NOTICE NO: 249/2025
RFQ: SUPPLY AND DELIVERY OF BELL TLB 315SL, 4x4 PARTS UNTIL THE 30th of JUNE 2026
An electronic copy of the completed tender document with returnable documents must be submitted with tender submission saved
in a flash drive or CD in a case or envelope. Failure to submit AN ORIGINAL HARD COPY AND A COPY ON EITHER USB or CD will
deem the bid non-responsive.
A compulsory virtual clarification session will be arranged for Monday, 27 October 2025 @14h00pm. Prospective bidders can use link
below which is direct from this advert to access the meeting. Please take note that no attendee arriving 10 minutes late or more will be
allowed to attend the clarification meeting.
Join Teams Meeting
https://teams.microsoft.com/l/meetupjoin/19%3ameeting_ODBkMTg0MTEtMTVmYi00MDI5LTg0YTQtMzI4YTQwZjgxZTg5%40thread.v2/0?context=%7b%22Tid%22%3a%22262
27dc1-4e2b-407e-9bee-81acf6fe8aa9%22%2c%22Oid%22%3a%220f003184-f74c-40a3-9b40-9fda5b3dfcff%22%7d
Meeting ID: 373 838 534 691 6
Passcode: Lx6WB77R
Closing Date

Tuesday, 04 November 2025 @ 12:00

Location of Bid

Tender Box, 16 Woltemade Street, Jeffrey’s Bay, Room 122

Name of Bidder:
Contact Person (Full Names):
Tel No.:

Cell No.:

Fax No.:
Email Address:
Kouga Municipal Supplier Database No.:
Centralised Supplier Database No:
Signature of Tenderer:
Issued By: KOUGA LOCAL MUNICIPALITY, P.O BOX. 21, JEFFREYS BAY, 6330
Any inquiries relating to this tender must be submitted in writing via e-mail to tenders@kouga.gov.za and copied to ngouws@kouga.gov.za
NB: THIS TENDER WILL BE EVALUATED ON THE 80 AND 20 POINT FOR SPECIFIC GOALS

2

PLEASE TAKE NOTE OF ALL LISTED INSTRUCTIONS AND COMMENT
1. IN ADDITION TO ALL APPLICABLE LEGISLATION THE SUPPLY CHAIN POLICY APPROVED 31
MAY 2023, WILL APPLY TO THIS TENDER.
2. NB: PLEASE ENSURE THAT YOU FAMILIARIZE YOURSELF WITH THE COMPLETE DOCUMENT
AND SIGN ALL PAGES WHERE IT IS REQUIRED TO DO SO. ALL DOCUMENTATION MUST BE
ORIGINALLY SIGNED IN BLACK INK (COPIES OF SIGNARTORIES WILL NOT BE ACCEPTED)
3. FAILURE TO FULLY COMPLETE THE COMPULSORY MUNICIPAL BIDDING DOCUMENTS WILL
RESULT IN THE TENDER BEING CLASSIFIED AS NON-RESPONSIVE.
4. THE NATIONAL TREASURY CENTRAL DATABASE AND TAX COMPLIANCE WILL BE VERIFIED
ON DAY OF EVALUATING ANY TENDER. IN INSTANCES OF NON-COMPLIANCE BIDS WILL BE
DECLARED NON-RESPONSIVE. (subject to MFMA Circular 90)
5. TENDER DOCUMENTATION IS AVAILABLE ON E-TENDER AND THE MUNICIPAL WEBSITE.
6. PLEASE BE ADVISED THAT A COPY OF A CERTIFIED COPY DOES NOT CONSTITUTE A
CERTIFIED COPY.
7. DO NOT USE CORRECTION FLUID IN THE DOCUMENT. IF ANY MISTAKES ARE MADE, PLEASE
DRAW A LINE THROUGH IT AND INITIAL NEXT TO IT.
8. DOCUMENT TO BE COMPLETED IN INK. DOCUMENTATION COMPLETED IN PENCIL WILL NOT
BE CONSIDERED.
9. THE FOLLOWING DOCUMENTS MAY BE REQUESTED AS SUPPORT TO THE CONTRACT FILE
DOCUMENTATION FOR EVALUATION PURPOSES MUST BE SUBMITTED WITHIN THE TIME
SPECIFIED IN THE REQUEST FOR INFORMATION. FAILURE TO COMPLY WILL RESULT IN
NON-ACCEPTANCE OF THE TENDER.
1. National Treasury Central Database Summary Report
2. Business
Registration
Documents/
Formal
Registration
Documentation/
JV
Agreements/Consortia/ Partnerships and Trust’s – Applicable to all entities (i.e. Companies,
Public & Private Entities, Partnerships and Joint Ventures). CM9/ Name Change Document
will not suffice as Proof of Business Registration.
3. A copy of a valid SARS Tax Compliance Status Pin number for all entities and all partners of
Joint Venture)
4. Certified ID copies.
5. Latest Municipal Billing Clearance Certificate/ Copy of Municipal Account / Rental
Documentation to be submitted.
6. Any Special Conditions of Contract Documentation- Must be submitted as set out in tender
contract or upon request.

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PERSONAL DETAILS OF THE TENDERER
PLEASE PROVIDE THE FOLLOWING DETAILS:
YOU ARE HEREBY INVITED TO BID FOR REQUIREMENTS OF THE KOUGA LOCAL MUNICIPALITY
CLOSING
DATE:

04 NOVEMBER 2025

CLOSING
TIME:

BID NUMBER:

248 OF 2025

12:00

DESCRIPTION

RFQ: SUPPLY AND DELIVERY OF BELL TLB 315SL, 4x4 PARTS UNTIL THE 30th of JUNE
2026

THE SUCCESSFUL BIDDER WILL BE REQUIRED TO FILL IN AND SIGN A WRITTEN CONTRACT FORM (MBD7).
BID RESPONSE DOCUMENTS MAY BE DEPOSITED IN
THE BID BOX SITUATED AT (STREET ADDRESS)
Kouga Local Municipality: Woltemade Building
16 Woltemade Street, Room 122
Jeffreys Bay
6330
SUPPLIER INFORMATION
NAME OF BIDDER
POSTAL ADDRESS
STREET ADDRESS
TELEPHONE NUMBER

CODE

NUMBER

CODE

NUMBER

CELLPHONE NUMBER
FACSIMILE NUMBER
E-MAIL ADDRESS
VAT
NUMBER

REGISTRATION

TAX COMPLIANCE STATUS
B-BBEE STATUS LEVEL
VERIFICATION
CERTIFICATE

TCS PIN:

OR

CSD No:

B-BBEE STATUS
LEVEL SWORN
AFFIDAVIT

Yes

[TICK APPLICABLE BOX]

Yes

No

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No

[A B-BBEE STATUS LEVEL VERIFICATION CERTIFICATE/ SWORN AFFIDAVIT (FOR EMES & QSEs) MUST BE SUBMITTED
IN ORDER TO QUALIFY FOR PREFERENCE POINTS FOR B-BBEE]

ARE YOU THE
ACCREDITED
REPRESENTATIVE IN
SOUTH AFRICA FOR THE
GOODS /SERVICES
/WORKS OFFERED?

Yes

No

[IF YES ENCLOSE PROOF]

TOTAL NUMBER OF ITEMS
OFFERED
SIGNATURE OF BIDDER

………………………………

MAY

Supply Chain Office

042 200 2200

FACSIMILE NUMBER
E-MAIL ADDRESS

No

[IF YES, ANSWER
PART B:3]

R

DATE

BE

CONTACT PERSON
TELEPHONE NUMBER

ARE YOU A
FOREIGN BASED
SUPPLIER FOR THE
GOODS /SERVICES
/WORKS OFFERED?

TOTAL BID PRICE

CAPACITY UNDER WHICH
THIS BID IS SIGNED
BIDDING PROCEDURE ENQUIRIES
DIRECTED TO:
DEPARTMENT

Yes

TECHNICAL INFORMATION MAY BE DIRECTED TO:
CONTACT PERSON

Mr. N. Gouws

TELEPHONE NUMBER

042 200 2200

FACSIMILE NUMBER
E-MAIL ADDRESS

ngouws@kouga.gov.za

tenders@kouga.gov.za

1. BID SUBMISSION:
1.1. BIDS MUST BE DELIVERED BY THE STIPULATED TIME TO THE CORRECT ADDRESS. LATE BIDS WILL NOT
BE ACCEPTED FOR CONSIDERATION.
1.2. ALL BIDS MUST BE SUBMITTED ON THE OFFICIAL FORMS PROVIDED– (NOT TO BE RE-TYPED) OR
ONLINE
1.3. THIS BID IS SUBJECT TO THE PREFERENTIAL PROCUREMENT POLICY FRAMEWORK ACT AND THE
PREFERENTIAL PROCUREMENT REGULATIONS, 2022, THE GENERAL CONDITIONS OF CONTRACT (GCC)
AND, IF APPLICABLE, ANY OTHER SPECIAL CONDITIONS OF CONTRACT.

2. TAX COMPLIANCE REQUIREMENTS
2.1 BIDDERS MUST ENSURE COMPLIANCE WITH THEIR TAX OBLIGATIONS.
2.2 BIDDERS ARE REQUIRED TO SUBMIT THEIR UNIQUE PERSONAL IDENTIFICATION NUMBER (PIN) ISSUED

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5
BY SARS TO ENABLE THE ORGAN OF STATE TO VIEW THE TAXPAYER’S PROFILE AND TAX STATUS.
2.3 APPLICATION FOR THE TAX COMPLIANCE STATUS (TCS) CERTIFICATE OR PIN MAY ALSO BE MADE VIA
E-FILING. IN ORDER TO USE THIS PROVISION, TAXPAYERS WILL NEED TO REGISTER WITH SARS AS EFILERS THROUGH THE WEBSITE WWW.SARS.GOV.ZA.
2.4 FOREIGN SUPPLIERS MUST COMPLETE THE PRE-AWARD QUESTIONNAIRE IN PART B:3.
2.5 BIDDERS MAY ALSO SUBMIT A PRINTED TCS CERTIFICATE TOGETHER WITH THE BID.
2.6 IN BIDS WHERE CONSORTIA / JOINT VENTURES / SUB-CONTRACTORS ARE INVOLVED. EACH PARTY
MUST SUBMIT A SEPARATE TCS CERTIFICATE / PIN / CSD NUMBER.
2.7 WHERE NO TCS IS AVAILABLE BUT THE BIDDER IS REGISTERED ON THE CENTRAL SUPPLIER DATABASE
(CSD), A CSD NUMBER MUST BE PROVIDED.
3. QUESTIONNAIRE TO BIDDING FOREIGN SUPPLIERS
3.1. IS THE ENTITY A RESIDENT OF THE REPUBLIC OF SOUTH AFRICA (RSA)?

YES

NO

3.2. DOES THE ENTITY HAVE A BRANCH IN THE RSA?

YES

NO

3.3. DOES THE ENTITY HAVE A PERMANENT ESTABLISHMENT IN THE RSA?

YES

NO

3.4. DOES THE ENTITY HAVE ANY SOURCE OF INCOME IN THE RSA?

YES

NO

3.5. IS THE ENTITY LIABLE IN THE RSA FOR ANY FORM OF TAXATION?

YES

NO

IF THE ANSWER IS “NO” TO ALL OF THE ABOVE, THEN IT IS NOT A REQUIREMENT TO REGISTER FOR A TAX
COMPLIANCE STATUS SYSTEM PIN CODE FROM THE SOUTH AFRICAN REVENUE SERVICE (SARS) AND IF
NOT REGISTER AS PER 2.3 ABOVE.

CERTIFICATION:
I declare that the information in this annexure is true and correct in all respects.
NB: FAILURE TO PROVIDE ANY OF THE ABOVE PARTICULARS MAY RENDER THE BID INVALID.
NO BIDS WILL BE CONSIDERED FROM PERSONS IN THE SERVICE OF THE STATE.

SIGNATURE OF BIDDER:

……………………………………………

CAPACITY UNDER WHICH THIS BID IS SIGNED:

……………………………………………

DATE:

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6

KOUGA MUNICIPALITY
GOVERNMENT PROCUREMENT:
General Conditions of Contract- applicable to this contract- please refer to
www.treasury.gov.za
The Kouga Municipality Supply Chain Management policy as approved on the 31 May 2023
will be applicable to the contract– please refer to www.kouga.gov.za
The 2022 Preferential Procurement Regulations

6

7

KOUGA LOCAL MUNICIPALITY
NOTICE: 249/2025
RFQ: SUPPLY AND DELIVERY OF BELL TLB 315SL, 4x4 PARTS UNTIL THE 30th of
JUNE 2026
EVALUATION CRITERIA
Phase 1
Phase 2
Phase 3

Special conditions
Price Scoring
Specific Goals Scoring

No

Specific Goals Categories

1
2

B-BBE Status Level Contributor
The promotion of enterprises located in
a specific province for work to be done
or services to be rendered in that
province.

Max points
allocation
10

10

Evaluation Indicators
As for B-BBEE points allocation table above.
10 Points- Located within the boundaries of the Kouga
Local Municipality
6 Points- Located within the boundaries of Sarah
Baartman District Municipality
4 Points- Located within the boundaries of the Eastern
Cape
1 Point- Outside of the boundaries of the Eastern Cape

Bidders MUST submit valid B-BBEE sworn affidavit/ certificate AND Latest Municipal Billing Clearance Certificate/ Copy of
Municipal Account / Rental Documentation for operational offices in the name of the bidding company to claim points for
specific goals. In the event that the municipal account is in the name of the director, an affidavit must be done to that effect
clearly stating the company name operating from the address. Information provided for virtual offices will not be accepted.

An electronic copy of the completed tender document with returnable documents must be
submitted with tender submission saved in a flash drive or CD (in a case or envelope). Failure
to submit AN ORIGINAL HARD COPY AND A COPY ON EITHER USB or CD will deem the bid
non-responsive.
1. DELIVERY OF BELL 315 SL PARTS TO KOUGA MUNICIPAL WORKSHOP
1.1 Deliveries will be at the Municipal workshop in St. Croix Street Jeffrey’s Bay.
1.2 All deliveries must be on Mondays to Thursdays between 07H30 to 15H00 and
on Fridays between 07H30 and 12H00.
2. KEY PERFORMANCE INDICATORS
2.1 The Kouga municipality has a system by which service delivery is measured.
The appropriate Key Performance Indicators (KPI’s) to which the Service
Provider in this tender will be measured are as follows.
2.2 Timeously delivery of the correct parts and quantities as per order of items lead
time not exceeding seven (7) working days from the date of order.
2.3 Quality of product and lead time of delivery as per tender document.

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8
2.4 The Service Provider will be notified if the KPI’s are not met. If the Service
Provider cannot submit satisfactory reasons why the KPI’s was not met, the
contract may be cancelled, and the Service Provider may be listed at National
Treasury restricted list.
3. PRICE ESCALATION
3.1 Prices remain firm for the duration of the tender no prices escalations will be
accepted, nor will it be granted.
4. BRANDNAMES
4.1 Note that no aftermarket parts will be accepted.
4.2 Only original manufactured parts will be accepted. (John Deere Parts or Bell
Parts only)
5. PACKAGING
5.1 All parts must be delivered in its original package.
5.2 No open boxes or loose parts will be accepted.
6. CLARIFICATION MEETING
6.1 Compulsory clarification meeting will be held.
6.2 Bids received from bidders who did not attend the clarification meeting will be
deemed non-responsive and will not be evaluated.
7. EVALUATION
7.1 The tender will not be awarded per item, but in whole to one Service provider.
7.2 Bidders will quote in bill of quantities on one of each item.
7.3 Quantities will depend on the need of each item for the duration of the tender.
8. SPECIAL CONDITIONS
8.1 Bidders to supply proof of previous related contracts by means of award letters,
invoices and delivery notes for parts delivered.
Documents may be requested as support to the contract file documentation for evaluation
purposes must be submitted within the time specified in the request for information. FAILURE TO
COMPLY WILL RESULT IN NON-ACCEPTANCE OF THE TENDER.
9. MACHINE INFORMATION
❖
❖

The below information must be used as reference for the parts.
Please take note although only one machine Vin number are supplied parts will be
required for eight (8) machines.

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9
Model
Vin number
Machine serial number
Engine serial number

TLB,315SL, 4x4
AEBF877LL01200689
BTLB 8176
CD4045G171856

10. BELOW IS THE LIST OF PARTS THAT MUST BE QUOTED ON.
10.1
10.2
10.3
10.4
10.5
10.6
10.7
10.8
10.9
10.10
10.11
10.12
10.13
10.14
10.15
10.16
10.17
10.18
10.19
10.20
10.21
10.22
10.23
10.24
10.25
10.26
10.27
10.28
10.29
10.30
10.31
10.32
10.33
10.34
10.35
10.36
10.37
10.38
10.39

Engine oil filter.
Hydraulic oil filter.
Air filter set. (inner and outer)
Diesel filter set big and small.
Diesel filter Lock ring.
Fan belt.
Fanbelt traveller pully.
Thermostat.
Water pump.
Complete fan unit with bearing.
Right hand side bonnet panel.
Left hand side bonnet panel.
Bonnet top. (Hood)
Bonnet gas lifts.
Bonnet cables.
Bonnet Grill.
Grease nipples.
Universal joint front prop shaft with bolts and caps.
Universal joint rear prop shaft with bolts and caps.
Front cranshaft seals.
Front cranshaft seals.
Front hub seals.
Front propshaft seals.
Front dust cover on prop shaft seal.
Rear prop shaft seals.
Rear prop shaft dust cover.
Front bucket cutting edge.
Cir-clips for boom pins with spacers and washers.
Deep cycle Battery not less than 110 amp hours.
Alternator.
Starter motor.
Fuel gauge tank sensor unit.
Radiator caps.
Engine oil filler cab.
Gear selection solenoid for drive and reverse.
Complete radiator.
Complete oil cooler.
Water pipe hoses for oil cooler.
Taillight lenses left and right.

9

PRICE SCHEDULE
NOTICE: 249/2025
RFQ: SUPPLY AND DELIVERY OF BELL TLB 315SL, 4x4 PARTS UNTIL THE 30th of JUNE 2026
NOTE:
1. Only firm prices will be accepted. Non-firm prices will not be considered.
2. All delivery costs MUST be included in the bid price, for delivery at the prescribed destination.
3. Document MUST be completed in non-erasable black ink.
4. NO correction fluid/tape may be used.
a. In the event of a mistake having been made; it shall be crossed out in ink and be accompanied by an initial at each and every alteration.
5. The Bidder MUST indicate whether he/she/the entity is a registered VAT Vendor or not.
6. In the case of the Bidder not being a registered VAT Vendor, both columns (amount/rate excluding AND including VAT) must reflect the same amount

•
•

Take note that all items quoted for must be delivered within seven (7) working days from date of purchase order issued.
Should the parts not be available within seven (7) working days from date of order a written explanation must be submitted to the project
manager accompanied with proof for reason provided.

ITEM NO

ITEM DESCRIPTION

PRICE PER UNIT VAT
EXCL.

UNIT

PRICE PER UNIT VAT
INCL.

VAT

10.1

Engine oil filter.

each

R

R

R

10.2

Hydraulic oil filter.

each

R

R

R

10.3

Air filter set. (inner and outer)

each

R

R

R

10.4

Diesel filter set big and small.

each

R

R

R

10.5

Diesel filter Lock ring.

each

R

R

R

10.6

Fan belt.

each

R

R

R

10.7

Fanbelt traveller pully.

each

R

R

R

10.8

Thermostat.

each

R

R

R

10.9

Water pump.

each

R

R

R

11

10.10

Complete fan unit with bearing.

each

R

R

R

10.11

Right hand side bonnet panel.

each

R

R

R

10.12

Left hand side bonnet pannel.

each

R

R

R

10.13

Bonnet top. (Hood)

each

R

R

R

10.14

Bonnet gas lifts.

each

R

R

R

10.15

Bonnet cables.

each

R

R

R

10.16

Bonnet Grill.

each

R

R

R

10.17

Grease nipples.

each

R

R

R

10.18

each

R

R

R

each

R

R

R

10.20

Universal joint front prop shaft
with bolts and caps.
Universal joint rear prop shaft
with bolts and caps.
Front cranshaft seals.

each

R

R

R

10.21

Front cranshaft seals.

each

R

R

R

10.22

Front hub seals.

each

R

R

R

10.23

Front propshaft seals.

each

R

R

R

10.24

each

R

R

R

10.25

Front dust cover on prop shaft
seal.
Rear prop shaft seals.

each

R

R

R

10.26

Rear prop shaft dust cover.

each

R

R

R

10.27

Front bucket cutting edge.

each

R

R

R

10.28

Cir-clips for boom pins with
spacers and washers.

each

R

R

R

10.19

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12

each

R

R

R

10.30

Deep cycle Battery not less than
110 amp hours.
Alternator.

each

R

R

R

10.31

Starter motor.

each

R

R

R

10.32

Fuel gauge tank sensor unit.

each

R

R

R

10.33

Radiator caps.

each

R

R

R

10.34

Engine oil filler cab.

each

R

R

R

10.35

each

R

R

R

10.36

Gear selection solenoid for drive
and reverse.
Complete radiator.

each

R

R

R

10.37

Complete oil cooler.

each

R

R

R

10.38

Water pipe hoses for oil cooler.

each

R

R

R

10.39

Taillight lenses left and right

each

R

R

R

10.29

TOTAL

NAME OF TENDERER: _____________________________________________
COMPANY REPRESENTATIVE: ______________________________________
AUTHORIZED SIGNATURE: _________________________DATE: _____________

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FORM OF OFFER AND ACCEPTANCE – COMPULSORY
NOTICE NO: 249/2025
RFQ: SUPPLY AND DELIVERY OF BELL TLB 315SL, 4x4 PARTS UNTIL THE 30th of
JUNE 2026
1. I hereby undertake to render services/goods described in the attached bidding documents to
Kouga Municipality in accordance with the requirements and task directives / proposals
specifications stipulated in Bid Number: 249/2025 at the price/s quoted. My offer/s remain
binding upon me and open for acceptance by the Purchaser during the validity period
indicated and calculated from the closing date of the bid.
2. The following documents shall be deemed to form and be read and construed as part of this
agreement:
(i)

(ii)
(iii)

Bidding documents, viz
Invitation to bid;
Tax clearance certificate / Tax compliance Status;
Pricing schedule(s);
Filled in task directive/proposal;
Preference claims for Broad Based Black Economic Empowerment Status
Level of Contribution in terms of the Preferential Procurement Regulations
2022;
Declaration of interest;
Declaration of Bidder’s past SCM practices;
Certificate of Independent Bid Determination;
Special Conditions of Contract;
General Conditions of Contract; and
Other (specify)

3. I confirm that I have satisfied myself as to the correctness and validity of my bid; that the
price(s) and rate(s) quoted cover all the services specified in the bidding documents; that the
price(s) and rate(s) cover all my obligations and I accept that any mistakes regarding price(s)
and rate(s) and calculations will be at my own risk.
4. I accept full responsibility for the proper execution and fulfilment of all obligations and
conditions devolving on me under this agreement as the principal liable for the due fulfilment
of this contract.
5. The offered total price for the supply and delivery of supply and delivery of bell tlb
315sl, 4x4 parts until the 30th of June 2026 inclusive of Value Added Tax is correct.
.............................................................................................................. (in words)
............................................................................................................ (in figures).

