agri pl 002 2006 - prospective supplier list
TRANSCRIPT
PROSPECTIVE SUPPLIER APPLICATION
REFERENCE NUMBER: Agri/PL/002/2006 CLOSE Date: 30 June 2006 Time: 11:00 DESCRIPTION: Invitation to suppliers and service providers
to apply for registration on the AgriSETA list of prospective suppliers
id20989461 pdfMachine by Broadgun Software - a great PDF writer! - a great PDF creator! - http://www.pdfmachine.com http://www.broadgun.com
Reference No: Agri/PL/002/2006
AgriSETA Prospective Supplier Application Document
Content Page
Page 2
DOCUMENTS IN THIS APPLICATION DOCUMENT PACK
Bidders are to ensure that they have received all pages of this document, which consist of the following sections: Invitation to Register Special Conditions of Registration Prospective Supplier Information Form Commodities Form Evaluation Process Curriculum Vitae Guideline Template Tax Clearance Certificate Declaration of Interest Declaration of bidder�s past SCM practices Preference Points Claim Form in terms of the Preferential Procurement Regulations 2001 (Purchases) Preference Points Claim Form in terms of the Preferential Procurement Regulations 2001 (Promotion of Small Enterprises) Note: Deloitte is responsible for the procurement process
Reference No: Agri/PL/002/2006 AgriSETA Prospective Supplier
Application Document Invitation to Register
Page 3
INVITATION TO REGISTER
SUPPLIERS ARE HEREBY INVITED TO REGISTER ON THE LIST OF PROSPECTIVE SUPPLIERS OF AgriSETA
REFERENCE NUMBER
Agri/PL/002/2006 CLOSING DATE 30 June 2006 CLOSING TIME 11:00
DESCRIPTION Invitation to suppliers and service providers to apply for registration on the AgriSETA list of
prospective providers VALIDITY Offer to be valid for 60 days from the closing date of the bid.
The successful applicants will be registered on the prospective supplier list
APPLICATION DOCUMENTS MAY BE: DEPOSITED IN THE BID/TENDER BOX SITUATED AT (Street address)
The Foyer, Deloitte Brooklyn House, 315 Veale Street, Brooklyn, Pretoria
OR POSTED TO: Deloitte, P O Box 11007, Hatfield, Pretoria, 0028 OR HANDED IN AT RECEPTION SITUATED AT (Street address)
Deloitte Brooklyn House, 315 Veale Street, Brooklyn, Pretoria
No faxed or e-mailed application forms will be accepted
Applicants should ensure that application forms are delivered before the closing date and time to the correct
address. Late applications will only be considered during the next (quarterly) update.
Application forms can be delivered and deposited into the bid/tender box between 08:00 and 16:30,
Mondays to Thursdays and 08:00 to 16:00 on Fridays, prior to the closing date, and between 08:00 and 11:00 on the closing date.
All application documents must be submitted on the official forms (not to be re-typed). This application is subject to the Special Conditions of Registration. Application forms submitted that do not comply with the following may not be considered for evaluation:
An application that is not in the format prescribed. An application without some or all of the required documents. Applications without the required number of copies.
Any queries regarding the registration procedures and technical information may be directed to:
Name: Mr Mohamed Ganchi
Tel.: 012 482 0102
Fax: 012 482 0245
e-Mail [email protected]
Reference No: Agri/PL/002/2006 AgriSETA Prospective Supplier
Application Document Special Conditions for Registration
Page 4
SPECIAL CONDITIONS OF REGISTRATION 1 FRAUD AND CORRUPTION 1.1 All suppliers are to take note of the implications of contravening the Prevention
and Combating of Corrupt Activities Act, Act No 12 of 2004 and any other Act applicable.
2 NOTES TO ALL SUPPLIERS SEEKING REGISTRATION ON THE LIST OF
PROSPECTIVE SUPPLIERS OF AgriSETA 2.1 The purpose of this list is to give all prospective suppliers an equal opportunity to
submit quotations to AgriSETA. 2.2 Preference will be given to registered suppliers but it does not necessarily follow
that suppliers who are not yet registered will be totally exempted from quoting for the supplying of goods or services to the AgriSETA. It is envisaged however, that this list will contribute to efficient administration and compliance with the PFMA.
2.3 Attached please find inter alia an official prospective supplier application form to
assist in compiling the list according to legislation. It is imperative that applicants read the prospective supplier application document carefully, complete it in full and sign where appropriate.
2.4 Late submissions would only be considered for registration on the list every three
months (quarterly) provided that all the information and documentation as set out in this document are satisfactory, or after the publishing of the next advertisement.
2.5 Only suppliers that handed in all the correct documentation will be considered for
registration on the list. The organisation will not be considered for registration unless the required number of copies is submitted.
2.6 The list will be valid for a period until March 2008. AgriSETA will update the list
on a quarterly basis. 2.7 Suppliers will be notified whether their applications were accepted or not. 3 CLARIFICATIONS/QUERIES 3.1 Any clarification required by a supplier regarding the meaning or interpretation of
the prospective supplier application document, or any other aspect concerning the application, is to be requested in writing (letter, facsimile or e-mail) from Mr Mohamed Ganchi by 15 June 2006. The reference number should be mentioned in all correspondence. Telephonic requests for clarification will not be accepted. If appropriate, the clarifying information will be made available to all suppliers by e-mail only.
