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

SECTION 1: COMPANY DETAILS
1.1 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 N D 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


GENERAL INFORMATION Form II (Cont.)


SECTION 3: CONTACT PERSONS

3.1 Commercial Contact Information
3.1.1 Commercial Contact Name:
K E L V I N K A M A L A T A
3.1.2 Commercial Contact Number:
0 8 1 7 2 8 0 9 4 6
3.1.3 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


3.2 Technical Contact Information
3.2.1 Technical Contact Name:

3.2.2 Technical Contact Number:

3.2.3 Technical Contact e-Mail:




3.3 Sales Representative Contact Information
3.3.1 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:



SECTION 4: COMPANY PROFILE

Please indicate which of the following represents your Company:

4.1 Listed Company YES
4.2 Private Company YES
4.3 CC Owned Company YES
4.4 Section 21 Company YES
4.5 NGO YES
4.6 Other YES




GENERAL INFORMATION Form II (Cont.)

SECTION 5: COMPANY HIERARCHY


Please indicate which of the following represents your Company:
5.1 A Holding Company YES NO

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








5.2 A Subsidiary 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 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.)

6.5 Demographics of Shareholders and Senior Management (please insert appropriate details)


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?
Yes No

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

6
months
12
months
18
months
24 months 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 YES
7.2

ISO 14000 Environmental Management System YES

7.3 Other YES


If Other Please Specify:
__________________________________________________________________________





RELEVANT EXPERIENCE RECORD 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














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
PERSONS
EXPERIENCE
















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



Form II (Cont.)


PERMITS


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

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


Please attach copies of your company documentation, as applicable:

Certificate of Registration or Trade Certificate/Permit
Registration certificate for the Workmens 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

SECTION 8: ATTACHMENTS: