SUPPLIER DATABASE REGISTRATION
FORM
APPLICABLE TO ALL SUPPLIERS SEEKING REGISTRATION AS AN APPROVED SUPPLIER ON THE DATABASE OF THE SOUTH AFRICAN STATE THEATRE
(Herein after referred to as “SAST”)
NAME OF SUPPLIER: _____________________________________________________
Official Use:
Application Accepted Application Rejected
Captured By: Date: Signature:
Suppliers are herewith invited to register as an approved supplier on the database of the entity.
In order to comply with the Public Finance Management Act, 1999 (Act 1 of 1999) (herein referred to as “PFMA”), the entity developed a supplier database to be used by the procurement office.
The purpose of this database is to give all prospective suppliers an equal opportunity to submit quotations to the entity.
Preference will be given to registered suppliers but it does not necessarily follow that suppliers who are not yet registered will be totally exempted from quoting for the supplying of goods or services to the entity. It is envisaged, however, that this database will contribute to efficient administration and compliance with the PFMA.
Attached please find an official registration form to assist us in creating and updating our database according to legislation.
The following important notes must be read carefully before completion of this form: 1. Registration form to be completed by all suppliers seeking to conduct business with
the entity.
2. A company profile and B-BBEE STATUS LEVEL VERIFICATION CERTIFICATE must be submitted.
3. This form must be completed in full and signed by the authorized person. 4. Full signature is required when alterations are made in this document.
5. If the information required is not applicable to your business, clearly insert “N/A” in the appropriate space.
6. Mark the appropriate square with an 'X' where it is applicable to you.
7. All fields on the application form MUST be completed. If the space provided is left blank, it will be regarded as information that is still outstanding and you will not be registered.
8. The front page of the form must be clearly marked "DATABASE" and posted to the postal address or hand delivered to the entity.
9. Please note that unsigned, faxed or e-mailed forms will not be accepted. 10. A supplier registered on the database must notify the SAST in writing within 14
comply may result in such a business being removed and/or blacklisted from the database.
11. Suppliers providing information intentionally incorrectly or fraudulently will be disqualified.
12. Suppliers that appear on the National Treasury Database of Restricted Suppliers must first be removed or cleared before submitting this application for registration. 13. Copies of the following documents must be attached to application form:
13.1. A concise company profile (max 2 pages);
13.2. Company Incorporation Documents, including Shareholder(s) register; 13.3. Original valid Tax Clearance Certificate;
13.4. VAT registration certificate (for VAT vendors only);
13.5. Certified ID for all members / partners / directors / shareholders;
13.6. B-BBEE Status Level Verification Certificate certified as a true copy of the original. NB: the certificate must be issued by a SANAS accredited agent or an IRBA registered Auditor.
13.7. Signed and completed SBD 4 forms 13.8. Signed and completed SBD 9 forms
Failure to submit all the above documents will result in non-registration.
14. Fronting (in the context of preferential procurement means a misrepresentation or the making of a misrepresentation in order to obtain undue preference point) will result in a supplier being blacklisted.
15. SAST has the right to visit the supplier’s premises to verify information provided in this form. Please ensure that you provide a physical business address in this form.
16. Members /directors /partners /shareholders in service with any government body; must declare any conflict of interest. Failure to do so may lead to disqualification or de-registration.
17. This is only a registration form for database registration and does not guarantee any award of bid /contract.
18. Preference will be given to registered suppliers but it does not necessarily follow that suppliers who are not yet registered will be totally excluded from quoting for the supply of goods or services to the entity.
19. The database will be updated on quarterly basis. A summary of the supplier’s info on the database will be posted for verifying. Changes can be made on the summary and emailed back to the entity. Only on receipt of a signed changed summary, updates will be added to the database.
20. SAST reserves the right to reject any application, which in its opinion failed to comply with the registration requirements or criteria.
21. Applicants will be contacted via EMAIL and must therefore submit an email address; failure to comply will result in excluding the supplier from the database; 22. Suppliers must comply with all registration-criteria for registration to be finalized.
Failure to do so may result in the application being declined.
Completed database forms can be hand delivered at: The South African State Theatre
Supply Chain Management 320 Pretorius Street
Pretoria Or post it to:
The South African State Theatre PO Box 566
PRETORIA 0001
SECTION A:
SUPPLIER DATABASE REGISTRATION FORM
Supplier detail:
Company/Supplier Registered Name:
Trading Name if different from the above:
Company / Close Corporation Registration
Number #
VAT registration number (if applicable):
Income tax reference number ##
Web Address: E-Mail Address:
Telephone Number: Fax Number:
(compulsory) Toll Free Number: Number of full time employees:
# For Companies and Close Corporations, as with the Registrar of Companies / CC ## Insert Personal Income Tax Number for sole proprietor of Personal Income Tax
numbers for all parties in terms of partnerships
Postal Address: (compulsory) Physical Address:
Postal Code:
Supplier Classification: (Please mark with X the relevant box or boxes) ISO
Listed
Importer Services Manufacturer Repairer Black
Owned Distributor Exporter Sales (Please mark with X the relevant box)
Tax Clearance Certificate Attached yes no
BLACKLISTED
Reason:
Expiry Date:
Supplier Grouping Detail: Type of Firm: (Please mark with X the relevant box) 1 Public Company (Ltd)
2 Private company (Pty) Ltd 3 Closed Corporation (cc) 4 Other (specify)
5 Joint Venture (see terminology page 7) 6 Consortium (see terminology page 7) 7 Sole Proprietor
8 Foreign Company 9 Partnership 10 Trust
11 Section 21 Company
12 Government / Organ of state / Parastatals
Main contact person in your company:
Name & Surname ID Number
Company Position:
Cell phone Number: Fax Number: E-mail address:
Contact person (sales) in your company: Name &
Surname ID Number
Position in company:
Cell Phone Number: Fax Number: E-mail address:
mark with X, Preferred method of correspondence
SECTION B: BANKING DETAILS
I/We hereby request and authorise you to pay any amounts, which may accrue to me/us to the credit of my/our account with the mentioned bank.
I/we understand that the credit transfers hereby authorised will be processed by computer through a system known as "ACB - Electronic Fund Transfer Service", and I/we understand that no additional advice of payment will be provided by my/our bank, but that the details of each be printed on my/our bank statement or any accompanying voucher. (This does not apply where it is not customary for banks to furnish bank statements).
I/we understand that the entity will supply a payment advice in the normal way, and that it will indicate the date on which the funds will be made available on my/our account.
This authority may be cancelled by me/us by giving thirty days notice by prepaid registered post. Please ensure information is validated as per required.
I/We understand that bank details provided should be exactly as per the records held by the bank.
I/We understand that the entity will not assume responsibility for any delayed payments, as a result of incorrect information supplied.
Company / Personal Details
Registered Name Trading Name Tax Number VAT Number Title: Initials: First Name: Surname: Address Detail Payment Address (Compulsory if Supplier) Postal Code New Detail
New Supplier information Update Supplier information
Supplier Type: Individual Department Partnership Company Trust
CC Other
/ /
Supplier Account Details
(Please note that this account MUST be in the name of the supplier. No 3rd party payments allowed). Account Name
Account Number Branch Name Branch Number
Account Type Cheque Account
Savings Account Transmission Account Bond Account Other (Please Specify) ID Number
Passport Number
Company Registration Number *CC Registration
*Please include CC/CK where applicable
Practice Number Bank stamp Business Home Fax Cell Email Address Contact Person: Contact Details
Area Code Telephone Number Area Code Telephone Number Area Code
Cell Code Cell Number
Supplier Signature
OFFICE USE ONLY
Captured by: Sign:
Print Name Date:
Authorised by:
/ / / /
SECTION C: COMPANY OWNERSHIP
Suppliers are required to submit a certified copy of a BBBEE certificate or the Original BBBEE certificate issued by a SANAS approved BBBEE certification agency or IRBA registered Auditors to be allocated BBBEE points.
