The Following Information Must Be Supplied in Full by the Supplier/Service Provider

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NAME OF COMPANY

______

(1) CORRECTNESS OF INFORMATION AFFIDAVIT

The following information must be supplied in full by the Supplier/Service provider

1. BUSINESS / ENTERPRISE PARTICULARS

1. Name of Company/Enterprise: ......
2. Postal Address: ......

Physical Address: ......

......

Telephone No: ...... Fax no: ......

Cell No: ......

1. Contact person: (Print Name) ......
2. Business Registration No : ......
3. Company/Enterprise Income Tax No : ......
4. PAYE No :......
5. VAT Registration No:......
6. Unemployment Insurance Fund No: ......
7. Workmen Compensation Registration No: ......
8. Regional Council/District Council no: ......

DECLARATION OF INTEREST

1.No bid will be accepted from persons in the service of the state.

1. Any person, having a kinship with persons in the service of the state, including a blood relationship, may make an offer or offers in terms of this invitation to bid. In view of possible allegations of favouritism, should the resulting bid, or part thereof, be awarded to persons connected with or related to persons in service of the state, it is required that the bidder or their authorised representative declare their positionin relation to the evaluating/adjudicating authority and/or take an oath declaring his/her interest.

3In order to give effect to the above, the following questionnaire must be completed and submitted with the bid.

3.1Full Name: …………………………………………………………………………

3.2Identity Number: …………………………………………………………………

3.3Company Registration Number: …………………………………………………

3.4Tax Reference Number: …………………………………………………………

3.5VAT Registration Number: ………………………………………………………

3.6Are you presently in the service of the state YES / NO

3.6.1If so, furnish particulars.

………………………………………………………………

………………………………………………………………

3.7Have you been in the service of the state for the past YES / NO

twelve months?

3.7.1If so, furnish particulars.

………………………………………………………………

………………………………………………………………

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3.8Do you, have any relationship (family, friend, other) with persons in the service of the state and who may be involved with the evaluation and or adjudication of this bid?

3.8.1If so, furnish particulars.

………………………………………………………………

………………………………………………………………

3.9Are you, aware of any relationship (family, friend, other) between a bidder and any persons in the service of the state who may be involved with the evaluation and or adjudication of this bid?

3.9.1If so, furnish particulars

…………………………………………………………….

…………………………………………………………….

YES / NO

YES / NO

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3.10Are any of the company’s directors, managers, principal YES / NO

shareholders or stakeholders in service of the state?

3.10.1If so, furnish particulars.

………………………………………………………………

………………………………………………………………

3.11Are any spouse, child or parent of the company’s directors, YES / NO

managers, principal shareholders or stakeholders in service

of the state?

3.11.1If so, furnish particulars.

………………………………………………………………

………………………………………………………………

CERTIFICATION

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

CERTIFY THAT THE INFORMATION FURNISHED ON THIS DECLARATION FORM IS CORRECT.

I ACCEPT THAT THE STATE MAY ACT AGAINST ME SHOULD THIS DECLARATION PROVE TO BE

FALSE.

…………………………………..……………………………………..

SignatureDate

………………………………….…………………………………………………………………………….

Position Name of Bidder

NB. COPIES OF VARIOUS REGISTRATION CERTIFICATES MUST BE SUPPLIED. Please tick the appropriate box for the certificates supplied.

1. FINANCIAL DETAIL (BANKING)

2.1Name of banking institution: ......

2.2Branch: ...... Branch No………………………………………….

2.3Town/City: ......

2.4Banking account number: ......

2.5Name under which the account is operated: ......

NB: DOCUMENTARY PROOF OF BANKING INSTITUTION MUST BE SUPPLIED

(Cancelled cheque or letter from Bank)

3. PARTICIPATION

Are you participating on this database as (tick one block)

NOTE: All pages of this Affidavit must be initialed by both the Deponent and the Commissioner of Oaths.

......

......

......

