Mogale City Local Municipality

1 RangeProcurement processR 2 000 - R 30 000 Faxed quotations from suppliers on databaseR 30 001 - R 200 000 Advertisement on website requiring a written quotationAbove R 200 000A letter with the company's letterhead stating physical, postal address, telephone and fax number and e-mail address (compulsory)Certified copy of company registration documents (compulsory)Latest municipal account irrespective of Municipality /metro or a copy of the lease/rental agreement if not responsible for payment of municipal services (compulsory)A cancelled cheque or a copy of a bank statement (compulsory)Original, valid tax clearance certificate (compulsory)Proof of registration with statutory body (if applicable)The Mogale City Local Municipality (MCLM) hereby invites current and prospective service providers to apply to be accredited and registered on our Supplier Database as required by the Municipal Finance Management Act of 2003. Henceforth, MCLM will not do business with suppliers that are not accredited and registered on the existing and potential suppliers must register on the supplier database before they can do business with the registration forms as well as B-BBEE certificates for existing creditors must reach the SCM unit before 30 March 2011.

2 Should the completed form not be received by the mentioned date, the Creditor Section will not be able to affect your application forms will be accepted continiously, but the supplier database will only be updated information requested on the application form as well as supporting documentaion must be in order for your company to be accredited and registered. The following is a checklist for supporting documentation: Mogale City Local Municipality Supplier registration ApplicationThe SCM Unit will inform suppliers of the status of their applications in familiarise yourself with the official SCM procurement procedures and note that it is imperative that potential suppliers regularly log onto the website to obtain information regarding requests for quotations in excess of R30,000 as well as tenders. Suppliers registered on the database will only be approached for submission of quotations for procurement of goods/services below R30,000.

3 Above R30,000 it is the responsibility of the supplier to respond to requests as tender via website, noticeboard and newspaperCertified copies of ID's of shareholders or sole propriotor (compulsory)Affidavits of shareholders with disabilities (if applicable)Company profile / cataloguesService providers with an annual total revenue of R 5 million or more must submit an Original and valid Broad-Based Black Economic Empowerment (B-BBEE) Status Level Certificate or certified copy MCLM reserves the right to validate all information supplied and misrepresentation of facts may lead to disqualification and potentially being restricted to do business with all spheres of governmentService providers with an annual total revenue of R 5 million or less, qualify as Exempted Micro Enterprises and must submit a certificate issued by a registered auditor, accounting officer or an accredited verification agency to this business types:AgricultureMining and QuarryingManufacturingElectricity, Gas and WaterConstructionWholesale trade, Commercial agents and Allied servicesRetail and Motor Trade and Repair servicesCatering, Accomodation and Other tradeTransport, Storage and CommunicationsFinance and Business servicesCommunity, Social and Personal types:Public / Private CompanyCC (Close corporation)PartnershipSole propriotorBusiness trustNPO (Non Profit Organisation) forms must be completed and returned to the following address:Please deposit in:Tender Box 4 Reception Desk of Supply Chain Management UnitSituated on the upper level of the West Wing of the Civic CentreCorner Commissioner Street and Market StreetKrugersdorpOr mail to: Mogale City MunicipalityAttention: Supply Chain Management Box 94 Krugersdorp1740 Direct enquiries to the Supply Chain Management Unit:Tel:(011) 951-2014/2016/2541 orFax.

4 (011) or Chain Application - 1 Application InformationSupplier registration postal detailsContact person ..Telephone detailsBank & branch hereby grant the Municipality the right to deposit payments due to the company, electronically into theabove mentioned a cancelled cheque or a copy of your bank statement informationCompany tax clearance valid an original, non expired tax clearance certificate body for your industryControlling copy of the proof of registration to the statutory body for your industry servicesMunicipality/Metro name where your current municipal account is heldMunicipal acc (Yes/No)Provide details if in the last 5 years a Municipality terminated a contract before it's expiry dateAre copies of service accounts not older than 2 months attached or a lease agreement or a rental aggreement(Yes/No)Provide the names of other municipalities to whom similar services have been provided(Yes/No)(Yes/No)

5 Supply Chain Application - 2 Application of interestSpecify if any of the following relationships exists:Councillor of any of any / Consultant to municipalityMember of Provincial / National GovIs any director, manager, shareholder or stakeholder aCouncillor of any of any / Consultant to of Provincial / National GovHas any of the above been in service of the state for the last twelve months ?Please complete attached MBD 4 form Additional contact personsNameCapacityTelephoneCellphoneE-m ailBusiness activitiesRegistration (Refer to point 9 in the introduction for options)Is a copy of your registration documents attached (Certificate of incorporation/CK1/etc.).Core (Refer to point 8 in the introduction for options)Previous experienceDo you have any previous contract work or tendering 'Yes', please list the last contracts awarded to you or relevant previous experienceBusiness nameContact personContact noDescriptionValueYearThe year that the company started practicing the current core any child, parent or spouse of any director, shareholder or stakeholder a(Yes/No)(Yes/No)NO CONTRACT MAY BE AWARDED TO A PERSON IN SERVICE OF THE STATE(Yes/No)Supply Chain Application - 3 Application availablePlease give a summary of your facilities, plant ad equipment available to execute contractsPhysical facilitiesDescriptionAddressOwned or leasedArea (sqr mtr)Staffing profileProvide information on key staff in your organisation:NameDesignationQualificatio nYearsHDIA nnual financial information Information for the financial year ending on (ccyymm - year/month).