Reference No: Agri/PL/002/2006 AgriSETA Prospective Supplier
Application Document Special Conditions for Registration
Page 5
4 ADDITIONAL INFORMATION REQUIREMENTS 4.1 During evaluation of the supplier application forms, additional information may be
requested in writing. Replies to such request must be submitted, within 2 (two) working days or as otherwise indicated. Failure to comply, may lead to your supplier application being disregarded.
5 SUBMITTING PROSPECTIVE SUPPLIER APPLICATION DOCUMENTS 5.1 An original plus three (3) copies of the application documents, i.e. four (4)
documents in total should be handed in/delivered to:
The Procurement Manager Deloitte Deloitte Brooklyn House 315 Veale Street Brooklyn 0181
5.2 NB: Suppliers are to indicate on the cover of each document whether it is the
original or a copy. 5.3 Prospective supplier application documents should be submitted in a sealed
envelope, marked with:
Reference Number (AgriSETA) Closing date and time (11:00 on 30 June 2006) The name and address of the applicant.
5.4 Documents submitted on time by suppliers shall not be returned. 6 DIRECTIONS TO DELOITTE OFFICES FOR DELIVERY OF APPLICATIONS
Physical Address Deloitte Deloitte Brooklyn House 315 Veale Street Brooklyn 0181
Reference No: Agri/PL/002/2006 AgriSETA Prospective Supplier
Application Document Special Conditions for Registration
Page 6
7
DIRECTIONS TO DELOITTE
N1 North N1 South
Lynnw
ood Road
Duncan Street
Fehrsen Street
Middle S
treetG
e orge Storra r
Fountain
Circle
Brooklyn
Circle
Veale Street
R21 toJohannesburg International
DeloitteWaterkloof House
Eeufees Road (off ramp)
Nelson Mandela Ave (R21) to Pretoria
Dey Street
Queen Wilhelmina Ave
BankForum
Brooklyn Mall
Brooklyn Square
Deloitte Brooklyn House
Charles S
treet
Atterbury R
oad
Veale Street
R28
Waterkloof R
oad
SARS
Bronkhorst S
treet
Reference No: Agri/PL/002/2006 AgriSETA Prospective Supplier
Application Document Special Conditions for Registration
Page 7
8 FORMAT OF APPLICATION DOCUMENT 8.1 Applicants must complete all the necessary documents and undertakings
requirements in this prospective supplier application documents. Applicants are to set out their applications in the format prescribed hereunder.
8.2 Part 1: Invitation To Register 8.2.1 Applicants must complete, sign and return the full �Invitation to register�
document. 8.3 Part 2: SARS Tax Clearance Certificate(s) 8.3.1 An original, valid tax clearance certificate must accompany the application. In
the case of a consortium/joint venture, or where sub-contractors are included in the application, an original valid SARS tax clearance certificate for each consortium/joint venture member and/or subcontractor (individual) must be submitted. The conditions as well as the example tax clearance should not be returned as part of the application.
8.4 Part 3: Declaration of Interest 8.4.1 Each party to the application must complete, sign and return the �Declaration of
Interest form. 8.5 Part 4: Preference Point Claim Form in terms of the Preferential
Procurement Regulations 2001 (Purchases) 8.5.1 Each applicant wishing to highlight its status, must complete, sign and return the
Preference Point Claim form (purchases). 8.6 Part 5: Preference Point Claim Form in terms of the Preferential
Procurement Regulations 2001 (Promotion of Small Enterprises) 8.6.1 Applicants must complete, sign and return the Preference Point Claim form
(promotion of small enterprises). 8.7 Part 6: Prospective Supplier Information Form 8.7.1 Applicants must complete and return the full application form. 8.8 Part 7: Commodities Form 8.8.1 Applicants must complete and return the commodities form 8.8.2 Each applicant will be allowed to register for 16 commodities. 8.9 Part 8: Organisational Profile 8.9.1 Only to be supplied by organisations, not individuals. 8.9.2 Not more than three (3) pages, and must at least contain information below:
Reference No: Agri/PL/002/2006 AgriSETA Prospective Supplier
Application Document Special Conditions for Registration
Page 8
Highlight core business of the organisation. When was the organisation established.
Profile of the management of the organisation (People without voting rights,
Women, Disability).
Profile of the employees of the organisation (People without voting rights, Women, Disability).
What is the role of the organisation in the empowerment of employees with
regards to training (bursaries, in-house training etc).
Details of contracts for similar work within the last 2 years.
Two contactable references for whom work was done in the specified categories.
Samples of work done are not required at this stage.
8.10 Part 9: Proposed Curricula Vitae 8.10.1 A maximum of 2 representative CV�s per professional service category must be
provided in order to demonstrate skill and capacity in the specific category. A CV format is provided as a guide and each CV may not exceed 2 pages.