4. PRINCIPAL BUSINESS ACTIVITY: (Tick the category of business that applies to your company)

5. COMPANY/ENTERPRISE INFORMATION

In which of the categories mentioned in the table below do you (the supplier/service provider) fall?

(Mark with an x where applicable.) See attached.

6.PARTICULARS OF EMPLOYEES

State the total numbers of permanent and temporary staff employed

7. PARTICULARS OF EMPLOYERS

State the number of Males/ Females that own the company.

8. What percentage of share is owned by Females: ______%

NOTE: All pages of this Affidavit must be initialed by both the Deponent and the Commissioner of Oaths.

9.PREVIOUS EXPERIENCE

List the last 4 contracts/quotations awarded to you or previous experience with other firms/companies related

to the type of work/services that you can offer the Umtshezi Municipality

NOTE: All pages of this Affidavit must be initialed by both the Deponent and the Commissioner of Oaths.

10. CERTIFICATION OF CORRECTNESS OF INFORMATION SUPPLIED IN THIS DOCUMENT

AND THE ATTACHED ANNEXURE RELATING TO THE PREFERENCE CLAIM

I/ WE THE UNDERSIGNED, WHO WARRANTS THAT HE/SHE IS DULY AUTHORIZED TO DO SO

ON BEHALF OF THE SERVICE PROVIDER/SUPPLIER CERTIFIES THAT THE INFORMATION SUPPLIED IN TERMS OF THIS DOCUMENT IS CORRECT AND ACCURATE AND ACKNOWLEDGES THAT:

The Service provider/Supplier will be required to furnish documentary proof of the claims if requested to

do so.

If the information supplied is found to be incorrect then the UMTSHEZI MUNICIPALITY may:-

10.1. Recover from the Service provider/Supplier all costs, losses or damages incurred or sustained by the

State as a result of the award of the contract/service, and/or

10.2.Cancel the contract/service and claim any damages which the State may suffer by having to make favorable arrangements after such cancellations: an/or

10.3.Impose a penalty on the Service provider/Supplier not exceeding 5% of the contract/service value.

SIGNED ON THIS ...... DAY OF ...... AT ......

BEFORE THE COMMISSIONER OF OATHS

......

SIGNATURE ON BEHALF OF THE (TENDERER’S NAME) ......

IN BLOCK LETTERS ……………………………….……………………………………………………………

NOTE: All pages of this Affidavit must be initialed by both the Deponent and the Commissioner of Oaths.

CONDITIONS PERTAINING TO TARGETED PROCUREMENT

FOR CONTRACTS/SERVICES UNDER R58,000.00

Prime Contracts (Minor)

Definitions and Interpretations

Affiliated Entity

Affirmable Business Enterprise (ABE)

1. The following words and expressions having capital initial letters, shall have the meanings

indicated.

1.1. A business entity which has control of or the power to control another business entity, albeit indirectly, e.g., where a third person has control of or has the power to control both entities. Indicators of control shall, without limitation, include interlocking management or ownership, identity of interests among family members, shared facilities and equipment, or common use of employees.

1.2. This Condition of procurement refers to and is read with the Conditions Pertaining to Targeted Procurement for Contracts/Services Under R58 thousand rands included in these documents.

1.3. Defined terms have the meanings given to them in the Specification.

1.4. A business which adheres to statutory labour practices, is a legal entity, registered with the Department of Inland Revenue and a continuing and Independent Enterprise for profit, providing a Commercially Useful Function and:

a) which is at least two thirds Owned by one or more Previously Disadvantaged Individuals or, in the case of a company, at least two thirds of the shares are owned by one or more Previously Disadvantaged Individuals; and

b) whose management and daily business operations are in the control

of one or more of the Previously Disadvantaged Individuals who effectively own it:- provided, however, that the annual average turnover excluding Value Added Tax (VAT) of the business during the lesser of the period of which the business has been operating and the previous three financial years does not exceed:

• R25 millions in respect of contractors/service providers who generate more than 75% of their turnover as Prime Contractors

