APPLICATION TO BE REGISTERED ON THE COMMISION FOR GENDER EQUALITY

SUPPLIER DATABASE

TO ALL SUPPLIERS SEEKING REGISTRATIONAS AN APPROVED SUPPLIER ON THE DATABASE OF THE COMMISSION FOR GENDER EQUALITY

All suppliers are herewith invited to register as an approved supplier on the database of the Commission.

In order to comply with the procedures set out in the Supply Chain Management Guidelines, as referred to in the Public Finance Management Act (PFMA)), the Commission developed a supplier database to be used by the Procurement section.

The purpose of this database is to give all prospective suppliers an equal opportunity to submit quotations to the Commission.

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 Commission. 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 updating our database according to legislation.

It is imperative that suppliers read the application document carefully, complete it in full and sign it. Please note that an Original Valid Tax Clearance Certificate, Certified Copy of ID documents, Company Registration documents, BEE Certificate and Company Profile must be attached and/or delivered to the Commission.

When completed this questionnaire, send with the reference number CGESCM14/15 to:

For Attention: The Supply Chain Administrator Shadrack Mafutsa Commission for Gender Equality 2 Kotze Street Women’s Jail, East Wing Constitution Hill Braamfontein 2017

011 403 7182

Or alternatively post to:

For Attention: The Supply Chain Administrator Shadrack Mafutsa Commission for Gender Equality PO Box 32175 Braamfontein 2017

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IMPORTANT NOTESPlease read carefully

To be completed by all vendors seeking registration as an approved supplier; The questionnaire must be completed in full and be signed by the authorised signatories; A company profile may 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; Applicants will be contacted via fax and must therefore submit an operating fax number as well as

email address; failure to comply may result in excluding the supplier from the data base; It should be noted that the Commission reserves the right to accept or reject any application without

being obliged to give any reasons in this respect; Suppliers will be notified whether their application was accepted or not by means of written

confirmation; Supplier must comply with all the registration-criteria for registration to be finalized - failure to do

so may result in the application being declined.Supplier Detail:Company / Supplier Name:                                Company / CC Registration Number:                          VAT Registration Number (If Applicable):                    Income Tax Reference Number (compulsory):                    Web Address:  E-Mail Address:  Telephone Number:                                Fax Number (Compulsory):                                Toll Free Number:                                Number of Full Time Employees:          Number of years in businessPostal Address: (Compulsory)                                                                                                  

Code        

Physical Address: (Compulsory)                                                                                                                                   NB: NB: Supplier Banking Details: TO BE COMPLETED BY A BANK OFFICIAL(COMPULSORY)Name BankAccount NumberType of AccountBranch CodeBranch Name

SIGNATURE OF BANK OFFICIAL

BANK DATE STAMP: CERTIFYING ABOVE DETAILS AS CORRECT

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SUPPLIER APPLICATION FORM

Supplier grouping detail: Type of Firm: (Please tick the relevant box)

1 Public Company (Ltd)2 Private Company (Pty) Ltd3 Closed Corporation (CC)4 Other (Specify)5 Joint Venture6 Consortium7 Sole Proprietor8 Foreign Company9 Partnership10 Trust11 Section 21Company12 Government / Parastatals

Company / Supplier Classification: (Please tick the relevant box / boxes)

ISO Listed

Importer Services Manufacturer Repairer Black Owned

Distributor Exporter Sales

Tax Clearance Certificate Attached (Compulsory) YES NOExpiry Date of Tax Clearance Certificate

Main Contact Person in your Company:Name:Company Position:Cell Phone Number:Fax Number:E-Mail Address:

Sales Contact Person in your Company:Name:Company Position:Cell Phone Number:Fax Number:E-Mail Address:

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Suppliers of the following products/services are required to register on the database. Please mark the main services your company supplies: -Please note that no more than two main groups can be registered forRate per day only applicable for main groups: professional and sector specific analysts and experts

MAIN GROUP SERVICE / GOODSTICK

RELEVANT BOX

HR

Recruitment  Training and development / skills development  Payroll Outsourcing  Recruitment Advertising  HR Consultants  Employment Agencies  Response handling Employee Assistance Program providers

Finance Stationery  

IT

Software Development  System DevelopersIT Peripherals  IT Consultants  Computer Hardware Suppliers  Computer & Printer maintenance  Photocopying, Scanning, Printing Services  Printing  

Logistics

Driver (casual & part time)  Messenger/Delivery Services(of documents and people)Please supply details of fleet and drivers separately  Courier Services  Offsite Storage  Photocopying servicesTranscription Services  

CateringCatering Services  Supply of Meeting refreshments  

Facilities

Upholstery cleaning  Flower arrangements  Electrical services  Fire systems  Security Services  Access Control Systems  CCTV Systems  Metal Detector Systems  Building Construction  Furniture Repairs  Furniture Procurement  

