GT/GDF/038/2014 SECTION 2-ISSUE DATE:2014-05-08 Page 1 of 34

Procure To Pay

Price Schedule - Goods Page 1 of 3

Bidder Name Bid No

NOTE: If the information required regarding each item cannot be inserted in the space provided on
either page 1, 2 or 3 of this form, additional information may be attached to this form.
The Gauteng Department of Finance (GDF) is acting as Common Service Provider or buying organisation on behalf of all Gauteng Provincial
Government Customer Departments / Institutions. The goods / services are therefore required by the Customer Department / Institution, as
indicated on RFP 01.

CONDITIONS
1. All goods or services purchased will be subject to General Conditions of Contract.
2. All prices quoted must be inclusive of Value Added Tax (VAT) and prices must be quoted in South African currency.
3. In case of goods all delivery and/or railage charges must be included in the offered price(s) and goods must be delivered to the address
indicated on RFP 01.
4. All delivery lead times submitted must be firm.
5. Firm prices, being prices deemed to be fixed prices, which are only subject to the following statutory changes, namely VAT and any levy
related to customs and excise, are preferred to variable prices.
6. In case of bidding a price(s) subject to variance, please supply full details by completing RFP 07.
7. If an estimated quantity is called for, no guarantee is given that this or any quantity will be bought by GPG.

PRICING
ESTIMATED UNIT OF
ITEM NO DESCRIPTION
QUANTITY MEASURE
Refer from Page 4 of 34 to Page 23 of 34 for Price Schedule
(Refer to par. 16 of RFP 03 and condition no 3 on RFP 06
PRICE PER UNIT OF MEASURE (including VAT)* R page 1 of 3: in case of goods, all delivery and/or railage
costs must be included in the offered price*.)

How many days from the Closing Date of the Bid is the offer valid?

DELIVERY
TIME REQUIRED FOR DELIVERY AFTER RECEIPT OF ORDER (PLEASE STATE
IN HOURS, DAYS, WEEKS OR MONTHS)
Is the delivery period(s) per item firm? (Also see condition no 4 on RFP
Y N
06 page 1 of 3)

MODEL, SPECIFICATION AND GUARANTEE

Is the offer strictly
Brand and model Y N
to specification?
(For specification see RPF 05)
If not to specification, state deviation

GAURANTEE

Filename: RFP06GDF Revision: 2 Release Date: 18/01/2012

 GT/GDF/038/2014 SECTION 2-ISSUE DATE:2014-05-08 Page 2 of 34

Procure To Pay

Price Schedule - Goods Page 2 of 3

Are the goods/services guaranteed? Y N

(Also see warranty requirements as required in terms of par. 15 of the General Conditions of Contract)

If a specific guarantee is required in the RFP specification, are the

Y N
goods/services ACCORDINGLY guaranteed?
(For specification see RPF 05)

MANUFACTURING (in case of goods)

Is the bidder the
Country of manufacture Y N
manufacturer of the item?
If not, is a Letter of Supply from the relevant manufacturer(s) attached,
Y N
confirming firm supply arrangement(s)?

The said manufacturer/company/vendor must confirm that it has familiarised itself with:
o the item description;
o specifications; and
o bid conditions.
If the bid consist of more than one item, it should be clearly indicated in respect of which item(s) the supportive
letter has been issued. Failure to submit the Letter of Supply document may invalidate the bid.

Is the bidder the accredited representative in the RSA of the manufacturer of

Y N
the goods offered? (Also see RPF 01 page 2)

Indicate names and addresses of the factories where the goods will be manufactured/inspected?

SITE INFORMATION
Physical
Factory Name
Address
Factory Name
Physical
Address

Physical
Factory Name
Address

PHYSICAL ASSETS / EQUIPMENT (in case of goods)

What is the address in the RSA where the goods on bid, of the type offered by you may be inspected,
preferably under working conditions?

What is the approximate value of spares carried in stock in the RSA for
this particular make and model of equipment? R

Filename: RFP06GDF Revision: 2 Release Date: 18/01/2012

 GT/GDF/038/2014 SECTION 2-ISSUE DATE:2014-05-08 Page 3 of 34

Procure To Pay

Price Schedule - Goods Page 3 of 3

At what address(es) is/are these spares held in stock?

What facilities exist for servicing / maintenance of the equipment offered?

Where (at which address) are these servicing / maintenance facilities available?

IMPORTATION (in case of goods)

NOTE: The under mentioned information must be furnished where the offered price may be affected by the
fluctuation in the Rate of Exchange.

(Also ensure that RFP 07 (Non-Firm Prices per item) is completed.)

If only a general import

Is a special import permit required? Y N permit is required, indicate
your import permit number.

Please state the amount in foreign currency in respect of each item,

which will be remitted abroad. R

At what stage will the

amount be remitted abroad?

State the Rate(s) of Exchange

applied in the conversion of this
amount to South African currency.

SIGNATURE OF BIDDER DATE

Filename: RFP06GDF Revision: 2 Release Date: 18/01/2012

 GT/GDF/038/2014 SECTION 2-ISSUE DATE:2014-05-08 Page 4 of 34

Estimated
Material QuantityFor3
Number UOM ShortDescription LongDescription Years UnitPrice Comments

CATEGORY:A(ToiletPaper,FacialTissue,PaperServiettes,PaperTowels,
DisposablePaperWipes,NonWovenFabricWipes)

BATHROOMTISSUES(TOILETPAPER)

Paper toilet, unwrapped roll, single ply, white, 500

Paper toilet roll s/ply sheets per roll, soft grade, 48 rolls per carton,
157601 KAR
500x48 soft 110mm sheet length, 100mm sheet width, SANS
1887-2:2012
212190

Toilet paper, unwrapped roll, single ply, white, 500

Toilet paper roll s/ply sheets per roll, utility grade, 48 rolls per carton,
100447 KAR
500x48 utility 110mm sheet length, 100mm sheet width, SANS
1887-2:2012
46435

Toilet paper, jumbo roll, unwrapped, single ply,

Toilet paper jumbo
white, utility grade, unperforated sheets, 100mm
122481 KAR s/ply
sheet width, 550m rol length, 8 rolls per carton,
100mmx550mx8/ct
SANS 1887-2:2012
11847

Page1of20
 GT/GDF/038/2014 SECTION 2-ISSUE DATE:2014-05-08 Page 5 of 34

Estimated
Material QuantityFor3
Number UOM ShortDescription LongDescription Years UnitPrice Comments

Paper toilet, roll, single ply, white, 600 sheets per

Paper toilet roll s/ply
100445 KAR roll, soft grade, 48 rolls in plastic bag, unwrapped,
600x48 soft whit
marked "RSA", SANS 1887-2:2012
43416

