Ugu Municipality Database Form PDF Details

Are you looking to access information regarding the Ugu Municipality's services and operations? Understanding local regulations and procedures can be challenging – but with the right technology, getting connected is simple. Through our online database form, we provide citizens of the Ugu Municipality with an easy way to gain access to pertinent government information quickly. With a few clicks, users will have up-to-date details about their local tasks, projects, processes and more in one organized system. Read on for further insight into how our digital platform simplifies everyday tasks!

QuestionAnswer
Form NameUgu Municipality Database Form
Form Length12 pages
Fillable?No
Fillable fields0
Avg. time to fill out3 min
Other namesCIDB, Pneumatics, Shepstone, municipality database

Form Preview Example

UGU DISTRICT MUNICIPALITY

Supplier Application Form

Date:

Page 1 of 12

Attached is a Supplier application form to be completed, thus enabling your business to be registered on Ugu District Municipality‟s supplier database, in respect of business

classifications alluded to in Section C of the application form.

COPIES OF THE FOLLOWING CERTIFIED DOCUMENTS MUST BE FURNISHED TOGETHER WITH YOUR APPLICATION:

1.Business Registration Documents

2.Identity documents of directors/owners/members/ shareholders

3.Most recently approved Annual Financial Statements

4.Value Added Tax (VAT) Registration Certificate

5.Tax Clearance Certificate

6.Compensation of Occupational Injuries and Diseases (COID) Registration Certificate

7.Copy of resolutions (if applicable)

8.Company Profile

9.Certificate of acceptance for caterers Obtained from Environmental Health

10.All relevant registration certificate pertaining to your business, incl. but not limited to

NHBRC Registration

CIDB Registration Certificate

SETA Registration

SAQA pertaining to business sector

Trade test certificates

SOB Registration

Membership certificates for professional services

11.A cancelled cheque or stamped letter from the bank confirming banking details.

Completed Supplier Application Forms, CLEARLY MARKED “APPLICATION FOR REGISTRATION ONTO THE UGU SUPPLIER DATABASE” must be submitted to Procurement, 28 Connor Street, Port Shepstone

ALL SUPPLIER INFORMATION WILL BE TREATED STRICTLY CONFIDENTIAL

UGU DISTRICT MUNICIPALITY

Supplier Application Form

Date:

Page 2 of 12

SECTION A: Contact details

„Trading as‟ name of business:

____________________________________________

(Contracts/Orders/Cheques will be issued in this name and invoices must reflect it)

Registered name of business:

___________________________________________

Physical address of business:

Building / complex name: ____________________________________________________

Street name and number: _____________________________________________________

Suburb: ______________________City: _________________________________________

Code:

_____________ Municipal Area: ______________________________________

Postal address of business: (This is the address to which an Invitation to Tender / enquiry and orders / contracts must be sent to)

Postnet suite number ________________________________________________________

P O Box __________________________________________________________________

_____________________________City/Town: _______________________ Code: _______

Telephone numbers of business: Code: __________Number: ________________________

Alternative number of business: Code: __________Number: _________________________

Sales person fax number: Code: __________Number: ______________________________

Alternative person fax number: Code: __________Number: __________________________

(Used by Ugu District Municipality for electronic faxing of Request for Quotations, Contracts and Purchase orders)

Is this a dedicated fax number? (y/n) ____________________________________________

Business e-mail: ____________________________________________________________

Your own business contact person/sales representative name and telephone number:

___________________________________Tel: ___________________________________

UGU DISTRICT MUNICIPALITY

Supplier Application Form

Date:

Page 3 of 12

SECTION B: Business Details

Business Registration number _________________________________________________

(in case of a sole proprietor, please furnish identity number plus copy of identity documents) Income Tax number of business: ______________________________________________

VAT Registration number:

______________________________________________

CIDB registration number:

______________________________________________

Name of Banking Institution:

______________________________________________

Name of account

______________________________________________

Banking account number: ____________________________________________________

Branch: __________________________________________________________________

Branch code: ______________________________________________________________

Please indicate (x) the geographical areas where your business is located:

Gauteng

 

Kwa-Zulu Natal

 

Western Cape

 

Mpumalanga

 

Free State

 

Eastern Cape

 

North West

 

Northern Cape

 

Northern Province

 