Marketing & Communications

Advertising  Exhibitions  Billboard Advertising  Corporate Gifts  Layout and design of corporate publications  

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MAIN GROUP SERVICE / GOODSTICK

RELEVANT BOX

Photography  

Travel

Flights & Accommodation  Venue Hire  Car Hire  Visa applications  

Professional

(COMPLETE DISBURSEMENT

SECTION IF REGISTERING

HERE)

Facilitators: Teambuilding & Strategic Planning  Economists: Specify area of expertise

- Economic analysis- Competition- Sector specific

Forensic InvestigatorsLegal Services:

- Lawyers- Advocates

 

Competition Lawyers  Labour Lawyers  Sector Specific Analysts and ExpertsDispute ResolutionTechnical Experts: Please specify

INDICATE ANY SPECIAL DISCOUNT RATES APPLICABLE %

NOTES:

TRACK RECORD

LIST THE FOUR LARGEST MOST IMPORTANT CONTRACTS/ASSIGNMENTS COMPLETED BY YOUR FIRM IN THE LAST THREE YEARS

WORK PERFORMED FOR WHOM CONTACT PERSON AND TELEPHONE NUMBERS

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HDI OWNERSHIP STATUS: PLEASE READNOTES BELOW VERY CAREFULLY

Instructions and Definitions:(Please read carefully before completing PDI Ownership Status)

Legislation: Procedures are set out in the Supply Chain Management Guidelines, as referred to in the

Public Finance Management Act, 2003 (PFMA), to give all prospective suppliers an equal opportunity to submit quotations to the Commission.

Terminology: Commodities: The commodities the company wishes to be registered for as a supplier to the

Commission. Trade Names: The trade names that the company own or distribute, which you wish to be

registered for as a supplier to the Commission. Owned: Having all the customary elements of ownership, including the right of decision-making

and sharing all the risks and profits commensurate with the degree of ownership interests as demonstrated by an examination rather than the form of ownership arrangements.

Historically Disadvantaged Individuals (HDI): For the purpose of registering as a supplier for the Commission, the refutable presumption shall be made that SA citizens who fall into population groups that had no franchise in national elections prior to the introduction of the 1983 and 1993 constitution are Previously Disadvantaged Individuals. It is incumbent on individuals to demonstrate their claims to fall into such population groups on the basis of identification and association with and recognition by the members of such a group.

Woman: A female person who is a SA citizen. Establishment of HDI / Women Equity Ownership in a enterprise: Equity

ownership shall be equated to the percentage of an enterprise which is owned by individuals, or in the case of a company, the percentage shares that are owned by individuals who are actively involved in the management and daily business operations of the enterprise and exercise control over the enterprise, commensurate with their degree of ownership.

Where individuals are not actively involved in the management and daily business operations and do not exercise control over the enterprise commensurate with their degree of ownership, equity ownership may not be claimed.

List all Partners, Proprietors and Shareholders: (Compulsory)Name Position in Company Occupation ID Number

Note: Where owners are themselves a Company or Partnership, owners of the holding firm must be identified

EQUITY OWNERSHIP

% Shares owned by the following groups: (Compulsory)MALE FEMALE DISABLED

AFRICANCOLOUREDINDIANWHITE

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HDI Ownership Status:(Failure to complete this section will result in the application being rejected)

Previously Disadvantaged Individuals (PDI) %Women Equity (WE) %Disabled Individuals (DA) %

SMME Status of Your Enterprise:

Please use this table to determine the SMME status of your enterprise Please tick the relevant box in each column

A. Sector B. Full Time Paid Employees C. Annual Turnover (R millions) Total Gross Asset value (R millions

Med Small Very Small

Micro Med Small Very Small

Micro Med Small Very Small

Micro

Manufacturing 200 50 20 5 40 10 4 0.15 15 3.75 1.5 0.1

Construction 200 50 20 5 20 5 2 0.15 4 1 0.4 0.1

Retail and Motor Trade 100 50 10 5 30 15 3 0.15 5 2.5 0.5 0.1

Wholesale Trade 100 50 10 5 50 25 5 0.15 8 4 0.5 0.1

Catering / Accommodation

100 50 10 5 10 5 1 0.15 2 1 0.2 0.1

Transport / Storage 100 50 10 5 20 10 2 0.15 5 2.5 0.5 0.1

Finance & Business Services

100 50 10 5 20 10 2 0.15 4 2 0.4 0.1

Repair / Allied Services 100 50 10 5 30 15 3 0.15 5 2.5 0.5 0.1

Communications 100 50 10 5 20 10 2 0.15 5 2.5 0.5 0.1

Other Trade 100 50 10 5 10 5 1 0.15 2 1 0.2 0.1

Commercial Agents(e.g Travel Agent)

100 50 10 5 50 25 5 0.15 8 4 0.5 0.1

Community and Social Services

100 50 10 5 10 5 1 0.15 5 2.5 0.5 0.1

Personal Services (e.g Consulting Services)

