SUPPLIER DATABASE REGISTRATION
NAME OF SERVICE PROVIDER: _________________________________
(To be completed by supplier)
FOR OFFICIAL PURPOSES Verified By: Verified by: ________________ Signature: ________________ Persal No: ______________ Date: ______________
Captured By: Captured by: ________________ Signature: ________________ Persal No: ______________ Date: ______________
Entity Maintenance No: Captured by: ________________ Signature: ________________ Persal No: ______________ Date: ______________
APPLICATION ACCEPTED
APPLICATION REJECTED
DoJ & CD Supplier Number
SUPPLIER DATABASE REGISTRATION
The Department of Justice and Constitutional Development (DoJ&CD) is an outwardly focused, customer-centred government department mandated to uphold and protect the Constitution and Rule of Law in the interest of a safer and more secure South Africa. DoJ & CD, pursuant to the provisions of the Public Finance Management Act (PFMA), Act 1 of 1999) read with DoJ&CD Supply Chain Management Policy invites service providers to register on DoJ&CD’s database of suppliers/services as official vendors and suppliers for the 2012 to 2013 Financial Year. Suppliers and service providers currently registered as vendors on the DoJ&CD database should also re-apply for considerations to be re-registered on the DoJ&CD vendor/supplier database. A list of commodities requirements are enlisted in the supplier database application form. Prospective suppliers/service providers may apply to be enlisted on the supplier database for a maximum of five (5) commodities specific as per their principle business, other than those suppliers on SITA transversal contracts. Failure to comply with this condition will invalidate the applications and would not be evaluated further. Supplier Database registration forms are obtainable from: Website: www.justice.gov.za Physical Address: Momentum Centre Postal address: Private Bag X81 329 Pretorius Street Pretoria Pretoria 0001 0001
Enquiries should be forwarded to:
Tel No: N.Skosana J. Mokgothu B. Mokhutle K. Masilo 012 357 8583 012 315 1682 012 315 1546 012 357 8198 E-mail Address nskosana@justice.gov.za jmokgothu@justice.gov.za bmokhutle@justice.gov.za kmasilo@justice.gov.za Fax No. 086 640 3113 086 641 3835 086 678 2168 086 642 3759
Closing date: 30 November 2012 at 11:00 Completed registration forms must be hand delivered or posted to the above mentioned postal address on or before closing date and time for attention: The Director: Supply Chain Management (DoJ & CD).
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SUPPLIER REGISTRATION FORM
IMPORTANT NOTES Please read carefully before completion of registration form To be completed by all vendors seeking registration as an approved supplier; The supplier registration form must be completed in full and be signed, and forwarded to the National Department of Justice and Constitutional Development at Pretoria with all supporting documentation; A company profile must accompany the registration form but will not be accepted as substitute for the application form – all fields on application form MUST be completed by applicant; Successful applicants will be contacted via fax and/or email and must therefore submit an operating fax number and/or email address; failure to comply will result in excluding the supplier from the database; Only successful suppliers will be notified in writing on their application been accepted;
Information Checklist
Telephone / Cell number as contact Physical address and Postal address Fax number or E-mail address Valid and Original SARS Tax Clearance Certificate Original or certified copy of B-BBEE certificate Original latest Bank Statement or Bank Letter with a bank stamp Company / CC Registration Certificate (Issued by CIPRO). Certified copy of identity documents (ID) of all shareholders/members/Directors or sole traders Latest entity’s original or certified water /electricity Utility bill A Business profile of not more than five (5) pages Commodity listed only five (5) may be selected Location where goods and/or services may be required Fill all forms completely Sign all forms
Submitted Yes No
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1. SUPPLIER DETAILS (All fields are mandatory) Company Details: Legal Name: Trading Name: Registration Number: VAT Number: Income Tax Number: Company Contacts: Telephone Number: Fax Number: E‐mail Address: Website Address Postal Address: Physical Address: Main contact: Name: Surname: Position: Telephone Number: Facsimile Number: Cellular Number: E‐mail Address:
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2. SUPPLIER GROUPING DETAILS: (Please mark with an X the relevant box) 1. Public Company (LTD) 7. Foreign Company 2. Private Company (PTY) LTD 8. Joint Venture / Consortium 3. Closed Corporation (CC) 9. Section 21 Company 4. Sole Proprietor 10. Government / Parastatals 5. Partnership 11. Co‐operative 6. Trust 11. Other (Please specify) 3. BROAD‐BASED BLACK ECONOMIC EMPOWERMENT (B‐BBEE) VENDOR PROFILE List all partners / owners and shareholders (Compulsory) Name and Surname Position Citizenship ID Number Note: Where owners are themselves a company or partners, owners of the holding firm must be identified. Certified ID copies of partners, members, shareholders or owners must be attached. BROAD‐BASED BLACK ECONOMIC EMPOWERMENT (B‐BBEE) INFORMATION Please mark your B‐BBEE credentials with an (X)
