Labour  Vacuum Truck Services o Firefighting Equipment  Valve Repair Services  Vehicle Leasing & Rental o Specialised Equipment  Vehicle Servicing Servicing  Waste Disposal  Sandblasting o Hazardous/Toxic  Scaffolding o Sewage  Security o Garbage Disposal  Special Services  Water Treatment Services Please specify ______ Welding & Fabricating  Steam Blowing o Specialized Services  Storage Tanks Fabrication/Erection o Regular Works  Tax/Audit  Woodworking APPENDIX B VENDOR PRODUCTS & SUPPLIES</p><p>Please tick the appropriate box (es) for which you wish to be pre-qualified . SECTION B: TYPE OF BUSINESS/COMMODITY TO BE PRE-QUALIFIED</p><p> Air Condition o Safety Apparel  Bars, Plates, Angle, Sheets o General Supplies  Bearings  Furnaces & Boilers  V-Belts  Galley Supplies  Building Material  Gaskets, Seals, Packing, Shim  Burner  Guages  Catalyst  Hardware & General Supplies  Chemicals  Hoses o Water Treatment o Caustic Soda  Industrial Gases o Sulphuric Acid  Industrial Packaging Supplies o Cleaning o Bags o Other o Shrink Film Please Specify______o Cardboard Tear Sheets  Computer & Communication Equipment o Strapping & Accessories  Convertors  Instruments  Electrical  Instrumentation Equipment & Accessories o Conduit & Fitting  Insulation & Refractory Materials o Lamps & Lighting Fixture  Janitorial Supplies Motors & Accessories o  Laboratory Supplies & Accessories o Wires, Cables & Accessories Lumber (Cooling Tower) o Communication, Alarm  o Switch/Control  Mechanical Repair Equipment & Accessories  Exchangers  Medical Equipment & Supplies  Fans & Blowers  Office Equipment  Fasteners  Office Furniture & Appliances  Filters & Filtration Supplies  Office Supplies  Fire & Safety Supplies o Equipment  Oils & Lubricants o Foam  Paints, Varnishes & Coatings o Safety Footwear  Pallets  Pipe & Pipe Fittings  Printing  Reactors  Resins  Spares Please Specify ______ Stationery  Tools o Testing & Inspection Equipment o Hand Tools o Power Tools o Welding  Tubing & Fittings  Valves & Accessories  Vessels  Welding Equipment & Accessories APPENDIX C FINANCIAL INFORMATION</p><p>DETAILS VALUE IN $TT</p><p>OUTSTANDING GUARANTEES GIVEN BY THE COMPANY:</p><p>OUTSTANDING BANK GUARANTEES ISSUED ON BEHALF OF THE COMPANY:</p><p>STATEMENT OF OUTSTANDING LITIGACTION OR DISPUTES CHARGES IN EXCESS OF $25,000 THAT YOUR COMPANY IS INVOLVED IN AS A PLAINTIFF OR AS A DEBTOR:</p><p>APPENDIX D HUMAN RESOURCES INFORMATION (SUPERVISORY STAFF)</p><p>YRS SUPERVISORY STAFF QUALIFICATIONS EXPER. (director, manager, supervisor, (Degree, Advance Diploma, POSITON In the engineer, foreman etc) Other) Industry TEMPOR CONTRACT PERMANENT ARY APPENDIX D (CON’T) HUMAN RESOURCES INFORMATION (OTHER STAFF)</p><p>YRS TECHNICAL STAFF QUALIFICATIONS EXPER. (welder, draftsman, NO. OF PERSONNEL ( Diploma, Certificate, other) In the technician, etc) Industry TEMPOR CONTRACT PERMANENT ARY</p><p>APPENDIX E PROFESSIONAL ALLIANCES/AFFILIATIONS</p><p>AFFILIATION/ SPHERE OF OPERATIONS & COMPANY NAME AGREEMENT EXPERTISE APPENDIX K MAJOR CURRENT CUSTOMERS</p><p>1) NAME OF COMPANY / INDIVIDUAL:______CONTACT PERSON:______TELEPHONE #:______</p><p>2) NAME OF COMPANY / INDIVIDUAL:______CONTACT PERSON:______TELEPHONE #:______</p><p>3) NAME OF COMPANY / INDIVIDUAL:______CONTACT PERSON:______TELEPHONE #:______</p><p>4) NAME OF COMPANY / INDIVIDUAL:______CONTACT PERSON:______TELEPHONE #:______</p><p>5) NAME OF COMPANY / INDIVIDUAL:______CONTACT PERSON:______TELEPHONE #:______</p>