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!
Question | Answer |
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Form Name | Ugu Municipality Database Form |
Form Length | 12 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 3 min |
Other names | CIDB, Pneumatics, Shepstone, municipality database |
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) |
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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
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 |
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Western Cape |
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Mpumalanga |
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Free State |
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Eastern Cape |
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North West |
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Northern Cape |
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Northern Province |
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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
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Vehicle Services |
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Construction |
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Material supply |
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Auxiliary services |
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Advertising/communicatio |
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Panel beating |
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Concrete works |
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Building materials |
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Auto Electrical |
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Cleaning supplies |
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Carpet cleaning |
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Brakes and Clutch |
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Demolition |
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Safety Clothing |
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Cleaning services |
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Transmissions |
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Electrical contracts |
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Office furniture |
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Catering/vending |
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Tyres |
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Evacuation systems |
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Office supplies& stationery |
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Catering equipment hire |
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Batteries |
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Fencing |
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Fire protection equipment |
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Computer hardware |
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Mechanical work |
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General building work |
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Oil & Lubricants |
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Computer software |
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Windscreens |
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Glazing |
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Bulk gases |
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Vehicle hire |
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Communicative |
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Goods transport hire |
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Chemicals |
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Training |
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Engine overhauls |
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Earthworks |
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Fuel |
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Arts and culture |
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Metalwork |
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burglar |
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Towing Services |
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guards |
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Hardware supplies |
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Horticultural services |
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Upholstery |
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Sheeting |
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Workshop tools |
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Garden Maintenance |
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Radiator repairs |
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Industrial Painting |
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Food supplies |
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Site cleaning |
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Decorative painting |
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Plumbing material |
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Landscaping |
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Workshop Services |
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Paving |
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Pipe& irrigation supplies |
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Interior decorating |
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Electrical component supplies |
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Plumbing |
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Hydraulics & Pneumatics |
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Waste management |
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Electrical motor repairs |
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Pumping installation |
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Vehicle Spares |
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Laundry services |
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Transformer services |
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Road works |
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Pumps / spares |
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Locksmith services |
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Pump repairs |
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Special contracts |
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Bolts & nuts |
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Courier services |
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Mechanical |
seals |
& |
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Motor rewinds |
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Sand and stone |
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packings |
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Health care services |
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Hydraulic & Pneumatic repairs |
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Equipment hire |
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Lifting equipment |
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Municipal services |
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Bearings |
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Personnel services |
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Professional services |
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Glass specialists |
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Pest removal services |
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Insurance services |
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Real estate |
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Financial services |
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Travel agencies |
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Architects |
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Security & access control |
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Legal services |
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Air conditioning systems |
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Land surveyors |
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Telemetry |
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Medical practitioners |
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Water Purification |
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Project managers |
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Quantity surveyors |
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Corporate services |
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Town planners |
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Corporate Clothing /gifts |
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Engineers |
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Events Management |
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Consulting Engineers (Civil/Structural) |
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Printing/graphic design |
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Consulting Engineers (Electrical) |
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Sound equipment |
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Consulting Engineers (Mechanical) |
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Consulting Engineers |
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(Multidisciplinary) |
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Consulting Engineers (Geotechnical) |
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Social development consultants |
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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 |
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Signed and sworn to before me at … |
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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.