Supplier Registration

INSTRUCTIONS FOR COMPLETION

All suppliers, service providers and subcontractors wishing to be approved and engaged by Centrals are required to complete this questionnaire by answering the questions in the sections as instructed below.

Please note:

  • Answering NO to the questions below will not necessarily preclude your organisation from being approved as a subcontractor to Centrals - please answer all questions honestly and accurately.
  • When instructed to complete a section, all fields within that section are mandatory.

PART A

  • Section 1 must be completed by ALL companies to establish a payment account

PART B

  • Section 3 is to be completed by Subcontractors and service providers who will be operating on Centrals sites or offices
  • Sections 4 – 6 must be completed by companies performing work under a Subcontract agreement
PLEASE COMPLETE SECTIONS AS INDICATED TO BE COMPLETED BY
PART A
Section 1 General & Commercial Details All
Section 2 Review and Approval Section Centrals
PART B
Section 3 Insurance, Licence and Capabilities Details Subcontractors & Service Providers
Section 4 Health & Safety Subcontractors Only
Section 5 Quality Management Systems Subcontractors Only
Section 6 Environmental Management Systems Subcontractors Only

 

PART A

SECTION 1 - GENERAL & COMMERCIAL DETAILS OF PROVIDER (click to expand)

Company Name:
ABN:

Nature of Business

Registered Address:

Postal Address:

Email Contact:

Contact Details (For Account Queries)

Name:
Phone:
Email:

Contact Details (For Sales Queries)

Name:
Phone:
Email:

Payment Details

Financial Institution:
Branch:

Branch Address:

BSB Number:
Account Number:
Account Name:

By agreeing to supply goods and or services to Central Systems Pty Ltd (Centrals), the provider whose details are provided above hereby agrees as follows:

  • All payments by Centrals for goods and/or services supplied by us pursuant to current or future purchase orders or contract(s) are to be directed to the aforementioned bank account.
  • Centrals are under no obligation to verify the correctness of the bank account details provided.
  • Any changes to any of the provider’s details must be notified to Centrals in writing. Centrals will not be responsible for any delays in payment or error due to factors outside the reasonable control of Centrals (including but not limited to delays or errors in the banking system).
  • Notwithstanding Centrals standard method of payment is via Electronic Funds Transfer (EFT), we reserves the right at any time to terminate or suspend this payment method and to pay by cheque or any other manner which Centrals may determine.
  • If Centrals makes an incorrect payment to the above, the provider shall repay those monies to Centrals immediately upon written notification by Centrals.
  • All of the information contained in this completed questionnaire is true and correct.
  • Centrals standard payment terms are 30 days from end of month in which the invoice is received unless otherwise amended by a specific purchase order or contract.
  • The supply of all goods and services shall be in accordance with Centrals standard terms and conditions of purchase order unless specifically amended by a Centrals purchase order or contract.
  • Centrals accepts no liability for any goods and/or services provided by the Provider unless they are in receipt of an executed Centrals Purchase Order or Contract.

Agreement by a company directory/duly authorised officer of the Provider

Name:
Title:
Date:

PART B

SECTION 3 - INSURANCE, LICENSES AND CAPABILITIES (click to expand)

Registrations

Type:
Number:
Expiry Date:
Type:
Number:
Expiry Date:
Type:
Number:
Expiry Date:

Licenses

Type:
Number:
Expiry Date:
Type:
Number:
Expiry Date:
Type:
Number:
Expiry Date:

Insurance

Public Liability Insurer:
Expiry Date:
Attach Certificate:
Workers Compensation Insurer:
Expiry Date:
Attach Certificate:
Professional Indemnity Insurer:
Expiry Date:
Attach Certificate:
Motor Vehicle Insurer:
Expiry Date:
Attach Certificate:
Plant & Equipment Insurer:
Expiry Date:
Attach Certificate:
Other Insurer:
Expiry Date:
Attach Certificate:

Capabilities and Experience (please provide at least 3 to be contacted as referees)

Project Name/Description
Contact Name & Phone
From - To
Project Name/Description
Contact Name & Phone
From - To
Project Name/Description
Contact Name & Phone
From - To
Prior experience with Centrals?
YesNo
Duration/Project Details

Resources
Are your personnel police cleared?
YesNo

Number of personnel in organisation:
Wages:

Company facilities / plant / equipment (please provide brief details)

SECTION 4 - HEALTH AND SAFETY (click to expand)

Has your organisation been prosecuted for a breach of safety legislation?
YesNo
If Yes, provide details:
Has the company ever been issued with a statutory improvement notice?
YesNo
If Yes, provide details:
Has your company had any serious incidents in the past two years?
YesNo
If Yes, provide details:
Does your company have third party health & safety certification?
YesNo
If yes, please attach copy of certification:
If no, please confirm that your company will comply with Centrals safety, procedures and instructions while performing any works under a subcontract agreement.
Yes
Is your organisation in the process of working toward third party health & safety certification?
YesNo
Health & Safety standard applicable (eg. AS/NZS 4801-2001)
Proposed certification to be obtained by (date)
Does your company provide safety training for its employees?
YesNo
If Yes, provide details:
Does your Company verify competency of its employees?
YesNo
If Yes, provide details:
Provide safety statistics for the previous 3 years:
No of fatal injuries
No of lost time injuries
Frequency rate per million hours
No of restricted duty cases
No of medical treatment injuries
No of days lost due to injury
Hours worked in period

Please provide workers compensation claims history for previous 3 years:

Workers compensation as % of payroll

Brief description of workers compensation injuries:

SECTION 5 - QUALITY MANAGEMENT (click to expand)

Does your company have third party quality certification?
YesNo
Attach Certificate:
If no, please confirm that your company will comply with Centrals quality procedures and instructions while performing any works under a subcontract agreement
Yes
Is your organisation in the process of working toward third party quality certification?
YesNo
Quality standard applicable (eg. AS/NZS ISO 9001)
Proposed certification to be obtained by (date)

SECTION 6 - ENVIRONMENTAL MANAGEMENT (click to expand)

Has your organisation been prosecuted for a breach of environmental legislation?
YesNo
If Yes, provide details:
Does your company have third party environmental certification?
YesNo
Attach Certificate:
If no, please confirm that your company will comply with Centrals environmental procedures and instructions while performing any works under a subcontract agreement.
Yes
Is your organisation in the process of working toward third party environmental certification?
YesNo
Quality standard applicable (eg ISO14001:2001)
Proposed certification to be obtained by (date)

SECTION 7 - HUMAN RESOURCES (click to expand)

Does your company have a formal employee recruitment / engagement process?
YesNo
Does your company maintain records of employee reference checks?
YesNo
If your company does maintain employee reference checks, please provide details: