Annex 11 - PROCES VERBAL Data:

RECEPTIE
A SERVICIILOR Page: 1 of 1

BENEFICIAR: FURNIZOR:

JCE Christof EP Services /JCR-Christof Consulting

Str. Trandafirilor 49A,107084 Sat Brazii de Sus,

Com. Brazi, Jud. Prahova

PROJECT / CONTRACT:

Proiect: Punct de lucru:

Contract No.:

Contract Value: ___________________________ RON □ EURO □ DOLLAR □ ________ □

Subject / Description of Services:
Observatii:
Fel de cheltuiele Denumire serviciilor Quantity Unit (ora, Informatii relevante pt. evaluarea
km, etc.)

Manopera

Materiale

Echipamente

Alte cheltuiele
(transport, cazare, etc.)

Are the services completed? YES □ NO □

Beneficiary 1:
(Construction manager)
___________________________ ______________________________ ____________________
Nume Semnatura Date

RECEPTION NUMBER: _______________________________________

RON □ EURO □ DOLLAR □ ________ □
Previous Receptions: Suma already accepted: ____________________________

Present Reception:
Data Inceput: _____________________ Suma present Reception: ____________________________

Data finalizare: _____________________ Final Reception? YES □ NO □

Total: ____________________________

Beneficiary 2:
(Project manager)
___________________________ ______________________________ ____________________
Nume Semnatura Date
The Supplier is aware that the invoice can only be issued based on the fully signed Reception Protocol
registered with the Reception Number!
The Reception protocol is for only for invoicing purposes only! Beneficiary’s signature on present Reception
Protocol shall not be perceived as an approval or acceptance of the works/services provided by Supplier, but
as an approval of the amount to be invoiced. The reception of construction works / services delivered by
Supplier shall be made in accordance with HG 273/1994 or applicable legislation in force at the respective date
and with the contractual provisions.
Furnizor:

JCE/Fisier SIM / Formulare / PYS F-102, Ed.2

 Annex 11 - PROCES VERBAL Data:

RECEPTIE
A SERVICIILOR Page: 1 of 1

___________________________ ______________________________ ____________________

Nume Semnatura & Stamp Date

JCE/Fisier SIM / Formulare / PYS F-102, Ed.2

 Data
Annex 12 - SUPPLIERS AUDIT PROGRAM
Pag/ total pag. 1 | 2
Year………

APROBAT,

Managing Director JCE: ______________________, Date_____________

Managing Director JCRC: ______________________, Date _____________

Department
Nr. Follow-up necessary
A- Critical Other Assess- leading the Quarter / Assessment / Audit
Crt. Name of the Suppliers Audit due to findings/
Supplier Supplier Reason ment Assessment / Year performed on
incompleteness?
Audit
1 x Suppliername SRL x Quality JCE Q3/2016 06.07.2016 no

JCE /Fisier SIM / Formulare / Procurement F-141, Ed. 1

 Annex 13 - Lista furnizorilor pentru produse sau activitati Data:

critice 16.10.2015

(in conformitate cu cerinta 5.6.1.2 din API spec. Q1 ed.9)

Produsul sau activitatea critica Furnizor / Supplier Solicitat de

aprovizionata (manufacturer) Organizatie Specificatia Client este este un anume
produsului indispensabil esential scop
transport Eugen Trans x X
transport BAT Bascov x X
transport ATM x X
reparatii macarale Terra - Palfinger x x
reparatii auto MHS-Trucks x x
reparatii macarale Hyarom x x
cutite strung RAMCO (Toolflo) X X x x
EMM, calibre RAMCO (Truthread) X X x x
unsoare RAMCO (Oilcenter) X X x x
degripant RAMCO (Lubristore) X X x x
vaselina Ramco x x x x x
solutie conservare interna Ramco x x x x x
solutie curatare protectoare Ramco x x x x x
servicii tehnice (instruire personal) Ramco x x
servicii mentenanta echipamente Ramco x x x
lichid racire CNC Ramco x x
Verificare dozimetre IFIM Bucuresti x x x x x x
Cursuri "Pasaport HSSE" F&R x
Conducere defensiva Titi Aur x
Instruire "Echipamente de ridicare" Mavlo x x

Fisier SIM / Formulare / Procurement F-128, ed.2

 Inregistrat in Departament
PROCUREMENT
Annex 14 - DECLARATIE

Catre:
JCR-CHRISTOF CONSULTING S.R.L. / J.CHRISTOF E&P SERVICES S.R.L.

