Professional Documents
Culture Documents
VENDOR/SUPPLIER
NAME:
You are hereby invited to register on Musina Local Municipalitys supplier database.
The following documents/ information must be provided/ attached when submitting the
supplier database:
Completed supplier application forms and all required documents must be posted or
delivered to:
Postal Address:
Private Bag X611
Musina
0900
Physical Address:
21 Corner Irwin & Scholtz Street
Musina
0900
Application Forms are available at the Procurement Office, Musina Local Municipality civic centre, 21 Irwin and
Scholltz Street and website: www. http://musina.gov.za
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1. BUSINESS PARTICULARS
1.1 Name of business as registered with Registrar of Companies / Close Corporations
1.2 Name of business used for trading purposes, if different from 1.1 or Name of
Business if not registered with the Registrar of Companies / Close Corporations
1.3 Registration Number as registered with the Registrar of Companies / Close
Corporations(if applicable)
1.4 Vat Registration Number
1.5 Income Tax Reference Number
1.6 Unemployment Insurance Fund No. (if applicable) *
* Please attach copy of Registration Form. If you are unable to do so, kindly provide explanation.
Enquiries can be directed to Procurement Office, P/ bag x 611, Musina, Tel: 015 534 6118 / 6166
Fax: 086 743 1811
Email: suzanm@musina.gov.za
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Enquiries can be directed to Procurement Office, P/ bag x 611, Musina, Tel: 015 534 6118 / 6166
Fax: 086 743 1811
Email: suzanm@musina.gov.za
Page |4
3. TYPE OF BUSINESS
Please tick the appropriate box.
Public Company (Pty) Ltd
Close Corporation CC
Sole Proprietor
Partnership
Trust
Co-operative
Voluntary Associations
* Please ensure to attach a certified copy of the appropriate document dependent on type, e.g. Public Co. to
attach certified copy of Certificate of Incorporation
4. COMPANY STRUCTURE
Please state a total and not a percentage on Item A, B & C
Directors
Total:
Shareholders %
Enquiries can be directed to Procurement Office, P/ bag x 611, Musina, Tel: 015 534 6118 / 6166
Fax: 086 743 1811
Email: suzanm@musina.gov.za
Page |5
5. CATEGORY OF SERVICES
Please state the category of services
A)
GENERAL SUPPLY
B)
C)
D)
MANUFACTURER
E)
F)
CONSULTANTS/PROFESSIONAL SERVICES
Declaration
I/ we, the undersigned on behalf of the business declare that the information furnished is true and
correct and that I/we, have attached all the required documentary proof to substantiate the validity of the
credentials of the business and give the municipality the authority to reject or impose any penalty should
the business be found to have misrepresented some vital information. I/we declare that the banking
details provided are correct. And declare that I/we are fully acquainted with the conditions of purchase
and delivery, payments, definitions, vendor requirements and general definitions as stipulated on page 12
to 16.
Date
Witnesses 1.
2.
Enquiries can be directed to Procurement Office, P/ bag x 611, Musina, Tel: 015 534 6118 / 6166
Fax: 086 743 1811
Email: suzanm@musina.gov.za
Page |6
No
SUPPLIER'S NUMBER
I have checked all the details provided by this business and found to be in order and that
all the necessary documentary proof has been provided to my satisfaction and therefore
accept the registration of this business in the Municipal Service Provider database.
Database Administrator----------------------------------
Date----------------------------
Enquiries can be directed to Procurement Office, P/ bag x 611, Musina, Tel: 015 534 6118 / 6166
Fax: 086 743 1811
Email: suzanm@musina.gov.za
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7. COMMODITY GROUPS
SERVICES
SUPPLY
SERVICES
SUPPLY
SERVICES
AUTO ELECTRICAL
AUTOMOTIVE SPARES
AUDITING
AIRCON
ARCHITECTS
AUCTIONEER
ADVERTISING
AUDIO SYSTEM
ACCOMMODATION (LODGE/HOTELS)
AGENTS (ALL TYPES)
B)
BLASTING SERVICES
BOOKKEEPING
BANKERS
BOREHOLE EQUIPMENT
BOREHOLE DRILLING
BOREHOLE MAINTENANCE
BRICKS
BURIAL SERVICES
C)
CATERING
CARPENTRY
Enquiries can be directed to Procurement Office, P/ bag x 611, Musina, Tel: 015 534 6118 / 6166
Fax: 086 743 1811
Email: suzanm@musina.gov.za
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CHEMICALS
CABINET MAKING
CLEANING SERVICES
CEMENT
COMPUTER EQUIPMENT
CONCRETE READY MIX
Construction, Engineering, Building
CAR HIRE
CABLING
COURIER SERVICES
CONSULTANTS
SUPPLY
SERVICES
SUPPLY
SERVICES
CIVIL ENGINEERING
MECHANICAL ENGINEERING
ARCHITECTURAL LAND SCAPE
QUANTITY SURVEYING
LAND SURVEYING
ELECTRICAL ENGINEERING
PROPERTY VALUERS
TOWN PLANNING
ENVIRONMENTAL CONSULTATION
ATTORNEY/LEGAL ADVISORS
PROJECT MANAGEMENT
IT CONSULTANTS
PROPERTY DEVELOPERS
PROPERTY EVALUATORS
FINANCIAL SERVICES
PUBLIC HEALTH SERVICES
D)
Enquiries can be directed to Procurement Office, P/ bag x 611, Musina, Tel: 015 534 6118 / 6166
Fax: 086 743 1811
Email: suzanm@musina.gov.za
Page |9
DECORATION
E)
SUPPLY
SERVICES
SUPPLY
SERVICES
SUPPLY
SERVICES
SUPPLY
SERVICES
SUPPLY
SERVICES
SUPPLY
SERVICES
FURNITURE
Fencing
FUEL / OIL/ GAS
H)
HOUSEHOLD APPLIANCES
I)
INTERIOR DESIGNER
INSURANCE BROKERS
L)
LABOUR HIRE
LIBRARY SERVICES
LAWN MOWER
LOCKSMITH
M)
MEDICAL EQUIPMENT
Enquiries can be directed to Procurement Office, P/ bag x 611, Musina, Tel: 015 534 6118 / 6166
Fax: 086 743 1811
Email: suzanm@musina.gov.za
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MEDICAL SERVICES
MACHINE HIRING
P)
SUPPLY
SERVICES
SUPPLY
SERVICES
SUPPLY
SERVICES
PAINTING
PEST CONTROL
PLASTERING
R)
SLASH WORK
SIGNBOARD (SIGN WRITING)
Enquiries can be directed to Procurement Office, P/ bag x 611, Musina, Tel: 015 534 6118 / 6166
Fax: 086 743 1811
Email: suzanm@musina.gov.za
P a g e | 11
STEEL WORK
SECURITY SYSTEM
STATIONERY
SOUND HIRE
STORAGE EQUIPMENT
SEWER SYSTEM
SHELVING
SHOP FITTERS
SWIMMING POOL
SAND
SCRAP METAL
SOLD WASTE
T)
SUPPLY
SERVICES
SUPPLY
SERVICES
TRENCH DIGGING
TOOLS
TREATED POLES
TAR PRODUCTS
TRAFFIC CONTROL EQUIPMENTS
TYRES
TOURISM
TELECOMMUNICATION
TRANSPORT
TILES/TILING
THATCHING
TRAVEL AGENCY
TOWING SERVICES
V)
VEHICLE PURCHASING
VIDEO PRODUCTION
Enquiries can be directed to Procurement Office, P/ bag x 611, Musina, Tel: 015 534 6118 / 6166
Fax: 086 743 1811
Email: suzanm@musina.gov.za
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VALUATORS AND ACTUARIES
VETERINARY SERVICES
W)
SUPPLY
SERVICES
SUPPLY
SERVICES
2.
3.
4.
All goods must be delivered at the stores, except where other arrangement
has been made between the purchaser and suppliers.
9. CONDITIONS OF PAYMENT
1.
A valid TAX INVOICE must be provided before any payment can be done as
been required by the ACT.
Enquiries can be directed to Procurement Office, P/ bag x 611, Musina, Tel: 015 534 6118 / 6166
Fax: 086 743 1811
Email: suzanm@musina.gov.za
P a g e | 13
2.
In order for council to obtain any goods or services from a vendor the following
requirements must be met:
I
The vendor must be registered with the council and a database with
the relevant information will be submitted by the Financial Manager to
the relevant departmental managers;
II
All vendors must supply the council with their business addresses and
their tax certificates;
III
All vendors rendering goods and services to the council must comply
with any labour legislation or regulations promulgated, with special
reference to the Basic Conditions of Employment Act, Labour Relations
Act, and the Occupational, Health and Safety Act (where a vender do
not comply with the above legislation the Council has the right to
intervene, to correct the situation within available legal remedies.
IV
All vendors must declare the employment rations and compliance with
the Employment Equity Act;
Council may require from vendors to enter into Joint ventures with
other vendors;
Vendors must declare their business and family relationship with any
person working for council or their relationship with a Councilor;
VI
VII
Vendors may not be in arrears with their Municipal Accounts for more
than 30 days. The Council will set off any outstanding balances for
longer than 30 days against any money outstanding to the vendor.
