KFUPM Supplier Pre-Qualification Questionnaire

‫ر‬
‫المشتيـات‬ ‫إدارة‬
Purchasing Department
‫نـ ـ ـ ـ ـ ـ ـ ــموذج الت ـ ـ ــأهيل الم ـ ـ ـ ــسبـ ــق لل ـم ـ ــوردي ـ ـ ــن‬

2021 ‫لع ـ ـ ـ ـ ـام‬
‫المشتيات بجامعة الملك فهد ر‬
‫للبتول والمعادن‬ ‫ر‬ ‫هذه الوثيقة صادرة من ادارة‬
This document is prepared and issued by
KFUPM - Purchasing Department.
Address:
Building # 21, 5th Floor
PO Box 5013, Dhahran, 301261
Eastern Province, Kingdom of Saudi Arabia
Tel: [+966-13] 8603434
Fax: [+966-13] 8607126
E-mail: purchase@kfupm.edu.sa
Website: www.kfupm.edu.sa
KING FAHD UNIVERSITY OF PERTROLEUM & MINERALS – KSA
PRE-QUALIFICATION OF SUPPLIERS PROGRAM &

REGISTRATION QUESTIONNAIRE
1ST JANUARY 2021 - 31 DECEMBER 2021
KFUPM, Purchasing Department, Building # 21, 5th Floor

PO Box 5013, Dhahran, 301261
Eastern Province, Kingdom of Saudi Arabia
Tel: [+966-13] 8603434

Fax: [+966-13] 8607126
E-mail: Pre-qualification@kfupm.edu.sa
Website: www.kfupm.edu.sa
1
KFUPM - Supplier Pre-Qualification Questionnaire 2021
Table of Contents
PRE-QUALIFICATION OF SUPPLIERS FOR GOODS AND SERVICES .............................. 3
DETAILS FOR SUBMISSIONS OF THE PRE-QUALIFICATION DOCUMENTS .................. 3
CATEGORIES FOR SUPPLY OF GOODS AND SERVICES ............................................4-6
PRE-QUALIFICATION INSTRUCTIONS ....................................................................... 7
ESSENTIAL CRITERIA FOR PRE-QUALIFICATION ........................................................ 8
PRE-QUALIFICATION EVALUATION CRITERIA ............................................................ 9
MANDATORY REQUIREMENTS .................................................................................9
TECHNICAL EVALUATION- SCORING.........................................................................9
PART I. SUPPLIER REGISTRATION QUESTIONNAIRE ........................................... 10-11
PAST EXPERIENCE/REFERENCE CLIENT DETAILS ..................................................... 12
PART II. CONFIDENTIAL BUSINESS QUESTIONAIRE................................................. 13
APPENDIX “A” CONFIDENTIAL BUSINESS QUESTIONNAIRE .................................... 14
LITIGATION HISTORY ............................................................................................. 15
APPENDIX “B” DECLARATION FORM .................................................................15-16
APPENDIX “C” CODE OF ETHICS AND

CONFLICT OF INTEREST DISCLOSURE FORM ...........................................................17
2
PRE-QUALIFICATION OF SUPPLIERS FOR GOODS AND SERVICES
KFUPM is a Governmental Organization (that has been working in KSA since 1963 to
support its globally competitive graduates, innovative research and leadership in energy
fields. Teaching & research are the two core functions of KFUPM. We are currently
implementing programs that are aimed at strengthening and increasing access to and
utilization of high quality Products & Services for our Academic & Non-Academic
Departments.
KFUPM seeks to invite interested and eligible organizations to submit applications for
the pre-qualification of suppliers.Following are the lists of categories, you need to choose
the categories based on our registered CR Only.
3
CATEGORIES FOR SUPPLY OF GOODS AND SERVICES

Category -A
Reference Main
Number
Sub-categories
Categories
1.1- Electrical, Mechanical & Civil Engineering Equipment
✔
1.2- Physics , Chemistry & Petro-Chemical Engineering Equipment
Teaching/ 1.3- Petroleum & Minerals Engineering Equipment

PQL/01/2020 Laboratory
1.4- Environment & Water (Marine) Equipment
Equipment
1.5- Aerospace Engineering Equipment
1.6- Annual Maintenance Contracts
Research & 2.1- Supply of Equipment, Installation, Commissioning, Training and