6 Turnover last financial gross asset value (fixed properties excluded)..RFull time time StatusIs your annual Total Revenue less that R 5 million?..EME If yes, you are classified as an Exempted Micro Enterprise (also includes Start-Up enterprises) Attach registered auditor's certificate or similar certificate issued by accounting officer or accredited verification agencyAttached Y/N?Is you annual Total Revenue between R 5 million and R 35 million?..QSE * If yes, you are classified as a Qualifying Small EnterpriseIs your annual Total Revenue in excess of R 35 million?..LE * If yes, you are classified as a Large Enterprise.* QSE and LE did you attached your BEE certificate?..* What is your BEE status level contribution (Level 1 - 8)?..Certificate numberExpiry DateB-BBEE score per Element:Equity OwnershipPreferential ProcurementManagement & ControlEnterprise DevelopmentEmployment EquitySocio Economic DevelopmentSkills DevelopmentPlease note that BEE certificates and detailed scorecards should ONLY be obtained from rating agenciesaccredited by Department of Trade and Industry (DTI) and Chain Application - 4 Application of shareholdersNameId numberPositionDate appointed in positionDate RSA CitizenDisabled% OwnershipTOTALAre copies of the shareholders id's attached ?

7 CompulsoryAre affidavids for all disabled people attached ?Compulsory (if applicable)No Francise Black WomenSupply Chain Application - 5 Mark with an 'X' the commodities / services you can provideGroup: CONSTRUCTION EQUIPMENT AND SUPPLIESG roup: GENERAL SERVICESAIR CONDITIONING AND TEMPERATURE CONTROL EQUIPMENTACCOMMODATION AND LODGINGBUILDING EQUIPMENT AND ACCESSORIES (CEMENT MIXERS,ADVERTISING, COMMUNICATION, DESIGN, EDITORIAL, PUBBUILDING MATERIALS (BRICKS, CEMENT, SAND, PAINTINGAUCTIONEERING SERVICESCEILING BOARDS, SKIRTINGS, ETCBOOKKEEPING AND ACCOUNTING SERVICESPLANT HIRECATERING AND REFRESHMENTSDOORS AND WINDOWSCLEANING SERVICESELECTRICAL SYSTEMS, LIGHTING, COMPONENTS ACCESSORICONFERENCING FACILITIES AND FACILITATIONFLOORING MATERIALS (CARPETS, TILES, ETC)CONTRACT ADMINISTRATIONPLUMBING WARE AND MATERIALSCOURIER SERVICESROOFING MATERIALSEDUCATION AND TRAININGSANITATION WARE AND EQUIPMENTENVIRONMENTAL IMPACT STUDIESG roup: CONSTRUCTION SERVICESEVENT MANAGEMENTBURGLAR PROOFING AND SYSTEMSGENERAL MAINTENANCE SERVICESCONCRETE MANUFACTURE AND WORKSHEALTH CARECONSTRUCTION-RELATED TRANSPORTHORTICULTUREDEMOLITION SERVICESINFRASTRUCTURAL MAINTENANCEEARTHWORKS, DRILLING AND LANDSCAPINGINSPECTION SERVICESELECTRICAL INSTALLATIONINSURANCEFENCINGIT, BROADCASTING AND TELECOMMUNICATION SERVICESGENERAL BUILDING WORKINTERIOR DECORATING, REFURBISHMENT AND UPHOLSTERYGLAZINGLABORATORY SERVICESMECHANICAL CONTRACTSLAND VALUATION SERVICESMETALWORKLAUNDRY AND DRY-CLEANING SERVICESPAINTINGLOCKSMITH SERVICESPAVINGMAILING SERVICESPLUMBINGMANAGEMENT SERVICESPRE-CAST CONCRETE MANUFACTUREMISCELLANEOUS EQUIPMENT AND GOODS HIRINGPUMP INSTALLATIONPERSONNEL SERVICESROAD WORKSPEST CONTROLSEWERAGE SYSTEMS AND CONSTRUCTIONREMOVAL SERVICESWATER WORKS AND PIPELINESPHOTOGRAPHIC AND GRAPHIC DESIGN SERVICESG roup.))

