SUPPLIER APPLICATION FORM
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1 SUPPLIER APPLICATION FORM COMPANY NAME: PRODUCT/SERVICE: Upon completion return to: SENIOR MANAGER: PROCUREMENT ATNS Eastgate Office Park, Block C, South Boulevard Road Bruma, 2198 Private Bag X15 Kempton Park Johannesburg The following important notes should be read carefully prior to completion of this form. 1.1 The form must be completed in full and signed by the owner(s) 1.2 Full signatures are required when alterations are made on this document. 1.3 If the information required is not applicable to your business, clearly insert N/A in the appropriate space. 1.4 Mark the appropriate square with an 'X' where it is applicable to you. 1.5 All fields on the application must be completed by the applicant; if the space provided is left blank, it will be regarded as information still outstanding and you will not be registered. 1.6 No faxed or ed application forms will be accepted 1.7 Businesses providing information intentionally incorrect or fraudulently will be disqualified. 1.8 Blacklisted businesses by the state must first be cleared from the blacklist registering. 1.9 The following documents must be attached to the application form: Company Registration documents Certified Identity documents of the owner, partners, shareholders and directors (copies of certified copies will not be accepted) Partnership / Joint Venture agreements signed and witnessed by all parties ATNS/HO/FIN/PROCUREMENT 1/2011 Page 1 of March 2014
2 concerned Share / shareholder certificates if applicable Proof of registration with Workman s Compensation commission & Letter of Good Standing Valid Original Tax Clearance Certificate Audited financial statements for the two previous financial years/credit rating Proof of registration with the Unemployment Insurance Fund (UIF) & PAYE if applicable SANAS accredited BBBEE Certificate (must be valid) 2. BUSINESS INFORMATION Full registered name of business Company registration number Trading number VAT registration number Tax Number Type of business Sole Proprietor Private company Closed Corporation (Pty) Ltd (CC) Foreign Company Other (specify) Public company (Ltd) Joint venture Consortium Partnership Trust Section 21 Company Government/ Parastatal 2.2 Physical address of business: 2.3 Postal address of business: 2.3 Premises: Owned or Rented Owned Rented ATNS/HO/FIN/PROCUREMENT 1/2011 Page 2 of March 2014
3 Name of landlord if rented Indicate (X) the geographical areas where your business is willing and capable of supplying ATNS: Johannesburg Pretoria East London Kruger/Mpumalanga Pilanesburg Mafikeng Bisho/King Upington George Williamstown Port Elizabeth Bloemfontein King Shaka 3.0 State names of Directors / Owners /Partners with vested interest in ATNS. Name Race Gender Percentage Shareholding 3.1 State whether directors/owners/partners are ex ATNS employees or relatives. 4. Technical Information 4.1 Is the company a certificate holder under ISO, SABS or any other authority? If no, to what standard does the company adhere to? ATNS/HO/FIN/PROCUREMENT 1/2011 Page 3 of March 2014
4 4.2 Does the company operate within a formal, auditable Quality Management System? 4.3 Does the company have an Occupational Health, Safety and Environmental Policy and system? 4.4 State the grading company and the grading body (e.g. SA) 4.5 Are you registered with any Bargaining Council? (If yes please attach Certificate of Compliance). If no, please explain. 4.6 Does the company carry any grading for the Occupational, Health, Safety and environment System? 4.7 Does the company comply with the Compensation of Occupational Injuries and Disease Act. If no, please explain. ATNS/HO/FIN/PROCUREMENT 1/2011 Page 4 of March 2014
5 4.8 Please indicate the products/services provided by the company and for how long such products/services have been provided. Description of product/service provided Years 4.9 Indicate membership of the company or its personnel to professional bodies. Professional body Date registered 4.10 NB: According to ATNS Preferential Procurement and Enterprise Development Policy (PPEDP), ATNS shall deal with suppliers in accordance with the BBBEE Codes of Good Practice. In particular, preference shall be given to the following: Order of Preference Black Owned (>51%) Suppliers. Black Women Owned (>30%) Suppliers. BEE LEVEL (only 1-4) Points / % claimed 4.11 Supply references of contracts/large orders completed by the company in the past twelve months. Company Contact Person Contact details Value 4.12 Indicate the magnitude of contracts that the company can successfully complete. >5 Million R5Million &>R30 Million >R30 Million ATNS/HO/FIN/PROCUREMENT 1/2011 Page 5 of March 2014
