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Call for Service Rural Districts
Reference: CFSR1
VERSION 1: MAY 2014
CALL FOR SERVICE RURAL DISTRICTS
CALL FOR THE PROVISION OF HEALTH CARE SERVICES BY PRIVATE SERVICE PROVIDERS OR
NON GOVERNMENTAL ORGANISATIONS IN THE WESTERN CAPE
YOU ARE HEREBY INVITED TO SUBMIT YOUR APPLICATION IN RESPONSE TO THIS CALL FOR
SERVICE TO THE DEPARTMENT OF HEALTH: WESTERN CAPE GOVERNMENT
More information available on: http://www.westerncape.gov.za/your_gov/191/
CLOSING DATE: 31 AUGUST 2014
THE WESTERN CAPE GOVERNMENT HEALTH DEPARTMENT CALLS ON PRIVATE HEALTH
SERVICE PROVIDERS WITH RELEVANT SKILLS, EXPERIENCE AND FACILITIES TO SUBMIT THEIR
APPLICATIONS TO RENDER FAMILY PLANNING AND/OR IMMUNISATION SERVICES ON
BEHALF OF THE WESTERN CAPE GOVERNMENT.
APPLICATION DOCUMENTS MAY BE:
EMAILED TO:
[email protected]
OR faxed to: 086 203 9046
APPLICATION DOCUMENTS MAY BE POSTED
CLEARLY MARKED CALL FOR SERVICE TO:
BUSINESS DEVELOPMENT UNIT
DEPARTMENT OF HEALTH
8 RIEBEEK STREET
5TH FLOOR NORTON ROSE HOUSE
CAPE TOWN
8000
Please note the following important requirements:
1. Applications may be posted, faxed or submitted via the Business Development
email.
2. Please submit Annexure A and F together with supporting documents as indicated
in Annexure B. All applications must be submitted on the official forms as per the
Annexures to this document – (not to be re-typed) and only originally signed
documents will be considered.
3. The following contact details should be attached: Addressed to the Business
Development Unit, contact name, contact title, company name, address,
telephone number, cellular number and email.
Please refer all technical/specification enquiries to Andisiwe Pula, tel: 021 483 3212,
email: [email protected]
PURPOSE
To enhance the current Primary Health Care network through partnership with the Private
Sector, thereby increasing quality and access to care available to citizens of the Western
Cape.
BACKGROUND
There are multiple historical arrangements that have arisen over the past 15-20 years, in
terms of provision of state stock for family planning methods and vaccines to private
practitioners and non-governmental providers (including NPO’s) in the Western Cape. It
is intended that all providers who receive state stock will comply with a uniform policy.
OBJECTIVE
The intent of such a policy(s) is to address the following standard items, amongst others;
1.1
Ordering and supply of stock e.g. inventory, medicines and medical
supplies
1.2
Management of state stock (medicines and medical supplies)
1.3
Management of seconded personnel (as applicable)
1.4
Provision of services (including referrals)
1.5
Monitoring and evaluation of performance of providers
1.6
Adverse Events
1.7
Confidentiality of information
1.8
Risk management
1.9
Copyright and intellectual property rights
1.10
Payment of fees and expenses (where applicable)
1.11
Public Liability & Indemnity Cover
The following highlighted concerns will expressly be addressed in the aforementioned
policy(s);
1.12
Wastage and expired stock: - more strict stock control measures;
1.13
Fees: - specify conditions under which fees and/or service fees may be
levied by providers;
1.14
Stricter criteria and clear guidelines for monitoring and evaluation of the
various Providers;
1.15
The introduction of a revised standard contract which comprehensively
addresses the Supply Chain Management requirements for all providers
and
1.16
Control, prescribing, dispensing and administering of medicines and
medical supplies required to provide the service.
CRITERIA FOR APPLICATION
In order to be considered, applicants must comply with criteria as per Annexure A to this
document. Applicants will also be subject to a vetting and approval process as well as a
site inspection. Application approval will be based on the district’s need for such a
service among other criteria. The rendering of family planning services is subject to
authorisation in terms of the Nursing Act 33 of 2005, section 56(6).
Page 2 of 27
Call for Service Rural Districts
Reference: CFSR1
ANNEXURE A: APPLICATION CRITERIA
Applicants that have submitted complete forms and passed the initial screening evaluation will
be issued with a reference number via post or email. Applications must include the following
documents (including this Annexure A) to be considered for further processing:
Item
no
1
3
4
5
6
7
8
9
10
11
12
Description
Yes
Applications must be properly received (fully completed and signed)
in a sealed envelope indicating the application name, Bid reference
number and Call for Service reference number
Submission of certified copy/copies of ID documents or passports
Certified copy of proof of Registration
Certified copy of proof of payment of annual fee for current year –
pharmacy, hospital, etc.
Certified copy of relevant permits (Annexure B)
Motivational letter (to include estimate of number of patients
currently making use the facility, as well as estimated future patient
demand for baby vaccinations and family planning consultations
respectively.)
Section 56(6) authorisation (Nursing Act) or proof that application for
authorisation has been made.
Evidence of current competence e.g. CPD activities, proof of
attendance of courses for updates within last 3 years, Family Planning
course, Expanded child immunization programme
Copy of the Registration Certificate(s) of organisation
A valid original Tax Clearance Certificate issued by the South African
Revenue Service (SARS)
Cold Chain:

Is the refrigerator only used for vaccines?

Is a functional continuous electronic monitoring device used to
record temperatures in the fridge and is correctly placed?

Does the fridge have a dedicated plug with a warning notice?
No
Comments
Disclaimer
1.
2.
3.
4.
Applications that do not meet the requirements as set out in Annexure A or do not have the
specified supporting documents will not be accepted;
The Department may request additional information and conduct such enquiry in order to finalise its
decision in relation to the application;
The Department may at its sole discretion decline any application for whatsoever reason/s. The
Department shall however inform applicants in writing thereof provided that the applicant has
passed the initial screening evaluation;
Applicants that have not received any correspondence or reference numbers within 30 days may
consider their application to be unsuccessful.
I, _____________________(Full name) ,____________________(Position) hereby certify that the
information, representations and documents attached to this application is true and correct at
the time of completion, and that I am duly authorised to furnish this application on behalf of the
organisation.
_______________________________ (Signature)
___________________________ (Date)
Page 3 of 27
immunisation or family planning
immunisation service in a
planning service in a pharmacy
immunization & family planning
immunisation service in a private
Nurse rendering a family
X
of
payment
of
X
for
pharmacy
X
X
X
of
current
Pharmacist rendering
X
service
proof
of
terms
of
the
a
health
pharmacy (employed)
Nurse rendering a family
(employed)
Nurse rendering an
service in a pharmacy
Nurse rendering an
organization
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Dispensing license
Nursing Act 33 of 2005
terms of Sec 56(6) of
providing the service in
Authorisation of nurse/s
Nursing Act 33 of 2005
service (Sect 56(6) of
performing
the DG of organisation
Proof of designation by
1965
Substances Act 101 of
Medicines and Related
in
Section 22A(15) permit
or updates within last 3
attendance of courses
activities,
competency e.g. CPD
Evidence
rendering the service
annual fees of person/s
proof of payment of
Proof of registration &
the service
ID of person/s rendering
of reg. fees (2013)
registration / payment
Pharmacist + proof of
ID doc. of Responsible
(2013)
year
annual fees for current
Proof
NDOH
Pharmacy license from
Call for Service Rural Districts
Reference: CFSR1
ANNEXURE B: DOCUMENTATION REQUIRED
PRIVATE PROVIDER
X (if products
above S2 are
Nurse rendering an
supplied)
X
X
service in a private hospital (as
part of the hospital ward)
immunization services
planning services (includes
dispensing of medicines)
X
of
payment
of
X
for
pharmacy
immunization & family planning
X
of
current
service in a private organisation
Nurse rendering immunisation
(employed)
Medical officer (doctor)
Medical officer (doctor) family
X
X
X
X
X
X
X
X
X
X
X
X
proof
of
terms
of
the
X
a
health
X
Dispensing license
Nursing Act 33 of 2005
terms of Sec 56(6) of
providing the service in
Authorisation of nurse/s
Nursing Act 33 of 2005
service (Sect 56(6) of
performing
the DG of organisation
Proof of designation by
1965
Substances Act 101 of
Medicines and Related
in
Section 22A(15) permit
or updates within last 3
attendance of courses
activities,
competency e.g. CPD
Evidence
rendering the service
annual fees of person/s
proof of payment of
Proof of registration &
the service
ID of person/s rendering
of reg. fees (2013)
registration / payment
Pharmacist + proof of
ID doc. of Responsible
(2013)
year
annual fees for current
Proof
NDOH
Pharmacy license from
PRIVATE PROVIDER
planning service in a private
organization
Nurse rendering an
X
X
Page 5 of 27
NOTES
1. Pharmacists can provide immunization and family planning if they can prove competence. A Section 22A(15) permit will be required if pharmacist
supplies any medicine which falls above S2 (to check latest scheduling of vaccines).
2. If a nurse in a pharmacy is not an employee of the pharmacy, she will be treated the same as a nurse in a private organization.
3. Where a nurse is providing immunization or family planning services in a pharmacy, a Section 22A(15) permit is not required to enable possession of the
medicine as the pharmacy is entitled by law to keep medicine .
4. In cases where a nurse supplies immunization in a private organization, she/he does not require authorization in terms of Section 56(6) as the nurse is not
making a cognitive choice as to what to use but simply following the EPI guidelines. A Section 22A(15) permit is required.
5. In cases where a nurse supplies family planning in a pharmacy or private organization she/he requires authorization in terms of Section 56(6) as in this
case the nurse is prescribing.
6. In cases where organizations need to be designated by the DG of the NDOH as organizations providing a health service in order to provide services on
behalf of the province, the applications for such designation must be submitted to NDOH by the province. NDOH consults with SAPC. Proof must be
provided by the organisation of the medical practitioner who will take responsibility for the actions of the nurses.
7. The designated organization must employ a medical practitioner who will then authorize nurses to prescribe and be responsible for their supervision
(such medical practitioner must not be in the employ of the province).
8. In all cases where a patient leaves a facility with medicine e.g. oral contraceptives supplied by a nurse or medical practitioner a dispensing license is
required.
Page 6 of 27
Call for Service Rural Districts
Reference: CFSR1
ANNEXURE C: APPLICATION PROCESS
Application Process
Private Provider

Complete applications together with
supporting documents submitted via Post
Box or Department of Health Bid Box
Business



Initial screening and evaluation
Refer to applicable district committee
Safekeeping of all documents and records

Evaluation panel to scrutinise the
application and supporting documentation
against established criteria
Premises inspection by authorised
personnel using a structured checklist
Development
(BDU)
District
committee
(evaluation)
Delegated
Authority
SLA





Recommendation made to District
Manager or Chief Director to approve
Reasons for unsuccessful decision taken to
be communicated to the applicant
SLA to be signed by District Manager or
Chief Director
All parties informed and documentation
updated by information management
Call for Service Rural Districts
Reference: CFSR1
ANNEXURE D: ORDERING PROCESS
Ordering Process
Stock Process Flow
Private Provider

Orders placed by Private Provider
electronically via fax/email using a
standardized DOH order format
District office

Delegated Sub-district Director or Primary
Health Care Manager responsible for
confirming, vetting and capture on RDM
Primary Health Care Manager /Sub –
District Director to confirm whether
relevant reporting data has been
submitted before approving order

