4 Brothers Limited

Operational Management System · Tauranga, Bay of Plenty NZ

4B.CMP.006

Version 1.0

Compliance Form

Subcontractor Prequalification Checklist

Complete before any subcontractor commences work. Both parties are PCBUs under HSWA 2015 s34. A coordination agreement must be in place before work starts. Retain on file — minimum 6 years. | Basis: HSWA 2015 s34 (overlapping duties); ERA 2000 s6 (employment definition); HSWA 2015 s36.

1 Subcontractor / Company Details

Trading Name / Business Name

Legal Entity (if different)

GST Number

Company Number (NZBN)

Entity Type

Primary Contact Name

Mobile / Phone

Email Address

Physical Address

Services to be Provided

Expected Start Date

Approximate Duration

Number of Workers Subcontractor Will Deploy

Sites / Orchards to Work At

2 Health & Safety Capability — HSWA 2015 s34

Requirement	Legal basis	Status
H&S Policy in place Written policy signed by principal. Active, not template-only.	HSWA 2015 s36
Hazard identification process Method for identifying site hazards before work commences each day.	HSWA 2015 s36(3)
Incident reporting procedure Must notify 4 Brothers of all incidents, near misses, and notifiable events immediately.	HSWA 2015 s25, s56
Worker H&S induction process All workers inducted on site hazards, PPE, emergency procedures before starting.	HSWA 2015 s36(3)(f)
First aid provision At least one trained first aider and kit on site at all times. Provide name.	Health and Safety at Work (First Aid) Regulations 2016
PPE provision for workers Adequate PPE supplied and maintained for the tasks to be performed.	HSWA 2015 s36(3)
Stop work authority confirmed Workers empowered to stop work if unsafe. No penalty for exercising this right.	HSWA 2015 s83
Drug and alcohol policy Zero tolerance for drug/alcohol use while working on 4 Brothers sites.	HSWA 2015 s36; 4B.HS.014

H&S notes / any variance from above

3 Insurance — Evidence Required

Insurance Type	Minimum Cover	Expiry Date	Provided
Public Liability Covers third-party injury/property damage arising from the subcontractor's work.	NZD $1,000,000 per event
Employer's Liability / Statutory Liability Covers claims by the subcontractor's own workers beyond ACC.	NZD $500,000
Motor Vehicle Liability Required if subcontractor's vehicles operate on client orchards or public roads.	Third-party as minimum
Professional Indemnity Required if providing advisory, management, or consulting services.	NZD $500,000

Insurer Name(s) and Policy Reference(s)

4 Licences, Qualifications & Certifications

Requirement	Applicable?	Held / Expiry	Evidence
Growsafe / RCA Spray Certificate Required for anyone operating motorised spraying equipment (HSNO Act 1996 / EPA rules).
Zespri CAV Accreditation Required if subcontractor works on Zespri-licensed kiwifruit orchards. 12-month validity, 3 inspections for new contractors.
KVH Biosecurity Plan Mandatory for all contractors classified as high-risk by KVH. Includes hygiene protocols and movement records.
Driver Licence (relevant class) Class 2+ for agricultural vehicles above 26,000 kg GVM. Class 1 minimum for all drivers.
Forklift / MEWP Licence WorkSafe-recognised competency required to operate forklifts and elevated work platforms.
First Aid Certificate At least one qualified first aider on site when subcontractor's crew is working.
Other trade licence / qualification Specify any other trade licence, certification, or compliance requirement relevant to the services.

5 Employment Law — Worker Protections

Declaration Item	Legal Basis	Confirmed
All workers are paid at least minimum wage $23.50/hr adult (from 1 April 2025). No deductions that reduce pay below minimum.	Minimum Wage Order 2025
Employment agreements in place for all workers Written individual employment agreement signed before work commences (ERA 2000 s63A).	ERA 2000 s63A
Accurate wage and time records kept Records retained minimum 6 years. Available to Labour Inspectorate on request.	ERA 2000 s130
Holiday Act 2003 entitlements met 4 weeks annual leave; 10 days sick leave (after 6 months); 8% holiday pay for casuals if agreed.	Holidays Act 2003
ACC levies current Employer ACC Work Account levy paid for all employees. Earners' levy deducted from wages.	Accident Compensation Act 2001
No unlawful labour hire / sham contracting arrangements Workers are genuinely engaged on terms consistent with their actual working arrangement.	ERA 2000 s6; Tax Admin Act 1994

6 Trade References

Provide two current references from clients for whom the subcontractor has performed similar work in the last 24 months. 4 Brothers may contact these references before approving the subcontractor.

Reference 1 — Name

Company / Orchard

Phone / Email

Reference 1 — Nature of work performed

Reference 2 — Name

Company / Orchard

Phone / Email

Reference 2 — Nature of work performed

7 Subcontractor Declaration

I/We declare that the information provided in this prequalification checklist is accurate and complete. I/We agree to:

Comply with all applicable New Zealand health and safety legislation, including HSWA 2015
Follow all 4 Brothers Limited site safety rules and procedures while on site
Notify 4 Brothers immediately of any notifiable event, incident, or near miss involving my/our workers
Maintain all required licences, insurances, and certifications for the duration of the engagement
Not subcontract any work to a further party without prior written approval from 4 Brothers Limited
Allow 4 Brothers Limited to audit compliance with this prequalification at any time

I/We understand that providing false information may result in immediate termination of the engagement and may constitute a breach of contract.

Subcontractor Signature

Full name

Role / Title

Sign here

Date

Witness (if applicable)

Full name

Role / Title

Sign here

Date

8 4 Brothers Limited — Review & Approval

Reviewed by

Review Date

References Checked? (circle/select)

Both references contacted and satisfactory One reference checked Known contractor — references waived Not yet checked

Outstanding items or conditions

Approval Decision

APPROVED — All requirements met. Work may commence. CONDITIONAL — Outstanding items must be resolved within 5 working days. DECLINED — Requirements not met. Do not engage.

Operations Manager / Director

Full name

Sign here

Date

Next Review Due

Date

Prequalification valid for 12 months from approval date, or earlier if: insurance lapses, licence expires, incident occurs, or significant change in scope of work.