6 4.13 Company/ Supplier Classification: (Please X the relevant box or boxes) ISO Listed Sales Importer Exporter Services Manufacturer Distributor Repairer 5.1 Extensive List of commodities and services Services Required We are looking for suppliers in the below listed categories: Advertising Agencies Air-conditioning maintenance & repair Catering and Events Cleaning Services Construction and related services Crane & hoist certification Electrical maintenance & repair Engineering Fire Systems maintenance & repair Forensics General Building maintenance & repair Legal Services Management Consultants Marketing (Photography, Event Management, Corporate Clothing and gifts) Pest control Plumbing maintenance & repair Publications Security Services, Permanent and ad hoc Site maintenance, grass cutting, gardening etc Stationery ATNS/HO/FIN/PROCUREMENT 1/2011 Page 6 of March 2014
7 Training Services( valid proof of accreditation by the relevant SETA) ATNS/HO/FIN/PROCUREMENT 1/2011 Page 7 of March 2014
8 ANNEXURE 1 BANK DETAILS ATNS prefers effecting payment via EFT hence complete the details below (Attach original cancelled cheque or original bank verification letter) Supplier Name Postal Address P O Box Code Physical Address Telephone Numbers: Business Facsimile Number After hours Cell Phone address Contact person Payment terms/discount VAT Registration number Bank details Bank Branch name & code Account number Current Type of (Cheque) account Savings Transmission Other (specify) ATNS/HO/FIN/PROCUREMENT 1/2011 Page 8 of March 2014
9 If there are any changes to the information supplied on this form, please inform the relevant ATNS Management Units / ATNS Procurement Office within 7 working days. Outdated information could lead to your company not being invited to tender or not receiving correct payment! ATNS reserves the right to verify and /or follow-up on any of the claims made or references in this application form. Additional information can be requested by ATNS during its evaluation process. Suppliers will be re-accessed at regular intervals. Incomplete submissions will not be processed. This includes the supporting documentation as stipulated on the first page. TE: ATNS PAYMENT TERMS ARE 30 DAYS OF STATEMENT I certify that I have the appropriate authority to furnish the above-mentioned information, sign this document on behalf of my employer, and confirm that the information is correct at the time of completion. I herby confirm acknowledgement of the abovementioned and agree to abide by it. AUTHORISED SIGNATORY DATE ATNS/HO/FIN/PROCUREMENT 1/2011 Page 9 of March 2014
10 For internal office use only Checked By: Authorised by: Procurement Specialist Processed by: Senior Manager: Procurement Vendor No: Procurement administrator Date ATNS/HO/FIN/PROCUREMENT 1/2011 Page 10 of March 2014
11 CHECK LIST Company Registration documents Certified Identity documents of the owner, partners, shareholders and directors (copies of certified copies will not be accepted) Partnership / Joint Venture agreements signed and witnessed by all parties concerned Share / shareholder certificates if applicable Proof of registration with Workman s Compensation commission & Letter of Good Standing Valid Original Tax Clearance Certificate Audited financial statements for the two previous financial years/credit rating Proof of registration with the Unemployment Insurance Fund (UIF) & PAYE (if applicable) SANAS accredited BBBEE Certificate (must be valid) Original Cancelled Cheque/original stamped letter from the bank Certificate of Compliance (If line of business requires registration with any statutory body) ATNS/HO/FIN/PROCUREMENT 1/2011 Page 11 of March 2014
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Goodwill Shivuri on
City of Johannesburg Supply Chain Management Unit SUPPLIER NAME: REQUEST FOR QUOTATION FOR GOODS AND SERVICES FOR THE CITY OF JOHANNESBURG Procurement Less than R 200 000 (Including Vat) (For publication
City of Johannesburg Supply Chain Management Unit
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City of Johannesburg Supply Chain Management Unit
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City of Johannesburg Supply Chain Management Unit
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City of Johannesburg Supply Chain Management Unit SUPPLIER NAME: REQUEST FOR QUOTATION FOR GOODS AND SERVICES FOR THE CITY OF JOHANNESBURG Procurement Less than R 200 000 (Including Vat) (For publication
City of Johannesburg Supply Chain Management Unit
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City of Johannesburg Supply Chain Management Unit
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