8.10.2 Please provide a summary chart containing names of representative CV�s:
Name Specialist areas of knowledge linked to commodity
9 REASONS FOR REJECTION 9.1 AgriSETA shall reject an application to be registered if the supplier has
committed a proven corrupt or fraudulent act in applying to register. 9.2 AgriSETA may disregard the application of any supplier if that supplier, or any of
its directors:
Have abused the SCM system of AgriSETA.
Have committed proven fraud or any other improper conduct in relation to such system.
Have failed to perform on any previous contract and the proof exists.
9.3 Such actions shall be communicated to the National Treasury.
Reference No: Agri/PL/002/2006 AgriSETA Prospective Supplier
Application Document Special Conditions for Registration
Page 9
10 GENERAL CONDITIONS OF CONTRACT 10.1 The General Conditions of Contract, which are available on request, will only
guide the quotations to be invited from the list of prospective suppliers.
Reference No: Agri/PL/002/2006 AgriSETA Prospective Supplier
Application Document Prospective Supplier Information Form
Page 10
PROSPECTIVE SUPPLIER INFORMATION FORM
All applicants must furnish the following particulars and include it in their submission (Failure to do so may result in your application being disqualified)
(This form only needs to be completed once, irrespective of the number of commodities being applied
for) Business Service (Make a tick next to the appropriate one) Supplier Service Provider Name of Business Supplier grouping detail/Type of firm (Mark a tick next to the appropriate one) 1 Public Company (Ltd) 2 Private Company (Pty) Ltd 3 Close Corporation registered in terms of the SA
Companies Act (cc)
4 Other (specify) 5 Joint Venture 6 Partnership 7 Consortium 8 Sole Proprietor 9 Foreign Company 10 Trust 11 Section 21 Company 12 Government/parastatals Where business service can be rendered (Make a tick next to the appropriate one) International National If none of the above are
applicable, please specify the Province/s
Please indicate where the Organisation�s Head Office is:
Reference No: Agri/PL/002/2006 AgriSETA Prospective Supplier
Application Document Prospective Supplier Information Form
Page 11
Business Registration Number:
Postal Address:
Code Physical Address:
Code Company Contact Number:
Code Number
Contact person:
Telephone number:
Code Number
Fax Number: Code Number Cellular number:
Number
e-Mail address:
Annual Turnover (Average over last 3 years)
R
VAT Registration number:
Income Tax Reference Number:
Income tax clearance (Make a tick next to the appropriate one)
Yes No Arrangements made (attach proof)
Not applicable (attach proof)
Reference No: Agri/PL/002/2006 AgriSETA Prospective Supplier
Application Document Prospective Supplier Information Form
Page 12
Number of Fulltime Employees
HDI Equity Ownership (Provide the percentage next to each of the following) (Transfer information from Preference Points Claim Form in terms of the Preferential Procurement Regulations, 2001 (Purchases) People without
voting rights %
Women equity % Disabled
individuals %
SMME status (Transfer information from the Preference Points Claim Form in terms of the Preferential Procurement Regulations, 2001 (Promotion of Small Enterprises) for the correct option according to the industry you fall in) Medium Small Very Small Micro Other BEE status (Please determine your BEE status in terms of the new approved Codes of Good Practice issued in terms of the Broad Based Black Economic Empowerment Act and attach the required proof where available.) Ownership status of Broad Based Black Economic Empowerment in terms of Code 100
Management and control status of Broad Based Black Economic Empowerment in terms of Code 200
Reference No: Agri/PL/002/2006 AgriSETA Prospective Supplier
Application Document Commodities Form
Page 13
COMMODITIES FORM
All applicants must furnish the following particulars and include it in their submission (Failure to do so may result in your application being disqualified
Please tick all categories applicable for your business Remember that you may apply for a maximum of 16 categories
PROSPECTIVE SUPPLIER LIST
LIST OF COMMODITIES
* Please note that these commodities are also for the Stellenbosch and Bellville offices
Please
indicate with a
GOODS Access control systems Air conditioning systems Alarm systems and equipment Asset management systems Audiovisual equipment* Bar codes and magnetic cards Cabling systems Cards identification Cartridges* Cellular telephone sales and contracts Cleaning equipment general* Closed circuit TV Coffee and vending machines* Computer components, consumables, hardware and software* Computer solutions* Computer systems* Containers & packaging* Copier / copier drums* Crockery & cutlery* Curtains, rails & accessories Duplicating equipment* Electrical appliances* Electronic appliances* Fire extinguishing equipment First aid supplies and equipment*
Reference No: Agri/PL/002/2006 AgriSETA Prospective Supplier
Application Document Commodities Form
Page 14
PROSPECTIVE SUPPLIER LIST LIST OF COMMODITIES
* Please note that these commodities are also for the Stellenbosch and Bellville offices
Please
indicate with a
