REGISTRASIE VORM: VERSKAFFERS / DIENSVERSKAFFERS AFDELING A KORPORATIEWE BESONDERHEDE

Transcription

1 REGISTRASIE VORM: VERSKAFFERS / DIENSVERSKAFFERS AFDELING A KORPORATIEWE BESONDERHEDE 1. Titel: (Prof./ Dr./ Mnr./ Mev./ Me.).. 2. Van: (Identiteitsnommer ) (naam van kontakpersoon) 3. Naam van onderneming:... (Kontrakte/Bestellings sal in dié naam geplaas word en fakture moet dit weerspieël.) 4. Geregistreerde naam van onderneming 5. Straatadres van onderneming:.. 6. Pos-/Postnet-adres van onderneming:.... (Dit is die adres waarheen n uitnodiging om te tender/navrae en bestellings/kontrakte gestuur moet word) 7. E-pos-adres:. 8. Telefoonnommers van onderneming: Kode: Nommer:. 9. Selfoonnommer van onderneming: Nommer: Kontakpersoon se faksnommer: Kode: Nommer:.... (Deur die Kaap Agulhas Munisipaliteit gebruik vir die elektroniese faks van Versoek om Kwotasies, Kontrakte en Aankooporders) 11. Is dit n toegewese faksnommer? (J/N):. 12. Onderneming/Maatskappy se Inkomstebelastingnr.:.... (Vul persoonlike inkomstebelastingnommer in indien dit n eenmansaak is en die persoonlike inkomstebelastingnommers van vennote, indien dit n vennootskap is.) 13. BTW-registrasienr.: 14. Onderneming/Maatskappy-registrasienr.: Tipe onderneming: (bv. vennootskap, maatskappy, bk, eenmansaak, ens.) 16. CIDB- registrasienr.: Land van registrasie of inlywing:. 18. Manier van deelname:. (bv. hoofkontrakteur, verskaffer, professionele diensverskaffer, gemeenskaplike onderneming, konsortium, ens.) 19. Sakesektor:. 1

2 20. Het u firma voorheen onder n ander naam bestaan? j/n): 20.1 Indien ja, wat was die vorige naam daarvan? Wie was die eienaars/vennote/direkteure? Lys die name van al die vennote, eienaars en aandeelhouers per naam, identiteitsnommer, burgerskap en aandeelhouding: Naam ID-nommer Datum RSA Burgerskap verkry Ras Geslag M/V Gestremd Ja/Nee Datum van eienaarskap % tyd aan die onderneming bestee % Aandeelhouding/ Eienaarskap Let wel: Indien die eienaars self n korporatiewe entiteit of vennootskap is, identifiseer dit asseblief. 22. Hoeveel voltydse en tydelike werknemers in tans in u diens. (Aantal) Mans Histories Benadeelde Individue Ander Voltyds Tydelik Voltyds Tydelik Vroue 2

3 AFDELING B BREËBASIS SWART EKONOMIESE BEMAGTIGING Die volgende definisies dien as 'n gids tot hoe Kaap Agulhas Munisipaliteit BBSEB interpreteer: - "swart mense" is 'n generiese term wat Afrikane, Kleurlinge en Indiërs beteken; "breëbasis-swart ekonomiese bemagtiging" beteken die ekonomiese bemagtiging van alle swart mense, insluitende vroue, werkers, die jeug, mense met gestremdhede en mense wat in landelike gebiede deur middel van uiteenlopende maar geïntegreerde sosio-ekonomiese strategieë wat die volgende insluit, maar is nie beperk tot (a) die verhoging van die aantal swart mense wat bestuur, besit en beheer van ondernemings en produktiewe bates; (b) die fasilitering van eienaarskap en bestuur van ondernemings en produktiewe bates deur gemeenskappe, werkers, koöperasies en ander gesamentlike ondernemings; (c) van menslike hulpbronne en die ontwikkeling van vaardighede; (d) die bereiking van billike verteenwoordiging in alle beroepskategorieë en vlakke in die arbeidsmag; (e) voorkeurverkryging, en (f) die belegging in ondernemings wat deur swart mense besit of bestuur word; BBSEB KEURING SERTIFIKAAT Alle Diensverskaffers moet 'n B-BSEB Sertifikate soos uitgereik deur: Die verifikasie-agentskappe geakkrediteer deur die Suid-Afrikaanse Nasionale Akkreditasie Stelsel (SANAS) of Geregistreerde Ouditeure goedgekeur deur die Onafhanklike Regulerende Raad van Ouditeure (IRBA) in ooreenstemming met die goedkeuring verleen deur die Departement van Handel en Nywerheid (DTI) 3

