Supplier Database Submission Form Page 1 of 17 “FEEL THE BEAT AT AFRICA’S FEET” Name of Supplier: _________________________________ PREFERRED SUPPLIER DATABASE SUBMISSION Province: (Only one province may be indicated per submission) Organisation Registered Name / Name of individual Organisation Trading name: Contact Person: Telephone Number: Fax Number: E-mail address: Supplier Database Submission Form Page 2 of 17 Contents: Suppliers must ensure that they have received all pages of this document, which consist of the following: The checklist must be completed as a guideline for the Supplier to comply with AFCON 2013 LOC requirements for submission and registration thereof. Please note that non-compliant submissions to any of these conditions will not be evaluated. No Description Special Instruction 1 Instructions for completion To be completed in full 2 Vendor Information Form To be completed in full 3 Supplier Database Registration Commitment and Declaration of Interest To be completed in full 4 Tax Clearance Requirements Valid original tax clearance certificate must be submitted 5 Preference Points Claim Form To be completed in full 6 General Conditions of Contract Each page must be initialled 7 Company Profile Company Profile must be submitted 8 Certified Copy of the owner/member, director’s Identification Document Certified copy of the owner/member, director’s identification document must be submitted 9 Company Registration Documents Company registration documents must be submitted Supplier Database Submission Form Page 3 of 17 1 INSTRUCTIONS FOR COMPLETION  In order to comply with the Supply Chain Framework Regulations , Suppliers are requested to please complete the Supplier Database registration forms included in this document.  Failure to complete these forms fully and return these forms may lead to disqualification of the Supplier.  Please return original documents to the AFCON 2013 LOC Head Office at SAFA House 76 Nasrec Road Nasrec Johannesburg  Please clearly mark envelopes with the title “Supplier Database Submission”, Supplier name, contact information. Please make use of courier services if needed. Only originally signed submissions will be evaluated  All queries must be in writing and addressed to Mncedisi Khumalo:  No telephonic queries will be responded to.  All responses must be in the standard format as contained in this document. Responses which are not in this format will be disregarded.  The service/s for which the organisation would like to be registered must be marked by putting a cross (x) in the “applicable” column in the list of services hereunder.  Where there is a special requirement listed for a service, proof of compliance to such special requirement should be attached to the submission and marked “Special Requirement”. Should no such proof be attached, the assumption will be non-compliance to such special requirement and the submission will not be considered for that service. Supplier Database Submission Form Page 4 of 17 Products and Services 1.1 indicate (X) the business sector in which your company is involved /operating. 1.2 Indicate (X) the preferred City of conducting business or mark all for National. Business Sector Johannesburg Durban Mbombela Nelson Mandela Bay Rustenburg Advertising (Print, TV, Radio, Outdoor Media) Aircraft / Charter Flight Services Architects and Project Management Brand Management Services Catering Chauffer and Driver Managed Services Cleaning Consumables Cleaning Contractor Services Clothing Designers and Suppliers (Formal Uniform, Sports Apparel) Clothing Suppliers (Safety Apparel) Corporate Gifts and Marketing Promotional Items Courier and Postal Services Event Management Services Exhibition Services Facilities Management Services Filing, Archiving, and Document Management Systems Services Florist Hygiene and Sanitary Services Indoor Plant Services Information Technology (Support, Software, Hardware, Consumables) Interior Decoration Irrigation System Suppliers Language Translation, Training and Interpretation Services Laundry and Dry Cleaning Services Legal Services Marketing Service Providers Marquee, Tent, and Portable Restroom Hire Media Analysis, Monitors, Photographers Medical Service Providers (Emergency, Travel, Event, Hospitals) Network and Data Cabling (Supply, Install and Maintain) Pitch Protection Services Printing Services Programme and Project Management Services Public and International Relations Services Publications Removals and Storage Facilities Supplier Database Submission Form Page 5 of 17 Risk Management Services Security Services (Guards, Stewards, VIP Protection, Fence, Surveillance, Access Control, Radios) Signage Design and Erection Sound, Audio Visual, Stage, Lighting, Video Production, Supplies, Installation) Sports Hospitality & Entertainment Telecommunication Supplies and Services Training Service Providers – Stewards and Volunteers (SETA Accredited) Transportation Waste Disposal and Management Logistics Management Services Supplier Database Submission Form Page 6 of 17 2. VENDOR INFORMATION FORM Please complete this document accurately as the information contained herein is required for the following purposes:  To support AFCON 2013 LOC in the implementation of a system of preferences as required by the Preferential Procurement Policy Framework Act (No 5 of 2000).  