Flags Flowers/florists* Furniture & Fittings Gifts/promotional items* Heaters and heating equipment Intercommunication systems Labels and labelling equipment* Leather products general Lights and fittings Magazines Maps Marketing Materials* Materials and textiles Office equipment* Office furniture * Packaging materials/containers* Photography equipment* Printers and printer consumables* Publications Recording equipment* Safes* School supplies Security and Access control systems (Move Security to General Services) Sound and music equipment* Stationery* Storage systems* Telecommunications systems* Training materials and software* PROFESSIONAL SERVICES Accounting and bookkeeping services & Audit Services Administration services Advertising/promotion* Asset management Assurance companies
Reference No: Agri/PL/002/2006 AgriSETA Prospective Supplier
Application Document Commodities Form
Page 15
PROSPECTIVE SUPPLIER LIST LIST OF COMMODITIES
* Please note that these commodities are also for the Stellenbosch and Bellville offices
Please
indicate with a
Auctioneering services Bid evaluations Brokers finance Capacity Building* Computer repairs* Conference centres and facilities* Conferencing services general* Consulting services* Data capturing services* Development: Assessment Tools* Development: Job Profiles and Grading Development: Learning Materials* Development: Performance Management Development: Qualifications* Development: Quality Management System Editing services* Emergency and disaster management Facilitation service* Graphic design services* Insurance Labour relations* Legal services* Marketing communication* Media liaison* Procurement support services Project management* Recording services* Recruitment agents* Research & development* Skills analysis * Strategic planning* Stress management* Telecommunication services* Training: ABET* Training: AIDS*
Reference No: Agri/PL/002/2006 AgriSETA Prospective Supplier
Application Document Commodities Form
Page 16
PROSPECTIVE SUPPLIER LIST LIST OF COMMODITIES
* Please note that these commodities are also for the Stellenbosch and Bellville offices
Please
indicate with a
Training: Assessor* Training: Computer literacy* Training: Staff* Training: Unit Standard Based Skills Programmes and Qualifications* Translation services* Travel arrangements* Web pages: Design & Update Workshop facilitators*
GENERAL SERVICES Accommodation* Air conditioning services and repairs Audiovisual services* Carpet cleaning services Catering service* Cleaning services* Construction services Courier Services* Document binding services* Document duplicating services* Dry cleaning services Electricians Engraving services* Events Organisers* Flooring contractors Framing services* Gardening services Hardware Indoor Plants* Interior decorators Landscape services Lifts: Building Lighting contractors Locksmiths* Logo design services
Reference No: Agri/PL/002/2006 AgriSETA Prospective Supplier
Application Document Commodities Form
Page 17
PROSPECTIVE SUPPLIER LIST LIST OF COMMODITIES
* Please note that these commodities are also for the Stellenbosch and Bellville offices
Please
indicate with a
Maintenance & repairs Office layout design services* Painting contractors* Pest control services* Photocopy Services* Photographer* Photographic services* Plumbing services* Postage* Printing* Recycling services* Security Vehicles hiring/shuttle services*
Reference No: Agri/PL/002/2006 AgriSETA Prospective Supplier
Application Document Evaluation Process
Page 18
ALL SUPPLIERS MUST TAKE NOTE OF THE EVALUATION PROCESS THAT WILL BE FOLLOWED
1. EVALUATION PROCESS 1.1 RESPONSIVENESS CHECK 1.1.1 One (1) original and three (3) copies of supplier application forms submitted. 1.1.2 Invitation to register completed and signed. 1.1.3 Prospective supplier information form completed. 1.1.4 Commodity form completed. 1.1.5 Declaration of interest signed. 1.1.6 Tax clearance certificate submitted. 1.2 EVALUATION 1.2.1 Suppliers that are regarded as responsive will be presented to the AgriSETA Bid
Evaluation Committee to be assessed on the following: 1.2.2 Assessment Criteria
CRITERION
Yes No
Minimum requirements of submission of information as mentioned above
Demonstrated knowledge and experience in categories applied for as a supplier
Demonstrated previous projects in the delivery of goods/services (2 contactable references)
1.3 BID ADJUDICATION COMMITTEE 1.3.1 The recommendations will be submitted to the Adjudication Committee for
consideration and final approval of the list of prospective suppliers of AgriSETA.
Reference No: Agri/PL/002/2006 AgriSETA Prospective Supplier
Application Document Curriculum Vitae Template
Page 19
CURRICULUM VITAE TEMPLATE GUIDELINE TEMPLATE Proposed skills area: 1. Family name 2. First name: 3. Date of birth: 4. Nationality 5. Education
Institution (Date from - Date to)
Degree(s) or Diploma(s) obtained
6. Membership of
professional bodies
7. Other skills (e.g.
computer literacy, etc.)
8. Present position: 9. Years within the
organisation:
10. Key qualifications (relevant
to the categories)
11. Professional experience
Date (From � To) (mm/yy)
Organisation Location Position Description of duties
Date (From � To) (mm/yy)
Organisation Location Position Description of duties
12. Other relevant
information (e.g. Publications)
Reference No: Agri/PL/002/2006 AgriSETA Prospective Supplier
Application Document Tax Clearance Certificate
Page 20
TAX CLEARANCE REQUIREMENTS It is a condition of bid (tender) that the taxes of the successful bidder bust be in order, or that satisfactory arrangements have been made with South African revenue Services (SARS) to meet the bidder�s tax obligations. 1. In order to meet this requirement, bidders are required to complete in full the form
TCC 001 �Application for a Tax Clearance Certificate� and submit it to any SARS branch office nationally. The Tax Clearance Certificate Requirements are also applicable to foreign bidders/ individuals who wish to submit bids.
