Copy of 10421191633 - Performance Scorecard - HVAC Maintenance Services - 20211109

Service Agreement No.
10421191633
Provision of HVAC Maintenance Services
Key Performance Indicator Evaluation Form
Technical Evaluation Criteria
Heading Description Point Scale

SCHEDULE 2: SCOPE OF Monitoring of Contractor's performance detailed in
2
SERVICES the Schedule 2 - Scope of Services
Monitoring of Contractor's performance detailed in
SCHEDULE 3: RATES AND FEES 2
the Schedule 3 - Rates and Fees
SCHEDULE 3 - ATTACHMENT 2 & Monitoring of Contractor's performance detailed in

2
3 - LOCAL CONTENT the Schedule 3 Attachment 2 and 3 - Local Content
INSURANCE REQUIREMENT Monitoring of Contractor's performance detailed in

2
(CLAUSE 22.2) Clause 22.2 of the Agreement - Insurance
Monitoring of Contractor's performance detailed in

SCHEDULE 4: HSSE 2
the Schedule 4 - HSSE
Total
Minimum Technical Score Threshold

Management Recognition
Yellow Sanction and penalty
Red Sanction
Evaluation Team
Name Position Department

Daniel Silaban Maintenane Reliability Engineer Operations
Gadis Ayunda Contract Management Officer SCM
Scoring
Point Value Description

2 Fully meets or Exceeds performance expectation
1 Partially satisfied the performance requirement
0 Failed to satisfied performance requirement
100%
Weight
45%
25%
10%
10%
10%
100%
75
>80
<40
<30
Department
Operations
SCM
Well Site Services Agreement No. 10421191633
Provision of HVAC Maintenance Services
Key Performance Indicator Evaluation Form
Maximum 2020 2021

Evaluation Criteria
Points Score Score
Performance Evaluation
SCHEDULE 2: SCOPE OF SERVICES 45.00 45.00 40.50
SCHEDULE 3: RATES AND FEES 25.00 25.00 25.00
SCHEDULE 3 - ATTACHMENT 2 & 3 - LOCAL CONTENT 10.00 10.00 10.00
INSURANCE REQUIREMENT (CLAUSE 22.2) 10.00 10.00 10.00
SCHEDULE 4: HSSE 10.00 8.28 10.01
Total Performance Evaluation 100.00 98.28 95.51
75 75
Met Minimum Performance Score Threshold
Yes Yes
2023
Score
0.00
75
No
Provision of Asset Integrity and Process Safety Management Services
Key Performance Evaluation Score Card (2020)
PERFORMANCE EVALUATION SCORE (OUT OF 100) = 98.28

Max. Score : 100
Min. Score : 75
SCHEDULE 2: SCOPE OF SERVICES
Maximum Score = 45.00
POINT WEIGHTED
No. TOPIC SPECIFIC KPI and DEFINITIONS WEIGHT SCORE SCORING GUIDELINES PIC REF. REQUIRED EVIDENCE AND/OR REMARKS
SCALE SCORE
Schedule 2 -
Scope of
Daniel Services
Maintenane Services are always performed as per Not as per manufacturer recommendation: 0
Silaban -
manufacturer recommendation 10.0% 1.00 1.00 4.50 As per manufacturer recommendation: 1 Preventive Maintenance Report
Operations Clause 2.1.1
Dept. Preventive
Maintenance
Services
1 Preventive Maintenance
The activities performed always include the following: Schedule 2 -

(i) Record environmental conditions. Scope of
(ii) Measuring parameters of temperature, pressure, relative Daniel Services
More than 1 of the required activities are not performed: 0
humidity, flow rate of inlet air. Silaban -
10.0% 2.00 2.00 4.50 1 of the required activity is not performed: 1 Preventive Maintenance Report
(iii) Inspection of all v-belt of motor blower. Operations Clause 2.1.2
All of the required activities are performed covered: 2
(iv) Measuring pressure of refrigerant in HVAC System. Dept. Preventive
(v) Function test of all motor dampeners, instrument Maintenance
transmitters related to HVAC (including solenoid valve) Services
Schedule 2 -
In the event of equipment failure, Contractor does not inspect,
Scope of
In case of equipment failure, Company requests Contractor to troubleshoot, repair, configure, and or upgrade as per
Daniel Services
inspect, troubleshoot, repair, configure, and or upgrade (if Company's requirement: 0
Silaban -
needed) equipment in order to meet its existing performance. 10.0% 1.00 1.00 4.50 Correctice Maintenance Report
In the event of equipment failure, Contractor inspect,
Dept. Corrective
(if not needed, full score) troubleshoot, repair, configure, and or upgrade as per
Maintenance
Company's requirement: 1
Services
2 Corrective Maintenance Services
Schedule 2 -
Scope of
Daniel Services
Warranty is not provided as required or less than the
Contractor provides six (6) months of warranty for every Silaban -
10.0% 1.00 1.00 4.50 requirement: 0 Warranty Letter
Corrective Maintenance Service) Operations Clause 2.2.2
Warranty provided as required: 1
Dept. Corrective
Maintenance
Services
Contract Name Company #1 01/19/2022 - Page 5

Provisions of Reimbursable Materials:

(i) In case needed, Contractor shall provide the materials upon
written request by Company’s representative.
(ii) Contractor shall submit proposal that includes price and
delivery time within 3 (three) calendar days after notification
sent by Company.
(iii) Material shall be delivered by Contractor upon approval of
proposal by Company’s representative.
Schedule 2 -
(iv) Material shall be sent to Delivery Point include with its
Scope of
necessary documents such as certificate of origin, certificate of
Daniel Services
manufacturer. <70% of the provisions are not being met in average: 0
Silaban -
3 Reimbursable Materials (v) Material will be inspected by Company’s representative at 5.0% 2.00 2.00 2.25 70 - 99% of the provisions are being met in average: 1 Delivery Note
Operations Clause 2.3
Delivery Point prior to acceptance. 100% of provisions are always being met: 2
Dept. Provision of
(vi) The material will be reimbursed back to the Company
Reimbursable
based agreed price or on actual cost including the handling
Materials
cost.
(vii) Company reserves the right to reject material from the
Contractor if found defective, not in perfect condition, or do not
meet specifications.
(viii) Contractor take all responsibility of shipping charges
including import taxes, transportation cost, packaging cost,
and other charges during the shipping material until it arrives
at Delivery Point.
Provisions of Rental Tools:

(i) If required, Contractor will provide rental tools which are
needed to complete the Services. The requirement to provide
rental tools will be discussed prior to performing the Services.
(ii) List of rental tools includes (but not limited to) are in
Schedule 2 -
Appendix-2.
Daniel Scope of
(iii) Contractor’s personnel will carry rental tools by themselves <70% of the provisions are not being met in average: 0
Silaban - Services
4 Rental Tools to Site. If rental tools cannot be carried by Contractor’s 5.0% 2.00 2.00 2.25 70 - 99% of the provisions are being met in average: 1 Delivery Note
Operations
personnel due to constraint in tool’s weight, dimension, or any 100% of provisions are always being met: 2
Dept. Clause 2.4
issues that come up during transportation, then Contractor
Rental Tools
needs to deliver rental tools to Delivery Point in order for
Company to deliver rental tools from Delivery Point to Site
using vessel.
(iv) Cost for rental tools shall be based on actual time spent
using the tools.

Qualification Requirement of HVAC Engineer:

(i) A bachelor’s degree in engineering with at least three (3)
years of working experience in HVAC system.
(ii) Has certificate of competence related with HVAC from
Badan Nasional Sertifikasi Profesi (BNSP).
(iii) Healthy and fit for providing the Services, which shall be
Schedule 2 -
confirmed and proved with annual medical check-up at
Scope of
Contractor’s sole cost. The assigned personnel does not meet all the Qualification Daniel
Services
(iv) Nominated personnel will be subject to Company interview Requirement: 0 Silaban - CV of the assigned personnel and relevant
5.0% 1.00 1.00 2.25
and technical assessment. The assigned personnel meets all the Qualification Requirement: Operations certification
Clause 3.1
(v) Main roles shall include but not limited to intervention, 1 Dept.
HVAC
troubleshooting, issue action plan and its schedule.
Engineer
Supervisory and lead technicians for the works, issue daily
activities and troubleshooting close out reports.
For working at Site, Personnel shall bring:

(i) Valid KTP
(ii) Certificate T-BOSIET/T-BOSET
5 Contractor's Personnel
Qualification Requirement of HVAC Technician:

(i) STM or equal with minimum three years working experience
in HVAC.
Badan Nasional Sertifikasi Profesi (BNSP) and K3 Listrik
certificate from the Departemen Ketenagakerjaan Republik
Schedule 2 -
Indonesia (DEPNAKER RI).
Scope of
(iii) Healthy and fit for providing the Services, which shall be The assigned personnel does not meet all the Qualification Daniel
Services
confirmed and proved with annual medical check-up at Requirement: 0 Silaban - CV of the assigned personnel and relevant
5.0% 1.00 1.00 2.25
Contractor’s sole cost. The assigned personnel meets all the Qualification Requirement: Operations certification
Clause 3.2
(iv) Nominated person will be subject to Company interview 1 Dept.
HVAC
and technical assessment.
Technician
(v) Main roles shall include but not limited to intervention the
works which has prepared by HVAC Engineer.

(i) Valid KTP

The deliverables under this Agreement are: Schedule 2 -

(i) Site Activity Report for Scheduled Maintenance Service or Daniel Scope of
Corrective Maintenance Service. Both deliverables never submitted: 0 Silaban - Services
4 Deliverables 10.0% 1.00 1.00 4.50 Submitted Deliverables
(ii) Acceptance Certificate signed by Company’s Both deliverables always submitted as required: 1 Operations
representative as Company’s acceptance of the Services Dept. Clause 4
performed. Deliverables
Contractor shall deliver minimum documents listed as follow:

(i) Proposed initial work plan and estimated parts required
referred to the items in Company notification or BR prior to
starting The Services.
(ii) Records of Daily Report, which have been signed by
Company’s representative if The Services is performed in
Schedule 2 -
Company’s facilities. > 90% of the required documents are submitted in average: 0 Daniel
Scope of
(iii) Record of Daily Report, which have been signed by 91% - 99% of the required documents are submitted in average: Silaban -
5.0% 2.00 2.00 2.25 Services Report Transmittal Note
Contractor’s representative if The Services is performed in 1 Operations
Contractor’s facilities. 100% of the required documents are submitted in average: 2 Dept.
Clause 8.1
(iv) Each of Contractor’s personnel shall submit daily
timesheets to show hours spent on each work assignment.
These timesheets, must be approved by Company, and shall
be attached to Contractor’s invoice along with a copy of RO.
(v) Final Report consisting of finding/background, action to be
taken, recommendation after completing The Services.
Schedule 2 -
Daniel
5 Reporting The final report is not presented as required: 0 Scope of
Contractor shall present The Final Report in front of Silaban -
5.0% 1.00 1.00 2.25 The final report is always presented as required: 1 Services Attendace List, Minutes of Meeting.
Company’s personnel. Operations
Dept.
Clause 8.2
Contractor shall send draft of report within 10 (ten) working

Schedule 2 -
day after completion of service and Company’s representative Daniel
The timeline requirement of the report are never being met: 0 Scope of
shall provide comments within 10 (ten) working days from the Silaban -
5.0% 1.00 1.00 2.25 The timeline requirement of the report is always being met: 1 Services Report Transmittal Note
date of draft reports submission. Contractor shall incorporate Operations
all the Company’s comments and changes in the draft report Dept.
Clause 8.3
to make the Final Report within 10 (ten) working days.

Final Report shall be in hardcopy and softcopy format. For Schedule 2 -

Daniel
closing out Final Report, minimum one (1) original printed The submission requirement is never being met: 0 Scope of
Silaban -
report and one (1) soft copy report in Microsoft Office format or 5.0% 1.00 1.00 2.25 The submission requirement is always being met: 1 Services Report Transmittal Note
Operations
PDF file format (stored in CDs) shall be submitted to
Dept.
Company. Clause 8.4
Contractor never provide safety gudelines as required and

installation, erections, welding and all related construction works
not always reflect all safety aspects: 0
Contrctor shall provide safety guidelines for offshore and Schedule 2 -
Daniel
onshore work and Contractor must show the ability to perform Contractor always provide safety gudelines as required but Scope of
Silaban -
the work in a safe manner. The installation, erections, welding 5.0% 2.00 2.00 2.25 installation, erections, welding and all related construction works Services Maintenance Report
Operations
and all related construction works should reflect all safety inconsistently reflect all safety aspects: 1
Dept.
aspects. The safe work environment will also be examined. Clause 11.3
Contractor always provide safety gudelines as required and
always reflect all safety aspects: 2
6 Safety, Health and Environment
Contractor shall provide safety equipment (PPE) for the

assigned personnel, which include but not limited to:
Schedule 2 -
(i) Long sleeve Fire Resistant Coverall > 90% of the required PPE are provided in average: 0 Daniel
Scope of
(ii) Safety Helmet with Chin strap 91% - 99% of the required PPE are provided in average: 1 Silaban -
5.0% 2.00 2.00 2.25 Services Maintenance Report
(iii) Safety glasses 100% of the required are provided in average: 2 Operations
(iv) Safety boots Dept.
Clause 11.4
(v) Protective gloves
(vi) Hearing protector
100%
Schedule 2 - Scope of Services Score = 45.00
SCHEDULE 3: RATES AND FEES