• R10 million in respect of contractor/service providers who generate less than 25% of their turnover as Prime Contractors/Service providers (labour and material sub-contractors)

• R2,5 million in respect of labour-only sub-contractors

• R10 million in respect of Manufacturers

• R15 million in respect of Suppliers

• R2,5 million, exclusive of any turnover generated in respect of out sourced activities which the enterprise does not have the in-house competence and expertise to perform, in respect of professional services providers, and

• R2,5 million in respect of other service providers, e.g. transporters and that the sum of the average Annual turnovers over the same period of all the business concerns which are under the Control of Previously Disadvantaged Individuals within the business entity and Affiliated Entities does not exceed one and a half (1.5) times the maximum allowable annual average turnover for the particular category of enterprise as set out in b) above, seeking ABE status.

NOTE: The restriction on turnover of all Affiliated Business Entities applies only in respect of the category of work for which the ABE participates in the performance of the Contract/Service. This in practice means that where Previously Disadvantaged Individuals have interests in a business not operating in the field in which an ABE is seeking participation in the Contract/Service, such business turnovers are not considered in determining the total annual average turnover limits.

Commercially Useful

Function

1.3.The possession and exercise of legal authority and power to manage the assets, goodwill and daily operations of a business and the active and continuous exercise of appropriate managerial authority and power in determining the policies and directing the operations of the business.

Control

1.4. The performance of real and actual work, or the provision of services, in the discharge of any contractual obligation, which shall include but not be limited to the performance of a distinct element of work which the business has the skill and expertise to undertake and the responsibility for management and supervision.

Executive Director

1.5. A partner in a partnership, a director of a company established in terms of the Companies Act 1973, (Act 61 of 1973) or a member of a close corporation registered in terms of the Close Corporation Act, who, jointly and severally with her other partners, co-directors or co-members, as the case may be, bears the risk of business and takes responsibility for the management and liabilities of the partnership, company, or close corporation.

Independent Enterprise

1.6. An enterprise which is free of any degree of direct or indirect Ownership, or Control, by any firm which engages in activities similar to those which the enterprise performs, or by any Executive Director of such a firm who is not a Previously Disadvantaged Individual.

NOTE:Any enterprise whose owners include firms which engage in the majority of activities that would be required of a Prime Contractor in the execution of the Contract/Service cannot claim Affirmable Business Enterprise or Women Equity Ownership status. Likewise any enterprise which has any non-PDI Executive Directors who have interests in such firms cannot claim such status.

Manufacturer

1.7. A firm that operates or maintains a factory or establishment that produces on its premises materials or supplies required by the Prime Contractor for the performance of the Contract/Service.

Owned

1.8. Having all the customary incidents of ownership, including the right of dispositions and sharing all the risks and profits commensurate with the degree of ownership interests as demonstrated by an examination of the substance, rather than the form of ownership arrangements.

Historically Disadvantaged Individuals (HDI)

1.9. Individuals who, being South African citizens, are socially and economically disadvantaged by the legacy of the South African political dispensation prior to April 28, 1994. For the purpose of the Contract, the refutable presumption shall be made that individuals who fall into population groups that had no franchise in national elections prior to the introduction of the 1984 constitution and the tricameral parliamentary system, are Previously Disadvantaged Individuals, subject to persons who obtained South African citizenship after 2 February 1990, demonstrating traceable South African parentage. 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 group.

Prime Contractor/Service Provider

1.10. A contractor/service provider who contracts with an employer as the principal or main contractor/service provider or as a joint venture partner to such contractors, to provide goods, services and works.

Supplier

1.11. A firm that:

a) owns, operates or maintains a store, warehouse, or other establishment in which materials or supplies are bought, kept in stock and regularly sold to the public in the usual course of business; and

b) engages as its principal business and in its own name, in the purchase and sale of the products.

Woman

1.12.A female person who is a South African citizen and a female at birth.

Women Equity Ownership (WEO)

1.13.The collection Ownership percentage of full time Executive Directors within an enterprise who are Women.

