A2601/3 Bongimfundo Street
Private Bag X4012
SIYABUSWA
0472
www.moroka.gov.za
Tel: 013 973 1101/1390
Database Registration Form
SECTION A
Name:
Surname:
Position:
Cell:
Fax:
Email:
Preferred Method Of
Communication (Please tick):
Email
Fax
SECTION B
New Company Profile
Company Details
Name:
Trading Name:
Company Reg No:
Translated Name:
HDI:
YES
NO
Did the business exist under
another name previously?
YES
NO
If "yes" what is the name:
Reason For Change:
1
Post
Registration Date:
Business Type:
CLOSE CORPERATION
PRIVATE COMPANY (PTY) LTD
PUBLICK COMPANY
SECTION 21 COMPANY
CONSORTUIM OR JOINT VENTURE
PARTNERSHIP
SOLE TRADE OR PROPREITOR
TRUST
Water Acc No:
Financial Details
Annual Turnover:
Financial Year End (Month):
Contact Details
Telephone:
Fax:
Website:
Postal Address:
Code:
Registered Office Address:
Code:
Location (Municipality):
Business Classification
Classification (Please tick):
MICRO
VERY SMALL
SMALL
MEDUIM
2
COMMODITIES (please do not choose more than 6 commodities, only 6 commodities will be considered)
CODE
COMMODITY_DESCRIPTION
CODE
COMMODITY_DESCRIPTION
0001
Accounting & Bookkeeping
0109
E250.3 ReticMaster
0002
Accounting Systems Software
0110
Stadia & High Mast Floodlighting
0003
Architects
0111
Stadia & High Mast Floodlighting
0004
Advertising
0112
Decorative & Festive Lighting
0005
Agricultural Services & Equip
0113
Street Lighting - Design & Pro
0006
Air Conditioner Repairs
0114
Street Lighting Maintenance &
0007
Accommodation
0115
High & Medium Voltage Network
0008
Accounting Services
0116
HV Overhead Head Transmission
0009
Fertiliser
0117
High Voltage Technical & Safet
0010
Minor Structures
0118
Medium & Low Voltage Technical
0011
Major Structures
0119
Transformers & Miniature Subst
0012
Recreational & Sporting Facili
0120
Streetlight Poles
0013
Architectural Maintenance
0121
Streetlights Fittings/Floodlig
0014
Low Cost Housing
0122
General Electrical Spares/Prod
0015
Auditing Services
0123
Medium Voltage Circuit Breaker
0016
Repair and supply of Tyres
0124
High Voltage Circuit Breakers
0017
Batteries
0125
Cables & Overhead Conductors
0018
Parts
0126
High-Mast Lights
0019
Panel Beating
0127
Electricity Energy Meters
0020
Auto electrical
0128
Low Voltage Panels
0021
General mechanical work
0129
Medium & High Voltage Switchge
0022
Oil
0130
Quality of Supply Equipment
0023
Fuel
0131
Load Control Equipment
0024
Other: please provide details
0132
Bridges
0025
Supply of new vehicles
0133
Reinforced Concrete Structures
0026
Supply of Bitumen & Emulsions
0134
Pre-stressed Concrete Structur
0027
Supply of hot bituminous aspha
0135
Water Retaining Structures
0028
Clay Products
0136
Subsurface Structures includin
0029
Masonry Products
0137
Structural Remedial Works & Ma
0030
Catering Services
0138
Timber Structures
0031
Bagged Cement
0139
Masonry Structures
0032
Readymix Cement
0140
Structural Steel Structures
0033
Lime for soil stabilisation
0141
Marine Structures
0034
Herbicides
0142
Engineering ¿ Traffic
0035
Chlorine
0143
Community Facilitation & Parti
0036
Liquefied Gas (LPG)
0144
Transportation Planning
0037
Compressed oxygen
0145
Traffic Management
0038
Other: please provide details
0146
Traffic Operations
0039
Fax machines
0147
Public Transport Planning
0040
Telephone systems
0148
Urban Traffic Control
0041
Mobile Phones
0149
Related IT
0042
Radio Telephones
0150
Traffic Survey / Data Collecti
0043