POINT WEIGHTED
SCALE SCORE
Contractor shall be subject to a maximum penalty of zero-point 2: Contractor properly informing and communicating with the Schedule 2 -
one percent of the Release Order for each day of delay or Company representative for any possible delay which will be Gadis Scope of
failure to perform the Service. The maximum delay is fifty (50) impacting the performance and possibility for penalty Ayunda - Services
1 Penalty 25.0% 2.00 2.00 6.25 Penalty calculation
days. The total amount of penalty will not be in excess of five 1: No performance issue that need to be penalized SCM
percent (5%) of the estimated total Contract Value in Schedule 0: The Contractor being penalized for this specific penalty for Department Clause 13
2 - Compensation. more than one (1) times Penalty

2: The Contract Expenditure Report is submitted and accurate Schedule 3 -

Daniel
compares to the Company's report Rates and
The accuracy of the remaining contract value stated in the Silaban -
2 Contract Expenditure Report 25.0% 2.00 2.00 6.25 1: The Contract Expenditure Report is not submitted but not Fees Contract Expenditure Report
Contract Expenditure Report Operations
accurate compares to the Company's report
Dept.
0: The Contract Expenditure Report is not submitted Attachment 1
The completeness of the invoice's supporting documents as

follow:
i. Copy of Work Authorization (Release Order).
ii. Original and four (4) copies of completed Tax Invoice.
iii. Copy of the compensation section of the Agreement.
iv. Original Delivery Ticket or Delivery Order for the goods Schedule 1 -
2: The invoice and its supporting documents is submitted and
delivered. Daniel Contract
accurate before the 25th day of each month
v. Original Time Sheet, Operating Time Report or Standby Silaban - Particulars
3 Invoicing 25.0% 2.00 2.00 6.25 1: The invoice and its supporting documents is submitted and Invoice and its supporting documents
Time Report, Job Ticket or Service Ticket, for the services Operations
accurate by 25th day of each month
performed. Dept. Invoicing
0: The invoice and its supporting documents is not submitted
vi. Original invoice from third party along with a copy of Procedures
regularly each month
purchase order and a proof of payment to third party for
reimbursable costs.
vii. Contract Expenditure Report.
viii. Progress of the domestic component utilization as
required in the Agreement.
Performance bond requirements:

- Issued by a commercial bank (exclusive of Bank Perkreditan
2: The required performance bond is valid/renewal of the
Rakyat) which is State-Owned Enterprise (the “BUMN”) or
required performance bond is provided to the Company on the Gadis Letter of Award Performance Bond:
Regional-Owned Enterprise (the “BUMD”) and in the format
expiry date and the minimum threshold is met Ayunda - Issued by Bank Mandiri
4 Performance Bond acceptable to Company 25.0% 2.00 2.00 6.25
1: The required performance bond is invalid/below the minimum SCM Agreement Value: IDR 64.341.500,00
- Value: IDR 64.341.472,00
threshold Department Clause 25 Validity: 22 June 2020 - 21 July 2023
- Validity: 22 June 2020 - 21 July 2023 ( as of the Effective
0: The required performance bond is not submitted to the
Date of the Agreement up to one (1) month after the expiry
Company
date of the Agreement.)
100%
Schedule 3 - Rates and Fees Score = 25.00
SCHEDULE 3 - ATTACHMENT 2 & 3 - LOCAL CONTENT

POINT WEIGHTED
SCALE SCORE

Schedule 3 -
Rates and
Fees
2: The Domestic Content Expenditure Report is always submitted
Attachment 2
on each invoice submission Daniel
Local Content
Domestic Content Expenditure The Domestic Content Expenditure Report is submitted on 1: The Domestic Content Expenditure Report is not submitted in Silaban -
1 100.0% 2.00 2.00 10.00 Commitment Domestic Content Expenditure Report
Report each invoice submission one (1) invoice submission Operations
0: The Domestic Content Expenditure Report is not submitted in Dept.
Attachment 3
more than one (1) invoice submission
Domestic
Product
Expenditure
Report
100%
Schedule 3 - Attachment 2 - Local Content Score = 10.00
INSURANCE REQUIREMENT (CLAUSE 22.2)

POINT WEIGHTED
SCALE SCORE
Shall be fully compliant with the regulations and laws of the 2: The required insurance certificate is valid/renewal of the
state and country in which the Contractor’s personnel or required insurance certificate is provided to the Company on the
Gadis
Insurance Certificate: Workmen's employees reside, the state and country in which the expiry date and the minimum threshold is met
Ayunda - Agreement
1 Compensation and Occupational Contractor is domiciled and all international laws applicable to 25.0% 2.00 2.00 2.50 1: The required insurance certificate is invalid/below the Respective Insurance Certificate
SCM Clause 22.2 (a)
Disease Contractor’s personnel (expatriate) or employees extended to minimum threshold
Department
include, as required, working offshore and whilst being 0: The required insurance certificate is not submitted to the
conveyed by land, sea or air. Company
2: The required insurance certificate is valid/renewal of the

Shall be submitted with a limit of not less than US$ 500,000.00 required insurance certificate is provided to the Company on the
Gadis
Insurance Certificate: Employers per occurrence or higher if required by any Applicable Law. expiry date and the minimum threshold is met
Ayunda - Agreement
2 Liability Insurance with a limit not Such insurance shall be endorsed to so that claim formulated 25.0% 2.00 2.00 2.50 1: The required insurance certificate is invalid/below the Respective Insurance Certificate
SCM Clause 22.2 (a)
less than US$ 500,000.00 by employees of the Contractor against the Company Group minimum threshold
Department
shall be treated as claim against the Contractor. 0: The required insurance certificate is not submitted to the
Company

required insurance certificate is provided to the Company on the
Shall be submitted including pollution liability with a combined Gadis
Insurance Certificate: expiry date and the minimum threshold is met
single limit for bodily injury and property damage of not less Ayunda - Agreement
3 Comprehensive General Liability 25.0% 2.00 2.00 2.50 1: The required insurance certificate is invalid/below the Respective Insurance Certificate
than US$1,000,000.00 per occurrence or series of SCM Clause 22.2 (b)
Insurance minimum threshold
occurrences. Department
0: The required insurance certificate is not submitted to the
Company


