rainbow declaration[1]

GPDRTPROFORMA SMME SUBCONTRACT FOR ROUTINE

ROAD MAINTENANCE

&

CIVILS

PRE-QUALIFICATION APPLICATIONFOR (SMME’S/ BE’S )

UTILIZED ONROUTINE ROAD MAINTENANCE (RRM) PROJECTS

TENDER NUMBER: RC 001 – RC 006

MANAGEMENT AND EXECUTION OF ROUTINE ROAD MAINTENANCE CONTRACTS ON SELECTED RISFSA CLASSES 1 & 2 PROVINCIAL ROADS IN BENONI REGION OF GAUTENG PROVINCE

MAIN CONTRACTOR: RAINBOW CIVILS

DECLARATION DOCUMENT

NAME OF APPLICANT: …………………………………………………………………..

CIDB GRADING: …………………...

CIDB NUMBER: ……………………

DOCUMENT NUMBER: .....................................

PRE-QUALIFICATION / TENDER NOTICE

Pre-qualification applications are hereby invited from experienced Small,Medium and Micro Enterprises (SMME) that may/may not beBlack Owned Companies as sub-contractors for Routine Road Maintenance on SELECTED RISFSA CLASSES 1 & 2 PROVINCIAL ROADS IN BENONI REGION OF GAUTENG PROVINCE.An active CIDB contractor grading designation of3 – 4 CE is a requirement for the sub-contract.

A compulsory information briefing meeting will take place on 30 day April 2014at 10:00 am.Prospective Applicants shall meet the Project Management Team at theDR&T OFFICES, 1215 NICO SMITH STREET (prev. Michel Brink Str), KOEDOESPORT, PRETORIASubmissions from applicants arriving late shall be deemed to be non-responsive.

Pre-qualification application documents will only be made available at the information briefing meeting.

Applicants must be represented at the information briefing meeting by a representative who must be the Applicant himself or an authorised person in the direct employ of the Applicant.

The Pre-qualification and supporting documents shall be sealed in an envelope or package clearly marked "Pre-qualification forRC 001 – RC 006 Routine Road Maintenance on SELECTED RISFSA CLASSES 1 & 2 PROVINCIAL ROADS IN BENONI REGION OF GAUTENG PROVINCE” and shall be delivered by hand toBENONI GDRT Regional offices atMAIN REEFF ROAD, .Telephonic, telegraphic, telex, facsimile, e-mailed or electronic applications will not be accepted.

In all cases the Pre-qualification Application Document shall reach the stipulated address not later than 10h00 on 27 May 2014.No late entries will be accepted.

Queries relating to issues arising from this document may be addressed to:

Mr: Azola Mayatula

Tel No: 083 461 8567

Fax No: 086 632 6944

e-mail: [email protected]

Pre-qualification Document Page 1

PREAMBLE

This Pre-qualification Application document forms part of the procurement process of sub-contractors for

Routine Road Maintenance (RRM).Applicants must take note that points earned in this document will be

shortlisted and ranked according their strength for consideration by the PMT.

Successful sub-contractors will enter into an Agreement/Contract with the Main RRM Contractor,

RAINBOW CIVILS


TABLE OF CONTENTS

SECTION PAGE

1. CONDITIONS OF PRE-QUALIFICATION 41.1 Attendance at the Compulsory Information Briefing 41.2 Cost incurred for Pre-Qualification 41.3 Pre-Qualification acceptance 41.4 CIDB Requirements 41.5 Joint Venture (JV) Applications 51.6 Late Applications 51.7 Rejection of Pre-Qualification application 51.9 General 5

2. REQUIREMENTS IN TERMS OF THE BROAD BASED BLACK ECONOMIC EMPOWERMENT (BBBEE) ACT (ACT 53 OF 2003) 62.1 Ownership 62.2 Definitions 62.3 Small, Medium and Micro Enterprises (SMME) 72.4 Routine Road Maintenance Sub-Contract 72.5 Main Contractor 82.6 Project Management Team (PMT) 8

3. SCOPE OF WORK 93.1 Description of Site 93.2 Description of Work 9

4. EVALUATION PROCEDURE 104.1 Previous relevant experience 104.2 Relevant construction equipment 114.3 Ownership and Designated Groups (GEYODI) 124.4 Location 135. RETURNABLE 15

SCHEDULES 155.1 List of Returnable Schedules 15

FORM A1: CERTIFICATE OF ATTENDANCE OF COMPULSORY INFORMATION BRIEFING MEETING 16FORM A2: COMPANY DETAILS 17FORM A3: OWNERSHIP 19FORM A4: LOCATION OF BUSINESS 20FORM A5: PREVIOUS RELEVANT EXPERIENCE 21LIST OF KEY PERSONNEL EXPERIENCE 22FORM A6: EQUIPMENT 24FORM A7: Declaration 26


1. CONDITIONS OF PRE-QUALIFICATION

1.1 Attendance at the Compulsory Information Briefing

The Project Management Team shall consider a pre-qualification application only if the compulsory information briefing meeting has been attended by a representative who must:-

i) be the Applicant himself: orii) an authorised person in the direct employ of the Applicant that will be involved with this

specific project.

Pre-qualification applications received by applicants arriving late or not attending the compulsory information briefing meeting, will be rejected.

The applicant is to acknowledge in writing receipt of any addenda to the pre-qualification document, which the Main Contractor may issue and take into account these addenda.

1.2 Cost incurred for Pre-Qualification

The Managing Contractor shall not be responsible for, or pay for, any expenses or losses, which may be incurred by the Applicant in the preparation and submission of the pre-qualification application or in attending the compulsory information briefing meeting.

1.3 Pre-Qualification acceptance

The recommendations made by the Evaluation Committee and approved by the Project Management Team (PMT)regarding the adjudication of the applications will be final.

1.4 CIDB Requirements

Only applicants who are ACTIVELY registered with the CIDB, prior to evaluation of the pre-qualification applications, in a contractor grading designationof 3 – 4 CE are eligible to have their pre-qualification applications evaluated. The applicant shall provide a printed copy of the “Active Contractors Listing” from the CIDB website: (www.cidb.org.za).

Where an application for re-instating of Active status or for upgrading of status has been made with the CIDB in writing and the decision is pending, proof of this application and acknow-ledgement of receipt of the application by the CIDB is to be provided. The pre-qualification application will remain valid and considered for pre-qualification acceptance pending notification from the CIDB on acceptance of re-instating an ACTIVE status or upgrading of the status.

The applicant is to note, however, that should the status or upgrading not be confirmed or considered by the CIDB during the tender evaluation stage, the applicant/tenderer will no longer be considered. (Note to compiler: The application is to be considered up until the PMT prepare the final tender submissions and score/evaluate these for recommendation.)

Joint Ventures (JV) will be considered provided that:

1. Every member of the JV is actively registered for a CE class of construction work with the CIDB.


http://www.cidb.org.za/

2. The lead partner (highest % ownership) has a contractor grading designation of minimum 3CE.

1.5 Joint Venture (JV) Applications

Where a Joint Venture (JV) application is to be considered, all parties to the JV are to inde-pendently complete all forms and questions required and provide documents for all partners proposed.

1.6 Late Applications

Any application received after 10h00 on 27 MAY 2014will not be accepted by theProject Teamand will be returned unopened to the applicant’s representative present. The name of the applicant and time of arrival will be recorded with those applications accepted.

1.7 Rejection of Pre-Qualification application

The pre-qualification application of any Applicant who has not conformed to these conditions and the instructions reflected on the pre-qualification notice may be rejected at the discretion of the Project Management Team (PMT).

1.9 General

i) Complete fully all questions and all returnable forms/pages, in BLACK INK.ii) Initial all pages inBLACK INK at the bottom right hand corner.iii) Supplementary pages may be photocopied and attached where required. These pages

are also to be initialled in BLACK INK.iv) Retain a copy of your complete submission.v) Original or certified copies of current SARS Tax Clearance Certificate, UIF compliance

and Company Registration Forms must accompany this questionnaire. Where any of this documentation has expired, submission of the invalid documentation must be made with proof of application for renewed documentation provided. Applicant will be given 24 hours on notification by the Main Contractor to comply by providing the current documentation, failing which thereafter the application will be rejected.

vi) Nothing contained in this document shall be interpreted to be a contract between an Applicant and the Main Contractor.


2. REQUIREMENTS IN TERMS OF THE BROAD BASED BLACK ECONOMIC EMPOWERMENT (BBBEE) ACT (ACT 53 OF 2003)

2.1 Ownership

Initiatives aimed at achieving broad-based ownership will be encouraged, through allocation of higher weightings to different forms of broad-based ownership, as follows:-

o Black Ownership;

o Women ownership;

o Youth Ownership;

o People with disabilities ownership

o Other broad-based Black ownership.

2.2 Definitions

BEE Companies Companies which are black-owned, black-empowered, black women-owned.Black-empowered Company

Companies, which are more than 25% owned by black people and with participation in control by black people.

Black-owned Company

Companies, which are more than 50% owned and controlled by black people.

Black women-owned Company

Companies with at least 30% representation of black women within the black equity and management portion 1.

Black people/Blacks Africans, Coloureds and Indians who are South African citizens.Black Designated Groups (Employment Equity Act, 1998)

Black people who are youth, people with disabilities or people living in rural areas.

Broad-based Black Economic Empowerment

The economic empowerment of all black people including women, workers, youth, people with disabilities and people living in rural areas through diverse but inte-grated socio-economic strategies that include, but are not limited to:

increasing the number of black people that manage, own and control enterprises and productive assets;

facilitating ownership and management of enterprises and productive assets by communities, workers, co-operatives and other collective enterprises;

targeted procurement; and investment in enterprises that are owned or managed by black people;

human resources and skills development; achieving equitable representation in all occupational categories and

levels in the workforce; facilitating the provision of additional skills to black employees at all levels

in the workforce.Control Centres on the authority and power to manage assets, the determination of policies

and the direction of business operations. Indicators of control may include: participation in control of a business unit or of the company (such as

shareholder meetings, the Board of Directors, board sub-committees and divisional boards);

the exercise of voting rights on the Board of Directors and committees thereof, and controlling equity; and

participation in executive management.


Company Includes a CC and a (Pty) Ltd company registered in terms of the Companies Act.Disabled person An individual who has a disability and as a result suffers from loss or limitation of

opportunity to take part equally with others or to contribute in equivalent measure to such opportunity, in the context of any activity relating to the execution of a contract or the services to be provided there under. Disability refers to permanent or pro-longed impairment of physical, intellectual or sensory structure or function, which results in a restricted or lack of ability within an objectively determined range of pro-ductivity measurement or equivalent productivity criteria considered normal for a human being.

Formal contract A written contract, all the terms of which are embodied in a single or composite document signed by all the parties thereto and duly witnessed.

Joint Venture Joint ventures are, normally, unincorporated bodies, regarded in law as partner-ships in which the partners are jointly and severally liable for the acts, neglects and omissions of the partnership. A Joint Venture is a venture normally formed ad-hoc for a specific project, in which two or more parties share the obligations, risks and rewards.

Rural Area Area beyond the development fringe of urban area. Consists of natural and agr-icultural areas with a general population of less than 2500 persons.

Youth People between the ages of 14 and 35.

2.3 Small, Medium and Micro Enterprises (SMME)

Any person, group of persons in association, or body corporate (whether formally constituted or otherwise) that are privately and independently, or co-operatively, owned and managed and do not form part of an enterprise which exceeds any two of the quantitative criteria referred to in Table 2.3 below, but may have more than one branch.

Small, Medium and Micro Enterprises will be businesses which adhere to statutory labour practices, are legal entities registered with the South African Revenue Service as continuing and independent enterprises for profit, providing a commercially useful function.

