Jaw & a 4 Joburs JOHANNESBURG ROADS AGENCY (PTY) LTD (Company Registration No: 2000/028993/07) (VAT NO: 4370192314) REQUEST FOR INFORMATION PUBLIC PRIVATE PARTNERSHIP IV- PROPOSALS FOR FINANCIAL DEVELOPMENT PROJECTS FOR A PERIOD OF UP TO TWO YEARS Reference No: 020/2011 26 JANUARY 2012 Issue Date: Closing Date and Time: 9 FEBRUARY 2010, 10H30 a.m. NOTE: A NON-REFUNDABLE DEPOSIT OF R114-00 WILL BE CHARGED FOR THIS DOCUMENT ON THE EXPRESSION OF INTEREST (Eo).Joburg 2 ont of Content PART 1 - B ACKGROUND 1.1 JRA Overview 1.3 The Opportunity oe eats 2.2. Contact Details 2.3. Queries and questions during the RFI period 2.4. Opportunity briefing and site visit if required 2.5. Response lodgement methods and requirements 2.6. Late responses 2.8.Costs of preparing the response 2.9. Acceptance of these Conditions: PART 3 - | NFORMATION TO BE PROVIDED 3.1 Supplier/contractor details 3.2 Supplier/contractor capabilities and experience 3.3. Supplier/contractor financials 3.5. Policies & Plans 3.7 Evaluation Criteria 10 10 10 10 a a n u 2 2 1B 3B B 13ie he Joburs & a i ‘9 world dass African city PART 1 - B ACKGROUND This Part provides background information 1.1 JRA Overview COMPANY VISION “The vehicle that makes the City work” The JRA regards itself as the ultimate catalyst that makes other services and opportunities in water, electricity, waste, schooling, health, employment or the City realizable, whether it recreation. The provision of transport infrastructure cannot be seen as an end in itself, but rather the means to a better quality of life for all, i.e. “mobility for all” COMPANY MISSION “To provide a sound transit infrastructure management system in support of enhanced mobility”. JRA is an entity owned by the City of Johannesburg. It endeavor's to accelerate service delivery in the following areas: traffic management, storm water services, (open drain conversion, emergency and recurring) gravel roads upgrade, mobility enhancement, road rehabilitation, professional services. 1.2 Purpose of the RFI 1. JRA is inviting Service Providers who are willing to engage on fully funded projects and Public Private Partnerships (PPP) in order to accelerate service delivery. This is innovative partnerships for the solicitation of bids on innovative ideas related to financial development projects. 2. The JRA is seeking to engage in various partnerships with suitable service providers in order to enhance service delivery and value for money. In so doing JRA is calling for partnership proposals to address various services delivery challenges (as stated above) and enhance the functioning of the JRA in the delivery of its mandate to the citizens of Johannesburg. Proposals must be accompanied with a clearly defined funding model.tie Jobur 3 world cass African city JRA 3. T his RFI is intended to systematically identify similarities and differences between suppliers/ contractors in the market for the services described as part of the ‘s | opportunity, and additionally gain a greater understanding of specific suppl contractor's abilities, core business and strategic outlook with respect to the management of these goods and services. The JRA intends to assess supplier/ contractors responses and use the resultant assessments in future decision making in regard to supply/ delivery of the Opportunity. Whilst it is the intention of the JRA to compare supplier's / contractor's responses for the purposes of identifying the capabilities of the supply market, the JRA makes no obligations or undertakings in any way to: ‘a. Go to tender; or b. Accept any RFI information received from supplier's! contractor's ; or ¢. Include suppliers! contractors responding to this RFI in any future tender invitation; or negotiations; d. Any other commitment to suppliers/ contractors whatsoever, including any intention to form a contract with any supplier/ contractor for provision of the Opportunity. Public Private Partnerships Definitions In this regulation, unless the context indicates otherwise, a word or expression to which a meaning has been assigned in the Act, has the same meaning, and ~ “Affordability” means that the financial commitments to be incurred by an institution in terms of ‘the PPP agreement can be met by funder . (2) designated within the institution's existing budget for the institutional function to which the agreement relates; and/or {b) destined for the institution in accordance with the relevant treasury's future budgetary 4te world class Ata city JRA