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14
6. I declare that I have no participation in any collusive practices with any bidder or any other
person regarding this or any other bid.
7. I confirm that I am duly authorized to sign this contract.
NAME (PRINT)

…………………………….

CAPACITY

…………………………….

SIGNATURE

…………………………….

NAME OF FIRM

…………………………….

DATE

…………………………….

WITNESSES

1

…….……………………………
.

2

……….…………………………
.

DATE: ……………………………..

ACCEPTANCE
TO BE COMPLETED BY THE ACCOUNTING OFFICER OF KOUGA MUNICIPALITY
By signing this part of the Form of Offer and Acceptance Kouga Municipality accepts the tender
offer. This acceptance of this offer shall form an agreement between the municipality and the
tenderer upon the terms and conditions contained in this document. By signing this form of offer
and acceptance it constitutes a legal and binding contract between Kouga Municipality and the
tenderer.
NAME (PRINT)

…………………………….

CAPACITY

…………………………….

SIGNATURE

……………………………

WITNESSES

3

…….……………………………
.

4

……….…………………………
.

DATE: ……………………………..

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DECLARATION OF INTEREST – COMPULSORY
1.

No bid will be accepted from persons in the service of the state*.

2.

Any person, having a kinship with persons in the service of the state, including a blood relationship, may
make an offer or offers in terms of this invitation to bid. In view of possible allegations of favouritism,
should the resulting bid, or part thereof, be awarded to persons connected with or related to persons in
service of the state, it is required that the bidder or their authorised representative declare their position
in relation to the evaluating/adjudicating authority.

3.

In order to give effect to the above, the following questionnaire must be completed and
submitted with the bid.

3.1

Full Name: …………………………………………………………………………

3.2

Identity Number:

3.3

Position occupied in the Company (Director, trustee, shareholder) ...................

3.4

Company Registration Number: …………………………………………………

…………………………………………………………………

3.5 Tax Reference Number:

…………………………………………………………

3.6

VAT Registration Number: ………………………………………………………

3.7

The names of all the directors/ trustees/shareholders member, their individual identity numbers
and state employee numbers must be indicated in paragraph 4 below.

3.8

Are you presently in the service of the state*

YES / NO

 MSCM Regulations: “in the service of the state” means to be –
(a) a member of –
(i)
any municipal council;
(ii)
any provincial legislature; or
(iii)
the national Assembly or the national Council of provinces;
(b) a member of the board of directors of any municipal entity;
(c) an official of any municipality or municipal entity;
(d) an employee of any national or provincial department, national or provincial public entity or constitutional institution within the
meaning of the Public Finance Management Act, 1999 (Act No.1 of 1999);
(e) a member of the accounting authority of any national or provincial public entity; or
(f) an employee of Parliament or a provincial legislature.

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16
3.8.1 If yes, furnish particulars...............................................................................................................
.......................................................................................................................................................
.......................................................................................................................................................
3.9.

Have you been in the service of the state for the past twelve months?

YES / NO

3.9.1 If yes, furnish particulars.
………………………………………………………………
………………………………………………………………

3.10. Do you, have any relationship (family, friend, other) with
persons in the service of the state and who may be involved
with the evaluation and or adjudication of this bid?

YES / NO

3.10.1 If yes, furnish particulars.
………………………………………………………………
………………………………………………………………

3.11 Are you, aware of any relationship (family, friend, other)
between any other bidder and any persons in the service
of the state who may be involved with the evaluation and
or adjudication of this bid?

YES / NO

3.11.1 If yes, furnish particulars

…………………………………………………………….

…………………………………………………………….

Shareholder” means a person who owns shares in the company and is actively involved in the management of the company or
business and exercises control over the company.

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17
3.12 Are any of the company’s directors, trustees, managers,
principal shareholders or stakeholders in the
service of the state?

YES / NO

3.12.1 If yes, furnish particulars.
………………………………………………………………
………………………………………………………………
3.13

Are any spouse, child or parent of the company’s directors, trustees,
managers, principal shareholders or stakeholders in service of the state?

YES / NO

3.13.1 If yes, furnish particulars.
………………………………………………………………
………………………………………………………………
3.14

Do you or any directors, trustees, managers, principal shareholders
YES / NO
Or stakeholders of this company have any interest in other related companies or business whether
or not they are bidding for this contract?

3.14.1

If yes, furnish particulars.

..............................................................................................................................................
...........................................................................................................................................
4.

Full details of directors/ trustees/ members/ shareholders.

Full Name

Identity Number

17

State Government
Employee Number

18
…………………………………..

……………………………………..

Signature

Date

……………………………

………………………………………

Capacity

Name of Bidder
Commissioner of Oaths

18

19
MBD 6.1
PREFERENCE POINTS CLAIM FORM IN TERMS OF THE PREFERENTIAL PROCUREMENT
REGULATIONS 2022
This preference form must form part of all tenders invited. It contains general information and
serves as a claim form for preference points for specific goals.
NB:

BEFORE COMPLETING THIS FORM, TENDERERS MUST STUDY THE GENERAL
CONDITIONS, DEFINITIONS AND DIRECTIVES APPLICABLE IN RESPECT OF THE
TENDER AND PREFERENTIAL PROCUREMENT REGULATIONS, 2022

1.

GENERAL CONDITIONS

1.1

The following preference point systems are applicable to invitations to tender:
-

1.2

the 80/20 system for requirements with a Rand value of up to R50 000 000 (all
applicable taxes included); and
the 90/10 system for requirements with a Rand value above R50 000 000 (all
applicable taxes included).

To be completed by the organ of state
(delete whichever is not applicable for this tender).
a) The applicable preference point system for this tender is the 90/10 preference point
system.
b) The applicable preference point system for this tender is the 80/20 preference point
system.
c) Either the 90/10 or 80/20 preference point system will be applicable in this tender. The
lowest/ highest acceptable tender will be used to determine the accurate system once
tenders are received.
B-BBEE Status
Level of Contributor
1
2
3
4
5
6
7
8
Non-compliant
contributor

1.3

Number of Points
Preference (80/20)
10
8
6
4
3
2
2
2
0

for Number of Points for
Preference (90/10)
5
4
3
2
1
1
1
1
0

Points for this tender (even in the case of a tender for income-generating contracts) shall
19

20
be awarded for:
(a) Price; and
(b) Specific Goals.
POINTS

1.4

PRICE

80

SPECIFIC GOALS

20

TOTAL POINTS FOR PRICE AND SPECIFIC
GOALS

100

To be completed by the organ of state:
The maximum points for this tender are allocated as Price and Specific Goals:

1.5

Failure on the part of a tenderer to submit proof or documentation required in terms of this
tender to claim points for specific goals with the tender, will be interpreted to mean that
preference points for specific goals are not claimed.
Below would be the allocation for Specific Goals:

NO

Specific Goals Categories

1

B-BBE Status Level
Contributor
The
promotion
of
enterprises located in a
specific province for work
to be done or services to
be rendered in that
province.

2

Max points Evaluation Indicators
allocation
10
As for BBBEE points allocation please see table
above.
10 Points- Located within the boundaries of the Kouga
Local Municipality
6 Points- Located within the boundaries of Sarah
10
Baartman District Municipality
4 Points- Located within the boundaries of the Eastern
Cape
1 Point- Outside of the boundaries of the Eastern Cape

1.6

The organ of state reserves the right to require of a tenderer, either before a tender is
adjudicated or at any time subsequently, to substantiate any claim in regard to preferences,
in any manner required by the organ of state.

2.

DEFINITIONS
(a) “tender” means a written offer in the form determined by an organ of state in response to
an invitation to provide goods or services through price quotations, competitive tendering
process or any other method envisaged in legislation;
(b) “price” means an amount of money tendered for goods or services, and includes all
applicable taxes less all unconditional discounts;
(c) “rand value” means the total estimated value of a contract in Rand, calculated at the time
of bid invitation, and includes all applicable taxes;
20

21
(d) “tender for income-generating contracts” means a written offer in the form determined by
an organ of state in response to an invitation for the origination of income-generating
contracts through any method envisaged in legislation that will result in a legal agreement
between the organ of state and a third party that produces revenue for the organ of state,
and includes, but is not limited to, leasing and disposal of assets and concession contracts,
excluding direct sales and disposal of assets through public auctions; and
(e) “the Act” means the Preferential Procurement Policy Framework Act, 2000 (Act No. 5 of
2000).
3.

FORMULAE FOR PROCUREMENT OF GOODS AND SERVICES

3.1.

POINTS AWARDED FOR PRICE

3.1.1 THE 80/20 OR 90/10 PREFERENCE POINT SYSTEMS
A maximum of 80 or 90 points is allocated for price on the following basis:
80/20

𝑷𝒔 = 𝟖𝟎 (𝟏 −
Where

or

𝑷𝒕−𝑷 𝒎𝒊𝒏
𝑷 𝒎𝒊𝒏

90/10

) or

𝑷𝒔 = 𝟗𝟎 (𝟏 −

𝑷𝒕−𝑷 𝒎𝒊𝒏
𝑷 𝒎𝒊𝒏

Ps

=

Points scored for price of tender under consideration

Pt

=

Price of tender under consideration

Pmin =

)

Price of lowest acceptable tender

3.2.

FORMULAE FOR DISPOSAL OR LEASING OF STATE ASSETS AND INCOME
GENERATING PROCUREMENT

3.2.1.

POINTS AWARDED FOR PRICE
A maximum of 80 or 90 points is allocated for price on the following basis:
80/20

𝑷𝒔 = 𝟖𝟎 (𝟏 +
Where

𝑷𝒕−𝑷 𝒎𝒂𝒙
𝑷 𝒎𝒂𝒙

or

) or

90/10

𝑷𝒔 = 𝟗𝟎 (𝟏 +

𝑷𝒕−𝑷 𝒎𝒂𝒙

Ps

=

Points scored for price of tender under consideration

Pt

=

Price of tender under consideration

Pmax =

Price of highest acceptable tender

21

𝑷𝒎𝒂𝒙

)

22
4.

POINTS AWARDED FOR SPECIFIC GOALS

4.1.

In terms of Regulation 4(2); 5(2); 6(2) and 7(2) of the Preferential Procurement Regulations,
preference points must be awarded for specific goals stated in the tender. For the purposes
of this tender the tenderer will be allocated points based on the goals stated in table 1 below
as may be supported by proof/ documentation stated in the conditions of this tender:

4.2.

In cases where organs of state intend to use Regulation 3(2) of the Regulations, which states
that, if it is unclear whether the 80/20 or 90/10 preference point system applies, an organ of
state must, in the tender documents, stipulate in the case of—
(a) an invitation for tender for income-generating contracts, that either the 80/20 or
90/10 preference point system will apply and that the highest acceptable tender will
be used to determine the applicable preference point system; or
(b) any other invitation for tender, that either the 80/20 or 90/10 preference point
system will apply and that the lowest acceptable tender will be used to determine
the applicable preference point system, then the organ of state must indicate the
points allocated for specific goals for both the 90/10 and 80/20 preference point
system.

Table 1: Specific goals for the tender and points claimed are indicated per the table below.
(Note to organs of state: Where either the 90/10 or 80/20 preference point system is
applicable, corresponding points must also be indicated as such.
Note to tenderers: The tenderer must indicate how they claim points for each preference
point system.)
Number
points
allocated

of

Number
points

Number
of points
claimed

allocated
(90/10
The
specific
goals
(80/20
system)
allocated
points
in
system)
(To
be
terms of this tender
be
completed by (To
completed
the organ of
by the organ
state)
of state)

22

of Number of points
claimed
(80/20
system)

(90/10
system)
(To
be
completed
by
the
tenderer)

(To be completed
by the tenderer)

23

DECLARATION WITH REGARD TO COMPANY/FIRM
4.3.

Name of company/firm…………………………………………………………………….

4.4.

Company registration number: …………………………………………………………...

4.5.

TYPE OF COMPANY/ FIRM

Partnership/Joint Venture / Consortium

One-person business/sole propriety

Close corporation

Public Company

Personal Liability Company

(Pty) Limited

Non-Profit Company

State Owned Company
[TICK APPLICABLE BOX]

4.6.

I, the undersigned, who is duly authorised to do so on behalf of the company/firm, certify
that the points claimed, based on the specific goals as advised in the tender, qualifies the
company/ firm for the preference(s) shown and I acknowledge that:
i) The information furnished is true and correct;
ii) The preference points claimed are in accordance with the General Conditions as
indicated in paragraph 1 of this form;
iii) In the event of a contract being awarded as a result of points claimed as shown in
paragraphs 1.4 and 4.2, the contractor may be required to furnish documentary proof
to the satisfaction of the organ of state that the claims are correct;
iv) If the specific goals have been claimed or obtained on a fraudulent basis or any of the
conditions of contract have not been fulfilled, the organ of state may, in addition to any
other remedy it may have –
(a)

disqualify the person from the tendering process;

(b)

recover costs, losses or damages it has incurred or suffered as a result
of that person’s conduct;

(c)

cancel the contract and claim any damages which it has suffered as a
result of having to make less favourable arrangements due to such
cancellation;

(d)

recommend that the tenderer or contractor, its shareholders and
directors, or only the shareholders and directors who acted on a
fraudulent basis, be restricted from obtaining business from any organ
of state for a period not exceeding 10 years, after the audi alteram
partem (hear the other side) rule has been applied; and
23

24
(e)

forward the matter for criminal prosecution, if deemed necessary.

……………………………………….
SIGNATURE(S) OF TENDERER(S)

SURNAME AND NAME:

……………………………………………………….

DATE:

………………………………………………………

ADDRESS:

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

24

25

Compulsory Format for Sworn Affidavit for Exempted Micro Enterprise
I, the undersigned,
Full name & Surname
Identity number
Hereby declare under oath as follows:
1. The contents of this statement are to the best of my knowledge a true reflection of the facts.
2. I am a Member / Director / Owner of the following enterprise and am duly authorised to act on
its behalf:
Enterprise Name:
Trading Name (If
Applicable):
Registration Number:
Enterprise Physical
Address:

Type of Entity (CC,
(Pty)
Ltd, Sole Prop etc.):
Nature of Business:
Definition of “Black
People”

As per the Broad-Based Black Economic Empowerment Act 53 of 2003 as
Amended by Act No 46 of 2013 “Black People” is a generic term which
means Africans, Coloureds and Indians –
(a) who are citizens of the Republic of South Africa by birth or descent;
or
(b) who became citizens of the Republic of South Africa by
naturalisation
before 27 April 1994; or
ii. on or after 27 April 1994 and who would have been
entitled to acquire citizenship by naturalization prior to that
date;”

Definition of “Black
Designated Groups”

“Black Designated Groups means:
(a) unemployed black people not attending and not required by law to
attend an educational institution and not awaiting admission to an
educational institution;
25

26
(b) Black people who are youth as defined in the National Youth
Commission Act of 1996;
(c) Black people who are persons with disabilities as defined in the
Code of Good Practice on employment of people with disabilities
issued under the Employment Equity Act;
(d) Black people living in rural and underdeveloped areas;
(e) Black military veterans who qualifies to be called a military
veteran in terms of the Military Veterans Act 18 of 2011;”
3. I hereby declare under Oath that:
• The Enterprise is ______________% Black Owned as per Amended Code Series 100 of the Amended Codes of Good
Practice issued under section 9 (1) of B-BBEE Act No 53 of 2003 as Amended by Act No 46 of 2013,
• The Enterprise is ______________% Black Female Owned as per Amended Code Series 100 of the Amended Codes
of Good Practice issued under section 9 (1) of B-BBEE Act No 53 of 2003 as Amended by Act No 46 of 2013,
• The Enterprise is ______________% Black Designated Group Owned as per Amended Code Series 100 of the
Amended Codes of Good Practice issued under section 9 (1) of B-BBEE Act No 53 of 2003 as Amended by Act No 46
of 2013,
• Black Designated Group Owned % Breakdown as per the definition stated above:
• Black Youth % = ______________%
• Black Disabled % =______________%
• Black Unemployed % =______________%
• Black People living in Rural areas % = ______________%
• Black Military Veterans % =______________%
• Based on the Financial Statements/Management Accounts and other information available on
the latest financial year-end of _________________, the annual Total Revenue of less than
R10,000,000.00 (Ten Million Rands),
• Please confirm on the table below the B-BBEE level contributor, by ticking the applicable
box.
100% Black Owned
Level One (135% B-BBEE procurement recognition level)
At Least 51% black
owned
Less than 51% Black
Owned

