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RFQ No:1064 DESCRIPTION: PROVISION OF OCCUPATIONAL HYGIENE SURVEYS Procurement Less than R 500 000 (Including Vat) (For publication on Amatola Water Board Notice Board/s and Website) AMATOLA WATER RFQ: 1064 PROVISION OF OCCUPATIONAL HYGIENE SURVEYS 1 of 45 IMS-SCM-020F The Amatola Water Board requests your quotations to be submitted as per below. Please furnish all information and forms as requested and return your quotation on or before the stipulated closing date. Late and incomplete submissions will invalidate the quotation submitted. ADVERISMENT DATE 16/02/2018 DEPARTMENT Health & Safety RFQ NUMBER 1064 DESCRIPTION OF GOODS/SERVICES Provision of Occupational Hygiene Surveys RFQ SPECIFICATION FORMS/ DOCUMENTS ARE OBTAINABLE FROM Amatola Website and from Supply Chain Office COMPULSORY REQUIREMENTS As detailed on the Returnable Schedules and Scope of Works SUBMISSION OF QUOTES HAND DELIVERED ONLY TO: RFQ/Quotation Box at 6 Lancaster Road Reception Area, Vincent , East London, SITE MEETING/BRIEFING N/A DELIVERY OF GOODS/ SERVICES AMATOLA WATER SAFETY OFFICE , NAHOON DAM COMPLEX, NAHOON DAM SAMPLES REQUIRED N/A CLOSING DATE AND TIME 28/02/2018 ENQUIRIES For more information or clarity kindly contact Mr J. Beli @ 084 619 6696 PLEASE NOTE: Quotations above R30 000 will be evaluated on the basis of the 80:20 point system as stipulated in the Preferential Procurement Policy Framework Act (Act number 5 of 2000) & Amatola Water Board Supply Chain Management Policies and Procedures. SUBMISSION OF QUOTES: All quotes must be submitted to the dedicated quotes email address or submitted to the box. No quotes to individual inboxes will be accepted.

RFQ No:1064 - amatolawater.co.za · Company Name Ref. RFQ No: 1064 Fax No. From Ms Mavuso Email Address RFQ Closing Date and Time : Wednesday 28 February 2018 AT 11:00

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RFQ No:1064 DESCRIPTION: PROVISION OF OCCUPATIONAL HYGIENE SURVEYS

Procurement Less than R 500 000 (Including Vat)

(For publication on Amatola Water Board Notice Board/s and Website)

AMATOLA WATER RFQ: 1064 PROVISION OF OCCUPATIONAL HYGIENE SURVEYS 1 of 45

IMS-SCM-020F

The Amatola Water Board requests your quotations to be submitted as per below. Please furnish all information and forms as requested

and return your quotation on or before the stipulated closing date. Late and incomplete submissions will invalidate the quotation

submitted.

ADVERISMENT DATE

16/02/2018

DEPARTMENT

Health & Safety

RFQ NUMBER

1064

DESCRIPTION OF GOODS/SERVICES

Provision of Occupational Hygiene Surveys

RFQ SPECIFICATION FORMS/ DOCUMENTS

ARE OBTAINABLE FROM

Amatola Website and from Supply Chain Office

COMPULSORY REQUIREMENTS

As detailed on the Returnable Schedules and Scope of Works

SUBMISSION OF QUOTES

HAND DELIVERED ONLY TO:

RFQ/Quotation Box at 6 Lancaster Road Reception Area, Vincent , East London,

SITE MEETING/BRIEFING

N/A

DELIVERY OF GOODS/ SERVICES

AMATOLA WATER SAFETY OFFICE , NAHOON DAM COMPLEX, NAHOON DAM

SAMPLES REQUIRED

N/A

CLOSING DATE AND TIME

28/02/2018

ENQUIRIES

For more information or clarity kindly contact Mr J. Beli @ 084 619 6696

PLEASE NOTE: Quotations above R30 000 will be evaluated on the basis of the 80:20 point system as stipulated in the Preferential

Procurement Policy Framework Act (Act number 5 of 2000) & Amatola Water Board Supply Chain Management Policies and Procedures.

SUBMISSION OF QUOTES: All quotes must be submitted to the dedicated quotes email address or submitted to the box. No quotes to

individual inboxes will be accepted.

AMATOLA WATER RFQ: 1064 PROVISION OF OCCUPATIONAL HYGIENE SURVEYS 2 of 45

Confidential Request for Quotation

Description PROVISION OF OCCUPATIONAL HYGIENE SURVEYS

Attention Date 16/02/2018

Company Name Ref. RFQ No: 1064

Fax No. From Ms Mavuso

Email Address

RFQ Closing Date and Time : Wednesday 28 February 2018 AT 11:00

NB: No late or incomplete quotations will be considered

No of pages, including this one: 44

SCM ENQUIRIES

Ms Mavuso – Tel: (043) 707 3700 / 043-707 3742

E-mail: [email protected]

TECHNICAL ENQUIRIES

Mr J. Beli - Tel (043) 709 3700 / 084 619 6696

E-mail: [email protected]

Amatola Water seeks a suitably experienced service provider for Provision of Occupational Hygiene Surveys in line with

the Scope of Work as detailed in Annexure 1.

Your quotation must be submitted in accordance with our CONDITIONS OF PURCHASE.

1. QUOTATION DOCUMENTS

Your quotation must be submitted in accordance with the following documentation enclosed herewith:

1.1. Scope of Work and Eligibility Criteria: (Annexure 1)

1.2. Functionality Scoring : (Annexure 2)

1.3. Price Schedule: (Annexure 3).A detailed quotation may be submitted together with the Price Schedule.

1.4. Compulsory Returnable Schedules: (Annexure 4)

(a) Proof of CSD Registration

(b) Declaration of Interest

(c) Preference Points Claim Form

(d) B-BBEE Verification Certificate / Affidavit

(e) Declaration of bidder’s past supply chain management practices

(f) Certificate of independent bid determination

(g) Reference Schedule

(h) Local Content Declaration (Not applicable)

1.5 Conditions of Purchase: (Annexure 5)

2. COMPANY PROFILE

A brief company profile detailing your company’s experience and expertise in the area of work quoted for must be

provided.

AMATOLA WATER RFQ: 1064 PROVISION OF OCCUPATIONAL HYGIENE SURVEYS 3 of 45

3. CRITERIA TO BE USED FOR EVALUATION OF QUOTATIONS

In line with Amatola Water’s Supply Chain Management Policy, quotations will be evaluated on the 80/20

preference point system for acquisitions with a rand value below R50 Million. The 80/20 preference point system

allocates 80 points for price and 20 points for the B-BBEE status level of contributor.

3.1 Evaluation of Preference/B-BBEE

The Preferential Procurement Policy Framework Act (PPPFA) principles will apply, whereby submissions will be

evaluated according to the provision of the Act. The measurement of the B-BBEE status of the suppliers/service

providers will be scored in line with the Broad-Based Black Economic Empowerment Codes of Good Practice

(Government Gazette No. 29617, Notice 112 of 2007). B-BBEE status will be scored in accordance with the DTI

Codes of Good Practice and bidders must submit their original and valid B-BBEE status level verification

certificate or a certificate issued by a registered auditor, accounting officer (as contemplated in section 60 (4)

of the Closed Corporations Act, 1984) or an accredited verification agency in order to be eligible for B-BBEE

points.

