akpk hq office relocation / movers (ref: …

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AGENSI KAUNSELING DAN PENGURUSAN KREDIT

AKPK HQ OFFICE RELOCATION / MOVERS

(REF: AKPK/RFQ20/FEB01)

Request for Quotation

[RFQ]

Issuer

Agensi Kaunseling Dan Pengurusan Kredit

Level 14, TH Perdana Towers

1001 Jalan Sultan Ismail

50250 Kuala Lumpur

ISSUE DATE : 17 February 2020

CLOSING DATE/TIME : 24 February 2020 / 1:00pm

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1. INTRODUCTION

The purpose of this Request for Quotation (RFQ) is to seek quotation from the

prospective Mover for moving in work to our new office space at level 5 & 6 Menara

Bumiputra Commerce, Jalan Raja Laut, Kuala Lumpur.

2. DELIVERABLES

The specifications for the Deliverables as follows:

2.1 Refer Appendix A

3. LOCATION

3.1 The location for the Deliverables to AKPK’s office is at:

No Location Address

1

Agensi Kaunseling Dan Pengurusan Kredit

Level 5 & 6, Menara Bumiputra Commerce Jalan Raja Laut, Kuala Lumpur

3.2 Current location of AKPK HQ office & KL Branch office is at:

No Location Address Department

1 Agensi Kaunseling Dan Pengurusan Kredit

Level 14, Menara TH Perdana, 1001 Jalan Sultan Ismail, 50250 Kuala Lumpur

a) CEO Office b) Corporate Communication

Department c) Human Capital Department d) Compliance & Risk Management

Department e) GM’s Office f) Finance Department


Level 29, Menara TH Perdana, 1001 Jalan Sultan Ismail, 50250 Kuala Lumpur

a) Financial Education Department


Level 8, Maju Junction Mall, 1001 Jalan Sultan Ismail, 50250 Kuala Lumpur

a) KL branch office b) IT Department c) DMP Department d) CMD Department e) Call Centre Unit f) Office Admin Store g) Business Development Marketing

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4. DELIVERY TIMEFRAME

No Description Expected Timeframe

1 Delivery of the Deliverables 4 Days

5. RELOCATION SCHEDULE

5.1 Schedule A

DATE TIME DEPARTMENT

26 – 27 MARCH 2020 Thursday & Friday

9.00AM Level 14 & 29 TH Perdana

5.2 Schedule B

DATE TIME DEPARTMENT

28 - 29 MARCH 2020 Saturday & Sunday

9.00AM Level 8, Maju Junction Mall

* The schedule may change subject to AKPK requirement.

6. STAFF INFORMATION

i. Total AKPK HQ staff - 141 staffs.

ii. Movers to provide 3-5 boxes per staff for their personal belonging.

iii. Movers to provide designated boxes to put ABBA file document for every respective

departments (14 departments).

7. TRANSPORTATION

i. Movers to provide lorry specification details.

(Tonne, height, insurance coverage, license, latest Puspakom report)

ii. Details of the loading bay as per Appendix A.

(The remaining page is intentionally left blank)

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8. RFQ SUBMISSION

Interested vendors wishing to participate in this RFQ exercise are required to: -

8.1 Provide the following information/documents as Solution Proposal (Appendix

A): -

8.1.1 The vendor must indicate any additional information or changes that would

meet AKPK’s deliverables and fully describe the proposed solution.

i. The vendor must provide clear information that describes the

capabilities and features of the equipment such as brochures or

general literature.

ii. The vendor should provide the proposed brand/model complying with

technical specification given in Appendix A: Solution Proposal No.

3.

iii. The models under quality testing should not be offered.

8.1.2 To fill up the checklist as follows:

i. Proposed Item Specifications; and Delivery timeline

ii. Attach relevant Suruhanjaya Syarikat Malaysia’s (SSM) documents as

follows: -

For Enterprise Company

Company Profile (Appendix C)

SSM Corporate Information

Form D

For Sendirian Berhad & Berhad Company

Company Profile (Appendix C)

Memorandum and Articles of Association


Form 49

Form 9 (Sendirian Berhad) & Form 8 (Berhad)

iii. Latest Audited Financial Statements

iv. Product brochures

v. Appointment letter as a product reseller.

vi. Declaration of any relationship with AKPK Board members or Staff

i.e. parents, spouse, children, siblings (if any)