Delivery Process
RDM
Collection of stock by
Private Provider at a
health facility

The cold chain must be maintained both
during the transportation and storage of
the medicines

Private providers to collect medicines at a
relevant clinic or hospital
Page 8 of 27
Call for Service Rural Districts
Reference: CFSR1
ANNEXURE E: PRIVATE PROVIDER AUDIT TOOL
Please note this is the rapid monitoring tool once approval has been granted, and is not the initial inspection
tool. This tool is subject to change and merely serves as a guideline. Compliance to Good Pharmacy
Practice (GPP) will also be taken into consideration.
Immunisation practices
Yes
No
Comment
Notes for supervisor
Can the immunizer indicate how and when the
Given as liquid drops per
Rotavirus vaccine is administered? Also indicate
mouth at 6 and 14 weeks.
the maximum age at which the Rotavirus vaccine
RV cannot be given after
can be given?
24 weeks of age
Can the immunizer name the injection sites of the
Intramuscularly in left thigh
Pentaxim Vaccine?
at 6,10 & 14 weeks & in the
left arm at 18 months
Is
there
an
emergency
tray
with
at
Check that none of the
least
drugs have expired
Adrenaline, Promethazine and hydrocortisone
injections?
Is the emergency procedure displayed in the
immunization room?
Is there a private consultation room appropriate
As per minimum standards
for the administration of immunisations?
in GPP
Are infection control measures observed?*
Hand washing between
patients, etc.
Is there a sharps container for the appropriate
disposal of used needles and syringes?
Is the RTHB checked and correctly completed?*
Stock Management*
Observe
Yes
No
Comment
Notes for supervisor
Is there an up-to-date, completed stock card for
Stock cards must reflect
all vaccines, diluents and family planning?
name of medicine,
expiry date, quantity
received, batch number,
pack size/presentation, min
/ max levels (status of temp
regulatory devices in the
case of vaccines must also
be recorded)
Have any of the following items been out of stock
(check stock cards):
Page 9 of 27
Nur-Isterate
Hepatitis B vaccine
2ml syringes
Pentaxim vaccine
Does the number of measles vials equal the
Number of vaccine vials
number of measles vaccine diluent?
must be equal to the
number of vaccine diluents
Is stock rotated and FEFO (First Expiry First Out)
Note: VVM status must also
principles adhered to.
be considered
EPI Disease Surveillance
Yes
No
Comment
Notes for supervisor
Yes
No
Comment
Notes for supervisor
Are there Case Investigation Forms for all 4
conditions (AFP, Measles, NNT, AEFI)?
Cold Chain Management
Are there sufficient cooler boxes and ice bricks?
Are there any vaccines with expired VVMs?*
The square must be lighter
than the surrounding circle
Is a contingency plan in place to maintain the
cold chain should current measures fail?
Cooler box:
Are there any frozen icepacks?*
Icepacks must not be
frozen solid, but must be
conditioned
Is a functional continuous electronic monitoring
Check if this has been
device used to record temperatures in the cooler
activated and is working
box?
properly. Also check that
temperatures have not
gone below 2 degrees
Celsius
Multi
Dose
Vial
Policy
(MDVP):
Check
the
following*
Measles Vaccine- vial has the opening date and