A maximum of 20 points may be awarded to a bidder for attaining their B-BBEE status level contemplated in

the B-BBEE Codes of Good Practice. The points scored by a bidder in respect of the level of B-BBEE

contribution contemplated in sub-regulation (3) must be added to the points scored for price.

As per the Supply Chain Management policy, Amatola Water strives to perform preferential procurement with

organizations that have a procurement recognition level of 4 (100%). Suppliers who currently do not meet this

recognition are strongly encouraged to further empower their organization to reach this level.

B-BBEE Status Level of Contributor Number of Points

1 20

2 18

3 14

4. 12

5 8

6 6

7 4

8 2

Non-compliant contributor 0

4. Central Supplier Database Registration

If not already registered as a vendor on National Treasury Database, bidders must be registered.

Tenderers who wish to register as service providers on the Central Supplier Database can register onto

www.csd.gov.za. For further enquiries contact the Supply Chain Management Department on Tel:

043 707 3770

AMATOLA WATER RFQ: 1064 PROVISION OF OCCUPATIONAL HYGIENE SURVEYS 4 of 45

5. METHOD OF SUBMISSION OF QUOTATION:

Your quotation may be submitted by only the following method by: Wednesday 28

February 2018 at 11:00:

Only Hand delivered submissions will be accepted to Amatola Water Head Office,

No. 6 Lancaster Road Reception, Vincent, East London

(Please put your RFQ submission in RFQ Box located at Reception after signing the

register).

AMATOLA WATER RFQ: 1064 PROVISION OF OCCUPATIONAL HYGIENE SURVEYS 5 of 45

Annexure 1

Scope of Work

AMATOLA WATER RFQ: 1064 PROVISION OF OCCUPATIONAL HYGIENE SURVEYS 6 of 45

Annexure 1

Amatola Water invites quotations from suitably experienced qualified and professional

service providers for the Provision of Occupational Hygiene Surveys as set out below:

Scope of Work:

INTRODUCTION

The Occupational Health and Safety Act places the onus on employers to ensure that the working

environment is safe and without risks to the health of their employees. In order to accomplish this,

employers must, through the services of a competent person, assess the exposure of their

employees to hazardous environmental conditions in the workplace. Where this assessment

indicates an ongoing risk from exposure, the employer must measure that exposure, compare the

results with prescribed standards and implement the steps that are needed to comply with the

provisions of the Act. This process, which is known as compliance monitoring, must be performed by

an Approved Inspection Authority.

Amatola Water Board seeks to appoint an Approved Inspection Authority (Service Provider) for the

evaluation of occupational hygiene parameters relating to hygiene as in terms of internationally

accepted standards. In this regard, current South African Occupational Health and Safety

legislation referred to the Occupational Health and Safety Act, OHSACT, Act 85 of 1993.

APPROVED INSPECTION AUTHORITY

The Occupational Health and Safety Act, 1993 (Act No. 85 of 1993), defines an Approved

Inspection Authority as:

“any person who with the aid of specialised knowledge or equipment or after such investigations,

tests, sampling or analyses as he may consider necessary, and whether for reward or otherwise,

renders a service by making special findings, purporting to be objective findings, as to:

a) The exposure of any person

b) The safety or risk to health of any work, article, substance, plant or machinery, or any condition

prevalent on or in any premises

c) The question of whether any particular legislated standard has been or is being complied with,

with respect to any work, article, substance, plant or machinery, or with respect to work or a

condition prevalent on or in any premises or with respect to any other matter, and by issuing a

certificate, stating such findings, to the person to whom the service is rendered.”

The AIA will follow South African and internationally accepted standards, methodologies and

procedures to anticipate, recognise, identify, evaluate and prepare recommendations to reduce

and or minimise exposure to any health risks in the workplace. The meaning of a certificate should

also be read as a report/statement/certificate as pertaining to each specific situation.

The use of the term “monitoring” means more than just measuring an occupational hygiene stress

factor.

It includes the:

Identification of workplaces which could cause or exacerbate adverse health effects

Measurement of prevailing conditions

AMATOLA WATER RFQ: 1064 PROVISION OF OCCUPATIONAL HYGIENE SURVEYS 7 of 45

Scientific interpretation of those measurement results

Evaluation of the potential impairment of health or well-being

Formulation of recommendations for alleviation of such problems.

1. The service provider needs to conduct surveys on the occupational hygiene stressors that

covers but which is not limited to the following sections:

Hazardous chemical substance surveys such as fumes, vapours and gasses.

Illumination Survey.

Hazardous Biological Agents

Noise Survey.

Ventilation and indoor air quality surveys for the labs and Head office building.

Ergonomic survey (Admin areas).

Reviewing and update of our Health Risk Assessment

Reviewing and update of our Asbestos Monitoring Systems

Expected Deliverables:

On completion of a survey a comprehensive report should be submitted, the report should

include, but not limited to:

1. Title Page

Physical Address

Date

Title Monitoring

Unique number and serial number of the report

Surveyor name and signature

AIA Occupational Hygienist who verified the report

2. Executive Summary

3. Introduction

Purpose of the survey

Health effects

4. Process

Description of a process in the area measured.

Layout plans attached

AMATOLA WATER RFQ: 1064 PROVISION OF OCCUPATIONAL HYGIENE SURVEYS 8 of 45

5. Method

Describe the methodology used include the legal aspect. Add equipment used and

serial numbers.

Measurement taken over time and include time measured.

Calibration information

6. Results

Clear indication and description of results. Include plans to indicate sampling position on

plans.

Indication and clear description of the location where measurements or sampling was

taken.

Indication of areas where problems occurred.

Inclusion of tables, photos, figures, histograms or other systems of displaying results.

7. Discussion and remarks

Interpretation of results and effects.

PREMISES OF SERVICE:

The following Amatola Water sites shall be included in the survey:

Nahoon Dam Complex, Workshops and WTW

Laing WTW

Sandile WTW

Debe WTW

Masincedane WTW

Binfield WTW.

Peddie WTW

Albany Coast WTW

Head Office,

Scientific Services and

Clinic

AMATOLA WATER RFQ: 1064 PROVISION OF OCCUPATIONAL HYGIENE SURVEYS 9 of 45

N.B ELIGIBILITY CRITERIA AS PER BELOW REQUIREMENTS :

1. The Service Provider must be eligible to submit the following documents:

The organisation must hold a certificate of accreditation from the South African National

Accreditation System (SANAS)

The AIA must have the Basic suitable monitoring and analytical equipment pertinent to

the service/s rendered (See Annexure I)

The AIA must have access to additional equipment that may be required for the service/s

to be rendered and a formal agreement must be in place for such equipment

The AIA must keep a logbook which contains calibration and maintenance schedules

and records for all relevant equipment for a period of five years

The AIA must have suitably documented and controlled systems, methods and

procedures

relating to the regulated services they wish to render.

The service provider to have at least three references of similar work previously and

successfully performed.

2. Personnel

Personnel involved in the regulated services of the AIA must be currently registered with a

professional occupational hygiene organisation recognised by the Chief Inspector

Personnel involved in the regulated services of the AIA must hold a valid legal knowledge

certificate acceptable to the Department

The personnel employed by an AIA must include at least one Registered Occupational

Hygienist who is in overall control of, and responsible for, all the regulated aspects of the

Approved Inspection Authority. In addition AIAs are permitted to carry out occupational

health risk assessments, walk-through surveys, plan and supervise surveys, evaluate

monitoring results, prepare reports, and recommend appropriate control measures within the

ambit of the scope of work for which the AIA is authorised.

