Request for Proposal/Tender: AFF T01/2015 REQUEST FOR PROPOSALS/TENDER TENDER NUMBER: AFF: T01/2015 DESCRIPTION: The purpose of this Request for Proposals (“RFP”) is to request proposals from suitably qualified service provider for the project management, development and implementation of a web based Fidelity Fund Certificate application, payment and certificate issuing system, including related databases and interfaces, for the Attorneys Fidelity Fund and the respective Law Societies. PUBLISHED DATE: 6 March 2015 CLOSING: Date: 15 April 2015 Time: 12h00 Noon VALIDITY PERIOD: 40 days BID RESPONSES MUST BE HAND DELIVERED / COURIERED TO: Attorneys Fidelity Fund 5th Floor Waalburg Building 28 Wale Street Cape Town Attention: Ms Ateeqah Salie Notes: Bidders must ensure that they sign the register at reception when delivering their bids. Bidders should ensure that bids are delivered in time to the correct address. If the bid is late, it shall not be accepted for consideration. The reception is generally accessible 8 hours a day (08h30 to 16h30); 5 days a week (Monday to Friday). Bidders must ensure that they sign the register at the reception when delivering bids. Bidders must advise their couriers of the instruction above to avoid misplacement of bid responses. AFF: T01/2015 Page 1 of 33 6 March 2015 Service Provider: ___________________________________ Signature:_______________ Request for Proposal/Tender: AFF T01/2015 TABLE OF CONTENTS Tenderers are to ensure that they have received all pages of this document, which consist of the following documents: PART A: TENDER INSTRUCTIONS & REQUIREMENTS Content Page 1. Invitation to Tender 3 2. Price Declaration by the Tenderer 6 3. Validity of Tender for the Period of Acceptance 7 4. Declaration of Interest 8 5. Certificate of Independent Bid Determination 12 6. General Conditions of Tender 15 7. Tax Clearance Requirements 17 8. Preference Points Claim in terms of the Procurement Policy 18 9. Timeframes 21 10. Tender/ Bid Declaration (Service Providers Declaration Form) 22 PART B: TERMS OF REFERENCE 11. Project Terms of Reference AFF: T01/2015 Part B, 1 - 5 Page 2 of 33 6 March 2015 Service Provider: ___________________________________ Signature:_______________ Request for Proposal/Tender: AFF T01/2015 1. INVITATION TO TENDER Tender number: AFF T01/2015 Closing date: 31 March 2015 Closing time: 12h00 Noon DESCRIPTION The purpose of this Request for Proposals (“RFP”) is to request proposals from suitably qualified service provider for the project management, development and implementation of a web based Fidelity Fund Certificate application, payment and certificate issuing system, including the related databases and interfaces, for the Attorneys Fidelity Fund and the respective Law Societies. SCOPE INITIATIVE The Attorneys Fidelity Fund is underway on an initiative to improve and align core and support business processes, and resulting areas for improvement in its technology applications. VALIDITY 60 days from the closing date of the tender TENDER DOCUMENTS MUST BE PLACED IN THE TENDER BOX AS PER DETAILS BELOW: Attorneys Fidelity Fund 5th Floor Waalburg Building 28 Wale Street Cape Town Faxed or E-mailed tenders will NOT be accepted and will be disqualified. Tenderers should ensure that their tender document is placed in the tender box before the closing date and time at the correct address. If the tender is late, it will not be accepted for consideration. All Tenderers must furnish the following particulars and include it in their submission (Failure to do so may result in your bid being disqualified). Name of Tenderer Registration number AFF: T01/2015 Page 3 of 33 6 March 2015 Service Provider: ___________________________________ Signature:_______________ Request for Proposal/Tender: AFF T01/2015 In case of a consortium/joint venture, full details on consortium/joint venture members: (1) Name of Entity Registration number VAT registration number Tax Clearance Certificate submitted Yes No Yes No Yes No (2) Name of Entity Registration number VAT registration number Tax Clearance Certificate submitted (3) Name of Entity Registration number VAT registration number Tax Clearance Certificate submitted AFF: T01/2015 Page 4 of 33 6 March 2015 Service Provider: ___________________________________ Signature:_______________ Request for Proposal/Tender: AFF T01/2015 Name of contracting entity in case of a consortium/joint venture: Name of Tenderer Registration number VAT registration number Postal address Street address Contact details of responsible person who will act on behalf of the entity/consortium/joint venture: Name and Surname Position Telephone number Code: Number: Code: Number: Cell number Facsimile number E-mail address AFF: T01/2015 Page 5 of 33 6 March 2015 Service Provider: ___________________________________ Signature:_______________ Request