Table 2.3: Small, Medium & Micro Enterprises (SMME)

SizeTotal Annual

TurnoverTotal Number of Full-

time EmployeesTotal Gross Asset

Value (Fixed Property excluded)

less than less than less thanMedium R26.0 million 200 R5,00 millionSmall R 6 million 50 R1,00 millionMicro R0.2 million 5 R0,10 million

2.4 Routine Road Maintenance Sub-Contract

Routine Road Maintenance sub-contract is a contract in which:-

the potential risks involved in the works for the contracting parties are limited; on the job training is provided as required; the period for completion is a minimum of 12 months with an option to extend to a maximum

of 36 months at the PMT’s discretion based on a performance evaluation by the PMT of the Sub-contractor;

a probation period of 3 months is applicable; the works are of a straightforward nature in terms of complexity, quality and tolerances and the

possibility of significant variations from the work envisaged is adjudged to be relatively low;


the contractor has no responsibility for the design of permanent works; and the contractor is not required to undertake work of a specialist nature.

2.5 Main Contractor

Main Contractor is a contractor which:-

has to provide coaching, mentorship, guidance and where necessary,certain resources which SMME sub-contractors may lack and undertakes certain obligations to assist the SMME;

would be required to advise, assist and train on-the-job, administer payments made to the SMME sub-contractors, provide certain items of equipment, report to the Client on project expenditure, construction and progress and to co-ordinate site activities;

is to provide an independent office for use by SMME which includes furniture, an available telephone line, and fax facilities, a computer and printer with internet and email facilities if needed;

has to make provision for the SMME to store materials and equipment on site / at site office; is responsible to let tenders to SMME sub-contractors.

2.6 Project Management Team (PMT)

This team that shall consist of the Main Contractor, the Engineer and a delegated persons from the Client.


3. SCOPE OF WORK

3.1 Description of Site

The “Site” comprises the road reserve of following list of roads:SELECTED RISFSA CLASSES 1 & 2 PROVINCIAL ROADS IN BENONI REGION

3.2 Description of Work

The following activities may form part of the sub-contract: in accordance with the Standard Specification for Routine Road Maintenance:-

M0200 General Requirements and provisionsM0300 Site EstablishmentM0500 Accommodation of TrafficM1100 Pavement Layers repairM1200 Repairs of Potholes, Edge breaks and surface failuresM1300 Crack SealingM1400 Bleeding repairM1600 Surface treatment of surfaced roads)M1700 Repair of slope failures and washawaysM2100 Repair and maintenance of Inlet and Outlet StructuresM2200 Sub-soil Drain Installation and MaintenanceM2300 Cleaning of waterway structuresM2400 Cleaning of Prefabricated CulvertsM2500 Cleaning of Concrete Drains and ChannelsM2600 Cleaning and Maintenance of Earth DrainsM2700 Edge Build-up RemovalM2800 Concrete Channel Construction and Maintenance of Existing ChannelsM3100 FencingM3200 Collection and Removal of Debris and LitterM3300 Shoulder RepairsM3400 Maintenance of arrestor bedM3500 Stabilisation of cuttingsM4200 Cleaning of Signs and Removal of Illegal SignsM4400 Guard Rail Erection and MaintenanceM4600 Road MarkingsM4700 Maintenance of lay-byes and rest areasM5100 General Erosion ProtectionM5200 Gabion ProtectionM6100 Controlling Vegetation Growth: Mowing and CuttingM6200 Chemical Control of Vegetation and Eradication of undesirable vegetationM6300 Removal of Undesirable Vegetation: Physical EradicationM6400 Maintenance and establishment of plants, trees and shrubsM6500 Establishment of GrassM8100 Minor repairs to structuresM9100 Dayworks


4. EVALUATION PROCEDURE

The evaluation of the application for pre-qualification will follow the following process:-

All accepted pre-qualification documents submitted to the address stated in the Pre-qualification Notice before the closing date and time will be evaluated. Pre-qualification documents received after the closing of the applications will not be opened or evaluated and will be returned to the Applicant.

