Supplier Database Submission form - South African Football ...

Supplier Database Submission Form“FEEL THE BEAT AT AFRICA’S FEET”Name of Supplier: _________________________________PREFERRED SUPPLIER DATABASE SUBMISSIONProvince: (Only one province may be indicatedper submission)Organisation Registered Name / Name ofindividualOrganisation Trading name:Contact Person:Telephone Number:Fax Number:E-mail address:Page 1 of 17

Supplier Database Submission FormContents:Suppliers must ensure that they have received all pages of this document, which consist of thefollowing:No Description Special Instruction1 Instructions for completion To be completed in full2 Vendor Information Form To be completed in full3 Supplier Database RegistrationTo be completed in fullCommitment and Declaration of Interest4 Tax Clearance Requirements Valid original tax clearancecertificate must besubmitted5 Preference Points Claim Form To be completed in full6 General Conditions of Contract Each page must beinitialled7 Company Profile Company Profile must besubmitted8 Certified Copy of the owner/member,director’s Identification DocumentCertified copy of theowner/member, director’sidentification documentmust be submitted9 Company Registration Documents Company registrationdocuments must besubmittedThe checklistmust becompleted as aguideline for theSupplier 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.Page 2 of 17

Supplier Database Submission Form1 INSTRUCTIONS FOR COMPLETION• In order to comply with the Supply Chain Framework Regulations , Suppliers are requested toplease 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 theSupplier.• Please return original documents to the AFCON 2013 LOC Head Office atSAFA House76 Nasrec RoadNasrecJohannesburg• Please clearly mark envelopes with the title “Supplier Database Submission”, Supplier name,contact information. Please make use of courier services if needed. Only originally signedsubmissions 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 whichare not in this format will be disregarded.• The service/s for which the organisation would like to be registered must be marked by puttinga 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 specialrequirement should be attached to the submission and marked “Special Requirement”. Shouldno such proof be attached, the assumption will be non-compliance to such special requirementand the submission will not be considered for that service.Page 3 of 17

Supplier Database Submission FormProducts and Services1.1 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 NelsonMandelaBayAdvertising (Print, TV, Radio, Outdoor Media)Aircraft / Charter Flight ServicesArchitects and Project ManagementBrand Management ServicesCateringChauffer and Driver Managed ServicesCleaning ConsumablesCleaning Contractor ServicesClothing Designers and Suppliers (FormalUniform, Sports Apparel)Clothing Suppliers (Safety Apparel)Corporate Gifts and Marketing PromotionalItemsCourier and Postal ServicesEvent Management ServicesExhibition ServicesFacilities Management ServicesFiling, Archiving, and Document ManagementSystems ServicesFloristHygiene and Sanitary ServicesIndoor Plant ServicesInformation Technology (Support, Software,Hardware, Consumables)Interior DecorationIrrigation System SuppliersLanguage Translation, Training andInterpretation ServicesLaundry and Dry Cleaning ServicesLegal ServicesMarketing Service ProvidersMarquee, Tent, and Portable Restroom HireMedia Analysis, Monitors, PhotographersMedical Service Providers (Emergency, Travel,Event, Hospitals)Network and Data Cabling (Supply, Install andMaintain)Pitch Protection ServicesPrinting ServicesProgramme and Project Management ServicesPublic and International Relations ServicesPublicationsRemovals and Storage FacilitiesRustenburgPage 4 of 17

Supplier Database Submission FormRisk Management ServicesSecurity Services (Guards, Stewards, VIPProtection, Fence, Surveillance, Access Control,Radios)Signage Design and ErectionSound, Audio Visual, Stage, Lighting, VideoProduction, Supplies, Installation)Sports Hospitality & EntertainmentTelecommunication Supplies and ServicesTraining Service Providers – Stewards andVolunteers (SETA Accredited)TransportationWaste Disposal and ManagementLogistics Management ServicesPage 5 of 17