3. Analytical Services

The AIA will remain accountable for the results obtained from any analytical laboratory.

Therefore prior to using a laboratory for analytical services, the AIA must:

Instruct the laboratory on the specific method of analysis required.

Ensure the analytical laboratory has competent laboratory personnel and is making use of

nationally/ internationally acceptable standards and is accredited by SANAS in terms of

SANS 17025.

Appropriate analytical equipment and facilities are available for the tests required.

Ensure that an external proficiency testing scheme is used where available and where there

is no scheme available, agree on the quality assurance procedures to be employed.

Have a written agreement with the analytical laboratory.

AMATOLA WATER RFQ: 1064 PROVISION OF OCCUPATIONAL HYGIENE SURVEYS 10 of 45

Demand a certified statement from the laboratory that the given method was used and any

deviation from the method was recorded and the reason for such deviation was motivated

and the report provided shall reflect all the relevant signatories.

4. Documentation

The service provider shall ensure compliance in all statutory and regulations applicable to

the industry where the service is rendered.

The Occupational and Safety Act, 1993 (Act no 85 of 1993)

The National Environmental Management Act (Act no 107 of 1998)

Environmental Regulations for Workplaces

Noise Induced Hearing Loss Regulations

Occupational Hygiene Regulations

SANAS Accredited Inspection Body

Department of Labour Approved Inspection Authority.

Hazardous Chemical Substance Regulations.

Asbestos Regulations

National Building Regulations and Building Standards Act.

Facilities Regulations.

General Safety regulations.

LIST OF BASIC EQUIPMENT REQUIRED TO PERFOM THE SERVICES:

1 Airborne contaminants (hazardous chemicals, hazardous biological

agents.)including asbestos

• Personal Sampling Pump/s (PSP) with a constant airflow system. Pump must

have variable flow settings to accommodate low flow rates as well

• Primary calibration standard i.e. electronic calibration instrument or an

inverted burette able to calibrate PSP to a known flow rate

• Detector tubes for measuring gas or vapour (including detector tube pump

i.e. bellow pump)

• Will be an advantage if available: direct reading instruments for airborne

gases and vapours (real time quantification) or direct reading diffusion

tubes/badges

• Phase contrast microscope fitted with a Walter-Beckett graticule for

asbestos counting will be an advantage

• Correct sample media (filters and sorbent tubes), sample heads (i.e. open

face, antistatic cowl), cyclones and other consumables are important

2 Noise

• Integrating sound level meter that complies at least with the accuracy

requirements specified for a type 2 instrument in SANS 61672-1 and SANS

61672-2

• Sound calibrator that complies with the requirements prescribed for a type

2 calibrator in SANS 60942

• Personal sound exposure meter (noise dose meter) that comply with the

relevant accuracy requirements of IEC 61252 (and its calibrator) for personal

exposure measurements will also be an advantage

AMATOLA WATER RFQ: 1064 PROVISION OF OCCUPATIONAL HYGIENE SURVEYS 11 of 45

• A type 1 SLM with frequency analyser (and its calibrator) will again be an

advantage, especially due to accuracy, sound integrating properties and

for noise control purposes

3. Illumination

• Photometer (cosine calibrated and colour corrected), e.g. Lux meter.

The proposal must include at least the following key information:

Certificate issued by the Registrar of Companies

Tax Clearance Certificate

Letter of good standing from COIDA

Company Profile

Relevant experience of company

Relevant resources needed from Amatola Water personnel

SANAS accreditation certificate.

Measuring equipment that would be used.

Valid, up-to-date registration certificates for each employee who would be conducting the

assessment.

Programme/ Schedule to indicate how the survey will be conducted per area, the

activities to be performed and the time of delivery on completion of the surveys.

Schedule of rates

A copy of your registration with the Department of Labour must be attached to your

quotation.

The respective Service Provider to submit DRAFT reports that must be verified by both parties

(Amatola Water representative and relevant Service Provider), to agree that the status of work

that was performed has been completed in a satisfactory manner and as far as appropriate be of

a paper and electronic based, i.e. at least tangible agreed to proof of both.

Work will be done in various sites as stated in the scope of works (delivery point of services)

For more information please contact Mr J. Beli @ 084 619 6696

AMATOLA WATER RFQ: 1064 PROVISION OF OCCUPATIONAL HYGIENE SURVEYS 12 of 45

Annexure 2

Functionality Scoring

AMATOLA WATER RFQ: 1064 PROVISION OF OCCUPATIONAL HYGIENE SURVEYS 13 of 45

Annexure 2

FUNCTIONALITY SCORING

RFQs will be evaluated using Eligibility as per Compulsory Returnable Schedules,

Functionality Scoring as Stage 1 and Stage 2 for Price and preference.

Stage 1: Functionality Criteria:

RFQs will be evaluated based on the functionality as detailed on below table:

Scoring Functionality - The allocation of the scoring criteria will be applied as

follows

EVALUATION CRITERIA WEIGHTING POINTS SCORED

Company Experience in similar projects

50

5 and above Relevant References 50

3-4 Relevant References 30

1-2 Relevant Reference 10

Company References: As per Reference Schedule 20

5 and above Relevant References 20

3-4 Relevant References 10

1-2 Relevant Reference 5

Delivery Schedule 30 0-5 days delivery from date of purchase order 30

6-10 days delivery from date of purchase order 20 11-15 days delivery from date of purchase order 10

From 16 days and above delivery from date of

purchase order 0

Maximum possible score for quality 100

Minimum number of total evaluation points required for

functionality

60

AMATOLA WATER RFQ: 1064 PROVISION OF OCCUPATIONAL HYGIENE SURVEYS 14 of 45

Annexure 3

Pricing Schedule

AMATOLA WATER RFQ: 1064 PROVISION OF OCCUPATIONAL HYGIENE SURVEYS 15 of 45

Annexure 3

Pricing Schedule

Item Description Quantity

Unit Price

(Excl.

Vat)

Total Price

(Excl. Vat)

Provision of Occupational Hygiene Surveys

Travelling rate per km

Sub Total

VAT

Total

NB: Please specify lead time…………………………………. days after order award.