B‐BBEE Recognition Level % Mark with an (X) Level 1 Contributor 135% Level 2 Contributor 125% Level 3 Contributor 110% Level 4 Contributor 100% Level 5 Contributor 80% Level 6 Contributor 60% Level 7 Contributor 50% Level 8 Contributor 10% Non‐Compliant Contributor 0% Exempted Micro‐Enterprise(EME) Any enterprise with an annual total Revenue of R5 million or less qualifies as an Exempted Micro‐ Enterprise (EME). A start‐up enterprise must be measured as an Exempted Micro‐Enterprise for the first year following its formation or incorporation. I/ We confirm that the information provided is correct as at this date: Name and Surname Signature Position Date
B‐BBEE Status
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4. DECLARATION
Verification of information supplied in this document, including attached documents: I/We, the undersigned, warrant that he / she is duly authorised to do so on behalf of the supplier, certifies that the information supplied including the annexure, is correct and accurate and acknowledge that: If I found that the information supplied is incorrect the Department of Justice and Constitutional Development will disqualify and remove the supplier from our database permanently.
TERMS AND CONDITIONS The Department of Justice and Constitutional Development cannot guarantee business opportunities. All procurement will be subject to the departmental SCM policy, the general conditions of contract, and applicable legislation. All suppliers will be subjected to regular performance service review and could be deregistered if service levels are not maintained. The validity period of a quotation must be at least 30 ( thirty) days Certified documents: Please ensure that The Commissioner of Oath has certified your company registration documents, Identity Documents and other copies. Verification of information supplied will perform against third party source such as SARS, CIPRO or CIPC, Safety net, etc. Please notify the Department immediately of any change to the provided information. Please ensure all fields are completed. Incomplete application forms will not be processed.
Supplier Name: ____________________________________________________________
________________________________________ Signature of Authorised Representative
__________________________ Signatory Name in Print
________________________________________ Signatory Position:
__________________________ Signatory ID Number:
Signed at __________________________ on this ____ day of________________ 20_____
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Regional Office Only
Region: Reference Number: Contact person: Contact Telephone number:
6. SUPPLIER MAINTENANCE FORM:
Contact Fax number:
Head Office Only
BAS JYP PERSAL
Captured By: Date Captured: Authorized By: Date Authorized: Supplier code: SUPPLIER NO
PLEASE WRITE IN BLOCK LETTERS
I/We hereby request and authorize 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 authorized will be processed by computer through a system known as "ACB - Electronic Fund Transfer Service", and I/we understand that not additional advice of payment will be provided by my/our bank, but that the details of each payment will 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 Department 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 30 days notice by prepaid registered post. Please ensure that the information is validated as per required bank screens I/We understand that bank details provided should be exactly as per the records held by the bank. I/We understand that the Department 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:
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Address Detail Postal Address
( Compulsory if Supplier )
Postal Code New Detail New Supplier information Update Supplier information
Supplier Type:
Individual Company CC
Department Trust Other ( Specify )
Partnership
Department Number 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
Cheque Account Savings Account Transmission Account Bond Account Other (Please Specify)
Account Type
ID Number
IF SPOUSE ACC HOLDER
Passport Number
Company Registration Number *CC Registration
/
/
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*Please include CC/CK where applicable
Practise Number
Bank stamp PLEASE ATTACHED A PRINTOUT FROM THE BANK
It is hereby confirmed that this details have been verified against the following screens:
ABSA-CIF screen FNB-Hogans system on the CIS4
PLEASE PROVIDE BANK STAMP PLUS SIGNITURE OF OFFICIAL
STD Bank-Look-up-screen Nedbank- Banking Platform under Client Details Tab
Contact Details Business Area Code Home Area Code Fax Area Code Cell Cell Code Email Address Contact Person: Extension Extension
Supplier Signature
Print Name
/
Date (dd/mm/yyyy)
/
NB: All relevant fields must be completed
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6. LOCATION WHERE GOODS AND/OR SERVICES MAY BE REQUIRED PROSPECTIVE SERVICE PROVIDERS MUST INDICATE BY MEANS OF AN X WHERE GOODS AND SERVICE CAN BE PROVIDED BASED ON THE LOCATION OF THEIR ENTITY. FAILING TO COMPLY WITH THIS CONDITION WILL INVALIDATE THE PROSPECTIVE SUPPLIERS APPLICATION.
