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					                                  SUPPLIER/SUBCONTRACTOR PREQUALIFICATION PROFILE
                                     APPENDIX V –MANUFACTURER/FABRICATOR INFORMATION
                                    COMPLETE THIS APPENDIX IN ITS ENTIRETY PLUS APPLICABLE ATTACHMENTS.
                                             AN INDEX OF ATTACHMENTS CAN BE FOUND ON PAGE V-5


COMPANY NAME:
PLANT LOCATION
If Company is proposing more than one manufacturing or fabrication plant, please provide an individual Appendix V for
each plant location. Attach additional sheets, if necessary, to explain the capabilities of each plant.

Plant Name (if any):
Plant Address:                                        City:                     State:        County:                  Zip:
Principal Contact:                                                            Title:
Phone:                                 FAX:                                    E-mail:

EMPLOYEES & PERSONNEL
                                                                                                  Number of        Average Yrs
                                                                                                  Employees        Experience
      Plant Management:
      Shop Employees:
        Shifts Worked:             Hours/Shift:
        Days/Week:                 Shop Hours Worked/Week:
      Engineers:
      Draftsmen:
      Shop Inspectors:
      Purchasing/Material Control:
      Other:
        Total Plant Personnel:
LABOR AFFILIATION

Plant labor operation basis is:                 Union            Merit                       Open
Union Affiliation(s):
Contract Expiration(s):
Have there been any strikes, walkouts, or slowdowns in last three years?                     No         Yes – if so, explain below

Date of last work stoppage:                         Reason for stoppage:


FACILITY & EQUIPMENT
 Is plant facility owned or leased?                                  If facility is leased, what is expiration date?
 Total area owned or leased for plant facility                       Total area not under roof:
 Total Sq. footage under roof                                        Total sq. footage under roof heated
 Total Sq. footage used for:                                         Total usable yard area
    Manufacturing                                                    Capacity of largest crane
    Fabrication                                                      Fabrication / shipping dimension limits
    Assembly                                                         Stress relieve furnace temperature max.
 Total no. of cranes
 Lifting/shipping weight limits
 Stress relieving furnace capacity

 Describe facility and capacity for sandblasting
 Describe facility and capacity for painting
 Describe rail siding access
 Describe barge/ship access

    Attach a complete list of Major Equipment used at this Plant for Material handling, Machining, Manufacturing,
    Fabrication, and Assembly with capacities, sizes, dimensions, year of manufacture, and condition for each.


APPENDIX V – M ANUFACTURER/FABRICATOR INFORMATION             V- 1                                                PROC FORM 1013F
REVISED 08 M AY 07
                                  SUPPLIER/SUBCONTRACTOR PREQUALIFICATION PROFILE
                                     APPENDIX V –MANUFACTURER/FABRICATOR INFORMATION
                                     COMPLETE THIS APPENDIX IN ITS ENTIRETY PLUS APPLICABLE ATTACHMENTS.
                                              AN INDEX OF ATTACHMENTS CAN BE FOUND ON PAGE V-5


COMPANY NAME:
CAPABILITIES & CAPACITIES
CAPACITIES
How do you measure your capacity?          Work hours        Value      Volume        Other: (Specify)

What is the current average monthly production capacity?

What is the current month’s available production capacity?

PRIMARY PRODUCT CAPABILITIES
List below the Primary Products you manufacture or fabricate at this Plant, and describe your Product Range in terms
of size, weight, ratings, materials, or other characteristics (Attach a description):



WORK NORMALLY SUBCONTRACTED
List below the work you typically subcontract to or have performed by others;



QUALITY ASSURANCE

Does your Company have a Quality Assurance Manual?                No    Yes – if yes, attach a copy for review. Submit a
paper copy and a copy on CD.

Does your company have Implementation Procedures for your Quality Assurance Program?                  No        Yes – if yes,
attach a copy for review. Submit a paper copy and a copy on CD.

