Jorge Chavez International Airport Expansion Proyect-Newlim: Applicants Information
Jorge Chavez International Airport Expansion Proyect-Newlim: Applicants Information
Jorge Chavez International Airport Expansion Proyect-Newlim: Applicants Information
APPLICANTS INFORMATION
COUNTRY OF CONSTITUTION/INCORPORATION
PRIMARY CONTACT
SECONDARY CONTACT
SIGNIFICANT OWNER
SIGNIFICANT OWNER
SIGNIFICANT OWNER
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Contractor Pre-Qualification Form
1. Do you have Management Systems approved by senior management to proactively manage Health and Safety
within your organization? (If yes, please indicate: Scope, List of the main components/elements, international
standards that the System Management is aligned with, copy of certificates
Yes No Find out more below
Additional information:
2. Do you have a procedure to ensure that health and safety risks are properly assessed and controlled prior to
the start of the works?
Yes, (attach procedure and risk record) No Find out more below
Additional information:
5. Have you received any charges and/or fines within the last two years on HSE-related issues? (If yes, provide a
brief summary of the case and the results.
Yes No Find out more below
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Contractor Pre-Qualification Form
Additional information
8. Do you have control inspection procedures or to verify compliance with H&S requirements?
Yes (please, detail) No Find out more below
Additional information
9. Has Health and Safety responsibilities been clearly defined for managers, supervisors and workers?
Yes No
Additional information
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Contractor Pre-Qualification Form
SAFETY RATES
NON-PERFORMING CONTRACTS
Contract
Year Non-Conformance Outcome
Value
QUALITY MANAGEMENT
1. . Do you have a formal QA/QC system?
Yes (please, detail) No Find out more below
Additional information ->
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Contractor Pre-Qualification Form
13. . Are records of inspections and tests or other QA/QC activities maintained?
Yes (please, detail) No Find out more below
Additional information ->.
SOCIAL RESPONSABILITY
Do you have Management Systems approved by Senior Management to proactively manage Social
1 Responsibility within your organization?
Yes (if yes provide certificates, policies) No Find out more below
Additional information
Strategies are carried out to ensure the health and safety of workers, contemplating the implementation of
3. occupational health and industrial safety programmes, in agreementor with the provisions of the Law?
Yes (please, detail) No Find out more below
Additional information
Do you have policies to prevent bribery and corruption in any of its forms?
Yes (please, detail) No Find out more below
Additional information
Do you have adequate communication channels to identify and correct risks and corruption situations?
Yes (please, detail) No Find out more below
Additional information
Actions are implemented to ensure transparency in paperwork, donations, sponsorships, gifts and
representation expenses?
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Contractor Pre-Qualification Form
Actions are taken to ensure the promise of sale, the proper response to complaints and complaints and after-
sales service for customers, users and / or consumers taking into account the expectationsof them?
Yes (please, detail) No Find out more below
Additional information
Do you carry out actions that promote the generation of constructive relationships between the communities of
the area of influence and the impact of your operations?
Yes (please, detail) No Find out more below
Additional information
COMMUNITY RELATIONS
Do you currently have or have had experience in local employment procedures with communities in recent
years?
Yes (please, detail) No Find out more below
Additional information ->
Do you currently have or have had experience in procurement procedures for goods and/or services
with communities in recent years?
Yes (please provide) No Find out more below
Additional information:
Do you currently have or have had in recent years the design and implementation of Social Responsibility
projects in communities?
Yes (please, detail) No Find out more below
Additional information
Additional information
FINANCIAL SITUATION
Financial information in US$ Historic information for previous ( 3 ) years
equivalent (US $ equivalent in 000s)
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Contractor Pre-Qualification Form
Attached are copies of financial statements (balance sheets, including all related notes, and income statements) for the years
required above complying with the following conditions:
a) Must reflect the financial situation of the Bidder or party to a JV, and not sister or parent companies
c) Historic financial statements must be complete, including all notes to the financial statements
d) Historic financial statements must correspond to accounting periods already completed and audited (no
statements for partial periods shall be requested or accepted)
1. Has the Applicant been declared ineligible for funding by any bank? YES NO
3. Has Applicant failed to complete any awarded work within the last 5 years? YES NO
4. Has Applicant been terminated or dismissed from any contract within the last 5
YES NO
years?
5. Does Applicant have any pending litigation? (please provide relevant details) YES NO
6. Has Applicant had liquidated damages assessed against it on any project within the
YES NO
last 3 years?
COMPLIANCE
YE
1. The Applicant has reviewed and acknowledges compliance with LAP Policy. NO
S
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Contractor Pre-Qualification Form
YE
2. The Applicant has a Compliance System. NO
S
Name of Company:
Address of Company:
Contract Amount
Contract Name:
Name of Company:
Address of Company:
Contract Amount
Contract Name:
Name of Company:
Address of Company:
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Contractor Pre-Qualification Form
Contract Amount:
Contract Name:
Name of Company:
Address of Company:
Contract Amount:
Contract Name:
Name of Company:
Address of Company:
Contract Amount:
Contract Name:
Brief Description of Work
Performed by the Bidder:
Name of Company:
Address of Company:
Contract Amount
SPECIFIC CONSTRUCTION EXPERIENCE (Runway and taxiway, airport control towers, airport special systems,
terminal buildings and ancillary facilities)
Similar Contract Number: ____
Information
of ____ required
Contract Identification
Award Date
Completion Date
Management
Role in Contract Contractor
Contractor
Subcontractor
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Contractor Pre-Qualification Form
Telephone/Fax Number:
E-mail:
2. Physical Size
3. Complexity
4. Methods/Technology
5. Other Characteristics
Name of Company:
Address of Company:
Contract Amount
Contract Name:
Name of Company:
Address of Company:
Contract Amount
Contract Name:
Name of Company:
Address of Company:
Contract Amount:
Contract Name:
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Contractor Pre-Qualification Form
Name of Company:
Address of Company:
Contract Amount:
Contract Name:
Name of Company:
Address of Company:
Contract Amount:
Contract Name:
Brief Description of Work
Performed by the Bidder:
Name of Company:
Address of Company:
Contract Amount
REFERENCES
2. FINANCIAL INSTITUTION
3. CLIENTS/OWNERS
4. CLIENTS/OWNERS
5. SUB-CONTRACTOR
6. SUB-CONTRACTOR
RECENT / CURRENT
PROJECT DESCRIPTION CONTRACT VALUE & TERM
PROJECTS & LOCATION
1. US$
YRS MTHS
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Contractor Pre-Qualification Form
2. US$
YRS MTHS
TITLE TITLE
DATE DATE
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