✔
PQL/02/2020 Scientific Testing.
Equipment
3.1- Lab Consumables
✔ 3.2- Spare Parts & Accessories

PQL/03/2020 Lab Supplies
3.3- Glassware
3.4- Hardware & Tools
Academic Text 4.1- Academic Text Books/ E-Books

PQL/04/2020
Books
Library Books & 5.1- Library Books, Database Access Codes & Software Subscriptions
PQL/05/2020 License (Magazines & Journols)
Subscriptions
6.1- Supply of Lab Chemicals for Teaching & Research
PQL/06/2020 Lab Chemicals
6.2- Disposal of Chemical waste.
PQL/07/2020 Industrial Gases 7.1- Supply of Industrial Gases for Teaching & Research
8.1- Furniture & Fixture (For Office)
8.2- Furniture & Fixture (For Housing)
8.3- Mattress, Linen & Blanket etc.

Housing Supplies
PQL/08/2020
& Services 8.4- Home Decoration: Carpets,Curtains,Flooring,VB, RB w/Installation.
8.5- Home Appliances: Kitchen Ware, Oven & Accessoriesetc.
8.6- For Convocation Ceremony:Branded Watches, Plaques, & Gifts etc.
Maintenance 9.1- HVAC Maintenance: Supply of AC, Cooling Tower, Chiller, Spare
Supplies & Parts, Accessories and Services
PQL/09/2020 9.2- Construction Maintenance: Supply of Building/Construction
Services
(HVAC, Electrical, Materials & Repair Works
4
Mechanical, 9.3- Electrical Maintenance: Supplies & Services (Elevators, Automatic

Plumbing, Doors, Lamps etc.)
Construction, 9.4- Construction Projects: Construction Works,
Garage & Engineering/Design Consultation and Other Services.
Water Plant etc.) 9.5- Mechanical Maintenane: Supply / Repairing of Pumps, Engines,
turbines, Generators etc. and Installation Services.
9.6- Plumbing Material: Supply & Services
9.7- Welding Works (Supplies & Services): Aluminium/ Steel Doors etc.
9.8- Industrial Equipment & Machineries (Forklift, Compressor etc.)
9.9- Supply of Vehicle Spare Parts & Services
9.10- Water Plant Maintenance (Supply of Chemicals, Spare Parts,

Accessories & Services)
9.11- Supply of Fuel
10.1- Kitchen Equipment & Spare Parts
10.2- Grain Supplies (Rice, Oil & Pulses etc.)

10.3- Meat Supplies (Chicken, Mutton, Beef & Sea Food)
10.4- Vegetables & Fresh Fruits

Food Supplies & 10.5- Bakery Items (Bread, Sandwich etc.)
PQL/10/2020
Services
10.6- Milk & Juices
10.7- Drinking Water
10.8- Disposable (Cup, containers etc.)
10.9- Cleaning & Sanitizing Material
11.1- Computer Hardware (PC, Monitor, Printer, Scanner,

Workstation, Spare Parts etc.)
11.2- IT Software (Academic & Non-Academic)
11.3- Networking (Supplies & Services)
11.4- Smart Classes (Audiovisual systems, Projectors Supplies & Services)
11.5- IT Consulting Services

ICTC Supplies &
PQL/11/2020
Services 11.6- Telecommunication Supplies & Services
11.7- Traffic Control Supplies & Services: (Traffic Lights, Gate Barriers
Sign Boards, Speed Cameras etc.)
11.8- Radio Systems: Supplies & Services
11.9- Smart Access Control: Supplies & Services (CCTV, Fingerprint

Attendance System, Smart Access Cards etc.)
11.10- Supply, Installation and maintenance of Security
Alarms/ Equipment and Security Systems
5
11.11- Supply, Installation and Maintenance of Firefighting Equipment

and Materials.
12.1- Medical Equipment: Supplies & Services (X-Ray, Dental Chair etc.)
12.2- Medicines Supplies (Tablets & Syrups etc.)

PQL/12/2020 Medical Center
12.3- Treatment Room Supplies (Band-Aid, Cotton, Alcohol Pad etc.)
Supplies &
Services 12.4 Medical Laboratory Supplies (Medical Testing Kits)
Printing Press 13.1- Printing Material (Papers, Ink, blades etc.)