Dl/Dna __________________________________, cetatean ____________________________, nascut la data

de _____._____._________ in _________________________________________, domiciliat in
___________________________, identificat cu ________________________________ seria
________________ nr. ______________________, emis la data de __________________ de catre
__________________, cod numeric personal _______________________________________, in calitate de
Administrator al _________________________________________, persoana juridica romana, cu sediul social
situat in _____________________________, nr. de inregistrare in Registrul Comertului
__________________________, cod fiscal _________________________ (“Societatea”), cunoscand
sanctiunile legii penale privind falsul in declaratii, infractiune prevazuta si pedepsita de art. 326 din Codul
Penal, declar pe propria raspundere ca impotriva mea si/sau a societatii nu a fost pornita o actiune penala
pentru savarsirea infractiunii de evaziune fiscala prevazuta si pedepsita de Legea 241/2005 privind
prevenirea si combaterea evaziunii fiscale, precum si a infractiunii de spalare de bani prevazuta si pedepsita
de Legea 656/2002 privind prevenirea şi sancţionarea spălării banilor. De asemenea, declar ca eu si/sau
Societatea nu am fost condamnat(i) sau supus(i) vreunei investigatii, in calitate de suspect sau orice alta
calitate, fie din partea autoritatilor fiscale, fie din partea organelor de certare si/sau de urmarire penala,
pentru savarsirea infractiunilor mai sus-amintite.

Dau prezenta declaratie atat personal, cat si in calitate de Administrator al Societatii, cu intreaga
responsabilitate, fiind constient ca orice tainuire a informatiilor de mai sus poate atrage raspunderea penala
atat a mea si a Societatii, cat si a clientilor persoane juridice ai Societatii.

Totodata, declar ca voi aduce la cunostinta clientilor, pe orice cale, orice modificare a celor declarate in scris
mai sus si ca voi compensa clientii pentru orice dauna suferita in cazul in care declaratiile de aici se
dovedesc sau devin false.

Redactata in 2 (doua) exemplare originale, cu aceeasi forta probanta, din care unul a ramas in arhiva Societatii,
iar unul s-a emis catre JCR-CHRISTOF CONSULTING S.R.L. / J.CHRISTOF E&P SERVICES S.R.L.

______________________________ _______________________________
[NUMELE SOCIETATII DECLARANTE] [NUMELE SI TITULATURA SEMNATARULUI]

_______________________________ _____________
[SEMNATURA SEMNATARULUI] [DATE]

JCE / Fisier SIM / Formulare / Procurement F-138, Ed. 1

 Annex 15 - Informatii Furnizori Data
(autoevaluare)
Pag / total pag. 1|5
Supplier Information

For JCE internal only / Doar pt. JCE intern:

• Purchasing department/dep. Aprovizionare:
Supplier-No / Furnizor-Nr.........................................
Evaluation
A Main Details Name/Nume: .......................
Detalii Principale Date/Data: ...............

• JCE-Q: Evaluation
Name/Nume: .......................
Date/Data: ...............

Company name; address,

Phone number, Fax, E-mail/Numele companiei, adresa. telefon, fax, mail
.................................................................................. Completed on: ....................................
Completat la
.................................................................................. By: ....................................
De
.................................................................................. Position: ....................................
Functie
.................................................................................. Signature:
....................................
Semnatura
..................................................................................

Affiliated Group to which the company belongs:…......................................................................................

Branches, company subsidiaries, daughter companies (if so enclosed list)
Grupul de care apartine compania filiala, sucursala, companie fiica
..................................................................................................................................................................
The company has been established since.......................…
Compania inffintata la
Capital ...........................................................
Capital
Annual sales ...................................................... ...
Vanzari anuale

Numbers of employees ..................

Numar salariati
Entry in commercial register ...................................................................................................................
Numar registrul comercial
Entry in the trades register ..................................................................................................................
JCE /Fisier SIM / Formulare / Procurement F-110, Ed 2
 Annex 15 - Informatii Furnizori Data
(autoevaluare)
Pag / total pag. 2|5
Supplier Information

Nr. In registrul de comert

Liability insurance (please attach policy) ................................in the amount of ....................................
Polita asigurare (rugam atasati) in valoare de
for ............................................................................................................................................................
pentru
Cod Unic Inregistrare (Cod TVA):
Registration Sole Number (VAT code): _______________________________________

Banca/ Sucursala:
Bank/ Branch: _______________________________________

Cod IBAN: Cod Swift:

IBAN Code: ___________________________ Swift Code:
______________________

B Branch/Type of Supplier
Ramura/Tip furnizor

The company is a: Manufacturer Supplier/Merchandiser Subcontractor

Compania este Producator Furnizor/Comerciant Subcontractor
Human Resource Supplier/Labour Hire
Servicii resurse umane/angajator forta
de munca
Details/Limits of Supply:............................................................................................................................
Detalii/Limite aprovizionare
..................................................................................................................................................................
..................................................................................................................................................................