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5 AFDELING C DIENSVERSKAFFERPROFIEL Let wel: Indien n spesifieke navraag nie op u onderneming van toepassing is nie, merk asseblief die betrokke navraag as nie van toepassing nie (Nvt), en moenie die navraag net blanko laat nie. DEEL A BANKINLIGTING 1. Heg asseblief n oorsponklike gekanselleerde tjek of n oorspronklike bankverifiëringsbrief aan. 2. Bank:. 2.1 Rekeninghouer Naam:. 2.2 Taknommer/-kode:. 2.3 Taknaam:. 2.4 Bankrekeningnommer: Tipe Rekening:. 2.6 Bankstempel BANK STEMPEL (Hiermee word gesertifiseer dat die bankbesonderhede soos hierbo verstrek korrek is) 3 Alle Betalingstransaksies sal deur middel van Elektroniese oordrag plaasvind 4. Die diensverskaffer gee hiermee die waarborg dat sy bankbesonderhede en alle ander inligting hierin voorsien (hierna gesamentlik na verwys as "die inligting" is waar, akkuraat en korrek is in alle opsigte en verder verseker dat die Kaap Agulhas Munisipaliteit betyds skriftelik in kennis gestel sal word van enige veranderinge tot die inligting. Die diensverskaffer vrywaar en stel Kaap Agulhas Munisipaliteit skadeloos teen enige verlies of eis van enige aard, hetsy direkte, indirekte van gevolglike, wat die diensverskaffer of enige ander persoon mag hê of beweer teen Kaap Agulhas Munisipaliteit te hê wat voortspruit uit die inligting wat onwaar is, onakkurate andersins onjuis en / of versuim om Kaap Agulhas Munisipaliteit betyds skriftelik in kennis te stel van enige veranderinge aan die inligting, vir enige rede. GETEKEN en aanvaar HIERDIE... dag van Handtekening:... Naam & Posisie by Onderneming 5

6 AFDELING D 1. Elke diensverskaffer moet hierdie verklaring teken ten einde vir registrasie op die Kaap Agulhas Munisipaliteit se databasis vir diensverskaffers oorweeg te word. 2. Die Kaap Agulhas Munisipaliteit behou die reg voor om te enige tyd van enige diensverskaffer te vereis om enige inligting wat verskaf is op enige manier wat die Munisipaliteit verlang, te staaf. VERKLARING DEUR DIENSVERSKAFFER Ek, die ondergetekende,... waarborg dat ek deur my organisasie/onderneming/firma/maatskappy gemagtig is om die inligting wat in dié aansoek vervat word, te verskaf en dat alle inligting sowel waar as korrek is Verder verklaar ek spesifiek dat die stellings wat ten opsigte van die status van histories benadeelde individue, voorheen benadeelde ondernemings, ondernemings in die besit van vroue en klein-, medium- en mikroondernemings gemaak is, waar en korrek is en dat ek of enige lid van my organisasie onmiddellik die Kaap Agulhas Munisipaliteit in kennis sal stel van enige verandering in die gemelde status, ongeag van die gevolge wat dit op voortgesette of toekomstige opname in die databasis vir diensverskaffers van die Kaap Agulhas Munisipaliteit kan hê. Ek stem toe dat indien daar bevind word dat enige stellings wat in dié aansoek gemaak is of inligting wat daarin verskaf is, onwaar of op bedrieglike wyse verskaf is, die Kaap Agulhas Munisipaliteit, benewens enige ander regsmiddel tot sy beskikking, die volgende kan doen: alle kostes, verliese of skade wat deur die Kaap Agulhas Munisipaliteit as gevolg van die verskaffing van onwaar of bedrieglike inligting gely of aangegaan is, van my organisasie verhaal; en/of enige kontrak wat met die diensverskaffer gesluit is, kanselleer; en/of vir enige skade wat die Kaap Agulhas Munisipaliteit mag ly deur minder gunstige reëlings na sodanige kansellasie te moet tref, eis; en/of die organisasie of individu van toekomstige kontrakte met Kaap Agulhas Munisipaliteit uitsluit (swartlysting). Handtekening Datum Hoedanigheid Behoorlik gemagtig om namens te teken. 6

