SUPPLIER DATABASE REGISTRATION FORM

Transcription

1 SUPPLIER DATABASE REGISTRATION FORM APPLICABLE TO ALL SUPPLIERS SEEKING REGISTRATION AS AN APPROVED SUPPLIER ON THE DATABASE OF THE SOUTH AFRICAN STATE THEATRE (Herein after referred to as SAST ) NAME OF SUPPLIER: Official Use: Application Accepted Application Rejected Captured By: Date: Signature: Approved By: Date: Signature: Page 1 of 24

2 Suppliers are herewith invited to register as an approved supplier on the database of the entity. In order to comply with the Public Finance Management Act, 1999 (Act 1 of 1999) (herein referred to as PFMA ), the entity developed a supplier database to be used by the procurement office. The purpose of this database is to give all prospective suppliers an equal opportunity to submit quotations to the entity. Preference will be given to registered suppliers but it does not necessarily follow that suppliers who are not yet registered will be totally exempted from quoting for the supplying of goods or services to the entity. It is envisaged, however, that this database will contribute to efficient administration and compliance with the PFMA. Attached please find an official registration form to assist us in creating and updating our database according to legislation. The following important notes must be read carefully before completion of this form: 1. Registration form to be completed by all suppliers seeking to conduct business with the entity. 2. A company profile and B-BBEE STATUS LEVEL VERIFICATION CERTIFICATE must be submitted. 3. This form must be completed in full and signed by the authorized person. 4. Full signature is required when alterations are made in this document. 5. If the information required is not applicable to your business, clearly insert N/A in the appropriate space. 6. Mark the appropriate square with an 'X' where it is applicable to you. 7. All fields on the application form MUST be completed. If the space provided is left blank, it will be regarded as information that is still outstanding and you will not be registered. 8. The front page of the form must be clearly marked "DATABASE" and posted to the postal address or hand delivered to the entity. 9. Please note that unsigned, faxed or ed forms will not be accepted. 10. A supplier registered on the database must notify the SAST in writing within 14 (Fourteen) days of any changes to information provided in this form. Failure to Page 2 of 24

3 comply may result in such a business being removed and/or blacklisted from the database. 11. Suppliers providing information intentionally incorrectly or fraudulently will be disqualified. 12. Suppliers that appear on the National Treasury Database of Restricted Suppliers must first be removed or cleared before submitting this application for registration. 13. Copies of the following documents must be attached to application form: A concise company profile (max 2 pages); Company Incorporation Documents, including Shareholder(s) register; Original valid Tax Clearance Certificate; VAT registration certificate (for VAT vendors only); Certified ID for all members / partners / directors / shareholders; B-BBEE Status Level Verification Certificate certified as a true copy of the original. NB: the certificate must be issued by a SANAS accredited agent or an IRBA registered Auditor Signed and completed SBD 4 forms Signed and completed SBD 9 forms Failure to submit all the above documents will result in non-registration. 14. Fronting (in the context of preferential procurement means a misrepresentation or the making of a misrepresentation in order to obtain undue preference point) will result in a supplier being blacklisted. 15. SAST has the right to visit the supplier s premises to verify information provided in this form. Please ensure that you provide a physical business address in this form. 16. Members /directors /partners /shareholders in service with any government body; must declare any conflict of interest. Failure to do so may lead to disqualification or de-registration. 17. This is only a registration form for database registration and does not guarantee any award of bid /contract. 18. Preference will be given to registered suppliers but it does not necessarily follow that suppliers who are not yet registered will be totally excluded from quoting for the supply of goods or services to the entity. 19. The database will be updated on quarterly basis. A summary of the supplier s info on the database will be posted for verifying. Changes can be made on the summary and ed back to the entity. Only on receipt of a signed changed summary, updates will be added to the database. Page 3 of 24

4 20. SAST reserves the right to reject any application, which in its opinion failed to comply with the registration requirements or criteria. 21. Applicants will be contacted via and must therefore submit an address; failure to comply will result in excluding the supplier from the database; 22. Suppliers must comply with all registration-criteria for registration to be finalized. Failure to do so may result in the application being declined. Completed database forms can be hand delivered at: The South African State Theatre Supply Chain Management 320 Pretorius Street Pretoria Or post it to: The South African State Theatre PO Box 566 PRETORIA 0001 Page 4 of 24