for Proposal/Tender: AFF T01/2015 2. PRICE DECLARATION BY THE TENDERER I/ We have examined the information provided in your tender document and offer to undertake the work prescribed in accordance with the requirements as set out in the tender document. The tender price quoted in this tender is valid for the stipulated period. We confirm the availability of the proposed team members. We confirm that this tender will remain binding upon us and may be accepted by you at any time before the expiry date. Name and Surname Signature Date Are you duly authorised to commit the tender Yes No Capacity under which this tender is signed The TOTAL TENDER PRICE is the all-inclusive price taking the various pricing elements of the pricing schedule and adding them all together: TOTAL TENDER PRICE note 1 R Note 1: Total Cost of Ownership (TCO) to the Attorneys Fidelity Fund, inclusive of VAT AFF: T01/2015 Page 6 of 33 6 March 2015 Service Provider: ___________________________________ Signature:_______________ Request for Proposal/Tender: AFF T01/2015 3. VALIDITY OF TENDER FOR THE PERIOD OF ACCEPTANCE Validity of tenders for the period of acceptance: The tender price shall be open for acceptance for a period of at least 60 calendar days after the closing date of the tender. It should be noted that Tenderers may offer a shorter validity period, but their bid may in that event, be disregarded for this reason. State if tender prices shall be fixed or are subject to escalation in terms of a formula defined in the tender, or to be defined by the tenderer, as applicable. The tender holds good until: __________________________________________________ (State alternative period) Print name : _______________________________________ Signature of Tenderer: _______________________________ Name of Company : _________________________________ Date : ____________________________________________ AFF: T01/2015 Page 7 of 33 6 March 2015 Service Provider: ___________________________________ Signature:_______________ Request for Proposal/Tender: AFF T01/2015 4. DECLARATION OF INTEREST 4.1. Any legal person, including persons employed by the Fund, the Attorneys Insurance Indemnity Fund, the respective Law Societies, or the Law Society of South Africa, persons having a kinship with persons employed by the Fund, the respective Law Societies, or the Law Society of South Africa, including a blood relationship, may make an offer or offers in terms of this invitation to bid/tender. In view of possible allegations of favouritism, should the resulting bid or part thereof, be awarded to persons employed by the Fund, the respective Law Societies, or the Law Society of South Africa, or to persons connected with or related to them, it is required that the bidder or his/her authorised representative declare his/her position in relation to the evaluating/adjudicating authority where – The bidder is employed by the state; and/or The legal person on whose behalf the bidding document is signed, has a relationship with persons/a person who are/is involved in the evaluation and or adjudication of the bid(s), or where it is known that such 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 bid. 4.2. In order to give effect to the above, the following must be completed and submitted with the bid. Full name of bidder or his/her representative Identity number Position occupied in the Company (director, trustee, shareholder, etc.) Company registration number Tax reference number VAT registration number AFF: T01/2015 Page 8 of 33 6 March 2015 Service Provider: ___________________________________ Signature:_______________ Request for Proposal/Tender: AFF T01/2015 4.2.1. The names of all directors /trustees/shareholders/members, their individual identity numbers, tax reference numbers and, if applicable, employee numbers, must be indicated in paragraph __ below. 4.2.2. Are you or any person connected with the bidder presently employed by the Attorneys Fidelity Fund, the Attorneys Insurance Indemnity Fund, the respective Law Societies and/or the Law Society of South Africa. YES / NO 4.2.3. If so, furnish the following particulars: Name of person/ director/trustee/member/ shareholder Name of institution at which you or the person connected to the bidder is employed Position occupied in the institution Any other relevant particulars 4.2.4. If you are presently employed by the Attorneys Fidelity Fund, the Attorneys Insurance Indemnity Fund, the respective Law Societies and/or the law Society of South Africa, did you obtain the appropriate authority to undertake remunerative work outside your employment. YES / NO 4.2.4.1. If yes, did you attach proof of such authority to the bid document? YES / NO 4.2.4.2. If no, please furnish reasons for non-submission of such proof. AFF: T01/2015 Page 9 of 33 6 March 2015 Service Provider: ___________________________________ Signature:_______________ Request for Proposal/Tender: AFF T01/2015 4.2.5. Did you or your spouse, or any of the company’s directors/trustees/shareholders/ members or their spouses conduct business with the Attorneys Fidelity Fund, the Attorneys Insurance Indemnity Fund, the respective Law Societies and/or the Law Society of South Africa in the previous twelve months? YES / NO 4.2.5.1. If so, please furnish particulars. 