projections for the institutio “Institution” means a department, a constitutional institution, a public entity listed, or required to be listed in Schedules 3A, 3B, 3C and 3D to the Act, or any subsidiary of any such public entity. “Institutional function” means ~ (a) a service, task, assignment or other function that an institution is entitled or obliged to perform ~ (i) in the public interest; or (i) on behalf of the public service generally; or (b) any part or component of or any service, task, assignment or other function porformed or to be performed in support of such a service, task, assignment or other function; “Private party” means a party to a PPP agreement, other than ~ (2) an institution to which the Act applies; (b) a municipality or a municipal entity under the ownership control of one or more municipalities; or {¢) the accounting officer, accounting authority or other person or body acting on behalf of an institution, municipality or municipal entity referred to in paragraph (a) or (b); “project officer” means a person identified by the accounting officer or accounting authority of an institution, who is capable of managing end is appropriately qualified to manage a PPP to which that institution is party from its inception to its expiry or termination; “Public private partnership” or “PPP” means a commercial transaction between an institution and a private party in terms of which the private party — (a) performs an institutional function on behalf of the institution; and / or (b) acquires the use of state property for its own commercial purposes; and (c} assumes substantial financial, technical and operational risks in connection with the performance of the institutional function and/or use of state property; and Treasury Regulations: PFMA44 (d) receives @ benefit for performing the institutional function or from utilising the state property, either by way of: ° (i) consideration to be paid by the institution which derives from a revenue fund or, 5Do jours Tegeaaa SRA. where the institution is a national government business enterprise or a provincial government business enterprise, from the revenues of such institution; or (ii) charges or fees to be collected by the private party from users or customers of a service provided to them; or {ii) a combination of such consideration and such charges or fees; “Preferred bidder” means the bidder, including any bidding consortium, to be appointed as preferred bidder in terms of regulation 16.5.4; “PPP agreement” means a written contract recording the terms of a PPP concluded between an Institution and a private party; “relevant treasury” means the National Treasury unless delegated in terms of section 10(1)[b) of the Act; “State property” includes all movable and immovable property belonging to the state as well as intellectual property rights vested in the state; “Transaction advisor” means a person or persons appointed in writing by an accounting officer or accounting authority of an institution, who has or have appropriate skills and experience to assist and advise the institution in connection with a PPP, including the preparation and conclusion of a PPP agreement; and “Value for money” means that the provision of the institutional function or the use of state property by a private party in terms of the PPP agreement results in a net benefit to the institution defined in terms of cost, price, quality, quantity, risk transfer or a combination thereof. 1.2.1. Types of Public Private Partners! {a) Operations and Maintenance- The JRA contracts with a private partner to operate and maintain a publicly owned facility. The private partner funds the projects. (b) Design-Build-The JRA contracts with a private partner to design and build a facility that conforms to the standards and performance requirements of the JRA. Once the facility has been built, the JRA takes ownership and is responsible for the operation of the facility. The funding must come from the private partner. (c) Wrap Around Addition-A private partner finances and constructs an addition to an public facility. The private partner may then operate the addition to the facilityJoburs eae FRA for a specified period of time or until the partner recovers the investment plus a reasonable return on the investment. Lease-Purchase-The JRA contracts with the private partner to design finance and build a facility to provide public service. The private partner then leases the facility to the JRA for a specified period