2. SARS will then furnish the bidder with a Tax Clearance Certificate that will be
valid for a period of 1 (one) year from date of approval. 3. The original Tax Clearance Certificate must be submitted together with the bid.
Failure to submit the original and valid Tax Clearance Certificate will result in the invalidation of the bid. Certified copies of the Tax Clearance Certificate will not be acceptable.
4. In bids where Consortia / Joint ventures / Sub-contractors are involved, each
party must submit a separate Tax Clearance Certificate. 5. Copies of the TCC 001 �Application for a Tax Clearance Certificate� form are
available from any SARS branch office nationally or on the website www.sars.gov.za.
6. Applications for Tax Clearance Certificates may also be made via eFiling. In
order to use this provision, taxpayers will need to register with SARS as eFilers through the website www.sars.gov.za.
Reference No: Agri/PL/002/2006 AgriSETA Prospective Supplier
Application Document Declaration of Interest
Page 21
DECLARATION OF INTEREST
1. Any legal person, including persons employed by the principal, or persons having a kinship with persons employed by the principal, including a blood relationship, may make an offer or offers in terms of this invitation to register. In view of possible allegations of favouritism, should the resulting application, or part thereof, be awarded to persons employed by the principal, or to persons connected with or related to them, it is required that the applicant or his/her authorised representative declare his/her position in relation to the evaluating/adjudicating authority and/or take an oath declaring his/her interest, where:
the applicant is employed by the principal; and/or the applicant is a board member the legal person on whose behalf the application document is signed, has a relationship with
persons/a person who are/is involved in the evaluation and or approval of the application, or where it is known that such a relationship exists between the person or persons for or on whose behalf the declarant acts and persons who are involved with the evaluation and or adjudication of the application.
2. In order to give effect to the above, the following questionnaire must be completed and submitted
with the application document. 2.1 Are you or any person connected with the applicant, employed by the principal? YES/NO 2.1.2 If so, state particulars. 2.2 Do you, or any person connected with the organisation, have any relationship
(family, friend, other) with a person employed by the principal and who may be involved with the evaluation and or approval of this application?
YES/NO
2.2.1 If so, state particulars 2.3 Are you, or any person connected with the applicant, aware of any relationship
(family, friend, other) between the applicant and any person employed by the principal who may be involved with the evaluation and or approval of this application?
YES/NO
2.3.1 If so, state particulars
DECLARATION
I, THE UNDERSIGNED (NAME) CERTIFY THAT THE INFORMATION FURNISHED IN PARAGRAPH 2.1 TO 2.3.1 ABOVE IS CORRECT. I ACCEPT THAT THE PRINCIPAL MAY ACT AGAINST ME IN TERMS OF PARAGRAPH 23 OF THE GENERAL CONDITIONS OF CONTRACT SHOULD THIS DECLARATION PROVE TO BE FALSE. Signature Date Position Name of applicant
Reference No: Agri/PL/002/2006 AgriSETA Prospective Supplier
Application Document Declaration of bidder�s past SCM practices
Page 22
DECLARATION OF BIDDER'S PAST SUPPLY CHAIN MANAGEMENT PRACTICES 1 This declaration will 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. 2 The bid of any bidder may be disregarded if that bidder, or any of its directors have:
a. 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.
3 In order to give effect to the above, the following questionnaire must be completed and submitted with
the bid.
Item Question Yes No
3.1 Is the bidder or any of its directors listed on the National Treasury�s database 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 National Treasury after the audi alteram partem rule was applied).
Yes
No
3.1.1 If so, furnish particulars:
3.2 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)?
To access the Register enter the National Treasury�s website, www.treasury.gov.za click on the icon �Register for Tender Defaulters� or submit your written request for a hard copy of the Register to facsimile number 012-3265445.
Yes
No
3.2.1 If so, furnish particulars:
3.3 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?
Yes
No
3.3.1 If so, furnish particulars:
3.4 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?
Yes
No
3.4.1 If so, furnish particulars:
CERTIFICATION I, THE UNDERSIGNED (FULL NAME) ����������������������������������. 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.
Signature Date
Position Name of Bidder
Reference No: Agri/PL/002/2006 AgriSETA Prospective Supplier
Application Document Preference Points Claim Form (Purchases)
Page 23
PREFERENCE POINTS CLAIM FORM IN TERMS OF THE PREFERENTIAL PROCUREMENT REGULATIONS, 2001
PURCHASES
This preference form must form part of all applications. It contains general information and serves as a claim form for Historically Disadvantaged Individual (HDI) preference points as well as a summary for preference points claimed for attainment of other specified goals. NB: BEFORE COMPLETING THIS FORM, ORGANISATION MUST STUDY THE GENERAL
CONDITIONS, DEFINITIONS AND DIRECTIVES APPLICABLE IN RESPECT OF EQUITY OWNERSHIP BY HISTORICALLY DISADVANTAGED INDIVIDUALS (HDIs), AS PRESCRIBED IN THE PREFERENTIAL PROCUREMENT REGULATIONS, 2001
1. GENERAL CONDITIONS 1.1 Failure on the part of an applicant to fill in and/or sign this form may be interpreted to mean that the
preference points are not claimed. 1.2 The purchaser reserves the right to require of an applicant, either before a application is accepted or
at any time subsequently, to substantiate any claim in regard to preferences, in any manner required by the purchaser.