Toilet paper, sheet, single ply, white, utility grade,

Toilet paper sheet interfolded, 213mm sheet length, 105mm sheet
157661 KAR
s/ply util 213x105mm width, 500 sheets per sleeve, 30 sleeves per outer
container, SANS 1887-2:2012
596

Paper toilet, roll, unwrapped, single ply, white, soft

Paper toilet roll s/ply
100444 KAR grade, 600 sheets per roll, 48 rolls per case, "Scott
soft 600x48
Cushy" equal or better ,SANS 1887-2:2012

7948

FACIALTISSUE

Tissue, facial, two ply, white, size C, 190mm

Tissue facial 2 ply
length, 212mm width, interleaved and multi-fold,
100452 KAR whit 190x212mm
hard box, 100 sheets per box, 36 boxes in a
36/ct
carton, SANS 1887-3:2008 4085

Tissue two ply 100mm Tissue, two ply, 100mm length, 40mm width,
110022 EA
length 40mm width disposable paper,SANS 1887-3:2008
1007
Tissue, facial, two ply, white, size B, 195mm
Tissue facial 2 ply
length, 210mm width, interleaved and multi-fold,
157742 PAK whit 195x210mm
soft pack refill, 100 sheets per pack, 36 per box,
36/ct
SANS 1887-3:2008 1339

Page2of20
 GT/GDF/038/2014 SECTION 2-ISSUE DATE:2014-05-08 Page 6 of 34

Estimated
Material QuantityFor3
Number UOM ShortDescription LongDescription Years UnitPrice Comments

PAPERSERVIETTES

Serviette, paper, single ply, white, 300mm length,

Serviette paper single
100453 KAR 300mm width, folded, creped and embossed, 1000
ply white 1000
per carton,SANS 1887-7:2008 4551

Dispenser, paper serviettes, 210x160mm sheet,

Dispenser paper
closed type, plastic or painted metal, wall
126332 EA serviett 210x160mm
mounted, dispensing single serviette at a time,
close
1000 sheets capacity,SANS 1887-7:2008
45
Serviette, paper, two-ply, white, 160mm L, 210mm
Serviette paper two- W, minimum 17g/m, folded, creped and
122486 EA
ply white 160x210mm embossed, 1000 serviettes per case, SANS 1887-
7:2008 90

Serviette, paper, two-ply, white, 330mm L, 330mm

Serviette paper two-
100454 KAR W, folded, creped and embossed, 1000 serviettes
ply white 330x330mm
per case, SANS 1887-7:2008
870

PAPERTOWELS

Page3of20
 GT/GDF/038/2014 SECTION 2-ISSUE DATE:2014-05-08 Page 7 of 34

Estimated
Material QuantityFor3
Number UOM ShortDescription LongDescription Years UnitPrice Comments

Towel paper, single sheet, single ply, white, folded,

350mm length, 240mm width, 120 sheets per
Towel paper single sleeve, 20 sleeves per container, SABS 707 and
164249 KAR sheet fold CKS 285, except that a tolerance to maximum of
350x240mm 9.5 will be allowed the Ph value (sheets to fit and
dispenser must conform to type 2 dispenser of
SANS 1887-4:2008
8244
Towel paper, single sheet, single ply, white, folded,
Towel paper sheet 212mm length, 240mm width, 100 sheets per
158772 KAR s/ply 212x240mm sleeve, 20 sleeves per container, sheets to fit and
100she dispenser must conform to type 2 dispenser of
SANS 1887-4:2008 4861
Towel paper, sheet, single ply, white, folded,
Towel paper sheet
240mm length, 324mm width, 120 sheets per
111691 EA s/ply 240x324mm
sleeve, 20 sleeves per container,SANS 1887-
20/pac
4:2008 131922

Towel paper sheet Towel paper, single sheet, single ply, white, folded,
122490 KAR s/ply 330x245mm 330mm length, 245mm width, 100 sheets per
100she sleeve, 20 sleeves per containerSANS 1887-4:2008
7009

Towel paper, roll, single ply, unperforated,

Towel paper roll s/ply
122516 ROL unembossed, 1400mm length, 205mm width,
unperf 1400x205mm
unwrapped
1316

Page4of20
 GT/GDF/038/2014 SECTION 2-ISSUE DATE:2014-05-08 Page 8 of 34

Estimated
Material QuantityFor3
Number UOM ShortDescription LongDescription Years UnitPrice Comments
Towel paper, roll, single ply, white, unperforated,
Towel papr rol s/ply 444m length, 235mm width, 50mm core diameter,
109772 EA
unperf 360x235 4/pk 4 rolls per pack, use to fit in centre feed dispenser,
SANS 1887-4:2008 44468

Towel paper, roll, single ply, white, perforated,

Towel papr rol s/ply 360m length, 240mm width, 50mm core diameter,
164167 ROL
perfor 360x240 4/pk 4 rolls per pack, use in centrefeed dispenser, SANS
1887-4:2008
170647

Towel paper, medical dressing, roll, two ply, white,

Towel paper med roll perforated, creped and embossed, 444mm length,
100472 ROL
perfo 444x254 12/pk 254mm width, 100 sheets per roll, 12 rolls per
pack, SANS 1887-4:2008
6009

Towel paper, medical dressing, roll, two ply,

Towel paper med roll perforated, 444mm length, 508mm width, 100
100474 ROL
perf 444x508 9/pk sheets per roll, 9 rolls per pack, for steam
sterilizing, SANS 1887-4:2008
940
Towel paper, medical dressing, sheet, two ply,
Towel paper med perforated, 480mm length, 425mm width, 100
100476 KAR sheet perf 425x480 sheets per sleeve, 10 sleeves per outer container,
10/pk 10 per pack, for steam sterilizing, SANS 1887-
4:2008 1512

DISPOSABLEPAPERWIPES

Page5of20
 GT/GDF/038/2014 SECTION 2-ISSUE DATE:2014-05-08 Page 9 of 34

Estimated
Material QuantityFor3
Number UOM ShortDescription LongDescription Years UnitPrice Comments

Wipes, paper, disposable, two ply, roll,

unperforated, unembossed, wet strength 17g/m
Wipes paper 2ply roll
per ply nominal, premium grade, 270mm width,
100466 ROL unperf
1000m length, insolubale in solvents, Type 3,
270mmx1000m
SANS 1887-5:2008, fit a sturdy galvanised
steeldispenser without wheels
1144

Wipes, paper, disposable, two ply, roll,

unperforated, unembossed heavy creped texture,
Wipes paper 2ply roll
wet strength 30g/m, standard grade, 270mm
100467 ROL unperf
width, 1500m length, insolubale in solvents, Type
270mmx1500m
2, SANS 1887-5:2008, fit a sturdy galvanised
steeldispenser without wheels
279