Gadis
Shall be covering Contractor’s equipment based on expiry date and the minimum threshold is met
Insurance Certificate: Equipment All Ayunda - Agreement
4 replacement value and coverage shall apply in transit by land, 25.0% 2.00 2.00 2.50 1: The required insurance certificate is invalid/below the Respective Insurance Certificate
Risks Insurance SCM Clause 22.2 (c)
sea or air and while in storage away from the worksite. minimum threshold
Department
Company
100%
Insurance Requirement Score = 10.00
SCHEDULE 4: HSSE
POINT WEIGHTED
SCALE SCORE
Lagging Indicator
3: no case
FAIL: one (1) or more cases. If Service Provider failed to fulfil this Muh. Razi -
1 First Aid Case (FAC) 0.0% requirements, Company will directly decide that Service Provider HSSE & AI B.2 Case report
performance is fail for the whole contract in the respective Dept.
quarter and sanction will be imposed based on PTK 007.
3: no case
2 Medical Treatment Case (MAC) 0.0% requirements, Company will directly decide that Service Provider HSSE & AI B.2 Case report
3: no case
3 Restricted Work Case (RWC) 0.0% requirements, Company will directly decide that Service Provider HSSE & AI B.2 Case report
3: no case
4 Lost Workdays Case (LWC) 0.0% requirements, Company will directly decide that Service Provider HSSE & AI B.2 Case report
3: no case
5 Fatality Case 0.0% requirements, Company will directly decide that Service Provider HSSE & AI B.2 Case report
3: no case
6 Oil / Hydrocarbon Spill Case > 2 Barrel 0.0% requirements, Company will directly decide that Service Provider HSSE & AI B.2 Case report


3: no case
7 Major Fire Incident 0.0% requirements, Company will directly decide that Service Provider HSSE & AI B.2 Case report
Leading Indicator
Evidence:
3: More than 1 visit/year
Muh. Razi - Visit Record
2: 1 Management visit/year
5 Management Visit 10% 3.00 1.00 0.33 HSSE & AI B.2
1: Less then 5 management visit during Term (5 years)
Dept. Remarks:
0: No management visit in 1 year
PTK to provide evidence
Evidence:
3: more than 1/month/person
Muh. Razi - OBIT Card Summary and sample of OBIT Card
2: 1/month/person
6 OBIT Card 5% 3.00 2.00 0.33 HSSE & AI 2.5
1: Not all personnel submit
Dept. Remarks:
0: No card submitted
PTK to provide evidence:
Evidence:
3: 100% close out for all risk OBIT Card Summary, Action Log, Close Out
Muh. Razi -
2: 100% close out for high risk Evidence
7 OBIT Close Out Percentage 10% 3.00 3.00 1.00 HSSE & AI E.2.2
1: Less than 100% close out for high risk
Dept.
0: No close out for all risk Remarks:
Evidence:
3: more than 1/shift with quality record
Muh. Razi - Safety Talk Material and Attendance List
2: conducted 1/shift
8 Safety Talk 3% 3.00 1.00 0.10 HSSE & AI F.1
1: less than 1/shift (not consistent)
Dept. Remarks:
0: No safety talk record
Evidence:
3: more than 1/week with quality record
Muh. Razi - Toolbox Material and Attendance List
2: conducted 1/week
9 Toolbox Meeting 3% 3.00 1.00 0.10 HSSE & AI F.1
1: less than 1/week (not consistent)
Dept. Remarks:
0: No toolbox meeting record
Evidence:
3: more than 1/month with quality record
Muh. Razi - HSE Material and Attendance List
2: conducted 1/month
10 HSE Meeting / Commitee 5% 3.00 2.00 0.33 HSSE & AI F.1
1: less than 1/month(not consistent)
Dept. Remarks:
0: No meeting record
Evidence:
3: training matrix include with the competency matrix and applied
Training Matrix, HSE Training Material and
consistently Muh. Razi -
Attendance List
11 HSE Training 5% 3.00 3.00 0.50 2: training matrix conducted consistently with training record HSSE & AI F.1
1: training matrix not applied consistently Dept.
Remarks:
0: No training record and training matrix
Evidence:
3: conducted PTW for high risk activities with quality record PTW Summary, scan PTW for high risk
Muh. Razi -
2: conducted PTW for high risk activities activities
12 PTW Issued 5% 3.00 1.00 0.17 HSSE & AI F.1
1: not consistent PTW
Dept.
0: No PTW record and procedure Remarks:
3: conducted MCU 1/year as of Mubadala Petroleum Standard Evidence:

2: conducted MCU as of Mubadala Petroleum Standard Muh. Razi - Medical Checkup Summary
13 MCU 10% 3.00 3.00 1.00 1: not consistent MCU and not as of Mubadala Petroleum HSSE & AI F.1
Standard Dept. Remarks:
0: No MCU record and procedure PTK to provide evidence:


Evidence:
3: conducted 1 per 3 month in Mubadala Petroleum area of
Emergency Drill Scenario, MOM, Photo, and
contract Muh. Razi -
Attendance List
14 Emergency Drill 10% 3.00 3.00 1.00 2: conducted 1 per 3 month HSSE & AI F.1
1: less than 1 per 3 month Dept.
Remarks:
0: No record and procedure
Evidence:
3:conducted consistently 1/year as of schedule (original)
Muh. Razi - Audit Schedule and Audit Report
2: conducted consistently 1/year
15 HSE Internal Audit 7% 3.00 3.00 0.70 HSSE & AI F.1
1: No record OR schedule
Dept. Remarks:
0: No record AND schedule
Evidence:
3:conducted consistently as of schedule (original) Inspection Matrix, Inspection Schedule and
Muh. Razi -
2: conducted consistently Inspection Report
16 HSE Inspection 10% 3.00 3.00 1.00 HSSE & AI F.1
1: No record OR matrix
Dept.
0: No record AND matrix Remarks:
Evidence:
3:conducted consistently as of schedule (original) Measurement Matrix, Measurement Schedule
Muh. Razi -
2: conducted consistently and Measurement Report
17 Measurement work Environment 10% 3.00 3.00 1.00 HSSE & AI F.1
Dept.
0: No record AND matrix Remarks:
Evidence:
Muh. Razi - Permit Log
18 Legal Compliance 7% 3.00 3.00 0.71 HSSE & AI F.1
Dept. Remarks:
Is it align with MP request for annual MCU for crews 100%
Schedule 4 Score = 8.28