4.2.6. Did you or any person connected with the bidder, have any relationship (family, friend, other) with a person employed by the Attorneys Fidelity Fund, the Attorneys Insurance Indemnity Fund, the respective Law Societies and/or the Law Society of South Africa, and who may be involved with the evaluation and/or adjudication of this bid? YES / NO 4.2.6.1. If so, please furnish particulars. 4.2.7. Are you or any person connected with the bidder, aware of any relationship (family, friend, other) between any other bidder and any person employed by the Attorneys Fidelity Fund, the Attorneys Insurance Indemnity Fund, the respective Law Societies and/or the Law Society of South Africa, who may be involved with the evaluation and/or adjudication of this bid? YES / NO 4.2.7.1. If so, please furnish particulars. AFF: T01/2015 Page 10 of 33 6 March 2015 Service Provider: ___________________________________ Signature:_______________ Request for Proposal/Tender: AFF T01/2015 4.2.8. Do you or any of the directors/trustees/shareholders/members of the company have any interest in any other related companies whether or not they are bidding for this contract? YES / NO 4.2.8.1. If so, please furnish particulars. 4.2.9. Full details of directors/trustees/shareholders/members Full Names Identity Number Personal Tax Reference Number Employee number DECLARATION I, THE UNDERSIGNED (Name) _______________________________________________ CERTIFY THAT THE INFORMATION FURNISHED IN PARAGRAPHS 4.2.1 to 4.2.9 ABOVE IS CORRECT. I ACCEPT THAT THE ATTORNEYS FIDELITY FUND MAY REJECT THE BID OR ACT AGAINST ME SHOULD THIS DECLARATION PROVE TO BE FALSE. Signature: ___________________________ Name:__________________________ Position: ____________________________ Date: __________________________ AFF: T01/2015 Page 11 of 33 6 March 2015 Service Provider: ___________________________________ Signature:_______________ Request for Proposal/Tender: AFF T01/2015 5. CERTIFICATE OF INDEPENDENT BID DETERMINATION 5.1. This Standard Bidding Document (SBD) must form part of all bids¹ invited/ submitted. 5.2. Section 4 (1) (b) (iii) of the Competition Act No. 89 of 1998, as amended, prohibits an agreement between, or concerted practice by, firms, or a decision by an association of firms, if it is between parties in a horizontal relationship and if it involves collusive bidding (or bid rigging).² Collusive bidding is a per se prohibition meaning that it cannot be justified under any grounds. 5.3. Treasury Regulation 16A9 prescribes that accounting officers and accounting authorities must take all reasonable steps to prevent abuse of the supply chain management system and authorizes accounting officers and accounting authorities to: 5.3.1. disregard the bid of any bidder if that bidder, or any of its directors have abused the institution’s supply chain management system and or committed fraud or any other improper conduct in relation to such system. 5.3.2. cancel a contract awarded to a supplier of goods and services if the supplier committed any corrupt or fraudulent act during the bidding process or the execution of that contract. 5.4. This SBD serves as a certificate of declaration that would be used by institutions to ensure that, when bids are considered, reasonable steps are taken to prevent any form of bid-rigging. 5.5. In order to give effect to the above, the attached Certificate of Bid Determination must be completed and submitted with the bid: ¹ Includes price quotations, advertised competitive bids, limited bids and proposals. ² Bid rigging (or collusive bidding) occurs when businesses, that would otherwise be expected to compete, secretly conspire to raise prices or lower the quality of goods and / or services for purchasers who wish to acquire goods and / or services through a bidding process. Bid rigging is, therefore, an agreement between competitors not to compete. AFF: T01/2015 Page 12 of 33 6 March 2015 Service Provider: ___________________________________ Signature:_______________ Request for Proposal/Tender: AFF T01/2015 CERTIFICATE OF INDEPENDENT BID DETERMINATION I, the undersigned, in submitting the accompanying bid: _________________________________________________________________________ (Bid Number and Description) in response to the invitation for the bid made by: _________________________________________________________________________ (Name of Institution) do hereby make the