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SECTION F

Tenderers must complete this section accurately, as the evaluation of tenders will also be based on the information submitted

GENERAL INFORMATION

Form II

ALL INFORMATION DISCLOSED WILL BE TREATED AS HIGHLY CONFIDENTIAL

PLEASE ENSURE THAT THE QUESTIONNAIRE IS SIGNED-OFF

1.1 SECTION 1: COMPANY DETAILS Full name of Company: H I G H W A
1.1
SECTION 1: COMPANY DETAILS
Full name of Company:
H
I
G
H
W A
Y
T
R
E
K
K
E
R
C
L
O
S
E
C
O
R
P
O
R
A
T
I
O
N
1.2
Company Registration Number:
C
C
/
2
0
0
9
/
0
5
2
3
1.3
Company Web Address:
N
/
A
1.4
Vat Registration Number:
4
8
5
9
5
7
1
0
1
5
SECTION 2: ADDRESS & CONTACT INFORMATION
2.1
Telephone Number (Include area code):
+ 2
6
4
8
1
7
2
8
0
9
4
6
2.2
Fax Number (Include area code):
2.3
Company e-Mail Address:
K
e
l
v
i
n
m z
i
n
a
@ h
o
t
m a
i
l
.
c
o
.
u
k
2.4
Physical Address (Include Suburb, City, etc. as part of address)
1
7 H
A
H
N
E
M A
N
N
S
T
R
E
E
T
W
I D
N
H
O
E
K
- W
E
S
T
W I
N
D
H
O
E
K
Postal Code:
Province / Region:
K H
O
M A
S
R
E
G I
O
N
Country:
N A
M I
B
I
A
2.5
Postal Address (Include Suburb, City, etc. as part of address)
P
. O
B
O
X
2
1
3
9
W
I N
D
H
O
E
K
A 2.5 Postal Address (Include Suburb, City, etc. as part of address) P . O B

GENERAL INFORMATION

Form II (Cont.)

3.1

 

3.1.1

3.1.2

3.1.3

3.2

 

3.2.1

3.2.2

3.2.3

SECTION 3: CONTACT PERSONS

Commercial Contact Information Commercial Contact Name: K E L V I N K A M
Commercial Contact Information
Commercial Contact Name:
K
E
L
V
I
N
K
A
M A
L
A
T
A

Commercial Contact Number:

0 8 1 7 2 8 0 9 4 6 Commercial Contact e-Mail: K e
0
8
1
7
2
8
0
9
4
6
Commercial Contact e-Mail:
K
e
l
v
i
n
m z
i
n
a
@ h
o
t
m a
i
l
.
c
o
.
u
k

Technical Contact Information Technical Contact Name:

u k Technical Contact Information Technical Contact Name: Technical Contact Number: Technical Contact e-Mail: 3.3

Technical Contact Number:

Technical Contact Name: Technical Contact Number: Technical Contact e-Mail: 3.3 3.3.1 Sales

Technical Contact e-Mail:

Name: Technical Contact Number: Technical Contact e-Mail: 3.3 3.3.1 Sales Representative Contact Information

3.3

3.3.1

Sales Representative Contact Information Representative Contact Name:

 
 
 

3.3.2

Representative Contact Phone Number:

 
 
 

3.3.3

Representative Contact Fax Number:

 
 
 

3.3.4

Representative Cell Phone Number:

 
 
 

3.3.5

Representative Contact e-Mail:

    3.3.5 Representative Contact e-Mail: SECTION 4: COMPANY PROFILE Please indicate which of the

SECTION 4: COMPANY PROFILE

Please indicate which of the following represents your Company:

4.1

Listed Company

YES4.1 Listed Company

4.2

Private Company

YES4.2 Private Company

4.3

CC Owned Company

YES4.3 CC Owned Company

4.4

Section 21 Company

YES4.4 Section 21 Company

4.5

NGO

YES4.5 NGO

4.6

Other

YES4.6 Other

GENERAL INFORMATION

Form II (Cont.)

SECTION 5: COMPANY HIERARCHY

Please indicate which of the following represents your Company:

5.1

A Holding Company

the following represents your Company: 5.1 A Holding Company YES NO If Yes, Please supply details

YES

following represents your Company: 5.1 A Holding Company YES NO If Yes, Please supply details (full

NO

If Yes, Please supply details (full names only) of all Subsidiary Companies:

5.2

A Subsidiary

names only) of all Subsidiary Companies: 5.2 A Subsidiary YES If Yes, Please supply details (full

YES

If Yes, Please supply details (full names only) of your Holding Companies:

5.3 Do you have agents operating on you behalf? YES NO If Yes, Please supply
5.3
Do you have agents operating on you behalf?
YES
NO
If Yes, Please supply details in line with the following table:
Name of Agent
Town in which located
Province

SECTION 6: COMPANY OWNERSHIP & DEMOGRAPHICS

The following information will remain confidential at all times and will only be used for reference purposes

6.1 Gross Asset Value (please tick appropriate box)

<R2 million

<R20 million

<R50 million

>R50 million

6.2 Annual Turnover (please tick appropriate box)

 

<R2 million

<R20 million

<R50 million

>R50 million

6.3 Total number of employees (please tick appropriate box)

 

<10

<100

<150

<200

>200

6.4 Total number of shareholders actively involved in business

:

GENERAL INFORMATION

Form II (Cont.)

