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APPLICATION FOR REGISTRATION AS A PREQUALIFIED CONTRACTOR FOR

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					    DEPARTMENT OF INFRASTRUCTURE, ENERGY and RESOURCES




                       APPLICATION FOR REGISTRATION
                                        AS A
                            PREQUALIFIED CONTRACTOR
                                        FOR
                                  CIVIL WORKS
                                  CONTRACTS




                                  COMPANY NAME




                                        DATE




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                DEPARTMENT OF INFRASTRUCTURE, ENERGY and RESOURCES

APPLICATION FOR REGISTRATION AS A PREQUALIFIED CONTRACTOR FOR

                                    CIVIL WORKS CONTRACTS



                                            APPLICATION



When completed in full this document should provide all the information required for assessment in each
category.

It is recommended that applicants refer to the document titled Guidelines for Registration as a Pre-Qualified
Contractor for Civil Works Contract before making an application.

Contractors have to use this document for submitting information. An electronic version can be obtained by
contacting Debbie Ayres at the address below.

This document is compiled with text boxes into which information is entered, alternatively the document may be
printed and information entered in script form.

A contractor may submit supplementary information, but such information must directly address the criteria for
registration. Marketing publications are not required and will be returned to the applicant.

Should additional information be required for assessment purposes a request will be made directly to the
contractor.

The completed application document may be forwarded by post to the following addresses:

Postal:            Department of Infrastructure, Energy and Resources
                   Level 4, 10 Murray Street
                   HOBART TAS 7000
                   Attention: Debbie Ayres, Executive Officer Contract Services

Email:             debbie.ayres@dier.tas.gov.au
Telephone:         (03) 6233 6074
Fax:               (03) 6233 6736




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APPLICATION DECLARATION

In submitting this application the contractor is deemed to have made the following Declaration:
I/we hereby:

1.   Make application to the Department of Infrastructure, Energy and Resources for registration as a pre-
     qualified contractor for Government civil contracts; and

2.   Declare that the particulars in all the documentation are true and correct in every detail; and

3.   Confirm that none of the proprietors, directors, trustees, managers or their spouses is or has ever been
     bankrupt, or a director, manager or secretary of a company that is being or has been wound up (whether
     voluntarily or otherwise), and that the business is not trading under:
     •   an arrangement and/or restructuring; or
     •   receiver and management; or
     •   official management; or
     •   an arrangement with creditors without sequestration; and

4.   Undertake to advise the Department of Infrastructure, Energy and Resources of any changes to the
     circumstances of the information contained in this application during the duration of the pre-qualification
     period should pre-qualification be granted in any category; and

5.   Undertake to provide details of any adverse change affecting the financial position contained in this
     application and/or supplied by the company accountant as soon as practicable after the change in
     circumstances become known.

Signed …………………………………………………..…                                             Date: ……………………….

Name (Print) ………………………………………………

Position ……………………………………………………


BUSINESS INFORMATION

Company Name




Business Trading Name




Business Address




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Postal Address




Contact Officer




Telephone Number                                          Facsimile Number




Mobile Phone                                              Email Address




Australian Company Number                                 Business Registration Number




TasBuild Registration Number




Associated Companies
List all associated, subsidiary and holding companies including trusts. Include company/business name and address.




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Directors and Managers

List all Directors and Managers. (Further information in the form of CVs may be required)




Other Businesses

List any other business and/or company that any person referred to above has involvement with – include name, position
held, business/company and address.




Other Registrations

List details of any registration held with other Authorities

 Category                                                                Authority




Are you currently registered for Civic Works with Department of Treasury and Finance?

Yes                             No                             (Please tick appropriate box)

If Yes – up to what financial level              $…………………………


Industry Associations

List membership of industry associations – MBA, etc




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CIVIL (ROADS, BRIDGES and MAINTENANCE) CATEGORIES


                                MAJOR WORKS CATEGORIES

            Categories for which contractors may register. Please tick appropriate box.


R        Roadworks               R0.5 (Up to $0.5 million)
                                 R1.5 (Up to $1.5 million)
                                 R3   (Up to $3.0 million)
                                 R6   (Up to $6.0 million)

B        Bridgeworks
                                 B0.5     (Up to $0.5 million)
                                 B1       (Up to $1.0 million)
                                 B3       (Up to $3.0 million)

S        Sealing Works           Up to $2.0 million

    For projects valued greater than R6 or B3, Expressions of Interest will be called at the
                                            time.

