INSIKA PROSPECTIVE SUPPLIER DATABASE APPLICATION DATABASE FORM
APPLICATION DETAILS
Description:
Reference:
Invitation for prospective suppliers and professional service providers to register on the Insika Foundation Supplier Database
INSIKA/PSD/2017-18
RESPONDENT DETAILS
This page must be completed and submitted with each sealed application
Company Name:
Co Registration:
CSD Vendor Nr:
Contact person:
Contact number:
Email address:
PROVINCE: (Please tick the Province/s that you are able to supply) MUNICIPALITY & DISTRICT: (Please indicate the Municipality and District you are based in)
Province: KZN GP
Municipality
District
INSIKA FOUNDATION PROSPECTIVE SUPPLIER DATABASE APPLICATION 2017/18
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DOCUMENTS IN THIS APPLICATION PACK
Respondents are to ensure that they have received all pages of this document, which consists of the following sections: SECTION 1 Documents in this section are for information /instruction to respondents and must not be returned with applications.
A. Background
B. Application submission conditions and instructions
C. Application evaluation process
SECTION 2 Documents in this section must be completed and returned or supplied with applications.
A. Prospective supplier information form
B. Commodity list (Goods & Services)
SECTION 3 Documents in this section must be completed/ supplied and returned with applications.
A. Compliance checklist
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SECTION 1: A. BACKGROUND
This section is for information only, do not return with the application
The Community Work Programme (CWP) is a government programme based in the Department of Coorporative Governance. The primary purpose of the programme is to create an employment safety net (basic minimum income) for the unemployed especially in the rural communities. The programme supplements livelihood strategies by providing a basic level of income security. Each site employs 1 000 or more participants. The programme/ participants need the following goods and services:
1. Goods Protective Wear, Tools, Agricultural inputs etc
2. Services Various Training Courses
The sites are managed by Implementing Agents (IA’s). Insika Foundation is an Implementing Agent for: Gauteng Merafong Local Municipality City of Johannesburg District - Region E Kwazulu-Natal Ilembe District Zululand District uThungulu District uMgungundlovu District uThukela District Amajuba District eThekwini In order to comply with the regulations of the Public Finance Management Act and to ensure a competitive procurement process, Insika Foundation invites prospective suppliers of the goods/ services as indicated above, to apply for a listing on Insika Foundation’s prospective supplier database. It is important to note that should an applicant/ supplier be successful in their application to be added to the prospective supplier database, Insika Foundation is under no obligation to utilise their services. Successful applicants are not in any way guaranteed future business.
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SECTION 1: B. APPLICATION SUBMISSION CONDITIONS AND INSTRUCTIONS
This section is for information only, do not return with the application
1 FRAUD AND CORRUPTION 1.1 All suppliers are to take note of the implications of contravening the Prevention
and Combating of Corrupt Activities Act, Act No 12 of 2004 and any other Act applicable.
2 NOTES TO ALL SUPPLIERS SEEKING REGISTRATION ON THE DATABASE
OF PROSPECTIVE SUPPLIERS OF INSIKA FOUNDATION 2.1 The purpose of this database is to give all prospective suppliers an equal
opportunity to submit quotations to Insika Foundation. 2.2 Attached please find, inter alia, an official prospective supplier application form to
assist in compiling the list according to legislation. It is imperative that applicants read the prospective supplier application document carefully, complete it in full and sign where appropriate.
3 REQUEST FOR CLARIFICATIONS/ QUERIES
Any clarification required by a supplier regarding the supplier application document/ process must be requested from the following contact details: Insika SCM Officer Tel: 011 695 6800 Fax: 086 762 6839 Email: [email protected]
OR alternatively contact the following project co-ordinators:
Name & Surname Cell Number Sites
Hangwi Masakona 074 631 3714 Merafong Local Municipality,
City of Johannesburg District Region E
Zamani Ngidi 062 877 5633 Indaka, Dannhauser, Newcastle, Ladysmith
Nompumelelo Ngubane
061 007 2975 Impendla, Umshwathi, Mkhambathini
Bongani Majola 074 341 4077 Maphumulo, Mthonjaneni, Inkandla
Bongekile Zulu 074 649 3559 Phongola, Nongoma, uLundi, eDumbe
Zabiwe Mkhize 076 338 1061 uMlalazi/eShowe, Mandeni,KwaDukuza, Ntambanana, Umfolozi, City of Umhlathuze
INSIKA FOUNDATION PROSPECTIVE SUPPLIER DATABASE APPLICATION 2017/18
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4 SUBMITTING THE APPLICATION DOCUMENT PACK 4.1 All applications must be submitted via email to [email protected]
with the Reference number and Company name on the subject line.