Pre-qualification documents will be evaluated according to the following points based system:-

Previous relevant experience (Table 4.1) 30 Relevant construction equipment (Table 4.2) 30 Ownership and Designated Groups (GEYODI) (Table 4.3) 20 Location (Table 4.4) 20

100

Points will be awarded to each Applicant according to the above system. The Applicants scoring 70 points or more will be invited to tender for sub-contracts.

4.1 Previous relevant experience

The points for previous experience (work over last 3 years) will be based on the following table:-

Table 4.1: Previous relevant experience

Previous Experience Maximum Points

Previous experience of Company (applicant) 10Site Agent: Experience and Qualifications (including Traffic Control) 16Organogram 2Quality / Management control 2

Total 30

When the information regarding previous relevant experience is evaluated, particular attention will be paid to the relevance of the previous experience. In other words, prospective Applicants that have completed similar work successfully will score higher points than those who have not com-pleted similar work.

The information in Returnable Schedule: Form A5 will be used to calculate the points for previous relevant experience. The maximum number of points that can be awarded for previous relevant experience is 30.


4.2 Relevant construction equipment

The points for construction equipment will be based on the following table:-

Table 4.2: Relevant construction equipment

The construction equipment necessary to carry out this contract successfully is listed below in Table 4.2 and in Returnable Schedule: Form A6.

The number of each piece of equipment that is owned by the applicant must be indicated on this form. Vehicle registration documents, receipt/proof of purchase or company asset registers submitted during company audits are forms of acceptable proof of ownership. Photographs given as proof of ownership will not be accepted.

This information will be used to calculate the points for relevant construction equipment.

The maximum number of points that can be awarded for relevant construction equipment is 30., and only one of the categories below will be considered for evaluation purposes. In cases where an applicant submits equipment for different categories, the one where the score is the highest will be used for evaluation purposes.

General maintenance

ITEMS OWNED MAXIMUM POINTS LDV (1ton) 5Truck (3ton or bigger) 7Tractor for mowing 42 x Set of two way radio’s 2 x 1= 2 Brush Cutters (12) 12 x 1 = 12 30

Mowing / Vegetation ControlITEMS OWNED MAXIMUM POINTS

1 x LDV (1ton) 3Trailer (at least 3m) 3Tractor for mowing 2*3=6Mower for mowing 3Bailing machine 3Brush cutters for mowing (12) 12 x 1 =12 30


Pavement maintenance – Patching

ITEMS OWNED MAXIMUM POINTS 1 x LDV (1ton) 2Trailer 2Truck (4ton tipper or bigger) 7Bomag 76 or bigger 6Concrete Mixer 2TLB 52 x Set of two way radio’s 2 x 1 = 2Breaker with Generator 4 30

Earth work maintenance

ITEMS OWNED MAXIMUM POINTS 1 x LDV (1ton) 3Grader 9Vibrating roller 5Water cart 5Tipper trucks (>4m*3) 2*4=8

30


4.3 Ownership and Designated Groups (GEYODI)

The points for ownership and designated groups in line with the Department’s GEYODI (Gender, Youth and People living with Disabilities) targets will be based on the following table:-

Table 4.3: Ownership and Designated Groups

DescriptionBlack Equity

within Company

(%)

Base Points

Bonus Points onlyMaximum

PointsEquity by HDI

PersonsEquity by Women

Equity by

Youth

Equity by Designated

GroupsBlack Influenced

Company < 50 3.0 1.0 1.0 1.0

20Black

Empowered Company

50 >=75 7.0 2.0 2.0 1.0

Black Owned Company 75 >= 100 14.0 3.0 2.0 1.0

Points may only be scored for persons who own equity in the business enterprise and have sub-stantial management control (see Item 2.2 Definitions).

Points will be calculated by the following method:-

i) The column indicating points for Equity by HDI Persons will be used to allocate Base points on the percentage of black equity (incl. black women and designated equity) in the total equity of the enterprise.

ii) The column indicating points for Equity by Women will then be used to allocate Bonus points for the percentage of women equity (including designated equity) included in the total equity of the enterprise.

iii) The column indicating points for Equity by Youth will then be used to allocate Bonus points for the percentage of youth equity (including designated equity) included in the total equity of the enterprise.

iv) The column indicating points for Equity byDesignated Groups will then be used to allocate Bonus points for the percentage of black designated groups equity included in the total equity of the enterprise.