Wipes, paper, disposable, one ply, roll,

unperforated, unembossed heavy creped texture,
Wipes paper 1ply roll
wet strength 22g/m, economy grade, 210mm
122533 ROL unperf
width, 1500m length, insolubale in solvents, Type
210mmx1500m
1, SANS 1887-5:2008, fit a sturdy galvanised
steeldispenser without wheels

Page6of20
 GT/GDF/038/2014 SECTION 2-ISSUE DATE:2014-05-08 Page 10 of 34

Estimated
Material QuantityFor3
Number UOM ShortDescription LongDescription Years UnitPrice Comments

NONWOVENFABRICWIPES

Wipes cleaning, non woven fabric, 75 - 80%

viscose, 20 - 25% rayon fabric, roll, perforated,
Wipes cleaning roll
100472 ROL 45g/m minimum basic mass, 250mm width, 400m
250mmx400m blue
length, blue, absorption rate not exceeding 5
seconds, for general wiping purposes
24

Wipes cleaning, non woven fabric, 75 - 80%

viscose, 20 - 25% rayon fabric, folded sheet,
Wipes clean sheet 40g/m minimum basic mass, 300mm width,
109597 PAK 300x400mm blue 400mm length, blue, 650% absorption capacity,
6x50 absorbtion rate not exceeding 5 seconds, 50 wipes
per pack, 6 per pack, squared packed, for general
wiping purposes
1849
Wipes cleaning, non woven fabric, 75 - 80%
viscose, 20 - 25% rayon fabric, folded sheet,
40g/m minimum basic mass, 600mm width,
Wipes clean sheet
100471 CS 300mm length, blue, 650% absorption capacity,
600x300 blue 5x50
absorbtion rate not exceeding 5 seconds, 50 wipes
per pack, 5 per pack, squared packed, for general
wiping purposes
6141

Page7of20
 GT/GDF/038/2014 SECTION 2-ISSUE DATE:2014-05-08 Page 11 of 34

Estimated
Material QuantityFor3
Number UOM ShortDescription LongDescription Years UnitPrice Comments

Wipes cleaning, non woven fabric, 75 - 80%

viscose, 20 - 25% rayon fabric, folded sheet,
40g/m minimum basic mass, 300mm width,
Wipes clean sheet
159575 PAK 400mm length, green, 650% absorption capacity,
300x400 green 6x50
absorbtion rate not exceeding 5 seconds, 50 wipes
per pack, 6 per pack, squared packed, for general
wiping purposes
116

Wipes cleaning, non woven fabric, 75 - 80%

viscose, 20 - 25% rayon fabric, folded sheet,
40g/m minimum basic mass, 600mm width,
Wipes clean sheet
159577 PAK 300mm length, green, 650% absorption capacity,
600x300 green 5x50
absorbtion rate not exceeding 5 seconds, 50 wipes
per pack, 5 per pack, squared packed, for general
wiping purposes

754

Wipes cleaning, non woven fabric, 75 - 80%

viscose, 20 - 25% rayon fabric, folded sheet,
40g/m minimum basic mass, 300mm width,
Wipes clean sheet
159576 PAK 400mm length, red, 650% absorption capacity,
300x400 red 6x50
absorbtion rate not exceeding 5 seconds, 50 wipes
per pack, 6 per pack, squared packed, for general
wiping purposes

61

Page8of20
 GT/GDF/038/2014 SECTION 2-ISSUE DATE:2014-05-08 Page 12 of 34

Estimated
Material QuantityFor3
Number UOM ShortDescription LongDescription Years UnitPrice Comments

Wipes cleaning, non woven fabric, 75 - 80%

viscose, 20 - 25% rayon fabric, folded sheet,
40g/m minimum basic mass, 600mm width,
Wipes clean sheet
159578 PAK 300mm length, red, 650% absorption capacity,
600x300 red 5x50
absorbtion rate not exceeding 5 seconds, 50 wipes
per pack, 5 per pack, squared packed, for general
wiping purposes
69

Wipes cleaning, non woven fabric, 75 - 80%

viscose, 20 - 25% rayon fabric, folded sheet,
40g/m minimum basic mass, 300mm width,
Wipes clean sheet
159579 PAK 400mm length, yellow, 650% absorption capacity,
300x400 yellow 6x50
absorbtion rate not exceeding 5 seconds, 50 wipes
per pack, 6 per pack, squared packed, for general
wiping purposes

1095

Page9of20
 GT/GDF/038/2014 SECTION 2-ISSUE DATE:2014-05-08 Page 13 of 34

Estimated
Material QuantityFor3
Number UOM ShortDescription LongDescription Years UnitPrice Comments

Wipes cleaning, non woven fabric, 75 - 80%

viscose, 20 - 25% rayon fabric, folded sheet,
40g/m minimum basic mass, 600mm width,
Wipes clean sheet
159580 PAK 300mm length, yellow, 650% absorption capacity,
600x300 yellow 5x50
absorbtion rate not exceeding 5 seconds, 50 wipes
per pack, 5 per pack, squared packed, for general
wiping purposes

367

Page10of20
 GT/GDF/038/2014 SECTION 2-ISSUE DATE:2014-05-08 Page 14 of 34

Estimated
Material QuantityFor3
Number UOM ShortDescription LongDescription Years UnitPrice Comments

CATEGORY:B(DIAPERS)

DIAPERS

Diaper, disposable, baby, small, hospital, leak

guards to help prevent side leakage, absorbent
material, top layer of tissue draw liquid away from
Diaper dispos baby
157668 PAK the skin, elasticised legs, 106mm end fold; 120mm
small elasticis 84/pk
maximum fold with width, grip-refastenable
stretchable velcro tapes, 28.4g total diaper mass,
4g super absorbent mass, pack of 84 diapers

37055

Page11of20
 GT/GDF/038/2014 SECTION 2-ISSUE DATE:2014-05-08 Page 15 of 34

Estimated
Material QuantityFor3
Number UOM ShortDescription LongDescription Years UnitPrice Comments

Diaper, disposable, baby, medium, hospital, leak

guards to help prevent side leakage, absorbent
material, top layer of tissue draw liquid away from
Diaper dispos baby
157745 PAK the skin, elasticised legs, 106mm end fold; 120mm
medium elasticis 58/p
maximum fold with width, grip-refastenable
stretchable velcro tapes, 34.4g total diaper mass,
5g super absorbent mass, pack of 58 diapers

