SUPPLIER REGISTRATION FORM - HRDC

[Pages:11]SUPPLIER REGISTRATION FORM

Locally registered suppliers interested in doing business with HRDC must complete and submit Supplier Registration Form. Completion of the Supplier Registration Form does not imply that the supplier is qualified to meet HRDC Procurement requirement as all parties will be subjected to evaluation. Companies that will pass the evaluation process will be registered for future procurement.

1. COMPANY DETAILS Name of Company Tax Registration Number (Tax Payer Pin) and the Tax Certificate No. VAT Number (if applicable) PPADB Code EDD CERTIFICATE No.

(attach a certified copy of the EDD Certificate if applicable)

2. ADDRESS DATA Telephone Number Fascimile Number Postal Address

Physical Address

Website Address

Email Address

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HRDC Supplier Registration Form

3. CONTACT PERSON INFORMATION First Name Last Name Contact Email Address Contact Tel/ Mobile No.

4. LIST OF SHAREHOLDERS (complete the attached Declaration Form for Tendering Purposes- APPENDIX A)

NAME

SURNAME

CITIZENSHIP

SHAREHOLDING

5. LIST OF DIRECTORS (complete the attached Declaration Form for Tendering Purposes)

NAME

SURNAME

CITIZENSHIP SHAREHOLDING

6. TYPES OF BENEFIT- COMPANY OWNERSHIP OR CONTROLLED (Indicate the status of the company by ticking the appropriate box hereunder that the above mentioned business is 100% owned by women/ youth/ people with disability.) (attach certified copy of ID & complete the Local Procurement Registration Certificate-

APPENDIX B)

Rural Setting

Female

Youth

People Living With Disability

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HRDC Supplier Registration Form

7. PAST EXPERIENCE REFERENCE (please attach at least 1 Reference) REFERENCE Company Name Telephone Number Contact Person Name & Surname

The supplier is requested to indicate/ mark their area of goods and services;

8. SUPPLIER CATEGORY OF GOODS AND SERVICES

No Description

Yes/No PPADB PPADB

Code Sub

Code

1 Fire Products & Services (fire safety)

2 Events Management

3 Entertainment Services (PA System Hire, DJ Hire, Sound,

Performing Artists)

4 Photography Services

5 Florist Services

6 Mobile Toilets Services

7 Mobile Coolers/ Refrigeration

8 Exhibition Space Rental

9 Graphic Design

10 Printing Services

11 Master of Ceremonies

12 Rapporteuring

13 Hotel (Accommodation) & Catering, Conferencing & Workshop

Services

14 General Travel Services (Local/ International Air Travel Bookings/

Road/ Rail)

15 Refuse Collection & Disposal Services

16 Rental Services (Motor Vehicles, other rental services)

17 HVAC Products & Services, Mechanical & Electrical Maintenance

Services

18 General Building Maintenance & related services (construction &

plumbing)

19 Maintenance of Vehicles (Tyre Repairs, wheel alignment &

balancing, panel beating, spray painting, wind screen, air

conditioning, radiator service etc)

20 Audio Visual products & services

21 Generator & Batteries Services & Maintenance

22 Office Equipment Maintenance

23 Pest Control

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HRDC Supplier Registration Form

24 ICT Systems & Maintenance Services (Systems Development, Server Management, Desktop Management, Network Management, ICT Security Management, Internet Services etc)

25 Media Services (Radio & Television Content) 26 Cleaning Services (disinfecting and extermination services) 27 Auctioneering Services 28 Marketing & Public Relation Services (Marketing Services,

Advertising Services-billboards, electronic, internet, signage) 29 Physical Wellbeing Services 30 Miscellaneous Equipment Maintenance Services 31 Training Services (Human Resource) 32 Safety & Health Services (Occupational H & S, Maintenance of

Fire Extinguishers) 33 Printed Matter & Related Equipment (Printed Matter-Books,

postcards, promotional material) 34 Electronic & ICT Supplies 35 Transport Equipment & Accessories (Motor Vehicles, General

Spares & Accessories, tyres) 36 General Supplies (Stationery, Art & Crafts, Clothing, Office

Furniture, Sports & Recreation Equipment, Spares & Accessories, Audio Visual Equipment, Paper, domestic etc) 37 General Manufacturers/ Producers (Handicraft & Art Supplies, Furniture, Paper & Paper Boards) 38 Petroleum Products (Fuel) 39 Architecture Services 40 Civil Engineering Services (Water Supply) 41 Water Engineering Services (Ground Water Mapping, Borehole siting) 42 Project Management Services 43 Finance Related Services (Accounting & Auditing Services) 44 Human Resource Services (Organisation Design & Change Management, Job Evaluation, Compensation & Reward Management, Human Resource Policy) 45 Real Estate Services (Property Valuation & Rating, Property Consultancies) 46 Other Consultancy Services (Management Consultancy, Education Research Consultancy) 47 Legal Services 48 ICT Consultancy 49 Electrical Engineering Works (Installations, security systems installations-CCTV, Access Control, Alarms, Fire Detection System) 50 Works Maintenance (Electrical, Mechanical) 51 Specialised Construction Works (Water Proofing) 52 Mechanical Engineering Works (Air Conditioning, Lifts) 53 Drilling Works (Drilling, Borehole Development & Equipping) 54 Catering Services 55 Motivational Speaker 56 Gym Equipment Maintenance

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HRDC Supplier Registration Form

57 Haulage Services 58 Events D?cor Hiring (tent, chairs, cutlery etc) 59 Interior Design & Decor

9. DECLARATION OF INTEREST

Indicate if there is any relationship between your company and any of the employee (s) of the Botswana Human Resource Development Council

Yes

No

Family

Friend

Business Partner

If yes, please specify the employee (s) 1.

2.

DECLARATION I/ We the undersigned confirm that all the information provided is true and correct.

Name.....................................................................................

Surname.................................................................................

Capacity.................................................................................

Date.......................................................................................

Company Stamp

*suppliers that provide false information will be disqualified. Also, kindly initial on each page of this document.*

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HRDC Supplier Registration Form

HRDC

APPENDIX A

TENDER RETURNABLE DOCUMENT

DECLARATION FORM FOR TENDERING PURPOSES

Declaration to establish that Directors, Shareholders, Partners, Members have not participated through any other bid for the same tender.

PART A

I, ____________________________ (full name), in my capacity as.....................................(state position in Entity)

hereby declare that on my behalf, and on behalf of the owners, partners / directors/administrators and/or Other (Please specify) ....................................................

of: ..................................................................................................................................(name of Entity)

of:

...........................................................................................................................................................

...................................................................................................... (Postal/physical address)

that, in connection with the enclosed tender,

All information contained herein is true and not misleading, and it is to the best of my knowledge factual and binding on the Entity and/or its Representatives. I state that the (State Name of Entity) ................................................................................................and/or its representatives confirm that they have not, through other entities, participated in the same tender and offer the same products in response to the same items.

NOTE THAT: In the case of competing franchises, the franchises may bid for the same item but with different products. Item means the commodity required by the procuring entity indicated in the ITT. Product means the commodity offered by the bidder.

I declare and confirm that the Entity and/or its Representatives have in fact not participated in the same tender and offered the same products in response to the same items, through any other registered company or other entity. I hereby provide a current list of Directors/ Administrators/ Partners/ Members and/or Shareholders for the Company/Partnership/ Society/Joint Venture/ Private Foundation/Statutory Body and/or other (Please specify) ....................................................

DIRECTORS/MEMBERS/ PARTNERS/ ADMINISTRATORS NAME and/ OR Other (Please Specify).............................

CAPACITY ENTITY

IN NATIONALITY

PERCENTAGE OF SHAREHOLDING

1 2 3 4 5 6

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HRDC Supplier Registration Form

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SHAREHOLDERS NAME

1 2 3 4 5 6 7

NATIONALITY

PERCENTAGE

OF

SHAREHOLDING

If more space is required attach additional sheet. Note that Public companies should state which stock exchange the company is listed under.

I further acknowledge that should any of the directors, partners, and shareholders, members/administrators /(others please specify) be found to be associated in a similar or other manner in another company/entity, participating in this tender and offering the same products in response to the same items, this shall disqualify this Company/Partnership/ Society/Joint Venture/ Private Foundation/Statutory Body, and whichever company or other entity the said director/partner/shareholder/member and/or administrator is consequently involved in.

I further acknowledge that should the Company /Partnership/ Society/Joint Venture/ Private Foundation/ Statutory Body or any of its affiliates or subsidiaries be found to have participated in the same tender and offered the same products in response to the same items, the said Company/Partnership/ Society/Joint Venture/ Private Foundation/Statutory Body/(others please specify) and its affiliates and/or subsidiaries shall be disqualified.

The Company/Partnership/ Society/Joint Venture/ Private Foundation/ Statutory Body/(others please specify), through its agents, employees or directors has not illegally communicated with any member of the procuring department or the Human Resource Development Council (HRDC) except as may be permitted in the relevant "instructions to tenderers" or by law.

The Company/Partnership/ Society/Joint Venture/ Private Foundation/Statutory Body/(others please specify), through its agents, employees, partners, members, administrators and/or directors has not paid or offered to pay any consideration, favour or promise to any member of the procuring department or any person employed by or associated with HRDC or its Committees.

I declare that this tender is submitted by us in our own right and we have not colluded in any way with any other potential tenderer in the production and submission of this tender other than in the establishment of a joint venture or sub-contractor arrangement as fully and correctly declared in the tender.

I acknowledge that if after the award of this tender any of these declarations are found to be false then any contract(s) between ourselves and the procuring department and/or HRDC shall be terminated forthwith and we may be barred from future tendering for government services and liable to possible prosecution.

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HRDC Supplier Registration Form

I confirm that our entity has undertaken not to collude to withdraw from a tender award, only for the reason that an unsuccessful bidder be awarded the tender. I confirm further that the entity has undertaken not to engage in frivolous complaints and litigation that frustrates project implementation. SIGNED: ............................................................. NAME: ................................................................. DATED:.........................................

............................................................................. Entity Stamp

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HRDC Supplier Registration Form

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