Level Two (125% B-BBEE procurement recognition level)
Level Four (100% B-BBEE procurement recognition level)

4. I know and understand the contents of this affidavit and I have no objection to take the prescribed oath and consider
the oath binding on my conscience and on the owners of the enterprise which I represent in this matter.
5. The sworn affidavit will be valid for a period of 12 months from the date signed by commissioner.
26

27

Deponent Signature: _______________________
Date: ___________________________________

__________________________________________
Commissioner of Oaths
Signature & stamp

27

28

Compulsory Format for Sworn Affidavit for Qualifying Small Enterprises
I, the undersigned,
Full name & Surname
Identity number
Hereby declare under oath as follows:
1. The contents of this statement are to the best of my knowledge a true reflection of the facts.
2. I am a Member / Director / Owner of the following enterprise and am duly authorised to act on
its behalf:
Enterprise Name:
Trading Name (If
Applicable):
Registration Number:
Enterprise Physical
Address:

Type of Entity (CC,
(Pty)
Ltd, Sole Prop etc.):
Nature of Business:
Definition of “Black
People”

As per the Broad-Based Black Economic Empowerment Act 53 of 2003 as
Amended by Act No 46 of 2013 “Black People” is a generic term which
means Africans, Coloureds and Indians –
(a) who are citizens of the Republic of South Africa by birth or descent;
or
(b) who became citizens of the Republic of South Africa by
naturalisation.
before 27 April 1994; or
ii. on or after 27 April 1994 and who would have been
entitled to acquire citizenship by naturalization prior to that
date;”

Definition of “Black
Designated Groups”

“Black Designated Groups means:
(a) unemployed black people not attending and not required by law to
attend an educational institution and not awaiting admission to an
28

29
educational institution;
(b) Black people who are youth as defined in the National Youth
Commission Act of 1996;
(c) Black people who are persons with disabilities as defined in the
Code of Good Practice on employment of people with disabilities
issued under the Employment Equity Act;
(d) Black people living in rural and under developed areas;
(e) Black military veterans who qualifies to be called a military
veteran in terms of the Military Veterans Act 18 of 2011;”
3. I hereby declare under Oath that:
• The Enterprise is ______________% Black Owned as per Amended Code Series 100 of the Amended Codes of Good
Practice issued under section 9 (1) of B-BBEE Act No 53 of 2003 as Amended by Act No 46 of 2013,
• The Enterprise is ______________% Black Female Owned as per Amended Code Series 100 of the Amended Codes
of Good Practice issued under section 9 (1) of B-BBEE Act No 53 of 2003 as Amended by Act No 46 of 2013,
• The Enterprise is ______________% Black Designated Group Owned as per Amended Code Series 100 of the
Amended Codes of Good Practice issued under section 9 (1) of B-BBEE Act No 53 of 2003 as Amended by Act No 46
of 2013,
• Black Designated Group Owned % Breakdown as per the definition stated above:
• Black Youth % = ______________%
• Black Disabled % =______________%
• Black Unemployed % =______________%
• Black People living in Rural areas % = ______________%
• Black Military Veterans % =______________%
• Based on the Financial Statements/Management Accounts and other information available on
the latest financial year-end of _________________, the annual Total Revenue was between
R10,000,000.00 (Ten Million Rands) and R50,000,000.00 (Fifty Million Rands),
• Please confirm on the table below the B-BBEE level contributor, by ticking the applicable
box.
100% Black Owned
Level One (135% B-BBEE procurement recognition level)
At Least 51% black
owned
Less than 51% Black
Owned

Level Two (125% B-BBEE procurement recognition level)
Level Four (100% B-BBEE procurement recognition level)

4. I know and understand the contents of this affidavit and I have no objection to take the prescribed oath and consider
the oath binding on my conscience and on the owners of the enterprise which I represent in this matter.
5. The sworn affidavit will be valid for a period of 12 months from the date signed by commissioner.
29

30
Deponent Signature: _______________________
Date: ___________________________________

__________________________________________
Commissioner of Oaths
Signature & stamp

30

31
KOUGA MUNICIPALITY
Please refer to instruction on Page 3 of the terms of reference document.
AUTHORITY FOR SIGNATORY
Companies submitting tenders must provide evidence that the person who signed the tender
document has authority to do so, by attaching a copy of the relevant resolution of the Board of
Directors, duly signed and dated, to this form. Alternatively, this form may be completed by
competent authority.
By resolution of the Board of Directors at a meeting held on ……………………..

Mr/Ms …………………………………………………………………………………………..

Has been duly authorised to sign all documents in connection with this Tender on behalf of:
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………

SIGNED OF BEHALF OF COMPANY:………………………………..............................

IN HIS CAPACITY AS: ………………………………………………………………………

SIGNATURE OF SIGNATORY: ……………………………………………………

COMPANY STAMP:

31

32

MBD 9
CERTIFICATE OF INDEPENDENT BID DETERMINATION - COMPULSORY
1.

This Municipal Bidding Document (MBD) must form part of all bids¹ invited.

2. Section 4 (1) (b) (iii) 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 a horizontal relationship and if it involves collusive bidding (or bid
rigging).² Collusive bidding is a pe se prohibition meaning that it cannot be justified under
any grounds.
3. Municipal Supply Regulation 38 (1) prescribes that a supply chain management policy must
provide measures for the combating of abuse of the supply chain management system,
and must enable the accounting officer, among others, to:
a)
b)
c)
d)
e)
f)

take all reasonable steps to prevent such abuse;
reject the bid of any bidder if that bidder or any of its directors has abused the
supply chain management system of the municipality or municipal entity or has
committed any improper conduct in relation to such system; and
cancel a contract awarded to a person if the person committed any corrupt or
fraudulent act during the bidding process or the execution of the contract.

4

This MBD 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 bidrigging.

5

In order to give effect to the above, the attached Certificate of Bid Determination (MBD9) must
be completed and submitted with the bid:

¹ Includes price quotations, advertised competitive bids, limited bids and proposals.
² Bid rigging (or collusive bidding) occurs when businesses, that would otherwise be expected to compete, secretly conspire
to raise prices or lower the quality of goods and / or services for purchasers who wish to acquire goods and / or services
through a bidding process. Bid rigging is, therefore, an agreement between competitors not to compete.

32

33
CERTIFICATE OF INDEPENDENT BID DETERMINATION - COMPULSORY
I, the undersigned, in submitting the accompanying bid:
NOTICE NO: 248 OF 2025: SUPPLY AND DELIVERY OF SEM GRADER CUTTING
EDGES, RETAINER PLATES, DIGGING TIPS FOR BELL, BULL, NEW HOLLAND AND
KOMATSU TLB'S AND MISCALLANEOUS PARTS FOR FALCON F50/150 TRACTOR
DRAWN BUSH CUTTERS UNTIL 30TH JUNE 2026
in response to the invitation for the bid made by: Kouga Local Municipality do hereby
make the following statements that I certify to be true and complete in every respect:

I certify, on behalf of: ______________________________________________that:
(Name of Bidder)
1. I have read and I understand the contents of this Certificate;
2. I understand that the accompanying bid will be disqualified if this Certificate is found not to be
true and complete in every respect;
3. I am 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;
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
their 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 consortium³ 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)
(c) methods, factors or formulas used to calculate prices;
(d) 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
33

34
(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.
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

³ Joint venture or Consortium means an association of persons for the purpose of combining their expertise, property, capital,
efforts, skill and knowledge in an activity for the execution of a contract.

34

35

DECLARATION OF BIDDER’S PAST SUPPLY CHAIN MANAGEMENT
PRACTICES - COMPULSORY
1

This Municipal Bidding Document must form part of all bids invited.

2

It serves as a declaration to be used by municipalities and municipal entities 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 rejected if that bidder, or any of its directors have:
a. abused the municipality’s / municipal entity’s supply chain management system or
committed any improper conduct in relation to such system;
b. been convicted for fraud or corruption during the past five years;
c. willfully neglected, reneged on or failed to comply with any government, municipal or
other public sector contract during the past five years; or
d. been listed in the Register for Tender Defaulters in terms of section 29 of the
Prevention and Combating of Corrupt Activities Act (No 12 of 2004).

4

In order to give effect to the above, the following questionnaire must be completed
and submitted with the bid.
Item

Question

Yes

No

4.1

Is the bidder or any of its directors listed on the National
Treasury’s Database of Restricted Suppliers as companies or
persons prohibited from doing business with the public sector?

Yes

No

(Companies or persons who are listed on this Database were
informed in writing of this restriction by the Accounting
Officer/Authority of the institution that imposed the restriction after
the audi alteram partem rule was applied).
The Database of Restricted Suppliers now resides on the
National Treasury’s website(www.treasury.gov.za) and can be
accessed by clicking on its link at the bottom of the home
page.

4.1.1 If so, furnish particulars:

35

36
4.2

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)?

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

The Register for Tender Defaulters can be accessed on the
National Treasury’s website (www.treasury.gov.za) by
clicking on its link at the bottom of the home page.

4.2.1 If so, furnish particulars:
4.3

Was the bidder or any of its directors convicted by a court of law
(including a court of law outside the Republic of South Africa) for
fraud or corruption during the past five years?

4.3.1 If so, furnish particulars:
Item
4.4

Question
Does the bidder or any of its directors owe any municipal rates
and taxes or municipal charges to the municipality / municipal
entity, or to any other municipality / municipal entity, that is in
arrears for more than three months?

4.4.1 If so, furnish particulars:
4.5

Was any contract between the bidder and the municipality /
municipal entity or any other organ of state terminated during the
past five years on account of failure to perform on or comply with
the contract?

4.5.1 If so, furnish particulars:

36

37
CERTIFICATION
I, THE UNDERSIGNED (FULL NAME) …………..……………………………..……
CERTIFY THAT THE INFORMATION FURNISHED ON THIS DECLARATION FORM TRUEAND
CORRECT.

I ACCEPT THAT, IN ADDITION TO CANCELLATION OF A CONTRACT, ACTION MAY BE
TAKEN AGAINST ME SHOULD THIS DECLARATION PROVE TO BE FALSE.

………………………………………...

…………………………..

Signature

Date

……………………………………….

…………………………..

Position

Name of Bidder

37

38
KOUGA MUNICIPALITY
CERTIFICATE FOR PAYMENT OF MUNICIPAL SERVICES

DECLARATION IN TERMS OF CLAUSE 112(1) OF THE MUNICIPAL FINANCE MANAGEMENT ACT
(NO.56 OF 2003) - (To be signed in the presence of a Commissioner of Oaths)
I, _______________________________________, _________________ (full name and ID no.), hereby
acknowledge that according to SCM Regulation 38(1)(d)(i), the Municipality may reject the tender of the
tenderer if any municipal rates and taxes or municipal service charges owed by the Tenderer or any of its
directors/members/partners to the Kouga Municipality, or to any other municipality or municipal entity, are in
arrears for more than 1 (one) month.
I declare that I am duly authorised to act on behalf of __________________________________________
(name of the firm) and hereby declare, that to the best of my personal knowledge, neither the firm nor any
director/member/partner of said firm is in arrears on any of its municipal accounts with any municipality in the
Republic of South Africa, for a period longer than 1 (one) month.
I further hereby certify that the information set out in this schedule and/or attachment(s) hereto is true and
correct. The Tenderer 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.

PHYSICAL BUSINESS ADDRESS(ES) OF THE TENDERER

MUNICIPAL ACCOUNT NUMBER

FURTHER DETAILS OF THE BIDDER’S Director / Shareholder / Partners, etc.:

Director /
Shareholder /
partner

Physical address
of the Business

Municipal
Account
number(s)

38

Physical
residential
address of the
Director /
shareholder /
partner

Municipal Account
number(s)

39

If the entity. rents/leases premises, a copy of the rental/lease agreement must be submitted with this
tender. Please refer Instruction sheet of this document

Signature

Position

COMMISSIONER OF OATHS
Signed and sworn to before me at

, on

this

20

day of

by the Deponent, who has acknowledged that he/she
knows and understands the contents of this Affidavit, it is
true and correct to the best of his/her knowledge and that
he/she has no objection to taking the prescribed oath, and
that the prescribed oath will be binding on his/her
conscience.
COMMISSIONER OF OATHS:Position:
Address:
Tel:

39

Date

Apply official stamp of authority on this
page:

40

KOUGA MUNICIPALITY
NOTICE NUMBER: 249/2025
RFQ: SUPPLY AND DELIVERY OF BELL TLB 315SL, 4x4 PARTS UNTIL THE 30th of
JUNE 2026
SCHEDULE OF WORK CARRIED OUT BY THE TENDERER
The Tenderer shall list below the contracts undertaken by him during the past five (5) years,
or present / ongoing contracts with contactable references.
Employer
(Contact
Person)

Description
of Project

Contact Telephone &
E-mail

Value of Work
Including of
VAT

Date of
completion

SIGNED OF BEHALF OF THE TENDERER: ............................................................

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41
KOUGA MUNICIPALITY SUPPLIER DATABASE INFORMATION – PLEASE COMPLETE IF NOT
UPDATED OR LISTED ON MUNICIPAL SUPPLIER DATABASE
1.

BUSINESS PARTICULARS:

1.1

Name of Business as registered with the Registrar of Companies / Close Corporations (Legal
Name)
…………………………………………………………………………………………………

1.2

Name of business used for TRADING purposes, if different form 1.1 or name of business if
business is not registered with the registrar (Trading Name)
…………………………………………………………………………………………………

1.3

Registration Number as registered with the Registrar of companies / close corporations (if
applicable) OR identity number if sole proprietor
………………………………………………………………………………………………

1.4

Postal Address
…………………………………………………………………………………………………
…………………………………………………………………………………………………
…………………………………………………………………………………………………

Postal Code: ……………..
Physical Address
………………………………………………………………………………………………….
………………………………………………………………………………………………….
………………………………………………………………………………………………….
Postal Code: …………….
Telephone Number: (……….) ……………….. Fax No: (……….) ……………….……
E-mail Address
……………………………………………………………………………………………….
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42
1.5

Contact Person for database and tenders

Contact name: …………………………………………………………...

Cell Number: …………………………………………………………….

Email address: ……………………………………………………………

Telephone: (………..) ………………………….
2. BANKING DETAILS - An original (signed and stamped) bank letter from the bank not older
than three months, or an original cancelled cheque must be supplied. Also the account
holder must match the trading name of the organization.
2.1

Name of banking institution: ………………………………………………………………….

2.2

Branch Name: ………………………………………………………………………………

2.3

Branch Code: …………………………………………………………………………………

2.4

Town / City: ………………………………………………………………………………….

2.5

Banking account number: ……………………………………………………………………

2.6

Account type: ……………………………………………………………………………

2.7

Account Holder (Name under which account is operated)
………………………………………………………………………………………………

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43
3. COMMODITIES AND SERVICE PROVIDED
In order to identify your organization as a potential service provider, types of commodities or services
rendered have to be classified.