38884

Diaper, disposable, baby, large, hospital, leak

guards to help prevent side leakage, absorbent
material, top layer of tissue draw liquid away from
Diaper dispos baby
157746 PAK the skin, elasticised legs, 106mm end fold; 120mm
large elasticis 54/pk
maximum fold with width, grip-refastenable
stretchable velcro tapes, 42g total diaper mass, 6g
super absorbent mass, pack of 54 diapers

27021

Diaper, disposable, baby, xtra large, hospital, leak

guards to help prevent side leakage, absorbent
material, top layer of tissue draw liquid away from
Diaper dispos baby XL
157750 PAK the skin, elasticised legs, 106mm end fold; 120mm
elasticis 50/pk
maximum fold with width, grip-refastenable
stretchable velcro tapes, 47.4g total diaper mass,
7g super absorbent mass, pack of 50 diapers
29465

Page12of20
 GT/GDF/038/2014 SECTION 2-ISSUE DATE:2014-05-08 Page 16 of 34

Estimated
Material QuantityFor3
Number UOM ShortDescription LongDescription Years UnitPrice Comments

Diaper, disposable, baby, premature, hospital,

absorbent material, 22 x 10cm absorbent pad size,
elasticised legs with 2 strands of elastic, 100 -
106mm end fold; 120mm maximum fold with
width, 4cm width grip-refastenable stretchable
Diaper dispos baby
157761 PAK velcro tapes to ensure proper fit, 30cm diaper
prem elasticis 30/pk
length, 6cm width between baby's legs to allow for
proper positioning of baby's legs, soft waistband
which folds inwards to protect the umbilical cord,
1.5 - 2.75kg fit size, 7g super absorbent mass,
pack of 30 diapers
16905

Undergarment incontinency, disposable diaper,

child, medium, pull-up type for easy removing,
Undergarment dispos cloth like outer encasing pulp/cotton layer
100001 EA
diaper medium child containing absorbent compound, top layer of tissue
draw liquid away from the skin, 18 - 29kg, 600ml
absorbancy

200

Undergarment incontinence, disposable diaper,

child, large, pull-up type for easy removing, cloth
Undergarment dispos like outer encasing pulp/cotton layer containing
100002 EA
child large pull-up absorbent compound, top layer of tissue draw
liquid away from the skin, 29 - 39kg, 600ml
absorbancy

Page13of20
 GT/GDF/038/2014 SECTION 2-ISSUE DATE:2014-05-08 Page 17 of 34

Estimated
Material QuantityFor3
Number UOM ShortDescription LongDescription Years UnitPrice Comments

Diaper incontinence, disposible, adult, 60/80cm hip

dimention, small, refastenable peel-off adhesive
tapes at wing extremities, wetness indicator, non-
woven lining, absorbent core will have fluff pulp
and super absorbent compound, outer plastic
Diaper dispos adult material, have absorbent pad consists of non-
158272 PAK
small heavy 26/pk woven distribution layer, heavy incontinence
protection, 100ml absorbancy, elastic leg gathers
and hydrophobic lengthwise leakage cufs, pack of
26 diapers, non-woven lining and absorbent pad
shall be intermittent bonded to the outer plastic or
foil to prevent the pad to disintegrate during usage

2994

Diaper incontinence, disposable, adult, 70/110cm

hip dimention, medium, refastenable peel-off
adhesive tapes at wing extremities, wetness
indicator, non-woven lining, absorbent core will
have fluff pulp and super absorbent compound,
outer plastic material, have absorbent pad consists
Diaper dispos adult
100504 CS of non-woven distribution layer, heavy
medium heavy 26/pk
incontinence protection, 1330ml absorbancy,
elastic leg gathers and hydrophobic lengthwise
leakage cufs, pack of 26 diapers, non-woven lining
and absorbent pad shall be intermittent bonded to
the outer plastic or foil to prevent the pad to
disintegrate during usage
17525

Page14of20
 GT/GDF/038/2014 SECTION 2-ISSUE DATE:2014-05-08 Page 18 of 34

Estimated
Material QuantityFor3
Number UOM ShortDescription LongDescription Years UnitPrice Comments

Diaper incontinence, disposable, adult, 100/150cm

hip dimention, large, refastenable peel-off adhesive
tapes at wing extremities, wetness indicator, non-
woven lining, absorbent core will have fluff pulp
and super absorbent compound, outer plastic
Diaper dispos adult material, have absorbent pad consists of non-
100505 CS
large heavy 26/pk woven distribution layer, heavy incontinence
protection, 1600ml absorbancy, elastic leg gathers
and hydrophobic lengthwise leakage cufs, pack of
26 diapers, non-woven lining and absorbent pad
shall be intermittent bonded to the outer plastic or
foil to prevent the pad to disintegrate during usage
33593

Diaper incontinence, disposable, adult, 110/170cm

hip dimention, extra-large, refastenable peel-off
adhesive tapes at wing extremities, wetness
indicator, dry touch non-woven top lining,
absorbent core will have fluff pulp and super
Diaper dispos adult XL
100506 EA absorbent compound, flexable outer plastic/ foil,
severe 26/pk
have absorbent pad consists of non-woven
distribution layer, severe incontinence protection,
2290ml absorbancy, elastic leg gathers and
hydrophobic lengthwise leakage cufs, pack of 26
diapers
19541

Page15of20
 GT/GDF/038/2014 SECTION 2-ISSUE DATE:2014-05-08 Page 19 of 34

Estimated
Material QuantityFor3
Number UOM ShortDescription LongDescription Years UnitPrice Comments

Diaper incontinence, disposable, adult, 60-80cm

hip dimention, small, refastenable peel-off
adhesive tapes at wing extremities, wetness
indicator, dry touch non-woven top lining,
Diaper dispos adult absorbent core will have fluff pulp and super
157875 EA
small severe 26/pk absorbent compound, outer plastic material, have
absorbent pad consists of non-woven distribution
layer, severe and overnight incontinence
protection, 2l absorbancy, elastic leg gathers and
hydrophobic lengthwise leakage cufs, 26 per pack
1505
Diaper incontinence, disposable, adult, 70-110cm
hip dimention, medium, refastenable peel-off
adhesive tapes at wing extremities, wetness
indicator, dry touch non-woven top lining,
absorbent core will have fluff pulp and super
Diaper dispos adult
159665 EA absorbent compound, flexable outer plastic/ foil,
medium severe 26/pk
have absorbent pad consists of non-woven
distribution layer, severe and overnight
incontinence protection, 2l absorbancy, elastic leg
gathers and hydrophobic lengthwise leakage cufs,
26 per pack 8764

Page16of20
 GT/GDF/038/2014 SECTION 2-ISSUE DATE:2014-05-08 Page 20 of 34

Estimated
Material QuantityFor3
Number UOM ShortDescription LongDescription Years UnitPrice Comments