Repairs of communication devic
0151
Transportation Policy
0044
Precast reinforced Concrete ma
0152
Transport Economics
0045
Precast Concrete kerbs, paving
0153
Demography
0046
Concrete Pipes
0154
Public Relations & Graphics
0047
Courier Services
0155
Transport Modelling
0048
Strategic Planning
0156
Environment Management Systems
0049
Integrated Development Plannin
0157
Environmental Impact Assessmen
3
0050
Community Facilitation & Parti
0158
Ecological Surveys
0051
Social Economic Planning & Res
0159
Environmental Planning
0052
Property Development Economics
0160
Environment Auditing
0053
Economic Feasibility Studies
0161
Environmental Policy
0054
Land Use Management Systems
0162
Enviromental Law
0055
Land Use Data Collection (Fiel
0163
Other: please provide details
0056
Spatial Analysis
0164
Supply of materials
0057
Urban Spatial Economics
0165
Installation of Fencing
0058
Layout Planning
0166
Curtains/Blinds
0059
Planning Policy & Legal
0167
Carpets
0060
Land Use Transport Planning
0168
Light Fittings
0061
Public Housing & In-site Upgra
0169
Software and software developm
0062
Minor Roads - Urban
0170
System analysis and design
0063
Major Roads - Arterials
0171
Land Information Systems
0064
Road Maintenance/Rehabilitatio
0172
Geological studies and investi
0065
Hydraulic Engineering (Pipes N
0173
Foundations - minor structures
0066
Stormwater Maintenance System
0174
Foundations - major structures
0067
Catodic Protection
0175
Other: please provide details
0068
Recreational & Sporting Facili
0176
General hardware & supplies
0069
Pavement Design - Roads
0177
Hire Plant & Equipment
0070
Pavement Design - Road mainten
0178
Vehicle Hire
0071
Flood Hydraulic studies
0179
Supply of plants
0072
Catchment Management
0180
Computers, Laptops, Printers
0073
General Air Conditioning & Mec
0181
Software suppliers
0074
Compressed Air, Gas and Vacuum
0182
Software developers
0075
Cranes & Hoists
0183
Insurance service providers
0076
Specialised air conditioning
0184
Land Survey
0077
Acoustics & Sound proofing
0185
Engineeering survey
0078
Metallurgical/CorrosionEnginee
0186
Sectional Title
0079
Fire Protection Engineering
0187
Provision of legal services
0080
Lifts
0188
Meters - Water
0081
General refrigeration
0189
Meters - Electric
0082
Specialised refrigeration
0190
Tables, Chairs, cabinets etc
0083
General lighting and earthing
0191
Photocopiers
0084
Floodlighting installation
0192
Laminating machine
0085
Building reticulation
0193
Other: please provide details
0086
Power installations
0194
Paint Suppliers
0087
Fire Detection and alarm syste
0195
Plumbing Contractors
0088
Building evacuation systems
0196
Plumbing Supplies
0089
Telephone & Comunication insta
0197
Printers
0090
Security installations
0198
Supply of Refuse Bags
0091
Emergency power installations
0199
Refuse containers, skips and b
0092
Public Address Systems
0200
Clothing
0093
Lightning Protection Systems
0201
Hard Hats
0094
Closed circuit TV and Radio In
0202
Boots
0095
Standby Generator installation
0203
Traffic Signs
0096
Telemetry systems
0204
Road Signs
0097
Flow Gauges
0205
Street Name signs
0098
Overhead high voltage transmis
0206
Stationery suppliers
0099
High Voltage Substation - plan
0207
Valuation service provider
0100
HV Cable - Planning, Design &
0208
Building Works
0101
High & Medium Voltage Network
0209
Alterations,restorations & red
0102
