Mangaung Metro Municipality Form PDF Details

Embarking on a journey to become a registered vendor with the Mangaung Metro Municipality requires navigating a comprehensive application process, designed to ensure that all potential suppliers meet the municipality's standards for quality and reliability. At the heart of this process is the vendor application form, an intricate document that serves as the first step toward inclusion in the municipality's database of approved service providers. This form, detailed and meticulous, requires applicants to furnish a range of documents, from company profiles to tax clearance certificates, and even B-BBEE status level verification for businesses aiming to demonstrate their commitment to broad-based black economic empowerment. Moreover, the form entails sections for banking details, areas of specialty, and a detailed vendor questionnaire, aimed at assessing the applicant's adherence to the principles of black economic empowerment and their eligibility based on predefined criteria. The application does not end with the submission of paperwork; it extends into declarations of interest to preempt conflicts of interest, especially concerning individuals in the service of the state. This exhaustive process, while demanding, underscores the Mangaung Metro Municipality's dedication to transparency, equality, and the highest standards of service delivery, ensuring that only the most competent and qualified vendors join their ranks.

QuestionAnswer
Form NameMangaung Metro Municipality Form
Form Length8 pages
Fillable?No
Fillable fields0
Avg. time to fill out2 min
Other namesmangaung metro municipality, mangaung metro municipality vacancies, mangaung metro municipality application forms pdf, municipality application form 2021

Form Preview Example

APPLICATION TO BE REGISTERED AS A VENDOR

ACCOMPANYING DOCUMENTS

Please note that the following documents MUST accompany your application:

Certified copies of the accompanying documents must be submitted to the Municipality’s Supply Chain Office within 14 (fourteen) days of submission of application. Failure to submit relevant documentation within the prescribed period will result in disqualification of your application.

NO.

 

 

DESCRIPTION

YES/NO

 

 

 

 

 

1.

 

 

Company Profile (maximum of 3 pages)

 

 

 

 

 

2.

 

Copy of the Company registration (CK)

 

 

 

 

 

 

3.

 

 

Copies of the owner(s) ID documents (Certified)

 

 

 

 

 

4.

 

Business Letterhead/company stamp

 

 

 

 

 

5.

 

Cancelled cheque or Bank confirmation on bank details

 

 

 

 

 

 

6.

 

 

Valid & Original Tax Clearance Certificate

 

 

 

 

 

 

7.

 

 

VAT Registration Certificate (if applicable)

 

 

 

 

 

 

 

 

 

Municipal Rates Clearance Certificate or Copy of a lease agreement (if

 

8.

 

 

renting/leasing) Not Monthly Account (to be collected at Bram Fischer Building,

 

 

 

 

Debt Collection Division)

 

9.

 

 

B-BBEE status level verification Certificate*

 

 

 

 

 

 

10.

 

 

CIDB Certificate (for construction, plumbing, electrical, etc)

 

 

 

 

 

11.

 

SIRA Certificate (for security)

 

 

 

 

 

 

12.

 

 

For Consulting Services we need CVs of consultants who are going to provide the

 

 

 

service

 

 

 

 

 

*Companies with an annual total revenue of R5 million or less qualify as Exempted Micro Enterprises (EMEs) in terms of the Broad-Based Black Economic Empowerment Act, and must submit a certificate issued by a registered auditor, accounting officer (as contemplated in section 60(4) of the Close Corporation Act, 1984 (Act No. 69 of 1984)) or an accredited verification agency.

PO Box 3704, Bloemfontein 9300, 6 Mannion Road, Oranjesig, Bloemfontein, 9301

Tel: +27 51 411 3215 Fax: +27 51 411 3240 E-Mail: sele.thebane@mangaung.co.za Website: www.mangauang.co.za

___________________________________________________________________________

Application form to be registered as a Vendor

Page 1 of 8

SCM#001

VENDOR INFORMATION

The following information should be completed in full.

Name of Business

: _______________________________________________________

Trading Names

: _______________________________________________________

Company Registration Number/ID No.: ___________________________________________________

Income Tax Reference Number. : _______________________________________________________

Vat Registration Number

: _______________________________________________________

Contact person

: _______________________________________________________

Telephone number

: _______________________________________________________

Fax number

: _______________________________________________________

Cell phone number

: _______________________________________________________

E-mail address

: _______________________________________________________

Physical Address

: _______________________________________________________

Postal Address

: _______________________________________________________

BANKING DETAILS

 

 

Name of Bank

 

 

 

 

Address of Bank

 

 

 

 

Branch Code of Bank

Bank Account Number

Type of Account

(If cheque account, please attach cancelled cheque)

___________________________________________________________________________

Application form to be registered as a Vendor

Page 2 of 8

NB: SERVICE PROVIDERS TO CHOOSE ONLY THREE AREAS OF SPECIALTY

Suppliers are expected to choose three services (Tick x were applicable)

A.