C Management System Contact person:......…...................................

Sistem de management Persoana contact

the enterprise has a certificate according to: (please attach certificate)

intreprindera a fost certificata conform (rugam atasati certificatele)
9001 14001 18001 altele
certificate through................................................ on ................................... valid to ....................
Certificat despre valid pana

and/or other certifications / certificari

Si/sau alte sisteme
certificate through................................................ on ................................... valid to ....................
JCE /Fisier SIM / Formulare / Procurement F-110, Ed 2
 Annex 15 - Informatii Furnizori Data
(autoevaluare)
Pag / total pag. 3|5
Supplier Information

Certificat despre valid pana

certificate in preparation:.....…...................................................................…...................................
Certificari in curs
Comments:...................................…...................................................................….................................
Comentarii

D Accreditations/Licences/Certificates Contact person:......…...................................

Acreditari/Licente/Certificari Persoana contact

Accreditations, Licences and Certificates in accordance with legislation and technical rules (please
attach)
Acreditari, licenter, certificari conform legislatiei si reglementarilor tehnice (rugam atasati)

valid to
Legislation Description/Issued by Issued on
Legislatie Descriere/emis de Emis la Valid
pana

E Human Resources
Resurse Umane
Numbers of employees ................................................................................................
Numar salariati
In the field of:
In departamentele

JCE /Fisier SIM / Formulare / Procurement F-110, Ed 2

 Annex 15 - Informatii Furnizori Data
(autoevaluare)
Pag / total pag. 4|5
Supplier Information

Manufacturing/ .................................................................................................
Productie/Montaj
Quality/Inspection department .................................................................................................
Calitate/Inspectie
Admin./Purchasing .................................................................................................
Administrativ/Aprov
Others (please specify) .................................................................................................

F Subcontractor
Subcontractori

Are substantial parts of supply provided by subcontractors?

Sunt parti substantiale asigurate de subcontractori?
Yes No
When yes, to what degree?......................................................................................................................
Daca da, in ce masura
...................................................................................................................................
...................................................................................................................................
...................................................................................................................................

G References
Referinte

List of References (if necessary attach list)

Lista referintelor (daca este necesar, rugam atasati)
..................................................................................................................................................................
.................................................................................................................................................................
..................................................................................................................................................................
List of References with JCE (if necessary attach list)
Lista referintelor cu JCE (daca este necesar, rugam atasati)
..................................................................................................................................................................
..................................................................................................................................................................
..................................................................................................................................................................

H Other Information
Alte Informatii

Which other additional information to this questionnaire do you still consider important?
Ce alte informatii suplimentare la acest chestionar, considerati ca sunt importante?
JCE /Fisier SIM / Formulare / Procurement F-110, Ed 2
 Annex 15 - Informatii Furnizori Data
(autoevaluare)
Pag / total pag. 5|5
Supplier Information

..................................................................................................................................................................
..................................................................................................................................................................
..................................................................................................................................................................

I Associated Documents
Documente Asociate

Please attach current personal organisation charts to the questionnaire.

Rugam atasati organigrame
..................................................................................................................................................................
..................................................................................................................................................................
..................................................................................................................................................................

Data Numele si prenumele Functia Semnatura

Date Name and Surname Position Signature

JCE /Fisier SIM / Formulare / Procurement F-110, Ed 2

 chestionar+raport audit Print date: 30.01.2017

Annex 16 - Questionnaire and audit report

Furnizor critic / necritic Critical / noncritical

supplier:

Assessed by:

Criterii Bunuri Descriere Bunuri N/A 1 2 3 4

1 = supplier poor, fluctuating, frequent deviations
2 = supplier acceptable, steady, some deviations not duly partially partially
duly agreed Percentage Score
3 = good supplier, steady, with almost any deviation applicable disagreed disagreed agreed
Clasificare / range 4 = excellent supplier, very steady, no deviations
Calitate / Quality - presence on Market N/A poor acceptable good excellent 25,0% 1,00
Produsele/bunurile/materialele funcţionează corect şi corespunzător, potrivit cu Products / goods / materials properly running, according to specifications,
Performanta / performing first article inspection to specificaţiile, fără defecte sau disfuncţionalităţi. Exista un control riguros asupra without defects or malfunctions. Proper control upon nonconformant 10,0% 0,40
ensure conformance to stated requirements produsului neconform; product.
Manuals / brochures / drawings for realizing, operation, maintenance and
Manualele/broşurile/desenele pentru realizare, operare, întreţinere şi reparaţie sunt repairing are annexed to the property and are easy to be used /understand. 10,0% 0,40
Planificare activitate / Documentation anexate bunurilor şi sunt uşor de aplicat/înţeles. Activitatea este planificata. Proper planning of activity.
Bunurile/materialele furnizorului reprezintă o valoare adăugată în sensul celor mai noi The services represent a value added in terms of the new approaches /
Valoare; feedback din piata; raport calitate pret / Value tehnologii/uşurinţă de utilizare/bunuri personalizate, raport bun preţ-performanţă, ease of use /customized methodology/ good price-performance ratio, 5,0% 0,20
added recunoastere pe piata positive feedback on market
Evaluare la fata locului / site specific evaluation N/A poor acceptable good excellent 30,0% 1,05

Evaluarea on site a proceselor relevante / on site
evaluation of relevant activities
Verificare daca produsul aprovizionat se conformeaza
cu cerintele legale / contractuale / verify how supplied
product conforms to stated requirements when limited
by proprietary legal and or contractual arrangements
Flexibilitate / Flexibility
Competenta personalului / employees competence
Evaluarea furnizorului daca atinge cerintele de achizitie livrat sunt ambalate, dimensionate, etichetate corespunzător şi uşor de manevrat.
ale organizatiei / assessment of the supplier to meet the Livrarea se face la timp şi potrivit programului; dacă este necesar, furnizorul se
organization's purchasing requirements.
Documente de livrare / Delivery documents
Services
Identificarea proceselor care sunt considerate cu impact asupra realizarii produsului / Identifying processes that are considered to impact on the achievement of 5,0% 0,20
activitatii. Evaluarea desfasurarii peroceselor. product / activity. Evaluating and developing peroceselor.
identificarea documentelor care stau la baza realizarii produsului; identificarea identification documents underlying product realization; identifying legal
cerintelor legale si / sau contractuale carora se conformeaza produsul; verificarea requirements and / or contract to which the product conforms; check how
modului in care aceste cerinte au fost respectate; these requirements have been met 5,0% 0,20
Furnizorul reacţionează corespunzător şi rapid la modificări de The supplier is acting promptly to any modifications (changes) related to
5,0% 0,05
loc/timp/cantitate/specificaţii tehnice sau scop. Are capabilitatea sa sugereze masuri de the nature of commitments, place of delivery / time / schedule / technical
In realizarea produsului sunt implicati angajati competenti pentru activitatea
5,0% 0,20
desfasurata. Competent employees are involved in product realization.
Bunurile prezinta caracteristicile mentionate in solicitarea de achizitie. Bunurile de
Goods reveal characteristi mentioned as purchased requirements. Goods 5,0% 0,20
to be delivered are packaged, sized, labeled and easy to handle, if possible,
adapteaza modificarilor solicitate. the packaging is made from recyclable materials, as per the requirements.
Avizul de livrare/de însoţire anexat este întotdeauna corect completat. Produsele sunt are accompanied by quality certificates, declarations of conformity,
5,0% 0,20
insotite de certificate de calitate, declaratii de conformitate, specificatii tehnice, technical specifications,
N/A poor acceptable good excellent 20,0% 0,80

Furnizorul răspunde repede tuturor solicitărilor, persoana de contact este întotdeauna Supplier responds promptly to all requests, the contact person is always
5,0% 0,20
disponibilă, oferă toate informaţiile necesare şi este activ pentru a îmbunătăţi available, providing all necessary information and is very commited to
Comunicarea / Communication comunicarea. improve the cooperation with Company