8.1.3 Fill up the Person In-Charge Form.

8.1.4 Fill up the Company Profile Form.

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8.2 Provide the following information/documents as Cost Proposal

(Appendix B): -

8.2.1 Official Company Quotation for the Deliverables.

(Vendor must submit this and refer to items no.12 VALIDITY OF THE

QUOTATION for the validity period of the Quotation)

8.2.2 Cost Summary.

8.2.3 Propose Payment Term.

8.2.4 Bank Info.

9. METHOD OF SUBMISSION

9.1 By hand ONLY, proposals to this RFQ must be deposited in a sealed envelope

into tender box at:

Agensi Kaunseling dan Pengurusan Kredit (AKPK)

Level 14, TH Perdana Tower,

1001, Jalan Sultan Ismail,

50250 Kuala Lumpur.

9.2 The proposals to be submitted in a separate cover, sealed envelope and to be

labelled clearly as follows:

i. Solution Proposal (Appendix A)

“NOTE: DO NOT OPEN. SOLUTION PROPOSAL ENCLOSED FOR

AKPK HQ OFFICE RELOCATION / MOVERS, RFQ#

AKPK/RFQ20/FEB01 SUBMITTED BY [VENDOR’S NAME HERE]” (Note:

Should submit 2 sets of copies – 1 original, 1 photocopies in one envelope)

ii. Cost Proposal (Appendix B)

“NOTE: DO NOT OPEN. SOLUTION PROPOSAL ENCLOSED FOR

AKPK HQ OFFICE RELOCATION / MOVERS, RFQ#

AKPK/RFQ20/FEB01 SUBMITTED BY [VENDOR’S NAME HERE]”

(Note: Should submit 2 sets of copies – 1 original, 1 photocopies in one

envelope).

9.3 Any submission of RFQ Proposal to be registered in our “Schedule of Tender

for RFQ Submission” i.e Name of Company and Contact Details (Name,

Designation, IC Number, H/P Number, Email Signature, etc.)

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10. OFFICER IN-CHARGE

10.1 AKPK’s Procurement officer in-charge:

1. Name : Nur Hayati Mat Salleh / Hadi Isma Che Wil

Contact No : 03-2610 5678 / 03-2610 5661

Email : [email protected]

10.2 AKPK’s Technical officer in-charge:

1. Name : Ahmad Firdaus Mohamad Ariff

Contact No. : 03-2610 5665 / 019-268 5275


2. Name : Mohd Haffiz Talib

Contact No. : 03-2610 5660 / 019-717 6283


3. Name : Siti Azreena Aida Binti Hamat

Contact No : 011-10402408


11. DATELINE OF SUBMISSION

11.1 All quotations must reach us by / before 1.00pm on 24 February 2020.

11.2 Tender received after the deadline and/or not comply with method of submission

as above mentioned will be rejected.

11.3 The vendor’s proof of posting and/or submission by other means shall not be

accepted as proof of receipt by AKPK.

11.4 Document that are rejected or disqualified will be dispose-off at our end.

11.5 Regardless of the method used for delivery, vendors shall be wholly responsible

for the timely delivery of submitted proposal.

mailto:[email protected]



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12. VALIDITY OF THE QUOTATION

12.1 The validity of the quotation submitted is 120 calendar days;

12.2 To provide additional service with the same specification and price within twelve

(12) months (if require) after first purchase done; and

12.3 All costs are inclusive GST, delivery charges & installation cost and all other taxes

incidental to the Deliverables.

13. AWARD OF THE CONTRACT

13.1 Before the expiry of the period of validity of the proposal, AKPK shall notify the selected

vendor in writing by registered letter or by email that its Proposal has been accepted by

AKPK and any intention to award a Contract.

13.2 The selected vendor will be issued with an official Letter of Award (LOA) or Purchase

Order (P.O).

13.3 Prior to such an issuance, price negotiation may be carried out with the selected

vendor.

13.4 The parties to the contract shall have it signed within 10 days from the date of

LOA issuance unless there is an administrative review request.

13.5 The selected vendor shall prepare the Project Agreement or Maintenance

Agreement within two (2) weeks upon acceptance of the Letter of Award from

AKPK.

13.6 Stamp duty to be borne by the selected vendor.

13.7 The project shall commence once the Project Agreement or Maintenance

Agreement is signed by both parties AKPK and the selected vendor.

14. ANTI-BRIBERY AND ANTI-CORRUPTION

14.1 AKPK is committed to conducting business in an ethical and honest manner and has

zero-tolerance for bribery and corrupt activities.

14.2 We are committed in all business dealings and relationships and will constantly uphold

all laws relating anti-bribery and anti-corruption in Malaysia in particular the Malaysia

Anti-Corruption Commission Act 2009.

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15. WHISTLE BLOWING

15.1 Report on whistleblowing matters are as follows:

i. The Supplier is encouraged to report any concern by completing the

Whistleblowing Incident Report Form (WIRF) as attached in Appendix D.

ii. The Supplier shall as soon as possible, in writing or orally, inform the CEO

of AKPK, upon having knowledge of any director, officer or employee of

AKPK, directly or indirectly, asking for or receiving, any gratification whether

for his own personal benefit or advantage or for the benefit or advantage of

any other person, in relation to this Agreement, whether before, during or

after the term of this Agreement at [email protected]

iii. If the concern involves the CEO of AKPK, the whistleblower could address

his concern either by post or email to the Chairman of AKPK’s Audit

Committee at [email protected]

iv. If the concern involves a director of the Board, you should share your

concern either by post or email with the Chairman of the Board at

[email protected]

‘Gratification’ includes corruption or bribery, any gift, money, property or thing o f value, or any

service, favor or other intangible benefit or consideration of any kind, or any other similar

advantage.





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APPENDIX A

A. SOLUTION PROPOSAL

1. VENDOR’S SOLUTION PROPOSAL

No Description Tick

() Envelope

I

Company Profile form

CIDB

Memorandum and Articles of Association


II

Form D (Enterprise), Form 9 (Sendirian Berhad) & Form 8 (Berhad)

Form 49 ( Sendirian Berhad & Berhad)

Latest Audited Financial Statements

III Proposed hardware specifications (mandatory)

IV Proposed Support and warranty (mandatory)

V Product Brochures (if applicable)

VI Letters of Authorization from Principals and Distributors, if any

VII Declaration of any relationship with AKPK Board members or Staff i.e. parents, spouse, children, siblings (if any)

2. PERSON IN-CHARGE

Name

Designation

Signature

Email

Contact Number (Off)

Mobile Number (HP)

Signature

Date

Company Stamp

3. DELIVERABLES

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3.1 Specifications (AKPK Assets)

a. Menara Bumiputra Commerce, Jalan Raja Laut, Kuala Lumpur (site visit to

this building upon request to person in-charge).

ITEMS LOCATION QUANTITY LOCATION QUANTITY

PC/DESKTOP LEVEL 14 & 29 44 units LEVEL 8 80 units

PRINTER LEVEL 14 & 29 8 units LEVEL 8 3 units

PEDESTAL LEVEL 14 & 29 36 units LEVEL 8 69 units

TELEPHONE LEVEL 14 & 29 48 units LEVEL 8 95 units

SHREDDER LEVEL 14 & 29 3 units LEVEL 8 3 units

LAMINATE MACHINE LEVEL 14 & 29 1 units LEVEL 8 1 unit

BINDING MACHINE LEVEL 14 & 29 1 units LEVEL 8 1 unit

1 SEATER SOFA LEVEL 14 & 29 2 units LEVEL 8 5 units

2 SEATER SOFA LEVEL 14 & 29 5 units LEVEL 8 2 units

3 SEATER SOFA LEVEL 14 & 29 1 units LEVEL 8 0

VISITOR CHAIRS LEVEL 14 & 29 14 units LEVEL 8 8 units

MEETING ROOM CHAIR (Leather)