PQL/13/2020 Supplies &
13.2- Printing Machine & Spare Parts
Services
14.1- General stationery.
14.2- Photocopy Paper (A4 & A3)

Office Supplies &
PQL/14/2020 14.3- Supply and maintenance of photocopier Machine & Scanners
Stationary etc.)
14.4- Toners
15.1- Security Equipment (Detectors, Security Scanners etc)

PQL/15/2020 Safety & Security
15.2-Personal Proctective Equipment (Safety Shoe, Gloves, Googles etc.)
16.1- Staff Training

PQL/16/2020 Training Courses
16.2- Faculty Training
17.1- Uniforms, Graduation Garments, Flags etc.

PQL/17/2020 Garments
PQL/18/2020 18- ISO, QC etc. Certifications
Accreditations
CATEGORY B: PROVISION OF OTHER SERVICES

PQL/17/2020 Provision of catering services.
PQL/18/2020 Provision of air travel, reservations and ticketing services.
PQL/19/2020 Provision of sanitary, fumigation, pest control and cleaning services.
PQL/20/2020 Provision of internet services.
PQL/21/2020 Provision of fleet management systems including tracking services.
PQL/22/2020 Repair and maintenance of audio-visual equipment, video and telephones.
PQL/23/2020 Provision of courier and mail delivery services.
PQL/24/2020 Repair, maintenance services of generators, power stabilizers and pumps.
PQL/25/2020 Supply and maintenance of air-conditioning installations and services.
PQL/26/2020 Provision of hotel accommodation and conference facilities.
PQL/27/2020 Provision of legal services.
PQL/28/2020 Provision of garbage collection services.
PQL/29/2020 Provision of general insurance services.
PQL/30/2020 Provision of motor vehicle insurance.
PQL/31/2020 Provision of security services (guards, dog patrols and security survey).
6
Provision of photography and video graphic and editing, including digital