Supplier Database Submission Form2. VENDOR INFORMATION FORMPlease complete this document accurately as the information contained herein is required for thefollowing purposes: To support AFCON 2013 LOC in the implementation of a system of preferences asrequired 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 theawarding of any orders or contracts by the AFCON 2013 LOC.PLEASE COMPLETE ALL PAGES.ORGANISATIONAL DETAILOrganisation Registered NameOrganisation Trading NamePostal AddressPhysical AddressTelephone NumberE-mail AddressFax NumberCellphone NumberCompany Registration NumberTax Clearance Certificate NumberVAT Registration NumberParticipation Capacity (please tick one)Sub ContractorConsortium PartnerOther (please specify)Type of Organisation (please tick one)Sole TraderClose CorporationLtdPublic entityOrganisational Classification DetailPrincipal Business activitiesSupplierJoint VenturePartnerPartnership(Pty) LtdS(21) companyBusiness SectorNumber of years the organisation hasbeen in businessTotal Number of EmployeesIs the organisation registered or does ithave a business licenseList all trade associations in which theorganisation has membershipDid the organisation exist under aprevious name?If so, list previous nameList the directors / members of theorganisation under the previous namePage 6 of 17

Supplier Database Submission FormIdentify any owner or management officer which has an interest in other firm(s):Name of owner/manager:Other firm(s)Duties in other firmName:Other firm:Duties in other firmOrganisation’s average annual turnover(excl. VAT) for the previous 3 financialyearsThe financial manager/ external auditor/ CEO/Accounting Officer (whichever is relevant toyour 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 yourSupplier Database Registration)A going concernIn a sound financial conditionHas the financial and operational capacity to fulfil the contract requirementsYes NoFull Names: ___________________________________________________Signature: _____________________________________________________Capacity: ______________________________________________________Page 7 of 17

Management DecisionsFinancing DecisionsRace(B/C/A/W)Gender(M/F)Disability(Y/N)Supplier Database Submission FormIdentify by name, HDI status and length of service, those individuals in the firm (includingowners and non-owners) responsible for the day-to-day management and businessdecisionsActivity Full Names I.D. NumberLengthofservice(Years)Cheque SigningAcquisition of linesof creditSuretiesMajor purchase orAcquisitionsContract SigningEstimatingMarketing andSalesHiring and Firing ofStaffSupervision ofOffice StaffSupervision of FieldStaffList the three largest contracts/assignments completed by your firm in the last three years.Work performed Purchaser Contact person andtelephone numberContract fee/amountThis application must be stamped and signed by a Commissioner of Oaths:Stamp and signature of Commissioner of Oaths:Page 8 of 17

Supplier Database Submission Form3. SUPPLIER DATABASE REGISTRATION COMMITMENT AND DECLARATION OFINTERESTPART A: SUPPLIER DATABASE REGISTRATION COMMITMENT1. I/We hereby submit the Supplier Database application for registration to supply all or any of thesupplies and/or to render all or any of the services described in the proposal documents to theAFCON 2013 LOC, on the terms and conditions and in accordance with the specificationsstipulated in the Supplier Database Registration Documents (and which shall be taken as partof, and incorporated into, this Supplier Database Register) at the prices and on the termsregarding 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 andconditions contained in the AFCON 2013 LOC General Conditions of Contract andPreference Points Claim Forms – General Conditions and Definitions of the PreferentialProcurement 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 haveagreed that the Supplier Database registration shall remain open for acceptance, or fail tofulfil the contract when called upon to do so, the AFCON 2013 LOC may, without prejudiceto its other rights, agree to the withdrawal of my/our Supplier Database registration or cancelthe contract that may have been entered into between me/us and the AFCON 2013 LOCand I/we will then pay to the AFCON 2013 LOC any additional expense incurred by theAFCON 2013 LOC having either to accept any less favourable Supplier Databaseregistration or, if new Supplier Database registrations have to be invited, the additionalexpenditure incurred by the invitation of new Supplier Database registrations and by thesubsequent acceptance of any less favourable Supplier Database registration; the AFCON2013 LOC shall also have the right to recover such additional expenditure by set-of againstmoneys which may be due or become due to me/us under this or any other SupplierDatabase registration or contract or against any guarantee or deposit that my have beenfurnished by me/us or on my/our behalf for the due fulfilment of this or any other SupplierDatabase registration or contract and pending the ascertainment of the amount of suchadditional expenditure to retain such moneys, guarantee or deposit as security for any lossthe AFCON 2013 LOC may sustain by reason of my/our default;(c) if my/our Supplier Database registration is accepted the acceptance may be communicatedto me/us by e-mail, letter or order by ordinary post or registered post and that SA Post OfficeLtd shall be regarded as my/our agent, and delivery of such acceptance to SA Post OfficeLtd shall be treated as delivery to me/us;(d) the law of the Republic of South Africa shall govern the contract created by the acceptanceof my/our Supplier Database registration and that I/we choose citandi et executandi in theRepublic at (full address of this place);..............................................................................................................................................................................................................................................................................3. I/We furthermore confirm that I/we have satisfied myself/ourselves as to the correctness andvalidity of my/our Supplier Database registration; that the price(s) and rate(s) quoted cover allthe work/item(s) specified in the Supplier Database registration documents and that theprice(s) and rate(s) cover all my/our obligations under a resulting contract and that I/weaccept that any mistakes regarding price(s) and calculations will be at my/our risk.Page 9 of 17

Supplier Database Submission Form4. I/We hereby accept full responsibility for the proper execution and fulfilment of all obligationsand conditions devolving on me/us under this agreement as the Principal(s) liable for the duefulfilment 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 againstme/us and I/we hereby undertake to satisfy fully any sentence or judgement which may bepronounced 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 / NO7. Has the Declaration of Interest (part B of this form :) been duly completed? *YES / NOPage 10 of 17

Supplier Database Submission FormPART B: DECLARATION OF INTEREST1. Any legal person, including persons employed by the principal, or persons having akinship with persons employed by the principal, including a blood relationship, may makean offer or offers in terms of this invitation to Supplier Database registration. In view ofpossible allegations of favouritism, should the resulting Supplier Database registration, orpart thereof, be awarded to persons employed by the principal, or to persons connectedwith or related to them, it is required that the Supplier or his/her authorised representativedeclare his/her position in relation to the evaluating/adjudicating authority and/or take anoath 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 issigned, has a relationship with persons/a person who are/is involved in the evaluationand or adjudication of the Supplier Database registration(s), or where it is known thatsuch a relationship exists between the person or persons for or on whose behalf thedeclarant acts and persons who are involved with the evaluation and or adjudicationof the Supplier Database registration.2. In order to give effect to the above, the following questionnaire must be completed andsubmitted with the Supplier Database registration.2.1 Are you or any person connected with the Supplier, Yes Noemployed by the principal?2.1.2 If so, state particulars:2.2 Do you, or any person connected with the Supplier, haveany relationship (family, friend, other) with a personemployed by the principal and who may be involved withthe evaluation and or adjudication of this SupplierDatabase registration?2.2.1 If so, state particularsYesNo2.3 Are you, or any person connected with the Supplier, awareof any relationship (family, friend, other) between theSupplier and any person employed by the principal whomay be involved with the evaluation and or adjudication ofthis Supplier Database registration?2.3.1 If so, state particularsYesNoDECLARATIONI, The undersigned (Name)Hereby certify that the information furnished in paragraph 2.1 to 2.3.1 above is correct. I acceptthat the AFCON 2013 LOC may act against me in terms of Paragraph 23 of the GeneralConditions of Contracts should this declaration prove to be false..SignatureDatePositionName of SupplierPage 11 of 17

Supplier Database Submission Form4. TAX CLEARANCE REQUIREMENTSIT IS A CONDITION OF THE AFCON 2013 LOC SUPPLIER DATABASE REGISTRATIONTHAT1. The taxes of the provider must be in order, or that satisfactory arrangements have been madewith the Receiver of Revenue to meet his / her tax obligations.2. An original valid Tax Clearance Certificate must be submitted together with the SupplierDatabase registration form. Failure to submit the original and valid Tax Clearance CertificateSHALL invalidate the Supplier Database registration.3. In Supplier Database registrations where Consortia / Joint Ventures / Sub-contractors areinvolved each party/member must submit a separate Tax Clearance Certificate.Page 12 of 17