5 SECTION A: SUPPLIER DATABASE REGISTRATION FORM Supplier detail: Company/Supplier Registered Name: Trading Name if different from the above: Company / Close Corporation Registration Number # VAT registration number (if applicable): Income tax reference number ## Web Address: Address: Telephone Number: Fax Number: (compulsory) Toll Free Number: Number of full time employees: # For Companies and Close Corporations, as with the Registrar of Companies / CC ## Insert Personal Income Tax Number for sole proprietor of Personal Income Tax numbers for all parties in terms of partnerships Postal Address: (compulsory) Physical Address: Postal Code: Supplier Classification: (Please mark with X the relevant box or boxes) ISO Listed Importer Services Manufacturer Repairer Black Owned Distributor Exporter Sales (Please mark with X the relevant box) Tax Clearance Certificate Attached yes no Expiry date: Page 5 of 24

6 Supplier Grouping Detail: Type of Firm: (Please mark with X the relevant box) 1 Public Company (Ltd) 2 Private company (Pty) Ltd 3 Closed Corporation (cc) 4 Other (specify) 5 Joint Venture (see terminology page 7) 6 Consortium (see terminology page 7) 7 Sole Proprietor 8 Foreign Company 9 Partnership 10 Trust 11 Section 21 Company 12 Government / Organ of state / Parastatals Main contact person in your company: Name & Surname ID Number Company Position: Cell phone Number: Fax Number: address: Contact person (sales) in your company: Name & Surname ID Number Position in company: Cell Phone Number: Fax Number: address: mark with X, Preferred method of correspondence Fax Telephone. BLACKLISTED Reason: Expiry Date: Page 6 of 24

7 SECTION B: BANKING DETAILS I/We hereby request and authorise you to pay any amounts, which may accrue to me/us to the credit of my/our account with the mentioned bank. I/we understand that the credit transfers hereby authorised will be processed by computer through a system known as "ACB - Electronic Fund Transfer Service", and I/we understand that no additional advice of payment will be provided by my/our bank, but that the details of each be printed on my/our bank statement or any accompanying voucher. (This does not apply where it is not customary for banks to furnish bank statements). I/we understand that the entity will supply a payment advice in the normal way, and that it will indicate the date on which the funds will be made available on my/our account. This authority may be cancelled by me/us by giving thirty days notice by prepaid registered post. Please ensure information is validated as per required. I/We understand that bank details provided should be exactly as per the records held by the bank. I/We understand that the entity will not assume responsibility for any delayed payments, as a result of incorrect information supplied. Company / Personal Details Registered Name Trading Name Tax Number VAT Number Title: Initials: First Name: Surname: Address Detail Payment Address (Compulsory if Supplier) Postal Code New Detail New Supplier information information Update Supplier Supplier Type: Individual Department Partnership Company CC Trust Other (Specify) Page 7 of 24

8 Supplier Account Details (Please note that this account MUST be in the name of the supplier. No 3rd party payments allowed). Account Name Account Number Branch Name Branch Number Account Type Cheque Account Savings Account Transmission Account Bond Account Other (Please Specify) ID Number Passport Number Company Registration Number / / *CC Registration *Please include CC/CK where applicable Practice Number Bank stamp Business Home Fax Cell Address Contact Person: Area Code Area Code Area Code Cell Code Contact Details Telephone Number Telephone Number Cell Number Supplier Signature OFFICE USE ONLY Print Name / / / / Date (dd/mm/yyyy) Date (dd/mm/yyyy) Captured by: Sign: Date: Authorised by: Page 8 of 24

9 SECTION C: COMPANY OWNERSHIP Suppliers are required to submit a certified copy of a BBBEE certificate or the Original BBBEE certificate issued by a SANAS approved BBBEE certification agency or IRBA registered Auditors to be allocated BBBEE points. Suppliers making a total revenue of less than R a year may submit a letter from an accountant or auditor stating the BBBEE status of the supplier. The letter must have the accountant s or auditor s practice number, LIST OF ALL OWNER/S, BOARD MEMBER/S AND SHAREHOLDER/S Title Initials Surname ID No Race Gender (M / F) Disability (Yes / No) % Share Owned Attach shareholders register (copy of register filed at CIPC) documents and shareholder agreements Page 9 of 24

10 LIST OF ALL INDIVIDUALS RESPONSIBLE FOR THE DAILY MANAGEMENT AND BUSINESS DECISIONS Title Initials Surname Race Gender (M / F) Disability Position / Designation Attached separate list of necessary Page 10 of 24