after which ownership vests with the JRA. This approach can be taken where JRA requires a new facility or service but is not in a position to provide financing. () Temporary Privatization-Ownership of an existing public facility is transferred to a private partner who improves and /or expands the facility. The facility is then owned and operated by the private partner for a period specified in a contract or until the partner has recovered the investment plus a reasonable return. The private partner provides the full funding. (f) Build ~Transf er-Operate-The JRA contracts with a private partner to finance and build a facility .Once completed, the private partner transfers ownership of the facility to the JRA. The JRA then leases the facility back to the private partner under a long torm lease during which the private partner has the opportunity to recover its investment and a reasonable rate of return, (g) Build - Own-Operate-Transfer-Tho private partner obtains exclusive franchise to finance, build, operate, maintain, manage and collect user fees for a fixed period to amortize investment. At the end of the franchise, title reverts to the JRA. (h Build-Own-Operate-The JRA either transfers ownership and responsibility for an existing facility or contracts ith a private partner to build, own and operate a new facility in perpetuity. The private partner generally provides the financing. 2. The Opportunity JRA is currently reviewing options for the provision of financial development partnerships sorvices within the City of Johannesburg. JRA is seeking to engage in various partnerships with suitable service providers in order to enhance service delivery and value for money. The opportunity includes, but is not limited to, the following services: A) INNOVATIVE EQUIPMENT AND MACHINERY This represents all the equipment and machines used within the road infrastructure to enhance service delivery, ranges from major and minor plants, trucks, traffic signals equipment, asphalt plant, etc). 7oe Joburg a se esa RA |, Traffic Management (Signal upgrade and maintenance, Remote Monitoring, Variable Message Systems, Back-up power supply, UPS, etc). ll, Road Signage and upgrade and maintenance (Road Marking and signage, street names and signs maintenance) Il, Storm water services (open drains conversation, emergency and Recurring) B) INNOVATIVE ROAD MATERIALS AND PRODUCTS Road Infrastructure materials encompass all the materials used within the road network and include paints, kerbs, guardrails, bitumen, aggregates, paving blocks, coment, sprays, stroct plates, street names, poles, sand and stones, bricks, oil, concrete products, etc). IV. New Roads materials (kerbs, guardrails, etc) V. Road Infrastructure upgrade and maintenance (pothole maintenance, patching, footways upgrade programme) VI. Gravel roads upgrade and stabilization (products/services) Vil. Road Rehabilitation Vill. Bridge Maintenance and Rehabilitation Programme C) _ FUNDING PROPOSALS FOR JRA JRA invites prospective funding proposal for JRA projects including but not limited on the ‘once mentioned below: Ix. Green Projects x. Alternative Source of Energy (Solar Energy, etc} Xt Mobility Enhancement Programme D) _ PROFESSIONAL SERVICES JRA invites prospective consulting or professional organisations to provide innovative ideas ‘on enhancing service delivery including but not limited to the following activities: xi. Batho Pele centre ~ JRA Traffic Management centre, etc xi, Enhancing Traffic Mobility PART 2 - INSTRUCTIONS This Part sets out instructions regarding submission of responses to this RFP. 8joburg & a e ‘a wortd class African city 2.1 RFI key dates ‘The following key dates apply to this RFI: RFP Issue Date 26 JANUARY 2012 Date of Compulsory Briefing | 18 NOVEMBER 2011 : nla RFP Closing Date and Time ~ | g FEBRUARY 2012 at 10:00 a.m. 2.2 Contact Details Commercial contact person: Name DUBE DUMISANI | Telephone 011 298 5031 [Eman eacvees DDUBE@JRA.ORG.ZA Postal address ~ | private Bag X70, Braamfontein , 2017 2.3 Queries and questions during the RFP period Suppliers/eontractors are to direct any queries and questions regarding the RFP content or process to the contact persons stated above. All questions should be submitted in writing either by post, facsimile or to the provided email addrosses. The JRA may choose to convey responses to submitted questions and queries to all suppliers/contractors so that each is equally informed. 