Kindly complete the following information:

Vendor Name: ________________________________________________________________________________________

Vendor Registration No.: ________________________________ Vat Reg. No.: ________________________________

Tel. Number: ___________________________________________ Fax. Number: ________________________________

Name (Block Letters): __________________________________________________________________________________

Vendor Office Address._________________________________________________________________________________

Quotation Date: ______________________________________ Signature: ___________________________________

Vendor E-mail address:________________________________________________________________

Vendor CSD Registration No: ______________________________________

AMATOLA WATER RFQ: 1064 PROVISION OF OCCUPATIONAL HYGIENE SURVEYS 16 of 45

Annexure 4

Compulsory Returnable Schedules

AMATOLA WATER RFQ: 1064 PROVISION OF OCCUPATIONAL HYGIENE SURVEYS 17 of 45

COMPULSORY RETURNABLE SCHEDULES CHECKLIST AS PER ANNEXURE 4

REQUIREMENTS BELOW

Compulsory Returnable Schedules Required for Evaluation Purposes

Tick if completed / submitted

1 Proof of CSD Registration

2 Declaration of Interest

3 Preference Points Claim Form

4 B-BBEE Verification Certificate / Affidavit

5 Declaration of bidder’s past supply chain management

practices

6 Certificate of independent bid determination

7 Reference Schedule

8 Local Content Declaration ( not applicable)

AMATOLA WATER RFQ: 1064 PROVISION OF OCCUPATIONAL HYGIENE SURVEYS 18 of 45

Annexure 4

Returnable Schedules Required for Eligibility and Evaluation Purposes

1. DECLARATION OF INTEREST (SBD4)

1. Declaration of Interest

1.1 Any legal person, including persons employed by the state¹, or persons having a kinship with

persons employed by the state, including a blood relationship, may make an offer or offers in

terms of this invitation to bid (includes a price quotation, advertised competitive bid, limited

bid or proposal). In view of possible allegations of favouritism, should the resulting bid, or part

thereof, be awarded to persons employed by the state, or to persons connected with or

related to them, it is required that the bidder or his/her authorised representative declare

his/her position in relation to the evaluating/adjudicating authority where-

the bidder is employed by the state; and/or

the legal person on whose behalf the bidding document is signed, has a relationship with

persons/a person who are/is involved in the evaluation and or adjudication of the bid(s),

or where it is known that such a relationship exists between the person or persons for or

on whose behalf the declarant acts and persons who are involved with the evaluation

and or adjudication of the bid.

2. In order to give effect to the above, the following questionnaire must be completed and submitted

with the bid.

2.1 Full Name of bidder or his or her representative: ____________________________________________

2.2 Identity Number: _________________________________________________________________________

2.3 Position occupied in the Company (director, trustee, shareholder²): ________________________

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 / persal numbers must

be indicated in paragraph three below.

¹“State” means –

Attach Relevant Document

AMATOLA WATER RFQ: 1064 PROVISION OF OCCUPATIONAL HYGIENE SURVEYS 19 of 45

(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.

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 / 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 YES / NO

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 to the bid YES / NO

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:

______________________________________________________________________

______________________________________________________________________

AMATOLA WATER RFQ: 1064 PROVISION OF OCCUPATIONAL HYGIENE SURVEYS 20 of 45

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 the state in the previous twelve months?

2.8.1 If so, furnish particulars:

____________________________________________________________________________________

____________________________________________________________________________________

2.9 Do you, or any person connected with the bidder, have YES / NO

any relationship (family, friend, other) with a person

employed by the state and who may be involved with

the evaluation and or adjudication of this bid?

2.9.1 If so, furnish particulars:

____________________________________________________________________________________

____________________________________________________________________________________

2.10 Are you, or any person connected with the bidder, YES/NO

aware of any relationship (family, friend, other) between

any other bidder and any person employed by the state

who may be involved with the evaluation and or adjudication

of this bid?

2.10.1 If so, furnish particulars:

___________________________________________________________________________________

___________________________________________________________________________________

2.11 Do you or any of the directors / trustees / shareholders / members YES/NO

of the company have any interest in any other related companies

whether or not they are bidding for this contract?

2.11.1 If so, furnish particulars:

___________________________________________________________________________

_____________________________________________________________________________

AMATOLA WATER RFQ: 1064 PROVISION OF OCCUPATIONAL HYGIENE SURVEYS 21 of 45

3 Full details of Directors / Trustees / Members / Shareholders

Full Name Identity Number Personal Tax Reference

Number State Employee Number

/ Personal Number

4 Declaration

I, the undersigned (name) _______________________________________________________________________________________

Certify that the information furnished in paragraphs 2 and 3 above is correct.

I accept that the state may reject the bid or act against me in terms of paragraph 23 of the general conditions of

contract should this declaration prove to be false.

_________________________________________ _________________________________________

Signature Date

_________________________________________ _________________________________________

Position Name of Bidder

May 2011

2. PREFERENCE POINTS CLAIM FORM IN TERMS OF THE PREFERENTIAL PROCUREMENT REGULATIONS

2011 (SBD 6.1)

This preference form must form part of all bids invited. It contains general information and serves as a

claim form for preference points for Broad-Based Black Economic Empowerment (B-BBEE) Status Level of

Contribution

NB: Before completing this form, bidders must study the general conditions, definitions and directives

applicable in respect of B-BBEE, as prescribed in the preferential procurement regulations, 2011.

1. General Conditions

1.1 The following preference point systems are applicable to all bids:

the 80/20 system for requirements with a Rand value of up to R50 000 000 (all applicable

taxes included); and

the 90/10 system for requirements with a Rand value above R50 000 000 (all applicable

taxes included).

2. The value of this bid is estimated to not exceed R50 000 000 (all applicable taxes included) and

therefore the __________________________________ system shall be applicable.

AMATOLA WATER RFQ: 1064 PROVISION OF OCCUPATIONAL HYGIENE SURVEYS 22 of 45

3. Preference points for this bid shall be awarded for:

Price; and

B-BBEE Status Level of Contribution.

3.1 The maximum points for this bid are allocated as follows:

Points

3.1.1 Price 80

3.1.2 B-BBEE Status Level of Contribution 20

Total points for Price and B-BBEE must not exceed 100

4. Failure on the part of a bidder to fill in and/or to sign this form and submit a B-BBEE Verification

Certificate from a Verification Agency accredited by the South African Accreditation System

(SANAS) or a Registered Auditor approved by the Independent Regulatory Board of Auditors (IRBA)

or an Accounting Officer as contemplated in the Close Corporation Act (CCA) together with the

bid, will be interpreted to mean that preference points for B-BBEE status level of contribution are not

claimed.

5. The purchaser reserves the right to require of a bidder, either before a bid is adjudicated or at any

time subsequently, to substantiate any claim in regard to preferences, in any manner required by

the purchaser.

3. DEFINITIONS

2.1 “all applicable taxes” includes value-added tax, pay as you earn, income tax, unemployment

Insurance fund contributions and skills development levies;

2.2 “B-BBEE” means broad-based black economic empowerment as defined in section 1 of the Broad

-Based Black Economic Empowerment Act;

2.3 “B-BBEE status level of contributor” means the B-BBEE status received by a measured entity

based on its overall performance using the relevant scorecard contained in the Codes of Good

Practice on Black Economic Empowerment, issued in terms of section 9(1) of the Broad-Based

Black Economic Empowerment Act;

2.4 “bid” means a written offer in a prescribed or stipulated form in response to an invitation by

an organ of state for the provision of services, works or goods, through price quotations,

advertised competitive bidding processes or proposals;

2.5 “Broad-Based Black Economic Empowerment Act” means the Broad-Based Black Economic

Empowerment Act, 2003 (Act No. 53 of 2003);

2.6 “comparative price” means the price after the factors of a non-firm price and all unconditional

discounts that can be utilized have been taken into consideration;

2.7 “consortium or joint venture” 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;

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2.7 “contract” means the agreement that results from the acceptance of a bid by an organ of

state;

2.9 “EME” means any enterprise with an annual total revenue of R5 million or less.