following statements that I certify to be true and complete in every respect: I certify, on behalf off: _____________________________________________________________________ that: (Name of Bidder) 1. I have read and I understand the contents of this Certificate; 2. I understand that the accompanying bid will be disqualified if this Certificate is found not to be true and complete in every respect; 3. I am authorized by the bidder to sign this Certificate, and to submit the accompanying bid, on behalf of the bidder; 4. Each person whose signature appears on the accompanying bid has been authorized by the bidder to determine the terms of, and to sign the bid, on behalf of the bidder; 5. For the purposes of this Certificate and the accompanying bid, I understand that the word “competitor” shall include any individual or organization, other than the bidder, whether or not affiliated with the bidder, who: (a) has been requested to submit a bid in response to this bid invitation; (b) could potentially submit a bid in response to this bid invitation, based on their qualifications, abilities or experience; and (c) provides the same goods and services as the bidder and/or is in the same line of business as the bidder. 6. The bidder has arrived at the accompanying bid independently from, and without consultation, communication, agreement or arrangement with any competitor. AFF: T01/2015 Page 13 of 33 6 March 2015 Service Provider: ___________________________________ Signature:_______________ Request for Proposal/Tender: AFF T01/2015 However communication between partners in a joint venture or consortium³ will not be construed as collusive bidding. 7. In particular, without limiting the generality of paragraphs 6 above, there has been no consultation, communication, agreement or arrangement with any competitor regarding: (a) prices; (b) geographical area where product or service will be rendered (market allocation); (c) methods, factors or formulas used to calculate prices; (d) the intention or decision to submit, or not to submit a bid; (e) the submission of a bid which does not meet the specifications and conditions of the bid; or (f) bidding with the intention not to win the bid. 8. In addition, there have been no consultations, communications, agreements or arrangements with any competitor regarding the quality, quantity, specifications and conditions or delivery particulars of the products or services to which this bid invitation relates. 9. The terms of the accompanying bid have not been, and will not be, disclosed by the bidder, directly or indirectly, to any competitor, prior to the date and time of the official bid opening or of the awarding of the contract. ³ Joint venture or Consortium 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. 10. I am aware that, in addition and without prejudice to any other remedy provided to combat any restrictive practices related to bids and contracts, bids that are suspicious will be reported to the Competition Commission for investigation and possible imposition of administrative penalties in terms of section 59 of the Competition Act No 89 of 1998 and or may be reported to the National Prosecuting Authority (NPA) for criminal investigation and or may be restricted from conducting business with the public sector for a period not exceeding ten (10) years in terms of the Prevention and Combating of Corrupt Activities Act No 12 of 2004 or any other applicable legislation. Signature: ___________________________ Name:__________________________ Position: ____________________________ Date: __________________________ AFF: T01/2015 Page 14 of 33 6 March 2015 Service Provider: ___________________________________ Signature:_______________ Request for Proposal/Tender: AFF T01/2015 6. GENERAL CONDITIONS OF TENDER 6.1. It is an absolute condition of the tender that the taxes of the tenderer must be in order, or that suitable arrangements have been made with the Receiver of Revenue to satisfy them. 6.2. An Original, Valid, Tax Clearance Certificate must be submitted as an original with the tender proposal on or before the closing date and time of the tender. Failure to submit an original and valid Tax Clearance Certificate may invalidate your tender. 6.3. Each party to a consortium/ sub-contractors submits a separate original and valid Tax Clearance Certificate. Copies of the Application for a Tax Clearance Certificate are available at any Receiver’s Office. 6.4. Tender forms contained within Part A of the Tender Document requesting information have been drawn up so that certain essential information is to be furnished in a specific manner and format. Any additional particulars shall be furnished in a separate annexure. 6.5. The tender forms must not be retyped or re-drafted but photocopies may be prepared and used. 6.6. Tender forms should not be filled in by means of mechanical devices, for example typewriters. Black ink must be used to fill in tenders. 