11 SECTION C: LIST OF COMMODITIES Choose a maximum of three (3) categories of goods and / or services you want to be listed under COMMODITY GROUPS AND SUB- COMMODITY GROUPS ADMINISTRATIVE SERVICES Asset Management Services Data Archiving Services Debt Collection Payroll Services Posting and Courier Services ADVERTISING Newspaper Advertising Radio Advertising ARTWORK AND PAINTING BUILDING, CONSTRUCTION AND MAINTENANCE SERVICES Air conditioning installation, maintenance and repair services Blinds and shades Burglar Proofing Carpentry Carpet installation and maintenance Concrete Fencing Dam, Reservoir, Water Towers service, maintenance and repairs Damp proofing Electrical fencing installation, maintenance and repairs Electrical Services Electrical Supplies Excavation Services COMMODITY GROUPS AND SUB- COMMODITY GROUPS Fencing Flooring Specialist General Building construction Glasshouse repairs and maintenance Grounds maintenance services Interior finishing Lifts (installation, commissioning and maintenance) Locksmith Services Marble, stone or tile installation Paint supplies Painting and wall paper Partitioning and Dry walling Plumbing system service, maintenance and repair Plumbing supplies and hardware Roof Services, maintenance and repairs Steel Suppliers Waterproofing BEVERAGES, SNACKS AND LIQOUR Coffee, teabags, sugar, milk Liquor Cooldrinks Snacks (Chips, chocolates, sweets, nuts) CATERING Catering equipment hire and décor Catering Services CLEANING AND LAUNDRY SERVICES Page 11 of 24

12 COMMODITY GROUPS AND SUB- COMMODITY GROUPS COMMODITY GROUPS AND SUB- COMMODITY GROUPS Cleaning chemicals and supplies Educational Institutions Cleaning Equipment Cleaning services COMPUTER SERVICES, HARDWARE AND SOFTWARE Occupational Health and Safety Training Research Services Training Computer cable installation and maintenance EMERGENCY MEDICAL SERVICES AND FIRST AID KITS Computer Equipment and maintenance Computer Network installation and maintenance Data Management Services Information retrieval systems Internet Services Management Information systems MIS EVENT MANAGEMENT Event Management Services Sound and Music System / Equipment hire GENERATORS AND TRANSFORMERS SUPPLY, SERVICES AND MAINTENANCE GLASS AND ALUMINIUM Aluminium Software Glass supplies Software installation, maintenance and support Uninterrupted Power Supply (UPS) supply, maintenance and service CONFERENCE, TRAVEL AND ACCOMMODATION Accommodation Conference and meeting facilities Travel Agency CORPORATE IMAGE Corporate Clothing Corporate Gifts Embroidery Promotional Items EDUCATION AND TRAINING SERVICES HUMAN RESOURCE SERVICES Human Resource and Human Resource Development Consulting Industrial Relations Labour training or development Labour Broking services Personnel Recruitment Temporary personnel services KITCHENWARE AND SUPPLIES Electrical Appliances Kitchen supplies LEGAL SERVICES Civil Litigation Competition Law Contractual Law Page 12 of 24

13 COMMODITY GROUPS AND SUB- COMMODITY GROUPS COMMODITY GROUPS AND SUB- COMMODITY GROUPS Corporate Law Environmental Law Intellectual Property Law Labour Law Printing services (including pamphlets, brochures, annual reports and newsletters) Reproduction services (includes photocopying and binding) Labour Relations Law Signage and accessories Local Government Law PROFESSIONAL SERVICES Patent Rights Architects LIGHTING Attorneys Theatrical lighting equipment Auction services OFFICE EQUIPMENT, ACCESSORIES< SUPPLIES AND MAINTENANCE Audio visual equipment, supply, installation and maintenance Office and desk accessories Office machine maintenance Office machine and their supplies and accessories Purified water and Water Dispensers OFFICE FURNITURE PACKAGING PEST CONTROL AND FUMIGATION SERVICES PHOTOGRAPHIC AND VIDEO SERVICES Civil Engineering Electrical Engineering ERP Services Information Technology consulting services Marketing and Communication services Mechanical Engineering Occupational Health and Safety Services Project Management Strategic Planning consultation / facilitation services PROTECTIVE CLOTHING PUBLICATIONS Books and publications Photographic services Transcribing services Translation services Video services PRINTING AND CREATIVE DESIGN SERVICES Design and layout Layout and design of Corporate publication Newspaper and magazine subscriptions REFRIGERATION AND COLD ROOMS Refrigeration and cold room supplies Page 13 of 24