Are you ISO 9000 Certified? If so, attach a copy of the applicable certificate: ISO 9001         ISO 9002        ISO 9003
If not ISO 9000 Certified, do you have written procedures for the following? ( If yes, attach a copy for review)

 Design Control:
   Control and verification of product design                                                   Yes        No
   Assessment of design output conformance to design input requirements                         Yes        No
 Process Control:
   Identification of processes which directly affect product/service quality                    Yes        No
   Documented work instruction for all processes                                                Yes        No
 Quality Audits:
   Performance of internal and external audits                                                  Yes        No
   Corrective action of deficiencies found during audits                                        Yes        No
   Qualification of personnel performing audits                                                 Yes        No
 Corrective Action:
   Analyzing processes, work operations, service reports, safety reports, and
   Customer complaints to detect and eliminate potential causes                                 Yes        No
 Training:
   Control and verification of product design
                                                                                                Yes        No




APPENDIX V – M ANUFACTURER/FABRICATOR INFORMATION          V- 2                                            PROC FORM 1013F
REVISED 08 M AY 07
                                      SUPPLIER/SUBCONTRACTOR PREQUALIFICATION PROFILE
                                         APPENDIX V –MANUFACTURER/FABRICATOR INFORMATION
                                        COMPLETE THIS APPENDIX IN ITS ENTIRETY PLUS APPLICABLE ATTACHMENTS.
                                                 AN INDEX OF ATTACHMENTS CAN BE FOUND ON PAGE V-5


COMPANY NAME:
QUALITY CONTROL
Does your Company have a Quality Control Manual?                    No      Yes – if yes, attach a copy for review. Submit a paper
copy and a copy on CD.

Do you have a written procedure for the following: (If yes, attach a copy for review)
    Pre-assessment of suppliers and subcontractors quality control before placing an order                         Yes         No
    Quality control inspection of suppliers and subcontractors during fabrication                                  Yes         No

Who is responsible for advance notification to Customers of inspection hold points?

Is Plant open to Customer’s Inspectors?             Yes           No – if no, explain:

Is Plant Code Certified?         No        Yes – if so, is non-code work done in same shop?               Yes        No

List Codes Plant is Certified for: (Attach a copy of certificates)
      ASME Div.                         ANSI No.                            API No.                      AWSD No.
      IEEE No.                          UL No.                              Other:

 Do you have the ability to perform the following                                 If No, state Name and City of your supplier or
 testing procedures in-house?                                 Yes         No      third party agency used for testing
   Radiographic Examination
   Ultrasonic Examination
   Liquid Penetrant/Magnetic Particle Examination

SAFETY
 List your Company’s insurance Experience Modification Rate (EMR for the last three years). If the EMR is above 1.0,
 please submit as an attachment an explanation of corrective actions and/or management actions that were taken to
 correct the trend.

    Interstate:     Yr                   EMR                Yr                    EMR             Yr                EMR

Using your OSHA Logs for the past three years and year-to-date data, provide the injury and illness information
requested by completing the chart below:
    INJURIES & ILLNESS DATA                          Year                    Year               Year               Year to Date
 Number of Employee Hours Worked
                                                   NO.       RATE           NO.       RATE     NO.     RATE        NO.     RATE
 Fatalities
 Lost Workday Cases
 Restricted Workday Cases
 Medical Treatment Only Cases
 Total Recordable Cases
 Number of Lost Workdays
 (including days of restricted duty)
RATE=[No. of each type of case x 200,000]/Employee Hours Worked
NOTE: To be considered responsible, an Offeror must be able to demonstrate to the satisfaction of MOX Services that it has a
record of safe construction performance as demonstrated by current interstate workers compensation insurance experience
modification rate (EMR) of less than or equal to 1.00; or the trend for the past three years is downward; or for Offerors that are too
small, too new, or self-insured, has an OSHA recordable incident rate of less than or equal to 8 injuries and illnesses per 200,000
man hours for the past calendar year; and the average total OSHA recordable incident rate for the past calendar year is less than or
equal to current comparable industry performance rates for construction general building contractors (source for data compari son is
the Bureau of Labor Statistics).
APPENDIX V – M ANUFACTURER/FABRICATOR INFORMATION                 V- 3                                            PROC FORM 1013F
REVISED 08 M AY 07
                                  SUPPLIER/SUBCONTRACTOR PREQUALIFICATION PROFILE
                                     APPENDIX V –MANUFACTURER/FABRICATOR INFORMATION
                                    COMPLETE THIS APPENDIX IN ITS ENTIRETY PLUS APPLICABLE ATTACHMENTS.
                                             AN INDEX OF ATTACHMENTS CAN BE FOUND ON PAGE V-5


COMPANY NAME:
How often are accident report summaries sent to the following:
              Title                   None                  Monthly              Quarterly            Annually
  CEO
  President/Vice President
  Manager of Construction
  Project or Site Managers

 Are site safety meetings held for field supervisors?          No      Yes – if so, how often?