LEVEL 14 & 29 20 units LEVEL 8 22 units

COFFEE TABLE LEVEL 14 & 29 4 units LEVEL 8 3 units

GLASS CABINET LEVEL 14 & 29 0 LEVEL 8 12 units

WOOD CABINET LEVEL 14 & 29 5 units LEVEL 8 0

ROUND TABLE LEVEL 14 & 29 2 units LEVEL 8 3 units

BANQUET TABLE LEVEL 14 & 29 1 units LEVEL 8 18 units

WATER DISPENSER LEVEL 14 & 29 3 units LEVEL 8 2 units

MICROWAVE LEVEL 14 & 29 3 units LEVEL 8 2 units

KETTLE LEVEL 14 & 29 2 units LEVEL 8 2 units

FRIDGE LEVEL 14 & 29 3 units LEVEL 8 3 units

SAFETY BOX LEVEL 14 & 29 4 units LEVEL 8 0

TENDER BOX LEVEL 14 & 29 1 units LEVEL 8 0

WHITE BOARD LEVEL 14 & 29 8 units LEVEL 8 5 units

STAND FAN LEVEL 14 & 29 3 units LEVEL 8 24 units

TV LEVEL 14 & 29 1 unit LEVEL 8 6 units

WHEELCHAIR LEVEL 14 & 29 0 LEVEL 8 1 unit

BANQUET CHAIR LEVEL 14 & 29 0 LEVEL 8 100 units

FLOWER POT LEVEL 14 &29 15 units LEVEL 8 5 units

VISITOR CHAIR LEVEL 14 & 29 18 units LEVEL 8 6 units

ART PAINTING LEVEL 14 & 29 9 units LEVEL 8 4 units

CARPET LEVEL 14 & 29 1 unit LEVEL 8 0

BOARD ROOM CHAIR LEVEL 14 & 29 12 units LEVEL 8 0

PLATE/GLASS/CUP/BOWL LEVEL 14 & 29 40 units LEVEL 8 25 units

AKPK BOOKS LEVEL 14 & 29 158 boxes LEVEL 8 8 boxes

FILE DOCUMENT (ABBA FILE)

LEVEL 14 & 29 1,200 units LEVEL 8 750 units

BANNER LEVEL 14 & 29 7 pcs LEVEL 8 2 pcs

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BUNTING LEVEL 14 & 29 20 pcs LEVEL 8 0

WOVEN BAG LEVEL 14 & 29 10 bundle LEVEL 8 0

PINGPONG TABLE LEVEL 14 & 29 1 unit LEVEL 8 1 units

IT EQUIPMENTS

HP Switch LEVEL 14 & 29 5 units LEVEL 8 2

NAS Server LEVEL 14 & 29 0 LEVEL 8 1

Dell Server LEVEL 14 & 29 0 LEVEL 8 8

KVM LEVEL 14 & 29 0 LEVEL 8 1

Dell Power Voult LEVEL 14 & 29 0 LEVEL 8 1

UPS LEVEL 14 & 29 0 LEVEL 8 1

TP Link LEVEL 14 & 29 0 LEVEL 8 1

3COM Switch LEVEL 14 & 29 0 LEVEL 8 1

HP Server LEVEL 14 & 29 0 LEVEL 8 5

IBM LEVEL 14 & 29 0 LEVEL 8 1

Litech LEVEL 14 & 29 0 LEVEL 8 1

Edge Core LEVEL 14 & 29 0 LEVEL 8 1

UPS LEVEL 14 & 29 0 LEVEL 8 1

Ruskus (Console) LEVEL 14 & 29 0 LEVEL 8 1

Ruskus (Switch) LEVEL 14 & 29 0 LEVEL 8 1

HP Switch LEVEL 14 & 29 0 LEVEL 8 4

ZTE LEVEL 14 & 29 0 LEVEL 8 1

Cisco (Server) LEVEL 14 & 29 0 LEVEL 8 1

Sangfor LEVEL 14 & 29 0 LEVEL 8 2

Fortinet LEVEL 14 & 29 0 LEVEL 8 2

HP Core Switch LEVEL 14 & 29 0 LEVEL 8 1

Linksys (AP) LEVEL 14 & 29 0 LEVEL 8 1

Unifi LEVEL 14 & 29 0 LEVEL 8 1

HP Desktop LEVEL 14 & 29 0 LEVEL 8 2

KVM Cable LEVEL 14 & 29 0 LEVEL 8 1 box

Screen Cle+D27:D36aning LEVEL 14 & 29 0 LEVEL 8 6

Mouse LEVEL 14 & 29 0 LEVEL 8 2

EZ-Label Printing LEVEL 14 & 29 0 LEVEL 8 6

RAM Laptop 4 GB LEVEL 14 & 29 0 LEVEL 8 6

RAM Laptop 8 GB LEVEL 14 & 29 0 LEVEL 8 3

Cable Lock LEVEL 14 & 29 0 LEVEL 8 2

Hard Disk 3 TB LEVEL 14 & 29 0 LEVEL 8 6

Cable Tight LEVEL 14 & 29 0 LEVEL 8 2

Tape Loader LEVEL 14 & 29 0 LEVEL 8 1

Casio Label Printing LEVEL 14 & 29 0 LEVEL 8 4

Dell XPS (Accessories) LEVEL 14 & 29 0 LEVEL 8 10

Old RAM LEVEL 14 & 29 0 LEVEL 8 6

Cable SATA LEVEL 14 & 29 0 LEVEL 8 5

Hard Disk 300 GB LEVEL 14 & 29 0 LEVEL 8 4


Biometric Card Reader LEVEL 14 & 29 0 LEVEL 8 5

HDMI Cable LEVEL 14 & 29 0 LEVEL 8 3

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Dell DVD Driver LEVEL 14 & 29 0 LEVEL 8 10