Local

1.14A Manufacturer, Service Provider or Supplier with its main office situated and operated

In the Umtshezi Municipal area.

1.15 Also suppliers who has a fully fledged office in Umtshezi qualifies.

Adjudication of quotations on a point system

2. The following shall be the system of Adjudicating Contracts/Services on a points system.

2.1. Adjudication Using a Points System : Allign to PPPFA

Responsive Quotations will be adjudicated by the Umtshezi Municipality using a system which awards points on

the basis of:

•HDI - No Franchise - Women - Disable

•The status of the enterprise in terms of ownership

• Affirmable Business Enterprises

•Local Preference

The Umtshezi Municipality will normally award the Quotation to the Supplier/service provider obtaining the highest number of points, but will not bind itself to do so.

2.2. Points Awarded for Price (Qp)

A maximum of 87.5 points is allocated to the quotation with the lowest price as per specification/requirements

and points for other and points for other Suppliers/Service Providers are calculated using the following formulae:

PS=80 (1 - (PE-Pmin)

Pmin

Where:

Qp= Points for quotation under consideration

Pm= Price of the lowest quotation received

P = Price of the quotation under consideration

2.3. Points Awarded in respect of the Status of the Enterprise

A maximum of 20 (twenty) points can be awarded to businesses which comply & shared according to your preferences are legal entities registered with the South African Revenue Service, are continuing and Independent Enterprises for profit which perform Commercially Useful Functions and have been operating as such for at least 3 months and that they undertake to execute a substantial portion of the Contract/service with their own resources and not to subcontract any portions of the quotation for which they, in the opinion of the Umtshezi Municipality, have the in-house competence and expertise to perform.

Total Adjudicated Points

The total number of adjudicated points awarded (AP) is the sum of:

Qp + AB + WE + LP (not to exceed 100)

Process to be confidential

3. The following notes pertain to process confidentiality

3.1. Information supplied by Service providers/suppliers and information relating to clarification, evaluation and adjudication of quotations and the award of contracts/service will not be disclosed to Service providers/suppliers or any other person not officially concerned with such processes.

3.2.Any effort by a Supplier/service provider to influence the Municipalities processing of quotations or the award of the Contracts/services may result in the rejection of his/her quotation.

Documentation to be Submitted in support

4. The following document must be submitted by the service provider/supplier in support

4.1. Service provider/supplier who wish to claim points in respect of their enterprise status must complete an Application Form for the Award of Points in respect of the Status of an Enterprise (bound in this document) and shall, as relevant, include in their submissions the following duly completed forms:

•Affirmable Business Enterprise Declaration Affidavit

•Women Equity Ownership Declaration Affidavit

•Local preference should be a person who has a business for a period longer than 6 months

and is a permanent resident for one year or more

4.2. The failure to submit completed forms and / or the submission of incomplete forms referred to in 4.1. shall be deemed to imply that the Service provider/supplier is not claiming points in respect of his enterprise status, in which case points will be awarded only on the basis of the quoted price.

Penalty for falsifying the Declaration Affidavit

5. The following shall be the method of calculating penalties for falsifying the declaration Affidavits or change in enterprise status offer award of supplier/service provider without written consent from the Municipality.

5.1.Where the Supplier/Service Provider was adjudicated points in respect of enterprise parameters and the information given in the Declaration Affidavit is found to have been false, the Supplier/Service Provider shall pay the Umtshezi Municipality penalties in an amount equal to one and a half times the number of points claimed and awarded under false pretenses, expressed as a percentage of the contract/service amount, exclusive of VAT and all allowances for contingencies and escalation, at the time of the award of the Contract/Service.

Documentation to be Submitted by the Successful Supplier/Service Provider under Consideration

1. Any other documents that may be required by the Umtshezi Municipality which is relevant to the Contract/service and which may be required for adjudicating purposes.

(2) ABE DECLARATION AFFIDAVIT

Name of ABE firm: ………………………………………………………………..…………………………………………………………

a) Postal Address:…………………………………………………………………………………………………………….