Medium & Low Voltage Reticulat
0210
Basic quantity surveying servi
0103
Low Voltage Service Connection
0211
Civil engineering works
0104
Medium & Low Voltage Reticulat
0212
Electrical engineering works
4
0105
Medium & Low Voltage Reticulat
0213
Industrial Building works
0106
0107
High, Medium & Low Voltage Net
E250.1 ERACS
0214
0215
Landscape Design
Horticultural design
0108
E250.2 PSSE
0216
Heritage/Historical design
0217
Urban design
Size Of Your Business In Terms Of The Following Structure Per The Sector
Busines size (Please tick):
Sector or Subsector in
accordance with the
standard Industrial
Classification
Size of Class
Manufacturing
The total full-time
equivalent of paid
employees
Total
Total gross asset value
turn-over (fixed property excluded)
200
R51m
R19m
50
R13m
R5m
20
R5m
R2m
5
R0.20m
R0.10m
200
R51m
R19m
50
R13m
R5m
20
R5.10m
R1.90m
5
R0.20m
R0.10m
200
R26m
R5m
50
R6m
R1m
20
R3m
R0.50m
5
R0.20m
R0.10m
200
R39m
R6m
50
R19m
R3m
20
R4m
R0.60m
5
R0.20m
R0.10m
200
R64m
R10m
50
R32m
R5m
20
R6m
R0.60m
5
R0.20m
R0.10m
200
R13m
R3m
50
R6m
R1m
20
R5.10m
R1.90m
5
R0.20m
R0.10m
200
R26m
R6m
Medium
Small
Very small
Micro
Electricity, gas and water
Medium
Small
Very small
Micro
Construction
Medium
Small
Very small
Micro
Retail and Motor Trade
and Repair Services
Medium
Small
Very small
Micro
Wholesale Trade,
Commercial Agents and
Allied Services
Medium
Small
Very small
Micro
Catering, accommodation
and other Trade
Medium
Small
Very small
Micro
Transport, storage &
Communications
Medium
5
50
R13m
R3m
20
R3m
R0.60m
5
R0.20m
R0.10m
200
R26m
R5m
50
R13m
R3m
20
R3m
R0.50m
5
R0.20m
R0.10m
200
R13m
R6m
50
R6m
R3m
20
R1m
R0.60m
5
R0.20m
R0.10m
Small
Very small
Micro
Finance & Business
Services
Medium
Small
Very small
Micro
Community, social &
personal services
Medium
Small
Very small
Micro
6
SECTION C
OWNERS/SHAREHOLDERS/MEMBERS/TRUSTEES
Full Names
ID NO
SA
Citizen
(Yes/NO)
Capacity
(Member,
shareholders
etc)
%
Ownership
Male/
Female
Handicapped
(Yes/No)
HDI
Status
Yes/No
7
Race
(W/C/I/A
)
% of time
devoted
to business
8
DEFINATIONS FOR THE TABLE ABOVE
Definition of ‘HDI’ & “youths” – Historically Disadvantaged Individuals
1. An HDI is defined in terms of Section 1(h) of the Preferential Procurement Policy Framework Act 2000 (Act 56 of
2000) as being a South African Citizen: I. Who due to the apartheid policy that had been in place, had no franchise in national elections prior to the
introduction of the Constitution of South Africa 1983 (Act no.110 of 1983) or the Constitution of the Republic
of South Africa 1983 (Act No. 200 of 1983) (The Interim Constitution) and/or;
II. who is female/male, and/or;
III. who has a disability provided that a person who obtained South Africa citizenship on or after the coming to
effect of the Interim Constitution, is not deemed to be an HDI;
IV. Generally accepted definition of “Youth” is any persons between the age of 18 and 35 year
SECTION D
Company Tax Details
Company Tax Details
Income Tax Number:
Date Approved:
Expiry Date:
VAT Registration Number:
PAYE Registration Number:
SDL Registration Number:
UIF Registration Number:
SECTION E
Banking Details
Name of Account Holder:
Name of Bank:
Name of Branch:
Branch Number:
Account Number:
Type of Account:
Current Account
Savings Account
Transmission Account
9
Cheque Account
SECTION F
Professional Affiliations Or Regulatory Body(e.g Saica, CIDB ect.)