2.10 “Enterprise Development” constitutes the support of other businesses with the intention of

achieving specific impact as defined in the B-BBEE Codes. All enterprise development activities

must achieve growth and sustainability and ultimate financial and operational independence

of beneficiaries

2.11 “Firm price” means the price that is only subject to adjustments in accordance with the actual

increase or decrease resulting from the change, imposition, or abolition of customs or excise

duty and any other duty, levy, or tax, which, in terms of the law or regulation, is binding on the

contractor and demonstrably has an influence on the price of any supplies, or the rendering

costs of any service, for the execution of the contract;

2.12 “functionality” means the measurement according to predetermined norms, as set out in the

bid documents, of a service or commodity that is designed to be practical and useful, working

or operating, taking into account, among other factors, the quality, reliability, viability and

durability of a service and the technical capacity and ability of a bidder;

2.13 “non-firm prices” means all prices other than “firm” prices;

2.14 “person” includes a juristic person;

2.15 “rand value” means the total estimated value of a contract in South African currency,

calculated at the time of bid invitations, and includes all applicable taxes and excise duties;

2.16 “sub-contract” means the primary contractor’s assigning, leasing, making out work to, or

employing, another person to support such primary contractor in the execution of part of a

project in terms of the contract;

2.17 “total revenue” bears the same meaning assigned to this expression in the Codes of Good

Practice on Black Economic Empowerment, issued in terms of section 9(1) of the Broad-Based

Black Economic Empowerment Act and promulgated in the Government Gazette on 9

February 2007;

2.18 “trust” means the arrangement through which the property of one person is made over or

bequeathed to a trustee to administer such property for the benefit of another person; and

2.19 “trustee” means any person, including the founder of a trust, to whom property is bequeathed in

order for such property to be administered for the benefit of another person.

3. ADJUDICATION USING A POINT SYSTEM

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3.1 The bidder obtaining the highest number of total points will be awarded the contract.

3.2 Preference points shall be calculated after prices have been brought to a comparative basis

taking into account all factors of non-firm prices and all unconditional discounts;.

3.3 Points scored must be rounded off to the nearest 2 decimal places.

3.4 In the event that two or more bids have scored equal total points, the successful bid

must be the one scoring the highest number of preference points for B-BBEE.

3.5 However, when functionality is part of the evaluation process and two or more bids have

scored equal points including equal preference points for B-BBEE, the successful bid must

be the one scoring the highest score for functionality.

3.6 Should two or more bids be equal in all respects, the award shall be decided by the

drawing of lots.

4. POINTS AWARDED FOR PRICE

4.1 The 80/20 or 90/10 Preference Point Systems

A maximum of 80 or 90 points is allocated for price on the following basis:

80/20 or 90/10

min

min180

P

PPtPs or

min

min190

P

PPtPs

Where

Ps = Points scored for comparative price of bid under consideration

Pt = Comparative price of bid under consideration

Pmin = Comparative price of lowest acceptable bid

5. Points awarded for B-BBEE Status Level of Contribution

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5.1 In terms of Regulation 5 (2) and 6 (2) of the Preferential Procurement Regulations, preference

points must be awarded to a bidder for attaining the B-BBEE status level of contribution in

accordance with the table below:

B-BBEE Status Level of

Contributor

Number of points (90/10

system)

Number of points (80/20

system)

1 10 20

2 9 18

3 8 14

4 5 12

5 4 8

6 3 6

7 2 4

8 1 2

Non-compliant contributor 0 0

5.2 Bidders who qualify as EMEs in terms of the B-BBEE Act must submit a certificate issued by an

Accounting Officer as contemplated in the CCA or a Verification Agency accredited by SANAS

or a Registered Auditor. Registered auditors do not need to meet the prerequisite for IRBA’s

approval for the purpose of conducting verification and issuing EMEs with B-BBEE Status Level

Certificates.

5.3 Bidders other than EMEs must submit their original and valid B-BBEE status level verification

certificate or a certified copy thereof, substantiating their B-BBEE rating issued by a Registered

Auditor approved by IRBA or a Verification Agency accredited by SANAS.

5.4 A trust, consortium or joint venture, will qualify for points for their B-BBEE status level as a legal

entity,

provided that the entity submits their B-BBEE status level certificate.

5.5 A trust, consortium or joint venture will qualify for points for their B-BBEE status level as an

unincorporated entity, provided that the entity submits their consolidated B-BBEE scorecard as if

they were a group structure and that such a consolidated B-BBEE scorecard is prepared for

every separate bid.

5.6 Tertiary institutions and public entities will be required to submit their B-BBEE status level

certificates in terms of the specialized scorecard contained in the B-BBEE Codes of Good

Practice.

5.7 A person will not be awarded points for B-BBEE status level if it is indicated in the bid documents

that such a bidder intends sub-contracting more than 25% of the value of the contract to any

other enterprise that does not qualify for at least the points that such a bidder qualifies for, unless

the intended sub-contractor is an EME that has the capability and ability to execute the sub-

contract.

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5.8 A person awarded a contract may not sub-contract more than 25% of the value of the contract

to any other enterprise that does not have an equal or higher B-BBEE status level than the

person concerned, unless the contract is sub-contracted to an EME that has the capability and

ability to execute the sub-contract.

6. BID DECLARATION

6.1 Bidders who claim points in respect of B-BBEE Status Level of Contribution must complete the

following:

7. B-BBEE STATUS LEVEL OF CONTRIBUTION CLAIMED IN TERMS OF PARAGRAPHS 1.3.1.2 AND 5.1

7.1 B-BBEE Status Level of Contribution: ________________ = _________________

(maximum of 10 or 20 points).

(Points claimed in respect of paragraph 7.1 must be in accordance with the table reflected in

paragraph 5.1 and must be substantiated by means of a B-BBEE certificate issued by a

Verification Agency accredited by SANAS or a Registered Auditor approved by IRBA or an

Accounting Officer as contemplated in the CCA).

8 SUB-CONTRACTING

8.1 Will any portion of the contract be sub-contracted? YES / NO (delete which is not applicable)

8.1.1 If yes, indicate:

(a) what percentage of the contract will be subcontracted?______________________________%

(b) the name of the sub-contractor? ______________________________________________________

(c) the B-BBEE status level of the sub-contractor?___________________________________________

(d) whether the sub-contractor is an EME? YES / NO (delete which is not applicable)

9 DECLARATION WITH REGARD TO COMPANY/FIRM

9.1 Name of company/firm: ____________________________________________________________________

9.2 VAT registration number: ____________________________________________________________________

9.3 Company registration number: ______________________________________________________________

9.4 Type of Company / Firm

Partnership/Joint Venture / Consortium

One person business/sole propriety

Close corporation

Company

(Pty) Limited

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9.5 Describe Principal Business Activities

_____________________________________________________________________________________________

___________________________________________________________________________________________

9.6 Company Classification

Manufacturer

Supplier

Professional service provider

Other service providers, e.g. transporter, etc.

9.7 Total number of years the company/firm has been in business? ________________________________

9.8 I / we, the undersigned, who is / are duly authorised to do so on behalf of the company/firm,

certify that the points claimed, based on the B-BBE status level of contribution indicated in

paragraph 7 of the foregoing certificate, qualifies the company/ firm for the preference(s)

shown and I / we acknowledge that:

(a) The information furnished is true and correct;

(b) The preference points claimed are in accordance with the General Conditions as

indicated in paragraph 1 of this form.