 

 

 

 

 

 

Are you locally based, i.e. within Ugu District Municipality yes/no ____________

Previous name of business (if applicable)

_________________________________________________________________

_________________________________________________________________

UGU DISTRICT MUNICIPALITY

Supplier Application Form

Date:

Page 4 of 12

BUSINESS OWNERSHIP

List of directors / owners / partners /members: (Attach your own list if the space provided is inadequate)

1. Name: ___________________________________________________________

Position: _________________________________________________________

%Shareholding/Members Interest _______________________________________

Identity Number____________________________________________________

Nationality________________________________________________________

Gender:__________________________________________________________

2.Name:____________________________________________________________

Position: _________________________________________________________

%Shareholding/Members Interest ________________________________________

Identity Number____________________________________________________

Nationality________________________________________________________

Gender:__________________________________________________________

3.Name: ___________________________________________________________

Position: _________________________________________________________

%Shareholding/Members Interest _____________________________________

Identity Number____________________________________________________

Nationality________________________________________________________

Gender:__________________________________________________________

UGU DISTRICT MUNICIPALITY

Supplier Application Form

Date:

Page 5 of 12

DECLARATION OF INTEREST

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

2Any person, having a kinship with persons in the service of the state, including a blood relationship, may make an offer or offers in terms of this invitation to bid. In view of possible allegations of favouritism, should the resulting bid, or part thereof, be awarded to persons connected with or related to persons in service of the state, it is required that the bidder or their authorised representative declare their position in relation to the evaluating/adjudicating authority and/or take an oath declaring his/her interest.

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

3.1Full Name: ……………….……………………………………………………………………….

3.2Identity Number: .………….………………………………………………………………………

3.3Company Registration Number: …………………………………………………………………

3.4Tax Reference Number:……………………………………………………………..……………

3.5VAT Registration Number: ……………………………………………………………………….

3.6Are you presently in the service of the state? ……………………………………..YES / NO 3.6.1 If so, furnish particulars……………………………………………………………….

………..………………………………………………………………………………………….

3.7Have you been in the service of the state for the past twelve months? ……….YES / NO 3.7.1 If so, furnish particulars……………………………………………………………….

…………………………………………………………………………………………………...

3.8Do you, have any relationship (family, friend, other) with persons in the service of the

state who may be involved in the evaluation and / adjudication of this bid? …..YES?NO

3.8.1If so, furnish particulars……………………………………………………………….

……………………………………………………………………………………………………

3.9Are you, aware of any relationship (family, friend, other) between a bidder and any

persons in the service of the state who may be involved with the evaluation and or adjudication of this bid? …………………………………………………………….YES / NO

3.9.1If so, furnish particulars……………………………………………………………….

……………………………………………………………………………………………………

3.10Are any of the company‟s directors, managers, principal shareholders or stakeholders in service of the state?..................................…………………………………….YES / NO

3.10.1If so, furnish particulars……………………………………………………………….

……………………………………………………………………………………………………

3.11 Is any spouse, child or parent of the company‟s directors, managers, principal

shareholders or stakeholders in service of the state?

YES / NO

3.11.1If so, furnish particulars…………...…..………………………………………………………

……………………………………..……………………………………………………………

UGU DISTRICT MUNICIPALITY

Supplier Application Form

Date:

Page 6 of 12

BUSINESS MANAGEMENT

List of management: Please indicate level of participation in the business (Attach your own list if the space provided is inadequate)

1.Name: ___________________________________________________________

Position: _________________________________________________________

Identity Number: ___________________________________________________

Nationality: ________________________________________________________

Gender: __________________________________________________________

2.Name:____________________________________________________________

Position: _________________________________________________________

Identity Number____________________________________________________

Nationality________________________________________________________

Gender: _________________________________________________________

3.Name: ___________________________________________________________

Position: _________________________________________________________

Identity Number_____________________________________________________

Nationality_________________________________________________________

Gender: __________________________________________________________

UGU DISTRICT MUNICIPALITY

Supplier Application Form

Date:

Page 7 of 12

SECTION C: Business Classification

1)Please indicate (x) in the business classification area applicable to your business:

Professional services

Auxiliary services

Material supply

Construction

Vehicles services

Workshop services

Corporate Services

Other specify

If there are operations performed by your business, not reflected in Section C (3) below, please complete this section [i.e. C (2)].