FINANCE & ADMINISTRATION

B.

TECHNICAL SERVICES & MAINTENANCE

Transport of Cash

Provision of services such as erection of car ports, kerbs

Tracing agencies

 

fixing, cleaning of storm water system, electrical work,

Seals and money bags for pay points

 

painting, fencing, pothole fixing

Credit Ratings

Geo-Hydrology

Printing & Stationery

Consulting Engineering

Office furniture and equipment

Building contractors

Newspaper suppliers

Cellular

Supply of uniform and protective clothing

Land-line telephones

Provision of security services

Escalators

Cleaning services of buildings

Air Conditions (installation and repairs)

Supply of cleaning materials and related items

Partitioning and ceiling

Car Rental

Supply of vehicles and related accessories

Travel Agencies

Panel beating and spray painting

Advertising

Supply chemicals for pool maintenance

Curtains and blinds

Supply of coal for swimming pool boilers

Computer accessories

Repairs on irrigation systems and water pipes

Courier Services

Servicing of equipment

 

 

Grading of soccer fields

 

 

Repairs alarm systems

 

 

Waterproofing

C.

EMERGENCY SERVICES

D.

EVENT MANAGEMENT

Pneumatic rescue equipment

Provision of catering services

Hydraulic rescue equipment

Photographic and Videos

Lubricants

Sound systems

Fire fighting equipment

Decorations

Electrically driven power tools

Guest Houses

Petrol driven power tools

Venue for Conferences

Portable fire fighting pumps

Performers

 

 

Beverages

 

 

Corporate Gifts

 

 

Promotional items

E.SPECIALISED SERVICES

Accredited inspection authority Accredited laboratories

Surveying and rezoning

Skills development and training Recruitment Consultants

GIS Consultants

Legal work such as Labour Law, litigation, contracts, deeds and conveyancing, and debt

collection

Printing and Design

Financial Consultants/Accounting Firms Business Development Support

Marketing services and Research

F.COMMUNITY SERVICES

Burial services Horticulture

Gardening service

Environmental impact assessment Waste management

Transport Services

___________________________________________________________________________

Application form to be registered as a Vendor

Page 3 of 8

BLACK ECONOMIC EMPOWERMENT : VENDOR QUESTIONNAIRE

List all Shareholders by Name, Position, Identity Number, Citizenship, HDI status and ownership, as

relevant. Information to be used to calculate the points

Name

Date/Position

occupied in

Enterprise

ID Number

Date RSA

Citizenship

obtained

* HDI Status

o franchise

 

 

prior to

omen

Disabled

elections

 

 

%

f business / enterprise

owned

*Indicate YES or NO

Notes:

a)The following questions should be completed comprehensively in order for Mangaung Metropolitan Municipality to conduct a representative BEE evaluation of your company.

b)An unwillingness to provide information as requested will result in Mangaung Metropolitan Municipality allocating a minimum score for that area of the questionnaire.

c)Mangaung Metropolitan Municipality reserves the right to request any additional information that would be deemed necessary to verify any answers provided by a company.

d)Misrepresentation of company status with respect to answers provided in this submission will result in disqualification from the evaluation processes or cancellation of contracts as deemed appropriate.

e)The municipality will deem persons completing this questionnaire as individuals authorized to do so.

f)Previously disadvantaged individuals (PDI’s) / Blacks shall mean Africans, Coloureds, Indians, Black Women and

Disabled people, excluding naturalized South Africans.

g)Previously disadvantaged individuals (PDI’s) in the context of this questionnaire shall be applicable to South African

Citizens only.

COMPANY STAMP:

Responding to the request does not automatically qualify a provider as a registered or preferred provider.

Note: The submission of this application form shall under no circumstance qualify a service provider as a preferred provider. The SCM policy will be followed for use of service providers.

___________________________________________________________________________

Application form to be registered as a Vendor

Page 4 of 8

DECLARATION OF INTEREST

1.The declaration of interest should be completed by all the directors/members/principle shareholders/stakeholders of the Company under oath.

2.No application will be accepted from persons in the service of the state.1

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

3.1 Are any of the directors/members/principle shareholders/stakeholders

YES / NO

presently in the service of the state?

 

If so, furnish particulars.

 

…………………………………………………………………………………….

 

…………………………………………………………………………………….

 

…………………………………………………………………………………….

 

3.2 Have any of the directors/members/principle shareholders/stakeholders

YES / NO

been in the service of the state for the past twelve months?

 

If so, furnish particulars.

 

…………………………………………………………………………………….

 

…………………………………………………………………………………….

 

…………………………………………………………………………………….