PQL/32/2020
communication services.
PQL/33/2020 Servicing, repair and maintenance of vehicles, motor cycles and a motor boat.
PQL/34/2020 Provision of car hire and taxi services.
PQL/35/2020 Provision of events equipment (tents, chairs and Public Address (PA) equipment).
PQL/36/2020 Provision of audit services.
PQL/37/2020 Clearing and forwarding services.
PQL/38/2020 Cleaning and landscaping services.
KFUPM reserves the right to accept or reject any application in completely or in part, and is not
bound to give reasons for its decision.
 Canvassing will lead to automatic disqualification.
 Only successful organizations will be contacted for RFQ/Bidding.
Please complete the form below and submit with the requested attachments.
PRE-QUALIFICATION INSTRUCTIONS
1. KFUPM herein referred to as the organization, requests applicants/candidates who meet the
criteria set out by the organization to apply for registration of pre-qualification.
2. The pre-qualification objective is to supply and deliver assorted items and provide services under
the relevant tenders/quotations to KFUPM on and as when required during the stated period.
3. Duly registered suppliers of goods and services under the Laws of KSA are invited to submit their
pre-qualification documents to KFUPM so that they may be pre-qualified for submission of
quotations. The prospective suppliers are required to supply mandatory information for pre-
qualification.
4. Prospective suppliers and contractors must have carried out successful supply and delivery of
similar items/services to Clients /Corporations/Institutions/Government Departments of similar
size. Potential suppliers/contractors must demonstrate the willingness and commitment to meet
the pre-qualification criteria.
5. This invitation of application for pre-qualification is open to potential applicants who are able to
demonstrate proven technical, financial and managerial capacity to supply the listed goods and
services.
6. This document includes questionnaire forms and documents required of prospective suppliers.
7. The successful applicants will be registered on KFUPM suppliers list for the period from
1- January-2021 to 31 December 2021 and the organization will only deal with the firms that are
registered.
7
8. Applicants must submit a duly completed and signed Confidential Business Questionnaire
provided herein as Appendix ‘A’.
9. KFUPM reserves the right to request the submission of additional information from applicants or
any other credible source, and to visit and inspect the business premises of the applicant to
verify the information given.
10. The organization will ensure information that is received from companies is treated with the
utmost confidentiality and shall be for the sole use of the organization.
11. The pre-qualified suppliers are required to advise the KFUPM of any significant change in its
financial, technical capacity, online USER, ownership or holdings it may have.
12. Failure to submit any of the mandatory requirements will lead to automatic disqualification from
the exercise.
ESSENTIAL CRITERIA FOR PRE-QUALIFICATION
1- Experience
a.Prospective Bidders shall have at least three (3) years’ experience in the supply of good and
services.
b. Prospective suppliers require special experience and capability to organize supply and delivery of
items or services at short notice.
c. KFUPM reserves the right to request additional qualification information as the tender/quotation
stage to suit particular procurement.
d. Share contracts/PURCHASE ORDERS of previous works done and/or recommendation letters.
2- Financial Capability
a.The suppliers financial capability will be determined by the latest financial statement submitted
with the pre-qualification document as well as letters of reference from their bankers regarding
suppliers/contractors credit position.
b. Potential suppliers/contractors will be pre-qualified on the satisfactory information given.
c. Special consideration will be given to the financial capability to execute orders.
3- Personnel/Staff
a.The suppliers/contractors/consultants shall provide pertinent information to demonstrate that
they have qualified staff to carry out the assignment.
b. Curriculum Vitae (CVs) of the key personnel for individuals or groups that will execute the
contract must be indicated in Part I.
4- Past Performance
a.Past performance will be given due consideration for any pre-qualifying bidders.
b. Letters of reference/recommendation from past customers should be attached.
5- Premise
The Firm must have a registered and fixed business premise in KSA, with a Certificate of
Registration, address proof from Saudi Post of which must be attached.
8
PRE-QUALIFICATION EVALUATION CRITERIA
MANDATORY REQUIREMENTS
No Requirement Mandatory/optional
1. A valid copy of Commercial Registration Certificate/ Trade License Mandatory
2. A valid copy of Zakat Certification Mandatory
3. A valid copy of Value Added Tax (VAT) Certification Mandatory
4. A valid copy of General Organization of Social Insurance (GOSI) Certification Mandatory
5. A valid copy of Civil Defense License or an equivalent Government License Mandatory
6. A valid copy of Chamber of Commerce/ Industry Membership Certification Mandatory
7. Contractor Government Classification, if applicable (Service Providers Only) Optional
8. A valid copy of SAGIA Certifications (if applicable) Optional
9. A valid copy of the Owner National ID or Iqama ID for an individual owner Mandatory
10. Latest & Valid Saudization Certificate Mandatory
11. Copies of past purchase orders or contracts for the last 3 years. Optional
12. Evidence Of physical Registered office– Please attach utility bill e.g.
Mandatory
Electricity/Water bill etc. or tenancy agreements with the name of the firm.
13. Financial statement for the last 3 Years in the name of the firm i.e. Mandatory
14. A minimum of three reference letters from current clients i.e. For the period 2018
Mandatory
– 2020.
15. A letter of identification (On Company Letterhead) providing the Company’s basic
information which state the Company’s objective of the registration and list the
product(s) & services offered. This letter must be signed by an authorized company
Mandatory
representative, certified with VENDOR business
Stamp, and authenticated by the appropriate Saudi Arabian regional Chamber of
Commerce.
16. Certification of Technical staff / Engineers. (If Applicable) Mandatory
TECHNICAL EVALUATIONͲ^KZ/E'
No. Requirements (Submit evidence) Score (%)

1. Registration documentation e.g. CR or Certificate of Incorporation, Zakat, GOSI, 25
Chamber of commerce, Saudization Certificate, VAT certificate
2. Evidence Of physical Registered office– Attach utility bill e.g. Electricity /Telephone 15
bill etc. or tenancy agreements with the name of the firm.
3. Owner ID, SAGIA, Civil defense license , Contractor Classification, User 10
Identification Letter
4. Man Power/Staffing 10
6. Past Performance & Experience e.g. provide contracts/Local Purchase Orders 20
(LPOs) /Recommendation letters
7. Financial capability 15
8. Litigation history 5
TOTAL 100
PASS MARK 75
9
PART I. SUPPLIER REGISTRATION QUESTIONNAIRE

1. Business Name
CR No. 4030343496 VAT Reg. No. 310095677500003
2. Category applied for (Write the item category Reference Number):

PQL/01/2020 PQL/02/2020
PQL/03/2020
Item Description:
3. Experience:
a) State the number of years the company has been in similar business :
6 years
State names of five major clients, references and contact persons :

(Attach list and evidence e.g. Purchase Orders, Contract Agreements Invoices, etc.)
Aramco Saudi King Abdullah University of Science and Technology Tabuk Chamber of Commerce and Industry
King Abdulaziz City for Science and Technology