2.4 Opportunity briefing and site visit — if required The JRA will hold an AFI briefing session to further familiarise suppliers/ contractors with the Opportunity. A maximum of two representatives from each supplier/ contractor is permitted to attend the RFI briefing session.peel Joours ‘a world class African cy it >: & a 2.5 Response lodgement methods and requirements ‘Suppliers/ Contractors must hand deposit 2 copies of their response to the JRA by placing the contents in the bid box located at: Ground Floor of the Johannesburg Roads Agency, 66 Sauer Street, Cnr Sauer & Jeppe Street, Johannesburg 2001, on the 9 OF FEBRUARY 2012 no later than 1000 a.m. The Bid Box is available from Monday to Friday: 8hOO to 16hO0. Responses must be prepared in English and in the format requested in Part 3 of this RFI. All response to be address to the Managing Director, Johannesburg Roads Agency, 66 Cnr Sauer & Jeppe Street, Johannesburg 2001. Herd copy responses must be contained in a sealed envelope or package, clearly labelled with the RFI title and reference number. 2.6 Late responses Suppliers/contractors are responsible for submitting their response prior to the RFI closing date and time in accordance with the acceptable lodgement requirements described in Clause 2. 8. There will be no allowance made by JRA for any delays in transmission of the response from Suppliers/contractors to JRA. Any information received by the JRA later than the stipulated RFI closing date and time will be removed from further consideration by the JRA. 2.7 Suppliers / Contractors to inform themselves ‘The JRA has taken all reasonable care to ensure that the RFI is accurate; however the JRA gives no representation or warranty as to the accuracy or sufficiency of the contained information, 2.8 Costs of preparing the response Alll costs relating to the preparation and submission of a response are the sole responsibility of the supplier/contractor. The JRA will not pay the supplier/ contractor, wholly or in part, for its response. 2.9 Acceptance of these Conditions Suppliers/contractors, by submitting a response to this RFI, are deemed to"have acknowledged and agreed to the conditions set out in this RFI. 10J. tie a world cass african city JRA PART 3- This Part INFORMATION TO BE PROVIDED details the information suppliers/ contractors are required to provide to the JRA. Submitted information will be used by the JRA as set out in Clause 1. 2. The following minimum information is to be provided. If this information, or any additional information, is ‘available on your website please provide the web address to enable the JRA to undertake further analysis. 3. 1Supplier/ Contractor - Compulsory Information ‘The information is compulsory and will be used during the Pre-Evaluation of bid. a) b) °) a) a) fl a hy uw Supplier/contractor name (Trading and Registered), company/business registration number, registered address. JRA Supplier/Contractor Data Base number, if already registered on the JRA Supplier Data base (Please note - this is not a prerequisite to participate in this RFI). Details of supplier/Contractor operations and operating locations. Supplier/Contractor ownership information, including details of Directors and other key office bearers. Details of any current legal actions pending against the supplier/contractor or its directors and/or office bearers. Relationships with any parent Company (if applicable) Details of joint venture arrangements (if applicable}. Details of when the supplier/contractor organisation was founded, including origins and historical development of the organisation. Details of BBBEE status. (BBBEE verification certificate is compulsory). Details of opportunities or plans to increase BBBEE participation (if applicable). Total number of employees. A valid original tax clearance certificate. Copies of up to date municipal rates and taxes. Company Organogram/project team structure. CV's of key personnel.s Joburg 2 sa world class African cy SRA 3.2 Supplier / Contractor capabil ies and experience a) A description of the core business of the supplier/ contractor, listing relevant case studies or examples (a maximum of three) that support this description. Where possible, include case studies that may relate to activities consistent with the Opportunity. Within necessary boundaries of confidentiality, please be as specific as you can. b) Additional services, products and works provided outside of supplier's/contractor’s core bu ©) Examples (if any) of similar services that supplier/contractor has provided to JRA, or any ess. Public entity, including the name of the Department representative/s concemed during the past five years. 