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Page 1 of 16
Does your company operate an HSE management system complying with ISO 14000, OHSAS
18001 or a similar recognized standard?
Onshore LNG
Tangguh Expansion Project
Yes
No
b) Provide a summary and include examples of established HSE performance goals that are supported
by senior management. Describe any established programs to increase worker HSE awareness and
motivate workers to be actively involved in HSE activities
For the Program and HSE activities can found at : Attached in Training data follow up matrix
B.05.3 - Safety Manuals & Procedures
a)
b)
c)
d)
e)
f)
Tingkat kesehatan karyawan kami menjadi yang utama, kami menerapkan jam kerja normal 8 jam sesuai
peraturan yang ada. Makan teratur disesuaikan jam kerja dan untuk tetap menjaga tingkat kesehatan setiap
karyawan kami.
The health level of our employees to be the main one, we apply the normal working hours of 8 hours in
accordance with existing regulations. Eating regularly adjusted working hours and to maintain the level of
health of each of our employees.
Provide with Summary MCU and example MCU one of other our employee
Page 4 of 16
Onshore LNG
Tangguh Expansion Project
i)
j)
No
Does your company have disciplinary Procedure addressing life threatening relations?
Yes No
m) Describe any established hazard assessment programs, which recognizes, evaluates and controls
HSE-related hazards associated with your operations. Describe any periodic HSE-focused
inspections and walkthroughs of your work sites. Summarize these efforts and include at least one
example of a completed hazard assessment and one example of a completed inspection or
walkthrough.
Hazard assessment programs that exist and the appropriate operation of our company, lighting inspection,
noise inspection, inspection work climate, work area inspection, the inspection period ie once a month.
n) Describe any established SHE guidelines used when screening, selecting and monitoring
subcontractors. Provide a summary of these applicable guidelines.
Please comment below or by separate attachment.
Each of our subcontractors in screaning and selected to give a special document "QHSE and Evaluation
Quetionnaire" concerning which there are questions regarding the involvement of HSE in every job.
Page 5 of 16
Onshore LNG
Tangguh Expansion Project
environment.
For The Appendix is : .
f)
Yes
No
Yes
No
h) Does your company have experience in executing construction work with due regard toward
sustainability of the environment in advanced countries and in remote and environmentally
sensitive project locations?
Yes
No
Please provide examples below, (or on a separate sheet), from your previous projects.
On progress- sedang mengerjakan konstruksi VCO CROSS OVER BRIDGE
Roman Zerr
031-7341401
No
Our Company is Inspection services.
Page 6 of 16
Onshore LNG
Tangguh Expansion Project
B.06.3 - Does your company have periodic improvement program such as Process Objective or KPI as part of
the Quality Management System?
Yes
No
If yes please provide recently KPI which related to QA/QC
Attachedment: CSS (Customert Satisfaction Survey) and MO (Mission Order)
B.06.4 - Has the subcontractor produced Inspection Testing Plan (ITP)?
If yes please provide the sample of ITP related to SOW or services
Yes
No
Fs 601773
Scope of Certification
Certifying Agency
BSI
11/10/2013
10/10/2016
AND
PUBLIC
No
Please provide examples below, (or on a separate sheet), from your previous projects.
-
B.07.2 - Describe the history of any substantial work you have performed within the governmental boundary of
the proposed site location for this CSTS JO project or in locations nearby or similar. Describe also
your experience with public and community affairs in this area.
XXX-XXX-003 Pre-Qualification Questionnaire
Page 7 of 16
Onshore LNG
Tangguh Expansion Project
B.07.3 - Describe your experience with public and community affairs in this area
Same with before question
b) Relative to work in the location of the described CSTS JO project, list any labor strikes or other
work stoppages at your company or on a project you were associated with during the last five years. If
stoppages have occurred during the past two years, identify what action has been taken to avoid
similar stoppages in the future.
We do not have any problem with labor strikes or other work stoppages at our company, Good
communication with all employees.
c) For working in the location of the described CSTS JO project, describe how labor relations are
managed by your company.
Page 8 of 16
Onshore LNG
Tangguh Expansion Project
Does your company utilize computer hardware and software programs for engineering and project
management, including procurement and construction management?
