Potatoes South Africa NPC Supplier Database Registration 2016-2017 PLEASE KEEP COPIES OF THIS REGISTRATION FORM AND ALL DOCUMENTATION SUBMITTED FOR YOUR RECORDS. Supplier no: (for office use only) Company Name Company Registration number VAT Registration number B-BBEE status level Contact addresses Postal Address Street Address Postal Code Postal Code 1. Potatoes South Africa NPC Contact Information Any enquiries regarding this request for Supplier Database Registration must be directed to: Head of the Project: Monique van der Merwe Email: serviceproviders@potatoes.co.za Telephone number: 012 349 1906 Fax number: 086 685 0594 1
2. Compulsory documents The following documents must be submitted as part of the Supplier Database Registration response: (Confirm in Yes and No columns whether documents are included or not) Documents YES NO Completed Supplier Database Registration form *SARS Original Tax Clearance certificate *Certified B-BBEE certificate *SBD 4 Declaration of Interest *SBD 8 Declaration of Bidder s Past Supply Chain Management Practices Company Registration forms Company Profile Bank details Documents marked with an * are non-negotiable and certificates must be valid certificates. Failure to comply with this requirement will lead to not being listed on Potato South Africa NPC s supplier database. 3. Supplier Information SALES CONTACT: CONTACT PERSON: TELEPHONE NUMBER: FAX NUMBER: E-MAIL ADDRESS: ACCOUNT CONTACT PERSON: CONTACT PERSON: TELEPHONE NUMBER: FAX NUMBER: E-MAIL ADDRESS: BANK DETAILS: NAME OF BANK: BRANCH CODE: ACCOUNT NAME: ACCOUNT NUMBER: SIGNITURE OF PUBLIC OFFICER: NAME OF PUBLIC OFFICER: 4. General information a. Our role Potatoes South Africa is an association incorporated under the South African Companies Act No 71 of 2008 that is funded through statutory levies whose main objective is to serve, protect and promote the interests of the South African potato industry. 2
In terms of its role in the potato industry, Potatoes South Africa operates as an organization and its structure represents a network of participating role players and individuals who have the development and competitiveness of the industry at heart. Potatoes South Africa s primary interest is therefore to build a viable South African potato industry through: the gathering, processing and compiling of relevant information and market statistics, the timely dissemination thereof as well as rendering an extension service to producers; the management of basic as well as applied research, including cultivar development and evaluation, and the timely dissemination of all relevant technical information; the development and implementation of a marketing plan to promote the consumption of potatoes in the Republic of South Africa and abroad; and assisting in transformation by developing emerging farmers with the objective of them becoming commercial potato farmers as well as creating market access for these farmers. b. The core businesses of Potatoes South Africa are: Management of an industry information system. Management of research, including the potato-breeding program. Management of a market development and generic product promotion program. Transformation. Provision of industry services. Provision of support services: Finance, Corporate Communication and Human Resource 5. Purpose of this Supplier Database Registration The purpose of this Supplier Database Registration is to comply with the Supply Chain Management Policy of Potatoes South Africa NPC. This Supplier Database Registration form does not constitute an offer to do business with Potato South Africa NPC, but merely serves as an invitation to Respondents to facilitate a requirements-based Supply Chain Procurement process. 6. Instructions to Respondents Supplier Database Registration forms must either be submitted electronically via email to serviceproviders@potatoes.co.za or in a sealed envelope marked: Database Registration: 2016-2017 Supplier Database Registration forms must be submitted to Potato South Africa NPC, Potato House, 6 De Havilland Crescent, Persequor Technopark, Persequor Park, Pretoria. All Supplier Database Registration forms must be submitted in English. Respondents should only use block letters for the completion of the Supplier Database Registration forms. CLEARLY INDICATE FOR WHAT TYPE OF GOODS OR SERVICES YOU ARE REGISTERING FOR. All Supplier Database Registration must be signed by a properly authorized person. 3
In the event that modifications, clarifications or additions to the Supplier Database Registration forms become necessary, all Respondents will be notified and receive, in writing, an addendum to the Supplier Database Registration forms. All costs incurred in responding to the Supplier Database Registration shall be for the account of the Respondent. All supporting documentation and manuals submitted with the Supplier Database Registration will become Potato South Africa NPC s property. 7. Services to be rendered Please indicate for which services you are registering for by clearly ticking the appropriate box or boxes: Finance and other Stationary Auditing services Internal Audit of Companies Telephone Systems (Man 3000) IT services IT supplies (Hardware & Software) Furniture and Office Equipment supplies Agricultural investigation services Cell phone contracts Photocopier supplies Legal services (Contracts) Legal services (Debtor collection) Human Resource services (Post grading) Human Resource services (Labour issues) Human Resource services (Legislation issues) Human Resource services (Policy and Conditions of service) Internet services Information services Economic and Agricultural economic studies/analysis Economic and Agricultural economic information services Marketing Consumer intelligence: Research and analysis to determine * Consumer buyer behavior * Consumer health and lifestyle trends * Nutritional information Market Intelligence: Collection of Research and analysis of: Formal Retail Information Independent Retail Information National Fresh Produce Markets Information Informal Traders Information MARK WITH 4