We
Provision of A
SCHEDULE 2: SCOPE OF SERVICES
No. TOPIC
1 Preventive Maintenance

3 Reimbursable Materials
4 Rental Tools
4 Deliverables
5 Reporting
6 Safety, Health and Environment
SCHEDULE 3: RATES AND FEES
No. TOPIC
1 Penalty
2 Contract Expenditure Report
3 Invoicing
4 Performance Bond
SCHEDULE 3 - ATTACHMENT 2 & 3 - LOCAL CONTENT

No. TOPIC
Domestic Content Expenditure

1
Report
INSURANCE REQUIREMENT (CLAUSE 22.2)
No. TOPIC
Insurance Certificate: Workmen's

1 Compensation and Occupational
Disease
Insurance Certificate: Employers

2 Liability Insurance with a limit not
less than US$ 500,000.00
Insurance Certificate:
3 Comprehensive General Liability
Insurance
Insurance Certificate: Equipment All

4
Risks Insurance
SCHEDULE 4: HSSE
No. TOPIC
Lagging Indicator
1 First Aid Case (FAC)
2 Medical Treatment Case (MAC)
3 Restricted Work Case (RWC)
4 Lost Workdays Case (LWC)

5 Fatality Case
6 Oil / Hydrocarbon Spill Case > 2 Barrel
7 Major Fire Incident
Leading Indicator
5 Management Visit
6 OBIT Card
7 OBIT Close Out Percentage
8 Safety Talk
9 Toolbox Meeting
10 HSE Meeting / Commitee

11 HSE Training
12 PTW Issued
13 MCU
14 Emergency Drill
15 HSE Internal Audit
16 HSE Inspection
17 Measurement work Environment
18 Legal Compliance
Is it align with MP request for annual MCU for crews

Provision of Asset Integrity and Process Safety M
Key Performance Evaluation Score Car
PERFORMANCE EVALUATION SCORE (OUT OF 100) =
Maximum Score =
POINT
SPECIFIC KPI and DEFINITIONS WEIGHT SCORE
SCALE
Maintenane Services are always performed as per

manufacturer recommendation 10.0% 1.00 1.00
The activities performed always include the following:

(i) Record environmental conditions.
(ii) Measuring parameters of temperature, pressure, relative
humidity, flow rate of inlet air.
10.0% 2.00 2.00
(iii) Inspection of all v-belt of motor blower.
(iv) Measuring pressure of refrigerant in HVAC System.
(v) Function test of all motor dampeners, instrument
transmitters related to HVAC (including solenoid valve)
In case of equipment failure, Company requests Contractor to

inspect, troubleshoot, repair, configure, and or upgrade (if
needed) equipment in order to meet its existing performance. 10.0% 1.00 1.00
(if not needed, full score)

Contractor provides six (6) months of warranty for every
10.0% 1.00 1.00
Corrective Maintenance Service)
Provisions of Reimbursable Materials:

(i) In case needed, Contractor shall provide the materials upon
written request by Company’s representative.
(ii) Contractor shall submit proposal that includes price and
delivery time within 3 (three) calendar days after notification
sent by Company.
(iii) Material shall be delivered by Contractor upon approval of
proposal by Company’s representative.
(iv) Material shall be sent to Delivery Point include with its
necessary documents such as certificate of origin, certificate of
manufacturer.
(v) Material will be inspected by Company’s representative at 5.0% 2.00 2.00
Delivery Point prior to acceptance.
(vi) The material will be reimbursed back to the Company
based agreed price or on actual cost including the handling
cost.
(vii) Company reserves the right to reject material from the
Contractor if found defective, not in perfect condition, or do not
meet specifications.
(viii) Contractor take all responsibility of shipping charges
including import taxes, transportation cost, packaging cost,
and other charges during the shipping material until it arrives
at Delivery Point.
Provisions of Rental Tools:
(i) If required, Contractor will provide rental tools which are
needed to complete the Services. The requirement to provide
rental tools will be discussed prior to performing the Services.
(ii) List of rental tools includes (but not limited to) are in
Appendix-2.
(iii) Contractor’s personnel will carry rental tools by themselves
to Site. If rental tools cannot be carried by Contractor’s 5.0% 2.00 2.00
personnel due to constraint in tool’s weight, dimension, or any
issues that come up during transportation, then Contractor
needs to deliver rental tools to Delivery Point in order for
Company to deliver rental tools from Delivery Point to Site
using vessel.
(iv) Cost for rental tools shall be based on actual time spent
using the tools.
Qualification Requirement of HVAC Engineer:

(i) A bachelor’s degree in engineering with at least three (3)
years of working experience in HVAC system.
Badan Nasional Sertifikasi Profesi (BNSP).
Contractor’s sole cost.
(iv) Nominated personnel will be subject to Company interview
5.0% 1.00 0.00
(v) Main roles shall include but not limited to intervention,
troubleshooting, issue action plan and its schedule.
Supervisory and lead technicians for the works, issue daily
activities and troubleshooting close out reports.

(i) Valid KTP
Qualification Requirement of HVAC Technician:
(i) STM or equal with minimum three years working experience
in HVAC.
Badan Nasional Sertifikasi Profesi (BNSP) and K3 Listrik
certificate from the Departemen Ketenagakerjaan Republik
Indonesia (DEPNAKER RI).
5.0% 1.00 0.00
Contractor’s sole cost.
(iv) Nominated person will be subject to Company interview
(v) Main roles shall include but not limited to intervention the
works which has prepared by HVAC Engineer.

