Supplies: General Tenders

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Returnable Documents: Letter of intent to subcontract. Skill Developments Tenderers are required to submit proposals in a table below for developing the skills of unemployed candidates in the country. Skills development is intended to address Eskom’s core, scarce and critical skills and the scarce and critical skills. These skills are also included in a 2020 list of occupations in high demand as stipulated in the Government Gazette 43937. Candidates shall be from all provinces in Controlled Disclosure Anonymously report fraud, corruption at 0800 11 2722/ forensic@eskom.co.za When downloaded from the document management system, this document is uncontrolled and the responsibility rests with the user to ensure it is in line with the authorized version on the system. No part of this document may be reproduced in any manner or form by third parties without the written consent of Eskom Holdings SOC Ltd, © copyright Eskom Holdings SOC Ltd, Reg No 2002/015527/30 of 63 File name: Invitation to Tender (ITT) E2373GXLPMED Gearbox (002) Template ID: 240-43921804 (Rev 7) Header and Footer portrait template Document 240-114238630 Rev 27 Invitation to Tender/ Request Identifier for Proposal Effective Date 30 October 2025 Review Date October 2030 Clause Number from Standard Tender Data Conditions of Tender the country, and their composition shall be representative of the population demographics of South Africa. Skills Type Output Outcome Bursaries for learners at 1st ,2nd year National university of technology Dimploma The process of developing these skills shall involve the participation by tenderers directly and through their supply network. In certain cases, the SETA’s accredited training providers can be approached to participate in developing critical and scarce skills. Note: That these targets for skills development candidates categorically exclude Eskom employees and registered learners. The tenderers are required to take full responsibility for the total cost of developing the requisite skills, and Eskom shall not make any financial contribution towards the fulfilment of this obligation.Tenderers also are advised to approach their relevant SETAs to access grants, subsidies, and incentives as well as South African Revenue Services for tax rebates that are earmarked for skills development initiatives SDL&I Penalty and Performance Security Eskom will apply a penalty of 2% of the Contract Value for failure to meet SDL&I obligations. For the duration of the contract, Eskom will retain 2% of every invoice (excluding VAT) as security for the fulfilment of all SDL&I Obligations. The retained amounts shall only be released to the Contractor upon fulfilment of all SDL&I obligations by the contractor. Reporting and Monitoring, The suppliers shall on a quarterly basis submit areport to Eskom in accordance with Data Collection Template on their compliance with the SDL&I obligations described above., Eskom shall review the SDL&I reports submitted by the suppliers within 30 (thirty) days of receipt of the reports and notify the suppliers in writing if their SDL&I obligations have not been met., Upon notification by Eskom that the suppliers have not met their SDL&I obligations, the suppliers shall be required to implement corrective measures to meet those SDL&I obligations before the commencement of the following report, failing which Retention clauses shall be invoked. Controlled Disclosure Anonymously report fraud, corruption at 0800 11 2722/ forensic@eskom.co.za When downloaded from the document management system, this document is uncontrolled and the responsibility rests with the user to ensure it is in line with the authorized version on the system. No part of this document may be reproduced in any manner or form by third parties without the written consent of Eskom Holdings SOC Ltd, © copyright Eskom Holdings SOC Ltd, Reg No 2002/015527/30 of 63 File name: Invitation to Tender (ITT) E2373GXLPMED Gearbox (002) Template ID: 240-43921804 (Rev 7) Header and Footer portrait template Document 240-114238630 Rev 27 Invitation to Tender/ Request Identifier for Proposal Effective Date 30 October 2025 Review Date October 2030 Clause Number from Standard Tender Data Conditions of Tender, Every contract shall be accompanied by the SDL&I Implementation Schedule, which must be completed by the suppliers and returned to SDL&I representative for acceptance 28 days after contract award. This will be used as a reference document for monitoring, measuring and reporting on the supplier’s progress in delivering on their stated SDL&I commitments Market Research The following information demonstrates market analysis and assisted in arriving at the targetsabove. Current Suppliers Providing the Potential Suppliers: Services, Open market, None General Information on Validity of Sworn Affidavits Tenderers submitting B-BBEE Sworn Affidavits must ensure that the affidavits meet the following key pointers to ensure their validity:, Name/s of deponent as they appear in the identity document and the identity number., Designation of the deponent as the director, owner or member must be indicated in order to know that person is duly authorized to depose of an affidavit. (Mark the applicable option)., Name of enterprise as per enterprise registration documents issued by the CIPC, where applicable, and enterprise business address., Percentage of black ownership, black female ownership and designated group. In the case of specialised enterprises as per Statement 004, the percentage of black beneficiaries must be reflected. (No blank spaces to be left)., Indicate total revenue for the year under review and whether it is based on audited financial statements or management account. (Mark the applicable option)., Financial year end as per the enterprise’s registration documents, which was used to determine the total revenue. (Financial year end to be stipulated by day/month/year)., B-BBEE Status level. An enterprise can only have one status level. (Tick applicable level), Empowering supplier status must be indicated. For QSEs, the deponent must select the basis for the empowering supplier status., Date deponent signed and date of Commissioner of Oath must be the same. (The sworn affidavit must be signed in the presence of the Commissioner of Oath. Furthermore the Commissioner must also sign and stamp) Controlled Disclosure Anonymously report fraud, corruption at 0800 11 2722/ forensic@eskom.co.za When downloaded from the document management system, this document is uncontrolled and the responsibility rests with the user to ensure it is in line with the authorized version on the system. No part of this document may be reproduced in any manner or form by third parties without the written consent of Eskom Holdings SOC Ltd, © copyright Eskom Holdings SOC Ltd, Reg No 2002/015527/30 of 63 File name: Invitation to Tender (ITT) E2373GXLPMED Gearbox (002) Template ID: 240-43921804 (Rev 7) Header and Footer portrait template Document 240-114238630 Rev 27 Invitation to Tender/ Request Identifier for Proposal Effective Date 30 October 2025 Review Date October 2030 Clause Number from Standard Tender Data Conditions of Tender, Commissioner of Oath cannot be an employee or ex officio of the enterprise because, a person cannot by law, commission a sworn affidavit in which they have an interest. Please complete the attached SDL&I Strategy Setting Template 2.30 Contract Participation Goals is Please complete the attached SDL&I Strategy Setting Template applicable Please note: Controlled Disclosure Anonymously report fraud, corruption at 0800 11 2722/ forensic@eskom.co.za When downloaded from the document management system, this document is uncontrolled and the responsibility rests with the user to ensure it is in line with the authorized version on the system. No part of this document may be reproduced in any manner or form by third parties without the written consent of Eskom Holdings SOC Ltd, © copyright Eskom Holdings SOC Ltd, Reg No 2002/015527/30 of 63 File name: Invitation to Tender (ITT) E2373GXLPMED Gearbox (002) Template ID: 240-43921804 (Rev 7) Header and Footer portrait template Document 240-114238630 Rev 27 Invitation to Tender/ Request Identifier for Proposal Effective Date 30 October 2025 Review Date October 2030 Tenderers are requested to bear in mind Eskom's standard payment terms as stipulated hereunder when submitting tenders and concluding contracts with Eskom: For contracts valued below R50 000 000 (Fifty Million Rand) including VAT, Eskom is committed to paying Suppliers within 30 days of receipt of undisputed invoices. For contracts valued above R50 000 000 (Fifty Million Rand) including VAT, Eskom is committed to paying suppliers within 60 days of receipt of undisputed invoices. Eskom reserves the right to negotiate with preferred bidders after a competitive bidding process or price quotations should the tendered prices not be market-related. Main contractors/ suppliers are discouraged from subcontracting with their subsidiary companies as this may be interpreted as subcontracting with themselves and / or using their subsidiaries for fronting. Where a main contractor subcontracts with a subsidiary, this must be declared in its tender documents. A report containing a list of potential sub-contractors may be drawn by accessing the following link: www.csd.gov.za “proof of B-BBEE status level of contributor” means- (a) the B-BBEE status level certificate issued by an authorised body or person; or (b) a sworn affidavit as prescribed by the B-BBEE Codes of Good Practice; or (c) any other requirement prescribed in terms of the Broad-Based Black Economic Empowerment Act 1.2 TENDER RETURNABLES The tenderer must submit the returnable set out hereunder as part of its tender at the stipulated deadline. NOTE THE FOLLOWING: -, Returnables required at Tender closing (disqualifiable): - These returnables are required to be fully completed, signed (if required on the returnable) and submitted with the tender at Tender closing date and time. If not fully completed, signed (if required on the returnable) and/or submitted by tender closing, the tenderer will be disqualified., * Returnable required at Tender closing (non-disqualifiable): - These returnables are required to be fully completed, signed (if required on the returnable) and submitted with Tender at Tender closing date and time; however, if not submitted by Tender closing, or submitted with incomplete information or without a required signature, the Procurement Practitioner will, in writing, request the tenderer to submit the returnable within 5 working days. If the returnable is not fully Controlled Disclosure Anonymously report fraud, corruption at 0800 11 2722/ forensic@eskom.co.za When downloaded from the document management system, this document is uncontrolled and the responsibility rests with the user to ensure it is in line with the authorized version on the system. No part of this document may be reproduced in any manner or form by third parties without the written consent of Eskom Holdings SOC Ltd, © copyright Eskom Holdings SOC Ltd, Reg No 2002/015527/30 of 63 File name: Invitation to Tender (ITT) E2373GXLPMED Gearbox (002) Template ID: 240-43921804 (Rev 7) Header and Footer portrait template Document 240-114238630 Rev 27 Invitation to Tender/ Request Identifier for Proposal Effective Date 30 October 2025 Review Date October 2030 completed, signed if required and/or received by the Procurement Practitioner within 5 working days of the request, the tenderer will be disqualified. The 5 working days period does not apply to CIDB proof of grading. Refer to the returnable table the prescribed period for CIDB proof of grading. # Returnables required at Tender Closing date and time for evaluation: - These returnable are required to be submitted at tender closing date and time. These returnables will not be requested by the Procurement Practitioner. A tenderer that does not submit the required returnable at stipulated deadline or submits an incomplete returnable; will not be disqualified but will score zero. Reference Returnable From Suppliers at at ** closing (Non- prior Award. required required closing. required Tender (disqualifiable)* Contract disqualifiable) to Tender Returnable Returnable Returnable Basic Compliance Electronic copy of the tender in a PDF format. The √ price list needs to be submitted in PDF and a copy in excel format (The limit is 50MB per file and total submission of 900MB per submission) Submit a complete tender with commercial, financial, technical and SHEQ files clearly marked. Annexure A Authorisation Form √ Annexure B Acknowledgement Form √ Annexure C Tenderers Particulars √ Annexure D Integrity Pact Declaration form √ Annexure E CPA for local goods/services (if applicable) √ Annexure F CPA(IG) for imported goods/services (if applicable) √ Annexure G1-G4 SBD 6.2 -Declaration certificate for local production √ and content and Annexures G2,G3,G4 [only applicable where designated materials are included] Controlled Disclosure Anonymously report fraud, corruption at 0800 11 2722/ forensic@eskom.co.za When downloaded from the document management system, this document is uncontrolled and the responsibility rests with the user to ensure it is in line with the authorized version on the system. No part of this document may be reproduced in any manner or form by third parties without the written consent of Eskom Holdings SOC Ltd, © copyright Eskom Holdings SOC Ltd, Reg No 2002/015527/30 of 63 File name: Invitation to Tender (ITT) E2373GXLPMED Gearbox (002) Template ID: 240-43921804 (Rev 7) Header and Footer portrait template Document 240-114238630 Rev 27 Invitation to Tender/ Request Identifier for Proposal Effective Date 30 October 2025 Review Date October 2030 Reference Returnable From Suppliers at at ** closing (Non- prior Award. required required closing. required Tender (disqualifiable)* Contract disqualifiable) to Tender Returnable Returnable Returnable Annexure H SBD 1- to be completed and submitted by all √ (applicable for all tenderers. suppliers including Foreign suppliers) # Annexure I SBD 6.1- Preference Points Claim Form in terms of √ PPPFA 2022 regulations Annexure J SBD 4 – Bidders Disclosure √ Reverse e-auction N/A training acknowledgement form (if applicable) E-tendering Help E-tendering Help Manual √ Manual acknowledgement Acknowledgement form (If applicable) form (If applicable) Additional Letter of intent to form a JV/consortium or Valid joint √ Documents required venture agreement confirming the rights and in the event of JV: - obligations of each of the joint venture partners and their profit-sharing ratios. Separate written confirmation that the joint venture will √ operate as a single business entity (incorporated) for the duration of the contract or this may be included as an obligation within the JV agreement. Details and confirmation of a single designated bank √ account in the name of the JV and independent of the individual JV partners, as set out in the joint venture agreement. # Specific Goals A tenderer’s failure to submit proof that it meets the specific goals will not result in its disqualification. The tenderer will, however, be scored zero for Specific Goals for purposes of PPPFA scoring and ranking. Tax Clearance A certified copy of a tax clearance certificate is √ Certificates required from foreign tenderers (with a footprint in Controlled Disclosure Anonymously report fraud, corruption at 0800 11 2722/ forensic@eskom.co.za When downloaded from the document management system, this document is uncontrolled and the responsibility rests with the user to ensure it is in line with the authorized version on the system. No part of this document may be reproduced in any manner or form by third parties without the written consent of Eskom Holdings SOC Ltd, © copyright Eskom Holdings SOC Ltd, Reg No 2002/015527/30 of 63 File name: Invitation to Tender (ITT) E2373GXLPMED Gearbox (002) Template ID: 240-43921804 (Rev 7) Header and Footer portrait template Document 240-114238630 Rev 27 Invitation to Tender/ Request Identifier for Proposal Effective Date 30 October 2025 Review Date October 2030 Reference Returnable From Suppliers at at ** closing (Non- prior Award. required required closing. required Tender (disqualifiable)* Contract disqualifiable) to Tender Returnable Returnable Returnable South Africa but that are not registered on CSD and have not provided a SARS pin number) and local tenderers (that have not provided their SARS e-filing PIN number for verification by Eskom and/or their CSD profile / CSD number). Foreign suppliers with no footprint in South Africa must complete the SBD1 document; however, no proof of tax compliance is required. Tax Evaluation Evaluation questionnaire to determine whether a √ Questionnaire (if company, close corporation (CC) or Trust is a personal services contract service provider for purposes of PAYE and was included as annexure) Compliance with To the extent that the tenderer falls within the definition √ Employment Equity of a “designated Employer” as contemplated in the Act Employment Equity Act , the tenderer is required to furnish the Employer with proof of compliance with the Employment Equity Act, including proof of submission of the Employment Equity report to the Department of Labour. (South African tenderers only) CIDB (where Valid proof of the required CIDB grading designation N/A applicable) for the main contractor; JV and /or sub-contractor as may be required in the tender data at tender closing deadline or within 21 working days from the closing date of submission of tenders if this is agreed with the Employer NEC or other NEC, completed in full. √ Contract Complete NEC3 Term Services Draft Contract: C1.1 Form of Offer and Acceptance (deviation schedule) C1.2a Contract Data provided by the Employer C1.2b Contract Data provided by the Contractor C2.2 The Pricing List (suppliers to submit price list provided) Controlled Disclosure Anonymously report fraud, corruption at 0800 11 2722/ forensic@eskom.co.za When downloaded from the document management system, this document is uncontrolled and the responsibility rests with the user to ensure it is in line with the authorized version on the system. No part of this document may be reproduced in any manner or form by third parties without the written consent of Eskom Holdings SOC Ltd, © copyright Eskom Holdings SOC Ltd, Reg No 2002/015527/30 of 63 File name: Invitation to Tender (ITT) E2373GXLPMED Gearbox (002) Template ID: 240-43921804 (Rev 7) Header and Footer portrait template Document 240-114238630 Rev 27 Invitation to Tender/ Request Identifier for Proposal Effective Date 30 October 2025 Review Date October 2030 Reference Returnable From Suppliers at at ** closing (Non- prior Award. required required closing. required Tender (disqualifiable)* Contract disqualifiable) to Tender Returnable Returnable Returnable Pricing schedule Completed pricing schedule (if not already submitted √ in the NEC or other Contract). Additional √ documents required (ECSA/ SACPCMP/CVs/ permits/licenses/ specific registration documents (if applicable to scope of work) MANDATORY CONTRACTUAL REQUIREMENTS SUPPORTING EVIDENCE Mandatory Proof of valid and current CSD Registration (CSD √ Contractual number/CSD Report)

Returnable Documents: Evaluation criteria/KPI Sub Total schedules/evidence Functionality Score Sub Criteria Criteria Level 0 level 1 level 2 level 3 level 4 level 5 Previous experience as an Auditor in a No of similar No information To have City (or assignments To have To have To have To have Report detailing scope of provided; OR successfully cities)/Water undertaken for undertaken 1 undertaken 2 to undertaken 4 to undertaken 7 to assignment, details and submission of no completed 10+ utility providing or including project of a 3 assignments 6 assignments 10 assignments contacts of clients, substance / assignments of 30 30 water and performance similar nature of a similar of a similar of a similar contract value; irrelevant a similar nature sanitation audit and within the past nature within the nature within the nature within the duration/period 1 services as certification information 15 years. past 15 years. past 15 years. past 15 years. within the past undertaken; provided 15 years. required in this requirements contract in the last 15 years % score 0% 20% 40% 60% 80% 100% Score 0 6 12 18 30 No information provided OR Minimum 1 submission of no Minimum 5 Minimum 10 Minimum 15 Minimum 20 years relevant substance / years relevant years relevant years relevant years relevant experience irrelevant experience experience experience experience Experience of including information OR including including including including 20 Key staff experience on less than 1 experience on experience on experience on experience on assignments year’s relevant projects of a assignments of assignments of assignments of of a similar experience on similar nature. a similar nature. a similar nature. a similar nature. nature. assignments of a similar nature. % score 0% 20% 40% 60% 80% 100% Qualification as CA (Auditor);CV with minimum post registration professional qualification of not less than 10 years’ Lead Auditor 0 2 4 6 8 10 10 experience in management of Audit teams, performance management, certification of performance results Part T1: Tendering Procedures Document Version : 14/03/2023(a) CV with minimum post registration professional qualification not less than Financial 0 1 2 3 4 5 10 years, CA/Equivalent 5 Specialist and expertise and expert in Financial Performance management auditing CV with minimum post registration professional qualification not lees than Technical 10 years as Pr Eng or 0 1 2 3 4 5 5 Specialist equivalent, experience and expert in Water /Sanitation on similar assignments Excellent - No information Good - Proposed Poor - Adequate - Low Very Good - Meets and provided OR Satisfactory Approach and Unacceptable level of Meets the exceeds the submission of no level of 3 methodology understanding understanding of expected level of expected level of Summary outline 50 substance / understanding of that will be of the the understanding of understanding of irrelevant the used requirements. requirements. the requirements the information requirements. requirements. % score 0% 20% 40% 50% 75% 100% Demonstrate comprehension of project objectives and challenges as articulated in the National Treasury Articulate envisaged role A;A1;A2 and A3 and governance structure; Guidelines;B&IP outline experience and and road map of Technical expertise to be utilised to the EWS and Understanding realise the objectives of 3.1 associated 0 2 4 5 7.5 10 10 of Project the City and the documents Requirements performance audit and ;Demonstrate certification aligned to the understanding of EWS turnaround strategy local water utility and ongoing reforms. context, water sector reforms, operational needs, regulatory compliance and infrastructure conditions Part T1: Tendering Procedures Document Version : 14/03/2023(a) Detail workplan The auditor must with defined demonstrate a clear, well- Proposed milestones and structured approach for Methodology deliverables; undertaking the 3.2 and Approach 0 0,07 0,14 0,175 0,2625 0,35 35 clear process assignment in evaluating to the work flow , and reporting on the assignment quality performance-based assuarance;etc contract. Proposed Creative solutions and modern Innovation and technologies 3.3 Value-Added 0 0,01 0,02 0,025 0,0375 0,05 5 that improve Services service delivery that will be applicable to EWS Total score 100 Min score required The Key staff listed are only for functionality evaluation- The full team must be disclosed in the methodology and approach document Part T1: Tendering Procedures Document Version : 14/03/2023(a) PART T2: RETURNABLE DOCUMENTS T2.1 LIST OF RETURNABLE DOCUMENTS T2.1.1 General The Tender Submission Documentation must be submitted in its entirety. All forms must be properly completed as required. The Tenderer is required to complete each and every Schedule and Form listed below to the best of their ability as the evaluation of tenders and the eventual contract will be based on the information provided by the Tenderer. Failure of a Tenderer to complete the Schedules and Forms to the satisfaction of the Employer will inevitably prejudice the tender and may lead to rejection on the grounds that the tender is non-responsive. T2.1.2 Returnable Schedules, Forms and Certificates Entity Specific T2.2.1 Compulsory Enterprise Questionnaire .............................................................................. 16 T2.2.2 Certificate of Attendance at Clarification Meeting ........................................................... 18 T2.2.3 Tax Compliance Status PIN / Tax Clearance Certificate .................................................... 19 T2.2.4 MBD 4: Declaration of Interest 20 T2.2.5 MBD 5: Declaration for Procurement Above R10 Million ................................................. 22 T2.2.6 MBD 6.1: Preference Points Claim Form ITO the Preferential Regulations ...................... 23 T2.2.7 MBD 8: Declaration of Bidder’s Past SCM Practices ......................................................... 23 T2.2.8 MBD 9: Certificate of Independent Bid Determination .................................................... 28 T2.2.9 Joint Venture Agreements (if applicable) ......................................................................... 31 T2.2.10 Record of Addenda to Tender Documents (if applicable) ................................................. 32 T2.2.11 Declaration of Municipal Fees .......................................................................................... 33 T2.2.12 CSD Registration Report .................................................................................................... 34 Technical or Functionality Evaluation T2.2.13 Experience of Tenderer ..................................................................................................... 35 T2.2.14 Experience of Key Staff................................................................................................................ 36 T2.2.15 Approach and Methodology ...................................................................................................... 36 Returnable Documents Error! Reference source not found. T2.2 RETURNABLE SCHEDULES, FORMS, AND CERTIFICATES The returnable schedules, forms, and certificates, as listed in T2.1.2, can be found on pages 16 to, NOTE The Form of Offer (C1.1.1), The Data to be Provided by Contractor (C1.2.2.2), and the Bill of Quantities (C2.2) are also required to be completed by the tenderer. Returnable Documents Error! Reference source not found. T2.2.1 COMPULSORY ENTERPRISE QUESTIONNAIRE Complete or Ref Description Circle Applicable 1.1 Name of enterprise 1.2 Name of enterprise’s representative 1.3 ID Number of enterprise’s representative Position enterprise’s representative 1.4 occupies in the enterprise National Treasury Central Supplier 1.5 MAAA Database Registration number eThekwini Supplier Database: 1.6 PR Reference number (PR), if any: 1.7 VAT registration number, if any: 2.0 Particulars of sole proprietors and partners in partnerships (attach separate pages if more than 4 partners) Full Name Identity No. Personal income tax No. * 2.1 2.2 2.3 2.4 3.0 Particulars of companies and close corporations 3.1 Company registration number, if applicable: 3.2 Close corporation number, if applicable: 3.3 Tax Reference number, if any: South African Revenue Service: 3.4 Tax Compliance Status PIN: Returnable Documents Error! Reference source not found. 4.0 Record in the service of the state (Insert on a separate page if necessary) Indicate by marking the relevant boxes with a cross, if any sole proprietor, partner in a partnership or director, manager, principal shareholder or stakeholder in a company or close corporation is currently or has been within the last 12 months in the service of any of the following:  a member of any municipal council  a member of any provincial legislature  an official of any municipality or municipal entity  aormemberprovincialof publican accountingentity authority of any national  a member of the board of directors of any municipal entity  aCouncilmemberof Provinceof the National Assembly or the National an employee of any provincial department, national or provincial public entity or constitutional institution within the meaning of an employee of Parliament or a provincial legislature   the Public Finance Management Act, 1999 (Act ) Name of sole proprietor, partner, director, manager, Name of institution, public office, board or Status of service principal shareholder or stakeholder organ of state and position held (tick appropriate column) Current Within last 12 mths 5.0 Record of spouses, children and parents in the service of the state (Insert on a separate page if necessary) Indicate by marking the relevant boxes with a cross, if any spouse, child or parent of a sole proprietor, partner in a partnership or director, manager, principal shareholder or stakeholder in a company or close corporation is currently or has been within the last 12 months in the service of any of the following:  a member of any municipal council  a member of any provincial legislature  an official of any municipality or municipal entity  aormemberprovincialof publican accountingentity authority of any national  a member of the board of directors of any municipal entity  aCouncilmemberof Provinceof the National Assembly or the National an employee of any provincial department, national or provincial public entity or constitutional institution within the meaning of an employee of Parliament or a provincial legislature   the Public Finance Management Act, 1999 (Act ) Name of spouse, child or parent Name of institution, public office, board or Status of service organ of state and position held (tick appropriate column) Current Within last 12 mths The undersigned, who warrants that he / she is duly authorised to do so on behalf of the enterprise:, authorizes the Employer to verify the tenderers tax clearance status from the South African Revenue Services that it is in order. ii) confirms that the neither the name of the enterprise or the name of any partner, manager, director 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. iii) confirms that no partner, member, director or other person, who wholly or partly exercises, or may exercise, control over the enterprise appears, has within the last five years been convicted of fraud or corruption. iv) 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 scope of work that could cause or be interpreted as a conflict of interest., confirms that the contents of this questionnaire are within my personal knowledge and are to the best of my belief both true and correct. NAME (Block Capitals): Date

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