National Talents Co.
List ongoing contracts/projects (goods & services) and values of contract/orders:
4. Submit organizational structure and CV profiles of relevant management and technical staff:
5 a) Have you previously deal with KFUPM? If yes, state nature of business. (PO Number):
No
b) State whether you have, at any one time, been blacklisted by the KFUPM. If yes, give
reasons:
No
10
6. Financial Strength
Provide copies of the Financial Statements for the last three (3) years.
7. Delivery & Logistics
a) State location of registered office, warehouse and space whether owned/rented indicating:
i. Location No.1: Advanced Business Building - Floor 6, office 604 Khalid Bin Waleed Street، Jeddah
ii. Building
iii. Street/Road
iv. City/Town
v. Location No.2:
vi. Building
vii. Street/Road
viii. City/Town
8. State whether your company is a:
a) Manufacturer
b) Authorized agent (Attach principal/manufacturer’s authorization letter) ✔
c) Stockiest
d) Other (Please specify):
9. Specify the amount of business you can handle at one time/ highest contract value:
10. Give any other information that you feel is relevant for purpose of Pre-qualification as a
supplier
11
ADDITIONAL INFORMATION
1. Bank details:
Bank Name Account Number Branch Name Bank Address

National 12291940000101 As Salamah, Jeddah Sari, As Salamah,
Commercial Bank Jeddah
PAST EXPERIENCE/REFERENCE CLIENT DETAILS
Please provide at least three major supplies/projects/assignments you have undertaken relevant
to the good/services you are bidding for, performed over the last three years. The referees can
both sign and stamp below.
1. Client name(Organization)
Address
Tel No
Contact person
Position in the organization
Value of Contract
Duration of Contract (date)
(Attach Documentary Evidence of Existence of Contract)
2.Client name(Organization)
Address
Tel No
Contact person
Value of Contract
3.Client name(Organization)
Address
Tel No
Contact person
Value of Contract
12
PART II. CONFIDENTIAL BUSINESS QUESTIONAIRE
Appendix “A”: Confidential Business Questionnaire

Appendix “B”: Declaration Form
Appendix “C”: Code of Ethics and Conflict of Interest Disclosure Form
You are requested to give particulars indicated in part 1 and part 2(a), 2(b) or 2(c).
You are advised that it is a serious offence to give false information on this Form.
APPENDIX “A” CONFIDENTIAL BUSINESS QUESTIONNAIRE
Part 1 General
Company /Business Name…………………………………………………………………………………………………

Geeks Valley Information Technology Est
Location of business premises; Country/Town…………………………………………………………………..
KSA - Jeddah
………………………………………………………………………………
KSA - Jeddah
Building / Plot No…………………….Street/Road……………………………………………………………………..
Advanced Business Building - Floor 6, office 604 Khalid Bin Waleed Street
0543321100 - 012 654 1310

Postal Code…………………..…...Tel / Mobile No…………………………………………………………………
Fax No……………………………………………………………………….
E-mail…………………………………………………………..……………
info@geeksvalley.com
Nature of Business……………………………………………………..........
Supplying electronic parts and CNC Machine
Current Trade License No………………………………………………..Expiring

4030343496 date…………………………….
Saudi Arabia
Maximum value of business, which you can handle at any time: Taher
…………………………………….
ِAl-Balawi
Name of your bankers………………………………………………………..

Taher ِAl-Balawi
Branch………………………………………………………………………..
Taher ِAl-Balawi
Part 2 (a) – Sole Proprietor
Your name in full…………………………………………………Age……………………