(c) In the event of a contract being awarded as a result of points claimed as shown in

paragraph 7, the contractor may be required to furnish documentary proof to the

satisfaction of the purchaser that the claims are correct;

(d) If the B-BBEE status level of contribution has been claimed or obtained on a

fraudulent basis or any of the conditions of contract have not been fulfilled, the

purchaser may, in addition to any other remedy it may have

disqualify the person from the bidding process;

recover costs, losses or damages it has incurred or suffered as a result of that

person’s conduct;

cancel the contract and claim any damages which it has suffered as a result

of having to make less favourable arrangements due to such cancellation;

restrict the bidder or contractor, its shareholders and directors, or only the

shareholders and directors who acted on a fraudulent basis, from obtaining

business from any organ of state for a period not exceeding 10 years, after the

audi alteram partem (hear the other side) rule has been applied; and

forward the matter for criminal prosecution

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Witnesses:

_______________________________________________ ________________________________________________

Witness 1 Witness 2

_______________________________________________

Witness 3

_______________________________________________ _________________________________________________

Signature of Bidder(s) Signature of Bidder(s)

Date: _______________________________________ Address: _________________________________________

4. B-BBEE VERIFICATION CERTIFICATE (SBD 6.1)

Bidders are to attach an original and valid B-BBEE verification certificate or a certified copy.

ATTACH RELEVANT DOCUMENT

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5. DECLARATION OF BIDDER’S PAST SUPPLY CHAIN MANAGEMENT PRACTICES (SBD 8)

1 This Standard Bidding Document must form part of all bids invited.

2 It 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.

3 The bid of any bidder may be disregarded if that bidder, or any of its directors have-

(a) 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.

4 In order to give effect to the above, the following questionnaire must be completed and

submitted with the bid.

Item Question Yes No

4.1 Is the bidder or any of its directors listed on the National Treasury’s database 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 National Treasury after the audi alteram partem rule was applied).

Yes

No

4.1.1 If so, furnish particulars:

4.2 Is the bidder 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)?

To access this Register enter the National Treasury’s website, www.treasury.gov.za, click on

the icon “Register for Tender Defaulters” or submit your written request for a hard copy of

the Register to facsimile number (012) 3265445.

Yes

No

4.2.1 If so, furnish particulars:

4.3 Was the bidder 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?

Yes

No

4.3.1 If so, furnish particulars:

4.4 Was any contract between the bidder and any organ of state terminated during the past

five years on account of failure to perform on or comply with the contract?

Yes

No

4.4.1 If so, furnish particulars:

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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

6. CERTIFICATE OF INDEPENDENT BID DETERMINATION (SBD9)

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.

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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

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.

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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.

10. I am aware that, in addition and without prejudice to any other remedy provided to combat any

restrictive practices related to bids and contracts, bids that are suspicious will be reported to the

Competition Commission for investigation and possible imposition of administrative penalties in terms

of section 59 of the Competition Act No 89 of 1998 and or may be reported to the National

Prosecuting Authority (NPA) for criminal investigation and or may be restricted from conducting

business with the public sector for a period not exceeding ten (10) years in terms of the Prevention

and Combating of Corrupt Activities Act No 12 of 2004 or any other applicable legislation.

_______________________________________________ _______________________________________________

Signature Date

_______________________________________________ _______________________________________________

Position Name of Bidder

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(not applicable) SBD 6.2

DECLARATION CERTIFICATE FOR LOCAL PRODUCTION AND CONTENT FOR DESIGNATED SECTORS

This Standard Bidding Document (SBD) must form part of all bids invited. It contains general information and serves as a declaration form for local content (local production and local content are used interchangeably).

Before completing this declaration, bidders must study the General Conditions, Definitions, Directives applicable in respect of Local Content as prescribed in the Preferential Procurement Regulations, 2011, the South African Bureau of Standards (SABS) approved technical specification number SATS 1286:2011 (Edition 1) and the Guidance on the Calculation of Local Content together with the Local Content Declaration Templates [Annex C (Local Content Declaration: Summary Schedule), D (Imported Content Declaration: Supporting Schedule to Annex C) and E (Local Content Declaration: Supporting Schedule to Annex C)].

1. General Conditions

1.1. Preferential Procurement Regulations, 2011 (Regulation 9) makes provision for the promotion of local

production and content.

1.2. Regulation 9.(1) prescribes that in the case of designated sectors, where in the award of bids local production and content is of critical importance, such bids must be advertised with the specific bidding condition that only locally produced goods, services or works or locally manufactured goods, with a stipulated minimum threshold for local production and content will be considered.

1.3. Where necessary, for bids referred to in paragraph 1.2 above, a two stage bidding process may be

followed, where the first stage involves a minimum threshold for local production and content and the second stage price and B-BBEE.

1.4. A person awarded a contract in relation to a designated sector, may not sub-contract in such a manner

that the local production and content of the overall value of the contract is reduced to below the stipulated minimum threshold.

1.5. The local content (LC) expressed as a percentage of the bid price must be calculated in accordance

with the SABS approved technical specification number SATS 1286: 2011 as follows: LC = [1 - x / y] * 100

Where

x is the imported content in Rand y is the bid bid price in Rand excluding value added tax (VAT)

Prices referred to in the determination of x must be converted to Rand (ZAR) by using the exchange rate published by South African Reserve Bank (SARB) at 12:00 on the date of advertisement of the bid as indicated in paragraph 4.1 below. The SABS approved technical specification number SATS 1286:2011 is accessible on http:/www.thedti.gov.za/industrial development/ip.jsp at no cost.

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1.6 A bid may be disqualified if – (a) this Declaration Certificate and the Annex C (Local Content Declaration: Summary Schedule)

are not submitted as part of the bid documentation; and

(b) the bidder fails to declare that the Local Content Declaration Templates (Annex C, D and E) have been audited and certified as correct.

2. Definitions

2.1. “bid” includes written price quotations, advertised competitive bids or proposals;

2.2. “bid price” price offered by the bidder, excluding value added tax (VAT);

2.3. “contract” means the agreement that results from the acceptance of a bid by an organ of state;

2.4. “designated sector” means a sector, sub-sector or industry that has been designated by the

Department of Trade and Industry in line with national development and industrial policies for local production, where only locally produced services, works or goods or locally manufactured goods meet the stipulated minimum threshold for local production and content;

2.5. “duly sign” means a Declaration Certificate for Local Content that has been signed by the Chief

Financial Officer or other legally responsible person nominated in writing by the Chief Executive, or senior member / person with management responsibility(close corporation, partnership or individual).

2.6. “imported content” means that portion of the bid price represented by the cost of components, parts

or materials which have been or are still to be imported (whether by the supplier or its subcontractors) and which costs are inclusive of the costs abroad (this includes labour or intellectual property costs), plus freight and other direct importation costs, such as landing costs, dock duties, import duty, sales duty or other similar tax or duty at the South African port of entry;

2.7. “local content” means that portion of the bid price which is not included in the imported content,

provided that local manufacture does take place;

2.8. “stipulated minimum threshold” means that portion of local production and content as determined by the Department of Trade and Industry; and

2.9. “sub-contract” means the primary contractor’s assigning, leasing, making out work to, or employing

another person to support such primary contractor in the execution of part of a project in terms of the contract.