Diaper incontinence, disposable, adult, 100-150cm

hip dimention, large, refastenable peel-off adhesive
tapes at wing extremities, wetness indicator, dry
touch non-woven top lining, absorbent core will
Diaper dispos adult have fluff pulp and super absorbent compound,
157874 PAK
large severe 26/pk flexable outer plastic/ foil, have absorbent pad
consists of non-woven distribution layer, severe
and overnight incontinence protection, 2l
absorbancy, elastic leg gathers and hydrophobic
lengthwise leakage cufs, 26 per pack

9502

Page17of20
 GT/GDF/038/2014 SECTION 2-ISSUE DATE:2014-05-08 Page 21 of 34

Estimated
Material QuantityFor3
Number UOM ShortDescription LongDescription Years UnitPrice Comments

CATEGORY:C(INCONTINENCEPADS)

INCONTINENCEPADS

Pad incontinence, disposable, anatomically shaped,

snug fit, absorbent, 9/23cm hip - extra small, self-
adhesive strip on backing to secure it to the
patient's underwear, 100ml absorbency, light
Pad incontinence
159793 PAK protection, non-woven top layer covers entire
shaped X small 24/pk
surface, waterproof foil backing, distribution layer
guides liquid into absorbent core, elasticated sides
for comfort and protection, used either with stretch
pants or inside normal underwear, 24 per pack
650

Page18of20
 GT/GDF/038/2014 SECTION 2-ISSUE DATE:2014-05-08 Page 22 of 34

Estimated
Material QuantityFor3
Number UOM ShortDescription LongDescription Years UnitPrice Comments

Pad incontinence, disposable, anatomically shaped,

snug fit, absorbent, 14/27cm hip - small, self-
adhesive strip on backing to secure it to the
patient's underwear, 200ml absorbency, light
Pad incontinence
159794 PAK protection, non-woven top layer covers entire
shaped small 28/pk
surface, waterproof foil backing, distribution layer
guides liquid into absorbent core, elasticated sides
for comfort and protection, used either with stretch
pants or inside normal underwear, 28 per pack
1400

Pad incontinence, disposable, anatomically shaped,

snug fit, absorbent, 16/30cm hip - medium, self-
adhesive strip on backing to secure it to the
patient's underwear, 250ml absorbency, moderate
Pad incontinence
159795 PAK protection, non-woven top layer covers entire
shaped medium 28/pk
surface, waterproof foil backing, distribution layer
guides liquid into absorbent core, elasticated sides
for comfort and protection, used either with stretch
pants or inside normal underwear, 28 per pack
900

Pad incontinence, disposable, anatomically shaped,

snug fit, absorbent, 20/44cm hip - large, self-
adhesive strip on backing to secure it to the
patient's underwear, 400ml absorbency, moderate
Pad incontinence
159862 PAK protection, non-woven top layer covers entire
shaped large 28/pk
surface, waterproof foil backing, distribution layer
guides liquid into absorbent core, elasticated sides
for comfort and protection, used either with stretch
pants or inside normal underwear, 28 per pack
170

Page19of20
 GT/GDF/038/2014 SECTION 2-ISSUE DATE:2014-05-08 Page 23 of 34

Estimated
Material QuantityFor3
Number UOM ShortDescription LongDescription Years UnitPrice Comments

Pad feminine, anatomically shaped, tiered

absorbent system quickly draws liquid inside to
Pad feminine shape keep pad surface dry and prevents leaks, normal,
122581 PAK normal 245x75mm 245mm length, 75mm width, waterproof polythene
12/pk backing, natural and secure fit not restrict freedom
of movement, 165ml absorbency, light
incontinence protection, 12 per pack
1100

CATEGORY:D(GUARDS)

GUARDS

Guard men, disposable, anatomiclly shaped to

male anotomy, absorbent, one size fits all, leak
proof polythene backing, with wide adhesive strip,
340ml absorbancy, moderate incontinence
Guard men disposable
100507 PAK protection, include granules of absorbent
one size 14/pk
compound, assembly filler of bleached pulp/cotton,
additional layer of tissue to draw liquid away from
skin, elasticised cloth and containment flaps to
prevent side leakage, 14 per pack
28633

Page20of20
 GT/GDF/038/2014 SECTION 2-ISSUE DATE:2014-05-08 Page 24 of 34

Procure To Pay

Non-firm Prices Page 1 of 5

NOTE: If the information required regarding each item cannot be inserted in the space provided
on either page 1, 2, 3, 4 or 5 of this form, additional information may be provided on a
photocopy of this form.

The *Gauteng Department of Finance (GDF) is acting as Common Service Provider or buying organisation on behalf of all
Gauteng Provincial Government Customer Departments / Institutions. The goods / services are therefore required by the
Customer Department / Institution, as indicated on RFP 01.

"Firm" prices are deemed to be fixed prices, which are only subject to the following statutory changes, namely VAT and
any levy related to customs and excise. "Non-firm" prices are all prices other than "firm" prices and which are either
subject to Rate of Exchange claims and/or subject to published indices or documentary evidence.

In case of a contract being awarded as a result of this RFP, all applications for price adjustments must be referred to the
GDF, Private Bag X112, Marshalltown. 2107. Price adjustments shall not be backdated and shall be applicable from date
of approval by the GDF. The successful vendor shall submit an application, in writing and supported by documentary
proof, to the GDF thirty (30) days before the effective date of any price adjustment, whether based on RoE (par. 1),
formula(e) (par. 1 and/or 2) or documentary proof (par. 3).

NOTE: Non-firm prices may be loaded when calculating comparative prices.

1. CLAIMS SUBJECT TO RATE OF EXCHANGE (RoE)

In case of bid prices being subject to Rate of Exchange (RoE) variations, please specify the amount, as well as the
applicable rate of exchange at the time of bidding applicable to each item.

Price adjustments, based on changes in the rate of exchange, shall only be considered if the change, based on the
previous rate, had moved by more than 5%.

1.1 COMPILING THE RoE FORMULA - Cost breakdown structure

A cost breakdown in terms of local & imported components must be submitted for each item as follows:

Imported portion % Local portion % Total 100%

Whatever breakdown chosen in terms of local and imported components cannot be changed over the duration of any
contract awarded based on this RFP.

1.2 AMOUNT(S) SUBJECT TO RoE VARIANCE - IMPORTED PORTION OF RoE FORMULA

Amount(s) subject to exchange rate variations please specify for each item number individually.

