FRANKLIN PROJECT

QUALITY PERSONNEL QUALIFICATION F

1. INSTRUCTIONS
Sections 2 and 3 shall be filled out accordingly.
Section 4. regarding certifications will be filled accordingly and the subject certifications shall be scanned
Section 5. shall be completed and signed off by the CONTRACTOR prior to the COMPANY processing the F
Section 6 shall be completed by the COMPANY
2. GENERAL INFORMATION
NAME: Miguel Hernandez Roberto
Last First
LOCATION: Altamira Tamaulipas 89603 México
City State Zip Code Country
Years of Quality Inspection Experience: 4 Years of Qualit
Years of Quality Mgmt Experience: 11 Tot
Resume Attached (Y/N): y Number of Pages:
3. DISCIPLINE INFORMATION
3-A. SHOP INSPECTORS ( Equipment Manufacturing, and pipe and steel
fabrication)
Knowledge of
Actual years Applicable
Equipment Inspection Industry Company Final
Experience Standards and Date Y/N
Exhibits adequate Approval
Codes
applicable experience

ELECTRICAL Generators, Transformers, Switchgear,MCCs,Motors(Induction,Synchronous,VS

13 NOM, NEC Yes
MECHANICAL-STATIC
(Non-Fired) Vessels, Columns,Reactors,S&T HEX,Plate Exchangers,Tanks,Drums,Silos, Pipe ,fittings,
10 ASME Yes

MECHANICAL-STATIC
(Fired Equipment)
Fired Equipment: Boilers,HRSGs,Fired Heaters,Furn
10 ASME Yes
ROTATING
EQUIPMENT Gas and Steam Turbines, Pumps,Compressors,Fans,Blowers,Air Coolers,Gear Boxes,Cetrifuge
10 Yes

CIVIL / STRUCTURAL Concrete pipe, manholes,other precast,structural steel(fabricated/non-fabricated)fast

FPQA Form No. 001-Rev 3 Page 1 of 8
 6 AWS Yes

INSTRUMENTATION/A
UTOMATION Field instruments,actuated valves,instrument air systems,analysers,FARS,CHARMS,Power Sup

13
Yes

SPECIAL PROCESSES Mechanical testing, refractory,linings,coatings/TSA,Heat

3-B. CONSTRUCTION SITE/MODULE YARD INSPECTORS AND FIELD

ENGINEERS PERFORMING INSPECTION

Actual years Knowledge of

Applicable
Site
Discipline/Activity Inspection Industry Company Final
Standards and Date Y/N
Experience Exhibits adequate Approval
Codes
applicable experience

CIVIL/STRUCTURAL Soils,site prep.,compaction,piling,UG piping,drainage,roads,bridges,paving,foundations,concre

MECHANICAL-STATIC
(Non-Fired) Vessels, Columns,Reactors,S&T HEX,Plate Exchangers,Tanks,Drums,Silos, Pipe ,fittings,
12 ASME Yes

MECHANICAL-STATIC
(Fired Equipment)
Fired Equipment: Boilers,HRSGs,Fired Heaters,Furnaces,
12 ASME Yes
ROTATING
EQUIPMENT Gas and Steam Turbines, Pumps,Compressors,Fans,Blowers,Air Coolers,Gear Boxes,Cetrifuge
12 NOM, NEC Yes

ELECTRICAL Substations,Generators, Transformers, Switchgear,MCCs,Motors(Induction,Synchronous,VSD),C

15 NOM, NEC Yes

INSTRUMENTATION/A
UTOMATION Field insts.,auto. valves,inst.air systems,analysers,FARS,CHARMS,PS Units,SIS,Fiber Panels,MPSD,CCR
12 Yes

SPECIAL PROCESSES Mechanical testing, refractory,linings,coatings/TSA,Heat Treatment,Weld

12 ASME, NACE Yes

FPQA Form No. 001-Rev 3 Page 2 of 8

 3-C. QUALITY ASSURANCE AND OTHER QUALITY PERSONNEL

Knowledge of
Applicable
Actual years
Quality Title Industry Company Final
Experience Standards Date Y/N
and Approval
Codes
Exhibits adequate
applicable experience
QA Manager
Quality Engineer
QC Manager 11 ISO 9001 Yes
Quality Auditor 6 ISO 9001 Yes
QC Supervisor

Inspection Coordinator
Other

4. CERTIFICATIONS
Cur
TYPE Title Discipline Y

AWS
ASNT
NACE
API
ASME
ASQ/ IRCA
Crane/Heavy Lift Equipment
PMI
Other Relevant,e.g. PE License

5. CONTRACTOR SIGN-OFF

What actions have been taken by the CONTRACTOR to verify this candidate's Qualifications and Certificati

Was an interview conducted (Y/N)? Y Date of Int

Was the validity of certifications verified (Y/N) Y

If yes, how? Verification of Documents

Is documented evidence on file and readily available? (Y/N) Y

FPQA Form No. 001-Rev 3 Page 3 of 8

 Based upon the attached resume and other supporting documented evidence the individual named above has been deter
requirements relevant to the work assignment.

Years of working in ICAF: 12 NAME:

TITLE:
COMPANY NAME:
DATE:

TELEPHONE NUMBER:
Email Address:

6. COMPANY DISPOSITION (SHELL USE ONLY)

NOT NAME:
APPROVED: APPROVED:
TITLE:

OFFICE LOCATION:

DATE:

FPQA Form No. 001-Rev 3 Page 4 of 8

KLIN PROJECT
EL QUALIFICATION FORM

tifications shall be scanned and attached to this form.

COMPANY processing the Form.

Roberto DATE: 4/3/1970

First mm/dd/yyyy
CONTACT: ejemplo@icafluor.com
Email Address

Years of Quality Auditing Experience: 6

Total Years of Experience: 15

SHELL USE ONLY

Comments

Motors(Induction,Synchronous,VSD),Control Panels, UPS, DC Supply Units, Cable

,Tanks,Drums,Silos, Pipe ,fittings,flanges,manual valves,SP Items,Pipe Spool Fabrication

Boilers,HRSGs,Fired Heaters,Furnaces, Flares,Stacks

Air Coolers,Gear Boxes,Cetrifuges, Package Equipment,conveyors,cranes/mechanical handling

eel(fabricated/non-fabricated)fasteners,em-beds/anchor bolts,piles,rebar,loading arms

FPQA Form No. 001-Rev 3 Page 5 of 8
nalysers,FARS,CHARMS,Power Supply Units,SIS,Fiber Batch Panels,MPSD,CCR cosoles/displays

ractory,linings,coatings/TSA,Heat Treatment,Welding,NDE

SHELL USE ONLY

Comments

ridges,paving,foundations,concrete batch plants,testing,buildings,structural(Stick and Module)

,Tanks,Drums,Silos, Pipe ,fittings,flanges,manual valves,SP Items,Pipe Spool Fabrication

rs,HRSGs,Fired Heaters,Furnaces, Flares,Stacks,Refractory

Air Coolers,Gear Boxes,Cetrifuges, Package Equipment,conveyors,cranes/mechanical handling

ors(Induction,Synchronous,VSD),Control Panels, UPS, DC Supply Units, Cable and wiring,lighting,

S Units,SIS,Fiber Panels,MPSD,CCR cosoles/displays,field wiring,testing,Telecomms.wiring/equipment

oatings/TSA,Heat Treatment,Welding,NDE, heat tracing,insulation,PFP,CP

FPQA Form No. 001-Rev 3 Page 6 of 8

 SHELL USE ONLY

Comments

Current SHELL USE ONLY

Y/N
COMMENTS

ualifications and Certifications?

Date of Interview: 12/3/2005

mm/dd/yyyy

on of Documents

FPQA Form No. 001-Rev 3 Page 7 of 8

named above has been determined by the CONTRACTOR to meet the competency and qualification

José Mario Gutierrez R.

Project Manager
ICA FLUOR DANIEL
10/18/2017
mm/dd/yyyy
+52 833 369 01 30 - Extension 4501
mario.gutierrez@icafluor.com

City State Country

mm/dd/yyyy

FPQA Form No. 001-Rev 3 Page 8 of 8