7 AFDELING E DOKUMENTASIE WAT VERSKAF MOET WORD SCM Regulasie 13: Algemene Voorvereistes vir oorweging van kwotasies/ tenders Heg asseblief afskrifte van die volgende dokumente aan u aansoek (waar van toepassing): Merk asseblief in vak: Diensverskaffer Aansoekvorm behoorlik voltooi en onderteken word (Afdeling A - D). 'n Oorspronklike en Geldige Belasting Klaringsertifikaat (verpligtend). Bewys van eienaarskap / aandeelhouers sertifikaat (identifikasie dokumente gesertifiseer) (verpligtend) BBSEB Rating Sertifikaat (Gesertifiseer) Nuutste munisipale rekening Maatskappy / BK / Trust / ander Registrasie dokumente (CK2 dokumente). BTW-registrasie sertifikaat (VAT103 dokumente) (waar van toepassing). Afskrif van LBS registrasie dokumente (Indien nie aangedui op belastingklaringsertifikaat). Afskrif van die WVF-registrasie-dokumente (Indien nie aangedui op belastingklaringsertifikaat). Workman s Compensation: Letter of Good Standing Sekuriteitsbeamptes Raad Sertifikaat (waar van toepassing). Raad op elektriese kontrakteurs (waar van toepassing). CIDB Sertifikaat (waar van toepassing). NHBRC Sertifikaat (waar van toepassing). Spyseniers - geskiktheidsertifikaat (COA) hantering van voedsel (R918 van 31 Julie 1999) in terme van Voedselpersele uitgereik deur die Plaaslike Owerheid: Departement van Omgewings Gesondheid Oorspronklike gekanselleerde tjek of 'n oorspronklike bank verifikasie brief. Verklaring van Belange (verpligtend) Maatskappy-Organogram, wat Holding en filiaalmaatskappy (s) sowel as bedryfsafdelings. JA NEE Let Wel: Die Belasting uitklaringsertifikaat (Tax Clearance) is slegs geldig vir n periode van twaalf (12) maande vanaf die datum van uireiking. Daar sal van u verwag word om n opgedateerde, oorspronklike en geldige Belasting uitklaringsertifikaat op of voor die vervaldatum van die huidige sertifikaat tans in besit van Kaap Agulhas Munisipaliteit te voorsien om steeds as geakrediteerde verskaffer, besigheid te kan doen. Indien dit nie nagekom word nie, sal u registrasie op die databasis opgeskort word totdat n heruitreiking van n sertifikaat gedoen is. Hierdie vorms moet voltooi word en versend word aan een die volgende: Kaap Agulhas Munisipaliteit Kaap Agulhas Munisipaliteit Dirkie Uys Straat 1 Posbus 51 Bredasdorp Bredasdorp Navrae kan gerig word aan Kaap Agulhas Munisipaliteit, Voorsieningskanaal kantoor - Tel: Epos: Geraldinek@capeagulhas.gov.za / sakkie@capeagulhas.gov.za Faks:

8 Please indicate the nature of operations, products or services applicable to your business by ticking the appropriate boxes with a X:Plz only what your company Specilizes in. CODE COMMODITY x CODE COMMODITY x 00100: CONSTRUCTION EQUIPMENT AND SUPPLIES 00400: GENERAL SERVICES Air conditioning and temperature control Accommodation and lodging equipment Building equipment and accessories (cement mixers, scaffolding, trowels, levels, etc) Advertising, communication, graphic design, editorial, publication and marketing services Building materials (bricks, cement, Auctioneering services sand, painting, plastic, stone, steel, tiles, etc) Ceiling boards, skirting, etc Bookkeeping and accounting services Construction machinery Catering and refreshments Doors and windows Cleaning services Electrical systems, lighting, components Conferencing facilities and facilitation accessories and supplies Flooring materials (Carpets, tiles, etc) Contract administration Glass repair works Courier services Plumbing ware and materials Education and training Roofing materials Environmental impact studies Sanitation ware and equipment Freight forwarding and clearing services General maintenance services General Wholesale Health care Horticulture Infrastructural maintenance Inspection services 00200: CONSTRUCTION SERVICES Insurance Burglar proofing and systems IT, broadcasting and telecommunication services Civil Engineering Structures Interior decorating, refurbishment and upholstery Concrete manufacture and works Land valuation Construction-related transport Laundry, dry-cleaning & ironing services Demolition services Locksmith services Earthworks, drilling and landscaping Mailing services Electrical installation Management services Fencing Miscellaneous equipment and goods hiring General building work Personnel Services Glazing Pest,weed control and removal services Mechanical contracts Photographic and graphic design services Metalwork Picture framing Painting Printing Paving Procurement services Plumbing Real estate services Pre-cast concrete manufacture Research services Pump installation Security, safety services & law enforcement Road works Site cleaning Sewerage systems and construction Social Facilitating Specialist Trade Contractors Storage Water works and pipelines Translation and interpreting services Transport services, general Travel services Vehicle hire Vending services Cellphones & vouchers Funeral services 8