Add Details
Afiliation/Regulatory Body
Registration No:
Name:
Indemnity No:
SECTION G
Declaration: Conflict Of Interest
DECLARATION: CONFLICT OF INTEREST
Are any members or shareholders of the business:
a) employed by Dr JS Moroka Local Municipality; or
b) in the service of the state?
YES
NO
NOTE: "in the service of the state" means
a) a member of
i) any municipal council;
ii) any provincial legislature; or
iii) the National Assembly or the National Council of Provinces;
b) a member of the board of directors of any municipality entity;
c) an official of any municipality or municipal entity;
d) any employee of 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)
e) a member of the accounting authority of any national or provincial public entity; or
f) an employee of Parliament or a provincial legislature.
If (YES) please state the nature if the relationship
Employee Name:
Salary Number:
10
DECLARATION
I/WE, THE UNDERSIGNED WHO WARRANTS THAT I/WE ARE DULY AUTHORISED TO DO SO
ON BEHALF OF THE ENTERPRISE, CERTIFIES THAT THE INFORMATION SUPPLIED IN TERMS
OF THIS DOCUMENT INCLUDING THE RELEVANT ATTACHMENT IS CORRECT AND ACCURATE
AND ACKNOWLEDGE THAT:
1. The enterprise will be required to furnish documentary proof requested to do so.
2. If the information supplied is found to be incorrect, then Dr JS Moroka Local Municipality may in addition to
any remedies it may have:
a) Disqualify the supplier/contractor for a particular bid/contract/project it may be considered for, or which had been awarded to
the supplier/contractor;
b) Recover from the contractor/supplier all costs, losses or damages incurred by Dr JS Moroka Local Municipality as a result of the
breach of contract ;
c) De-register the supplier from the accredited suppliers database;
d) Take any other action as may be deemed necessary.
Full Names:
ID Number:
Date:
Duly authorised on behalf of:
Address:
Telephone no:
Signature:
Date:
11
DECLARATION OF BIDDER’S PAST SUPPLY CHAIN MANAGEMENT PRACTICES
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 havea. 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
Yes
No
Is the bidder or any of its directors listed on the National Treasury’s
Database of Restricted Suppliers 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 Accounting Officer/Authority of the
institution that imposed the restriction after the audi alteram partem
rule was applied)
The Database of Restricted Suppliers now resides on the
National Treasury’s website(www.treasury.gov.za) and can be
accessed by clicking on its link at the bottom of the home
page.
4.1.1
If so, furnish particulars:
12
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)?
Yes
No
Yes
No
Yes
No
The Register for Tender Defaulters can be accessed on the
National Treasury’s website (www.treasury.gov.za) by
clicking on its link at the bottom of the home page.
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?
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?
4.4.1
If so, furnish particulars:
CERTIFICATION
I,
THE
UNDERSIGNED
NAME)……………………………………………………………………………..
(FULL
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.
………………………………………...
…………………………..
13
Signature
……………………………………….
Date
……………………………...
Position
Name of Bidder
14
ANNEXURE “A”
Required document checklist
Please ensure that all documentation listed below is attached (where applicable) to the registration form.
Document Name
Attached
Original Tax Clearance Certificate
□
Company Registration Certificate
□
Most recent municipal accounts for your business location or your personal
□
BBBEE Certificate
□
Residence i.e. rates, water, refuse, electricity (if applicable) and levy registration
□
Proof of Registration with professional body
Confirmation letter banking details certified by bank (page 2)
FOR OFFICE USE ONLY
RECEIPT NO
: _____________________________________
CAPTURED BY
: _____________________________________
CHECKED BY
: _____________________________________
VERIFIED BY
: _____________________________________
CHECKED BY: ______________________________________
VERIFIED BY: ______________________________________
15
16