(i) Valid KTP
The deliverables under this Agreement are:

(i) Site Activity Report for Scheduled Maintenance Service or
Corrective Maintenance Service.
10.0% 1.00 1.00
(ii) Acceptance Certificate signed by Company’s
representative as Company’s acceptance of the Services
performed.
Contractor shall deliver minimum documents listed as follow:
(i) Proposed initial work plan and estimated parts required
referred to the items in Company notification or BR prior to
starting The Services.
(ii) Records of Daily Report, which have been signed by
Company’s representative if The Services is performed in
Company’s facilities.
(iii) Record of Daily Report, which have been signed by
5.0% 2.00 2.00
Contractor’s representative if The Services is performed in
Contractor’s facilities.
(iv) Each of Contractor’s personnel shall submit daily
timesheets to show hours spent on each work assignment.
These timesheets, must be approved by Company, and shall
be attached to Contractor’s invoice along with a copy of RO.
(v) Final Report consisting of finding/background, action to be
taken, recommendation after completing The Services.
Contractor shall present The Final Report in front of

5.0% 1.00 1.00
Company’s personnel.
Contractor shall send draft of report within 10 (ten) working

day after completion of service and Company’s representative
shall provide comments within 10 (ten) working days from the
5.0% 1.00 1.00
date of draft reports submission. Contractor shall incorporate
all the Company’s comments and changes in the draft report
to make the Final Report within 10 (ten) working days.
Final Report shall be in hardcopy and softcopy format. For

closing out Final Report, minimum one (1) original printed
report and one (1) soft copy report in Microsoft Office format or 5.0% 1.00 1.00
PDF file format (stored in CDs) shall be submitted to
Company.
Contrctor shall provide safety guidelines for offshore and
onshore work and Contractor must show the ability to perform
the work in a safe manner. The installation, erections, welding 5.0% 2.00 2.00
and all related construction works should reflect all safety
aspects. The safe work environment will also be examined.
Contractor shall provide safety equipment (PPE) for the

assigned personnel, which include but not limited to:
(i) Long sleeve Fire Resistant Coverall
(ii) Safety Helmet with Chin strap
5.0% 2.00 2.00
(iii) Safety glasses
(iv) Safety boots
(v) Protective gloves
(vi) Hearing protector
100%
Schedule 2 - Scope of Services Score =
Maximum Score =
POINT
SCALE
Contractor shall be subject to a maximum penalty of zero-point

one percent of the Release Order for each day of delay or
failure to perform the Service. The maximum delay is fifty (50)
25.0% 2.00 2.00
days. The total amount of penalty will not be in excess of five
percent (5%) of the estimated total Contract Value in Schedule
2 - Compensation.
The accuracy of the remaining contract value stated in the
25.0% 2.00 2.00
Contract Expenditure Report
The completeness of the invoice's supporting documents as

follow:
i. Copy of Work Authorization (Release Order).
ii. Original and four (4) copies of completed Tax Invoice.
iii. Copy of the compensation section of the Agreement.
iv. Original Delivery Ticket or Delivery Order for the goods
delivered.
v. Original Time Sheet, Operating Time Report or Standby
25.0% 2.00 2.00
Time Report, Job Ticket or Service Ticket, for the services
performed.
vi. Original invoice from third party along with a copy of
purchase order and a proof of payment to third party for
reimbursable costs.
vii. Contract Expenditure Report.
viii. Progress of the domestic component utilization as
required in the Agreement.
Performance bond requirements:

- Issued by a commercial bank (exclusive of Bank Perkreditan
Rakyat) which is State-Owned Enterprise (the “BUMN”) or
Regional-Owned Enterprise (the “BUMD”) and in the format
acceptable to Company 25.0% 2.00 2.00
- Value: IDR 64.341.472,00
- Validity: 22 June 2020 - 21 July 2023 ( as of the Effective
Date of the Agreement up to one (1) month after the expiry
date of the Agreement.)
100%
Schedule 3 - Rates and Fees Score =
3 - LOCAL CONTENT
Maximum Score =
POINT
SCALE
The Domestic Content Expenditure Report is submitted on

100.0% 2.00 2.00
each invoice submission
100%
Schedule 3 - Attachment 2 - Local Content Score =
Maximum Score =
POINT
SCALE
Shall be fully compliant with the regulations and laws of the

state and country in which the Contractor’s personnel or
employees reside, the state and country in which the
Contractor is domiciled and all international laws applicable to 25.0% 2.00 2.00
Contractor’s personnel (expatriate) or employees extended to
include, as required, working offshore and whilst being
conveyed by land, sea or air.
Shall be submitted with a limit of not less than US$ 500,000.00

per occurrence or higher if required by any Applicable Law.
Such insurance shall be endorsed to so that claim formulated 25.0% 2.00 2.00
by employees of the Contractor against the Company Group
shall be treated as claim against the Contractor.
Shall be submitted including pollution liability with a combined
single limit for bodily injury and property damage of not less
25.0% 2.00 2.00
than US$1,000,000.00 per occurrence or series of
occurrences.
Shall be covering Contractor’s equipment based on