3. The stipulated minimum threshold(s) for local production and content (refer to Annex A of SATS

1286:2011) for this bid is/are as follows:

Description of services, works or goods Stipulated minimum threshold

_______________________________ _______%

_______________________________ _______% _______________________________ _______%

4. Does any portion of the services, works or goods offered have any imported content?

(Tick applicable box)

YES NO

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4.1 If yes, the rate(s) of exchange to be used in this bid to calculate the local content as prescribed in

paragraph 1.5 of the general conditions must be the rate(s) published by SARB for the specific currency at 12:00 on the date of advertisement of the bid.

The relevant rates of exchange information is accessible on www.reservebank.co.za. Indicate the rate(s) of exchange against the appropriate currency in the table below (refer to Annex A of SATS 1286:2011):

Currency Rates of exchange

US Dollar

Pound Sterling

Euro

Yen

Other

NB: Bidders must submit proof of the SARB rate (s) of exchange used. 5. Were the Local Content Declaration Templates (Annex C, D and E) audited and certified as correct?

(Tick applicable box)

YES NO

5.1. If yes, provide the following particulars:

(a) Full name of auditor: ……………………………………………………… (b) Practice number: ……………………………………………………………………….. (c) Telephone and cell number: ………………………………………………………………. (d) Email address: ………………………………………………………………………..

(Documentary proof regarding the declaration will, when required, be submitted to the satisfaction of the Accounting Officer / Accounting Authority)

6. Where, after the award of a bid, challenges are experienced in meeting the stipulated minimum threshold for local content the dti must be informed accordingly in order for the dti to verify and in consultation with the AO/AA provide directives in this regard.

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LOCAL CONTENT DECLARATION (REFER TO ANNEX B OF SATS 1286:2011)

LOCAL CONTENT DECLARATION BY CHIEF FINANCIAL OFFICER OR OTHER LEGALLY RESPONSIBLE PERSON NOMINATED IN WRITING BY THE CHIEF EXECUTIVE OR SENIOR MEMBER/PERSON WITH MANAGEMENT RESPONSIBILITY (CLOSE CORPORATION, PARTNERSHIP OR INDIVIDUAL)

IN RESPECT OF BID NO. ................................................................................. ISSUED BY: (Procurement Authority / Name of Institution): ......................................................................................................................... NB 1 The obligation to complete, duly sign and submit this declaration cannot be transferred to an external authorized representative, auditor or any other third party acting on behalf of the bidder. 2 Guidance on the Calculation of Local Content together with Local Content Declaration Templates (Annex C, D and E) is accessible on http://www.thdti.gov.za/industrial development/ip.jsp. Bidders should first complete Declaration D. After completing Declaration D, bidders should complete Declaration E and then consolidate the information on Declaration C. Declaration C should be submitted with the bid documentation at the closing date and time of the bid in order to substantiate the declaration made in paragraph (c) below. Declarations D and E should be kept by the bidders for verification purposes for a period of at least 5 years. The successful bidder is required to continuously update Declarations C, D and E with the actual values for the duration of the contract. I, the undersigned, …………………………….................................................... (full names), do hereby declare, in my capacity as ……………………………………… ……….. of ...............................................................................................................(name of bidder entity), the following:

(a) The facts contained herein are within my own personal knowledge. (b) I have satisfied myself that:

(i) the goods/services/works to be delivered in terms of the above-specified bid comply with the minimum local content requirements as specified in the bid, and as measured in terms of SATS 1286:2011; and

(ii) the declaration templates have been audited and certified to be correct.

(c) The local content percentage (%) indicated below has been calculated using the formula given in clause 3 of SATS 1286:2011, the rates of exchange indicated in paragraph 4.1 above and the information contained in Declaration D and E which has been consolidated in Declaration C:

Bid price, excluding VAT (y) R

Imported content (x), as calculated in terms of SATS 1286:2011 R

Stipulated minimum threshold for local content (paragraph 3 above)

Local content %, as calculated in terms of SATS 1286:2011

If the bid is for more than one product, the local content percentages for each product contained in Declaration C shall be used instead of the table above. The local content percentages for each product has been calculated using the formula given in clause 3 of SATS 1286:2011, the rates of exchange indicated in paragraph 4.1 above and the information contained in Declaration D and E.

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(d) I accept that the Procurement Authority / Institution has the right to request that the local content be verified in terms of the requirements of SATS 1286:2011. (e) I understand that the awarding of the bid is dependent on the accuracy of the information furnished in this application. I also understand that the submission of incorrect data, or data that are not verifiable as described in SATS 1286:2011, may result in the Procurement Authority / Institution imposing any or all of the remedies as provided for in Regulation 13 of the Preferential Procurement Regulations, 2011 promulgated under the Preferential Policy Framework Act (PPPFA), 2000 (Act No. 5 of 2000). SIGNATURE: DATE: ___________ WITNESS No. 1 DATE: ___________ WITNESS No. 2 DATE: ___________

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LOCAL CONTENT ANNEXES C, D, E

SATS 1286.2011

Annex C

Local Content Declaration - Summary Schedule

(C1) Tender No.

(C2) Tender description:

(C3) Designated product(s)

(C4) Tender Authority:

(C5) Tendering Entity name:

(C6) Tender Exchange Rate: Pula EU GBP

(C7) Specified local content %

Calculation of local content Tender summary

Tender item

no's

Tender price

- each

(excl VAT)

Exempted

imported

value

Tender value

net of

exempted

imported

content

Imported

valueLocal value

Local

content %

(per item)

Tender

Qty

Total tender

value

Total exempted

imported content

Total Imported

content

(C8) (C10) (C11) (C12) (C13) (C14) (C15) (C16) (C17) (C18) (C19)

(C20) Total tender value R 0

Signature of tenderer from Annex B (C21) Total Exempt imported content R 0

(C22) Total Tender value net of exempt imported content R 0

(C23) Total Imported content

(C24) Total local content R 0

Date: (C25) Average local content % of tender

Note: VAT to be excluded from all

calculations

List of items

(C9)

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SATS 1286.2011

Annex D

Imported Content Declaration - Supporting Schedule to Annex C

(D1) Tender No.

(D2) Tender description:

(D3) Designated Products:

(D4) Tender Authority:

(D5) Tendering Entity name:

(D6) Tender Exchange Rate: Pula EU R 9.00 GBP R 12.00

Calculation of imported content Summary

Tender item

no'sLocal supplier

Overseas

Supplier

Forign

currency

value as per

Commercial

Invoice

Tender

Exchange

Rate

Local value of

imports

Freight costs to

port of entry

All locally

incurred

landing costs

& duties

Total landed

cost excl VAT

Tender

Qty

Exempted imported

value

(D7) (D9) (D10) (D11) (D12) (D13) (D14) (D15) (D16) (D17) (D18)

(D19) Total exempt imported value R 0

B. Imported directly by the Tenderer Calculation of imported content Summary

Tender item

no's

Unit of

measure

Overseas

Supplier

Forign

currency

value as per

Commercial

Invoice

Tender Rate

of Exchange

Local value of

imports

Freight costs to

port of entry

All locally

incurred

landing costs

& duties

Total landed

cost excl VAT

Tender

Qty

Total imported

value

(D20) (D22) (D23) (D24) (D25) (D26) (D27) (D28) (D29) (D30) (D31)