Yes
No
In Progress
Please check all items that apply:
i. Engineering
Engineering & Design
ii.Project Execution
Planning & Scheduling
Procurement & Logistics
Other (
)
Other (
)
Other (
)
iii.
Construction
Page 9 of 16
Onshore LNG
Tangguh Expansion Project
Annex I
(Work History & Current Projects)
(Page 1 of 2)
(Work History)
Company Name:
Location:
Projects Completed
Client
PT. Bureau
Veritas
Indonesia
T. Vantage
Drilling
Company
Indonesia
Name of Project
Location
Work Category
BP Tangguh Papua
Contract
Value
(US$)
41,231.87
15,000.00
Scope
of
Work
Provision of
Lifting
Inspector
Competence
Person 2015
6
Montly
Lifting Gear
Inspection &
Drilling Tools
NDT
on
Boards
and
Onshore
Type
of
Contract
Yearly
Lump
Sum
Year
Completed
Peak
Manpower
2015
Inspector
2016
Inspector
PT. Bonne
Batam
23,363.07 QAQC OCTG Per Day
2016
Inspector
Indoteknik
PT. Petronas Lamongan Shorebase 13,703.00 NDT Test of Per Unit
2016
Inspector
Carigalli
Lifting Gears
Indonesia
Notes:
i. If you have no work experience with CSTS JO, please provide the names and contact details of persons to
contact with your other clients for reference purposes.
ii.In entering data in the above table please use the following abbreviations:
Scope of Work
E: Engineering
P: Procurement
C: Construction
O: Other
Type of Contract
L: Lump Sum
C: Cost Plus
U: Unit Price
Annex I
(Work History & Current Projects)
(Page 2 of 2)
(Current Projects)
Company Name:
Location:
Projects under Construction
Client
Project Name
Contract
Scope
Type
Construction Schedule
Peak
Page 10 of 16
Onshore LNG
Tangguh Expansion Project
Location
Work Category
Value
(US$)
of
Work
PT.
Bourbon
Indonesia
335,362.78
Construc
tion
work
agreeme
nt
PT.
Bourbon
Indonesia
2,719,45
23,884.32
5,112.78
PT.
Eastern
Logistics
PT. ELNUSA
1,315.78
OEG
3,520.00
PT. Prasadha
Pamunah
Limbah
Industri
PT.
Bureau
Veritas
Indonesia
2,233.08
Samudra
Marine
Project
PRV &
Preassur
e Gauge
Inspectio
n
Lifting
Gears
MPI
CCU
MPI
CCU
MPI
DCB
Provisio
n of
Lifting
Inspector
Compete
nce
Person
2016
80,542.32
of
Contra
ct
Lump
Sum
Start
Peak
Finish
Manpower
Jun 16
Sub Cont
Lump
Sum
Jun 16
Inspector
Lump
Sum
Jun 16
Inspector
Per
Unit
Per
Unit
Per
Unit
Per
Unit
May 16
Inspector
Jun 16
Inspector
Jun 16
Inspector
May 16
Inspector
Per
Day
Jan 16
Dec 16
Inspector
Notes:
i. If you have no work experience with CSTS JO, please provide the names and contact details of persons to
contact with your other clients for reference purposes.
ii.In entering data in the above table please use the following abbreviations:
Scope of Work
E: Engineering
P: Procurement
C: Construction
O: Other
Type of Contract
L: Lump Sum
C: Cost Plus
U: Unit Price
Annex II
(Construction Equipment)
Company Name:
Location:
List of Construction Equipment
XXX-XXX-003 Pre-Qualification Questionnaire
Page 11 of 16
Onshore LNG
Tangguh Expansion Project
Equipment Type
Bulldozer:
Capacity
D6 & above
Under D6
370 cfm & above
150 cfm & above
10 Ton & above
Under 10 Ton
300 A & above
300 kVA & above
200 kVA & above
100 kVA & above
Compressor:
Dump Truck:
Engine Welder:
Generator:
Mobile Crane:
Shovels:
(Power-Shovel, Back Hoe, etc.)