Failure to complete the form in full may result in the supplier not being considered for the awarding of any orders or contracts by the AFCON 2013 LOC. PLEASE COMPLETE ALL PAGES. ORGANISATIONAL DETAIL Organisation Registered Name Organisation Trading Name Postal Address Physical Address Telephone Number E-mail Address Fax Number Cellphone Number Company Registration Number Tax Clearance Certificate Number VAT Registration Number Participation Capacity (please tick one) Sub Contractor Supplier Consortium Partner Joint Venture Partner Other (please specify) Type of Organisation (please tick one) Sole Trader Partnership Close Corporation (Pty) Ltd Ltd S(21) company Public entity Organisational Classification Detail Principal Business activities Business Sector Number of years the organisation has been in business Total Number of Employees Is the organisation registered or does it have a business license List all trade associations in which the organisation has membership Did the organisation exist under a previous name? If so, list previous name List the directors / members of the organisation under the previous name Supplier Database Submission Form Page 7 of 17 Identify any owner or management officer which has an interest in other firm(s): Name of owner/manager: Other firm(s) Duties in other firm Name: Other firm: Duties in other firm Organisation’s average annual turnover (excl. VAT) for the previous 3 financial years The financial manager/ external auditor/ CEO/Accounting Officer (whichever is relevant to your type of business) needs to confirm the following: The business/entity (is): (Please indicate on each of the following. Failure to do so may invalidate your Supplier Database Registration) Yes No A going concern In a sound financial condition Has the financial and operational capacity to fulfil the contract requirements Full Names: ___________________________________________________ Signature: _____________________________________________________ Capacity: ______________________________________________________ Supplier Database Submission Form Page 8 of 17 Identify by name, HDI status and length of service, those individuals in the firm (including owners and non-owners) responsible for the day-to-day management and business decisions Activity Full Names I.D. Number Race (B/C/A/W) Gender (M/F) Disability(Y /N) Length of service (Years) Financing Decisions Cheque Signing Acquisition of lines of credit Sureties Major purchase or Acquisitions Contract Signing Management Decisions Estimating Marketing and Sales Hiring and Firing of Staff Supervision of Office Staff Supervision of Field Staff List the three largest contracts/assignments completed by your firm in the last three years. Work performed Purchaser Contact person and telephone number Contract fee/amount This application must be stamped and signed by a Commissioner of Oaths: Stamp and signature of Commissioner of Oaths: Supplier Database Submission Form Page 9 of 17 3. SUPPLIER DATABASE REGISTRATION COMMITMENT AND DECLARATION OF INTEREST PART A: SUPPLIER DATABASE REGISTRATION COMMITMENT 1. I/We hereby submit the Supplier Database application for registration to supply all or any of the supplies and/or to render all or any of the services described in the proposal documents to the AFCON 2013 LOC, on the terms and conditions and in accordance with the specifications stipulated in the Supplier Database Registration Documents (and which shall be taken as part of, and incorporated into, this Supplier Database Register) at the prices and on the terms regarding time for delivery and/or execution inserted therein. 2. I/We agree that - (a) this Supplier Database Registration and its acceptance shall be subject to the terms and conditions contained in the AFCON 2013 LOC General Conditions of Contract and Preference Points Claim Forms – General Conditions and Definitions of the Preferential Procurement Policy Framework Act - PPPFA with which I am/we are fully aware of; (b) if I/we withdraw my/our Supplier Database registration within the period for which I/we have agreed that the Supplier Database registration shall remain open for acceptance, or fail to fulfil the contract when called upon to do so, the AFCON 2013 LOC may, without prejudice to its other rights, agree to the withdrawal of my/our Supplier Database registration or cancel the contract that may have been entered into between me/us and the AFCON 2013 LOC and I/we will then pay to the AFCON 2013 LOC any additional expense incurred by the AFCON 2013 LOC having either to accept any less favourable Supplier Database registration or, if new Supplier Database registrations have to be invited, the additional expenditure incurred by the invitation of new Supplier Database registrations and by the subsequent acceptance of any less favourable Supplier Database registration; the AFCON 2013 LOC shall also have the right to recover such additional expenditure by set-of against moneys which may be due or become due to me/us under this or any other Supplier Database registration or contract or against any guarantee or deposit that my have been furnished by me/us or on my/our behalf for the due fulfilment of this or any other Supplier Database registration or contract and pending the ascertainment of the amount of such additional expenditure to retain such moneys, guarantee or deposit as security for any loss the AFCON 2013 LOC may sustain by reason of my/our default; (c) if my/our Supplier Database registration is accepted the acceptance may be communicated to me/us by e-mail, letter or order by ordinary post or registered post and that SA Post Office Ltd shall be regarded as my/our agent, and delivery of such acceptance to SA Post Office Ltd shall be treated as delivery to me/us; (d) the