(D32) Total imported value by tenderer R 0

Calculation of imported content Summary

Unit of measure Local supplierOverseas

Supplier

Forign

currency

value as per

Commercial

Invoice

Tender Rate

of Exchange

Local value of

imports

Freight costs to

port of entry

All locally

incurred

landing costs

& duties

Total landed

cost excl VAT

Quantity

imported

Total imported

value

(D34) (D35) (D36) (D37) (D38) (D39) (D40) (D41) (D42) (D43) (D44)

(D45) Total imported value by 3rd party R 0

D. Other foreign currency paymentsSummary of

payments

Local supplier

making the

payment

Overseas

beneficiary

Foreign currency

value paid

Tender Rate

of Exchange

Local value of

payments

(D47) (D48) (D49) (D50) (D51)

(D52) Total of foreign currency payments declared by tenderer and/or 3rd party

Signature of tenderer from Annex B

(D53) Total of imported content & foreign currency payments - (D32), (D45) & (D52) above R 0

Date:

C. Imported by a 3rd party and supplied to the Tenderer

`

Description of imported content

(D33)

A. Exempted imported content

Note: VAT to be excluded

from all calculations

Description of imported content

(D8)

This total must correspond with

Annex C - C 23

This total must correspond with

Annex C - C 21

Calculation of foreign

currency payments

Type of payment

(D46)

Description of imported content

(D21)

`

AMATOLA WATER RFQ: 1064 PROVISION OF OCCUPATIONAL HYGIENE SURVEYS 41 of 45

SATS 1286.2011

(E1) Tender No.

(E2) Tender description:

(E3) Designated products:

(E4) Tender Authority:

(E5) Tendering Entity name:

Local Products

(Goods, Services

and Works)

Local suppliers Value % of LC

(E7) (E8)

(E9) Total local products (Goods, Services and Works) R 0

(E10) Manpower costs ( Tenderer's manpower cost) R 0

(E11) Factory overheads (Rental, depreciation & amortisation, utility costs, consumables etc.) R 0

(E12) Administration overheads and mark-up (Marketing, insurance, financing, interest etc.) R 0

(E13) Total local content R 0

Signature of tenderer from Annex B

Date:

This total must correspond with Annex C -

C24

Description of items purchased

Annex E

Local Content Declaration - Supporting Schedule to Annex C

(E6)

Note: VAT to be excluded from all

calculations

AMATOLA WATER RFQ: 1064 PROVISION OF OCCUPATIONAL HYGIENE SURVEYS 42 of 45

REFERENCE SCHEDULE

Suppliers are to provide details of similar work/services, which have recently been successfully completed. The information shall include a description of the

type of work, the contract value, contract duration and contactable references.

No. Client’s Name Nature of Work Total Value of

Contract (Excl. VAT)

Duration of Contract in

months/years

(to be indicated)

Details of Contactable References

Name Telephone Number

1.

2.

3.

4.

5.

Signed : ____________________________________________ Name: _____________________________________________ Date: ___________________________________________

Position: _________________________________________ Company: _________________________________________

AMATOLA WATER RFQ: 1064 PROVISION OF OCCUPATIONAL HYGIENE SURVEYS 43 of 45

Annexure 5

Conditions of Purchase

AMATOLA WATER RFQ: 1064 PROVISION OF OCCUPATIONAL HYGIENE SURVEYS 44 of 45

Annexure 5

Conditions of Purchase

1. Your submission of a quotation in response to this invitation signifies your acceptance of the Conditions

as laid down in this document.

(a) If you do not intend submitting a quotation, kindly advise us accordingly.

(b) Any expenses incurred by the Vendor in preparing and submitting his tender will be for the

Vendor’s account, as Amatola Water will not accept any liability in this regard.

(c) We reserve the right to correct discrepancies and errors as necessary with the consent of the

Vendor, however the tendered total of the prices shall remain unaltered.

2. All quotations submitted must be signed by an authorized company representative.

3. Amatola Water requires the quoted rate to remain firm for acceptance for a period of thirty days (30)

calendar days commencing from the closing date stated in this document. Where prices are subject to

variation it must be noted that no prices are to be revised and invoiced, without prior mutual

agreement and official modification of the order.

4. We reserve the right to accept any quotation other than the lowest quotation and to accept or reject

any quotation in whole or in part without notice or reason, and if no tender is accepted, to abandon

the work, or have it performed in such other manner as we may elect, or re-issue a similar enquiry at

any time of our choosing.

5. All goods supplied in terms of this order shall be packed and delivered carriage paid at Supplier’s risk

until delivered.

6. The Supplier shall mark clearly Amatola Water order number on the consignment package, delivery

notes, packing notes, advice notes, invoices, monthly statements and all correspondence relating

thereto.

7. Amatola Water shall be entitled to inspect the goods which are the subject matter of this order at any

reasonable time at the Supplier’s works or at the works of sub-contractors.

8. No part of this order shall be sub-contracted by the Supplier without Amatola Water’s prior consent in

writing.

9. Should Amatola Water during the installation and implementation period for any reason regard the

Contractor’s Service levels and performances against this contract as being inadequate and not to

Amatola Water’s satisfaction, the details will be reduced to writing, clearly headed “Inadequate

Performance” and sent to the Contractor. In the event that the Contractor is unable to remedy any

complaints to Amatola Water’s satisfaction within seven (7) days of such notice of inadequate

performance, Amatola Water reserves the right to immediately cancel this contract. Notice of

cancellation shall either be by fax or in writing.

10. All contractors and suppliers, providing services on any Amatola Water site, must fully comply with the

relevant Health and Safety Specifications. The relevant documentation will be forwarded to the

AMATOLA WATER RFQ: 1064 PROVISION OF OCCUPATIONAL HYGIENE SURVEYS 45 of 45

successful vendor for completion and the submission of a SHE Plan. No work may commence with the

approval of the SHE Plan submitted. Failure to comply with the Health and Safety Specifications by

either the Contractor or Supplier, or any of their employees, may result in them being removed from site

or being denied access to the site.

11. All tools, materials, specifications and other data provided by Amatola Water in connection with this

order shall remain at all times Amatola Water’s property, are to be surrendered to Amatola Water on

completion of the order and are to be used solely for the purpose of completing the same.

12. Unless otherwise stated, all goods must conform to applicable SABS specifications.

13. Amatola Water shall be entitled to cancel any order in respect of goods and/or services not received

on due date and hold the Supplier liable for damages.

14. Amatola Water shall not be liable for any orders other than those issued or confirmed on Amatola

Water’s official printed order forms duly signed on Amatola Water’s behalf by an authorized signatory

and any extensions or amendments thereto shall be issued on like forms.

15. This order and the subject matter thereof shall be treated as confidential between the Supplier

and Amatola Water and shall specifically not be used by the Supplier or any sub-contractor for

advertisement, display or publication without Amatola Water’s prior written consent.

16. This order shall be construed in all respects in accordance with the laws of the Republic of South Africa.

17. Amatola Water shall not forfeit prompt payment discount on account of delayed payment occasioned

by:

(a) failure by the Supplier to send on the day of dispatch of each consignment such advice(s) of

dispatch and invoice(s) as may be indicated on this order; and

(b) failure to mark clearly Amatola Water’s order number on the consignment package, delivery

notes, packaging notes, advice notes, invoices, monthly statements and all correspondence

relating thereto.

18. Unless otherwise agreed upon, payment for purchase of these goods will be made by Amatola Water,

30 days from date of Statement.