Expression of Interest - REGISTRATION

To start the process of becoming a supplier to Albemarle in Australia, please fill out the form below. It is essential that potential suppliers carefully consider which areas they are qualified to supply.

You must nominate your preferred Albemarle supply areas which are defined as:

OPERATIONS

Select this option if your business:

Provides goods and services typically used in the ongoing operation, maintenance or support of a processing facility.

MAJOR & SUSTAINING CAPITAL

Select this option if your business:

Provides goods and services to make modifications to existing processing facilities/equipment (brown fields).

BOTH

Select this option if your business:

Provides goods and services typically used in both the categories of Operations and Major & Sustaining Capital.

Details of Your Organization

Business Name *

Trading Name *

ABN *

Registered Business Address *

Suburb *

State *

Post Code *

Year Established *

Business Size * (Permanent & Contract Staff)

Annual Turn Over * - last financial year in AUD (Australian Dollars)

Website *

Business Type *

Local Office Address * (if different than Registered Business Address)

Suburb *

State *

Post Code *

Contact Details

Contact Name *

Company Position *

Contact Email *

Contact Phone *

Business Activities You Can Provide to Albemarle

Scope/Package Type *
Are you electing to supply for operations, major supply, or both?

Business Activities Description
Describe the main business activities of your organization and what other goods and/or services do you offer that may be of benefit to Albemarle?

Kermerton Construction Project Experience *
Did your Company perform work or conducted business with Amec / Wood during the Albemarle Lithium construction Project?

If Yes, please provide a description

Mining Industry Experience *
Do you have experience to work with companies from mining industry?

Performance History *
Have you had any contracts terminated for poor performance in the last three years, or any contracts where damages have been claimed by the contracting authority?

Key Clients/References

Please provide at least 3 client contacts. *

Client

Commencement Date

Client Contact Details
(Client Name, Position and Contact Number)

Contract reference and brief description

Contract Value

Date contract was completed

+ Add

Insurances

Insurance Type

Insurer

Policy No

Amount

Expiry Date

Workers Compensation

Public Liability

Professional Indemnity

Motor Vehicle

Management System Status

Please describe the systems you have in place, including any external certification or auditing processes.

Occupational Health Safety & Rehabilitation

ISO Accreditation

Environmental and Waste Management

ISO Accreditation

Quality Assurance

ISO Accreditation

Other licenses and Registrations

Health, Safety & Environmental (HSE) Information

ISNetworld Registration
Is your business registered on the ISNetworld database?

If No and if offered the Contract
Will your business agree to register with ISNetworld at no additional cost to Albemarle prior to commencing the Contract?

HSE Representative
Does your Company have a full time HSE representative?

Workplace Health and Safety Prosecutions *
Did your company receive any Workplace Health and Safety prosecutions for the last 3 years?

Number of Fatalities
Number of Fatalities recorded for the last 3years

Sustainability

Sustainability
Does your company implement sustainability practices into your organization?

If Yes, please provide details

Additional Supporting Comments

PARTICULAR CHARACTERISTICS MAKES YOUR BUSINESS SUITABLE TO SUPPLYING TO THE KEMERTON LITHIUM PROCESSING PLANT *
Details If your business meet the criteria to register/is registered on the Aboriginal Business Directory WA (www.abdwa.com.au)

Uploads

Capability Statement (optional)

Other Optional Files

File Description (optional)

File (optional)

File Description (optional)

File (optional)

File Description (optional)

File (optional)

Form Completed By

Name *

Date *

Position *

Email *

Phone *

I declare that the answers submitted in this questionnaire are correct. I understand that the information will be used by Albemarle Corporation as an initial screening process to assess my organization's suitability *

If you experience technical difficulties in completing this form, please email kemertoncontracting@albemarle.com.