Prequal export 20-05-2021 10-37-41 AM updated PDF

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Pre-qualification Questionnaire Lendlease’s Services business

BUSINESS AREA:

Installation & Assurance

PROJECT NAME:

UNIFY

PROJECT NO.:

1: Subcontractor Details Name of individual / entity:

JK TECH SERVICES PTY. LTD.

Address:

30 Mary Ann Drive Glenfield NSW 2167

Mailing Address:

30 Mary Ann Drive Glenfield NSW 2167

Phone:

+61401309627

Email:

[email protected]

Website: ABN:

76612788235

QBSA No. (QLD Only) Are you incorporated as a company?

Yes

Date of incorporation

6/02/2016

Country of incorporation

Australia

Is this the Legal Entity proposed to enter into a formal Contract?

Yes

Please provide details of Legal Entity to enter into contract Corporate Structure

Company (P/L)

Last Year of SSAnnual Turnover Last Year's SSAnnual Turnover Value 2nd Last Year of SSAnnual Turnover

$127, 360.16

Pre-qualification Questionnaire Lendlease’s Services business

2nd Last Year's SSAnnual Turnover Value

$110278.74 – Can you please provide documentation to support this

3rd Last Year of SSAnnual Turnover 3rd Last Year SSAnnual $138506.8 Turnover Value Average Project Value Number of Current Projects Year Business Formed

2016

Is this supplier registered for GST?

Yes

Does the Supplier have No any outstanding debts due to the Australian Taxation Office Are you a part of a corporate group or joint venture?

No

Key Company Contact for future communications Name

Jayant Kamane

Key Contact - Phone no.

0401309627

Key Contact - Email

[email protected]

Managing Director

Jayant Kamane

Managing Director Phone No.

0401309627

Managing Director Email

[email protected]

Other Key Contact Name Other Key Contact Phone No.

Pre-qualification Questionnaire Lendlease’s Services business

Other Key Contact Email 2: Business Profile Brief Description of work generally provided

Fttc, fttn, copper services installations and fault, underground and aerial, residential and business, installations sockets, installations of leadin cables. Etc.

Do you source or manufacture goods or services outside of Australia?

No

Please provide details of the countries in which the goods and services are sourced or provided Number of Trades/Wages Emp.: (excluding working directors)

0

Number of Office/Staff Employees: (excluding working directors)

0

How many workers are 1 covered by the Workers Compensation Policy? Is the average employee value covered for Workers Comp. greater than $50.000 per annum?

Yes

Provide Details 1

Yes Is the Workers Comp. Insdustry Classification Covered appropriate for the type of Work to be performed? Provide Details 2

Pre-qualification Questionnaire Lendlease’s Services business

In which State do you conduct your principal business?

NSW

Is the Supplier required No to be registered for Long Service Leave (or comparable scheme)? If yes, are all current employees registered?

No

Is the Supplier required No to contribute to a redundancy trust scheme such as ACIRT? If yes above, are all current and past due contributions paid and up to date?

No

Is the Supplier required Yes to contribute to an employee’s Superannuation Scheme? If yes above, are all current and past due contributions paid and up to date?

Yes

Has the Supplier paid all current and past due remunerations payable to its employees?

Yes

How many years has the Supplier been providing the services for which it seeks qualification?

5

Pre-qualification Questionnaire Lendlease’s Services business

Does the Supplier hold all required licences to perform the services for which it seeks qualification? Provide details.

Open cable licence ( TATAB), traffic control plans, white card, nbn enable card. Etc

Does the Supplier have No employees who travel and work across State borders? Has ownership of the Supplier changed in the last 3 years?

No

Bankrupt, insolvent or similar associations

No

Provide details 3 Is the Supplier required Yes to be registered for Pay - Roll Tax? Service Locations

NSW - Metro

Capabilities

Copper (Major),Copper (Minor),Cutovers,Equipment Configuration,Equipment Install,Hauling

3: Work History Is the Supplier currently engaged or have they been previously engaged on any Lendlease projects?

No

Please list Lendlease projects involved in

Unify NBN

Is the Supplier currently engaged or have they been previously engaged on any non-Lendlease projects?

Yes

Pre-qualification Questionnaire Lendlease’s Services business

WH3 - Please list nonLendlease projects involved in

Telstra, nbn.

Reference 1 -

Company Name Tandem ( Telstra)

-

Name and Title

Mr. TOM Baghadi ( TM)

-

Phone

0472834093

-

Email

[email protected]

Reference 2 -

Company Name

-

Name and Title

-

Phone

-

Email

Reference 3 -

Company Name

-

Name and Title

-

Phone

-

Email

4: Insurance Details Public and Products Liability Insurance Company

GIO

Public and Products Liability Insurance Name Insured

JK Tech Services Pty Ltd

Public and Products Liability Insurance Policy Number

GPM004254747

Will Lendlease be noted as a “Named Insured” on the Public Liability policy?