Eastern Cape
Location Mark with X Location Mark with X
Aberdeen Adelaide Albany Albert Alexandria Aliwal North Barkly East Bathurst Bedford Bizana Butterworth Cathcart Cradock East London Elliot Elliotdale Engcobo Flagstaff Fort Beaufort Glen Grey Graaff-Reinet Hankey Herschel Hewu Hofmeyr Humansdorp Idutywa Indwe Jansenville Joubertina Keiskammahoek Kentani King William’s Town Kirkwood Komga Lady Grey Libode Lusikisiki Maclear
Matatiele Mdantsane Middelburg Middledrift Molteno Mount Ayliff Mount Fletcher Mount Frere Mpofu (Stockenström) Mqanduli Ngqeleni Nqamakwe Ntabathemba Pearston Peddie Port Elizabeth Port St Johns (Umzimvubu) Queenstown Qumbu Somerset East St Marks Sterkstroom Steynsburg Steytlerville Stutterheim Tabankulu Tarka Tsolo Tsomo Uitenhage Umtata Umzimkulu Venterstad Victoria East Willowmore Willowvale (Gatyana) Wodehouse Xalanga (Cala) Zwelitsha
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6. LOCATION WHERE GOODS AND/OR SERVICES MAY BE REQUIRED PROSPECTIVE SERVICE PROVIDERS MUST INDICATE BY MEANS OF AN X WHERE GOODS AND SERVICE CAN BE PROVIDED BASED ON THE LOCATION OF THEIR ENTITY. FAILING TO COMPLY WITH THIS CONDITION WILL INVALIDATE THE PROSPECTIVE SUPPLIERS APPLICATION.
Free State
Location Mark with X Location Mark with X
Bethlehem Bethulie Bloemfontein Boshof Bothaville Botshabelo Brandfort Bultfontein Clocolan Dealesville Dewetsdorp Edenburg Edenville Excelsior Fauresmith Ficksburg Fouriesburg Frankfort Harrismith Heilbron Hennenman Hertzogville Hobhouse Hoopstad Jacobsdal Jagersfontein Kestell Koffiefontein Koppies Kroonstad Ladybrand Lindley
Marquard
Memel Odendaalsrus Parys Paul Roux Petrusburg Petrus Steyn Philippolis Reddersburg Reitz Rouxville Sasolburg Senekal Smithfield Springfontein Steynsrus Thaba ’Nchu Theunissen Trompsburg Ventersburg Viljoenskroon Villiers Virginia Vrede Vredefort Warden Welkom Wepener Wesselsbron Winburg Witsieshoek Zastron
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6. LOCATION WHERE GOODS AND/OR SERVICES MAY BE REQUIRED PROSPECTIVE SERVICE PROVIDERS MUST INDICATE BY MEANS OF AN X WHERE GOODS AND SERVICE CAN BE PROVIDED BASED ON THE LOCATION OF THEIR ENTITY. FAILING TO COMPLY WITH THIS CONDITION WILL INVALIDATE THE PROSPECTIVE SUPPLIERS APPLICATION.
Gauteng
Location Mark with X Location Mark with X
Alberton Benoni Daveyton Boksburg Brakpan Bronkhorstspruit Cullinan Germiston Heidelberg Johannesburg Regional Office Kempton Park Tembisa Krugersdorp Meyerton Nigel Oberholzer Pretoria ( Include Supply to the National Office) Atteridgeville Pretoria North Mamelodi Randburg Randfontein Roodepoort Soshanguve Springs Vanderbijlpark Sebokeng Vereeniging Westonaria
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6. LOCATION WHERE GOODS AND/OR SERVICES MAY BE REQUIRED PROSPECTIVE SERVICE PROVIDERS MUST INDICATE BY MEANS OF AN X WHERE GOODS AND SERVICE CAN BE PROVIDED BASED ON THE LOCATION OF THEIR ENTITY. FAILING TO COMPLY WITH THIS CONDITION WILL INVALIDATE THE PROSPECTIVE SUPPLIERS APPLICATION.