Processing Information Import Information Export Information Foreign Markets Consumer and Trade Education: Recipe development: Development and testing of novel potato rich recipes including professional photography (ingredients, method preparation, food styling, presentation, etc.) Services of a Registered Dietician/Nutritionist who is pro potatoes and has acute knowledge on potato nutritional value, potato nutritional trends, and general nutritional hot topics (PS: Must be able to write nutritional articles for publishing in media, website and occasionally carry out interviews. Development of promotional material Generic Product Promotions: Public & Media Relations: Seeking the services of a PR specialist who knows how to communicate with targeted audiences directly or indirectly through media with the aim to create and maintain a positive image and create a strong relationship with the audience. The specialist must, in addition be able to develop news worthy content, execute PR stunts and media drops in a fashion that will generate media exposure and publicity for potatoes and PSA. Personal marketing events, e.g. Good food & wine show manage and coordinate all aspects of partaking in relevant events and exhibition, e.g. get stand space, stand design, stand build-up and breakdown, collateral and promoters. Sales promotions: Manage all aspects of conceptualizing top of mind in-store activations and coordinating the promotion from start to finish Informal sector promotions: identify opportunities for promoting potatoes in the informal sector, including promotion conceptualization, management and coordination. Direct Marketing: Fully manage PSA s social media platforms, generate content, design content, engage and generate talkabality across all platforms. University Program: Universities interested in collaborating with PSA through their faculties of Marketing Management, Food & Nutrition, & Consumer Psychology can forward their notice of interest and proposal to PSA via e-mail. Trade & Industry relations Market Access - Foreign Market Development: Export Consumer intelligence: Research and analysis to determine buyer behavior and health and lifestyle trends in current and potential export markets. Export Market Intelligence: Collection of; Research and analysis of the trade environment in current and potential export markets. Research Cultivar evaluation: On farm evaluation of potato cultivars in all production regions, as well as evaluation of potato cultivars for tolerance or resistance to pests and diseases Conservation practices and soil health: Long term, on farm, multi-disciplinary research to develop cultivation practices that will lead to improved soil health and sustainable production. Water usage and quality: Research and technology transfer towards efficient water use and preservation of water quality. 5
Crop rotation: Long term, on farm, multi-disciplinary research on the effect of different crop rotation approaches on soil quality, soil health and sustainable production Quality of seed and ware potatoes: Research to improve internal and external potato quality to improve user satisfaction Plant nutrition: Research to increase efficiency in potato plant nutrition Cultivation practices: Agronomic research on different husbandry methods to optimize potato yield and quality in different production regions Virus diseases: Identification of plant viruses Foliage diseases: early and late blight, botrytis, etc. Identification and research to develop management strategies Potato insect pests: Identification and research to manage potato pests Plant aphid monitoring: Long term monitoring of plant aphids, identification of aphid species, maintenance of database and distribution of information. Soil-borne diseases: common scab, powdery scab, soft rot-black leg complex, silver scurf and black dot, verticillium, fusarium, black scurf & bacterial wilt: Identification of fungal and bacterial pathogens, research on various strategies to manage soil-borne diseases Root-knot nematode: Identification and research on management of plant nematodes. Consultants in specific fields of expertise: Compilation of comprehensive research reports, reviews, etc. Service provider experienced in report writing to integrate background information, various reports, publications, etc in order to give an overview of research done over a period of time. Additional service providers needed on an ad hoc basis Editorial and translation services Design and lay-out of documents Photography Conference coordinators Catering services Diagnostic services at professional laboratories (disease diagnostics, chemical analysis, etc.) Communications Corporate Branding Corporate branding, including but not limited to embroidery, printing, embossing, engraving etc.: Clothing Gifts DVD and Video production Electronic Distribution of information, e.g. newsletter, newsflash etc. Corporate Events Facilitation, including but not limited to employee wellness program, strategic planning, team building, etc. Publications, including but not limited to graphic design, printing, editing, postage, etc.: CHIPS magazine Industry Report Brochures/guides/booklets, etc. Calendar Stationery IT services: comprehensive advisory MARK WITH 6
Legal services: advisory, contracts, governance, disclaimers, etc. Media services: monitoring, analyses, media releases, etc. Photography: studio/on site country-wide Editing and Translation services: documents & audio Afrikaans/English/African languages Voice recording Website: design, hosting, etc. 7