 

3.3 Have any of the directors/members/principle shareholders/stakeholders

YES / NO

have any relationship (family, friend, other) with persons in the service of

 

the state and who may be involved with the evaluation of this application?

 

If so, furnish particulars.

 

…………………………………………………………………………………….

 

…………………………………………………………………………………….

 

…………………………………………………………………………………….

 

1MSCM Regulations: “in the service of the state” means to be –

(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 directorates of any municipal entity;

(c)An official of any municipality or municipal entity;

(d)An 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 999);

(e)A member of the accounting authority of any national or provincial public entity; or

(f)An employee of Parliament or a provincial legislature.

___________________________________________________________________________

Application form to be registered as a Vendor

Page 5 of 8

3.4 Is any spouse, child or parent of the company’s

YES / NO

directors/members/principle shareholders/stakeholders in the service of

 

the state?

 

If so, furnish particulars.

 

…………………………………………………………………………………….

 

…………………………………………………………………………………….

 

…………………………………………………………………………………….

 

DECLARATION OF BIDDER’S PAST SUPPLY CHAIN MANAGEMENT PRACTICES

1.It serves as a declaration to be used by municipalities and municipal entities 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.

2.The bid of any company may be rejected if that company, or any of its directors have:

a.abused the municipality’s / municipal entity’s supply chain management system or committed any improper conduct in relation to such system;

b.been convicted for fraud or corruption during the past five years;

c.willfully neglected, reneged on or failed to comply with any government, municipal or other public sector contract during the past five years; or

d.been listed in the Register for Tender Defaulters in terms of section 29 of the Prevention and Combating of Corrupt Activities Act (No 12 of 2004).

3.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

Is the bidder or any of its directors listed on the National Treasury’s Database

Yes

No

 

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:

 

 

 

 

 

 

4.2

Is the bidder or any of its directors listed on the Register for Tender Defaulters

Yes

No

 

in terms of section 29 of the Prevention and Combating of Corrupt Activities

 

 

 

Act (No 12 of 2004)?

 

 

 

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.

 

 

 

 

 

 

___________________________________________________________________________

Application form to be registered as a Vendor

Page 6 of 8

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

Yes

No

 

court of law outside the Republic of South Africa) for fraud or corruption during

 

 

 

the past five years?

 

 

4.3.1

If so, furnish particulars:

 

 

 

 

 

 

Item

Question

Yes

No

4.4

Does the bidder or any of its directors owe any municipal rates and taxes or

Yes

No

 

municipal charges to the municipality / municipal entity, or to any other

 

 

 

municipality / municipal entity, that is in arrears for more than three months?

 

 

 

 

 

 

4.4.1

If so, furnish particulars:

 

 

 

 

 

 

4.5

Was any contract between the bidder and the municipality / municipal entity or

Yes

No

 

any other organ of state terminated during the past five years on account of

 

 

 

failure to perform on or comply with the contract?

 

 

4.7.1

If so, furnish particulars:

 

 

 

 

 

 

I, THE UNDERSIGNED (NAME) ______________________________________________________________

CERTIFY THAT THE INFORMATION FURNISHED ON THIS FORM IS CORRECT. I ACCEPT THAT THE MUNICIPALITY MAY ACT AGAINST ME SHOULD THIS DECLARATION PROVE TO BE FALSE.

_______________________________

______________________________

Signature

Date

I, THE UNDERSIGNED (NAME) ______________________________________________________________

CERTIFY THAT THE INFORMATION FURNISHED ON THIS FORM IS CORRECT. I ACCEPT THAT THE MUNICIPALITY MAY ACT AGAINST ME SHOULD THIS DECLARATION PROVE TO BE FALSE.

_______________________________

______________________________

Signature

Date

I, THE UNDERSIGNED (NAME) ______________________________________________________________

CERTIFY THAT THE INFORMATION FURNISHED ON THIS FORM IS CORRECT. I ACCEPT THAT THE MUNICIPALITY MAY ACT AGAINST ME SHOULD THIS DECLARATION PROVE TO BE FALSE.

_______________________________

______________________________

Signature

Date

___________________________________________________________________________

Application form to be registered as a Vendor

Page 7 of 8

COMMISSIONER OF OATH

I, _______________________________________, certify that the deponent(s) has acknowledged that

he/she knows and understands the contents of this declaration.

This declaration has been sworn/affirmed before me at ______________________________ on this

day of ________________________________ 20 _____

___________________________________

COMMISSIONER OF OATHS

FOR OFFICE USE

 

 

 

 

 

RECEIVED BY: _________________________________

DATE

________________________

 

CHECKED BY: _________________________________

DATE

________________________

 

 

APPROVED/NOT APPROVED: _____________________

DATE

________________________

 

 

 

SCM OFFICIAL STAMP:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

___________________________________________________________________________

Application form to be registered as a Vendor

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