Kwazulu Natal
Location Mark with X Location Mark with X
Babanango Bergville Camperdown Chatsworth Colenso Dannhauser Dukuza Dundee Durban Emlazi Ekuvukeni Empangeni Emzumbe Enseleni Eshowe Estcourt Emnabithi Glencoe Greytown Harding Himeville Hlabisa Hlanganani Howick Impendle Ingwavuma Inkanyezi Ixopo Izingolweni Kokstad Kranskop Kwamsane Ladysmith Louwsburg Madadeni Magudu Mahlabatini
Manguzi Maphumulo Matatiele Melmoth Mooiriver Mpumalanga Msinga Mtubatuba Mtunzini Ndwedwe New hanover Newcastle Nkandla Nongoma Nqutu Ntuzuma Ongoye Paulpietersburg Phungashe Pietermaritzburg Pinetown Pongola Port shepstone Richmond Scottburgh Simdlagentsha Stanger State attorney Ubombo Umbumbulu Umzimkhulu Utrecht Verulam Vryheid Vulamehlo Weenen
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6. LOCATION WHERE GOODS AND/OR SERVICES MAY BE REQUIRED PROSPECTIVE SERVICE PROVIDERS MUST INDICATE BY MEANS OF AN X WHERE GOODS AND SERVICE CAN BE PROVIDED BASED ON THE LOCATION OF THEIR ENTITY. FAILING TO COMPLY WITH THIS CONDITION WILL INVALIDATE THE PROSPECTIVE SUPPLIERS APPLICATION.
Limpopo
Location Mark with X Location Mark with X
Bochum Bolobedu Dzanani Ellisras Giyani Hlanganani Letaba Lulekani Malamulele Mankweng Mapulaneng Messina Mhala Mokerong Mutale Namakgale Naphuno Nebo Phalaborwa
Location
Mark with X
Phalala Polokwane Pietersburg Potgietersrus Praktiseer Ritavi Sekgosese Sekhukhuneland Seshego Soutpansberg Thabamoopo Thabazimbi Thohoyandou Tshilwavhusiku Tshitale Vuwani Warmbaths Waterberg Tshitale
Location
Mark with X
Mpumalanga
Amsterdam Amersfoort Balfour Barberton Belfast Bethal Breyten Carolina Delmas Eerstehoek Ekangala Ermelo Evander Graskop Groblersdal Hendrina Kriel KwaMhlanga Lydenburg Mbibana Mdutjana Middelburg Mkobola Morgenzon Moutse Nelspruit Nkomazi Nsikazi Piet Retief Sabie Standerton Volksrust Wakkerstroom Waterval Boven White River Witbank
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6. LOCATION WHERE GOODS AND/OR SERVICES MAY BE REQUIRED PROSPECTIVE SERVICE PROVIDERS MUST INDICATE BY MEANS OF AN X WHERE GOODS AND SERVICE CAN BE PROVIDED BASED ON THE LOCATION OF THEIR ENTITY. FAILING TO COMPLY WITH THIS CONDITION WILL INVALIDATE THE PROSPECTIVE SUPPLIERS APPLICATION.
Northern Cape
Location Mark with X Location Mark with X
Barkly West Britstown Calvinia Carnarvon Colesberg De Aar Douglas (Herbert) Fraserburg Galeshewe Garies Griekwastad (Hay) Groblershoop Hanover Hartswater Hopetown Jan Kempdorp Kakamas Kathu
Mark with X
Keimoes Kenhardt Kimberley Kuruman Noupoort Olifantshoek Philipstown Pofadder Port Nolloth Postmasburg Prieska Richmond Springbok (Namakwaland) Sutherland Upington (Gordonia) Victoria West Warrenton Williston
Mark with X
North West
Location Bafokeng Bloemhof Brits Christiana Coligny Delareyville Ditsobotla Ganyesa Klerksdorp Koster Kudumane (Tlhaping-Tlharo) Lehurutshe Lichtenburg Madikwe Location Mankwe Marico Molopo Moretele Odi Potchefstroom Rustenburg Schweizer-Reneke Swartruggens Taung Ventersdorp Vryburg Wolmaransstad
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6. LOCATION WHERE GOODS AND/OR SERVICES MAY BE REQUIRED PROSPECTIVE SERVICE PROVIDERS MUST INDICATE BY MEANS OF AN X WHERE GOODS AND SERVICE CAN BE PROVIDED BASED ON THE LOCATION OF THEIR ENTITY. FAILING TO COMPLY WITH THIS CONDITION WILL INVALIDATE THE PROSPECTIVE SUPPLIERS APPLICATION.
Western Cape
Location Mark with X Location Mark with X
Albertinia Atlantis Beaufort West Bellville Bonnievale Bredasdorp Caledon Calitzdorp Cape Town Ceres Clanwilliam George Goodwood Grabouw Heidelberg Hermanus High Court Cape Town Hopefield Khayelitsha Knysna Kuils River Laaiplek Ladismith Laingsburg Malmesbury Mitchells Plain
Montagu Moorreesburg Mossel Bay Murraysburg Oudtshoorn Paarl Piketberg Porterville Prince Albert Riversdale Robertson Simon’s Town Somerset West Stellenbosch Strand Swellendam Tulbagh Uniondale Van Rhynsdorp Vredenburg Vredendal Wellington Wolseley Worcester Wynberg Riversdale
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7. LIST OF COMMODITIES PROSPECTIVE SERVICE PROVIDERS MUST SELECT ONLY FIVE (5) COMMODITY SPECIFIC AS PER THEIR PRINCIPAL/CORE BUSINESS. FAILURE TO COMPLY WITH THIS CONDITION WILL INVALIDATE THE SERVICE PROVIDERS APPLICATION
–odes 2512030 2795030/ 2803030 4109030/3228030 2142030 2243030 2593030 2597030 3762030/1557030 2251030 2573030 3764030/1555030 2255030 3432030 4111030/3230030 2514030 2239030 3474030 2556030 1080030 2259030 3769030/1551030 377030/1549030 2233030 3474030 4135030/3222030 2660030 2666030 2668030
Name ADMIN & SUPPORT STAFF ADVERTISING (2805030/2797030) ADVERTISING BOARDS AIR CHARTER SERVICES ART AND DRAWING MATERIAL ARTISTS & PERFORMERS AUCTIONEERS AUDIO VISUAL EQUIPMENT AUDIO VISUAL MATERIALS AUDIO‐VISUAL SERVICE BAGS BAGS AND ACCESSORIES BROOMS & BRUSHES AIR‐CONDITIONING SYSTEMS (FIXED & MOVABLE) BURIAL SERVICES CARTRIDGES AND TONERS CAR VALET & WASHING SERVICES CASUAL LABOURERS CATERING CELL ACCESSORIES CELLULAR PHONES CELLULAR ROUTERS CLEANING SERVICES CAR VALET & WASHING SERVICES COMPUTER PERIPHERALS CONSULTING: ACCOUNTANTS & AUDITORS CONSULTING: COMMUNICATION CONSULTING: FINANCIAL MANAGEMENT
Select (X)
Codes 2640030 2642030 2644030 2646030 2654030 2648030 2658030 2650030 2572030 2450030 2138030 4113030/3232030 3653030/1585030 3586030 4127030/3214030 3428030 3748030/1541030 4115030/3234030 3750030/1539030 2271030 3752030/1537030 3754030/1535030 2558030 2560030 3758030 2225030 2275030
Name CONSULTING: HUMAN RESOURCE CONSULTING: OCCUPATIONAL SAFETY & HEALTH CONSULTING: ORGANISATIONAL CONSULTING: PROJECT MANAGEMENT CONSULTING: QUALIFICATION VERIFICATION CONSULTING: RESEARCH & ADVISOR CONSULTING: TRANSLATION &TRANSCRIPTION CONSULTING: VALUER CONTRACTORS: MEDICAL SERVICES CORPORATE GEAR COURIER & DELIVERY SERVICES CROCKERY & CUTLERY CYCLES DATA LINES DESKTOP PC DISPOSABLE PAPER/PLASTIC DOMESTIC EQUIPMENT DOMESTIC FURNITURE ELECTRIC WIRE & POWER DISTRIBUTION ELECTRICAL SUPPLIES ELEVATOR/ ESCALATING SYSTEMS EMERGENCY/ RESCUE EQUIPMENT EMPLOYEE WELLNESS EVENT PROMOTERS FIRE FIGHTING EQUIPMENT FIRE PROTECTION FIRST AID KITS FLAGS/ TENTS & ACCESSORIES
Select (X)
3671030/1471030
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Codes 3490030 3496030 3488030 3486030 3480030 3500030 3426030 2134030 2269030 2221030 3760030 2235030 2281030 2219030 3742030/1547030 2564030 2283030 2271030 2568030 2526030 3741030/1523030 2257030 3720030/1521030 4129030/3216030 3722030/1519030 3348030 3710030/1507030 3724030/1515030 6209030 3726030/1517030
Name FLEET SERVICES: LICENCE PLATES FLEET SERVICES: BATTERIES FLEET SERVICES: FUEL,OIL & GREASE FLEET SERVICES: SPARES & ACCESSORIES FLEET SERVICES: TYRES & TUBES FLEET SERVICES:TRACKING FOOD SUPPLIES: GROCERIES FREIGHT SERVICES & GOODS TRASNPORTATION FUEL, OIL & LUBRICANTS FUMIGATION SERVICES GARDENING EQUIPMENT GARDENING SERVICES GARDENING SUPPLIES GAS GAS CYLINDERS (COMMERCIAL &INDUSTRIAL) GRAPHIC DESIGNERS GIFTS HARDWARE AND BUILDING MATERIALS INTERIOR DECORATORS INTERNAL AUDITORS IRRIGATION EQUIPMENT IT CONSMABLES KITCHEN APPLIANCES LAPTOPS LAUNDRY EQUIPMENT LAUNDRY SERVICES LEARNING/TRAINING/SUPP/LIBRARY EQUIP LIBRARY BOOKS LIBRARY MATERIAL LIFTING &HANDLING EQUIPMENTS
Select
Codes 4117030/3236030 2247030 2801030 3544030 2572030 1571030 4119030/3238030 4121030/3240030 3424030 3242030 2271030 2496030 2213030 2570030 3272030/2253030 2542030 2692030 2237030 2126030 4137030/3224030 4211030/3226030 3538030 2799030 2500030 3682030/1495030 2694030 3690030/1487030 3744030/1545030 2271030 2211030 2698030
Name LINEN & SOFT FURNISHINGS MAGAZINES & NEWSPAPERS & JOURNALS MARKETING MEDICAL LAB SERVICES MEDICAL SERVICES MOTOR VEHICLES OFFICE EQUIPMENT OFFICE FURNITURE PACKING AND WRAPPING MATERIAL PAINT/SCULP AND ORNAMENTS PAINTING MATERIAL PERSONNEL & LABOUR PEST CONTROL PHOTOGRAPHER PHOTOGRAPHIC EQUIPMENT PLANT FLOWERS & OTHER DECORATIONS POST/STAMP/FRANKING MACHINES PRINTING PAPER PRINTING & PUBLICATIONS SERVICES PRINTERS (DESKTOP & SHARED NETWORK) PRIVATE FIRM: LEGAL ADVICE PROMOTIONAL ITEMS PROFESSIONAL STAFF PUMP/PLUMBING/SANITATION EQUIPMENTS RADIO AND TV TRANSMISSIONS RADIO EQUIPMENT REFRIGERATOR UNITS (COMMERCIAL & INDUSTRIAL) ROAD SIGNS AND NOTICE BOARDS SAFE GUARD &SECURITY SATELLITE SIGNALS
Select
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Codes 3262030 3264030 2506030 3218030 1428030/4051030 1434030/4047030 1436030/4045030 1430030/3644030 1432030/3642030 3576030 3664030/1478030 2536030 3534030 3532030 3536030 2245030 2116030 3578030 4011030 4133030/3220030 4081030/3560030 4077030/3256030 4079030/3258030 2688030 2700030 3422030