6.7. Tenderers shall check the numbers of the pages and satisfy them that none are missing or duplicated. No liability shall be accepted in regard to claims arising from the fact that pages are missing or duplicated. 6.8. Tenderers shall clearly state whether or not prices will remain firm for the duration of the contract. Only firm prices will be accepted. Non-firm prices (including prices subject to rates of exchange of variations) will not be considered. In cases where different delivery points influence the pricing, a separate pricing schedule must be submitted for each delivery point. 6.9. All prices shall be quoted in South African currency and be VAT inclusive. 6.10. Unless specifically provided for in the tender document, no tenders submitted may be transmitted by telegram, telex, facsimile, e-mail or similar apparatus and will not be considered. 6.11. The Attorneys Fidelity Fund reserves the right to withdraw this tender. 6.12. These conditions form part of the tender general conditions and failure to comply therewith will invalidate your tender. AFF: T01/2015 Page 15 of 33 6 March 2015 Service Provider: ___________________________________ Signature:_______________ Request for Proposal/Tender: AFF T01/2015 6.13. The service provider’s company letterhead must be used for the proposal’s cover letter and reflect the company’s name and address. 6.14. The correct Tender Reference Number (See the front page of this RFP for the Tender Number) and service provider’s company name must appear on all pages including the proposal. 6.15. All pages of the proposal must be initialled by the responsible person. 6.16. All bidders responding to this Tender must be prepared to schedule a visit the offices of the Attorneys Fidelity Fund or to another location upon request. In addition, bidders may be interviewed as part of the selection process. 6.17. The Attorneys Fidelity Fund is not responsible for any expense incurred in preparing and submitting a Proposal or taking any action in connection with the selection process, or for the costs of any services performed in connection with submission of a Proposal. 6.18. Late submissions will not be accepted. A submission will be considered late if it arrives only a second after 12:00 or any time thereafter. The tender shall be locked at exactly 12:00 and tenders arriving late will not be accepted under any circumstances. Tenderers are therefore strongly advised to ensure that their tenders be dispatched allowing enough time for any unforeseen events that may delay the delivery of the tender. AFF: T01/2015 Page 16 of 33 6 March 2015 Service Provider: ___________________________________ Signature:_______________ Request for Proposal/Tender: AFF T01/2015 7. TAX CLEARANCE REQUIREMENTS 7.1. It is a tender condition that the taxes of the successful bidder must be in order, or that satisfactory arrangements have been made with the South African Revenue Services (SARS) to meet the bidder’s tax obligations. Should a Tax Clearance Application be in progress, then proof from SARS must be provided that an application is in progress. 7.2. In order to meet this requirement, bidders are required to obtain from SARS and complete in full the “Application for a Tax Clearance Certificate” and submit it to any SARS branch office nationally. 7.3. Application for the Tax Clearance Certificate may also be made via e-Filling. In order to use this provision, taxpayers will need to register with SARS as an e-Filer through the SARS website. 7.4. Tax clearance requirements are also applicable to foreign bidders/individuals who wish to submit bids. 7.5. SARS will verify that the bidder’s tax matters are in order and furnish the bidder with a original Tax Clearance Certificate which will be valid for a period of one year from date of approval. 7.6. The original, valid Tax Clearance Certificate must be submitted together with the bid/tender proposal. Failure to submit original, valid Tax Clearance Certificate will result in the bid/tender proposal being invalidated. Certified copies of the Tax Clearance Certificate will not be accepted. 7.7. In bids where Consortia/Joint Ventures/Sub-Contractors are involved, each party must submit a separate original, valid Tax Clearance Certificate. Certified copies of the Tax Clearance Certificate will not be accepted. AFF: T01/2015 Page 17 of 33 6 March 2015 Service Provider: ___________________________________ Signature:_______________ Request for Proposal/Tender: AFF T01/2015 8. PREFERENCE POINTS CLAIM IN TERMS OF THE SUPPLY CHAIN POLICY The preference point system will be applied in the adjudication of all bids/tenders. 