 Does your Company have a Safety Department?                   No      Yes Who is the Safety Officer?

 Does your Company conduct craft “tool box” meetings?          No      Yes How often?

 Does your Company have a Hazardous Communication
 Program per OSHA 1926.59 and/or 1910.1200?                    No      Yes

 Do you conduct Hazard Communications Training for
 employees?                                                    No      Yes


Does your Company have an orientation program for new hires?     No       Yes – if so, does it cover the following:
                                        Yes       No       First Aid Procedures                   Yes         No
  Head Protection                       Yes       No       Hazard Communications                  Yes         No
  Eye Protection                        Yes       No       Process Safety Management              Yes         No
  Hearing Protection                    Yes       No       Electrical Safety                      Yes         No
  Respiratory Protection                Yes       No       Substance Abuse                        Yes         No
  Fire Protection                       Yes       No
  Emergency Response

Does Company have a program for newly hired or promoted foremen?        No       Yes – If so, does it cover the
following:
    Safe Work Practices                Yes        No        Accident Investigation                Yes         No
    Hazard Communication               Yes        No        Fire Protection and Prevention        Yes         No
    Conducting Craft Safety Mtgs       Yes        No        New Work Orientation                  Yes         No
    Emergency Response Procedure       Yes        No        Process Safety Management             Yes         No
    First Aid Procedures               Yes        No


Written ES & H Program
Does your company have a written environment, safety and health program, safety manual or procedures?
     Yes      No
    If yes, attach a copy of the Table of Contents, the manual or procedures for review.

Does the program include a commitment to safety and health from senior management?           Yes        No

Does the program include a commitment to environmental protection from senior management?          Yes        No

Does the program include procedures for waste management and disposal?          Yes        No

Does the program include accident/incident investigation procedures?     Yes          No


APPENDIX V – M ANUFACTURER/FABRICATOR INFORMATION       V- 4                                        PROC FORM 1013F
REVISED 08 M AY 07
                                  SUPPLIER/SUBCONTRACTOR PREQUALIFICATION PROFILE
                                     APPENDIX V –MANUFACTURER/FABRICATOR INFORMATION
                                    COMPLETE THIS APPENDIX IN ITS ENTIRETY PLUS APPLICABLE ATTACHMENTS.
                                             AN INDEX OF ATTACHMENTS CAN BE FOUND ON PAGE V-5


COMPANY NAME:
List additional policies and procedures addressed in the program:
 ______________________________________________

Do you permit Aguided (restricted) work?       Yes    No
EXAMPLE: If an employee is injured on the job and can not perform his/her hired duties, would you offer them another
position on the project until they were able to resume their normal duties?




                                           INDEX OF ATTACHMENT(S)
         Below is a list of the attachments to this appendix. Please complete and submit all that are applicable.
  Research & Development:
  If you perform Research and Development services, please complete Attachment A. (PROC Form 1013F/A)
  Design:
  If you perform design services, please complete Attachment B. (PROC Form 1013F/B)
  Manufacturing:
  If you are a manufacturer, please complete Attachment C. (PROC Form 1013F/C)
  Welding Methods:
  If you perform welding, please complete Attachment D(PROC Form 1013F/ D)
  Inspecting & Testing:
  If you perform inspecting and testing, please complete Attachment E (PROC Form 1013F/E)
  Mechanical Engineering Questionnaire:
  If you perform mechanical engineering services, please complete attachment f. (PROC Form 1013F/F)
  Production – Electrical Instrumentation & Controls Questionnaire:
  If you provide instruction & control services and items, please complete Attachment G. (PROC Form 1013F/G)
  Production – Seals:
  If you manufacture seals, please complete Attachment H. (PROC Form 1013F/H)
  Production – Filtration:
  If you manufacture filtration devices, please complete Attachment I. (PROC Form 1013F/I)
  Production – Radiation Protection Equipment:
  If you manufacture radiation production equipment, please complete Attachment J. (PROC Form 1013F/J)
  Production – Chemicals:
  If you manufacture chemicals, please complete Attachment K. (PROC Form 1013F/K)
  Production – Vital Protective Equipment:
  If you manufacture protective equipment, please complete Attachment L. (PROC Form 1013F/L)




APPENDIX V – M ANUFACTURER/FABRICATOR INFORMATION        V- 5                                           PROC FORM 1013F
REVISED 08 M AY 07

				
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