14 COMMODITY GROUPS AND SUB- COMMODITY GROUPS COMMODITY GROUPS AND SUB- COMMODITY GROUPS Refrigeration and cold room service, maintenance and repairs Telecommunication supply and maintenance SAFETY EQUIPMENT TRAINING Safety equipment supplies Financial Management Training Safety equipment service, maintenance and repairs SECURITY AND SURVEILLANCE SERVICES Access Control Armed Response Services Building Monitoring Services Cash-in-transit services Guard Services Locks and security hardware and accessories IT Training Other Training TRANSPORTATION Furniture removal Logistics services Transport services VEHICLE HIRE Chartered bus services Shuttle services Vehicle leasing Security system services Vehicle rental Surveillance, monitoring and detection equipment Vehicle Tracking equipment and services STATIONERY AND COMPUTER CONSUMABLES Stationery Computer Consumables TELECOMMUNICATIONS Analogue telephones Answering services Trailer hire VEHICLE SUPPLY, MAINTENANCE AND REPAIRS Panel beating Vehicle service, maintenance and repairs Vehicle tyres Vehicle spares Vehicle fitment centres Trailer supply, service, maintenance and repairs Cell Routers OTHER Digital enhanced cordless telecommunication DECT cordless phones Digital telephones Mobile phones Telecommunication maintenance Page 14 of 24

15 I/we the undersigned acknowledge(s) that: The information furnished is true and correct The Equity Ownership claimed is in accordance with Shareholder Register lodged at CIPC Any conflict of interest will be declared in the comment space below Payment of invoices will be made by SAST within 30 days of receipt of invoice SIGNATURE OF OWNER OR AUTHORISED REPRESENTATIVE DATE SIGNATURE OF OWNER OR AUTHORISED REPRESENTATIVE DATE SIGNATURE OF OWNER OR AUTHORISED REPRESENTATIVE DATE SIGNATURE OF OWNER OR AUTHORISED REPRESENTATIVE DATE Page 15 of 24

16 SBD 4 DECLARATION OF INTEREST 1. Any legal person, including persons employed by the state¹, or persons having a kinship with persons employed by the state, including a blood relationship, may make an offer or offers in terms of this invitation to bid (includes a price quotation, advertised competitive bid, limited bid or proposal). In view of possible allegations of favouritism, should the resulting bid, or part thereof, be awarded to persons employed by the state, or to persons connected with or related to them, it is required that the bidder or his/her authorised representative declare his/her position in relation to the evaluating/adjudicating authority where- - the bidder is employed by the state; and/or - the legal person on whose behalf the bidding document is signed, has a relationship with persons/a person who are/is involved in the evaluation and or adjudication of the bid(s), or where it is known that such a relationship exists between the person or persons for or on whose behalf the declarant acts and persons who are involved with the evaluation and or adjudication of the bid. 2. In order to give effect to the above, the following questionnaire must be completed and submitted with the bid. 2.1 Full Name of bidder or his or her representative:. 2.2 Identity Number: 2.3 Position occupied in the Company (director, trustee, shareholder²): Company Registration Number: Tax Reference Number:. 2.6 VAT Registration Number: The names of all directors / trustees / shareholders / members, their individual identity numbers, tax reference numbers and, if applicable, employee / persal numbers must be indicated in paragraph 3 below. ¹ State means (a) 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); (b) any municipality or municipal entity; (c) provincial legislature; Page 16 of 24

17 (d) national Assembly or the national Council of provinces; or (e) Parliament. ² Shareholder means a person who owns shares in the company and is actively involved in the management of the enterprise or business and exercises control over the enterprise. 2.7 Are you or any person connected with the bidder YES / NO presently employed by the state? If so, furnish the following particulars: Name of person / director / trustee / shareholder/ member: Name of state institution at which you or the person connected to the bidder is employed : Position occupied in the state institution: Any other particulars: If you are presently employed by the state, did you obtain YES / NO the appropriate authority to undertake remunerative work outside employment in the public sector? If yes, did you attached proof of such authority to the bid YES / NO document? (Note: Failure to submit proof of such authority, where applicable, may result in the disqualification of the bid If no, furnish reasons for non-submission of such proof: Page 17 of 24