The points scored for Preferential Procurement will be the sum of the above.

Where a JV is proposed, each enterprise of the JV will be evaluated separately. Thereafter the points scored by each enterprise will be factored by the percentage shown on the shareholders agreement (% given on FORM A3) of the member JV agreement.

The information in Returnable Schedule: Form A3 will be used to calculate the points for pre-ferential procurement. The maximum number of points that can be awarded for preferential pro-curement is 20.


4.4 Location

The points allocated in this section are for the promotion of contracting with applicants who are based within the geographical limits or region of this sub-contract.

The points for location shall be allocated as follows:-

Table 4.4: LocationLocation of Business Maximum Points

If the prospective Applicant is based within the limits of theBENONI Region in which the substantial portion of the project falls 20

If the prospective Applicant is based outside the BENONI Region, but within the Gauteng Province 10

If the prospective Applicant is based outside boundaries of the Gauteng Province. 5

For the purposes of this evaluation, “based” shall mean the currentphysical address as recorded by CIPRO of the Applicant’s place of business and/or residence for a period of at least one year prior to the closing date of this pre-qualification.

The information in Returnable Schedule: Form A4 will be used to calculate the points for location.Please attach proof of place of business address (copy of municipal or telephone account or lease agreement) to confirm location.

When a JV is proposed thecurrentphysical address of each party of the Applicant JV’s place of business and/or residence for a period of at least one year prior to the closing date of this pre-qualification will be scored. Thereafter the points scored by each enterprise will be factored by the percentage shown on the shareholders agreement (% given on FORM A3) of the member JV agreement.

The maximum number of points that can be awarded for location is 20.


5. RETURNABLESCHEDULES

5.1 List of Returnable Schedules

NOTE: This form has been created as an aid to ensure the Applicant’s compliance with the completion of the returnable forms and schedules. The applicant must make use of the “APPLICANT TICK IF CONFORMED” column to ensure that the document has been completed to the requirements as mentioned.

The “PMT TICK IF APPLICANT HAS CONFORMED” column is for evaluation use only and must not be completed by the Applicant

FORMNO DESCRIPTION

APPLICANT TICK

IFCONFORMED

PMT TICK IF APPLICANT

HAS CONFORMED

A1ATTENDANCE REGISTER / CERTIFICATE OF ATTENDANCE AT INFORMATION BRIEFING MEETING

A2 COMPANY DETAILS

A3 OWNERSHIP

A4 LOCATION OF BUSINESS

A5 PREVIOUS EXPERIENCE

A6 CONSTRUCTION EQUIPMENT

A7 DECLARATION


FORM A1: Certificate of Attendance of Compulsory Information Briefing Meeting

This is to certify that I, ………………………………………………………………………………………

Representative of (Applicant) ……………………………………………………………………………...

…………………………………………………………………………………………………………………

of (address) ………………………………………………………………………………………

………………………………………………………………………………………

………………………………………………………………………………………

Telephone No ………………………………………………………………………………………

Fax No ………………………………………………………………………………………

E-mail ………………………………………………………………………………………

Attended the information briefing meeting on …………………………..……………………….. (date)

Conducted by ………………………………………………………….…………………………. (person)

APPLICANT’S REPRESENTATIVE (signature) ……………………………..…

MAIN CONTRACTOR’S REPRESENTATIVE (signature) …………………………………

GPDRTSERVICE PROVIDER REPRESENTATIVECONSULTING ENGINEERING (signature) …………….…………………..


FORM A2: Company Details

Note to Applicants:

In the case of a Joint Venture, separate forms in respect of each partner must be completed and submitted.

1. Name of Company ……………………………………………………………………..

Physical address ……………………………………………………………………..

……………………………………………………………………..