Name SECURITY EQUIPMENTS,SYSTEMS,MATERIAL:FIXED SECURITY EQUIPMENTS,SYSTEMS,MATERIAL:MOVABLE SECURITY SERVICES SERVER/MAINFRAME SOFTWARE LICENCE: DEVELOPMENT SOFTWARE SOFTWARE LICENCE: OFFICE SUITE SYSTEM SOFTWARE LICENCE: OPERATING SYSTEMS SOFTWARE LICENCE: SECURITY SOFTWARE SOFTWARE LICENCE: UTILITY SOFTWARE SPECIALIZED COMPUTER SERVICES SPORT & RECREATION EQUIPMENT STAGE AND SOUND CREW STATE ATTORNEY: CONVEYANCING STATE ATTORNEY: LEGAL ADVICE STATE ATTORNEY: MESSGER OF THE COURT STATIONERY STORAGE OF FILES SYSTEM ADVISER SYSTEM DEVELOPER TABLET PC TELECOM EQUIPMENT ‐ EQUIPMENT TELECOM EQUIPMENT ‐ NETWORK LAN TELECOM EQUIPMENT ‐ NETWORK WAN TELEPHONE INSTALLATION TELEPHONE/FAX/TELEGRAP&TELEX TOILETRIES
Select (X)
Codes 3484030 2538030 2153030 2153030 2153030 2153030 2153030 2153030 2153030 2153030 2153030 2151030 2540030 2179030 3420030 3480030 4732030 3478030 823030 3418030 3383030 3677030/1460030 3395030
Name TOWING COSTS TRACING AGENTS & DEBT COLLECTORS TRAINING & DEVELOPMENT TRAINING: COMMUNICATION TRAINING: FINANCIAL MANAGEMENT TRAINING: HUMAN RESOURCE TRAINING: OCCUPATIONAL SAFETY & HEALTH TRAINING: ORGANISATIONAL TRAINING: PROJECT MANAGEMENT TRAINING: INFORMATION SERVICES TRAINING: COMPUTER LITERACY TRAINING: MATERIAL & MANUALS TRANSPORT CONTRACTOR TRANSPORT FOR PUBLIC EVENTS TUBE LIGHTS & LIGHT BULB TYRES & TUBES UNIFORM & PROTECTIVE CLOTHING VEHICLE REPAIRS VENUES AND FACILITIES WASHING/CLEANING DETERGENTS WASTE REMOVAL WRAPPING & PACKAGING EQUIPMENT WORKPLACE DÉCOR
Select (X)
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Codes 2197030 2197030 2197030 2197030 2197030 2197030 2197030 2197030 2197030 2197030 2197030 877030 877030 877030 877030 877030 877030 877030
Name DAY TO DAY MAINTENANCE: PLUMBING DAY TO DAY MAINTENANCE: ELECTRICIAN DAY TO DAY MAINTENANCE: BRICKLAYING DAY TO DAY MAINTENANCE: TILING DAY TO DAY MAINTENANCE: ROOFING DAY TO DAY MAINTENANCE: PAINTING DAY TO DAY MAINTENANCE: PARTITIONING DAY TO DAY MAINTENANCE: PAVING DAY TO DAY MAINTENANCE: FENCING DAY TO DAY MAINTENANCE: WELDING DAY TO DAY MAINTENANCE: CARPENTRY RENTAL & HIRING: AUDIO VISUAL EQUIPMENTS RENTAL & HIRING: TRAILERS & VEHICLES RENTAL & HIRING: TENTS, CHAIR & TABLES RENTAL & HIRING: TOILETS RENTAL & HIRING: GENERATORS RENTAL & HIRING: LIGHTS RENTAL & HIRING: HEATERS
Select (X)
Codes
Name
Select (X)
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Section 8
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 an advertised competitive bid, a limited bid, a proposal or written price quotation). 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 wherethe 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. Full Name of bidder or his or her representative: ………………………………………………………………………………………………………… Identity Number:…………………………………………………………………………………….. Position occupied in the Company (director, trustee, shareholder², member): …………………………………………………………………………………………………………
2.1
2.2 2.3
2.4
Registration number of company, enterprise, close corporation, partnership agreement or trust: ………………………………………………………………………..………….……………………
2.5 2.6 2.6.1
Tax Reference Number: ………………………………………………………………………… 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; (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.
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2.7
Are you or any person connected with the bidder presently employed by the state?