law of the Republic of South Africa shall govern the contract created by the acceptance of my/our Supplier Database registration and that I/we choose citandi et executandi in the Republic at (full address of this place); 3. I/We furthermore confirm that I/we have satisfied myself/ourselves as to the correctness and validity of my/our Supplier Database registration; that the price(s) and rate(s) quoted cover all the work/item(s) specified in the Supplier Database registration documents and that the price(s) and rate(s) cover all my/our obligations under a resulting contract and that I/we accept that any mistakes regarding price(s) and calculations will be at my/our risk. Supplier Database Submission Form Page 10 of 17 4. I/We hereby accept full responsibility for the proper execution and fulfilment of all obligations and conditions devolving on me/us under this agreement as the Principal(s) liable for the due fulfilment of any contract, which might be awarded based on this offer. 5. I/We agree that any action arising from this contract may in all respects be instituted against me/us and I/we hereby undertake to satisfy fully any sentence or judgement which may be pronounced against me/us as a result of such action. * Delete whichever is not applicable. 6. Are you duly authorised to sign the Supplier Database registration? *YES / NO 7. Has the Declaration of Interest (part B of this form :) been duly completed? *YES / NO [...]... the Supplier Database registration form Failure to submit the original and valid Tax Clearance Certificate SHALL invalidate the Supplier Database registration 3 In Supplier Database registrations where Consortia / Joint Ventures / Sub-contractors are involved each party/member must submit a separate Tax Clearance Certificate Page 12 of 17 Supplier Database Submission Form 4 PREFERENCE POINTS CLAIM FORM. .. of 17 Supplier Database Submission Form Page 16 of 17 Date RSA or TBVC citizenship obtained Percentage owned by others IDENTITY NUMBER Percentage owned by disabled people POSITION OCCUPIED IN ENTERPRISE Percentage owned by Women NAME Percentage owned by HDI’s DECLARATION WITH REGARD TO EQUITY OWNERSHIP: Supplier Database Submission Form 1 HOW MANY PERMANENT STAFF MEMBERS ARE EMPLOYED BY THE SUPPLIER? .. .Supplier Database Submission Form PART B: DECLARATION OF INTEREST 1 Any legal person, including persons employed by the principal, or persons having a kinship with persons employed by the principal, including a blood relationship, may make an offer or offers in terms of this invitation to Supplier Database registration In view of possible allegations of favouritism, should the resulting Supplier Database. .. RELEVANT CLAIM FORMS, SUPPLIERS MUST CAREFULLY STUDY THE GENERAL CONDITIONS AND DEFINITIONS 1 GENERAL CONDITIONS 1.1 The preference point system is applicable to all Supplier Database registrations 1.2 Failure on the part of a supplier to complete and sign a claim form may be interpreted to mean that preference points are not claimed 1.3 AFCON 2013 LOC reserves the right to require of a supplier, that... terms of Paragraph 23 of the General Conditions of Contracts should this declaration prove to be false Signature Position Date Name of Supplier Page 11 of 17 Supplier Database Submission Form 4 TAX CLEARANCE REQUIREMENTS IT IS A CONDITION OF THE AFCON 2013 LOC SUPPLIER DATABASE REGISTRATION THAT 1 The taxes of the provider must be in order, or that satisfactory arrangements have been made with the Receiver... adjudication of the Supplier Database registration(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 Supplier Database registration 2 In order to give effect to the above, the following questionnaire must be completed and submitted with the Supplier Database. .. 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 and/or take an oath declaring his/her interest, where:  the Supplier is employed by the principal; and/or  the Supplier is a board member  the legal person on whose behalf the Supplier Database registration document is signed, has... an HDI 2.9 “Management” in relation to an enterprise or business, means an activity inclusive of control and performed on a daily basis, by any person who is a principal executive officer of the company, by whatever name the person may be designated Page 13 of 17 Supplier Database Submission Form 2.10 “Non firm prices” means all prices other than “firm” prices 2.11 “Person” includes reference to a juristic... percentage of equity ownership 5.2 Preference points will not be awarded to public companies and tertiary institutions 5.3 The following formula will be applied to calculate the number of points for equity ownership by an HDI: Page 14 of 17 Supplier Database Submission Form NEP= NOP X EP 100 Where NEP = Points awarded for equity ownership by an HDI NOP = The maximum number of points awarded for equity... Are you, or any person connected with the Supplier, aware Yes of any relationship (family, friend, other) between the Supplier and any person employed by the principal who may be involved with the evaluation and or adjudication of this Supplier Database registration? 2.3.1 If so, state particulars DECLARATION I, The undersigned (Name) Hereby certify that the information furnished in paragraph 2.1 to . Supplier Database Submission Form Page 9 of 17 3. SUPPLIER DATABASE REGISTRATION COMMITMENT AND DECLARATION OF INTEREST PART A: SUPPLIER DATABASE. Supplier Database Submission Form Page 6 of 17 2. VENDOR INFORMATION FORM Please complete this document accurately as the information contained