2. GENERAL DEFINITIONS 2.1 �Acceptable bid� means any bid, which in all respects, complies with the specifications and
conditions of bid as set out in the bid document. For this application �bid� also includes application. 2.2 �Bid� means a written offer in a prescribed or stipulated form in response to an invitation by an
organ of state for the provision of goods, works or services. For this application �bid� also includes application.
2.3 �Comparative price� means the price after the factors of a non-firm price and all unconditional
discounts that can be utilised 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, skills and knowledge in an activity for the execution of a contract. 2.5 �Contract� means the agreement that results from the acceptance of a bid by an organ of state. 2.6 �Specific contract participation goals� means the goals as stipulated in the Preferential
Procurement Regulations, 2001. 2.6.1 In addition to the abovementioned goals, the Regulations [12(1)] also make provision for organs of
state to give particular consideration to procuring locally manufactured products. 2.7 �Control� means the possession and exercise of legal authority and power to manage the assets,
goodwill and daily operations of a business and the active and continuous exercise of appropriate managerial authority and power in determining the policies and directing the operations of the business.
2.8 �Disability� means in respect of a person, a permanent impairment of a physical, intellectual, or
sensory function, which results in restricted, or lack of, ability to perform an activity in the manner, or within the range, considered normal for a human being.
2.9 �Equity ownership� means the percentage ownership and control, exercised by individuals within
an enterprise. 2.10 �Historically Disadvantaged Individuals (HDI�s)� means a South African citizen
Reference No: Agri/PL/002/2006 AgriSETA Prospective Supplier
Application Document Preference Points Claim Form (Purchases)
Page 24
(1) 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 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 interim Constitution�); and or
(2) Who is a female; and/or
(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, is deemed not to be a HDI.
2.11 �Management� means an activity inclusive of control and performed on a daily basis, by any person
who is a principal executive officer of the company, by whatever name that person may be designated, and whether or not that person is a director.
2.12 �Owned� means having all the customary elements of ownership, including the right of decision-
making and sharing all the risks and profits commensurate with the degree of ownership interests as demonstrated by an examination of the substance, rather than the form of ownership arrangements.
2.13 �Person� includes reference to a juristic person. 2.14 �Rand value� means the total estimated value of a contract in Rand denomination that is calculated
at the time of invitations and includes all applicable taxes and excise duties. 2.15 �Small, Medium and Micro Enterprises (SMMEs)� bears the same meaning assigned to this
expression in the National Small Enterprise Act, 1996 (Act No 102 of 1996). 2.16 �Subcontracting� means the primary contractor�s assigning or leasing or making out work to, or
employing another person to support such primary contractor in the execution or part of a project in terms of the contract.
2.17 �Trust� means the arrangement through which the property of one person is made over or
bequeathed to a trustee to administer such property for the benefit of another person. 2.18 �Trustee� means any person, including the founder of a trust, to whom property is bequeathed in
order for such property to be administered for the benefit of another person. 3. ESTABLISHMENT OF HDI EQUITY OWNERSHIP IN AN ENTERPRISE 3.1 Equity ownership shall be equated to the percentage of an enterprise which is owned by individual
classified as HDIs, or in the case of a company, the percentage shares that are owned by individual classified as HDIs, who are actively involved in the management and daily business operations of the enterprise and exercise control over the enterprise, commensurate with their degree of ownership.
3.2 Where individuals are not actively involved in the management and daily business operations and
do not exercise control over the enterprise commensurate with their degree of ownership, equity ownership may not be claimed.
4. POINTS AWARDED FOR HISTORICALLY DISADVANTAGED INDIVUDUALS 4.1 In terms of Regulation 13(2) preference points for HDI�s are calculated on their percentage
shareholding in a business, provided that they are actively involved in and exercise control over the enterprise. The following formula is prescribed in Regulation 13(5)(c).
100
EPNOPxNEP
Where NEP = Points awarded for equity ownership by an HDI
NOP = The maximum number of points awarded for equity ownership by an HDI in
Reference No: Agri/PL/002/2006 AgriSETA Prospective Supplier
Application Document Preference Points Claim Form (Purchases)
Page 25
that specific category EP = The percentage of equity ownership by an HDI within the enterprise or
business, determined in accordance with the definition of HDI�s 4.2 Equity claims for a trust will only be allowed in respect of those persons who are both trustees and
beneficiaries and who are actively involved in the management of the trust. 4.3 Documentation to substantiate the validity of the credentials of the trustees contemplated above
must be submitted. 4.4 Listed companies and tertiary institutions do not qualify for HDI preference points. 4.5 A consortium or joint venture may, based on the percentage of the contract value managed or
executed by their HDI-members, be entitled to preference points in respect of an HDI. 4.6 A person awarded a contract as a result of preference for contracting with, or providing equity
ownership to an HDI, may not subcontract more than 25% of the value of the contract to a person who is not an HDI or does not qualify for the same number or more preference for equity ownership.