Suppliers making a total revenue of less than R5 000 000.00 a year may submit a letter from an accountant or auditor stating the BBBEE status of the supplier. The letter must have the accountant’s or auditor’s practice number,
LIST OF ALL OWNER/S, BOARD MEMBER/S AND SHAREHOLDER/S
Title Initials Surname ID No Race Gender (M / F) (Yes / No) Disability % Share Owned
LIST OF ALL INDIVIDUALS RESPONSIBLE FOR THE DAILY MANAGEMENT AND BUSINESS DECISIONS
Title Initials Surname Race Gender (M / F) Disability Position / Designation
SECTION C: LIST OF COMMODITIES Choose a maximum of three (3) categories of
goods and / or services you want to be listed under
COMMODITY GROUPS AND
SUB-COMMODITY GROUPS
ADMINISTRATIVE SERVICES Asset Management Services Data Archiving Services Debt Collection
Payroll Services
Posting and Courier Services ADVERTISING
Newspaper Advertising Radio Advertising ARTWORK AND PAINTING
BUILDING, CONSTRUCTION AND MAINTENANCE SERVICES
Air conditioning installation, maintenance and repair services Blinds and shades
Burglar Proofing Carpentry
Carpet installation and maintenance
Concrete Fencing
Dam, Reservoir, Water Towers service, maintenance and repairs Damp proofing
Electrical fencing installation, maintenance and repairs Electrical Services Electrical Supplies Excavation Services
COMMODITY GROUPS AND
SUB-COMMODITY GROUPS
Fencing
Flooring Specialist
General Building construction Glasshouse repairs and maintenance
Grounds maintenance services Interior finishing
Lifts (installation, commissioning and maintenance)
Locksmith Services
Marble, stone or tile installation Paint supplies
Painting and wall paper Partitioning and Dry walling Plumbing system service, maintenance and repair
Plumbing supplies and hardware Roof Services, maintenance and repairs
Steel Suppliers Waterproofing
BEVERAGES, SNACKS AND LIQOUR Coffee, teabags, sugar, milk
Liquor Cooldrinks
Snacks (Chips, chocolates, sweets, nuts)
CATERING
Catering equipment hire and décor
Catering Services
COMMODITY GROUPS AND
SUB-COMMODITY GROUPS
Cleaning chemicals and supplies Cleaning Equipment
Cleaning services
COMPUTER SERVICES, HARDWARE AND SOFTWARE
Computer cable installation and maintenance
Computer Equipment and maintenance
Computer Network installation and maintenance
Data Management Services Information retrieval systems Internet Services
Management Information systems MIS
Software
Software installation, maintenance and support Uninterrupted Power Supply (UPS) supply, maintenance and service
CONFERENCE, TRAVEL AND ACCOMMODATION
Accommodation
Conference and meeting facilities Travel Agency CORPORATE IMAGE Corporate Clothing Corporate Gifts Embroidery Promotional Items EDUCATION AND TRAINING SERVICES
COMMODITY GROUPS AND
SUB-COMMODITY GROUPS
Educational Institutions
Occupational Health and Safety Training
Research Services Training
EMERGENCY MEDICAL SERVICES AND FIRST AID KITS
EVENT MANAGEMENT
Event Management Services Sound and Music System / Equipment hire
GENERATORS AND
TRANSFORMERS SUPPLY, SERVICES AND MAINTENANCE GLASS AND ALUMINIUM
Aluminium Glass supplies
HUMAN RESOURCE SERVICES Human Resource and Human Resource Development Consulting
Industrial Relations
Labour training or development Labour Broking services
Personnel Recruitment
Temporary personnel services KITCHENWARE AND SUPPLIES
Electrical Appliances Kitchen supplies LEGAL SERVICES Civil Litigation Competition Law Contractual Law
COMMODITY GROUPS AND
SUB-COMMODITY GROUPS
Corporate Law Environmental Law Intellectual Property Law Labour Law
Labour Relations Law Local Government Law Patent Rights
LIGHTING
Theatrical lighting equipment OFFICE EQUIPMENT,
ACCESSORIES< SUPPLIES AND MAINTENANCE
Audio visual equipment, supply, installation and maintenance Office and desk accessories Office machine maintenance Office machine and their supplies and accessories