YES / NO
2.7.1
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: ............................................................……………………………………………………………… ............................................................……………………………………………………………… ............................................................……………………………………………………………… ………………………………………
2.7.2
If you are presently employed by the state, did you obtain the appropriate authority to undertake remunerative work outside employment in the public sector?
YES / NO
2.7.2.1 If yes, did you attach proof of such authority 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:
YES / NO
............................................................……………………………………………………………… ............................................................……………………………………………………………… ............................................................……………………………………………………………… 2.8 Did you or your spouse, or any of the company’s directors / trustees / shareholders / members or their spouses conduct business with the state in the previous twelve months? If so, furnish particulars: ............................................................……………………………………………………………… ............................................................……………………………………………………………… ............................................................……………………………………………………………… 2.9 Do you, or any person connected with the bidder, have 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? If so, furnish particulars. ............................................................……………………………………………………………… ............................................................……………………………………………………………… ............................................................……………………………………………………………… YES / NO YES / NO
2.8.1
2.9.1
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2.10
Are you, or any person connected with the bidder, 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?
YES/NO
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 bidding for this contract? YES/NO
2.11.1 If so, furnish particulars: ............................................................……………………………………………………………… ............................................................……………………………………………………………… ............................................................………………………………………………………………
3
Full details of directors / trustees / members / shareholders. Identity Number Personal Income Tax Reference Number State Employee Number / Persal Number
Full Name
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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 SHOULD THIS DECLARATION PROVE TO BE FALSE.
………………………………….. Signature
..…………………………………………… Date
…………………………………. Position
……………………………………………… Name of bidder
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Section 9
13. SPECIAL CONDITIONS:
As per section 7 of this supplier registration form entitled “Location where goods and/or services may be required”, prospective service providers must indicate by means of an X where goods and/or service can be provided based on the location of their entity. Prospective suppliers must submit a latest original Utility bill (water and electricity) and a certified copy of its entity business registration in respect to the Province applied for. Failing to comply with this condition will invalidate the prospective supplier’s application. Government Procurement General Conditions of contract (GCC) as issued by National Treasury will applicable on all instances. The general conditions is available on the
1.
2.
National Treasury website (www.treasury.gov.za)
3.
No advance payment would be made for the procurement of goods or services. Payment would be made in terms of the deliverables or other unless otherwise agreed upon by other parties (DoJ & CD and the contractor). DoJ & CD will pay within the prescribed period according to PFMA.
4.
Service providers must complete and submit all relevant information/documentation required as insufficient information and non compliance to the conditions set out will invalidate your application
5. Successful supplier providers enlisted of the DoJ CD supplier database must submit a new valid current Tax Clearance Certificate to the National Office (Pretoria) before the validity of the current Certificate expires, in order to ensure that the Department may continuously consider quotations submitted by your business.
6. It is imperative that only the DoJ & CD supplier database registration form with supporting documentation and Original Signatures be submitted. Applications with copied signatures or any part of the supplier application that has been retyped or redrafted will not be considered and disqualified for re-registration.
7.
Suppliers providing information incorrectly or fraudulently in their Supplier Database Registration form will be restricted from bidding, in addition to any other action the Department of Justice and Constitutional Development may institute against such a supplier. Furthermore, in the event of the DoJ & CD being prejudiced financially, it reserves the right to take legal action against the supplier
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Section 10 DoJ & CD ANTI-CORRUPTION TOLL-FREE HOTLINE 0800 701 701
The aim of the Hotline is to enhance an honest work ethic and simultaneously provide employees and persons not employed by the Department with a mechanism to bring any unethical business practices to the attention of management.
DECLARATION
I, THE UNDERSIGNED (NAME)
CERTIFY THAT I AM AWARE OF DoJ & CD ANTI-CORRUPTION TOLL-FREE LINE, WHERE I CAN FREELY REPORT POSSIBLE CORRUPT ACTIONS BY SUPPLIERS/SERVICE PROVIDERS/CONTRACTORS OR POSSIBLE CORRUPT ACTIONS WITHIN THE DEPARTMENT AT ANY TIME AND THAT THE DEPARTMENT WILL TREAT MY IDENTITY AS STRICTLY CONFIDENTIAL.
Signature
Date
Position
Name of Service Provider
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