Tender No.: 465S/2011/12 - City of Cape Town

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Tender No.: 465S/2011/12 Schedule 5: Declaration of Interest – State Employees The following particulars must completed by all tenderers. In the case of a partnership/consortium/joint venture, separate enterprise questionnaires in respect of each partner must be completed and submitted. Section 1: Name of enterprise: _____________________________________________________ Physical address of enterprise: _____________________________________________________ (LOCAL OFFICE) _____________________________________________________ _____________________________________________________ Section 2: VAT registration number, if any: ___________________________________________ Section 3: Particulars of sole proprietors or partners in partnership/consortium/joint venture Name* Identity number* Tax/VAT reference number* * Complete only if sole proprietor or partnership, and attach separate page if more than 3 partners Section 4: Particulars of companies and close corporations Company registration number _________________________________________________________ Close corporation number ____________________________________________________________ Tax and/or VAT reference number _________________________________________________________ Section 5: Record of service of the state Indicate, by marking the relevant boxes with a cross, if any sole proprietor, partner in a partnership/consortium/joint venture, or director, manager, principal shareholder or stakeholder in a company, or member of a close corporation, is currently or has within the last 12 months been in the service of any of the following: � a member of any municipal council � a member of any provincial legislature � a member of the National Assembly or the National Council of Provinces � a member of the board of directors of any municipal entity � an official of any municipality or municipal entity If any of the above boxes are marked, disclose the following*: Name of sole proprietor, partner, director, manager, principal shareholder or stakeholder or member *insert separate page if necessary � an employee of any provincial department, national or provincial public entity or constitutional institution within the meaning of the Public Finance Management Act, Act 1 of 1999 � a member of an accounting authority of any national or provincial public entity � an employee of Parliament or a provincial legislature Identity Number Name of institution, public office, board or organ of state and position held Status of service (tick appropriate column) current Within last 12 months 86
Tender No.: 465S/2011/12 Section 6: Record of spouses, children and parents in the service of the state Indicate, by marking the relevant boxes with a cross, if any spouse, child or parent of a sole proprietor, partner in a partnership/consortium/joint venture, or director, manager, principal shareholder or stakeholder in a company, or member of a close corporation, is currently or has within the last 12 months been in the service of any of the following: � a member of any municipal council � a member of any provincial legislature � a member of the National Assembly or the National Council of Provinces � a member of the board of directors of any municipal entity � an official of any municipality or municipal entity Name of spouse, child or parent *insert separate page if necessary � an employee of any provincial department, national or provincial public entity or constitutional institution within the meaning of the Public Finance Management Act, Act 1 of 1999 � a member of an accounting authority of any national or provincial public entity � an employee of Parliament or a provincial legislature Identity number Name of institution, public office, board or organ of state and position held Status of service (tick appropriate column) Current Within last 12 months The undersigned, who warrants that he/she is duly authorised to do so on behalf of the enterprise: i) confirms that the neither the name of the enterprise nor the name of any partner, manager, director, member or other person who wholly or partly exercises or may exercise control over the enterprise appears on the Register of Tender Defaulters established in terms of the Prevention and Combating of Corrupt Activities Act of 2004; ii) confirms that no partner, member, director or other person who wholly or partly exercises or may exercise control over the enterprise has within the last five years been convicted of fraud or corruption; iii) confirms that I/we are not associated, linked or involved with any other tendering entities submitting tender offers and have no other relationship with any of the tenderers or those responsible for compiling the specification that could cause or be interpreted as a conflict of interest. The tenderer hereby certifies that the information set out in this schedule and/or attached thereto is true and correct, and acknowledges that failure to properly and truthfully complete this schedule may result in the tender being disqualified, and/or (in the event that the tenderer is successful) the cancellation of the contract. ___________________________________ ___________________________________ Signature Print name: Date On behalf of the tenderer (duly authorised) 87
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Tender No.: 465S/2011/12 TENDER DOC
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Tender No.: 465S/2011/12 Name of Co
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Tender No.: 465S/2011/12 (3) CONTRA
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Tender No.: 465S/2011/12 PART 2 (TO
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Tender No.: 465S/2011/12 ITEM NO. 1
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Tender No.: 465S/2011/12 1. SCOPE O
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Tender No.: 465S/2011/12 3.6.2.15 A
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Tender No.: 465S/2011/12 3.6.4 TYPI
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Tender No.: 465S/2011/12 Set-piece
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Tender No.: 465S/2011/12 � Bothas
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Tender No.: 465S/2011/12 � Aeroso
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Tender No.: 465S/2011/12 3.7.4 TYPI
Page 35 and 36: Tender No.: 465S/2011/12 3.8 MOTIFS
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Page 39 and 40: Tender No.: 465S/2011/12 3.8.5 TYPI
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Page 55 and 56: Tender No.: 465S/2011/12 13.5 Quali
Page 57 and 58: Tender No.: 465S/2011/12 20.6 By do
Page 59 and 60: Tender No.: 465S/2011/12 (6) CONDIT
Page 61 and 62: Tender No.: 465S/2011/12 6.16 COIDA
Page 63 and 64: Tender No.: 465S/2011/12 7.1 Invali
Page 65 and 66: Tender No.: 465S/2011/12 7.5 Functi
Page 67 and 68: Tender No.: 465S/2011/12 (8) SPECIA
Page 69 and 70: Tender No.: 465S/2011/12 8.8 Settle
Page 71 and 72: Tender No.: 465S/2011/12 TABLE OF C
Page 73 and 74: Tender No.: 465S/2011/12 2.1 These
Page 75 and 76: Tender No.: 465S/2011/12 11. Insura
Page 77 and 78: Tender No.: 465S/2011/12 22. Penalt
Page 79 and 80: Tender No.: 465S/2011/12 31. Notice
Page 81 and 82: Tender No.: 465S/2011/12 Schedule 2
Page 83 and 84: Tender No.: 465S/2011/12 1 Definiti
Page 85: Tender No.: 465S/2011/12 1) With re
Page 89 and 90: Tender No.: 465S/2011/12 Schedule 7
Page 91 and 92: Tender No.: 465S/2011/12 GUARANTOR
Page 93 and 94: Tender No.: 465S/2011/12 Annexure A
Page 95 and 96: Tender No.: 465S/2011/12 PRICE ADJU
Page 97 and 98: Tender No.: 465S/2011/12 1. Tendere
Page 99 and 100: Tender No.: 465S/2011/12 The Mandat
Page 101 and 102: Tender No.: 465S/2011/12 SCHEDULE 1
Page 103 and 104: Tender No.: 465S/2011/12 Company Na
Page 105 and 106: Tender No.: 465S/2011/12 ANNEXURE C
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Tender No.: 465S/2011/12 - City of Cape Town

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