4) Dotails of key safety, environmental and other performance measures. ¢) Details of supplier/contractor infrastructure, including equipment and vehicles. Details of capacities for performing supplier's/contractor’s core business activities relevant to the Opportunity. 3.3. Supplier! Contractor financials a) Details of suppliers/contractors financial background, in particular latest annual reports or latest external audited financial statements for the past three years. b) Details of supplier/contractor bank rating on bank letterhead and signed. ©) Details of held insurances relevant to the Opportunity. e.g. public liability 3.4 Permits, Certifications and Authorizations e a) Details of all permits, certifications and authorizations held (e.g. ISO 9001, SABS) including date of last certification/recertification and details of the certifying bady (copies of certifications should be appended to your response ~ local or international certification). b) CIDB Rating, SANS, NHBRC, - or other relevant information. ¢)_ Details of any recent external corporate awards, including the awarding body, if relevent to the Opportunity. 2ad tn Joburg sonteam te RA 2) Details of all supplier/ Contractor policies and plans, including Safety, Environmental! Sustainability, Employee Relations and BEE Participation. Copies of policies are to be appended to your response. b) Details to indicate supplier! contractor understanding of the legislation, national standards and policies governing the management of the relevant service. 3.6 Evaluation Criteria In achieving the Value for Money of Public Private Partnership (PPP) all bids will be subject to 2 pre-evaluation based on the submitted information as listed from clause 31 to clause 3.5. Secondary evaluation processes will performed based on following criteria: ‘The following criteria will be used to evaluate proposals NO | CRITERIA SCALE ‘MAXIMUM POINTS Experience PPP. Provide | No experience = 0 pis detail of the nature and | 1-3 yrs experience = 10 pts 1 0 level of experience in | +3 - Sy rs experience = 20 pts ene PPP. +5 yrs experience = 90 pts 5 | Feasiity of business | Liketinood of implementation within 1 Sa eane model year 5 ‘Available capacity to render services including but not limited to number of eee staff, qualifications, availability, back- ee office support TOTAL 700 POINTS B1 world class African city ‘A maximum of 10 (ten) points are allocated to HDI on the following basis Description | Points Allocated | Shareholding of BBBEE’s 2 [BBBEE Management Operational | Involvement Employment equity 3 Preferential Procurement 3 Women Ownership i Total 10 3.7 Other Information Any further information you believe the JRA may require in support of its RFI review activities. 4Joburg 4. FORMS TO BE COMPLETED BY BIDDER oA aap & a >PREFERENCE CLAIMED FOR EQUITY OWNERSHIP BY HDI (To be completed by the Bidder) 4. SUPPLIER'S INFORMATION FORM. | supplier's registered name: Business registration no | Trading Name: | Registered as (i.e. (Pty) Ltd, CC, etc): VAT Registration Numbe! Rates and Services Account Number: Nature of Business: Products/Services provided: Main Tel no: Fax no: Web site: Sales dept (Contact person): Sales person (Contact no) Company's e-mail Sales person's e-mail 162. OWNERSHIP |» Is there equity ownership by BEE? © Is this a Joint Venture entity? Yes | No yes | No + If 1.1 or 1.2is yes provide names of Black partners hereunder and % shareholding/holding company: Shareholder Male/Female ‘% Shareholding % % % 3. EXECUTIVE MANAGEMENT AND BOARD MEMBERS INVOLVEMENT List all Black Directors /Board Members: Name Male/Female Position Disabled (yesino) ‘What is Black Directorship percentage? wv‘What percentage does Black Senior Management constitute? % NB: PLEASE PROVIDE AN ORGANOGRAM FROM DIRECTORS TO JUNIOR MANAGEMENT INDICATING RACIAL CLASSIFICATION 4, HUMAN RESOURCE 4.1, Is there an Employment Equity plan in your organization? ILyes indicate the DOL status with regards to the plan and attach Yes | No SKILLS DEVELOPMENT EXPENDITURE AS a PROPORTION OF PAYROLL: What is your total payroll per annum? What is your total training expenditure for the past financial year? What percentage of training expenditure was allocated to HDI's? ‘What is the total number of staff in each of the following occupational Levels? (Note: A=Africans, C=Coloureds, I=indlans