Taher ِAl-Balawi
Nationality……………………………………Country
Saudi Arabia of Origin…Saudi Arabia
13
*Citizenship details………………………………………………………
Part 2 (b) – Partnership
Give details of partners as follows:
Name in full, Nationality, citizenship details and shares
1) ……………………………………………………………………………
2) ……………………………………………………………………………
3) ……………………………………………………………………………
4) ……………………………………………………………………………
5) ……………………………………………………………………………
Part 2(c) - Registered Company
Private or Public……………………………………………………………
State the nominal and issued capital of the company –
Nominal SAR-…………………………………………………………...
25000
Issued SAR-………………………………………………………………
Give details of all directors as follows:
Name in full, Nationality, Citizenship Details and Shares
1) ……………………………………………………………………………
2) ……………………………………………………………………………
3) ……………………………………………………………………………
4) ……………………………………………………………………………
5) ……………………………………………………………………………
Date…………………………Signature of Applicant………………………
14
LITIGATION HISTORY
Name of contractor/supplier should provide information on any history of litigation or arbitration resulting
from contracts executed in the last five years or currently under execution.
No. Year Award for or Name of client cause of litigation and Disputed Amount (Current Value
against matter in dispute in Saudi Riyals
1.
2.
3.
APPENDIX “B” DECLARATION FORM
I/We………………………………………………………………………………………………………hereby
Taher Al-Balawi declare:
 That the information given above is true and further state that I/We also understand that filling of this
form does not guarantee pre-qualification or registration.
 That I/We are not insolvent/in receivership, bankrupt or being wound up, business activities not
suspended/not subject to legal proceedings.
 That I/We have legal capacity to enter into contract.
 That I/We have fulfilled obligations to pay taxes/social security contributions.
 That if the legal, technical, financial position, or the contractual capacity of the firm changes, we
commit ourselves to inform you and acknowledge your sole right to review the pre-qualification
made.
 That I/We understand that I/We shall be disqualified should the information submitted here for
purpose of seeking qualification be materially inaccurate or materially incomplete.
 That I/We give KFUPM , authority to seek any other references concerning my/Our Company from
whatever sources deemed relevant.
 That if pre-qualified, I/we undertake to participate in submission of a tender or quotation when called
upon to do so.
Name…………………………………………………………………………
Taher Al-Balawi
15
Designation……………………………………………………………………
Signature………………………………………………………………………
Official rubber stamp...………………………………………………………..
Date……………………………………………………………………………
APPENDIX “C” CODE OF ETHICS AND CONFLICT OF INTEREST DISCLOSURE FORM
KFUPM Procurement guidelines stipulate that KFUPM should not permit reciprocity in any
purchase transactions. Any reciprocal financial transactions between a supplier and an employee,
whether before or after pre-qualification, are prohibited. It does not matter that the transaction
is at arm’s length or not.
In view of the above, outlined below are the guidelines on code of ethics and conflict of interest.
Code of Ethics
Employees of KFUPM are not allowed to accept or agree to accept any money, gifts, or other
benefit on behalf of themselves or anyone else, from a person or institution having dealings with
the KFUPM. No gift may be accepted in any case where it is obvious that the gift will result in an
expected reciprocal action from the KFUPM.
The standard of conduct for all potential suppliers include the following:
1) Potential suppliers are required to refrain from offering, directly or indirectly, any gratuity,
gifts, favors, entertainment or any promise of future employment to employees of KFUPM
who may be in a position to influence the procurement decision.
2) Potential suppliers and/or their agents are not expected to deal with an employee who has
a financial interest in their business.
3) During the pre-solicitation phase, potential supplier(s) should avoid soliciting

information on a particular acquisition before such information is available to the business
community at large.
4) Potential suppliers should declare relationships with KFUPM employees, if any, that could
be termed as conflict of interest.
16
Conflict of Interest
Please give details of any conflict of interest that may exist between yourself and employee(s) of
the KFUPM as indicated below, and confirm that you have read the code of ethics and is in
agreement with it.
Has any employee of KFUPM been your employee in the past one year?
If yes, please give details

…………………………………………………………………………………….....……………………………………………………………
No
………………………….…………………........................................................................................................
Do you have any family ties with any KFUPM employee(s) through spouse or immediate family?
If so, please explain: ………………………………………………………………………………………

………………………………………………………………………………………………………………………………………………………
No
………………………
Have you had past business dealings with any employee of KFUPM?
If yes, please give details: ………………………………………………………………………………………

………………………………………………………………………………………………………………………………………………………
No
………………………
Do you have other social or political relationships with an employee of KFUPM in procurement,
which may impede his/her independence or objectivity?
……………………………………………………………………………………….………………………………………………………………
No
……………………….……………………………………………………………………………………….
I confirm that all the information given above is true. I understand that failure to comply with the
code of ethics and conflict of interest policy will lead to disqualification of my application.
Name…………………………………………………………………………………
Taher Al-Balawi
Designation…………………………………………………………………………..
Signature……………………………………………………………………………..
Official rubber stamp...………………………………………………………...........
Date………………………………………………………………………………….
17