8. 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 to supply services to Potatoes South Africa in terms of this invitation to register as supplier on the supplier database. In view of possible allegations of favouritism, should a supplier (s) be selected who are employed by the state, or who are connected with or related to them, it is required that the supplier or his/her authorised representative declare his/her position in relation to the evaluating/adjudicating authority where 1.1. the supplier is employed by the state; and/or 1.2. the legal person on whose behalf the supplier registration document is signed, has a relationship with persons/a person who are/is involved in the evaluation and or adjudication of the suppliers 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 suppliers. 2. In order to give effect to the above, the following questionnaire must be completed and submitted with the supplier database registration form. 2.1. Full Name of supplier or his or her representative:. 2.2. Identity Number:.. 2.3. Position occupied in the Company (director, trustee, shareholder²):. 2.4. Company Registration Number:.... 2.5. Tax Reference Number:... 2.6. VAT Registration Number:... 2.6.1. The names of all directors / trustees / shareholders / members, their individual identity numbers, tax reference numbers and, if applicable, employee / personnel 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; (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. 8
2.7. Are you or any person connected with the supplier YES / NO presently employed by Potatoes South Africa NPC? 2.7.1. If so, furnish the following particulars: Name of person / director / trustee / shareholder/ member:.... Name of department in Potatoes South Africa NPC at which you or the person connected to the supplier is employed:.. Position occupied in the Potatoes South Africa NPC: Any other particulars: 2.7.2. If you are presently employed by YES /NO /NA Potatoes South Africa NPC, did you obtain the appropriate authority to undertake remunerative work outside employment in the public sector? 2.7.2.1. If yes, did you attached proof of such authority YES /NO /NA to the bid document? (Note: Failure to submit proof of such authority, where applicable, may result in the disqualification of the bid) 2.7.2.2. If no, furnish reasons for non-submission of such proof:... 2.8. Did you or your spouse, or any of the company s directors / YES / NO trustees / shareholders / members or their spouses conduct business with Potatoes South Africa NPC in the previous twelve months? 2.8.1. If so, furnish particulars:........ 9
2.9. Do you, or any person connected with the supplier, have YES / NO any relationship (family, friend, other) with a person employed by Potatoes South Africa NPC and who may be involved with the evaluation and or adjudication of the suppliers? 2.9.1. If so, furnish particulars.......... 2.10. Are you, or any person connected with the supplier/s, YES / NO aware of any relationship (family, friend, other) between any other supplier/s and any person employed by Potatoes South Africa NPC who may be involved with the supplier database registration process? 2.10.1. If so, furnish particulars. 2.11. Do you or any of the directors / trustees / shareholders / members of the company have any interest in any other related companies whether or not they are registering on the supplier database? YES / NO 2.11.1. If so, furnish particulars:... 3. Full details of directors / trustees / members / shareholders. Full Name Identity Number Personal Tax Reference Number PSA Employee Number / Persal Number 10
4. DECLARATION I, THE UNDERSIGNED (NAME):.. CERTIFY THAT THE INFORMATION FURNISHED IN PARAGRAPHS 2 and 3 ABOVE IS CORRECT. I ACCEPT THAT POTATOES SOUTH AFRICA MAY REJECT THE OFFER TO SUPPLY SERVICES OR ACT AGAINST ME SHOULD THIS DECLARATION PROVE TO BE FALSE... Signature. Position.. Date Name of supplier 11
9. SBD 8 Declaration of Suppliers s Past Supply Chain Management Practices 1 This document serves as a declaration to be used by institutions in ensuring that when goods and services are being procured, all reasonable steps are taken to combat the abuse of the supply chain management system. 2 The supplier may be disregarded if that supplier, or any of its directors havea. abused the institution s supply chain management system; b. committed fraud or any other improper conduct in relation to such system; or c. failed to perform on any previous contract. 3 In order to give effect to the above, the following questionnaire must be completed and submitted with the supplier registration form. Item Question Yes No 4.1 Is the supplier or any of its directors listed on the National Treasury s Database of Yes No Restricted Suppliers as companies or persons prohibited from doing business with the public sector? (Companies or persons who are listed on this Database were informed in writing of this restriction by the Accounting Officer/Authority of the institution that imposed the restriction after the audi alteram partem rule was applied). The Database of Restricted Suppliers now resides on the National Treasury s website (www.treasury.gov.za) and can be accessed by clicking on its link at the bottom of the home page. 4.1.1 If so, furnish particulars: 4.2 Is the supplier or any of its directors listed on the Register for Tender Defaulters in terms of section 29 of the Prevention and Combating of Corrupt Activities Act (No 12 of 2004)? The Register for Tender Defaulters can be accessed on the National Treasury s website (www.treasury.gov.za) by clicking on its link at the bottom of the home page. 4.2.1 If so, furnish particulars: Yes No 4.3 Was the supplier or any of its directors convicted by a court of law (including a court outside of the Republic of South Africa) for fraud or corruption during the past five years? 4.3.1 If so, furnish particulars: Yes No 4.4 Was any contract between the supplier and any organ of state terminated during the past five years on account of failure to perform on or comply with the contract? 4.4.1 If so, furnish particulars: Yes No 12
CERTIFICATION I, THE UNDERSIGNED (FULL NAME) CERTIFY THAT THE INFORMATION FURNISHED ON THIS DECLARATION FORM IS TRUE AND CORRECT. I ACCEPT THAT, IN ADDITION TO CANCELLATION OF A CONTRACT, ACTION MAY BE TAKEN AGAINST ME SHOULD THIS DECLARATION PROVE TO BE FALSE.... Signature.. Date. Position.. Name of Bidder 13