8.1. GENERAL CONDITIONS 8.1.1. In order to give preference to affirmable enterprises, proposals from prospective providers/suppliers, procurement will be evaluated on a point-scoring system as follows: For values not exceeding R100 000 - the 80/20 preference point system is used. For values exceeding R100 000 - the 90/10 preference point system is used. 8.1.2. Points are allocated as follows: Criteria 80/20 point scoring system 90/10 point scoring system Price / Functionality 80 points 90 points Equity Ownership 4 points 2 points Management 2 points 1 point Employment Equity 2 points 1 point Skills Transfer 4 points 2 points Women 4 points 2 points Disability 2 points 1 point Locality/SME/SMME/other 2 points 1 point 8.2. ADJUDICATION USING A POINT SYSTEM 8.2.1. Tenders will be evaluated on Functionality and Price as well as HDI. 8.2.2. A specified minimum number of points must be scored for functionality to qualify for further adjudication, and points for qualifying bids will be combined with the points scored for price which will not exceed 80 or 90 points dependant on which point system is applicable. 8.2.3. Preference points shall be calculated after prices have been brought to a comparative basis. AFF: T01/2015 Page 18 of 33 6 March 2015 Service Provider: ___________________________________ Signature:_______________ Request for Proposal/Tender: AFF T01/2015 8.2.4. Points scored will be rounded off to 2 decimal places. 8.2.5. The tender obtaining the highest number of points will be awarded the contract. 8.3. POINTS AWARDED FOR FUNCTIONALITY AND PRICE 8.3.1. The 80/20 or 90/10 preference point system will be applied in the adjudication of all bids/tenders. A specified minimum number of points for functionality must be scored to qualify for further adjudication. Points for functionality and price will be established separately for each individual tender and calculated in accordance with the provisions stated within the policy. The functionality points for qualifying bids/tenders will be combined with the points scored for price which will not exceed 80 or 90 points. 8.3.2. Ownership Points will be allocated for ownership of an enterprise by HDIs 51 - 100% = 2 points 25.1 - 50% = 1 point 8.3.3. Management Only the executive management of the enterprise will qualify for a maximum of 1 point should the enterprise be managed by 50,1% or more HDIs at the executive level. 8.3.4. Employment Equity Enterprises will qualify for a maximum of 1 point should their staff complement comprise 50% or more people from historically disadvantaged communities. To this effect, tenderers must substantiate any claim for this point by submitting a certificate from the Department of Labour regarding their staff complement and positions held within. 8.3.5. Skills development A maximum of 2 points will be allocated for either of the two elements as follows: Employees within the enterprise – 2; or Transfer of skills to JV partners – 2. Tenderers must indicate in their tender submission the point/s claimed and substantiate what skills transfer have taken place in terms of their employees or how will this be managed during the execution of the contract. 8.3.6. Women In this respect, there is no distinction between women in terms of designated groups and all women shall therefore qualify for a maximum of 2 points as follows: Ownership – 25% or more = 1 point Management – 25% or more = 1 point 8.3.7. Disability An enterprise will qualify for a maximum of 1 point should any of their owners or employees fall into this category. AFF: T01/2015 Page 19 of 33 6 March 2015 Service Provider: ___________________________________ Signature:_______________ Request for Proposal/Tender: AFF T01/2015 8.3.8. Locality A maximum of 1 point will be allocated for an enterprise that is located within the boundaries of a designated municipal area in which the relevant office of the AFF is situated (Cape Town and/or Centurion). 8.3.9. Locality The value of tender attributable to sub-contractors is limited to 25%. 8.3.10. The 80/20 or 90/10 preference point allocation systems A maximum of 80 or 90 points is allocated for functionality and price where the total combined points allowed for functionality and price, may not exceed 80 or 90 points: 80/20 90/10 Np= 90{1 – (P - Pm)} Pm Where AFF: T01/2015 Np = or Np= 90{1 – (P - Pm)} Pm the number of tender adjudication points awarded for price Pm = the price of lowest responsive tender, adjusted to a common base if applicable P = the price of the responsive tender under consideration, adjusted to a common base if applicable. Page 20 of 33 6 March 2015 Service Provider: ___________________________________ Signature:_______________ Request for Proposal/Tender: AFF T01/2015 9. TIME FRAMES Published date 6 March 2015 Closing date 15 April 2015 Validity period 40 days Project completion 30 September 2015 AFF: T01/2015 Page 21 of 33 6 March 2015 Service Provider: ___________________________________ Signature:_______________ Request for Proposal/Tender: AFF T01/2015 10. TENDER BID DECLARATION Tenderers who claim points in respect of equity ownership must complete the service providers declaration form (Service Provider Declaration Form) below. AFF: T01/2015 Page 22 of 33 6 March 2015 Service Provider: ___________________________________ Signature:_______________ Request for Proposal/Tender: AFF T01/2015 SERVICE PROVIDER DECLARATION FORM NB: Should your FORM not be completed in full with your Tender/Proposal will be rejected. Information in this questionnaire received will be treated with confidentiality. Company name: Completed by: (Full name and surname) Designation Date IMPORTANT NOTES: PLEASE READ CAREFULLY To be completed by all Service Providers responding to a tender/ proposal or upon registration as an approved service provider on the procurement data base; The application must be completed in full, be signed and commissioned by a Commissioner of Oaths where required. A company profile must accompany the registration form but will not be accepted as a substitute for the application form – all fields on the application form must be completed by the tenderer. Attached the following: Valid original Tax Clearance Certificate Copy of Registration Certificate (CC or Pty Ltd), Articles of Association and Memorandum of Agreement, whichever is applicable. Company profile including experience. A copy of the previous three years audited/ signed-off financial statements. Copies of SABS or any other rating or accreditation, certificates etc. where applicable. AFF: T01/2015 Page 23 of 33 6 March 2015 Service Provider: ___________________________________ Signature:_______________ Request for Proposal/Tender: AFF T01/2015 SERVICE PROVIDER DETAILS Registered name of the Company Trading name of the Company Company/ Close Corporation Registration Number VAT Registration Number Income Tax Reference Number Telephone Number Fax Number Web Address E-mail Address Business Physical Address Postal Address Name of Contact Person Contact Numbers Cell AFF: T01/2015 Page 24 of 33 6 March 2015 Service Provider: ___________________________________ Signature:_______________ Request for Proposal/Tender: AFF T01/2015 SERVICE PROVIDER DETAILS Type of firm (Please √ the relevant box or boxes) Public Company Private Company Closed Corporation Sole Proprietor Partnership Trust Section 21 Company Government/Parastatal Joint Venture Consortium Other, specify: _______________________________________ Participation capacity (Please √ the relevant box or boxes) Prime Contractor Sub-Contractor Supplier Developer Services including Professional Manufacturer Repairer ISO Listed Importer Exporter Distributor Sales Other, specify: _______________________________________ Small, medium, micro enterprise (smme) status Please √ the relevant box or boxes) Total number of employees AFF: T01/2015 Micro Very small Small Medium Large Full time Number: Part time Number: Page 25 of 33 6 March 2015 Service Provider: ___________________________________ Signature:_______________ Request for Proposal/Tender: AFF T01/2015 SERVICE PROVIDER DETAILS List of all partners, proprietors and shareholders Name and Surname Identity Number Citizenship Date of % of Ownership Ownership % Voting Status (HDI, Woman, Disabled) List and identify any owner or management office bearer who has an ownership interest in another firm Name and Surname Identity Number Citizenship Date of % of Ownership Ownership % Voting Status (HDI, Woman, Disabled) List and identify any owner or management officer who is an employee or has duties in another business Name and Surname Identity Number AFF: T01/2015 Citizenship Date of % of Ownership Ownership Page 26 of 33 % Time Devoted Status (HDI, Woman, Disabled) 6 March 2015 Service Provider: ___________________________________ Signature:_______________ Request for Proposal/Tender: AFF T01/2015 SERVICE PROVIDER DETAILS Indicate by name and status, those individuals in the firm (including owners and nonowners) responsible for the day to day management and business decisions Activity Name and Surname Race Gender Disabled (Yes/No) Financial Decisions Cheque signing Acquisition of lines of credit Sureties Major purchases or acquisitions Signing of contract Management Decisions Estimating Marketing and sales operations Hiring and firing of management Supervision of office personnel Supervision of field/production activities AFF: T01/2015 Page 27 of 33 6 March 2015 Service Provider: ___________________________________ Signature:_______________ Request for Proposal/Tender: AFF T01/2015 SERVICE PROVIDER DETAILS Client details where similar projects to this tender have been undertaken Company/Institution name Address Contact person and number Value of contract and date Description of work Company/Institution name Address Contact person and number Value of contract