Unknown Chipset LEVEL 14 & 29 0 LEVEL 8 2

Hard Disk 1 TB LEVEL 14 & 29 0 LEVEL 8 3


Vacuum LEVEL 14 & 29 0 LEVEL 8 1

Faulty Desktop LEVEL 14 & 29 0 LEVEL 8 11

Desktop LEVEL 14 & 29 0 LEVEL 8 2

Keyboard LEVEL 14 & 29 0 LEVEL 8 27

DVI Cable LEVEL 14 & 29 0 LEVEL 8 1 box

Power Cable LEVEL 14 & 29 0 LEVEL 8 1 box

Power Cord LEVEL 14 & 29 0 LEVEL 8 1 box

Old HP Desktop LEVEL 14 & 29 0 LEVEL 8 3

Peplink LEVEL 14 & 29 0 LEVEL 8 1

Fortinet Cable LEVEL 14 & 29 0 LEVEL 8 1 box

ATEN LEVEL 14 & 29 0 LEVEL 8 1

Old (AP) LEVEL 14 & 29 0 LEVEL 8 1 box

WD USB FIREWIRE ESATA LEVEL 14 & 29 0 LEVEL 8 1

3COM Switch LEVEL 14 & 29 0 LEVEL 8 10

Cisco System LEVEL 14 & 29 0 LEVEL 8 3

TP Link Switch LEVEL 14 & 29 0 LEVEL 8 1

Juniper Network LEVEL 14 & 29 0 LEVEL 8 1

Fortinet Switch LEVEL 14 & 29 0 LEVEL 8 3

HP Switch LEVEL 14 & 29 0 LEVEL 8 6

Cisco Switch LEVEL 14 & 29 0 LEVEL 8 1

Sangfor LEVEL 14 & 29 0 LEVEL 8 1

RAM 8 GB LEVEL 14 & 29 0 LEVEL 8 4

QR SCAN Code LEVEL 14 & 29 0 LEVEL 8 2

ADATA External HDD (1TB)

LEVEL 14 & 29 0 LEVEL 8

6

Kingston 16 GB LEVEL 14 & 29 0 LEVEL 8 9

HP Printer LEVEL 14 & 29 0 LEVEL 8 2

CKIT Cable LEVEL 14 & 29 0 LEVEL 8 1 box

Ruckus (Accessories) LEVEL 14 & 29 0 LEVEL 8 1 box

Synology (Accessories) LEVEL 14 & 29 0 LEVEL 8 1 box

IBM Cable LEVEL 14 & 29 0 LEVEL 8 2 box

Quantum Tapeloader 3000 GB


24

Alied Telesis LEVEL 14 & 29 0 LEVEL 8 1 box

Dell Adapter LEVEL 14 & 29 0 LEVEL 8 2

Dell Latitude 3440 Laptop Batery


5



2



4



13

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HP Server LEVEL 14 & 29 0 LEVEL 8 5

Ipad Case LEVEL 14 & 29 0 LEVEL 8 4

Laptop LEVEL 14 & 29 0 LEVEL 8 7

Faulty Laptop LEVEL 14 & 29 0 LEVEL 8 3

Faulty Monitor LEVEL 14 & 29 0 LEVEL 8 2

Cisco Server LEVEL 14 & 29 0 LEVEL 8 1 box

Cable Network LEVEL 14 & 29 0 LEVEL 8 1 box

RG 45 Cat6 LEVEL 14 & 29 0 LEVEL 8 1 box

Cabel Mix LEVEL 14 & 29 0 LEVEL 8 1 box

TV LEVEL 14 & 29 0 LEVEL 8 2

Desktop TV LEVEL 14 & 29 0 LEVEL 8 1

Laptop LEVEL 14 & 29 0 LEVEL 8 11

Desktop LEVEL 14 & 29 0 LEVEL 8 6

HP Printer LEVEL 14 & 29 0 LEVEL 8 1

Monitor LEVEL 14 & 29 0 LEVEL 8 13

WIFI AP LEVEL 14 & 29 7 units LEVEL 8 5 units

Server Rack LEVEL 14 & 29 2 Units LEVEL 8 3 units

b. Scope of work

i. All equipment’s need expert services to pack, wrap and move assemble and position.