5. DECLARATION 5.1 Applicants who claim points in respect of equity ownership must complete the Declaration at the end
of this form. 6. EQUITY OWNERSHIP CLAIMED IN TERMS OF PARAGRAPH 2.10 ABOVE. POINTS TO BE
CALCULATED FROM INFORMATION FURNISHED IN PARAGRAPH 9.8 Ownership Percentage
owned 6.1 Equity ownership by persons who had no
franchise in the national elections
% 6.2 Equity ownership by women % 6.3 Equity ownership by disabled persons* %
*If points are claimed for disabled persons, indicate nature of impairment (see paragraph 2.8 above) ���������������������������������������
7. DECLARATION WITH REGARD TO EQUITY 7.1 Name of firm: 7.2 VAT registration number: 7.3 Company registration number: 7.4 Type of firm
Partnership One person business/sole trader Close corporation Company (Pty) Limited Tick applicable box
Reference No: Agri/PL/002/2006 AgriSETA Prospective Supplier Application Document Preference Points Claim Form (Purchases)
Page 26
7.5 List all shareholders by Name, Position, Identity Number, Citizenship, HDI status and ownership, as relevant. Information to be used to calculate the points claimed
in paragraph 8
*HDI Status Name Date/Position occupied in enterprise
ID number Date RSA citizenship obtained No franchise
prior to elections
Women Disabled
*Non-HDI status
% of business/ enterprise
owned
* Indicate Yes or No
Reference No: Agri/PL/002/2006 AgriSETA Prospective Supplier
Application Document Preference Points Claim Form (Purchases)
Page 27
7.6 I/We, the undersigned who warrants that he/she is duly authorised to do so on behalf of the firm
certify that points claimed, based on the equity ownership, indicated in paragraph 8 of the foregoing certificate, qualifies the firm for the preference(s) shown and I/we acknowledge that:
7.6.1 The information furnished is true and correct. 7.6.2 The equity ownership claimed is in accordance with the General Conditions as indicated in
paragraph 1 of this form. 7.6.3 In the event of a contract being awarded as a result of points claimed as shown in paragraph 8, the
contractor may be required to furnish documentary proof to the satisfaction of the seller that the claims are correct.
7.6.4 If the claims are found to be incorrect, the seller may, in addition to any other remedy it may have:
Recover costs, losses or damages it has incurred or suffered as a result of that person�s conduct.
Cancel the contract and claim any damages which it has suffered as a result of having to make
less favourable arrangements due to such cancellation.
Impose a financial penalty more severe than the theoretical financial preference associated with the claim which was made.
WITNESSES 1. ���������������� 2. ���������������� DATE: ���������������� ADDRESS: ��������������� ��������������������.. ��������������������.. ��������������������..
��������������. SIGNATURE(S) OF BIDDER(S)
Reference No: Agri/PL/002/2006 AgriSETA Prospective Supplier
Application Document Preference Points Claim Form (Promotion of Small Enterprises)
Page 28
PREFERENCE POINTS CLAIM FORM IN TERMS OF THE PREFERENTIAL PROCUREMENT REGULATIONS, 2001
PROMOTION OF SMALL ENTERPRISES
NB: BEFORE COMPLETING THIS FORM, APPLICANTS MUST STUDY THE GENERAL
CONDITIONS, DEFINITIONS AND DIRECTIONS SPECIFIED IN THE PREFERENCE POINTS CLAIM FORM (PURCHASES) IN TERMS OF THE PREFERENTIAL PROCUREMENT REGULATIONS, 2001
1. INTRODUCTION 1.1 In terms of regulation 17 of the Preferential Procurement Regulations pertaining to the
Preferential Procurement Policy Framework Act, 2000 (Act No 5 of 2000), it is the Government�s intention to promote small businesses (now referred to as small enterprises)..
2. CLAIM WITH REGARD TO BEING A SMALL ENTERPRISE 2.1 Applicants regarding itself as a micro, very small or medium enterprise (SMME) as defined
by the National Small Enterprise Act, 1996 (Act No 102 of 1996) as amended by the National Small Business Amendment Act (Act 26 of 2003) and the National Small Business Amendment Act (Act 29 of 2004) may claim its status.
2.2 Do you regard yourself as a SMME in terms of the Act? YES / NO 2.3 Should the applicant wish to claim its status as being a SMME, then the applicant must
complete the following table.
First select and tick in column (A) the relevant sector or sub-sector you are operating in. Within the chosen sector, select and tick in columns (B), (C) and (D) the relevant block indicating your organisation�s position pertaining to employees (B), turnover (C) and asset value (D).