and W=Whites) Foreign Mal Female Occupational level a emale __| _Nationals_| torat ale]! [w]Aa [ec |! | Ww | mae female Top management Senior management Professionally experienced specialist and mid management Skilled technical & academically qualified ‘workers, junior ‘management, supervisors, 8 superintendents Semi skilled & 18‘aecretionary decision making Unskiled & defined decision makng Total 5. INDIRECT EMPOWERMENT Does your company have a preferential procurement policy and if sodo youhave a |” scorecard to measure that? Yes | No What percentage of goodsiservices was sourced from black suppliers in the past twelve months? % Have you invested or offered business and non-business related support to BEE [ Yes | No companies? © Ifyes, state [Company Total asset Nature of investmentisupport 6. OWNERSHIP/DIRECTORSHIP OTHER COMPANIES: other companies? om Lv | Hise Do any of your members have ownership/directorshi it yes, please supply details. 19‘Company Total asset Nature of involvement 7. SMME STATUS Total full time paid | Total annual turnover | Total gross asset value | Remarks employees (fixed property excl) (for office use) TRADE REFERENCES Please provide at least three (3) trade references: Client Contact person Contact number PHYSICAL ADDRESS: POSTAL ADDRESS: 20I hereby declare the information provided Is correct and true FOR AND ON BEHALF OF THE COMPANY DATE CAPACITY OF SIGNATORY (POSITION HELD IN COMPANY) 2APPLICATION FOR TAX CLEARANCE CERTIFICATE (IN RESPECT OF BID) IT IS A CONDITION OF BID THAT- 1. ‘The taxes of the successful Bidder MUST be in order, or that suitable arrangements have been made with the Receiver of Revenue to satisfy them. (This is an absolute requirement), 2 The ST 5.1 form, Application for Tax Clearance Certificate (in respect of Bids), must be completed by the Bidder in all respects and submitted to the Receiver of Revenue where the Bidder is registered for income tax purposes. The Receiver will then furnish the Bidder with a Tax Clearance Certificate, which must be submitted in the original with the Bid before the closing time and date of the Bid. Failure to submit an original and valid Tax Clearance Certificate shall invalidate your Bid. 3. Each part to a Consortium/Sub-contractors must complete a separate Tax Clearance Certificate. Copies of the Application for Tax Clearance Certificates are available at any Receiver’s Office, 2FORM 4: Failure to complete the bank rating sheet may invalidate your bid TO BE COMPLETED BY THE ENTERPRISE’S BANK: FINANCIAL REFERENCE: No Alterations or use of correction pen will be accepted. IT IS A REQUISITE OF BID THAT A BANK RATING IS OBTAINED, BEARING AN: ORIGINAL STAMP BY THE RELEVANT BANK. CONTRACT NUMBER: 0241/2011 DESCRIPTION OF BANK DETAIL TO BE COMPLETED BY BANK Name of Bank Branch Name | Branch Code Branch Physical Address: Name of Account Holder: Name of Bank Manager Bank Telephone Number Bank Fax Number ‘Account Number Bank Rating This section is compulsory. Only Bank Ratings in codes (A to D and a code F) will be accepted.non compliance may invallate th Bld. Signed by Bank Manager: Date: 23Place Original Bank Stamp here -+ 24FORM 5: Failure to complete the form, to attach the required invoices/statement of account will invalidate your bi MUNICIPAL CHARGES Municipality where business is situated: Registered Account No: .. Stand No: Please attach the following documents to the bid a. Most recent municipal registration documents. voice | statement of principal members as stated on the company b. Business Enterprise. 255. DECLARATIONS Annexures 5.1 The following Annexures also form part of this Bid document and should be completed in full and signed accordingly. Annexure "A"; Declaration of Interest must be completed in full and signed by the bidder. ‘Annexure “B”; Declaration of bidders’ past Supply Chain Practices must be completed in full and signed by the bidder. Annexure “C": Certificate of Independent Bid Determination must be completed in full and signed by the bidder. Annexure “D": Authority for Signatory must be completed in full and signed by the bidder. By submitting a response to this bid, suppliers are deemed to have read and agreed to these General Conditions of Contract, General Rules and Instructions and any other special conditions of this Bid 26Annex DECLARATION OF INTEREST 1 2i 2 ‘Any legal person, including persons employed by the state’, or persons having a kinship with persons employed by the state, including a