Tractor/Trailer:
Truck:
Other (
):
Quantity Owned
Average Age
Annex III
(Estimated Future Workload)
Company Name:
Location:
Estimated Future Workload
XXX-XXX-003 Pre-Qualification Questionnaire
Page 12 of 16
Onshore LNG
Tangguh Expansion Project
Client
Name of Project
Location
Work Category
Contract
Value
(US$)
Scope
of
Work
Type
of
Contract
Year
Completion
Peak
Manpower
Notes:
i. If you have no work experience with CSTS JO, please provide the names and contact details of persons to
contact with your other clients for reference purposes.
ii.In entering data in the above table please use the following abbreviations:
Scope of Work
E: Engineering
P: Procurement
C: Construction
O: Other
Type of Contract
L: Lump Sum
C: Cost Plus
U: Unit Price
Annex IV
(Productivity: Overall)
Company Name:
Location:
Please indicate your companys productive man-hours for the various categories of work stated below for the
last full year for which you have records available. You should also indicate the breakdown of your figures (as
percentages both in terms of project types and locations) in the boxes provided.
a)
Man-Hours
Page 13 of 16
Onshore LNG
Tangguh Expansion Project
Structural Steel: Pre-Fabrication:
Structural Steel: Installation:
Equipment Installation:
Piping: Pre-Fabrication:
Piping: Installation:
Electrical Installation:
Instrumentation Installation:
Painting:
Insulation:
Ton (steel)
Ton (steel)
Ton (equipment)
Dia. Inch (pipe)
Dia. Inch (pipe)
Linear Meter (cable)
Linear Meter (cable)
m2 (painting)
m2 (insulation)
Percentage
100%
Page 14 of 16
Onshore LNG
Tangguh Expansion Project
Annex V
(Productivity: Individual Projects)
(PLEASE FILL THIS FORM FOR EACH PROJECT)
Company Name:
Location:
Please indicate your companys productive man-hours for the various categories of work stated below for the
last five completed projects for which you have records available. You should also indicate the project type and
location in the appropriate boxes.
a) Project #1
i. Please indicate the project name and construction period:
Project Name:
Start (month/year):
Finish (month/year):
ii.Please indicate the project type:
Chemical Plant
Gas Plant (LNG/NGL)
Power Plant
Petrochemical Plant
Petroleum Refinery
Other Industrial Plant (
Industrial Building
Commercial Building
Land Infrastructure
Marine Infrastructure
Other Infrastructure (
Other Construction (
)
)
iii.
Please provide the work volumes and man-hours expended per work category specified in the
table below for the above project:
Overall Work Volumes and Man-Hours per Work Category for the Project
Work Category
Unit
Work Volume
Piling:
Number (piles)
Civil Works:
m3 (concrete)
Buildings:
m2 (floor area)
Furnace Steel:
Ton (steel)
Structural Steel: Pre-Fabrication:
Ton (steel)
Structural Steel: Installation:
Ton (steel)
Equipment Installation:
Ton (equipment)
Piping: Pre-Fabrication:
Dia. Inch (pipe)
Piping: Installation:
Dia. Inch (pipe)
Electrical Installation:
Linear Meter (cable)
Instrumentation Installation:
Linear Meter (cable)
Painting:
m2 (painting)
Insulation:
m2 (insulation)
-
Man-Hours
-
Page 15 of 16
Onshore LNG
Tangguh Expansion Project
Form/Attachment
Questionnaire
Parent Company Guarantee (If required)
Bank References
Audited financial statement for the last 3 (three) years period.
Company Organization Chart
HSE Policy
HSE Management System Manual
Current HSE related accredited certification
HSE Organization Chart
Quality Manual and Procedures list
Quality Organization Chart
Recently KPI which related to QA/QC
Sample of ITP
Current Copy of quality related accredited certification ISO 9001: 2008
Other Certificate related to QA/QC
Annex I work volumes and productive man-hours
Annex II work volumes and productive man-hours for the various categories of
works for the last five completed projects.
Annex III Work History and current projects
Annex IV Construction Equipment List
Annex V Estimated Future Workload
Page 16 of 16