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‫نـ ـ ـ ـ ـ ـ ـ ــموذج الت ـ ـ ــأهيل الم ـ ـ ـ ــسبـ ــق لل ـم ـ ــوردي ـ ـ ــن‬

PRE-QUALIFICATION OF SUPPLIERS PROGRAM &

1ST JANUARY 2021 - 31 DECEMBER 2021

KFUPM, Purchasing Department, Building # 21, 5th Floor

Tel: [+966-13] 8603434

DETAILS FOR SUBMISSIONS OF THE PRE-QUALIFICATION DOCUMENTS .................. 3

CATEGORIES FOR SUPPLY OF GOODS AND SERVICES ............................................4-6

PRE-QUALIFICATION INSTRUCTIONS ....................................................................... 7

ESSENTIAL CRITERIA FOR PRE-QUALIFICATION ........................................................ 8

PRE-QUALIFICATION EVALUATION CRITERIA ............................................................ 9

MANDATORY REQUIREMENTS .................................................................................9

TECHNICAL EVALUATION- SCORING.........................................................................9

PART I. SUPPLIER REGISTRATION QUESTIONNAIRE ........................................... 10-11

PAST EXPERIENCE/REFERENCE CLIENT DETAILS ..................................................... 12

PART II. CONFIDENTIAL BUSINESS QUESTIONAIRE................................................. 13

APPENDIX “A” CONFIDENTIAL BUSINESS QUESTIONNAIRE .................................... 14

LITIGATION HISTORY ............................................................................................. 15

APPENDIX “B” DECLARATION FORM .................................................................15-16

APPENDIX “C” CODE OF ETHICS AND

PRE-QUALIFICATION OF SUPPLIERS FOR GOODS AND SERVICES

CATEGORIES FOR SUPPLY OF GOODS AND SERVICES

Teaching/ 1.3- Petroleum & Minerals Engineering Equipment

Research & 2.1- Supply of Equipment, Installation, Commissioning, Training and

✔ 3.2- Spare Parts & Accessories

3.4- Hardware & Tools

Academic Text 4.1- Academic Text Books/ E-Books

8.1- Furniture & Fixture (For Office)

8.2- Furniture & Fixture (For Housing)

8.3- Mattress, Linen & Blanket etc.

8.5- Home Appliances: Kitchen Ware, Oven & Accessoriesetc.

8.6- For Convocation Ceremony:Branded Watches, Plaques, & Gifts etc.

Mechanical, 9.3- Electrical Maintenance: Supplies & Services (Elevators, Automatic

9.9- Supply of Vehicle Spare Parts & Services

9.10- Water Plant Maintenance (Supply of Chemicals, Spare Parts,

10.1- Kitchen Equipment & Spare Parts

10.2- Grain Supplies (Rice, Oil & Pulses etc.)

10.4- Vegetables & Fresh Fruits

10.9- Cleaning & Sanitizing Material

11.1- Computer Hardware (PC, Monitor, Printer, Scanner,

11.3- Networking (Supplies & Services)

11.4- Smart Classes (Audiovisual systems, Projectors Supplies & Services)

11.5- IT Consulting Services

11.9- Smart Access Control: Supplies & Services (CCTV, Fingerprint

11.11- Supply, Installation and Maintenance of Firefighting Equipment

12.2- Medicines Supplies (Tablets & Syrups etc.)

Printing Press 13.1- Printing Material (Papers, Ink, blades etc.)

14.2- Photocopy Paper (A4 & A3)

15.1- Security Equipment (Detectors, Security Scanners etc)

16.1- Staff Training

17.1- Uniforms, Graduation Garments, Flags etc.

CATEGORY B: PROVISION OF OTHER SERVICES

Provision of photography and video graphic and editing, including digital

 Canvassing will lead to automatic disqualification.

 Only successful organizations will be contacted for RFQ/Bidding.

ESSENTIAL CRITERIA FOR PRE-QUALIFICATION

PRE-QUALIFICATION EVALUATION CRITERIA

No. Requirements (Submit evidence) Score (%)

PART I. SUPPLIER REGISTRATION QUESTIONNAIRE

CR No. 4030343496 VAT Reg. No. 310095677500003

2. Category applied for (Write the item category Reference Number):

State names of five major clients, references and contact persons :