replacement value and coverage shall apply in transit by land, 25.0% 2.00 2.00
sea or air and while in storage away from the worksite.
100%
Insurance Requirement Score =
Maximum Score =
POINT
SCALE
0.0%
0.0%
0.0%
0.0%
0.0%
se > 2 Barrel 0.0%
0.0%
10% 3.00 3.00
5% 3.00 3.00
10% 3.00 3.00
3% 3.00 3.00
3% 3.00 3.00
5% 3.00 3.00
5% 3.00 3.00
5% 3.00 3.00
10% 3.00 3.00
10% 3.00 3.00
7% 3.00 3.00
10% 3.00 3.00
10% 3.00 3.00
7% 3.00 3.00
est for annual MCU for crews 100%
Schedule 4 Score =
rvices Agreement No. 10421191633
grity and Process Safety Management Services
rmance Evaluation Score Card (2021)
95.51
Max. Score
Min. Score
45.00
WEIGHTED
SCORING GUIDELINES PIC REF.
SCORE
Schedule 2 -
Scope of
Daniel Services
Not as per manufacturer recommendation: 0
Silaban -
4.50 As per manufacturer recommendation: 1
Dept. Preventive
Maintenance
Services
Schedule 2 -
Scope of
Daniel Services
More than 1 of the required activities are not performed: 0
Silaban -
4.50 1 of the required activity is not performed: 1
All of the required activities are performed covered: 2
Dept. Preventive
Maintenance
Services
Schedule 2 -
In the event of equipment failure, Contractor does not inspect,
Scope of
troubleshoot, repair, configure, and or upgrade as per
Daniel Services
Silaban -
4.50
In the event of equipment failure, Contractor inspect,
Dept. Corrective
troubleshoot, repair, configure, and or upgrade as per
Maintenance
Services
Schedule 2 -
Scope of
Daniel Services
Warranty is not provided as required or less than the
Silaban -
4.50 requirement: 0
Warranty provided as required: 1
Dept. Corrective
Maintenance
Services
Schedule 2 -
Scope of
Daniel Services
<70% of the provisions are not being met in average: 0
Silaban -
2.25 70 - 99% of the provisions are being met in average: 1
Operations Clause 2.3
100% of provisions are always being met: 2
Dept. Provision of
Reimbursable
Materials
Schedule 2 -
Daniel Scope of
<70% of the provisions are not being met in average: 0
Silaban - Services
2.25 70 - 99% of the provisions are being met in average: 1
Operations
100% of provisions are always being met: 2
Dept. Clause 2.4
Rental Tools
Schedule 2 -
Scope of
The assigned personnel does not meet all the Qualification Daniel
Services
Requirement: 0 Silaban -
0.00
The assigned personnel meets all the Qualification Requirement: Operations
Clause 3.1
1 Dept.
HVAC
Engineer
Schedule 2 -
Scope of
The assigned personnel does not meet all the Qualification Daniel
Services
Requirement: 0 Silaban -
0.00
The assigned personnel meets all the Qualification Requirement: Operations
Clause 3.2
1 Dept.
HVAC
Technician
Schedule 2 -
Daniel Scope of
Both deliverables never submitted: 0 Silaban - Services
4.50
Both deliverables always submitted as required: 1 Operations
Dept. Clause 4
Deliverables
Schedule 2 -
> 90% of the required documents are submitted in average: 0 Daniel
Scope of
91% - 99% of the required documents are submitted in average: Silaban -
2.25 Services
1 Operations
100% of the required documents are submitted in average: 2 Dept.
Clause 8.1
Schedule 2 -
Daniel
The final report is not presented as required: 0 Scope of
Silaban -
2.25 The final report is always presented as required: 1 Services
Operations
Dept.
Clause 8.2
Schedule 2 -
Daniel
The timeline requirement of the report are never being met: 0 Scope of
Silaban -
2.25 The timeline requirement of the report is always being met: 1 Services
Operations
Dept.
Clause 8.3
Schedule 2 -
Daniel
The submission requirement is never being met: 0 Scope of
Silaban -
2.25 The submission requirement is always being met: 1 Services
Operations
Dept.
Clause 8.4
Contractor never provide safety gudelines as required and
not always reflect all safety aspects: 0
Schedule 2 -
Daniel
Contractor always provide safety gudelines as required but Scope of
Silaban -
2.25 installation, erections, welding and all related construction works Services
Operations
inconsistently reflect all safety aspects: 1
Dept.
Clause 11.3
Contractor always provide safety gudelines as required and
always reflect all safety aspects: 2
Schedule 2 -
> 90% of the required PPE are provided in average: 0 Daniel
Scope of
91% - 99% of the required PPE are provided in average: 1 Silaban -
2.25 Services
100% of the required are provided in average: 2 Operations
Dept.
Clause 11.4
40.50
25.00
WEIGHTED
SCORE
2: Contractor properly informing and communicating with the Schedule 2 -

Company representative for any possible delay which will be Gadis Scope of
impacting the performance and possibility for penalty Ayunda - Services
6.25
1: No performance issue that need to be penalized SCM
0: The Contractor being penalized for this specific penalty for Department Clause 13
more than one (1) times Penalty
2: The Contract Expenditure Report is submitted and accurate Schedule 3 -
Daniel
compares to the Company's report Rates and
Silaban -
6.25 1: The Contract Expenditure Report is not submitted but not Fees
Operations
accurate compares to the Company's report
Dept.
0: The Contract Expenditure Report is not submitted Attachment 1
Schedule 1 -
2: The invoice and its supporting documents is submitted and
Daniel Contract
accurate before the 25th day of each month
Silaban - Particulars
6.25 1: The invoice and its supporting documents is submitted and
Operations
accurate by 25th day of each month
Dept. Invoicing
0: The invoice and its supporting documents is not submitted
Procedures
regularly each month
2: The required performance bond is valid/renewal of the

required performance bond is provided to the Company on the Gadis Letter of Award
expiry date and the minimum threshold is met Ayunda -
6.25
1: The required performance bond is invalid/below the minimum SCM Agreement
threshold Department Clause 25
0: The required performance bond is not submitted to the
Company
25.00
10.00
WEIGHTED
SCORE
Schedule 3 -
Rates and
Fees
2: The Domestic Content Expenditure Report is always submitted
Attachment 2
on each invoice submission Daniel
Local Content
1: The Domestic Content Expenditure Report is not submitted in Silaban -
10.00 Commitment
one (1) invoice submission Operations
0: The Domestic Content Expenditure Report is not submitted in Dept.
Attachment 3
more than one (1) invoice submission
Domestic
Product
Expenditure
Report
10.00
10.00
WEIGHTED
SCORE

Gadis
expiry date and the minimum threshold is met
Ayunda - Agreement
2.50 1: The required insurance certificate is invalid/below the
SCM Clause 22.2 (a)
minimum threshold
Department
Company

Gadis
Ayunda - Agreement
SCM Clause 22.2 (a)
minimum threshold
Department
Company
Gadis
Ayunda - Agreement
SCM Clause 22.2 (b)
minimum threshold
Department
Company

Gadis
Ayunda - Agreement
SCM Clause 22.2 (c)
minimum threshold
Department
Company
10.00
10.00
WEIGHTED
SCORE
3: no case
requirements, Company will directly decide that Service Provider HSSE & AI B.2
3: no case
3: no case
3: no case
3: no case
3: no case
3: no case
3: More than 1 visit/year

Muh. Razi -
2: 1 Management visit/year
1.00 HSSE & AI B.2
1: Less then 5 management visit during Term (5 years)
Dept.
0: No management visit in 1 year
3: more than 1/month/person

Muh. Razi -
2: 1/month/person
0.50 HSSE & AI 2.5
1: Not all personnel submit
Dept.
0: No card submitted
3: 100% close out for all risk

Muh. Razi -
2: 100% close out for high risk
1.00 HSSE & AI E.2.2
1: Less than 100% close out for high risk
Dept.
0: No close out for all risk
3: more than 1/shift with quality record

Muh. Razi -
2: conducted 1/shift
0.30 HSSE & AI F.1
1: less than 1/shift (not consistent)
Dept.
0: No safety talk record
3: more than 1/week with quality record

Muh. Razi -
2: conducted 1/week
0.30 HSSE & AI F.1
1: less than 1/week (not consistent)
Dept.
0: No toolbox meeting record
3: more than 1/month with quality record