Supplier Database Submission Form4. PREFERENCE POINTS CLAIM FORM IN TERMS OF THE PREFERENTIALPROCUREMENT REGULATIONS 2001GENERAL CONDITIONS AND DEFINITIONS80/20 RULE: Estimated Value Less Than R 500 000 Per IncidentNB: BEFORE COMPLETING RELEVANT CLAIM FORMS, SUPPLIERS MUSTCAREFULLY STUDY THE GENERAL CONDITIONS AND DEFINITIONS1. GENERAL CONDITIONS1.1 The preference point system is applicable to all Supplier Database registrations.1.2 Failure on the part of a supplier to complete and sign a claim form may be interpreted to mean that preference points arenot claimed.1.3 AFCON 2013 LOC reserves the right to require of a supplier, that he/she should substantiate any claim, in any mannerrequired by AFCON 2013 LOC.2. GENERAL DEFINITIONSThe defined works and expressions commencing with capital letters, shall have the meanings hereby assigned to themunless such meanings are inconsistent with the context of a particular tender or contract:2.1 “Act” means the Preferential Procurement Framework Act, 2000 (Act No 5 of 2000)2.2 “Agent” means a person mandated by another person (“the principal”) to do business for an on behalf of, or to represent ina business transaction, the principal, and thereby acquire rights for the principal against AFCON 2013 LOC and incurobligations binding the principal in favour of AFCON 2013 LOC.2.3 “Comparative price” means the price after the factors of a non-firm price and all unconditional discounts that can beutilised have been taken into consideration.2.4 “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.2.5 “Contract” means the agreement that results from the acceptance of a tender by AFCON 2013 LOC.2.6 “Disability” means, in respect of a person, a permanent impairment of a physical intellectual, or sensory function, whichresults in restricted, or lack of, ability to perform an activity in the manner, or within the range, considered normal for ahuman being.2.7 “Firm price” is the price that is only subject to adjustments in accordance with the actual increase or decrease resultingfrom the change, imposition, or abolition of customs or excise duty and other duty, levy, or tax which, in terms of a law orregulation is binding on the contractor and demonstrably has an influence on the price of any supplies, or the renderingcosts of any service, for the execution of the contract.2.8 “Historically Disadvantaged Individual (HDI)” means a South African citizen –2.8.1 who has no franchise in national elections prior to the introduction of the Constitution of the Republic of South Africa, 1983(Act No 110 of 1983) or the Constitution of the Republic of South Africa, 1993 (Act No 200 of 1993)(“the InterimConstitution”) and/or2.8.2 who is a female; and/or2.8.3 who has a disability.Provided that a person who obtained South African citizenship on or after the coming to effect of the Interim Constitution, isdeemed not to be an HDI.2.9 “Management” in relation to an enterprise or business, means an activity inclusive of control and performed on a dailybasis, by any person who is a principal executive officer of the company, by whatever name the person may be designated.Page 13 of 17

Supplier Database Submission Form2.10 “Non firm prices” means all prices other than “firm” prices.2.11 “Person” includes reference to a juristic person.2.12 “Rand value” means the total estimated value of a contract in Rand denomination which is calculated at the time of tenderinvitations and includes all applicable taxes and excise duties.2.13 “Small, Medium and Micro Enterprises (SMME’s)” bears the same meaning assigned to this expression in the NationalSmall Business Act, 1996 (Act No 102 of 1996).2.14 “Sub-contracting” means the primary contractor’s assigning or leasing or making out work to, or employing, anotherperson to support such primary contractor in the execution of part of a project in terms of the contract.2.15 “Tender” means a written offer or Supplier Database registration in a prescribed or stipulated form in response to aninvitation by an organ of state for the provision of services or goods.2.16 “Trust” means the arrangement through which the property of one person is made over or bequeathed to a trustee toadminister such property for the benefit of another person.2.17 “Trustee” means any person, including the founder of a trust, to whom property is bequeathed in order for such property tobe administered for the benefit of another person.PREFERENCE POINTS CLAIM FORMEQUITY OWNERSHIP BY HISTORICALLY DISADVANTAGED INDIVIDUALS1. In terms of regulation 13 of the preferential procurement regulations pertaining to the Preferential Procurement PolicyFramework Act, 2000 (Act No 5 of 2000) the preference points system must include preference points of equity ownershipby historically disadvantaged individuals as defined by the Act.Equity OwnershipPoints allocated1.1 Preference points for equity ownership by historically disadvantaged individuals who, due to the apartheid policy that hadbeen in place had no franchise innational elections prior to the introduction of the Constitution of the RSA, 1983 (Act 110 of 1983) or the Constitution of theRSA, 1993 (Act 200 of 1993)(“the Interim Constitution”) and/or1.2 who is a female; and/or1.3 who is a person with a disability2. The equity ownership contemplated above must be equated to the percentage of an enterprise or business owned byindividuals or, in respect of a company, the percentage of a company’s shares that are owned by individuals, who areactively involved in the management of the enterprise or business and exercise control over the enterprise, commensuratewith their degree of ownership at the closing date of the tender.2.1 Where an organisation is classified as a non-governmental organisation (NGO), the ownership criterion is replaced by thepercentage of HDI directors on the Board of Directors of the NGO, irrespective of whether they are executive or nonexecutivedirectors.3. In the event that the percentage of ownership contemplated above changes after the closing date of the tender, theSUPPLIER must notify AFCON 2013 LOC and such tender will not be eligible for any preference points.4. Preference points should not be claimed in respect of individuals who are not actively involved in the managementof an enterprise or business and who do not exercise control over an enterprise or business commensurate withtheir degree of ownership.5. All claims made for equity ownership by an HDI will be considered according to the following criteria:5.1 Equity within private companies will be based on the percentage of equity ownership.5.2 Preference points will not be awarded to public companies and tertiary institutions.5.3 The following formula will be applied to calculate the number of points for equity ownership by an HDI:Page 14 of 17

