FM-QA-044 Rev 02 Supplier Evaluation Questionnaire

P.O.
Box 10270, Jubail Industrial City

31961
Kingdom of Saudi Arabia
Phone: +966-13-343 7700
Fax: +966-13-341-2571
Email: purchasing@aytb.com,
www.aytb.com
Reference
Number:
FM/QA/044
Revision Number
02
SUPPLIER EVALUATION
QUESTIONNAIRE
Document
Title:
COMPANY FULL NAME: INDUSTRIAL PROJECT MANAGEMENT SOLUTION

STREET ADDRESS: P.O.BOX 5555, DAMMAM 31432, KING DOM OF SAUDI ARABIA
P.O.BOX: 5555 CITY: DAMMAM ZIP CODE:31432 COUNTRY: KINGDOM OF SAUDI ARABIA
PHONE: +96638316714 FAX:+96638316677 E-MAIL: prasb@ipms.com.sa
BRANCHES (LOCALLY & OVERSEAS): _______________________________________________________
____________________________________________________________________________
INTRODUCTION
The attached questionnaire will be used by AYTB Quality Assurance personnel to evaluate
your Quality Assurance capabilities. Submittal of this questionnaire by itself, does not
constitute an approval of your company as an approved source. AYTB may, after receipt of
the completed questionnaire, conduct an on-site survey of your facility. Since Quality
Assurance approval is necessary before a procurement award can be made, it is to your
benefit to return this form as soon as possible.
INSTRUCTIONS:
1. If you have an ISO or any recognized Quality Standard certification, it is not necessary to
complete the remainder of this form. Please send a copy of the registration certificate
along with the completed first and second pages of this survey.
2. All questions should be answered. Enter an X in appropriate boxes on YES-NO-N/A(Not
Applicable) questions.
3. If supplemental data is submitted, check with an asterisk (*) and identify the
attachments by the applicable paragraph number. A supplemental data sheet is attached
for your convenience.
4. Answers should reflect your current status.
which are anticipated or proposed.
Do not reflect procedures or capabilities
5. Questionnaire should be returned within ten (10) days.

6. Completed questionnaire should be directed to the Purchasing Department - AYTB Co.
Ltd.
The information contained in this questionnaire is certified to be complete and accurate.
Authorized Official:
NAME: VIGHNESHVAR BHALCHANDRA BANDEKAR
TITLE: OPERATION DIRECTOR
SIGNATURE:_________________________________
Date: _____________________
Page 1 of 6
Reference
Number:
P.O.Box 10270, Jubail Industrial City

31961
Phone: +966-13-343 7700
Fax: +966-13-341-2571
www.aytb.com
Document
Title:
FM/QA/044
Revision Number
02
SUPPLIER EVALUATION
QUESTIONNAIRE
Section I Organization
1. Key Personnel:
President/Owner(s)/Partner(s)/ C.F.O: NABIL MUSTAFA NEMER NASR
Operation director.: VIGHNESHVAR BHALCHANDRA BANDEKAR
Quality Assurance Manager: DEIVENDRAN PETHANAN
2. Contact persons:
Name
Position
Phone No/Mobile No./Email Address
Prasad Bandekar
Operation Director
Deivendran P
Project /QA manager
Mohammed Iliyas
Khan
Lead - BD
0138316713/0509815111/prasb@ipms.com.s
a
0138316715/0556011337/deivp@ipms.com.s
a
0138316714/0552672566/mikhan@ipms.co
m.sa
3. Company Particulars:
a) How long has company been in business as presently organized?
5 years
b) What is your principal Product(s) and / or services?
Installation of switch gears and transformers and MCC etc.. and Testing &
Commissioning of various electrical systems and FOC termination, splicing and
testing & Supplying any kind of electrical (UPS & BATTERY BANK SYSTEMS) and
mechanical related products and spares on LSTK basis
c) Is the company an agent/sole distributor/representative for specific product(s)?
Yes
No
If Yes, please provide the name(s) of the manufacturer(s):

# MSA / # I-TORQ / #SAMSON / # INTERVALVE
d) Commercial Registration No.:2050075764 (please provide copy of your CR).
4. Mandatory Documents Required for Approval
a)
b)
c)
d)
e)
f)
g)
h)
Company Profile
Is your company approved by Aramco (Yes/No) (please provide a copy of approval)
Is your company approved by Sabic (Yes/No) (please provide a copy of approval)
Commercial Registration Certificate. Valid till 19-05-1438
Chamber of Commerce Certificate. Valid till 31-12-2015
Zakat Valid till 30-04-2015
GOSI (Insurance) Valid till 06-07-1436
Saudization Certificate. Valid till 20-04-2015
Page 2 of 6

31961
Phone: +966-13-343 7700
Fax: +966-13-341-2571
www.aytb.com
Reference
Number:
FM/QA/044
Revision Number
02
SUPPLIER EVALUATION
QUESTIONNAIRE
Document
Title:
5. Financial Information:
Name and address of bank(s): Riyad Bank , Branch - Al Mazrouiah., Dammam.
Section II Quality Assurance Systems and Procedures

1. Are you approved under ISO or any recognized Quality Standard?
Yes
No
2. If Yes, identify the standard (Attach Certificate copies):
ISO 9001:2008
_________________________________
Other
Standards
Registrars Name: ACM., Limited., U.K

Registration Number: 4301A
Valid until: 22-07-2017
3. Is a current copy of your Quality Manual available to AYTB upon request?