Item No
ROE
Variance
In cases where more than one item is quoted, complete RFP 07 Annexure A

1.3 BASE RoE - IMPORTED PORTION OF RoE FORMULA

Exchange rate applicable as at the time of bidding please specify every currency applicable and
indicate which items are affected by which exchange rate

Item No
EXCHANGE
RATE

In cases where more than one item is quoted, complete RFP 07 Annexure A

Filename: RFP07GDFQF Revision:1 Release Date: 02/02/2012

GT/GDF/038/2014 SECTION 2-ISSUE DATE:2014-05-08 Page 25 of 34

Procure To Pay

Non-firm Prices Page 2 of 5

2. CLAIMS SUBJECT TO PUBLISHED INDICES

For all items to which non-firm prices apply, bidders must submit a cost breakdown, which indicates
the proportion of the prices subject to adjustment.
Item No
(as per item number on RFP 06 Price Schedule)

Where price adjustments based on an escalation formula is chosen as the method of price adjustment, variations in the
actual costs for whatever reason are for the account of the successful bidder. This implies that:
formula-based adjustments (as per this method in par 2) and
proven cost increases (as per the method in par 3) cannot both be entertained at the same time for the same
cost element.

2.1 METHOD 1: FORMULA BASED ADJUSTMENTS

2.1.1 The escalation (or price adjustment) formula shall provide for a minimum fixed element of at least 15% of the
price, which shall not be subject to adjustment. The following standard formula structure is prescribed for
calculating escalation / price adjustments:

IN CASES OF PERIOD CONTRACTS, NON FIRM PRICES WILL BE ADJUSTED (LOADED) WITH THE
ASSESSED CONTRACT PRICE ADJUSTMENTS IMPLICIT IN NON FIRM PRICES WHEN CALCULATING
THE COMPARATIVE PRICES

IN THIS CATEGORY PRICE ESCALATIONS WILL ONLY BE CONSIDERED IN TERMS OF THE

FOLLOWING FORMULA:

R 4t
Pa = (1 V )Pt D1
R1t R 2t R3t
+ D2 + D3 + D4 + VPt
R1o R 2o R3o R 4o

Where:

Pa = The new escalated price to be calculated.

(1-V)Pt = 85% of the original bid price. Note that Pt must always be the original bid
price and not an escalated price.
D1, D2.. = Each factor of the bid price eg. labour, transport, clothing, footwear, etc. The total of
the various factors D1, D2etc. must add up to 100%.
R1t, R2t = Index figure obtained from new index (depends on the number of factors used).
R1o, R2o = Index figure at time of bidding.
VPt = 15% of the original bid price. This portion of the bid price remains firm i.e. it is not
subject to any price escalations.

The following index/indices must be used to calculate your bid price:

Index Dated Index Dated Index Dated

Filename: RFP07GDFQF Revision:1 Release Date: 02/02/2012

GT/GDF/038/2014 SECTION 2-ISSUE DATE:2014-05-08 Page 26 of 34

Procure To Pay

Non-firm Prices Page 3 of 5

2.1.2 Cost breakdown structure

A percentage (%) cost breakdown for each item must be submitted according to the following example actual figures to
be added to the table (2nd column) in par. 2.1.3 below:
the various elements specified in this paragraph will form the series (D1, D2 up to Dn) in the formula to be indicated
in par 2.1.1 above.
EXAMPLE OF COST BREAKDOWN STRUCTURE
Direct labour 25%**
Direct material 30%**
Transport 25%**
Other overheads 20%**

Total 100%

FURNISH A BREAKDOWN OF YOUR PRICE IN TERMS OF ABOVE-MENTIONED FORMULA. THE TOTAL OF

THE VARIOUS FACTORS MUST ADD UP TO 100%.

FACTOR
PERCENTAGE OF BID PRICE
(D1, D2 etc. eg. Labour, transport etc.)

Whatever breakdown of index series are chosen cannot be changed over the duration of any
contract awarded based on this RFP.

2.2 APPLICATION OF THE PRICE ADJUSTMENT FORMULA

2.2.1. Fixed price period
GPG suggests an initial fixed period of at least six (6) months from the
effective date of any agreement, which may be awarded as a result of this
RFP. Specify from what date the first price adjustment would be applicable
In cases where more than one item is quoted, complete RFP 07 Annexure A

2.2.2 Frequency of price adjustments after fixed price period

GPG suggests quarterly adjustments, after the initial fixed price period.
Longer periods than three (3) months (quarterly) between adjustments will
be considered even more favourably.
In cases where more than one item is quoted, complete RFP 07 Annexure A

Filename: RFP07GDFQF Revision:1 Release Date: 02/02/2012

 GT/GDF/038/2014 SECTION 2-ISSUE DATE:2014-05-08 Page 27 of 34

Procure To Pay

Non-firm Prices Page 4 of 5

3. METHOD 2: ADJUSTMENTS BASED ON DOCUMENTARY PROOF

Price adjustments shall also be considered based on independent trust worthy documentary proof of cost, price variances
or payments (forward cover cost).

GPG would however prefer claims based on published indices (as per the method in par 2 above), as a result of the fact
that the confidentiality regarding source and price of goods can be maintained with a formula. Providing substantiating
or supporting documentation (as per this method in par 3) often reveals information that may be considered confidential
by the bidder.

Please again note that

formula-based adjustments (as per the method in par 2) and
proven cost increases (as per this method in par 3) cannot both be entertained at the same time for the same
cost element.

3.1. Amount(s) subject to change based on documentary proof

Please specify for each item individually.
Item No

Amount

In cases where more than one item is quoted, complete RFP 07 Annexure A

3.2.1. Fixed price period

GPG suggests an initial fixed period of at least six (6) months from the
effective date of any agreement, which may be awarded as a result of this
RFP. Specify from what date the first price adjustment would be
applicable.
In cases where more than one item is quoted, complete RFP 07 Annexure A

3.2.2 Frequency of price adjustments after fixed price period

GPG suggests quarterly adjustments, after the initial fixed price period.
Longer periods than three (3) months (quarterly) between adjustments will
be considered even more favourably.
In cases where more than one item is quoted, complete RFP 07 Annexure A

Filename: RFP07GDFQF Revision:1 Release Date: 02/02/2012

GT/GDF/038/2014 SECTION 2-ISSUE DATE:2014-05-08 Page 28 of 34

Procure To Pay

Non-firm Prices Page 5 of 5

4 PRICES SUBJECT TO RATE OF EXCHANGE VARIATIONS

4.1. Please furnish full particulars of your financial institution, state the currencies used in
the conversion of the prices of the items to South African currency, which portion of the price is
subject to rate of exchange variations and the amounts remitted abroad.