VIII
Vendors must indicate on their tender document how many jobs will be
created or maintained when executing a tender.
Enquiries can be directed to Procurement Office, P/ bag x 611, Musina, Tel: 015 534 6118 / 6166
Fax: 086 743 1811
Email: suzanm@musina.gov.za
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11. DEFINITIONS
1
2)
3)
4)
5)
6)
Enquiries can be directed to Procurement Office, P/ bag x 611, Musina, Tel: 015 534 6118 / 6166
Fax: 086 743 1811
Email: suzanm@musina.gov.za
P a g e | 15
transports and that the sum of the average annual
turnovers over the same period of all the business
concerns which are under the Control of Previously
Disadvantaged Individuals within the business entity and
Affiliated Entities does not exceed one and a half (1,5)
times the maximum allowable annual average turnover
for the particular category of enterprise as set out in 11)
above, seeking ABE status.
b)
c)
d)
e)
f)
g)
h)
i)
Enquiries can be directed to Procurement Office, P/ bag x 611, Musina, Tel: 015 534 6118 / 6166
Fax: 086 743 1811
Email: suzanm@musina.gov.za
P a g e | 16
any supplies, or the rendering costs of any service, for the execution of
the contract;
j)
Who, due to the apartheid policy that had been in place, had no
franchise in national elections prior to the introduction of the
Constitutions of the Republic of South Africa, 1983 (Act no 10
of 1983) or the Constitution of the Republic of South Africa,
1993 (Act No 200 of 1993) (he Interim Constitution) and/or
(2)
l)
n)
Rand value means the total estimated value of the contract in
Rand denomination which is calculated at the time of tender
invitations and includes all applicable taxes and excise duties;
o)
p)
q)
Enquiries can be directed to Procurement Office, P/ bag x 611, Musina, Tel: 015 534 6118 / 6166
Fax: 086 743 1811
Email: suzanm@musina.gov.za
P a g e | 17
services or goods;
r)
s)
t)
u)
Enquiries can be directed to Procurement Office, P/ bag x 611, Musina, Tel: 015 534 6118 / 6166
Fax: 086 743 1811
Email: suzanm@musina.gov.za
P a g e | 18
ANNEXURE 1
CERTIFIED BANKING DETAILS FORM
This form needs to be completed, certified by the appropriate Banking Institution and attached to the registration form.
Name of Banking Institution
Branch Name
Branch Code
Town / City
__________________________________
Please place Bank stamp here
Received and stamped By (Name in Block Letters)
Signature of Recipient
Date of Receipt
Enquiries can be directed to Procurement Office, P/ bag x 611, Musina, Tel: 015 534 6118 / 6166
Fax: 086 743 1811
Email: suzanm@musina.gov.za
P a g e | 19
ANNEXURE 2
MBD 4
DECLARATION OF INTEREST
1.
2.
Any 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.
3 In order to give effect to the above, the following questionnaire must be completed
and submitted with the bid.
3.1 Full Name of bidder or his or her
representative:..
3.2 Identity Number:
.
3.7 The names of all directors / trustees / shareholders members, their individual
identity
numbers and state employee numbers must be indicated in paragraph 4
below.
Enquiries can be directed to Procurement Office, P/ bag x 611, Musina, Tel: 015 534 6118 / 6166
Fax: 086 743 1811
Email: suzanm@musina.gov.za
P a g e | 20
Have you been in the service of the state for the past twelve months? YES / NO
Enquiries can be directed to Procurement Office, P/ bag x 611, Musina, Tel: 015 534 6118 / 6166
Fax: 086 743 1811
Email: suzanm@musina.gov.za
P a g e | 21
3.11
.............................................................
3.12
.
3.13 Are any spouse, child or parent of the companys directors trustees, managers,
principle
shareholders
or
stakeholders
in
service
of
the
state?
YES / NO
3.13.1 If yes, furnish particulars.
.
3.14 Do you or any of the directors, trustees, managers, principle shareholders, or
stakeholders of this company have any interest in any other related companies or
business whether or not they are bidding for this contract........YES / NO
3.14.1 If yes, furnish particulars:
..
..
.
Enquiries can be directed to Procurement Office, P/ bag x 611, Musina, Tel: 015 534 6118 / 6166
Fax: 086 743 1811
Email: suzanm@musina.gov.za
P a g e | 22
4.
Identity Number
State Employee
Number
..
Signature
..
Date
.
Capacity
Name of Bidder
Enquiries can be directed to Procurement Office, P/ bag x 611, Musina, Tel: 015 534 6118 / 6166
Fax: 086 743 1811
Email: suzanm@musina.gov.za