Supplier Database Submission Form ppt

“FEEL THE BEAT AT AFRICA’S FEET” Name of Supplier: _________________________________ PREFERRED SUPPLIER DATABASE SUBMISSION Province: Only one province may be indicated per submission O

“FEEL THE BEAT AT AFRICA’S FEET”

Name of Supplier: _

PREFERRED SUPPLIER DATABASE SUBMISSION

Province: (Only one province may be indicated

per submission)

Organisation Registered Name / Name of

individual

Organisation Trading name:

Contact Person:

Telephone Number:

Fax Number:

E-mail address:

Contents:

Suppliers must ensure that they have received all pages of this document, which consist of the following:

completed as a guideline for the Supplier to comply with AFCON 2013 LOC requirements for submission and registration thereof Please note that non-compliant submissions to any of these conditions will not be evaluated

Commitment and Declaration of Interest

To be completed in full

certificate must be submitted

initialled

submitted

director’s Identification Document

Certified copy of the owner/member, director’s identification document must be submitted

documents must be submitted

1 INSTRUCTIONS FOR COMPLETION

 In order to comply with the Supply Chain Framework Regulations , Suppliers are requested to please complete the Supplier Database registration forms included in this document

 Failure to complete these forms fully and return these forms may lead to disqualification of the Supplier

 Please return original documents to the AFCON 2013 LOC Head Office at

SAFA House

76 Nasrec Road

Nasrec

Johannesburg

 Please clearly mark envelopes with the title “Supplier Database Submission”, Supplier name, contact information Please make use of courier services if needed Only originally signed submissions will be evaluated

 All queries must be in writing and addressed to Mncedisi Khumalo:

 No telephonic queries will be responded to

 All responses must be in the standard format as contained in this document Responses which are not in this format will be disregarded

 The service/s for which the organisation would like to be registered must be marked by putting

a cross (x) in the “applicable” column in the list of services hereunder

 Where there is a special requirement listed for a service, proof of compliance to such special requirement should be attached to the submission and marked “Special Requirement” Should

no such proof be attached, the assumption will be non-compliance to such special requirement and the submission will not be considered for that service

Products and Services

1.1 indicate (X) the business sector in which your company is involved /operating

1.2 Indicate (X) the preferred City of conducting business or mark all for National

Business Sector Johannesburg Durban Mbombela Nelson

Mandela Bay

Rustenburg

Advertising (Print, TV, Radio, Outdoor Media)

Aircraft / Charter Flight Services

Architects and Project Management

Brand Management Services

Catering

Chauffer and Driver Managed Services

Cleaning Consumables

Cleaning Contractor Services

Clothing Designers and Suppliers (Formal

Uniform, Sports Apparel)

Clothing Suppliers (Safety Apparel)

Corporate Gifts and Marketing Promotional

Items

Courier and Postal Services

Event Management Services

Exhibition Services

Facilities Management Services

Filing, Archiving, and Document Management

Systems Services

Florist

Hygiene and Sanitary Services

Indoor Plant Services

Information Technology (Support, Software,

Hardware, Consumables)

Interior Decoration

Irrigation System Suppliers

Language Translation, Training and

Interpretation Services

Laundry and Dry Cleaning Services

Legal Services

Marketing Service Providers

Marquee, Tent, and Portable Restroom Hire

Media Analysis, Monitors, Photographers

Medical Service Providers (Emergency, Travel,

Event, Hospitals)

Network and Data Cabling (Supply, Install and

Maintain)

Pitch Protection Services

Printing Services

Programme and Project Management Services

Public and International Relations Services

Publications

Removals and Storage Facilities

Risk Management Services

Security Services (Guards, Stewards, VIP

Protection, Fence, Surveillance, Access Control,

Radios)

Signage Design and Erection

Sound, Audio Visual, Stage, Lighting, Video

Production, Supplies, Installation)

Sports Hospitality & Entertainment

Telecommunication Supplies and Services

Training Service Providers – Stewards and

Volunteers (SETA Accredited)