Supplier Database Submission FormNEP= NOP X EP100WhereNEP = Points awarded for equity ownership by an HDI.NOP = The maximum number of points awarded for equity ownership by an HDI in the specific category.EP = The percentage of equity ownership by an HDI within the enterprise of business.6. Equity claims for a Trust will only be allowed in respect of those persons who are both trustees and beneficiaries and whoare actively involved in the management of the Trust.7. Documentation to substantiate the validity of the credentials of the trustees contemplated above must be submitted.7.1 Documentation to substantiate the validity of the credentials of the board of directors who are actively involved in themanagement of the NGO as contemplated in 2.1 above must be submitted.8. A Consortium or Joint Venture may, based on the percentage of the contract value managed or executed by their HDImembers, be entitled to equity ownership in respect of an HDI.9. The points scored for equity ownership will be added to the points scored for price and functionality.10. A person awarded a contract as a result of preference for contracting with, or providing equity ownership to an HDI, maynot subcontract more than 25% of the value of the contract to a person who is not an HDI or does not qualify for suchpreference.Page 15 of 17

Percentageowned byHDI’sPercentageowned byWomenPercentageowned bydisabledpeoplePercentageowned byothersSupplier Database Submission FormDECLARATION WITH REGARD TO EQUITY OWNERSHIP:NAMEPOSITIONOCCUPIED INENTERPRISEIDENTITY NUMBERDate RSA orTBVC citizenshipobtainedPage 16 of 17

Supplier Database Submission Form1. HOW MANY PERMANENT STAFF MEMBERS ARE EMPLOYED BY THESUPPLIER?……………………………………………..2. I/we, the undersigned, who warrants that he/she is duly authorised to do so on behalfof the firm certify that points claimed, based on owners/shareholders who are activelyinvolved in the day to day management of the enterprise equity ownership, qualifies thefirm for the points shown and I/we acknowledge that:2.1 The information furnished is true and correct.2.2 The Equity Ownership claimed is in accordance with the conditions.2.3 A person awarded a contract as a result of preference for contracting with, or providingequity ownership to an HDI, may not subcontract more than 25% of the value of thecontract to a person who is not an HDI or does not qualify for such preferences.2.4 In the event of a contract being awarded as a result of points claimed, the contractormay be required to furnish documentary proof to the satisfaction of AFCON 2013 LOCthat the claims are correct.2.5 If the claims are found to be incorrect, AFCON 2013 LOC may, in addition to any otherremedy it may have2.5.1 Recover all costs, losses or damages it has incurred or suffered as a result of thatperson’s conduct;2.5.2 Cancel the contract and claim any damages which it has suffered as a result of havingto make less favourable arrangements due to such cancellation.WITNESSES:1. ……………………………………….………………………………………….SIGNATURE(S)OF SUPPLIER(S)2. ………………………………………. DATE: ……………………………….Page 17 of 17