and date Description of work Company/Institution name Address Contact person and number Value of contract and date AFF: T01/2015 Page 28 of 33 6 March 2015 Service Provider: ___________________________________ Signature:_______________ Request for Proposal/Tender: AFF T01/2015 Description of work SERVICE PROVIDER DETAILS List your current main clients below Company/Institution name R-value per annum and turnover % R % R % R % R % Contact person and number Company/Institution name R-value per annum and turnover % Contact person and number Company/Institution name R-value per annum and turnover % Contact person and number Company/Institution name R-value per annum and turnover % Contact person and number AFF: T01/2015 Page 29 of 33 6 March 2015 Service Provider: ___________________________________ Signature:_______________ Request for Proposal/Tender: AFF T01/2015 SERVICE PROVIDER DETAILS General Did the firm exist under a previous name? YES / NO If YES, what was its previous name? Does your company or any of its employees have a vested interest in the Attorneys Fidelity Fund, the Attorneys Insurance Indemnity Fund, the respective Law Societies and/or the Law Society of South Africa YES / NO Indicate as to whether any of the partners, proprietors and shareholders is in the service of the Attorneys Fidelity Fund, the Attorneys Insurance Indemnity Fund, the respective Law Societies and/or the Law Society of South Africa, or has been in their service in the previous twelve months Name: If YES, state where the said employee/s have such vested interest Institution: Description: At what % of full capacity are you operating? What % of work, directly or indirectly, is for the Attorneys Fidelity Fund, the Attorneys Insurance Indemnity Fund, the respective Law Societies and/or the Law Society of South Africa Have you been previously on the approved supplier list of the Attorneys Fidelity Fund, the Attorneys AFF: T01/2015 YES / NO If YES, specify Page 30 of 33 6 March 2015 Service Provider: ___________________________________ Signature:_______________ Request for Proposal/Tender: AFF T01/2015 Insurance Indemnity Fund, the respective Law Societies and/or the Law Society of South Africa SERVICE PROVIDER DETAILS What was your average turnover (excluding VAT) during the previous three financial years? Who are your present material/equipment/services suppliers or provider Does your company have an afterhours service policy? YES / NO If YES, specify Are warranties offered on new items/ repairs, etc? YES / NO If YES, state particulars AFF: T01/2015 Page 31 of 33 6 March 2015 Service Provider: ___________________________________ Signature:_______________ Request for Proposal/Tender: AFF T01/2015 BANKING DETAILS I/We hereby request and authorize you to pay any amounts which accrue to me/us to the credit of my/our bank account with the below-mentioned bank. I/we understand that the credit transfer hereby authorized will be processed by computer through a system known as Electronic Funds Transfer and I/we also understand that no additional advice of payment will be provided by my/our bank, but details of each payment will be printed on my/our bank statement or any accompanying voucher. (This does not apply where it is not customary for banks to issue bank statements.) I/we understand that a payment will be applied by the Attorneys Fidelity Fund in the normal way, and that it will indicate the date on which funds will be available in my/our account. Bank account name: Name of Bank: Branch code and name: Account number: Type of account Cheque/current Savings Transmission Bank details to be certified as correct by DATE STAMP of BANK Name and Surname: Signature: Designation: Telephone number and code: Fax number and code AFF: T01/2015 Page 32 of 33 6 March 2015 Service Provider: ___________________________________ Signature:_______________ Request for Proposal/Tender: AFF T01/2015 I/We the undersigned, acknowledge(s) that: The information furnished is true and correct The B-BBEE points claimed is in accordance with the General Conditions contained within this document Any conflict of interest has been declared in writing An official AFF Purchase Order will be accepted Payment of any goods delivered or services rendered will be effected in terms of the subsequent engagement/appointment agreement Name and Surname: Signature: (Duly authorised to sign) On behalf of: (Name of Firm) Physical address: Telephone number and code Date REGISTERED COMMISSIONER OF OATHS: Commissioner’s stamp with registered number Signature: Date: Failure to have a copy of this document signed by a Commissioner of Oaths may invalidate this tender/proposal submission AFF: T01/2015 Page 33 of 33 6 March 2015 Service Provider: ___________________________________ Signature:_______________
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