Yes
No
Section III Quality Control System Elements:

YES
1
Quality Assurance
a)
There is a
implemented.
Quality
Assurance
system
that
is
properly
b) There is a Quality Assurance Manual.

c) There are documented procedures and detailed
instructions for all operations which effect quality.
work
d) The Quality Assurance Organization trains and documents

employees in the application of Quality Assurance Methods
2
.
Measuring and Test Equipment

a) There is a calibration program for your test and measurement
equipment
b) Your measuring and test equipment is identified to indicate the
last calibration date, by whom, and next calibration due date
3
.
Procurement Control
a) There is a system for rating suppliers for quality and delivery.
Page 3 of 6
NO
N/A

31961
Phone: +966-13-343 7700
Fax: +966-13-341-2571
www.aytb.com
Reference
Number:
Document
Title:
FM/QA/044
Revision Number
02
SUPPLIER EVALUATION
QUESTIONNAIRE
b) Quality Assurance personnel review purchase orders to assure

the incorporation of quality requirements
c) Quality capabilities of sources are evaluated prior to
procurement.
4
.
Inspection
a) Inspection records and traceability are provided with each order.
b) All materials are rated upon receipt to assure conformance to all
requirements
c) All of the discrepant materials are promptly and adequately
identified and separated from normal work operations.
d) You have documented inspection systems for incoming, inprocess and final inspection.
5
.
__
Complaints
a) There is a system for responding to customers complaints. If so,
please describe: As per our IPMS quality assurance procedure
As mentioned in the documents IPMS-QSP-002 as regards Internal
audit, control of non-conformity and corrective and preventive
action measures by using the following forms IPMS-FRM-006 / 007/
008/009. We can submit our detailed quality manual and following
procedure at any time upon request.
Section III Quality Control System Elements (Continued)
6.
Supplemental Information
You are invited to include any additional or supplemental information which would be
pertinent to this application and the evaluation of your capabilities. (Use continuation
sheets or attachments as necessary).
As conferred we Industrial Project Management Solutions (IPMS) an ISO

9001:2008 company and a division of Al Dammam development Holding
Company is synonymous with Prompt & Quality Industrial Project supplies
and services to our valuable Clients, IPMS can delivers Project oriented
Professional services and technical resources with the purpose to meet our
client commitments towards a successful completion of Industrial Projects
and Operational & Maintenance services.
IPMS also offer great service of Installation of switch gears and
transformers and MCC etc.. and Testing & Commissioning of various
electrical systems and FOC termination, splicing and testing & Supplying
Page 4 of 6

31961
Phone: +966-13-343 7700
Fax: +966-13-341-2571
www.aytb.com
Reference
Number:
Document
Title:
FM/QA/044
Revision Number
02
SUPPLIER EVALUATION
QUESTIONNAIRE
any kind of electrical (UPS & BATTERY BANK SYSTEMS) and mechanical
related products and spares on LSTK basis at a very competent price and
have never been known to compromise on the quality of our service.
We have a well-established proven track record in our Business and our
services have always met with great customer satisfaction in the field.
[ This page is for AYTB Corporate QA and Purchasing Department Internal

Use Only ]
Section IV AYTB Corporate Quality Assurance Review
1. General Company Information and Organization
Approved:
Yes
No
Comments: _______________________________________________________________________
_________________________________________________________________________________
2. Quality Assurance System
Approved:
Yes
No
Comments: _______________________________________________________________________
_________________________________________________________________________________
3. AYTB Corporate QA recommendation
Approved Supplier
Secondary Supplier
Unsatisfactory Supplier
Comments: _______________________________________________________________________
_________________________________________________________________________________
Page 5 of 6

31961
Phone: +966-13-343 7700
Fax: +966-13-341-2571
www.aytb.com
Reference
Number:
FM/QA/044
Revision Number
SUPPLIER EVALUATION
QUESTIONNAIRE
Document
Title:
Reviewed by AYTB Corp. Quality Assurance

_________________________
_____________________
_______________
_____________
Title
Signature
Date
Name
Note: Please return to Purchasing Department after QA review.
Section V AYTB Purchasing Dept.

Assigned Supplier No. :
______________________________
Industry Name:
______________________________
-------------
Page 6 of 6
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P.O.

Box 10270, Jubail Industrial City

COMPANY FULL NAME: INDUSTRIAL PROJECT MANAGEMENT SOLUTION

Do not reflect procedures or capabilities

5. Questionnaire should be returned within ten (10) days.

P.O.Box 10270, Jubail Industrial City

Phone No/Mobile No./Email Address

Project /QA manager

If Yes, please provide the name(s) of the manufacturer(s):

P.O.Box 10270, Jubail Industrial City

Section II Quality Assurance Systems and Procedures

Registrars Name: ACM., Limited., U.K

Valid until: 22-07-2017

3. Is a current copy of your Quality Manual available to AYTB upon request?

Section III Quality Control System Elements:

b) There is a Quality Assurance Manual.

d) The Quality Assurance Organization trains and documents

Measuring and Test Equipment

P.O.Box 10270, Jubail Industrial City

b) Quality Assurance personnel review purchase orders to assure

Section III Quality Control System Elements (Continued)

As conferred we Industrial Project Management Solutions (IPMS) an ISO

P.O.Box 10270, Jubail Industrial City

[ This page is for AYTB Corporate QA and Purchasing Department Internal

P.O.Box 10270, Jubail Industrial City

Reviewed by AYTB Corp. Quality Assurance

Note: Please return to Purchasing Department after QA review.

Section V AYTB Purchasing Dept.

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