                                  BRIDGE MAINTENANCE

          Up to $0.1 million      ,     Up to $0.5 million       ,   Up to $1 million

BM-1           Concrete Repair/Coatings
BM-2           Cathodic Protection
BM-3           Bridge Painting
BM-4           Lead Paint Removal
BM-5           Steel Repairs
BM-6           Bridge Joint and Bearing Repairs
BM-7           Timber Bridge Maintenance
BM-8           Masonry Maintenance

                      MINOR WORKS CATEGORIES (up to $250,000)

P              Pavement Marking
WRS            Wire rope/steel safety fences
Signs          Traffic Signs
R0.25          Roadworks (Up to $0.25 million)


Documentation supporting competence in each requested category must be provided.




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MANAGEMENT SYSTEMS

Third Party Certified contractors shall supply the following information:

a)      Copy of Certificates
b)      Capability Statement/Description as issued by the certifying organisation
c)      Copy of Executive Summary of latest audit report


Contractors with Integrated Management System certification are required to include Civil Contractor Federation
registration number with this application.


 CATEGORY                                    CERTIFICATION LEVEL
                       OH&S         QUALITY    ENVIRONMENT                           INTEGRATED
                      AS 4801        AS 9002      AS 14000                          MANAGEMENT
                                                                                       SYSTEM
                                     (See Note 1)                                     (See Note 2)
     R0.5                                                                OR
     R1.5
      R3
      R6
     B0.5
      B1
      B3
    Sealing
     BM-2
   BM-3 **
   BM-4 **
** DIER requires Contractors to hold the relevant Certificate in the Painting Contractors Certification
Program


     Pavement
     Marking
       WRS
       Signs
       R0.25
       BM-1
       BM-5
       BM-6
       BM-7
       BM-8          Relevant Trade Qualification
                = Certification level required by DIER for requested Category.

Note 1:

DIER will accept contractors who have an Integrated Management System that has been audited by a JASANZ
accredited certification body using a certified Senior Auditor, who can provide the Department with a statement
that the Integrated Management System of the Contractor complies with the requirement of AS 4801, ISO
9001/2 1994 (or ISO 9001:2000) and AS 14001.




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The auditor must be a Quality Society of Australia Registered Auditor in the Quality, OH&S and Environment
categories.

Note 2:

DIER may call for higher certification than IMS for specific projects which have significant complexities.

Safety at Roadworks:

Contractors shall provide evidence in their application that all personnel have passed an approved and
accredited training course in Safety at Roadworks.


STANDARD CONTRACT DOCUMENTS & SPECIFICATIONS

All DIER Standard Specifications are available on the Internet at the following address:

                                         www.transport.tas.gov.au

Once in this web site you will then need to click on:

                                            Road works
                                            Specifications Listings

to find the appropriate specification.




ORGANISATION
The contractor shall describe the company history, management, and location of offices in Tasmania



History
(Contractor to provide a brief history of the company)




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Management Structure
(Describe the organisation structure and how responsibilities are allocated)




Office Locations

(State location of company office(s))




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PERSONNEL

Management
Complete the following table for all Managers, and other key management personnel.


          Name                       Position                          Qualifications       Years of
                                                                                           Experience




Foremen and Supervisors
Complete the following table for all foremen, and key supervisory personnel.


                Name                                        Position                     Years of
                                                                                        Experience




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                                    TECHNICAL CAPACITY
                                 MAJOR PLANT AND EQUIPMENT

ITEM DESCRIPTION                             OWNED              LEASED        HIRE           OTHER
                                                                              PURCHASE




Construction and Office Personnel
Complete the following table for all construction and office personnel, and apprentices.


                                                                                           Number of
                                  Trade/Occupation
                                                                                            Persons




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PROJECT EXPERIENCE AND PERFORMANCE

The contractor shall list recent projects to demonstrate the capacity to undertake work in each category to the
financial level requested.

Appendix ‘A’ may be used to provide the information required.

Projects must be listed in each category for which registration is being sought.

Projects should have been undertaken in the past two years. Projects undertaken in the past five years may be
taken into consideration at the discretion of the assessment panel.

Where a project is relevant to more than one category list it under each category.

The largest four projects undertaken in each category should be described in Appendix A.




