Short-term insurance broker services – naledi local municipality (34 months)

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Returnable Documents: million (all applicable taxes included) completed and signed? (MBD 5), 23. Did you attach the annual financial statements as required in MBD 5?,  Certified copy of Identity document in the case of sole proprietorship;,  Original copies of Tax clearance certificates., 2. PRICING SCHEDULE

Bid checklist: Bidders must use checklist to ensure bid documentation is complete for administrative compliance. Items include: registration as accredited prospective supplier with Naledi Local Municipality, bid document administration fee paid and receipt attached, read and understood all pages, completed in black ink, certified copies of company registration and VAT certificates, certified ID for sole proprietors, registration certificate for relevant industry if applicable, covering letter, original and valid tax clearance certificate (MBD2), completed and signed Bid Declaration, Board Resolution (where applicable), Consortium/JV Resolution (where applicable), Invitation to Bid (MBD1), Declaration of Interest (MBD4), Declaration of Bidder's Past SCM Practices (MBD8), Certificate of Independent Bid Determination (MBD9), Previous Work Experience section, Preference Points Claim Form (MBD6.1), B-BBEE certificate, product/service conforms to specifications, Pricing Schedule (MBD3.1), Declaration for Procurement Above R10 million (MBD5) and annual financial statements if applicable.

Bidders must be registered on the Naledi Local Municipality supplier database and on the CSD (with a CSD report not older than 14 days). An original and valid tax clearance certificate and tax compliance status pin must be submitted (certified copies not accepted). Bidders must hold a valid FSP license under FAIS and be in good standing with the FSCA. Bidders must not be persons in the service of the state. Bidders must submit a certified copy of company registration and VAT registration certificates, and for sole proprietors, a certified ID copy. B-BBEE status level verification certificate (or sworn affidavit for EMEs) must be submitted to claim preference points. For procurements above R10 million, bidders must complete MBD 5 and submit audited annual financial statements for the past three years. Bidders must complete and sign all required forms including MBD 1, MBD 2, MBD 3.1, MBD 4, MBD 6.1, MBD 8, MBD 9, and the bid declaration and board resolution.

Supply Chain Management Regulations (Government Gazette May 2005)

Bid NO: NLM2027-003A

Provision of short-term insurance service

Venture................................................................................................................................................ 5

6. Invitation to bid (mbd 1) ................................................................................................................. 6

7. Tax clearance requirements (mbd 2) ......................................................................................8

8. Pricing schedule – firm prices (mbd 3.1) ...............................................................................11

9. Previous work experience of a similar nature ...............................................................20

10. Declaration of interest (mbd 4) ..............................................................................................21

11. Declaration for procurement above r10 million (all applicable taxes

Included) (mbd 5) ............................................................................................................................ 23

Less than R10 million 0

Equal to or greater than R10 million but less than R20 million 9

Equal to or greater than R20 million but less than R30 million 13

Equal to or greater than R30 million 20

Mbd 3.1

Qualifications, Professional Affiliation/Registration and Experience of Key Personnel: 25

i. Qualification:

List main work experience of a similar nature to this bid successfully executed and completed (or on-going) in the last five (5) years:

 Please complete all sections of the Pricing Schedule. Clearly indicate “N/A” where sections are not applicable. If more

information is supplied please reference from the pricing schedule.

 All prices on the Pricing Schedule must be VAT inclusive.

 Please note that section 9 of the Pricing Schedule requires personal accident cover for all councillors and appointed

drivers of vehicles of the Naledi Local Municipality.

 Directors Liability to be covered.

 Thatch cover for 2 properties as specified in the Schedule of Insurance Assets.

 Cover must be specific to the value of cover. Refer to [Insure at: Cost, Market related Cost or No Insurance] column on the

schedule of Insurance assets.

 Additional Cover considerations:

Broker fee and commission

Mbd 3.1

 It must be clearly stated on the pricing schedule whether broker fees and commission is included or excluded in the

premium.

Insurance brokers

 The municipality will only deal with reputable brokers directly (client – broker – insurance company) and will not consider

any bid that involves a sub-broker or agency.

 A full company profile containing detailed credentials must be submitted together with the bid. Joint Venture partners must

include a copy of the Joint Venture Agreement.

 The insurance broker must submit a copy of their Financial Services Board certificate to the bid document.

Mbd 3.1

Claims Administration

Administration of claims reported to the insurance Broker;

 The Insurance Broker will acknowledge receipt of claims forms and confirm all claims in writing to the client within 7

(seven) days after receipt of the notification of the incident.

 If the claim is approved by the insurer an Agreement of Loss will be generated and forwarded to the insurance section of

the client within 7 (seven) days of receipt of all the applicable documentation.

 The Insurance Broker will assist the Insurance Section of the client with the administration of claims in order to finalize all

outstanding claims i.e. obtaining of reports, invoices, quotations etc.

Scheduling and Coordinating of claims

 The Insurance Broker will schedule and coordinate a monthly claims meeting when required (ad-hoc) with the Insurance

Section of the client.

 The purpose of the meeting will be to discuss all claims as per applicable Insurance Policies reported by the Insurance

Section to the Insurance Broker. Monitoring of progress of all insurance claims reported to and authorized by the Insurance

Broker

 Claims Administration system to administrate occupational injuries and disease claims

 It is expected of the Broker to have capacity to provide the following services at an appropriate time to be determined by

the Municipality on a fee to be agreed with the Municipality.

 Administration of all claims arising from occupational activities of the employees of the Council pursuant the Compensation

for Occupational Injuries and Disease Act no and the Occupational Health and Safety Act

 Formulation and Implementation of Risk Management Strategy in line with the provision of the Municipal Finance

Management Act.

 Management of Occupational Injuries and Diseases Act as well as Occupational Health and Safety Act risk related to the

implementation of construction contracts by third parties on behalf of Council

General Conditions of Contract

 The National Treasury: General Conditions of Contract form part of this bid and will be applicable on signing of the final

contract by the preferred bidder.

Reputable insurance companies

 Only underwriting by reputable insurance companies with local government experience will be accepted. Naledi Local

Municipality shall in its absolute discretion be entitled to reject underwriting by any specific insurance company and shall

not have to furnish reasons therefore.

 The insurance broker must include documentary proof from the underwriting insurance company in order to support the

bid document

Policy class/section net premium VAT 15% brokerage gross premium (VAT remarks

(Exclusive of fee/commission included + brokerage

VAT) (VAT inclusive) fee)

1. Combined

2. House-owners

3. Glass

4. Business

Interruption

5. Office contents

6. Business all risks

7. Theft

8. Money

9. Fidelity

10. Motor

11. Motor liability

12. Goods in transit

13. Group personal

Accident

14. Electronic

Equipment

15. Machinery

Breakdown

16. Machinery

Breakdown

Business

Interruption

17. Public liability

Mbd 3.1

18. Employers liability

19. Aerodome

20. Marine/small

Crafts

21 a. Sasria non-motor

21 b. Sasria motor

21 c. Sasria cover for

Councillors

Total

Required by: ........................................

At: ........................................

Does offer comply with the specifications? *YES / NO

• Delete if not applicable

If not to specification, indicate deviation(s): ................................................................................

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

Period required for delivery: ........................................ *Delivery: Firm/not firm

• Delete if not applicable

Delivery basis: ...............................................

Note: All delivery costs must be included in the bid price, for delivery at the prescribed destination.

** “all applicable taxes” includes value- added tax, pay as you earn, income tax, unemployment insurance fund contributions and skills development levies.

certificate or a certified copy thereof or, if you qualify as an EME, did

you provide a verification certificate? (MBD 6.1)

20. Does the product/service offered conform to the Bid Specifications?
21. Is Pricing Schedule completed?(MBD 3.1)
22. Where applicable, is the Declaration for Procurement Above R10

million (all applicable taxes included) completed and signed? (MBD 5)

23. Did you attach the annual financial statements as required in MBD 5?

(For Procurements above R10 million)

documents (which shall be taken as part of, and incorporated into this bid) at the prices reflected in the Pricing Schedule.

2. I/we agree that this offer shall remain valid for a period of 90 days commencing from the closing date and time of this bid.

register with SARS as eFilers through the website www.sars.gov.za.

Mbd 2

Mbd 2

Mbd 3.1

8. Pricing schedule – firm prices (mbd 3.1)

(Purchases)

Note: only firm prices will be accepted. Non-firm prices (including prices subject to rates of

Exchange variations) will not be considered

 The period of the contract will be for one year, but at the discretion of the Naledi Local Municipality and by mutual consent

and after review of the rates quoted for the following year, renewed annually for up to a maximum of three (3) years.

Mbd 3.1

 It must be clearly stated on the pricing schedule whether broker fees and commission is included or excluded in the

premium.

transferred to an external authorized representative, auditor or any other third party acting

on behalf of the bidder.

I, the undersigned, ................................................................................... (full names),

do hereby declare, in my capacity as ............................................. ...........

of ...............................................................................................................(name of bidder

entity), the following:

(a) The facts contained herein are within my own personal knowledge.

(b) I have satisfied myself that the goods/services/works to be delivered in terms of the

above-specified bid comply with the minimum local content requirements as specified in

the bid, and as measured in terms of SATS 1286.

(c) The local content has been calculated using the formula given in clause 3 of SATS

1286, the rates of exchange indicated in paragraph 4.1 above and the following figures:

Bid price, excluding VAT (y) R

Imported content (x) R

Stipulated minimum threshold for Local content (paragraph

3 above)

Local content % as calculated in terms of SATS 1286

valid tax clearance certificate? (MBD2)

Valid tax clearance certificate been attached? (Mbd 2) *yes / NO

valid Tax Clearance Certificate and Tax Compliance Status pin will result in the invalidation of the Quotation

Tax Compliance Status pin, that will be valid for a period of 1 (one) year from the date of

Tax Compliance Status pin

Tax Compliance Status pin must be submitted together with the Quotation

Tax Compliance Status pin will result in the invalidation of the Quotation

Tax Compliance Status pin will not be acceptable

CSD report not older than

Central Supplier Database) by submitting a CSD report not older than

VAT registration certificates?

joint venture agreement and contract with the NALEDI LOCAL MUNICIPALITY in respect of the project under item 1

Joint Venture Agreement

Appointment Letters and reference 25

2. Pricing schedule
3. Tax clearance requirements (mbd 2)

Clearance Certificate” and submit it to any SARS branch office nationally. The Tax Clearance Certificate Requirements are also

2 SARS will then furnish the supplier with a Tax Compliance Status pin, that will be valid for a period of 1 (one) year from the date of

approval, which can be used by supplier to download a Tax Clearance Certificate via e-Filing to be submitted together with the Tax

3 Bidders should submit a proof of registration on the CSD (Central Supplier Database) by submitting a CSD report not older than

fourteen (14) days from closing date of this Quotation document. Registration on the CSD can be accessed at www.csd.gov.za.

4 The original Tax Clearance Certificate and Tax Compliance Status pin must be submitted together with the Quotation. Failure to

submit the original and valid Tax Clearance Certificate and Tax Compliance Status pin will result in the invalidation of the Quotation.

Certified copies of the Tax Clearance Certificate and Tax Compliance Status pin will not be acceptable.

Applicable taxes included) (mbd 5)

million (all applicable taxes included) completed and signed? (MBD 5)

23. Did you attach the annual financial statements as required in MBD 5?

 Certified copy of Identity document in the case of sole proprietorship;

 Original copies of Tax clearance certificates.

documents (which shall be taken as part of, and incorporated into this bid) at the prices reflected in the Pricing Schedule.

B-BBEE Minimum Level: 1

Points Allocation: 90 points

B-BBEE Details: d? (section 5)

13. Is invitation to bid completed and signed?(MBD 1)
14. Is the Declaration of Interest completed and signed? (MBD 4)
15. Is the Declaration of Bidder’s Past Supply Management Practices

completed and signed? (MBD 8)

16. Is the Certificate of Independent Bid Determination completed and

signed? (MBD 9)

17. Did you complete and sign the Previous Work Experience of a Similar

Nature section? (section 9)

18. Is the Preference Points Claim Form in Terms of the Preferential

Procurement Regulation 2011 completed and signed? (MBD 6.1)

19. Did you provide an original and valid B-BBEE status level verification

certificate or a certified copy thereof or, if you qualify as an EME, did

you provide a verification certificate? (MBD 6.1)

20. Does the product/service offered conform to the Bid Specifications?
21. Is Pricing Schedule completed?(MBD 3.1)
22. Where applicable, is the Declaration for Procurement Above R10

million (all applicable taxes included) completed and signed? (MBD 5)

23. Did you attach the annual financial statements as required in MBD 5?

(For Procurements above R10 million)

2. Special conditions of bid
3. The Municipality’s document must be kept as supplied and submitted with all schedules / forms fully

completed.

2. Any other documents, certificates etc. must be attached as an annexure to the official Municipal

document.

3. Where the Municipality’s official document is taken apart and not submitted as supplied, the bid

might be rejected.

4. Schedules / forms not duly completed and signed by the bidder will result in a bid not being

considered.

5. All Forms of Special Conditions in Specifications should be included.
6. The bid document must be completed in black ink, and prices must be VAT inclusive, unless

otherwise spec

Preference points claim form (MBD 6.1): The applicable preference point system for this tender is the 80/20 system (price 80 points, specific goals 20 points). Points for specific goals: B-BBEE status level: Level 1 = 4, Level 2 = 3, Level 3 = 1, Level 4 and up = 0. Ownership by Black people = 4 points. Additional specific goals: Taxes of not more than Three (3) People or Business residing with Naledi Local Municipality = 4 points (verification: statement of municipal rates and taxes/tribal letter). Women = 4 points (verification: ID document). People with disabilities = 4 points (verification: medical report). Youth (18-35 years) = 4 points (verification: ID document).

sign as follows:

(Specimen Signature)

be, and is hereby, authorised to sign the Bid and/or all other documents and/or correspondence in connection with and

relating to the Bid, as well as to sign any contract, and/or all documentation resulting from the award of the bid to the

enterprise mentioned above.

Note: The resolution must be signed by all the directors or members/partners of the bidding enterprise. Should the space provided

below not be sufficient for all directors to sign, please provide a separate sheet in the same format as below.

joint venture agreement and contract with the NALEDI LOCAL MUNICIPALITY in respect of the project under item 1:

(Physical Address)

Note: The resolution must be signed by all the directors or members / partners of the bidding enterprise. Should the space provided

below not be sufficient for all directors to sign, please provide a separate sheet in the same format as below.

 Claims Administration system to administrate occupational injuries and disease claims

 It is expected of the Broker to have capacity to provide the following services at an appropriate time to be determined by

the Municipality on a fee to be agreed with the Municipality.

 Administration of all claims arising from occupational activities of the employees of the Council pursuant the Compensation

for Occupational Injuries and Disease Act no and the Occupational Health and Safety Act

 Formulation and Implementation of Risk Management Strategy in line with the provision of the Municipal Finance

 Management of Occupational Injuries and Diseases Act as well as Occupational Health and Safety Act risk related to the

implementation of construction contracts by third parties on behalf of Council

Mbd 5

11.DECLARATION For procurement above r10 million (all

Applicable taxes included) (mbd 5)

For all procurement expected to exceed R10 million (all applicable taxes included), bidders must complete the following

questionnaire:

1. Are you by law required to prepare annual financial statements for auditing? *YES / NO

• Delete if not applicable

1.1 If yes, submit audited annual financial statements for the past three years or since the date of establishment if established

during the past three years.

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

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

have any imported content? YES / NO

Mbd 6.2

4.1 If yes, the rate(s) of exchange to be used in this bid to calculate the local content as

prescribed in paragraph 1.6 of the general conditions must be the rate(s) published

by the SARB for the specific currency at 12:00 on the date, one week (7 calendar

days) prior to the closing date of the bid.

Bid declaration terms: The bidder agrees the offer remains valid for 90 days from closing date. The bid and its acceptance are subject to the Municipality's Supply Chain Management Policy. If the bidder withdraws within the validity period or fails to fulfil the contract, the Municipality may recover additional expenses incurred by accepting a less favourable bid or inviting fresh bids, and may set off against moneys due or retain guarantees as security. Acceptance may be communicated by letter or order sent by certified or registered mail, deemed served from date of posting. The contract is governed by South African law; bidder chooses domicilium citandi et executandi in South Africa. The bidder confirms correctness and validity of the bid, that prices cover all work and obligations, and accepts risk of mistakes. The bidder accepts full responsibility for proper execution and fulfilment of all obligations as principal. Any action arising from the contract may be instituted against the bidder. The bidder declares participation or no participation in other offers for the same supplies/services.

Special conditions of bid: The Municipality's document must be kept as supplied and submitted with all schedules/forms fully completed. Any other documents must be attached as annexures. Where the official document is taken apart and not submitted as supplied, the bid might be rejected. Schedules/forms not duly completed and signed will result in the bid not being considered. All forms of special conditions in specifications should be included. The bid document must be completed in black ink, prices VAT inclusive unless otherwise specified. The lowest or any bid will not necessarily be accepted; the Municipality reserves the right to accept the whole or any portion of a bid. All prices and details must be legible. Corrections may not be made with correction fluid; mistakes should be crossed out in ink and signed at each alteration. The Municipality reserves the right to reject bids with improper corrections. All bid documents must include: original receipt for bid documents, certified copies of registration certificates, certified copy of ID for sole proprietors, original or certified copy of B-BBEE certificate, and original tax clearance certificates. Bidders may submit a comprehensive company profile. Bidders must be registered on the Municipality's Supplier Database; consultants on the Consultant Roster System. No bids via email, telegram, telex, fax or similar. Late bids shall not be considered. Bids must be deposited in the bid box at 19A Market Street, Vryburg, 8601, on or before 12:00 on Friday, 18 September 2026, in a sealed envelope marked with bid number and description. Copyright/patent rights in any document produced or system devised by a consultant in the course of the consultancy service vest in the Municipality.

Requirements for this bid: Bidders must be registered as accredited prospective suppliers with Naledi Local Municipality. A bid document administration fee must be paid and receipt attached. Certified copies of company registration and VAT registration certificates must be provided. For sole proprietorships, a certified copy of ID is required. Registration certificate for relevant industry if applicable. A covering letter must be provided. Original and valid tax clearance certificate (MBD2) required. Completed and signed Bid Declaration, Board Resolution (where applicable), Invitation to Bid (MBD1), Declaration of Interest (MBD4), Declaration of Bidder's Past SCM Practices (MBD8), Certificate of Independent Bid Determination (MBD9), Previous Work Experience section, Preference Points Claim Form (MBD6.1), and original/certified B-BBEE certificate. Pricing Schedule (MBD3.1) must be completed. Declaration for Procurement Above R10 million (MBD5) and annual financial statements if applicable. Bidders must be registered on the Municipality's Supplier Database; consultants on the Consultant Roster System. No bids via email, fax, etc. Late bids not considered. Bids must be in sealed envelope marked with bid number and description, deposited in bid box at 19A Market Street, Vryburg, 8601, by 12:00 on 18 September 2026.

Evaluation of bidders’ ability to execute the project in terms SCM regulation 28 (1)(b).

Failure to meet the following mentioned will lead to disqualification of your bid:

Maximum

Criteria Points

Relevant experience of years in the provision of short-term insurance services. (Appointment Letters and reference 25

letters on the relevant letterhead and signed by a delegated official from the client served for similar service – Indicating

the years):

Years of Relevant Experience Points

10+ Years 25

6–9 Years 10

1–5 Years 5

Relevant experience in project value in the provision of short-term insurance services has been successfully executed 15

by the tenderer itself; and for which an appointment and reference letters (signed by the client) have been submitted, will

be evaluated.

Points will be awarded as follows for each project completed successfully:

Project Value Points

Less than R10 million 0

Equal to or greater than R10 million but less than R20 million 9

Equal to or greater than R20 million but less than R30 million 13

Equal to or greater than R30 million 20

Mbd 3.1

Qualifications, Professional Affiliation/Registration and Experience of Key Personnel: 25

i. Qualification:

Post Level Minimum Qualification required Points

allocated

Director of the company Insurance related qualifications 4

Passed FAIS Regulatory Exam

(Attach exam results/ certificate)

Account Executive/ Insurance related qualifications

Relationship Manager 3

Passed FAIS Regulatory Exam

(Attach exam results/ certificate)

Claims Manager / Insurance related qualifications 2

Supervisor

Passed FAIS Regulatory Exam

(Attach exam results/ certificate)

Claims Administrator / Matric and Insurance related Course (Attach 1

Handler Matric & Insurance related Certificate)

ii. Staff Competency

Post Level Experience Experience

Account Executive/ Relationship Manager 10 yrs or more 5 – 9 yrs

(7 points) (5 points)

Claims Manager / 8 yrs or more 5 - 7 yrs

Supervisor (5 points) (3 points)

Claims Administrator / 5 yrs or more 1 - 4 yrs

Handler (3 points) (2 points)

NB!! Bidders to provide an organogram reflecting the positions as stated above and the position holders.

Methodology and Approach 5

A clearly defined Proposal including:

 Detailed Project plan with clear timelines

 Detailed process Plan on how the account will be managed i.e., processing of claims, queries, etc.

 The quality of the criteria to provide cover to be used i.e., what will be regarded as a valid claim to

maximum risk?

 Provide a detailed methodology including how the Service Provider will conduct services between the

Client, Broker, and Insured Party.

The methodology and workplan should include all the above-mentioned aspects and be in detail.

Evaluation Points

Comprehensive and detailed 5

Adequate 3

Poor / Inadequate 1

Not Submitted 0

Proof professional Indemnity Insurance

Project Value Points

R50 million 10

R30 million – R40 million 4

R20 million – R30 million 2

Proof of accredited professional insurance association or affiliation of the service provider:

• Financial Services Provider (FSP) under Financial Advisory and Intermediary Services (FAIS) License

and/or;

• Letter of good standing with the Financial Sector Conduct Authority FSCA.

Requirement Points

Valid FSP License and FSCA Good Standing submitted 15

Not Submitted / Not Valid 0

100Total Score

NB: A bidder that scores less than 75 points out of 100 points in respect of functionality will be regarded as submitting a non-

responsive bid and will not further be evaluated.

9. Previous work experience of a similar nature

List main work experience of a similar nature to this bid successfully executed and completed (or on-going) in the last five (5) years:

Date

completed

Date (indicate Project value in Name and contact details of contact person /No Institution / client / employer Project description

started projected Rand reference at institution

completion

if on-going)

Representatives of the NALEDI LOCAL MUNICIPALITY are hereby authorized to contact the above contact persons / references of the various institutions to verify the correctness of the information as supplied.

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

. Date

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

Position Name of Bidder

Mbd 4

10. Declaration of interest (mbd 4)

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

12. 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 and/or take an oath

declaring his/her interest.

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 Company Registration Number: ................................................................................................................. 3.4

Tax Reference Number: .................................................................................................................

3.5 VAT Registration Number: .................................................................................................................

3.6 Are you presently in the service of the state *YES / NO

• Delete if not applicable

3.6.1 If so, furnish particulars.

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

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

3.7 Have you been in the service of the state for the past twelve months *YES / NO

• Delete if not applicable

3.7.1 If so, furnish particulars.

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

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

3.8 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

• Delete if not applicable

3.8.1 If so, furnish particulars.

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

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

3.9 Are you aware of any relationship (family, friend, other) between a 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

• Delete if not applicable

3.9.1 If so, furnish particulars

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

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

 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.);

(e) a member of the accounting authority of any national or provincial public entity; or

(f) an employee of Parliament or a provincial legislature.

Mbd 4

3.10 Are any of the company’s directors, managers, principal shareholders or stakeholders in service of the state? *YES / NO

• Delete if not applicable

3.10.1 If so, furnish particulars.

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

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

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

state? *YES / NO

• Delete if not applicable

3.11.1 If so, furnish particulars.

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

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

Certification

I, the undersigned (name) .................................................................................................................

Certify that the information furnished on this declaration form is correct.

I accept that the state may act against me should this declaration prove to be false.

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

Signature .

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

Position Name of Bidder

Mbd 5

11.DECLARATION For procurement above r10 million (all

Applicable taxes included) (mbd 5)

For all procurement expected to exceed R10 million (all applicable taxes included), bidders must complete the following

questionnaire:

1. Are you by law required to prepare annual financial statements for auditing? *YES / NO

• Delete if not applicable

1.1 If yes, submit audited annual financial statements for the past three years or since the date of establishment if established

during the past three years.

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

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

2 Do you have any outstanding undisputed commitments for municipal services towards any municipality for more than three

months or any other service provider in respect of which payment is overdue for more than 30 days? *YES / NO

• Delete if not applicable

2.1 If no, this serves to certify that the bidder has no undisputed commitments for municipal services towards any municipality for

more than three months or other service provider in respect of which payment is overdue for more than 30 days.

2.2 If yes, provide particulars.

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

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

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

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

3 Has any contract been awarded to you by an organ of state during the past five years, including particulars of any material non-

compliance or dispute concerning the execution of such contract? *YES / NO

• Delete if not applicable

3.1.1 If yes, furnish particulars

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

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

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

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

4 Will any portion of goods or services be sourced from outside the Republic, and, if so, what portion and whether any portion of

payment from the municipality / municipal entity is expected to be transferred out of the Republic? *YES / NO

• Delete if not applicable

4.1 If yes, furnish particulars

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

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

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

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

Mbd 5

Certification

I, the undersigned (name) .................................................................................................................

Certify that the information furnished on this declaration form is correct.

I accept that the state may act against me should this declaration prove to be false.

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

Signature .

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

Position Name of Bidder

Mbd 6.1

12.PREFERENCE Points claim form in terms of

The preferential procurement regulations 2022 (mbd 6.1)

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:

• 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).

1.2 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.

1.3 Points for this tender (even in the case of a tender for income-generating contracts) shall be awarded for:

(a) Price; and

(b) Specific Goals.

1.4 To be completed by the organ of state:

The maximum points for this tender are allocated as follows:

Points

Price 80

Specific goals 20

Total points for Price and SPECIFIC GOALS 100

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.

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;

(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. ).

3. Formulae for procurement of goods and services

3.1. Points awarded for price

Mbd 6.1

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 or 90/10

Pt−Pmin Pt−Pmin

Ps= 80(1− ) or Ps= 90(1− )

Pmin Pmin

Where

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 or 90/10

Pt−Pmax Pt−Pmax

Ps= 80(1+ ) or Ps= 90(1+ )

Pmax Pmax

Where

Ps = Points scored for price of tender under consideration

Pt = Price of tender under consideration

Pmax = Price of highest acceptable tender

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.

Mbd 6.1

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.)

Preference Points for Specific Goals Means of Verification Number of Points

BEE Certificate/ Sworn Affidavit

BEE status:

 Level 1= 4

 Level 2= 3

 Level 3= 1

 Level 4 up 0

Ownership by Black people 4

Statement of Municipal Rates and

Taxes of not more than Three (3)

People or Business residing with Naledi Local Municipality Months/ tribal letter 4

Women Identification Document 4

People with disabilities Medical Report confirming disability 4

Youth (18 to 35 Years of age) Identification Document 4

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

(e) forward the matter for criminal prosecution, if deemed necessary.

Mbd 6.1

Mbd 6.2

12. Declaration certificate for local production and

Content mbd 6.2

This Municipal Bidding Document (MBD) must form part of all bids invited. It contains

general information and serves as a declaration form for local content (local production

and local content are used interchangeably).

Before completing this declaration, bidders must study the General Conditions,

Definitions, Directives applicable in respect of Local Content as prescribed in the

Preferential Procurement Regulations, 2011 and the South African Bureau of Standards

(SABS) approved technical specification number SATS 1286:201x.

1. General Conditions

1.1. Preferential Procurement Regulations, 2011 (Regulation 9.(1) and 9.(3) make

provision for the promotion of local production and content.

1.2. Regulation 9.(1) prescribes that in the case of designated sectors, where in the

award of bids local production and content is of critical importance, such bids must

be advertised with the specific bidding condition that only locally produced goods,

services or works or locally manufactured goods, with a stipulated minimum

threshold for local production and content will be considered.

1.3. Regulation 9.(3) prescribes that where there is no designated sector, a specific

bidding condition may be included, that only locally produced services, works or

goods or locally manufactured goods with a stipulated minimum threshold for local

production and content, will be considered.

1.4. Where necessary, for bids referred to in paragraphs 1.2 and 1.3 above, a two stage

bidding process may be followed, where the first stage involves a minimum

threshold for local production and content and the second stage price and B-BBEE.

1.5. A person awarded a contract in relation to a designated sector, may not sub-

contract in such a manner that the local production and content of the overall value

of the contract is reduced to below the stipulated minimum threshold.

1.6. The local content (LC) as a percentage of the bid price must be calculated in

accordance with the SABS approved technical specification number SATS 1286:

201x as follows:

LC = 1 x 100

Where

x imported content

y bid price excluding value added tax (VAT)

Prices referred to in the determination of x must be converted to Rand (ZAR) by

using the exchange rate published by the South African Reserve Bank (SARB) at

12:00 on the date, one week (7 calendar days) prior to the closing date of the bid as

required in paragraph 4.1 below.

1.7. A bid will be disqualified if:

 the bidder fails to achieve the stipulated minimum threshold for local

production and content indicated in paragraph 3 below; and.

 this declaration certificate is not submitted as part of the bid documentation.

Mbd 6.2

2. Definitions

2.1. “bid” includes advertised competitive bids, written price quotations or proposals;

2.2. “bid price” price offered by the bidder, excluding value added tax (VAT);

2.3. “contract” means the agreement that results from the acceptance of a bid by an

organ of state;

2.4. “designated sector” means a sector, sub-sector or industry that has been

designated by the Department of Trade and Industry in line with national

development and industrial policies for local production, where only locally produced

services, works or goods or locally manufactured goods meet the stipulated

minimum threshold for local production and content;

2.5. “duly sign”means a Declaration Certificate for Local Content that has been signed

by the Chief Financial Officer or other legally responsible person nominated in

writing by the Chief Executive, or senior member / person with management

responsibility(close corporation, partnership or individual).

2.6. “imported content” means that portion of the bid price represented by the cost of

components, parts or materials which have been or are still to be imported (whether

by the supplier or its subcontractors) and which costs are inclusive of the costs

abroad, plus freight and other direct importation costs, such as landing costs, dock

duties, import duty, sales duty or other similar tax or duty at the South African port of

entry;

2.7. “local content” means that portion of the bid price which is not included in the

imported content, provided that local manufacture does take place;

2.8. “stipulated minimum threshold” means that portion of local production and

content as determined by the Department of Trade and Industry; and

2.9. “sub-contract” means the primary contractor’s assigning, leasing, making out work

to, or employing another person to support such primary contractor in the execution

of part of a project in terms of the contract.

3. The stipulated minimum threshold(s) for local production and content for this

bid is/are as follows:

Mbd 6.2

Description of services, works or goods Stipulated minimum threshold

_______________________________ _______%

_______________________________ _______%

_______________________________ _______%

4. Does any portion of the services, works or goods offered

have any imported content? YES / NO

Mbd 6.2

4.1 If yes, the rate(s) of exchange to be used in this bid to calculate the local content as

prescribed in paragraph 1.6 of the general conditions must be the rate(s) published

by the SARB for the specific currency at 12:00 on the date, one week (7 calendar

days) prior to the closing date of the bid.

The relevant rates of exchange information is accessible on www.reservebank.co.za.

Indicate the rate(s )of exchange against the appropriate currency in the table below:

Currency Rates of exchange

US Dollar

Pound Sterling

Euro

Yen

Other

NB: Bidders must submit proof of the SARB rate (s) of exchange used.

Local content declaration by chief financial officer or other

Legally responsible person nominated in writing by the chief

Executive or senior member/person with management responsibility

(Close corporation, partnership or individual)

IN RESPECT OF BID No. .................................................................................

ISSUED BY: (Procurement Authority / Name of Municipality / Municipal Entity):

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

NB The obligation to complete, duly sign and submit this declaration cannot be

transferred to an external authorized representative, auditor or any other third party acting

on behalf of the bidder.

I, the undersigned, ................................................................................... (full names),

do hereby declare, in my capacity as ............................................. ...........

of ...............................................................................................................(name of bidder

entity), the following:

(a) The facts contained herein are within my own personal knowledge.

(b) I have satisfied myself that the goods/services/works to be delivered in terms of the

above-specified bid comply with the minimum local content requirements as specified in

the bid, and as measured in terms of SATS 1286.

(c) The local content has been calculated using the formula given in clause 3 of SATS

1286, the rates of exchange indicated in paragraph 4.1 above and the following figures:

Bid price, excluding VAT (y) R

Imported content (x) R

Stipulated minimum threshold for Local content (paragraph

3 above)

Local content % as calculated in terms of SATS 1286

If the bid is for more than one product, a schedule of the local content by product shall be

attached.