18 Did you or your spouse, or any of the company s directors / YES / NO trustees / shareholders / members or their spouses conduct business with the state in the previous twelve months? If so, furnish particulars: Do you, or any person connected with the bidder, have YES / NO any relationship (family, friend, other) with a person employed by the state and who may be involved with the evaluation and or adjudication of this bid? 2.9.1If so, furnish particulars Are you, or any person connected with the bidder, YES/NO aware of any relationship (family, friend, other) between any other bidder and any person employed by the state who may be involved with the evaluation and or adjudication of this bid? If so, furnish particulars. Page 18 of 24

19 2.11 Do you or any of the directors / trustees / shareholders / members YES/NO of the company have any interest in any other related companies whether or not they are bidding for this contract? If so, furnish particulars:... Page 19 of 24

20 3 Full details of directors / trustees / members / shareholders. Full Name Identity Number Personal Tax Reference Number State Employee Number / Persal Number 4 DECLARATION I, THE UNDERSIGNED (NAME) CERTIFY THAT THE INFORMATION FURNISHED IN PARAGRAPHS 2 and 3 ABOVE IS CORRECT. I ACCEPT THAT THE STATE MAY REJECT THE BID OR ACT AGAINST ME IN TERMS OF PARAGRAPH 23 OF THE GENERAL CONDITIONS OF Page 20 of 24

21 CONTRACT SHOULD THIS DECLARATION PROVE TO BE FALSE... Signature.. Date. Position Name of bidder Page 21 of 24

22 SBD 9 CERTIFICATE OF INDEPENDENT BID DETERMINATION I, the undersigned, in submitting the accompanying bid: (Bid Number and Description) in response to the invitation for the bid made by: (Name of Institution) do hereby make the following statements that I certify to be true and complete in every respect: I certify, on behalf of: that: (Name of Bidder) 1. I have read and I understand the contents of this Certificate; 2. I understand that the accompanying bid will be disqualified if this Certificate is found not to be true and complete in every respect; 3. I am authorized by the bidder to sign this Certificate, and to submit the accompanying bid, on behalf of the bidder; 4. Each person whose signature appears on the accompanying bid has been authorized by the bidder to determine the terms of, and to sign the bid, on behalf of the bidder; 5. For the purposes of this Certificate and the accompanying bid, I understand that the word competitor shall include any individual or organization, other than the bidder, whether or not affiliated with the bidder, who: Page 22 of 24

23 (a) (b) (c) has been requested to submit a bid in response to this bid invitation; could potentially submit a bid in response to this bid invitation, based on their qualifications, abilities or experience; and provides the same goods and services as the bidder and/or is in the same line of business as the bidder 6. The bidder has arrived at the accompanying bid independently from, and without consultation, communication, agreement or arrangement with any competitor. However communication between partners in a joint venture or consortium³ will not be construed as collusive bidding. 7. In particular, without limiting the generality of paragraphs 6 above, there has been no consultation, communication, agreement or arrangement with any competitor regarding: (a) prices; (b) geographical area where product or service will be rendered (market allocation) (c) methods, factors or formulas used to calculate prices; (d) the intention or decision to submit or not to submit, a bid; (e) the submission of a bid which does not meet the specifications and conditions of the bid; or (f) bidding with the intention not to win the bid. 8. In addition, there have been no consultations, communications, agreements or arrangements with any competitor regarding the quality, quantity, specifications and conditions or delivery particulars of the products or services to which this bid invitation relates. 9. The terms of the accompanying bid have not been, and will not be, disclosed by the bidder, directly or indirectly, to any competitor, prior to the date and time of the official bid opening or of the awarding of the contract. ³ Joint venture or Consortium means an association of persons for the purpose of combining their expertise, property, capital, efforts, skill and knowledge in an activity for the execution of a contract. Page 23 of 24

24 10. I am aware that, in addition and without prejudice to any other remedy provided to combat any restrictive practices related to bids and contracts, bids that are suspicious will be reported to the Competition Commission for investigation and possible imposition of administrative penalties in terms of section 59 of the Competition Act No 89 of 1998 and or may be reported to the National Prosecuting Authority (NPA) for criminal investigation and or may be restricted from conducting business with the public sector for a period not exceeding ten (10) years in terms of the Prevention and Combating of Corrupt Activities Act No 12 of 2004 or any other applicable legislation. Signature Date. Position Name of Bidder Page 24 of 24