2)Nature of Operations:

UGU DISTRICT MUNICIPALITY

Supplier Application Form

Date:

Page 8 of 12

Please indicate (X) nature of business operations

 

Vehicle Services

 

Construction

 

 

 

Material supply

 

 

 

Auxiliary services

 

 

 

 

 

 

 

 

 

 

 

Advertising/communicatio

 

Panel beating

 

Concrete works

 

 

Building materials

 

 

n

 

Auto Electrical

 

Pre-cast concrete manuf.

 

Cleaning supplies

 

 

Carpet cleaning

 

Brakes and Clutch

 

Demolition

 

 

 

Safety Clothing

 

 

 

Cleaning services

 

Transmissions

 

Electrical contracts

 

 

Office furniture

 

 

 

Catering/vending

 

Tyres

 

Evacuation systems

 

 

Office supplies& stationery

 

 

Catering equipment hire

 

Batteries

 

Fencing

 

 

 

Fire protection equipment

 

 

Computer hardware

 

Mechanical work

 

General building work

 

Oil & Lubricants

 

 

 

Computer software

 

Windscreens

 

Glazing

 

 

 

Bulk gases

 

 

 

Vehicle hire

 

Communicative

 

Goods transport hire

 

Chemicals

 

 

 

Training

 

Engine overhauls

 

Earthworks

 

 

 

Fuel

 

 

 

Arts and culture

 

 

 

Metalwork

&

burglar

 

 

 

 

 

 

 

Towing Services

 

guards

 

 

 

Hardware supplies

 

 

Horticultural services

 

Upholstery

 

Sheeting

 

 

 

Workshop tools

 

 

 

Garden Maintenance

 

Radiator repairs

 

Industrial Painting

 

 

Food supplies

 

 

 

Site cleaning

 

 

 

Decorative painting

 

 

Plumbing material

 

 

Landscaping

 

Workshop Services

 

Paving

 

 

 

Pipe& irrigation supplies

 

 

Interior decorating

 

Electrical component supplies

 

Plumbing

 

 

 

Hydraulics & Pneumatics

 

 

Waste management

 

Electrical motor repairs

 

Pumping installation

 

 

Vehicle Spares

 

 

 

Laundry services

 

Transformer services

 

Road works

 

 

 

Pumps / spares

 

 

 

Locksmith services

 

Pump repairs

 

Special contracts

 

 

Bolts & nuts

 

 

 

Courier services

 

 

 

 

 

 

 

Mechanical

seals

&

 

 

 

Motor rewinds

 

Sand and stone

 

 

packings

 

 

 

Health care services

 

Hydraulic & Pneumatic repairs

 

Equipment hire

 

 

Lifting equipment

 

 

Municipal services

 

 

 

 

 

 

 

Bearings

 

 

 

Personnel services

 

Professional services

 

 

 

 

 

Glass specialists

 

 

Pest removal services

 

Insurance services

 

 

 

 

 

 

 

 

 

Real estate

 

Financial services

 

 

 

 

 

 

 

 

 

Travel agencies

 

Architects

 

 

 

 

 

 

 

 

 

Security & access control

 

Legal services

 

 

 

 

 

 

 

 

 

Air conditioning systems

 

Land surveyors

 

 

 

 

 

 

 

 

 

Telemetry

 

Medical practitioners

 

 

 

 

 

 

 

 

 

Water Purification

 

Project managers

 

 

 

 

 

 

 

 

 

 

 

Quantity surveyors

 

 

 

 

 

 

 

 

 

Corporate services

 

 

 

 

 

 

 

 

 

 

 

 

Town planners

 

 

 

 

 

 

 

 

 

Corporate Clothing /gifts

 

 

 

 

 

 

 

 

 

 

 

 

Engineers

 

 

 

 

 

 

 

 

 

Events Management

 

 

 

 

 

 

 

 

 

 

 

 

Consulting Engineers (Civil/Structural)

 

 

 

 

 

 

 

 

 

Printing/graphic design

 

 

 

 

 

 

 

 

 

 

 

 

Consulting Engineers (Electrical)

 

 

 

 

 

 

 

 

 

Sound equipment

 

 

 

 

 

 

 