blood relationship, may make an offer or offers in terms of this invitation to bid (includes a price quotation, advertised competitive bid, limited bid or proposal). In view of possible allegations of favouritism, should the resulting bid, or part thereof, be awarded to persons employed by the state, 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 tothe 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 a 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. In order to give effect to the above, the following questionnaire must be completed and submitted with the bid. 1 Full Name of bidder or his or her representative: 2 Identity Number: ‘state’ meant ~ [s) any tinal er provincial department national or provina puble erty or constutionalnsthution within te meaning ofthe Pub France Managemert At, 1999 (Act No.1 of 1993) (6) anymuniipatty er municipal entity [cl provncallegtatre: (@) national stembiy or the rational Counc of provinces oF z Partament. @ Shaceholder" mesnéa person who owns shares inthe company ands ately volved in the management of he enterprise or busines 294 exercises conta ver the enterodise Page 27 of 4023 24 25 2.6 2.6.1 27 274 272 Position occupied in the Company (director, trustee, shareholder?) Company Registration Number: .. Tax Reference Number: ... VAT Registration Number ‘The names of all directors / trustees / shareholders / members, their individual Identity numbers, tax reference numbers and, if applicable, employee / persal numbers must be indicated in paragraph 3 below. ‘Are you or any person connected with the bidder YES / NO presently employed by the state? If so, furnish the following particulars: Name of person / director / trustee / shareholder/ member:. Name of state institution at which you or the person connected to the bidder Is employed. Position occupied in the state in the institution: Any other particulars: If you are presently employed by the state, did you obtain YES / NO the appropriate authority to undertake remunerative Page 28 of 40work outside employment in the public sector? 2.7.2.4 Ifyes, did you attached proof of such authority to the bid YES / NO document? jote: Failure to it proof of such authori e licable, may result in the disqualification of the bid.) 2.7.2.2 If no, furnish reasons for non-submission of such _—_ proof: 2.8 Did you or your spouse, or any of the company’s directors / YES / NO trustees / shareholders / members or their spouses conduct business with the state in the previous twelve months? 2.8.1 If so, furnish particulars 2.9 Do you, or any person connected with the bidder, have YES / NO any relationship (family, friend, other) with a person employed by the state and who may be involved with the evaluation and or adjudication of this bid? 2.9.1 If so, furnish other particulars: Page 29 of 402.10 Are you, or any person connected with the bidder, YES/NO aware of any relationship (family, friend, other) between any other bidder and any person employed by the state who may be involved with the evaluation and or adjudication of this bid? 2.10.1 If so, furnish other particulars: 2.11 Do you or any of the directors / trustees / shareholders / members YES/NO of the company have any interest in any other related companies whether or not they are bidding for this contract? 2.11.1 If so, furnish other particulars Page 30 of 40FULL DETAILS OF DIRECTORS / TRUSTEES / MEMBERS / SHAREHOLDERS. ‘State Eniployes Personal Tax Full Nam i 1c Identity Number | a cfcrence Number | Number / Persal Number 4. DECLARATION I, THE UNDERSIGNED (NAME). Page 31 of 40CERTIFY THAT THE INFORMATION FURNISHED IN PARAGRAPHS 2 and 3 ABOVE IS CORRECT. I ACCEPT THAT THE STATE MAY REJECT THE BID OR ACT AGAINST ME IN TERMS OF PARAGRAPH 23 OF THE GENERAL CONDITIONS OF CONTRACT SHOULD THIS DECLARATION PROVE TO BE FALSE. Signature: Position Date Page 32 of 40Annex B: DECLARATION OF BIDDERS PAST SUPPLY CHAIN PRACTICES DECLARATION OF BIDDER’S PAST SUPPLY CHAIN MANAGEMENT PRACTICES 1 This Standard Bidding Document must form part of all bids invited. 2 It serves as a declaration to be used by institutions in ensuring that when goods and services are being procured, all reasonable steps are taken to combat the abuse of the supply chain management system. 3 The bid of any bidder may be disregarded if that bidder, or any of its directors have: abused the Institution’s supply chain management system; b. committed fraud or any other improper conduct in relation to such system; or cc. failed to perform on any previous contract. 