Muh. Razi -
2: conducted 1/month
0.50 HSSE & AI F.1
1: less than 1/month(not consistent)
Dept.
0: No meeting record
3: training matrix include with the competency matrix and applied
consistently Muh. Razi -
0.50 2: training matrix conducted consistently with training record HSSE & AI F.1
1: training matrix not applied consistently Dept.
0: No training record and training matrix
3: conducted PTW for high risk activities with quality record

Muh. Razi -
2: conducted PTW for high risk activities
0.50 HSSE & AI F.1
1: not consistent PTW
Dept.
0: No PTW record and procedure
3: conducted MCU 1/year as of Mubadala Petroleum Standard

2: conducted MCU as of Mubadala Petroleum Standard Muh. Razi -
1.00 1: not consistent MCU and not as of Mubadala Petroleum HSSE & AI F.1
Standard Dept.
0: No MCU record and procedure
3: conducted 1 per 3 month in Mubadala Petroleum area of

contract Muh. Razi -
1.00 2: conducted 1 per 3 month HSSE & AI F.1
1: less than 1 per 3 month Dept.
0: No record and procedure

Muh. Razi -
0.70 HSSE & AI F.1
Dept.
3:conducted consistently as of schedule (original)

Muh. Razi -
2: conducted consistently
1.00 HSSE & AI F.1
Dept.
0: No record AND matrix
3:conducted consistently as of schedule (original)

Muh. Razi -
2: conducted consistently
1.00 HSSE & AI F.1
Dept.
0: No record AND matrix

Muh. Razi -
0.71 HSSE & AI F.1
Dept.
10.01
: 100
: 75
REQUIRED EVIDENCE AND/OR REMARKS
Preventive Maintenance Report
Preventive Maintenance Report
Correctice Maintenance Report

Warranty Letter
Delivery Note
Delivery Note
CV of the assigned personnel and relevant

certification
CV of the assigned personnel and relevant
certification
Submitted Deliverables
Report Transmittal Note
Attendace List, Minutes of Meeting.

Maintenance Report
Maintenance Report
Penalty calculation
Contract Expenditure Report
Invoice and its supporting documents
Performance Bond:
Issued by Bank Mandiri
Value: IDR 64.341.500,00
Validity: 22 June 2020 - 21 July 2023
Domestic Content Expenditure Report
Respective Insurance Certificate

Case report
Case report
Case report
Case report
Case report
Case report
Case report
Evidence:
Visit Record
Remarks:
PTK to provide evidence
Evidence:
OBIT Card Summary and sample of OBIT Card
Remarks:
Evidence:
OBIT Card Summary, Action Log, Close Out
Evidence
Remarks:
Evidence:
Safety Talk Material and Attendance List
Remarks:
Evidence:
Toolbox Material and Attendance List
Remarks:
Evidence:
HSE Material and Attendance List
Remarks:
Evidence:
Training Matrix, HSE Training Material and
Attendance List
Remarks:
Evidence:
PTW Summary, scan PTW for high risk
activities
Remarks:
Evidence:
Medical Checkup Summary
Remarks:
Evidence:
Emergency Drill Scenario, MOM, Photo, and
Attendance List
Remarks:
Evidence:
Audit Schedule and Audit Report
Remarks:
Evidence:
Inspection Matrix, Inspection Schedule and
Inspection Report
Remarks:
Evidence:
Measurement Matrix, Measurement Schedule
and Measurement Report
Remarks:
Evidence:
Permit Log
Remarks:

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Service Agreement No.

Key Performance Indicator Evaluation Form

Technical Evaluation Criteria

Heading Description Point Scale

SCHEDULE 3 - ATTACHMENT 2 & Monitoring of Contractor's performance detailed in

INSURANCE REQUIREMENT Monitoring of Contractor's performance detailed in

Monitoring of Contractor's performance detailed in

Minimum Technical Score Threshold

Name Position Department

Point Value Description

Key Performance Indicator Evaluation Form

Maximum 2020 2021

Key Performance Evaluation Score Card (2020)

PERFORMANCE EVALUATION SCORE (OUT OF 100) = 98.28

The activities performed always include the following: Schedule 2 -

2 Corrective Maintenance Services

Contract Name Company #1 01/19/2022 - Page 5

Key Performance Evaluation Score Card (2020)

Provisions of Reimbursable Materials:

Provisions of Rental Tools:

Contract Name Company #1 01/19/2022 - Page 6

Key Performance Evaluation Score Card (2020)

Qualification Requirement of HVAC Engineer:

For working at Site, Personnel shall bring:

Qualification Requirement of HVAC Technician:

For working at Site, Personnel shall bring:

Contract Name Company #1 01/19/2022 - Page 7

Key Performance Evaluation Score Card (2020)

The deliverables under this Agreement are: Schedule 2 -

Contractor shall deliver minimum documents listed as follow:

Contractor shall send draft of report within 10 (ten) working

Contract Name Company #1 01/19/2022 - Page 8

Key Performance Evaluation Score Card (2020)

Final Report shall be in hardcopy and softcopy format. For Schedule 2 -

Contractor never provide safety gudelines as required and

Contractor shall provide safety equipment (PPE) for the

Schedule 2 - Scope of Services Score = 45.00

SCHEDULE 3: RATES AND FEES

Contract Name Company #1 01/19/2022 - Page 9

Key Performance Evaluation Score Card (2020)

2: The Contract Expenditure Report is submitted and accurate Schedule 3 -

The completeness of the invoice's supporting documents as

Performance bond requirements:

Schedule 3 - Rates and Fees Score = 25.00

SCHEDULE 3 - ATTACHMENT 2 & 3 - LOCAL CONTENT

Contract Name Company #1 01/19/2022 - Page 10

Key Performance Evaluation Score Card (2020)

Schedule 3 - Attachment 2 - Local Content Score = 10.00

INSURANCE REQUIREMENT (CLAUSE 22.2)

2: The required insurance certificate is valid/renewal of the

2: The required insurance certificate is valid/renewal of the

Contract Name Company #1 01/19/2022 - Page 11

Key Performance Evaluation Score Card (2020)

2: The required insurance certificate is valid/renewal of the

Insurance Requirement Score = 10.00

Contract Name Company #1 01/19/2022 - Page 12

Key Performance Evaluation Score Card (2020)

3: conducted MCU 1/year as of Mubadala Petroleum Standard Evidence:

Contract Name Company #1 01/19/2022 - Page 13

Key Performance Evaluation Score Card (2020)

Schedule 4 Score = 8.28

Contract Name Company #1 01/19/2022 - Page 14