Yes

Pre-qualification Questionnaire Lendlease’s Services business

If no, provide details. Public and Products Liability Insurance Expiry Date

25/07/2021

Public and Products Liability Insurance Policy Limit

$20,000,000.000

Workers Compensation icare Workers Insurance Insurance - Company Workers Compensation JK Tech Services Pty Ltd Insurance - Name Insured Workers Compensation 109881601 Insurance - Policy Number Workers Compensation 30/06/2021 Insurance - Expiry Date Workers Compensation $56,772.530 Insurance - Policy Limit Professional Indemnity Insurance - Company Professional Indemnity Insurance - Insured Name Professional Indemnity Insurance - Policy Number Professional Indemnity Insurance - Date Professional Indemnity Insurance - Policy Limit Motor Vehicle Insurance - Company

NRMA

Motor Vehicle Insurance - Insured Name

J K Tech Services Pty Ltd

Motor Vehicle Insurance - Policy Number

MOT583150182

Pre-qualification Questionnaire Lendlease’s Services business

Motor Vehicle Insurance - Date

27/06/2021

$14,950.000 Motor Vehicle Insurance - Policy Limit Plant Insurance Company Plant Insurance Insured Name Plant Insurance - Policy Number Plant Insurance - Policy Date Plant Insurance - Policy Limit Other Insurance Company Other Insurance Insured Name Other Insurance Policy Number Other Insurance Policy Date Other Insurance Policy Limit 5: Work Health & Safety Are you prepared to comply with the Lendlease Global Minimum Requirements?

Yes

Does the Supplier have No a system for reporting, recording and investigating all incidents and near misses?

Pre-qualification Questionnaire Lendlease’s Services business

LTI or MTI records Last Year

2020

LTI or MTI records - LY Man Hours Worked

1,970

LTI or MTI records - LY Number of LTIs

0

LTI or MTI records - LY LTI Frequency Rate

0.00

LTI or MTI records - LY Number of MTIs

0

LTI or MTI records - LY MTI Frequency Rate

0.00

LTI or MTI records Previous Year

2019

LTI or MTI records - PY - 1,820 Man Hours Worked LTI or MTI records - PY - 0 Number of LTIs LTI or MTI records - PY - 0 LTI Frequency Rate LTI or MTI records - PY - 0 Number of MTIs LTI or MTI records - PY - 0 MTI Frequency Rate Safety incidents resulting in death or permanent disability 1st Incident Description 1st Incident Date 2nd Incident Description 2nd Incident Date 3rd Incident Description 3rd Incident Date

No

Pre-qualification Questionnaire Lendlease’s Services business

4th Incident Description 4th Incident Date 5th Incident Description 5th Incident Date System for providing employee consultation and comms?

No

Provide Details Is the Supplier working on-site?

Yes

Having formal WHS Management system?

No

Does your business employ a fulltime/specialist WHS Manager?

No

Does the Supplier produce project specific Health & Safety Management Plans?

No

Does your Management System require you to produce project specific Risk Assessments, Safe Work Method Statements and JSEA's?

Yes

Pre-qualification Questionnaire Lendlease’s Services business If the Supplier does not No have a WHS management system or produce project specific Health & Safety Management Plans, is it prepared to work under the Lendlease management system? Does the Supplier require personnel to undergo preemployment medical examinations, drug and alcohol screening?

No

Provide Details - drug screening Does the Supplier agree to participate in worker drug and alcohol screening organised by Lendlease?

Yes

Does the Supplier have No a Rehabilitation/Return to Work program? Provide Details Rehabilitation

No Does the Supplier maintain employee training records including verification of competency? Does the Supplier have Yes a permit to work process in place for high risk activities? Does the Supplier have Yes trained and currently qualified First Aiders in its workforce?

Pre-qualification Questionnaire Lendlease’s Services business

Lifting and Rigging Gear

Maintenance only

Portable Electrical equipment and leads

Both register and maintenance

Ladders, Scaffolding etc.

Both register and maintenance

Fire Fighting Equipment Both register and maintenance Pressure Vessels

Neither applicable

Hydraulic Equipment

Neither applicable

Mobile Plant & Equipment

Neither applicable

First Aid Facilities & Equipment

Both register and maintenance

Issued PPE

Both register and maintenance

Does the Supplier conduct pre-start hazard identification and risk assessments on Plant & Equipment? Does the Supplier intend to subcontract out all or part of the scope of works to subcontractors?

Yes

Are you prepared to allow Lendlease to conduct and inspection/audit to your work?

Yes

Tab 6: Quality Management QM1 - Does the supplier have an AS/NZS/ISO 9001 accredited Quality Planner?

No

Pre-qualification Questionnaire Lendlease’s Services business

QM2 - Details on AS/NZ/ISO 9001 Quality Planner

No QM3 - Does the Supplier have a process in place to identify and manage non-conforming systems and products? QM4 - Details on nonconforming systems identification and management QM5 - Does the Supplier have a process in place to monitor and manage product traceabillity?