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FINANCIAL

COMPANY DETAILS & FINANCIAL CAPACITY


     Indicate whether organisation is
     Sole Trader
     Partnership                                               Please tick appropriate box
     Limited Liability Company




                           If a Partnership, list details of all current partners
                                Full Name                                    Address




     If a Company, is it

     Private
     Public
     Holding                                                   Please tick appropriate box
     Subsidiary
     Trust Company

     Date of Incorporation ___________________________________________________
     State of Registration ___________________________________________________

     If registered outside Tasmania please indicate

                                   if registered as a recognised company in Tasmania
                                   ___________________________________________________

                                   Tasmanian Corporate Affairs Register No.
                                   ___________________________________________________




     How many years has your organisation been in business under

     (a) its present name?         ___________________________________________________
     (b) a former name?            ___________________________________________________

     if (b) state former name

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     In what other types of business are you financially engaged?




            List details of all current Directors, Managers and Company Secretaries
                                Full name                             Position




     COMPANY AUDITOR:


     Telephone:
     Facsimile:
     Mobile phone:
     E-Mail Address:




     Name of Bank:                          ____________________________________________

     Address:                               ____________________________________________

     Bank Contact Officer:                  ____________________________________________
     Telephone:                             ____________________________________________
     Facsimile:                             ____________________________________________
     Mobile Phone:                          ____________________________________________

     (a)     Will Banker supply a reference on your company’s financial position?

             Yes                              No

     (b)     Value of bank guarantees currently issued: $……………………….

     (c)     Amount of Overdraft, if any: $………………………..




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   In addition the following information shall be provided to DIER financial advisor.


     (a)     Description and value of securities lodged to obtain overdraft.

     (b)    Latest financial statements (audited and unaudited), including any
            accompanying notes to the accounts.

     (c)    List any doubtful or irrecoverable debts.

     (d)    Bank Guarantees
            Provide information on Bank Guarantees / Insurance Bonds currently held.




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APPENDIX ‘A’ - PROJECT EXPERIENCE AND PERFORMANCE
Provide examples of four projects in each category undertaken in the past two years.


                                                                             PROJECT 1
Project Name


Description of Work
(related to categories on page 6)

Client


Referee Name:
Address:
Telephone:


Quality Assured Contract (Yes/No)
List Quality / Environment / OH&S Standard
Applicable


Contract Award Value and Final Cost                        $
Contract commencing date
Contract period (No. of weeks)
Actual date of Practical Completion
Contractor Performance Report Available
(Yes/No)
Delays – external factors: (working days)
Delays – Principal: (working days)




Liquidated Damages Incurred (Yes/No)
Period of Liquidated Damages
(days/weeks/months)




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                                                            PROJECT 2
Project Name


Description of Work
(related to categories on page 6)

Client


Referee Name:
Address:
Telephone:


Quality Assured Contract (Yes/No)
List Quality / Environment / OH&S Standard
Applicable


Contract Award Value and Final Cost                    $
Contract commencing date
Contract period (No. of weeks)
Actual date of Practical Completion
Contractor Performance Report Available
(Yes/No)
Delays – external factors: (working days)
Delays – Principal: (working days)
Liquidated Damages Incurred (Yes/No)
Period of Liquidated Damages
(days/weeks/months)




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                                                            PROJECT 3
Project Name


Description of Work
(related to categories on page 6)

Client


Referee Name:
Address:
Telephone:


Quality Assured Contract (Yes/No)
List Quality / Environment / OH&S Standard
Applicable


Contract Award Value and Final Cost                    $
Contract commencing date
Contract period (No. of weeks)
Actual date of Practical Completion
Contractor Performance Report Available
(Yes/No)
Delays – external factors: (working days)
Delays – Principal: (working days)
Liquidated Damages Incurred (Yes/No)
Period of Liquidated Damages
(days/weeks/months)




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                                                            PROJECT 4
Project Name


Description of Work
(related to categories on page 6)

Client


Referee Name:
Address:
Telephone:


Quality Assured Contract (Yes/No)
List Quality / Environment / OH&S Standard
Applicable


Contract Award Value and Final Cost                    $
Contract commencing date
Contract period (No. of weeks)
Actual date of Practical Completion
Contractor Performance Report Available
(Yes/No)
Delays – external factors: (working days)
Delays – Principal: (working days)
Liquidated Damages Incurred (Yes/No)
Period of Liquidated Damages
(days/weeks/months)




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