100 50 10 5 10 5 1 0.15 5 2.5 0.5 0.1

SMME Status of your Enterprise: (Please tick the relevant Box)

MicroVery SmallSmallMediumLarge

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RATES/DISBURSEMENTS:(Compulsory for all entities/individuals registered under professional services)

DESCRIPTION RATE PER DAY (Based on 10 working hours)

RATE PER HOUR OTHER CHARGES

Director / Partner

Senior

Junior

Other

DISBURSEMENTS (Please specify in detail for services to be rendered)

Travel- Rate per km- Flights- Other

Admin- Specify

Other- Specify

SBD 49

DECLARATION OF INTEREST

1. Any legal person, including persons employed by the state*, 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 and/or take an oath declaring his/her interest, 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, shareholder etc):

……………………………………………

2.4 Company Registration Number:...............................................................................................

2.5 Tax Number: ........................................................................................................................

2.6 Reference Number ………………………………………………………………………………….………

2.7 VAT Registration Number: ………………………………………………………………………………...

* “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.

2.7 Are you or any person connected with the bidder YES / NO presently employed by the state?2.7.1 If so, furnish the following particulars:

Name of person / director / shareholder/ member: ……....………………………………Name of state institution to which the person is connected: ………………………………………Position occupied in the state institution: ………………………………………

Any other particulars:………………………………………………………………

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………………………………………………………………………………………………………………………………

2.8 Did you or your spouse, or any of the company’s directors / YES / NOshareholders / members or their spouses conduct business with the state in the previous twelve months?

2.8.1 If so, furnish particulars:…………………………………………………………………..………………………………………………………………….. ……………………………………………………..................

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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?

2.9.1 If so, furnish particulars.

………………………………………………………………………………………………………………………………………………………………………………………………

2.10 Are you, or any person connected with the bidder, aware of any relationship (family, friend, other) between the bidder and any person employed by the state who may be involved with the evaluation and or adjudication of this bid?

2.10.1 If so, furnish particulars. …………………………………………………………………………………………………………………………………………………….......................................................YES / NO

2.11 Do you or any of the director’s /shareholders/ members of the company have any interest in any other related companies whether or not they are bidding for this contract?

2.11.1 If so, furnish particulars:

……………………………………………………………………………………………………………………………………YES / NO

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DECLARATION

I, THE UNDERSIGNED (NAME)………………………………………………………………………

CERTIFY THAT THE INFORMATION FURNISHED IN PARAGRAPHS 2.1 TO 2.11.1 ABOVE IS CORRECT. I ACCEPT THAT THE STATE MAY ACT AGAINST ME IN TERMS OF PARAGRAPH 23 OF THE

GENERAL CONDITIONS OF CONTRACT SHOULD THIS DECLARATION PROVE TO BE FALSE.

………………………………….. ..…………………………………………… Signature Date

…………………………………. ………………………………………………Position Name of Owner/Representative

…………………………………. ………………………………………………Witness Date

SBD 9 CERTIFICATE OF INDEPENDENT BID DETERMINATION

1 This Standard Bidding Document (SBD) must form part of all bids¹ invited.

2 Section 4 (1) (b) (iii) of the Competition Act No. 89 of 1998, as amended, prohibits an

agreement between, or concerted practice by, firms, or a decision by an association of

firms, if it is between parties in a horizontal relationship and if it involves collusive

bidding (or bid rigging).² Collusive bidding is a pe se prohibition meaning that it cannot

be justified under any grounds.

3 Treasury Regulation 16A9 prescribes that accounting officers and accounting authorities must take all reasonable steps to prevent abuse of the supply chain management system and authorizes accounting officers and accounting authorities to:

a. disregard the bid of any bidder if that bidder, or any of its directors have abused

the institution’s supply chain management system and or committed fraud or any other improper conduct in relation to such system.

b. cancel a contract awarded to a supplier of goods and services if the supplier

committed any corrupt or fraudulent act during the bidding process or the execution of that contract.

4 This SBD serves as a certificate of declaration that would be used by institutions to

ensure that, when bids are considered, reasonable steps are taken to prevent any form

of bid-rigging.

5 In order to give effect to the above, the attached Certificate of Bid Determination (SBD 9)

must be completed and submitted with the bid:

¹ Includes price quotations, advertised competitive bids, limited bids and proposals.

² Bid rigging (or collusive bidding) occurs when businesses, that would otherwise be expected to compete, secretly conspire to raise prices or

lower the quality of goods and / or services for purchasers who wish to acquire goods and / or services through a bidding process. Bid

rigging is, therefore, an agreement between competitors not to compete.

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:

(a) has been requested to submit a bid in response to this bid invitation;

(b) could potentially submit a bid in response to this bid invitation, based on

their qualifications, abilities or experience; and

(c) provides the same goods and services as the bidder and/or is in the same

line of business as the bidder.

SBD 9

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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.

SBD 9

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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 BidderJs914w 2

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