AMOUNT IN
PORTION OF
FOREIGN
PARTICULARS OF FINANCIAL ITEM PRICE
PRICE CURRENCY RATE CURRENCY
INSTITUTION NO SUBJECT TO
REMITTED
ROE
ABROAD
ZAR=

ZAR=

ZAR=

ZAR=

ZAR=

ZAR=

4.2 Adjustments for rate of exchange variations during the contract period will be calculated
by using the average monthly exchange rates as issued by your commercial bank for the periods
indicated hereunder: (Proof from bank required)

DATE FROM WHICH DATE UNTIL WHICH

DATE DOCUMENTATION
AVERAGE MONTHLY EXCHANGE RATES FOR THE NEW CALCULATED NEW CALCULATED
MUST BE SUBMITTED TO
PERIOD: PRICES WILL BECOME PRICE WILL BE
THIS OFFICE
EFFECTIVE EFFECTIVE

Name(s) & Signature(s) of Bidder(s)

CAPACITY

DATE:

Filename: RFP07GDFQF Revision:1 Release Date: 02/02/2012

GT/GDF/038/2014 SECTION 2-ISSUE DATE:2014-05-08 Page 29 of 34

Procure To Pay

PREFERENCE POINTS
Page: 1 of 6
CLAIM FORM

This preference form must form part of all bids invited. It contains general information and serves as
a claim form for preference points for Broad-Based Black Economic Empowerment (B-BBEE)
Status Level of Contribution
NB: BEFORE COMPLETING THIS FORM, BIDDERS MUST STUDY THE GENERAL CONDITIONS,
DEFINITIONS AND DIRECTIVES APPLICABLE IN RESPECT OF B-BBEE, AS PRESCRIBED IN THE
PREFERENTIAL PROCUREMENT REGULATIONS, 2011.

1. GENERAL CONDITIONS

1.1 The following preference point systems are applicable to all bids:

- the 80/20 system for requirements with a Rand value of up to R1 000 000 (all applicable taxes
included); and
- the 90/10 system for requirements with a Rand value above R1 000 000 (all applicable taxes
included).

1.2 The value of this bid is estimated to exceed/not exceed R1 000 000 (all applicable taxes included) and
therefore the 90/10 system shall be applicable.

1.3 Preference points for this bid shall be awarded for:

(a) Price; and

(b) B-BBEE Status Level of Contribution.

1.3.1 The maximum points for this bid are allocated as follows:

POINTS
90
1.3.1.1 PRICE

1.3.1.2 B-BBEE STATUS LEVEL OF CONTRIBUTION 10

Total points for Price and B-BBEE must not exceed 100

1.4 Failure on the part of a bidder to fill in and/or to sign this form and submit a B-BBEE Verification
Certificate from a Verification Agency accredited by the South African Accreditation System (SANAS) or
a Registered Auditor approved by the Independent Regulatory Board of Auditors (IRBA) or an
Accounting Officer as contemplated in the Close Corporation Act (CCA) together with the bid, will be
interpreted to mean that preference points for B-BBEE status level of contribution are not claimed.

1.5. The purchaser reserves the right to require of a bidder, either before a bid is adjudicated or at any time
subsequently, to substantiate any claim in regard to preferences, in any manner required by the
purchaser.

Filename: Pref00 Revision: 1 Release Date: 17/01/2012

GT/GDF/038/2014 SECTION 2-ISSUE DATE:2014-05-08 Page 30 of 34

Procure To Pay

PREFERENCE POINTS CLAIM

Page: 2 of 6
FORM

2. DEFINITIONS

2..1 all applicable taxes includes value-added tax, pay as you earn, income tax, unemployment insurance
fund contributions and skills development levies;

2.2 B-BBEE means broad-based black economic empowerment as defined in section 1 of the Broad
-Based Black Economic Empowerment Act;

2.3 B-BBEE status level of contributor means the B-BBEE status received by a measured entity based
on its overall performance using the relevant scorecard contained in the Codes of Good Practice on
Black Economic Empowerment, issued in terms of section 9(1) of the Broad-Based Black Economic
Empowerment Act;

2.4 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 services, works or goods, through price quotations, advertised
competitive bidding processes or proposals;

2.5 Broad-Based Black Economic Empowerment Act means the Broad-Based Black Economic
Empowerment Act, 2003 (Act No. 53 of 2003);

2.6 comparative price means the price after the factors of a non-firm price and all unconditional
discounts that can be utilized have been taken into consideration;

2.7 consortium or joint venture means an association of persons for the purpose of combining their
expertise, property, capital, efforts, skill and knowledge in an activity for the execution of a contract;

2.8 contractError! Bookmark not defined. means the agreement that results from the acceptance of a bid by
an organ of state;

2.9 EME means any enterprise with an annual total revenue of R5 million or less .

2.10 Firm price means the price that is only subject to adjustments in accordance with the actual increase or
decrease resulting from the change, imposition, or abolition of customs or excise duty and any other duty,
levy, or tax, which, in terms of the law or regulation, is binding on the contractor and demonstrably has an
influence on the price of any supplies, or the rendering costs of any service, for the execution of the
contract;

2.11 functionality means the measurement according to predetermined norms, as set out in the bid
documents, of a service or commodity that is designed to be practical and useful, working or
operating, taking into account, among other factors, the quality, reliability, viability and durability of a
service and the technical capacity and ability of a bidder;

2.12 non-firm prices means all prices other than firm prices;

2.13 person includes a juristic person;

2.14 rand value means the total estimated value of a contract in South African currency, calculated at
the time of bid invitations, and includes all applicable taxes and excise duties;

2.15 sub-contract means the primary contractors assigning, leasing, making out work to, or employing,
another person to support such primary contractor in the execution of part of a project in terms of the
contract;

2.16 total revenue bears the same meaning assigned to this expression in the Codes of Good
Practice on Black Economic Empowerment, issued in terms of section 9(1) of the Broad-Based
Filename: Pref00 Revision: 1 Release Date: 17/01/2012
GT/GDF/038/2014 SECTION 2-ISSUE DATE:2014-05-08 Page 31 of 34

Procure To Pay

PREFERENCE POINTS CLAIM

Page: 3 of 6
FORM

Black Economic Empowerment Act and promulgated in the Government Gazette on 9 February
2007;

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; and

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. ADJUDICATION USING A POINT SYSTEM

3.1 The bidder obtaining the highest number of total points will be awarded the contract.

3.2 Preference points shall be calculated after prices have been brought to a comparative basis taking into
account all factors of non-firm prices and all unconditional discounts;.

3.3 Points scored must be rounded off to the nearest 2 decimal places.

3.4 In the event that two or more bids have scored equal total points, the successful bid
must be the one scoring the highest number of preference points for B-BBEE.

3.5 However, when functionality is part of the evaluation process and two or more bids have
scored equal points including equal preference points for B-BBEE, the successful bid must
be the one scoring the highest score for functionality.