ii. Movers should provide dedicated IT team to pack/unpack all desktop sets from origin to destination.

iii. Movers should provide sufficient packing and protective materials - bubble pack, stretch film, corrugated rolls, newsprints (glass/fragile items),

canvas and plywood protection to walkway & lift.

c. Insurance Coverage

i. Movers should provide insurance coverage against all accidental risk for all equipment’s.

ii. The list of equipment as below;

NO. ITEM

DESCRIPTIONS SUM TO INSURED

(RM)

1 PC/DESKTOP

1,731,536.00

2 FRIDGE

3 MICROWAVE 4 TV

5 WATER DISPENSER 6 PRINTER

7 STAND FAN

8 SERVERS EQUIPMENT

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d. Loading Bay

i. Height – 92 inch

ii. Distance (lorry parking area) from loading lift – 50 meters

iii. Actual picture as follows;

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APPENDIX B

1. COST PROPOSAL

A. CHECKLIST

No. Description Tick () Envelope

1 Official Company Quotation (compulsory)

COST PROPOSAL 2 Cost Summary in Appendix B (B)

3 Bank Info

B. COST SUMMARY

No. Description Total (RM)

1. Cost of Mover

2. Insurance Cost

Grand Total Cost

(All cost are inclusive of delivery charges and other taxes incidental to the deliverables)


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2. PAYMENT STRUCTURE

No Description

1.

Preferred Payment Term i. Upon full delivery and upon AKPK’s acceptance and satisfaction of

AKPK. 100%

(Please state if the payment term is not as per the above preferred term)

3. BANK INFO

No Description

1

Manner of Payment

i. Name of Bank :

ii. Address of Bank : iii. Account number :

iv. Account type : Current / Saving v. Account scheme : Conventional / Islamic

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APPENDIX C

COMPANY PROFILE FORM

This section covers generic company information that will provide a quick overview of the vendor/solution provider organization. Please fill in as much information as possible, and

feel free to add additional information in the form of attachment.

i. Particulars of Company

No Items Explanation

1. Company Name

2.

Company Registration No. (for company registered in

Malaysia)

3. Business Address

4.

Correspondence Address (if different from the above

business address)

5. Telephone No.

6. Fax No.

7. Contact Person(s)

8. Number of years in business operation

9. Latest Audited Financial Statements (MM/YYYY)

10. SSM Certification (e.g. Form 49. Form 9, etc.)

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ii. Company’s Directors

No Name of Directors Position In Company Period

1

2

3

iii. Company’s Current and Past Work Experience (latest 3 projects)

Please attach the list of similar contracts/projects performed by your company.

The list should be confined only to similar or related supply/services/works

described in this RFQ document and presented in the format specified below

(please add more rows if not sufficient).

No. Client Name Project Description Completion Date

1.

2.

3.

DECLARATION

We declare that all information on the company is true and correct; and there has been no deliberate suppression of facts, which are required in this form.

Signature

Name

Designation

Contact No.

Email address

Date

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APPENDIX D

Whistleblower Incident Report Form (WIRF)

Instruction: All reports should be made using the WIRF

Reporting Misconduct

You should share your concerns of misconduct to the Chief Executive Officer (CEO) of

AKPK. If it is inappropriate to make the report to the CEO, you can report your concerns

to the Chairman of the Board of Directors or Chairman of the Board Audit Committee.

Alternatively, you may mail the completed WIRF to the Chairman of the Board of

Directors or to the Chairman of the Board Audit Committee.

Date of Report: _____________________________________________________

Person reporting the actual or suspected misconduct.

(Do not complete this section if you wish this to be an anonymous report)

Name : ___________________________________________________

Email address : ___________________________________________________

Telephone number : ___________________________________________________

Person against whom the report of actual or suspected misconduct is being

made:

Name : ___________________________________________________

Email address : ___________________________________________________

Telephone number : ___________________________________________________

*Use the back of this form or additional sheets of paper to describe the alleged

misconduct. Include specific facts and documentation, if any, as well as the

names of any individual at AKPK with whom you have discussed your concerns.

END OF RFP

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