 

 

 

 

 

Consulting Engineers (Mechanical)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Consulting Engineers

 

 

 

 

 

 

 

 

 

 

 

(Multidisciplinary)

 

 

 

 

 

 

 

 

 

 

 

Consulting Engineers (Geotechnical)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Social development consultants

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

UGU DISTRICT MUNICIPALITY

Supplier Application Form

Date:

Page 9 of 12

SECTION D: SUPPLIER PROFILE

In order for Ugu District Municipality to establish a profile of its suppliers, please complete the following:

Commercial:

1.Name 3 commercial references/referees of previous projects and provide their name(s) and telephone number(s):

Financial:

1.Are there any pending legal proceedings or previous judgements against your business or has your business ever been declared bankrupt? (y/n)_____If yes, please elaborate:

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

Technical:

1.Is your business a permit holder under the SABS mark scheme? (y/n): ______________

If yes, indicate product(s) for which permits are held, including permit numbers:

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

2.Are you working to National or International Standards? (y/n)_____If yes, indicate products and to which standards:

________________________________________________________________________

_________________________________________________________________________

Quality:

1. Does your business operate a Quality Management System covering the product/service applying for? (y/n) _______Please elaborate:

________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

UGU DISTRICT MUNICIPALITY

Supplier Application Form

Date:

Page 10 of 12

2.Has your Quality Management System been assessed and certified by any National / Internationally recognised accredited body? (y/n)____If yes, please provide copy of certificate.

Safety:

1.Does your business have an Occupational Health and Safety Policy complying with the Occupational Health and Safety Act (OHSA)? (y/n)______________________________

2.Are you registered with Compensation of Occupational Injuries and Diseases Act (COID)? (y/n) ___________ COID registration number: __________________________

Environmental:

1.Do you have an Environmental Policy in place? (y/n) ____________________________

2.Does your facility routinely work with any hazardous substances? (y/n)______________

Human Resources:

1.Briefly state your Affirmative Action (AA) policy: _________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

Facilities, plant & equipment:

1.Please give a summary of your plant and facilities: ______________________________

________________________________________________________________________

________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

UGU DISTRICT MUNICIPALITY

Supplier Application Form

Date:

Page 11 of 12

2.Please give a summary of your equipment: ____________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

UGU DISTRICT MUNICIPALITY

Supplier Application Form

Date:

Page 12 of 12

SECTION E: DECLARATION

I/WE, THE UNDERSIGNED, WARRANTS THAT I AM/WE ARE DULY AUTHORISED TO DO SO ON BEHALF OF THE ENTERPRISE TO CERTIFY THAT THE INFORMATION SUPPLIED IN TERMS OF THIS DOCUMENT WITH ADDITIONAL INFORMATION IS CORRECT AND ACCURATE AND ACKNOWLEDGES THAT

1.The enterprise complies with all requirements for recognition as a Black / Priority Population Group / Black Business Enterprise / Priority Business Enterprise / Woman Business Enterprise / Disabled Person Enterprise / SMME (Delete as applicable) as defined, and

2.The contents of this Affidavit are within my personal knowledge, and save where stated otherwise are to the best of my belief both true and correct.

3.The enterprise will be required to furnish documentary proof if requested to do so.

4.If the information supplied is found to be incorrect then the Ugu District Municipality in addition to any remedies, it may have; may

i Recover from the Enterprise all costs, losses or damages incurred or sustained by the Municipality as a result of the award of any business, and/or

iiTake any other action as may be deemed necessary.

Signature................................................................................................................................................

Name…...................................................................................................................................................

I.D Number..............................................................................................................................................

Duly authorised to sign on behalf of: ……...............................................................................................

Address...................................................................................................................................................

...............................................................................................................................................................

..............................................................................................................................................................

Telephone..............................................................................................................................................

SECTION F: SWORN AFFIDAVIT

 

Signed and sworn to before me at

on this the

day of

by the Deponent, who has

acknowledged that he/she knows and understands the contents of this document, that it is true and correct to the best of his/her knowledge and that he/she has no objection to taking the prescribed oath, and that the prescribed oath will be binding on his/her conscience.

Commissioner of Oaths....................................................................................................................

NOTE: Both the Deponent and the Commissioner of Oaths must initial all pages of this Application form.