Transportation

Waste Disposal and Management

Logistics Management Services

2 VENDOR INFORMATION FORM

Please complete this document accurately as the information contained herein is required for the following purposes:

 To support AFCON 2013 LOC in the implementation of a system of preferences as required by the Preferential Procurement Policy Framework Act (No 5 of 2000)

 Failure to complete the form in full may result in the supplier not being considered for the awarding of any orders or contracts by the AFCON 2013 LOC

PLEASE COMPLETE ALL PAGES

ORGANISATIONAL DETAIL

Organisation Registered Name

Organisation Trading Name

Postal Address

Physical Address

Telephone Number

E-mail Address

Fax Number

Cellphone Number

Company Registration Number

Tax Clearance Certificate Number

VAT Registration Number

Participation Capacity (please tick one)

Partner Other (please specify)

Type of Organisation (please tick one)

Public entity

Organisational Classification Detail

Principal Business activities

Business Sector

Number of years the organisation has

been in business

Total Number of Employees

Is the organisation registered or does it

have a business license

List all trade associations in which the

organisation has membership

Did the organisation exist under a

previous name?

If so, list previous name

List the directors / members of the

organisation under the previous name

Identify any owner or management officer which has an interest in other firm(s):

Name of owner/manager:

Other firm(s)

Duties in other firm

Name:

Other firm:

Duties in other firm

Organisation’s average annual turnover

(excl VAT) for the previous 3 financial

years

The financial manager/ external auditor/ CEO/Accounting Officer (whichever is relevant to your type of business) needs to confirm the following:

The business/entity (is):

(Please indicate on each of the following Failure to do so may invalidate your

Supplier Database Registration)

Yes No

A going concern

In a sound financial condition

Has the financial and operational capacity to fulfil the contract requirements

Full Names: _

Signature: _

Capacity:

Identify by name, HDI status and length of service, those individuals in the firm (including owners and non-owners) responsible for the day-to-day management and business

decisions

Length

of service (Years)

Cheque Signing

Acquisition of lines

of credit

Sureties

Major purchase or

Acquisitions

Contract Signing

Estimating

Marketing and

Sales

Hiring and Firing of

Staff

Supervision of

Office Staff

Supervision of Field

Staff

List the three largest contracts/assignments completed by your firm in the last three years

telephone number

Contract fee/amount

This application must be stamped and signed by a Commissioner of Oaths:

Stamp and signature of Commissioner of Oaths:

3 SUPPLIER DATABASE REGISTRATION COMMITMENT AND DECLARATION OF INTEREST

PART A: SUPPLIER DATABASE REGISTRATION COMMITMENT

1 I/We hereby submit the Supplier Database application for registration to supply all or any of the supplies and/or to render all or any of the services described in the proposal documents to the AFCON 2013 LOC, on the terms and conditions and in accordance with the specifications stipulated in the Supplier Database Registration Documents (and which shall be taken as part

of, and incorporated into, this Supplier Database Register) at the prices and on the terms regarding time for delivery and/or execution inserted therein

2 I/We agree that -

(a) this Supplier Database Registration and its acceptance shall be subject to the terms and conditions contained in the AFCON 2013 LOC General Conditions of Contract and Preference Points Claim Forms – General Conditions and Definitions of the Preferential Procurement Policy Framework Act - PPPFA with which I am/we are fully aware of;

(b) if I/we withdraw my/our Supplier Database registration within the period for which I/we have agreed that the Supplier Database registration shall remain open for acceptance, or fail to fulfil the contract when called upon to do so, the AFCON 2013 LOC may, without prejudice

to its other rights, agree to the withdrawal of my/our Supplier Database registration or cancel the contract that may have been entered into between me/us and the AFCON 2013 LOC and I/we will then pay to the AFCON 2013 LOC any additional expense incurred by the AFCON 2013 LOC having either to accept any less favourable Supplier Database registration or, if new Supplier Database registrations have to be invited, the additional expenditure incurred by the invitation of new Supplier Database registrations and by the subsequent acceptance of any less favourable Supplier Database registration; the AFCON