NAME CITIZENSHIP GENDER POSITION HELD % SHARE- HOLDING
NAME
CITIZENSHIP
GENDER
POSITION HELD
% SHARE-
HOLDING

7 Total no of disabled shareholders :

% of total shareholding

%

If your business does not have any Designated Groups shareholding, please indicate your future intent below.

Do you plan to transform into a BEE business?

Yesintent below. Do you plan to transform into a BEE business? No If Yes, please indicate

below. Do you plan to transform into a BEE business? Yes No If Yes, please indicate

No

If Yes, please indicate a timeframe and provide a copy of your transformation plan.

a timeframe and provide a copy of your transformation plan. 6 12 18 months months 24

6

12 18 months months
12
18
months
months

24 months

your transformation plan. 6 12 18 months months 24 months 36 months 8 Do you have

36 months

8 Do you have a Preferential Procurement Initiative benefiting Historically Disadvantaged Namibians?

Yes

No

9 Do you sub-contract or outsource any of your requirements to Designated Groups in terms of the Affirmative Action Act?

Yes

No

10 Does your organisation have an HIV Policy?

Yes

No

11 Does your organisation have a Corporate Social Investment Policy?

Yes

No

SECTION 7 : QUALITY MANAGEMENT SYSTEMS Has your company been certified in accordance with the following Please attach a copy of the certificate:

7.1

ISO 9001:2000 Quality Management System

YES7.1 ISO 9001:2000 Quality Management System

7.2

ISO 14000 Environmental Management System

YES7.2 ISO 14000 Environmental Management System

7.3

Other

If Other Please Specify:

RELEVANT EXPERIENCE RECORD

Other If Other Please Specify: RELEVANT EXPERIENCE RECORD YES Form II (Cont.) List of all relevant

YES

Form II (Cont.)

List of all relevant contracts executed during the last three years.

NATURE OF WORK CONTRACT PERIOD TOTAL VALUE (N$) PROVIDE REFERENCE NAME, COMPANY & CONTACT DETAIL
NATURE OF WORK
CONTRACT PERIOD
TOTAL VALUE
(N$)
PROVIDE REFERENCE NAME, COMPANY
& CONTACT DETAIL

PLEASE LIST YOUR PROPOSED ORGANISATIONAL ON-SITE ORGANOGRAM, AS WELL AS YOUR PERMANENTLY ON-SITE BASED SKILLS LEVEL FOR THE SERVICES, IF SUCCCESFUL (ATTACH CURRUCULUM VITAES)

DESIGNATION/POSITION NO OF EXPERIENCE PERSONS
DESIGNATION/POSITION
NO OF
EXPERIENCE
PERSONS

DEDICATED ON-SITE MANAGER

Provide detail including cv. of your permanently on-site based Manager

PERSONNEL

Provide complete curriculum vitas of your personnel

TRACK RECORD / PREVIOUS WORK OF SIMILAR NATURE

Provide detail of previous similar work done

PERMITS

Form II (Cont.)

Provide certified copies of all relevant permits and licenses applicable to your Personnel and Conveyances that will be involved / utilized for the transportation Services.

DEMAND GUARENTEE IN RESPECT OF PERFORMANCE

Attach a copy of your valid performance guarantee certificate, or letter from your financial institute that a guarantee will be issued, should you tender be successful for the provision of the services.

SAFETY RULES & PROCEDURES FOR CONTRACTORS NAMDEB CC2: REVISION 13

Please Safety is Namdeb’s number 1 Value. Namdeb’s standard “Safety Rules and Procedures for Contractors – Namdeb CC2, revision 13 is attached and is as integral part of this the RFP.

Tenderer’s must clearly indicate in their RFP, either confirmation of acceptance and compliance with Namdeb’s SHE standards, or alternatively provide details of Tenderer’s own safety, health and environmental standards for review by Namdeb.

SECTION 8: ATTACHMENTS:

Please attach copies of your company documentation, as applicable:

Certificate of Registration or Trade Certificate/Permit

Registration certificate for the Workmen’s Compensation Fund

Registration certificate for the Social Security Commission

Quality Management Systems, if applicable

Ownership Transformation Plan

HIV Policy

Corporate Social investment policy

Letterhead

Quality Management System certificates

Company registration certificate (Issued by Ministry of Trade & Industry)

VAT registration certificate

ATTACHED

ATTACHED

ATTACHED

ATTACHED

ATTACHED

ATTACHED

ATTACHED

ATTACHED

ATTACHED

ATTACHED

ATTACHED

TO BE COMPLETED AND SIGNED-OFF BY AN AUTHORISED COMPANY REPRESENTATIVE

NAME (PRINT)

SIGNED

DESIGNATION

DATE