SECTOR
CODE

SECTOR

SCM1

Agriculture

SCM2

Mining and Quarrying

SCM3

Manufacturing

SCM4

Construction

SCM5

Retail and Motor Trade

SCM6

Catering, Accommodation

SCM7

Transport and Storage

SCM8

Finance and Business services

SCM9

Repair /allied Services

SCM10

Communications

SCM11

Other trade

SCM12

Community and Social Services

SCM13

Personnel Services

PLEASE TICK (√)

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44
Please specify the appropriate commodity or service that your organization provides as well as the
area of supply.
AREA WHERE SERVICE
CAN BE RENDERED

SERVICE

*IF MORE SPACE IS NEEDED TO SPECIFY SERVICES, PLEASE ADD A PAGE

AREA WHERE
CAN BE SOLD

PRODUCTS

*IF MORE SPACE IS NEEDED TO SPECIFY SERVICES, PLEASE ADD A PAGE

44

PRODUCTS

45
4.

CERTIFICATION OF CORRECTNESS OF INFORMATION SUPPLIED IN THIS
DOCUMENT

I / WE, THE UNDERSIGNED, WHO WARRANTS THAT HE/SHE IS DULY AUTHORISED TO DO
SO ON BEHALF OF THE SUPPLIER, CERTIFIES THAT THE INFOMRATION SUPPLIED IN
TERMS OF THIS DOCUMENT INCLUDING THE ANNEXURE/S WITH ADDITIONAL
INFORMATION, IS CORRECT AND ACCURATE AND ACKOWLEDGES THAT:
1. The supplier will be required to furnish documentary proof of the claims, if requested to do so.
2. If the information supplied is found to be incorrect then the KLM may, in addition to any remedies
it may have:
i) Disqualify the supplier/ contractor for a particular tender/contract/project it may be
considered for, or which had been awarded to the supplier / contractor;
ii) Recover form the supplier / contractor all costs, losses or damages incurred or
sustained by the KLM as a result of breach of the contract;
iii) Cancel the contract and claim any damages which the KLM may suffer by having to
make less favourable arrangements after such cancellation; and /or
iv) De-register the supplier registered on the Supplier Database.

SIGNED ON THIS ……………. DAY OF ……………. 20…… AT ………………………….

………………………………….

……………………………………………

SIGNATURE OF AUTHORISED REPRESENTATIVE

NAME IN BLOCK LETTERS

………………………………………………….
IN HIS/HER CAPACITY AS

ON BEHALF OF THE (SUPPLIER’S NAME)
…………………………………………………………….

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46
5. DECLARATION OF INTEREST
1.

No application will be accepted from persons in the service of the state*.

5.

Any person, having a kinship with persons in the service of the state, including a blood relationship, may
submit a database application. In view of possible allegations of favouritism, should the resulting
registration, award to persons connected with or related to persons in service of the state, it is required
that the bidder or their authorised representative declare their position in relation to the
evaluating/adjudicating authority.

6.

In order to give effect to the above, the following questionnaire must be completed and
submitted with the bid.

3.1

Full Name: …………………………………………………………………………

3.2

Identity Number:

3.3

Position occupied in the Company (Director, trustee, shareholder)...................

3.4

Company Registration Number: …………………………………………………

…………………………………………………………………

3.6 Tax Reference Number:
3.6

…………………………………………………………

VAT Registration Number: ………………………………………………………

3.7 The names of all the directors/ trustees/shareholders member, their individual identity
numbers and state employee numbers must be indicated in paragraph 4 below.
3.8

Are you presently in the service of the state*

YES / NO

 MSCM Regulations: “in the service of the state” means to be –
(g) a member of –
(i)
any municipal council;
(ii)
any provincial legislature; or
(iii)
the national Assembly or the national Council of provinces;
(h) a member of the board of directors of any municipal entity;
(i) an official of any municipality or municipal entity;
(j) an employee of any national or provincial department, national or provincial public entity or constitutional institution within the
meaning of the Public Finance Management Act, 1999 (Act No.1 of 1999);
(k) a member of the accounting authority of any national or provincial public entity; or
(l) an employee of Parliament or a provincial legislature.

46

47

3.8.1 If yes, furnish particulars
.......................................................................................................................................................
.......................................................................................................................................................
3.9.

Have you been in the service of the state for the past twelve months?

YES / NO

3.9.1 If yes, furnish particulars.

………………………………………………………………

………………………………………………………………
3.10. Do you, have any relationship (family, friend, other) with persons in the service of the state and who
may be involved with the evaluation and or adjudication of this bid?

YES / NO

3.10.1 If yes, furnish particulars.
………………………………………………………………

………………………………………………………………
3.11 Are you, aware of any relationship (family, friend, other) between any other bidder and any persons in
the service of the state who may be involved with the evaluation and or adjudication of this bid?
YES / NO
3.11.1If yes, furnish particulars
…………………………………………………………….

…………………………………………………………….
3.12 Are any of the company’s directors, trustees, managers,
Shareholder” means a person who owns shares in the company and is actively involved in the management of the company or
business and exercises control over the company.

47

48
principal shareholders or stakeholders in the
service of the state?

YES / NO

3.12.1 If yes, furnish particulars.
………………………………………………………………

………………………………………………………………

5.13

Are any spouse, child or parent of the company’s directors, trustees,
managers, principal shareholders or stakeholders in service of the state?

YES / NO

3.13.1 If yes, furnish particulars.
………………………………………………………………

………………………………………………………………

5.14

Do you or any directors, trustees, managers, principal shareholders

YES / NO

Or stakeholders of this company have any interest in other related companies or business whether
or not they are bidding for this contract?

3.14.1

If yes, furnish particulars.

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

4.

Full details of directors/ trustees/ members/ shareholders.

Full Name

Identity Number

48

State Employee
Number

49

…………………………………..

……………………………………..

Authoring Signature

Date

………………………….........

…………………………………………......

Full name

Capacity

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

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

Witness

Witness
Commissioner of Oaths

49

50
6. Undertaking
by
…………………………………………………………………..
(the “Supplier”)
vis a vis the
Kouga Local Municipality
(“KLM”)
WITH THIS FORM PLEASE ATTACH A LATEST MUNICIPAL BILLING CERTIFICATE FOR THE BUSINESS
PREMISES AND ALSO FOR ALL THE DIRECTORS, MEMBERS OR OWNERS OF THE BUSINESS. IF OFFICE
PREMISES ARE BEING RENTED PLEASE ATTACH COPY OF LEASE AGREEMENT.
Whereas:
(a)
(b)

the Supplier delivers or renders services to KLM;
KLM is liable to pay the Supplier for goods delivered or services rendered; and the
Supplier is liable to pay KLM or relevant Local Authority any due municipal rates
and taxes or municipal service charges and any other indebtedness owed by the
Supplier to the KLM or relevant Local Authority.

Now therefore the Supplier undertakes the following:
1.

In the event of the Supplier being in arrears in respect of any municipal rates and taxes, municipal services
charges, or any other indebtedness owed by the Supplier to the relevant Local Authority; which is / are due:
1.1
the Supplier shall make satisfactory and reasonable written settlement arrangements with the
KLM or relevant Local Authority for the payment thereof; and
1.2
failing which, the KLM may set-off any such due indebtedness owed by the Supplier to the KLM
from any amount owed by the KLM to the Supplier;

2.

To co-operate with the KLM and to do all things and sign all such documents (and / or procure same to
be done) as may be necessary or requisite in order to give proper and due effect to the terms of this
undertaking or any matter arising there from in accordance with its intent and purpose;

3.

No extension of time or indulgence granted by the KLM shall be deemed in any way to affect, prejudice
or derogate from its rights in any respect in terms of this undertaking, nor shall it in anyway be regarded
as a waiver of the KLM’s rights hereunder; and

4.

The Supplier shall not be entitled to cede any of its right’s nor delegate any of its obligations in terms of
this undertaking to any other person without the prior written consent of the KLM.

Thus done and signed by the Supplier at ……………………………………… on ……………………………… 20
………….

………………………………………
(The Supplier) duly authorized

………………………………..
Witness

50