2013 LOC shall also have the right to recover such additional expenditure by set-of against moneys which may be due or become due to me/us under this or any other Supplier Database registration or contract or against any guarantee or deposit that my have been furnished by me/us or on my/our behalf for the due fulfilment of this or any other Supplier Database registration or contract and pending the ascertainment of the amount of such additional expenditure to retain such moneys, guarantee or deposit as security for any loss the AFCON 2013 LOC may sustain by reason of my/our default;

(c) if my/our Supplier Database registration is accepted the acceptance may be communicated

to me/us by e-mail, letter or order by ordinary post or registered post and that SA Post Office Ltd shall be regarded as my/our agent, and delivery of such acceptance to SA Post Office Ltd shall be treated as delivery to me/us;

(d) the law of the Republic of South Africa shall govern the contract created by the acceptance

of my/our Supplier Database registration and that I/we choose citandi et executandi in the Republic at (full address of this place);

3 I/We furthermore confirm that I/we have satisfied myself/ourselves as to the correctness and validity of my/our Supplier Database registration; that the price(s) and rate(s) quoted cover all the work/item(s) specified in the Supplier Database registration documents and that the price(s) and rate(s) cover all my/our obligations under a resulting contract and that I/we accept that any mistakes regarding price(s) and calculations will be at my/our risk

and conditions devolving on me/us under this agreement as the Principal(s) liable for the due fulfilment of any contract, which might be awarded based on this offer

5 I/We agree that any action arising from this contract may in all respects be instituted against me/us and I/we hereby undertake to satisfy fully any sentence or judgement which may be pronounced against me/us as a result of such action

* Delete whichever is not applicable

6 Are you duly authorised to sign the Supplier Database registration?

*YES / NO

7 Has the Declaration of Interest (part B of this form :) been duly completed? *YES / NO

1 Any legal person, including persons employed by the principal, or persons having a

kinship with persons employed by the principal, including a blood relationship, may make

an offer or offers in terms of this invitation to Supplier Database registration In view of possible allegations of favouritism, should the resulting Supplier Database registration, or part thereof, be awarded to persons employed by the principal, or to persons connected with or related to them, it is required that the Supplier or his/her authorised representative declare his/her position in relation to the evaluating/adjudicating authority and/or take an oath declaring his/her interest, where:

 the Supplier is employed by the principal; and/or

 the Supplier is a board member

 the legal person on whose behalf the Supplier Database registration document is signed, has a relationship with persons/a person who are/is involved in the evaluation and or adjudication of the Supplier Database registration(s), or where it is known that such a relationship exists between the person or persons for or on whose behalf the declarant acts and persons who are involved with the evaluation and or adjudication

of the Supplier Database registration

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

submitted with the Supplier Database registration

2.1 Are you or any person connected with the Supplier,

employed by the principal?

2.1.2 If so, state particulars:

2.2 Do you, or any person connected with the Supplier, have

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

employed by the principal and who may be involved with

the evaluation and or adjudication of this Supplier

Database registration?

2.2.1 If so, state particulars

2.3 Are you, or any person connected with the Supplier, aware

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

Supplier and any person employed by the principal who

may be involved with the evaluation and or adjudication of

this Supplier Database registration?

2.3.1 If so, state particulars

DECLARATION

I, The undersigned (Name)

Hereby certify that the information furnished in paragraph 2.1 to 2.3.1 above is correct I accept that the AFCON 2013 LOC may act against me in terms of Paragraph 23 of the General Conditions of Contracts should this declaration prove to be false

4 TAX CLEARANCE REQUIREMENTS

IT IS A CONDITION OF THE AFCON 2013 LOC SUPPLIER DATABASE REGISTRATION THAT

1 The taxes of the provider must be in order, or that satisfactory arrangements have been made

with the Receiver of Revenue to meet his / her tax obligations

2 An original valid Tax Clearance Certificate must be submitted together with the Supplier

Database registration form Failure to submit the original and valid Tax Clearance Certificate SHALL invalidate the Supplier Database registration

3 In Supplier Database registrations where Consortia / Joint Ventures / Sub-contractors are involved each party/member must submit a separate Tax Clearance Certificate