4.2 A copy of the application document pack must be returned to the Insika SCM Officer at Insika Foundation via post or hand delivery at the following addresses:
Postal Address Physical Address
Gauteng
Insika Foundation P.O Box 3840 Halfway House 1685
Elethu House, Suite G4/Block 27 Thornhill Office Park 94 Bekker Road Midrand 1685
KZN
Insika Foundation P.O Box 1431 Umhlanga Rocks 4320
Mashona House 4A Royal Palm Suites 6 Palm Boulevard Umhlanga Ridge 4319
4.3 Prospective supplier application document packs should be submitted in a sealed
envelope, marked with:
Reference Number INSIKA/PSD/2017-18. The name and address of the applicant.
5 CLOSING OF APPLICATIONS
Please note that the closing date is 31 March 2018. Please ensure that you first register on the National Treasury Central Database before submitting this application form.
INSIKA FOUNDATION PROSPECTIVE SUPPLIER DATABASE APPLICATION 2017/18
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SECTION1: C. APPLICATION EVALUATION PROCESS
This section is for information only, do not return with the application
ALL SUPPLIERS MUST TAKE NOTE OF THE EVALUATION PROCESS THAT WILL BE
FOLLOWED FOR THIS APPLICATION PROCESS
1. EVALUATION PROCESS
Evaluation of the responses will be completed in the phases noted hereunder:
1.1 STAGE 1: RESPONSIVENESS CHECK
Please note: Applications without the completed/ submitted documents mentioned below will be regarded as non-responsive and disqualified immediately
1.1.1 The completed application form,
1.1.2 An original valid tax clearance certificate submitted (ensure that Insika always
has the most recent and valid copy),
1.1.3 B-BBEE Certificate or Sworn affidavit signed by a Commissioner of Oaths (ensure that Insika always has the most recent and valid copy),
1.1.4 Company registration certificate submitted,
1.1.5 Proof of Registration with National Treasury Central Supplier Database (CSD)
1.1.6 Certified ID copies of Director/s of the company
1.1.7 Proof of Banking Details of the company 1.1.8 A valid VAT registration certificate (VAT103) submitted if applicable, 1.1.9 Company profile of the entity (training service providers only)
1.1.10 Proof of accreditation where applicable (training service providers only)
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1.2 STAGE 2: OTHER REASONS FOR DISQUALIFICATION 1.2.1 In addition to the above compliance check, Insika Foundation will reject an
application to be registered if the supplier has: Committed a proven corrupt or fraudulent act in applying to register.
Made an attempt to gain information in a manner deemed to be unfair or
disadvantageous to other respondents or any attempt to influence the outcome of the response evaluation will result in immediate disqualification from the application process.
1.2.2 Insika Foundation will also disregard the application of any supplier if that supplier,
or any of its directors:
Have abused the SCM processes of Insika Foundation in the past; Have committed fraud or any other improper conduct; Have failed to perform or deliver on any previous contract with Insika
Foundation in the past;
1.2.3 Such actions will also be communicated to the National Treasury to incorporate such suppliers on their supplier blacklist.
INSIKA FOUNDATION PROSPECTIVE SUPPLIER DATABASE APPLICATION 2017/18
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SECTION 2: A. PROSPECTIVE SUPPLIER INFORMATION FORM
All applicants must furnish the following particulars and include it in their submission (Failure to do so will result in your application being disqualified)
2.1 IMPORTANT NOTES
▪ Applicants will be contacted via e-mail and must therefore submit an operating and valid e-mail
address; failure to comply will result in excluding the supplier from the database; ▪ It should be noted that Insika Foundation reserves the right to accept or reject any application
without being obliged to give any reasons in this respect;
2.2 SUPPLIER DETAILS
Supplier Name:
Company / CC Registration Number:
VAT Registration Number (if applicable):
Income Tax Reference Number:
Web Address (if applicable):
E-Mail Address:
Landline Contact Number:
Cell Number:
Number of Full Time Employees:
Number of years in business:
Physical or Postal Address: (compulsory)
2.3 SUPPLIER CLASSIFICATION: (PLEASE TICK THE RELEVANT BOX / BOXES)
ISO
Listed
Importer Services Manufacturer Repairer Black
Owned
Distributor Exporter Sales
2.4 MAIN CONTACT PERSON IN YOUR ORGANIZATION:
Name:
Organization Position:
Landline Number:
Cell Number:
E-Mail Address:
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SECTION 2: B. COMMODITY LIST (PRODUCTS & SERVICES):
Suppliers of the following products/services are required to register on the database. Please mark the main goods and/ or services your organization supplies. Please note the list below is indicative of the types of goods and services. Additional goods/ services may be required:
Item
Code
Description Tick applicable goods/ services
100 PPE
10001 Conti Suits 65/35 Poly Cotton Branded in full colour Size:
36, 100| Size 38, 100|Size 40, 150|Size 44, 200|Size 46, 150|Size 48, 200| Size 50, 100
10002 Dust Coats Poly Cotton Branded in Full Colour Safety googles
10003 T – Shirts 100% cotton Branded in Full colour. Sizes 280 small, 200 medium 200 large, 200 Xtra large 200 XX large, 120 XXX large
10004 Safety Boots and safety shoes. Bata, Bronx, Bova, Le Maitre, or Frams. Sizes: Size 4, 100|Size 5, 100| Size 6, 200|Size 7, 100|Size 8, 100| Size 9, 100|Size 10, 100
10005 Gumboots- Bata
10006 Disposable Gloves
10007 Industrial Leather Gloves
10008 HBC Work Suits
200 TOOLS AND MATERIAL
20001 Mops
20002 Refuse Bags (100 Pack )
20003 Window Washer
20004 Paint Brushes
20005 Hand Fork
20006 Two-Stroke (Oil) 10L
20007 Grass Cutting Machines
20008 Paint 20L
20009 Paint Roller Tray Sets
20010 Sanding Paper X 5 Sheets
20011 Thinners 20L
20012 Mutton Cloth
20013 HBC Kits
20014 Liquid Soap (Cleaning) 20L
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Item
Code
Description Tick applicable goods/ services
20015 Handy Andy 20L
20016 Floor Polish 20L
20017 Seedlings
20018 Box Of Pins
20019 Zips, Buttons And Thread
20020 Welding Mask
20021 Welding Gloves
20022 Electrode Holder
20023 Welding Rods
20024 Steel Bars - Square Bar
20025 Steel Bars - Square Tubing
20026 River Sand
20027 Building Accessories
20028 Cement
300 AGRICULTURAL INPUTS
30001 Cabbage seedlings
30002 Beetroot seedlings
30003 Spinach seedlings
30004 Mustard Spinach seedlings
30005 Green Pepper seedlings
30006 Carrots seedlings
30007 Kale seedlings
30008 Cabbage seeds
30009 Beetroot seeds
30010 Spinach seeds
30011 Mustard Spinach seeds
30012 Green Pepper seeds
30013 Carrots seeds
30014 Kale seeds
30015 Fruit Trees
400 OFFICE EQUIPMENTS
40001 Laptops
40002 Printers/scanners/Fax/Photocopier
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Item
Code
Description Tick applicable goods/ services
40003 Office Desks
40004 Office Chairs
40005 Extension Cables
40006 Steel Filing Cabinets
40007 Modems
500 TRAINING COURSES
50001 Home Based Care
50002 HIV/ AIDS
50003 Health & safety
50004 Beauty and nails technology
50005 Cooking
50006 Sewing/ Knitting
50007 Welding
50008 Painting
50009 Plumbing
50010 Brick making
50011 Arts and Craft
50012 Music Arts and Culture
50013 Waste Management/ Recycling
50014 Packaging
50015 Business development and support skills programme
50016 Work readiness
50017 Basic Computer
TRACK RECORD List three largest contracts/projects completed by your organisation in the last three years:
WORK PERFORMED FOR WHOM CONTACT PERSON AND TELEPHONE NUMBERS
CONTRACT FEE
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I/we the undersigned acknowledge(s) that: ▪ The information furnished in this application is true and correct; ▪ The Equity Ownership claimed is in accordance with the general conditions; ▪ Any conflict of interest has been declared.
Signature of Company Owner or Authorised Representative
Date
Witness Date
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SECTION 3: A. SUPPLIER COMPLIANCE CHECKLIST
Please tick YES/ NO and return this page including the documents required per this checklist
Please mark the documents that you have included/ submitted in the application pack.
# SUPPLIER RESPONSE CHECKLIST
YES NO
1. The application form (completed and signed)
2. Company registration certificate
3. An original valid tax clearance certificate
4. B-BBEE Certificate or Sworn affidavit signed by a Commissioner of Oaths
5. Proof of Registration with National Treasury Central Supplier Database (CSD)
6. Proof of Banking Details of the company
7. Certified ID copies of Director/s of the company
8. A valid VAT registration certificate (VAT103) submitted if applicable
14. Company profile of the entity (training service providers only)
15. Proof of accreditation where applicable (training service providers only)
16. The application document pack has been emailed to [email protected]
17. Submitted a copy of the application document pack to Insika Foundation via post or hand delivery