……………………………………………………………………..

……………………………………………………………………..

Postal address ……………………………………………………………………..

……………………………………………………………………..

Contact Person ......…………………………………………………………………

Telephone No ……………………………………………………………………..

Fax No ……………………………………………………………………..

Cell No ……………………………………………………………………..

E-mail .…………………………………………………………………….

Registered Office Address ……………………………………………………………………..

……………………………………………………………………..

……………………………………………………………………..

……………………………………………………………………..

2. Description of company (for example, General Civil Engineering Contractor)

………………………………………………………………………………………………………….

………………………………………………………………………………………………………….


3. CIDB Grading ……………………………………………………………..

4. CIDB Registration Number ……………………………………………………………..

Note: The applicant shall provide a printed copy of the Active Contractors Listing from the CIDB website (www.cidb.org.za) The print out shall state:

CRS Number Contractor Name Trading Name Grading (only CE acceptable) STATUS

5. Date on which enterprisewas established ...........………………………………….

6. Company Registration Number (Attach proof) ……………………………..……………

7. UIF Registration Number (Attach proof) …………………………………………..

8. SARS Tax Reference Number …………………………………………..(Attach copy of valid Tax Clearance Certificate)

9. What was the enterprise’s turnover (excluding VAT) during the previous financial year? R ………………………………………..(Attach income statement as proof)

10. What is the enterprise’s Total Gross Asset Value (fixed property excluded)? R…………………………………………(Attach income statement as proof

11. Total number of permanent employees? ……………..................………………

Note to applicant: Items 9, 10 and 11 will be verified as correct before award of sub-contract is awarded.

12. Bank Details

Name of Account Holder ……………………………………..………………………

Bank …………………………………………..…………………

Branch Name ………………………………………..……………………

Branch Code ………………………………………..……………………

Account Number ……………………………………………..………………

13. Permission to do a credit check Yes / No Signed ………………..………..

SIGNED ON BEHALF OF THE APPLICANT: …………………………….…………………….


http://www.cidb.org.za/

FORM A3: Ownership

Note to Applicants:

In the case of a Joint Venture (JV), separate forms in respect of each partner must be completed and submitted.

1. Type of Firm (Tick one box) :

Partnership Sole Trader Close Corporation Company Joint Venture

2. Details of shareholders/members/partners:

Please supply proof of share holding in company (CK2 Form or Partnership Agreement). Details listed below cannot be verified if proof is not supplied. Points will therefore not be allocated.

Equity Owners Name

% Equity in Firm

RaceBlack/White

GenderMale/Female

DisabledYes/No

YouthYes/No

RuralYes/No

1

2

3

4

3. If a Joint Venture Agreement is proposed (copy of JV agreement or letter of proposed agreement between partners to be provided)’ then please WRITE IN BLACK INK below shareholder %

Lead/Managing partner company: Percentage: ……. %Partner company: Percentage: ........ %

SIGNED ON BEHALF OF THE APPLICANT: ……………………………………………………


FORM A4: Location of Business

Registered Business Street Address

…………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………

District Municipality / Region ……………………………………………………………………...

Province ……………………………………………………………………………...

Number of years at present address …………………………………………………………….

NOTE: Attach proof of business address (Copy of municipal or telephone account or lease agreement dated or CIPRO registration.

SIGNED ON BEHALF OF THE APPLICANT: ………………………………….…………………


FORM A5: Previous Relevant Experience

The Applicant is to attach a detailed company profile.

List ofContracts/Projects undertaken

Please provide and list all relevant information regarding previous Roadworks experience (Routine Road Maintenance (RRM), periodic maintenance) projects completed over the past 3 (three) years.

Employer and Project Number Project type

Name and Tel No. Person responsible

for supervision

Contract price(Value of work

undertaken by the tendered)

Contract start date

Months to complete Works *

* : Where Works are still being undertaken, the proposed completion date is also to be given.