Purified water and Water Dispensers
OFFICE FURNITURE PACKAGING
PEST CONTROL AND FUMIGATION SERVICES
PHOTOGRAPHIC AND VIDEO SERVICES
Photographic services Transcribing services Translation services Video services
PRINTING AND CREATIVE DESIGN SERVICES
Design and layout
COMMODITY GROUPS AND
SUB-COMMODITY GROUPS
Printing services (including pamphlets, brochures, annual reports and newsletters)
Reproduction services (includes photocopying and binding) Signage and accessories PROFESSIONAL SERVICES Architects Attorneys Auction services Civil Engineering Electrical Engineering ERP Services Information Technology consulting services
Marketing and Communication services
Mechanical Engineering
Occupational Health and Safety Services
Project Management
Strategic Planning consultation / facilitation services
PROTECTIVE CLOTHING PUBLICATIONS
Books and publications
Layout and design of Corporate publication
Newspaper and magazine subscriptions
REFRIGERATION AND COLD ROOMS Refrigeration and cold room supplies
COMMODITY GROUPS AND
SUB-COMMODITY GROUPS
Refrigeration and cold room service, maintenance and repairs SAFETY EQUIPMENT
Safety equipment supplies Safety equipment service, maintenance and repairs SECURITY AND SURVEILLANCE SERVICES
Access Control
Armed Response Services Building Monitoring Services Cash-in-transit services Guard Services
Locks and security hardware and accessories
Security system services Surveillance, monitoring and detection equipment
Vehicle Tracking equipment and services
STATIONERY AND COMPUTER CONSUMABLES Stationery Computer Consumables TELECOMMUNICATIONS Analogue telephones Answering services Cell Routers
Digital enhanced cordless telecommunication DECT cordless phones
Digital telephones Mobile phones
Telecommunication maintenance
COMMODITY GROUPS AND
SUB-COMMODITY GROUPS
Telecommunication supply and maintenance
TRAINING
Financial Management Training IT Training Other Training TRANSPORTATION Furniture removal Logistics services Transport services VEHICLE HIRE
Chartered bus services Shuttle services
Vehicle leasing Vehicle rental Trailer hire
VEHICLE SUPPLY, MAINTENANCE AND REPAIRS
Panel beating
Vehicle service, maintenance and repairs
Vehicle tyres Vehicle spares
Vehicle fitment centres Trailer supply, service, maintenance and repairs OTHER
I/we the undersigned acknowledge(s) that
: The information furnished is true and correct The Equity Ownership claimed is in accordance with Shareholder Register lodged at CIPC Any conflict of interest will be declared in the comment space below
Payment of invoices will be made by SAST within 30 days of receipt of invoice
SIGNATURE OF OWNER OR DATE AUTHORISED REPRESENTATIVE
SIGNATURE OF OWNER OR DATE AUTHORISED REPRESENTATIVE
SIGNATURE OF OWNER OR DATE AUTHORISED REPRESENTATIVE
SIGNATURE OF OWNER OR DATE AUTHORISED REPRESENTATIVE
SBD 4
DECLARATION OF INTEREST
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 3 below.
¹“State” means –
(a) any national or provincial department, national or provincial public entity or constitutional institution within the meaning of the Public Finance Management Act, 1999 (Act No. 1 of 1999);
(b) any municipality or municipal entity; (c) provincial legislature;
(d) national Assembly or the national Council of provinces; or (e) Parliament.
²”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:
………. ………. ……….
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?
2.9.1If 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:
………. ………. ……….
3 Full details of directors / trustees / members / shareholders.
Full Name Identity
Number Personal Tax Reference Number State Employee Number / Persal 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
………. ………
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.
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
………. ………