9 00300: ELECTRICAL AND MECHANICAL 00700: PROFESSIONAL SERVICES EQUIPMENT, SERVICES AND SUPPLIES Bearing supplies Accounting, auditing and management services Bolts, nuts and fasteners Architectural services Electric cables Consulting engineering: Electrical Electrical component supplies Consulting engineering: Environmental Electrical equipment Consulting engineering: Geo-technical Electrical equipment repairs Consulting engineering: Mechanical Hardware supplies Consulting engineering: Other Lifting equipment Consulting engineering: Project management Mechanical seals and packing Consulting engineering: Roads & Storm water Pipe and irrigation supplies Consulting engineering: Sewerage systems Power generation and distribution Consulting engineering: Solid waste machinery and accessories Pump spares Consulting engineering: Structures, Building, Bridges, etc Small tools Consulting engineering: Water systems Transformer services Engineering services Valves, couplings Financial services Water meter, pipes, fittings, galvanised Land surveying PVC, upvc, mpvc, polyethylene, etcetera Legal services contracts 00500: OFFICE AND FACILITIES EQUIPMENT AND Legal services-- conveyance SUPPLIES Computer equipment hardware, Legal services litigation networks and software Consumables Legal services other Corporate gifts Medical services,equipment &accessories Domestic, industrial and cleaning Project management equipment and supplies Electronic equipment, including audiovisual Quantity surveying equipment Fire protection equipment Town and regional planning Flowers, plants,compost & nursery acc Motivational speakers Food and refreshments 00800: VEHICLE SUPPLY AND TRANSPORTATION SERVICES Households furniture and equipment Alarm and tracking systems Office furniture and equipments Auto electrical repairs Office supplies and stationery Batteries Printing, copying and photographic Engine overhauls equipment and supplies Fuel, oils and lubrications 00600: MISCELLANEOUS GOODS AND SUPPLIES Hydraulics Environmental cleansing equipment, Panel beating goods and supplies Fire fighting protection equipment, Radiator repairs goods and supplies Garden tools Radio & Electronic equipment Gas Spares and parts Laboratory chemicals Towing services & vehicle storage Material and warehousing machinery, Transmissions equipment and goods Measuring, testing and observation Tyres and tubes equipment Pharmaceutical products,drugs etc Upholstery Protective clothing and uniforms Vehicle fleet management Security equipment, goods and services Vehicle supply Specialised imported chemicals Windscreens Sports and recreational equipment and Taxi,busses transportation services goods Road & Traffic signs manufacturers Other plz specify Wine Distributing 9

10 MBD 4 DECLARATION OF INTEREST 1. No bid will be accepted from persons in the service of the state¹. 2. Any person, having a kinship with persons in the service of the state, including a blood relationship, may make an offer or offers in terms of this invitation to bid. In view of possible allegations of favouritism, should the resulting bid, or part thereof, be awarded to persons connected with or related to persons in service of the state, it is required that the bidder or their authorised representative declare their position in relation to the evaluating/adjudicating authority. 3 In order to give effect to the above, the following questionnaire must be completed and submitted with the bid. 3.1 Full Name of bidder or his or her representative: Identity Number:. 3.3 Position occupied in the Company (director, trustee, hareholder²): Company Registration Number:. 3.5 Tax Reference Number: 3.6 VAT Registration Number: 3.7 The names of all directors / trustees / shareholders members, their individual identity numbers and state employee numbers must be indicated in paragraph 4 below. 3.8 Are you presently in the service of the state? YES / NO If yes, furnish particulars.... ¹MSCM Regulations: in the service of the state means to be (a) a member of (i) any municipal council; (ii) any provincial legislature; or (iii) the national Assembly or the national Council of provinces; (b) a member of the board of directors of any municipal entity; (c) an official of any municipality or municipal entity; (d) an employee of any national or provincial department, national or provincial public entity or constitutional institution within the meaning of the Public Finance Management Act, 1999 (Act No.1 of 1999); (e) a member of the accounting authority of any national or provincial public entity; or (f) an employee of Parliament or a provincial legislature. ² Shareholder means a person who owns shares in the company and is actively involved in the management of the company or business and exercises control over the company. 10

11 3.9 Have you been in the service of the state for the past twelve months? YES / NO If yes, furnish particulars Do you have any relationship (family, friend, other) with persons in the service of the state and who may be involved with the evaluation and or adjudication of this bid? YES / NO If yes, furnish particulars Are you, aware of any relationship (family, friend, other) between any other bidder and any persons in the service of the state who may be involved with the evaluation and or adjudication of this bid? YES / NO If yes, furnish particulars Are any of the company s directors, trustees, managers, principle shareholders or stakeholders in service of the state? YES / NO If yes, furnish particulars Are any spouse, child or parent of the company s directors trustees, managers, principle shareholders or stakeholders in service of the state? YES / NO If yes, furnish particulars Do you or any of the directors, trustees, managers, principle shareholders, or stakeholders of this company have any interest in any other related companies or business whether or not they are bidding for this contract. YES / NO If yes, furnish particulars:

12 4. Full details of directors / trustees / members / shareholders. Full Name Identity Number State Employee Number.. Signature.. Date. Capacity Name of Bidder 12