See the example in 2.4 below:
Reference No: Agri/PL/002/2006 AgriSETA Prospective Supplier
Application Document Preference Points Claim Form (Promotion of Small Enterprises)
Page 29
Annex 1: Schedule National Small Enterprise Act
Sector or sub-
sector in accordance with
the Standard Industrial
Classification
A Size or class Total full time equivalent of
paid employees
B Total annual turnover
C Total gross asset value
(fixed property excluded)
D
Less than Less than Medium 100 R5.00 m R5.00 m Small 50 R3.00 m R3.00 m Very small 10 R0.50 m R0.50 m
Agriculture
Micro 5 R0.20 m R0.10 m
Medium 200 R39.00 m R23.00 m Small 50 R10.00 m R6.00 m Very small 20 R4.00 m R2.00 m
Mining and quarrying
Micro 5 R0.20 m R0.10 m
Medium 200 R51.00 m R19.00 m Small 50 R13.00 m R5.00 m Very small 20 R5.00 m R2.00 m
Manufacturing
Micro 5 R0.20 m R0.10 m
Medium 200 R51.00 m R19.00 m Small 50 R13.00 m R5.00 m Very small 20 R5.10 m R1.90 m
Electricity, gas and water
Micro 5 R0.20 m R0.10 m
Medium 200 R26.00 m R5.00 m Small 50 R6.00 m R1.00 m Very small 20 R3.00 m R0.50 m
Construction
Micro 5 R0.20 m R0.10 m
Medium 200 R39.00 m R6.00 m Small 50 R19.00 m R3.00 m Very small 20 R4.00 m R0.60 m
Retail and motor trade and repair service
Micro 5 R0.20 m R0.10 m
Medium 200 R64.00 m R10.00 m Small 50 R32.00 m R5.00 m Very small 20 R6.00 m R0.60 m
Wholesale trade, commercial agents and allied services Micro 5 R0.20 m R0.10 m
Medium 200 R13.00 m R3.00 m Small 50 R6.00 m R1.00 m Very small 20 R5.10 m R1.90 m
Catering, accommodation and other trade
Micro 5 R0.2 m R0.10 m
Medium 200 R26.00 m R6.00 m Small 50 R13.00 m R3.00 m Very small 20 R3.00 m R0.60 m
Transport, storage and communications
Micro 5 R0.20 m R0.10 m
Medium 200 R26.00 m R5.00 m Small 50 R13.00 m R3.00 m Very small 20 R3.00 m R0.50 m
Finance and business services
Micro 5 R0.20 m R0.10 m
Medium 200 R13.00 m R6.00 m Small 50 R6.00 m R3.00 m Very small 20 R1.00 m R0.60 m
Community, social and personal services Micro 5 R0.20 m R0.10 m
Reference No: Agri/PL/002/2006 AgriSETA Prospective Supplier
Application Document Preference Points Claim Form (Promotion of Small Enterprises)
Page 30
2.4 Applicants are to claim their status based on the size or class of enterprise indicated
above:
Example
Sector or sub-sector in accordance
with the Standard Industrial
Classification
A Size or class Total full time equivalent of
paid employees
B Total annual turnover
C Total gross asset value
(fixed property
excluded)
D
Less than Less than Medium 100 R5.00 m R5.00 m Small 50 R3.00 m R3.00 m Very small 10 R0.50 m R0.50 m
Agriculture
Micro 5 R0.20 m R0.10 m The annual turnover shall be the factor determining the ultimate classification and hence the points claimable. The company in this example would be classified as a �small� enterprise because of the turnover in lieu of the fact that according to the other parameters, the company could be classified as a �micro� or �very small� enterprise.
2.5 Insert your classification in the table below based on the information contained in
paragraph 2.3. 2.6 If required, the information supplied above must be substantiated by an internal auditor�s
certificate and the relevant documentation.
Classification Tick correct classification
Micro
Very Small
Small
Medium
3. DECLARATION 3.1 I/we, the undersigned, who warrants that he/she is duly authorised to do so on behalf of
the firm declare that status claimed, based on promotion of small, medium or micro enterprises, qualifies the firm for the status shown and I/we acknowledge that:
3.1.1 The information is true and correct. 3.1.2 The contractor may be required to furnish documentary proof of substantiating external
auditor certificate that the claims are correct.
Reference No: Agri/PL/002/2006 AgriSETA Prospective Supplier
Application Document Preference Points Claim Form (Promotion of Small Enterprises)
Page 31
3.1.3 If the claims are found to be incorrect, AgriSETA may, in addition to any other remedy it
may have:
Recover all costs, losses or damages it has incurred or suffered as a result of that person�s conduct.
Cancel the contract and claim any damages which it has suffered as a result of having
to make a less favourable arrangement due to such cancellation.
Impose a financial penalty more severe that the theoretical financial preference associated with the claim which was made.
Restrict the contractor, its shareholders and directors from obtaining business from
AgriSETA for a period determined by AgriSETA. WITNESSES 1. ���������������� 2. ���������������� DATE: ��������������
��������������. SIGNATURE(S) OF APPLICANT(S)