8 ELECTRICAL AND MECHANICAL EQUIPMENT, SERVICES AND SUPPLIESPICTURE FRAMINGBEARING SUPPLIESPRINTINGBOLTS, NUTS AND FASTENERSREAL ESTATE SERVICESELECTRIC CABLESRESEARCH SERVICESELECTRICAL COMPONENT SUPPLIESSECURITY AND SAFETY SERVICESELECTRICAL EQUIPMENT REPAIRSSITE CLEANINGHARDWARE SUPPLIESSTORAGELIFTING EQUIPMENTTRANSLATION AND INTERPRETING SERVICESMECHANICAL SEALS AND PACKINGTRANSPORT SERVICES, GENERALPIPE AND IRRIGATION SUPPLIESTRAVEL SERVICESPOWER GENERATION AND DISTRIBUTION MACHINERY AND ACVEHICLE HIREPUMPS AND PUMPS SPARESVENDING SERVICESSMALL TOOLSTRANSFORMER SERVICESVALVES, COUPLINGSWATER METERS, PIPES, FITTINGS, PVC, POLYETHYLENE,Group: OFFICE AND FACILITIES EQUIPMENT AND SUPPLIESG roup: VEHICLE SUPPLY AND TRANSPORTATION SERVICESBOOKS, PERIODICALS, NEWSPAPERSALARM AND TRACKING SYSTEMSA pplication EQUIPMENT, NETWORKS AND SOFTWAREBATTERIESCONSUMABLESENGINE OVERHAULSCORPORATE GIFTSFUEL, OILS AND LUBRICATIONSDOMESTIC, INDUSTRIAL AND CLEANING EQUIPMENT AND SUHYDRAULICSELECTRONIC EQUIPMENT, INCLUDING AUDIO-VISUAL EQUIPPANEL BEATINGFIRE PROTECTION EQUIPMENTRADIATOR REPAIRSFLOWERS AND PLANTSSPARES AND PARTSHOUSEHOLD FURNITURE, APPLIANCES AND GOODSTOWING SERVICESOFFICE FURNITURE AND EQUIPMENTTRANSMISSIONSOFFICE SUPPLIES AND STATIONERYTYRES AND TUBESPRINTING, COPYING AND PHOTOGRAPHIC EQUIPMENT AND SUPHOLSTERYG roup.

9 MISCELLANEOUS GOODS AND SUPPLIESVEHICLE FLEET MANAGEMENTENVIRONMENTAL CLEANSING EQUIPMENT, GOODS AND SUPPLVEHICLE SUPPLYFIRE PROTECTION EQUIPMENT, GOODS AND SUPPLIESWINDSCREENSGARDEN TOOLSLABORATORY EQUIPMENT AND SUPPLIESMATERIAL AND WAREHOUSING MACHINERY, EQUIPMENT ANDMEASURING, TESTING AND OBSERVATION EQUIPMENTPROTECTIVE CLOTHING AND UNIFORMSSECURITY EQUIPMENT, GOODS AND SERVICESSIGNS, NAMES AND NUMBER PLATESSPORTS AND RECREATIONAL EQUIPMENT AND GOODSG roup: PROFESSIONAL SERVICESACCOUNTING, AUDITING AND MANAGEMENT SERVICESARCHITECTURAL SERVICESCONSULTING ENGINEERING-ELECTRICALCONSULTING ENGINEERING-ENVIRONMENTALCONSULTING ENGINEERING-OTHERCONSULTING ENGINEERING-MECHANICALCONSULTING ENGINEERING-PROJECT MANAGEMENTCONSULTING ENGINEERING-ROADS AND STORM WATERCONSULTING ENGINEERING-SEWERAGE SYSTEMSCONSULTING ENGINEERING-STRUCTURES, BUILDINGS, BRIDCONSULTING ENGINEERING-WATER SYSTEMSCONSULTING ENGINEERING-GEO-TECHNICALCONSULTING ENGINEERING-SOLID WASTEENGINEERING SERVICESFINANCIAL SERVICESLAND SURVEYINGLEGAL SERVICES-CONTRACTSLEGAL SERVICES-CONVEYANCINGLEGAL SERVICES-LITIGATIONLEGAL SERVICES -OTHERMEDICAL SERVICESPROJECT MANAGEMENTQUANTITY SURVEYINGTOWN AND REGIONAL PLANNINGM otivation if more than 5 services are selectedAny other services / goods not indicated aboveSupply Chain Application - 6 DeclarationI, the undersigned _____duly authorised to sign for and on behalf of the company.

10 Certifiesthat the information furnished on this declaration form is correct. I accept thatthe State may act against me should this declaration prove to be DateCommissioner of OathsSigned and sworn to before me at _____on this the _____ day of _____ 20_____ by the_____Comissioner of official stamp of authority on this pageDeponent, who has acknowledged that he/she knows and understands the contents of this Affidavit, it is true and correct to the best of his/her knowledge and that he/she has no objection to taking the prescribed oath, and that the prescribed oath will be binding on his/her conscience.