List of KeyPersonnelExperience

Note toapplicant: The applicant is to propose and list the KEY PERSONNEL to be used in managing

these Works. The given SITE AGENT will be required to be on Site daily, manage and supervise all staff on site, liaise directly with the Main Contractor regarding all Site issues, assist and prepare monthly Payment Certificates and manage Site Traffic Safety and Health and Safety issues.If the Site Agent is replaced, the new candidate must have the same or better experience and can only be done so at the approval of the PMT.

Site Agent:

Name of proposed Site Agent: ………………………….......…………..

Position in Company: (If not currently employed with company state so); ................……..

Initial Qualification and Date attained (certified copy of qualification to be attached): ……………..

Additional qualification(s) and Date(s) obtained: ……………………………………………………

Recommendation:Attach copy of SITE AGENT CV

Years experience of Site Agent:

- in Routine Road Maintenance (RRM)……………………………………………

- in road construction …………………....................................

- in Management and supervision of Road Sites……………………………………………

Site safety:

Has this person completed any SANAS accredited training course/s relating to site/traffic safety within the last 3 years? (yes / no) -

………………, If YES please provide details (attach copy of Certificate/s)

Has this person held position of Traffic Safety Officer (TSO) on any previous Road Maintenance projects on Provincial or National Roads: -

………………, If YES please list project number/road numbers.


Organogram:

Applicant is to provide an organogram listing all the relevant and key personnel to successfully undertake this project. The organogram is to indicate clearly the link between site staff and head office/administration personnel, showing and listing the responsibilities of these key staff members.

Recommendation: Attach copy of any relevant staff CV’s

Quality/Management control:

The applicant is to provide a brief management proposal for the proposed works. A brief summary of management responsibilities, communication/liaison with Main Contractor and any site quality system should be detailed.

This summary can be given in point form and must not be longer than one A4 page.

The applicant is to list and provide any additional or further knowledge relevant to project.

…………………………………………………………….……………………………………………………

…………………………………………………………….……………………………………………………

…………………………………………………………….……………………………………………………



FORM A6: Equipment

The following equipment is essential for the successful completion of the contract. Please indicate availability of equipment owned and attached proof of ownership. Acceptable forms of ownership proof are vehicle registration documents, proof of purchase or company asset registers submitted during company audits.Please note that photographs given as proof of ownership will not be accepted.

The “PMT USE to score points” column is for evaluation use only and must not be completed by the Applicant

Equipment (General maintenance) Number required

Number Owned

PMT USE to score points

1 x LDV (1 ton) 1Truck (3 ton or bigger) 1Tractor for mowing 1Brush cutters 122 x Set of two way radio’s 2

Total (30)

Equipment (Vegetation control) Number required

Number Owned


1 x LDV (1 ton) 1Trailer (at least 3m) 1Tractor for mowing 2Mower for mowing 1Bailing machine 1Brush cutters for mowing (12) 12

Total (30)

Equipment (Pavement maintenance) Number Number PMT USE


required Owned to score points

1 x LDV (1ton) 1Trailer 1Truck (4ton tipper or bigger) 1Bomag 76 or bigger 1Concrete Mixer 1TLB 12 x Set of two way radio’s 2Breaker with Generator 1

Total (30)

Equipment (Earth works) Number required

Number Owned


1 x LDV (1ton) 1Grader 1Vibrating roller 1Water cart 1Tipper trucks (>4m*3) 2

Total (30)



FORM A7: Declaration

Note to Applicants:

In the case of a Joint Venture, separate forms in respect of each partner must be completed and submitted as well as a separate form by the signatory person of the Joint Venture.

I declare that the information furnished by me is to my knowledge true and correct in all respects.

Any false declarations will constitute a breach of the contract and the relevant person(s) will be disqualified from any further tender related matters, or if it becomes evident during contract stage that false information has been included, the subcontract will be terminated with immediate effect.

Signed on this …………………... day of ……………………………... (Month) 20………

Duly authorised signature ……………………………………………….....

Print name ………………………………………………….

Capacity ………………………………………………….

Company ....................................................................

Witness ………………………………………………….

Print name ………………………………………………….


rainbow declaration[1]

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