4 In order to give effect to the above, the following questionnaire must be completed and submitted with the bi Question Is the bidder or any of its directors listed on the National Treasury's database as companies or persons prohibited from doing business with the! > | 4 public sector? (Companies or persons who are listed on this database were informed in writing of this restriction by the National Treasury after the audi alteram partem rule was applied). 4.1.4 | If so, furnish particulars: Page 33 of 40a2 Is the bidder or any of its directors listed on the Register for Tender Defaulters in terms of section 29 of the Prevention and Combating of Corrupt Activities Act (No 12 of 2004)? To access this Register enter the National Treasury's website, www.treasury.gov.za, click on the icon “Register for Tender Defaulters” or submit your written request for a hard copy of the Register to facsimile number (012) 3265445. Yes No 4.24 Creat Tf so, furnish particular: [a3 | Was the bidder or any of its directors convicted by a court of law (including | Yes | No a court outside of the Republic of South Africa) for fraud or corruption during the past five years? ojo 4.3.4 | If so, furnish particulars: 44 | Was any contract between the bidder and any organ of state terminated | Yes | No during the past five years on account of fallure to perform on or comply with the contract? o}|.0 1 4A | Ifs0, furnish particulars: Page 34 of 40CERTIFICATION I, THE UNDERSIGNED (FULL NAME)... CERTIFY THAT THE INFORMATION FURNISHED ON THIS DECLARATION FORM IS ‘TRUE AND CORRECT. I ACCEPT THAT, IN ADDITION TO CANCELLATION OF A CONTRACT, ACTION MAY BE TAKEN AGAINST ME SHOULD THIS DECLARATION PROVE TO BE FALSE. Date Signature Posi Page 35 of 40Annex CERTIFICATE OF INDEPENDENT BID DETERMINATION (MBD) This Municipal Bidding Document (MBD) must form part of all bids® invited. Section 4 (1) (b) (ili) 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 @ horizontal relationship and if it involves collusive bidding (or bid rigging).? Collusive bidding is a per se prohibition meaning that it cannot be justified under any grounds. ‘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. a. 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. b. 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. 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. In order to give effect to the above, the attached Certificate of Bid Determination (SBD 9) must be completed and submitted with the bid: * nds pc oats, aero cmpelv bid, dtd nd popes ® iia (er elie in) ore when bse, a wou cherwee be epeted corps, cece nee trea price va tho gulf gods andr saves prchasars ve we i soqurgond and Jar seve ough abide precase.Girggngia tla, en sooner! etvaan corp ct ‘econo Page 36 of 401, 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: certify, on behalf of: that: (Name of Bidder) 1. Ihave read and I understand the contents of this Certificate; 2. understand that the accompanying bid will be disqualified if this Certificate Is found not to be true and complete in every respect; 3. Tam 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; Page 37 of 40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 thelr qualifications, abilities or experience; and (©) 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. However communication between partners in a joint venture or consortium 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) (©) methods, factors or formulas used to calculate prices; (a) _ 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. Page 38 of 40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. 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 Date Position Name of Bidder Page 39 of 40 —Annex D: AUTHORITY FOR SIGNATORY JOHANNESBURG ROADS AGENCY (PTY) LTD CONTRACT No. i FOR (SCOPE OF WORK: AUTHORITY FOR SIGNATORY Signatories for companies shall confirm their authority thereto by attaching a duly signed and dated ‘copy of the relevant resolution of the board of directors, to this form. ‘An example is shown below By resolution of the board of directors passed at a meeting held on... secre ace Mr whose signature appears below, has been duly authorised to sign all documents in connection with the Tender for Contract No____ and any Contract which may arise therefrom on behalf of (block capitals) ‘SIGNED ON BEHALF OF THE COMPANY IN HIS CAPACITY AS DATE ‘SIGNATURE OF SIGNATORY WITNESSES 1 Your response is appreciated! Page 40 of 40