3.6 Should two or more bids be equal in all respects, the award shall be decided by the
drawing of lots.

4. POINTS AWARDED FOR PRICE

4.1 THE 80/20 OR 90/10 PREFERENCE POINT SYSTEMS

A maximum of 80 or 90 points is allocated for price on the following basis:

80/20 or 90/10

Pt P min Pt P min
Ps = 801 or Ps = 901
P min P min
Where

Ps = Points scored for comparative price of bid under consideration

Pt = Comparative price of bid under consideration

Pmin = Comparative price of lowest acceptable bid

5. Points awarded for B-BBEE Status Level of Contribution

5.1 In terms of Regulation 5 (2) and 6 (2) of the Preferential Procurement Regulations, preference points must
be awarded to a bidder for attaining the B-BBEE status level of contribution in accordance with the table
below:

Filename: Pref00 Revision: 1 Release Date: 17/01/2012

GT/GDF/038/2014 SECTION 2-ISSUE DATE:2014-05-08 Page 32 of 34

Procure To Pay

PREFERENCE POINTS CLAIM

Page: 4 of 6
FORM

B-BBEE Status Number of points Number of points

Level of Contributor (90/10 system) (80/20 system)

1 10 20

2 9 18

3 8 16

4 5 12

5 4 8

6 3 6

7 2 4

8 1 2

Non-compliant 0 0
contributor

5.2 Bidders who qualify as EMEs in terms of the B-BBEE Act must submit a certificate issued by an
Accounting Officer as contemplated in the CCA or a Verification Agency accredited by SANAS or a
Registered Auditor. Registered auditors do not need to meet the prerequisite for IRBAs approval
for the purpose of conducting verification and issuing EMEs with B-BBEE Status Level
Certificates.

5.3 Bidders other than EMEs must submit their original and valid B-BBEE status level verification certificate or
a certified copy thereof, substantiating their B-BBEE rating issued by a Registered Auditor approved by
IRBA or a Verification Agency accredited by SANAS.

5.4 A trust, consortium or joint venture, will qualify for points for their B-BBEE status level as a legal entity,
provided that the entity submits their B-BBEE status level certificate.

5.5 A trust, consortium or joint venture will qualify for points for their B-BBEE status level as an unincorporated
entity, provided that the entity submits their consolidated B-BBEE scorecard as if they were a group
structure and that such a consolidated B-BBEE scorecard is prepared for every separate bid.

5.6 Tertiary institutions and public entities will be required to submit their B-BBEE status level certificates in
terms of the specialized scorecard contained in the B-BBEE Codes of Good Practice.

5.7 A person will not be awarded points for B-BBEE status level if it is indicated in the bid documents that
such a bidder intends sub-contracting more than 25% of the value of the contract to any other enterprise
that does not qualify for at least the points that such a bidder qualifies for, unless the intended sub-
contractor is an EME that has the capability and ability to execute the sub-contract.

5.8 A person awarded a contract may not sub-contract more than 25% of the value of the contract to any other
enterprise that does not have an equal or higher B-BBEE status level than the person concerned, unless the
contract is sub-contracted to an EME that has the capability and ability to execute the
sub-contract.

Filename: Pref00 Revision: 1 Release Date: 17/01/2012

GT/GDF/038/2014 SECTION 2-ISSUE DATE:2014-05-08 Page 33 of 34

Procure To Pay

PREFERENCE POINTS CLAIM

Page: 5 of 6
FORM

6. BID DECLARATION

6.1 Bidders who claim points in respect of B-BBEE Status Level of Contribution must complete the following:

7. B-BBEE STATUS LEVEL OF CONTRIBUTION CLAIMED IN TERMS OF PARAGRAPHS 1.3.1.2 AND 5.1

7.1 B-BBEE Status Level of Contribution: = (maximum of 10 or 20 points)

(Points claimed in respect of paragraph 7.1 must be in accordance with the table reflected in paragraph 5.1 and must
be substantiated by means of a B-BBEE certificate issued by a Verification Agency accredited by SANAS or a
Registered Auditor approved by IRBA or an Accounting Officer as contemplated in the CCA).

8 SUB-CONTRACTING

8.1 Will any portion of the contract be sub-contracted? YES NO

8.1.1 If yes, indicate:
(i) what percentage of the contract will be subcontracted?
(ii) the name of the sub-contractor?
(iii) the B-BBEE status level of the sub-contractor?
(iv) whether the sub-contractor is an EME? YES NO

9 DECLARATION WITH REGARD TO COMPANY/FIRM

9.1 Name of company/firm

9.2 VAT registration number

9.3 Company registration number

9.4 TYPE OF COMPANY/ FIRM [TICK APPLICABLE BOX]

- Partnership/Joint Venture / Consortium

- One person business/sole propriety
- Close corporation
- Company
- (Pty) Limited

9.5 DESCRIBE PRINCIPAL BUSINESS ACTIVITIES

9.6 COMPANY CLASSIFICATION [TICK APPLICABLE BOX]

- Manufacturer
- Supplier
- Professional service provider
- Other service providers, e.g. transporter, etc.

Filename: Pref00 Revision: 1 Release Date: 17/01/2012

GT/GDF/038/2014 SECTION 2-ISSUE DATE:2014-05-08 Page 34 of 34

Procure To Pay

PREFERENCE POINTS CLAIM

Page: 6 of 6
FORM

9.7 Total number of years the company/firm has been in business?

9.8 I/we, the undersigned, who is / are duly authorised to do so on behalf of the company/firm, certify
that the points claimed, based on the B-BBE status level of contribution indicated in paragraph 7
of the foregoing certificate, qualifies the company/ firm for the preference(s) shown and I / we
acknowledge that:

(i) The information furnished is true and correct;

(ii) The preference points claimed are in accordance with the General Conditions as
indicated in paragraph 1 of this form.

(iii) In the event of a contract being awarded as a result of points claimed as shown in
paragraph 7, the contractor may be required to furnish documentary proof to the
satisfaction of the purchaser that the claims are correct;

(iv) If the B-BBEE status level of contribution has been claimed or obtained on a fraudulent
basis or any of the conditions of contract have not been fulfilled, the purchaser may, in
addition to any other remedy it may have

(a) disqualify the person from the bidding process;

(b) recover costs, losses or damages it has incurred or suffered as a result of that
persons conduct;

(c) 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;

(d) restrict the bidder or contractor, its shareholders and directors, or only the
shareholders and directors who acted on a fraudulent basis, from obtaining
business from any organ of state for a period not exceeding 10 years, after
the audi alteram partem (hear the other side) rule has been applied; and

(e) forward the matter for criminal prosecution

WITNESSES

2
Name(s) & Signature(s) of Bidder(s)

DATE: 1
ADDRESS:

Filename: Pref00 Revision: 1 Release Date: 17/01/2012