No

QM6 - Details on traceability

No QM7 - Does the Supplier have a system in place to undertake inspection to monitor quality during and on completion of the works? 7: Environment & Sustainability Does the Supplier have No a Sustainability Policy? Greenhouse gas emissions & energy

No

Social and ethical responsibilities initiatives

No

Details on social and ethical initiatives

Pre-qualification Questionnaire Lendlease’s Services business

Penalty Infringement Notice

No

Prosecution under environmental legislation

No

AS/NZS/ISO 14001 certification

No

Details on AS/NZS/ISO 14001 Environmental Management Plans working under LL management system

Yes

Does the supplier have No an Environment Policy? Environmental resources

No

Environmental Risk Assessment(s)

No

Details on Environmental Risk Assessments Tab 8: Design Services any design services component design management process details on design management process areas of expertise in your design capability willingness to attend Safety in Design workshops familiarity with GMRs

No

Pre-qualification Questionnaire Lendlease’s Services business

9: Building Code Compliance Does the Tenderer, or its Related Entities, have an Enterprise Agreement that does not meet the requirements of section 11 of the Building Code?

No

Is the Tenderer subject No to Exclusion Sanction or excluded from performing Building Work funded by a state or territory government? Provide details 1 Has the Tenderer or its No Related Entities within the preceding 3 years been required to pay any amount under an adjudication certificate (provided in accordance with a law relating to the security of payments that are due to persons in respect of Building Work) to a Building Contractor or Building Industry Participant? Provide details (including whether the Tenderer is complying with the decision, direction or order) ownership of unsatisfied judgement debts

No

Pre-qualification Questionnaire Lendlease’s Services business

Provide details 3

10: Industrial Relations Sanctioned by a government agency

No

Industrial instruments relevant to the project engaged under?

Sample award.

Are you a party to a certified enterprise agreement?

No

Number of subcontractors

1

1 Name of individual/entity

Jayant Kamane

1 Address

30 Mary Ann Drive

1 Phone

0401309627

1 Email

[email protected]

1 Website 1 ABN/ACN 1 QBSA No. (QLD only) 2 Name of individual/entity 2 Address 2 Phone 2 Email 2 Website 2 ABN/ACN 2 QBSA No. (QLD only) 3 Name of individual/entity 3 Address

76612788235

Pre-qualification Questionnaire Lendlease’s Services business

3 Phone 3 Email 3 Website 3 ABN/ACN 3 QBSA No. (QLD only) 4 Name of individual/entity 4 Address 4 Phone 4 Email 4 Website 4 ABN/ACN 4 QBSA No. (QLD only)

11: Indigenous Participation

No Are you a majority owned Australian Aboriginal or Torres Strait Island Indigenous business? Are you Supply Nation Certified? What is the percentage 0% of Australian Aboriginal or Torres Strait Islander employees within your organisation? Do you directly engage No businesses majorityowned by Australian aboriginal or Torres Strait Islander people?

Pre-qualification Questionnaire Lendlease’s Services business

Do you have an Indigenous employment strategy or action plan for your business implemented within the last two (2) years?

Yes

No Support Aboriginal or Torres Strait Islander LL initiatives No Are there other ways (not described above) in which your Company demonstrates commitment to Indigenous Australians? 12: Third Party Integrity Are you prepared to comply with the Lendlease Supplier Code of Conduct?

Yes

Provided to a Lendlease employee any payment, hospitality, gifts...

No

Provide details 1 Are you a government owned or controlled entity, a Government Official, former Government Official or a close relative of a current or former Government Official?

No

Provide details 2

No Planned contact with Government Officials...

Pre-qualification Questionnaire Lendlease’s Services business

Provide details 3 Will any Government Official or relative of a GO be entitled to any part of the compensation to be paid by LL to you...

No

Provide details 4 Breaching of anticorruptions laws or sanctions?

No

Provide details 5 Been investigated, convicted, fined or similar...

No

Provide details 6 Been barred from tendering or bidding because of fines...

No

Provide details 7 Been disqualified from managing a company or...

No

Provide details 8 Been a subject of media scrutiny regarding any of the questions above?

No

Provide details 9 Do you have any antibribery and corruption compliance measures in place, such as policies, codes of conduct or training? Provide details 10

No

Pre-qualification Questionnaire Lendlease’s Services business

Tab 13: Conflict of Interest 1. The vendor hereby declares that it does not have a conflict of interest.

No

1a. Where you indicate that you have an actual, potential or perceived conflict of interest, please provide details in the space below. (If the space below is insufficient, please attach a separate page at the end of this form). 2. Name of authorised signatory

Jayant Kamane

3. Date

1/03/2021

14: Payment Details Account Name

JK Tech Services Pty Ltd

Bank

NAB

BSB No.

082343

Account No. Email

[email protected]

Fax No. Documentation meeting the above criteria has been reviewed and is attached 15: Declaration

Yes

Pre-qualification Questionnaire Lendlease’s Services business

1. Please enter your full name

Jayant Kamane

2. Do you confirm the above declaration?

Yes

2a. Please provide details on why you cannot confirm the declaration. Date

1/03/2021

LENDLEASE Assessed By - Name: Title:

Signature:

Date: Comments: Approved by Lendlease Project / Contract Manager: Name:

Signature:

Date: Comments:

Yes ☐ No ☐...