Furnizorul rezolvă corespunzător şi rapid toate cererile / plângerile în caz de orice The supplier solves promptly and in a suitable manner all requests / 5,0% 0,20
Reclamatii / Complaints abatere sau disfuncţionalitate. complaints in case of any failure or malfunctioning.
Furnizorul oferă toate serviciile logistice necesare, le livrează la toate centrele The supplier provides all necessary logistics services, delivers them to all
convenite şi reacţionează în manieră flexibilă faţă de toate nevoileorganizatiei în locations established with Company and acts in a flexible manner 5,0% 0,20
Logistics termeni de logistică. towardsits clients logistics needs.
Supplier offers support for any technical questions / engineering, instructs
Furnizorul oferă suport pentru orice chestiuni tehnice/de inginerie, instruieşte the personnel and provides training, informes about new technologies / 5,0% 0,20
Technical support personalul/oferă training, informează asupra noilor tehnologii/soluţii. solutions.
Sistem de management / Management system N/A poor acceptable good excellent 15,0% 0,60

Manual, politici, proceduri, instructiuni / Policy,
Management's Documents
Echipamente de munca / EMM / Equipment, tools
Mediul de lucru si cel inconjurator / work environment
Contract
Confidentialitate / confidentiality
Evaluarea produsului dupa livrare sau a activitatii dupa
completare / assessment of the product upon delivery
or activity upon completion
Furnizorul a documentat şi implementat sistem de management,care este conform cu The supplier documented and implemented a management system that 5,0% 0,20
sistemul de calitate solicitat de companie conforms to the quality system requirements specified for suppliers.
The supplier uses machines, tools and protective equipment correctly and
appropriately, as required. Machines are properly maintained and their
Furnizoul foloseşte maşini, unelte şi echipament de protecţie corect şi corespunzător, maintenance is made by certified suppliers; measuring and monitoring 5,0% 0,20
conform cerinţelor. Echipamentele sunt intretinute iar mentenanta este asigurata de equipments are metrologically tested and certificates are available'
societati certificate / atestate. EMM sunt verificate.
mediul de lucru este propice realizarii produsului. Furnizorul lucrează păstrând un a minimum impact upon the environment and an adequate waste
5,0% 0,20
impact minim asupra mediului şi cu un management adecvat al deşeurilor. management.
N/A poor acceptable good excellent 10,0% 0,40
;
5,0% 0,20
Furnizorul asigura confidentialitatea datelor Supplier ensures privacy of data.
The supplier delivers complete goods / services as per the contract, the
Furnizorul livrează bunurile potrivit cu contractul, respectă toţi termenii şi condiţiile supplier respects all agreed terms and conditions and the invoices 5,0% 0,20
convenite iar facturile conţin toate informaţiile şi referinţele convenite. containing all the established information and particular references.

Result 100,0%

Rezultatul a 18 criterii (0 criterii neevaluate) Result of 1 criteria (17 non assessed criteria) 96,3% 3,85

listed and approved supplier yes no

(have to fill out from MD)

Auditor Head of Procurement

Audit :

urmatoarea evaluare:

1/1 Annex 16 - Supplier performance evaluation.xlsx

 Re-evaluation report

Furnizor critic / necritic Critical /

noncritical supplier:

Assessed by:

DA NU nota
Products / goods / materials operate correctly and Produsele/bunurile/materialele funcţionează corect şi
appropriately, according to specifications without corespunzător, potrivit cu specificaţiile, fără defecte
defects or malfunctions. sau disfuncţionalităţi. 25

0 unsolved claims 0 Reclamatii nerezolvate 20

The Supplier shall deliver the goods to the contract,
comply with all terms and conditions agreed and
invoices contain all the information and references
agreed
The characteristics of the goods mentioned in the
request for acquisition. Goods shipped are
packaged, sized appropriately labeled and easy to
handle.
Furnizorul livrează bunurile potrivit cu contractul,
respectă toţi termenii şi condiţiile convenite iar
facturile conţin toate informaţiile şi referinţele
convenite. 15
Bunurile prezinta caracteristicile mentionate in
solicitarea de achizitie. Bunurile de livrat sunt
ambalate, dimensionate, etichetate corespunzător şi
uşor de manevrat. 10

Exista un control riguros asupra produsului

There is a rigorous control of nonconforming product neconform; 15
Livrarea se face la timp şi potrivit programului; dacă
Delivery is on time and according to the program; if este necesar, furnizorul se adapteaza modificarilor
necessary, the provider adapts the required changes. solicitate. 15

PUNCTAJ OBTINUT 100

JCE / Fisier SIM / Formulare / Procurement F-109a, ed 1.

JCE / Fisier SIM / Formulare / Procurement F-109a, ed 1.
JCE / Fisier SIM / Formulare / Procurement F-109a, ed 1.