Reconstituted Measles
time printed on the vial
vaccine must be used
within 6 hours of opening
Td (Diftavax)- vial has opening date printed on
Opened Td must be used
the vial
with 4 weeks of opening
Needles/syringes should not be left inserted in vials
This contrary to MDVP and
must be discarded
immediately
Vaccine Fridge:
Are the fridges temperature records completed
Temperatures must be
twice daily and appropriate action taken if
plotted twice a day. Check
temperature excursions occur?
that temperature
excursions have not
occurred in succession
Is the fridge only used for vaccines?
No food, or other drugs
stored in the vaccine fridge
Page 10 of 27
Is a purpose-built fridge used to store the
Note: Freezer and
vaccines?
refrigerator compartments
must each have separate
external doors and its own
thermostat controls
Is the fridge able to maintain temperature
between 2-8°C?
Is the fridge large enough to hold 1 month's stock
Vaccines are not stored
without crowding?
against unit walls or coils.
Vaccines are stored in their
original packaging
Is a functional continuous electronic monitoring
Check that the device is
device used to record temperatures in the fridge
activated and placed near
and is it correctly placed?
the vaccines in the middle
of the fridge
Has there been any temperature excursions
recorded in the last 30 days (check logger and
temp records)?
Does the fridge have a dedicated plug with a
warning notice?
Is the layer of ice in the freezer less than 0.5cm?
Have any vaccines frozen in the last month?*
Check stock records,
temperature monitors. Also
check for physical signs of
freezing such as wet
packaging, ice around
vials, etc.
Are there any reconstituted Measles vaccines in
Discard immediately
the fridge?*
Human Resources
Date
Comment
Notes for supervisor
State the date of the last EPI course that the
Contract only valid if
immunizer been on
competency training done
in the last 3 years
State the date of the last cold chain training the
immunizer received
Immunizer wears a name badge
Documentation
Yes
No
Comment
Notes for supervisor
Is there a copy of the following documents:
The Cold Chain Operations Manual (Sep 2003)
The New Vaccine Guidelines (Oct/Nov 2009)
The Vaccinators Manual (April 2005)
The EPI Disease Surveillance Field Guide (Oct
1998)
National Contraception Policy Guidelines
National
Contraception
Service
Delivery
Guidelines
Reporting
document
for
AEF
Contraceptive
method
Medicine Control Procedure
Page 11 of 27
Reports on audits conducted
Certificate in family planning course and updates
Proof of annual registration with regulatory body
Healthcare
and any other documentation required by law to
and service site
professional
carry out family planning and immunisation
services
Additional
Yes
No
Comment
Notes for supervisor
Electronic patient record database
e.g. Excel or export file
Prices of services and a notice indicating DoH
Applicable to the private
stock availability is placed in a prominent place
sector only
* Only applicable to sites that are already
receiving vaccines
Page 12 of 27
WCBD 2
TCC 001
Page 14 of 27
Page 15 of 27
WCBD 3
DECLARATION OF INTERESTS, BIDDERS PAST SCM PRACTICES AND INDEPENDENT BID
DETERMINATION
1. To give effect to the following legislative requirements:







Act No 8 of 2010: Western Cape Procurement (Business Interest of Employees)Act, 2010,
National Treasury Practice Note 4 of 2006: Declaration of Bidders Past SCM Practices-(SBD8),
National Treasury Instruction Note 33 of 2011: Enhancing Compliance Monitoring and
Improving Transparency and Accountability in Supply Chain Management: Declaration of
Interest (SBD4) ,
National Treasury Practice Note 2010: Prohibition of Restrictive practices (SBD9),
Section 4 (1) (b) (iii) of the Competitions Act No. 89 of 1998 as amended together with its
associated regulations,
Act No 12 of 2004: Prevention and Combating of Corrupt Activities and
Regulations pertaining to the tender defaulters register, Paragraph 16A9 of the National
Treasury Regulations and/or any other applicable legislation.
2. Please note that all prospective bidders intending to do business with the Western Cape Provincial
Government must be registered on the Western Cape Supplier Database by 1 April 2012.
3.
Definitions
“Bid” includes a price quotation, advertised competitive bid, limited bid or proposal
“Bid rigging (or collusive bidding)” occurs when businesses, that would otherwise be expected to
compete, secretly conspire to raise prices or lower the quality of goods and / or services for
purchasers who wish to acquire goods and / or services through a bidding process. Bid rigging is,
therefore, an agreement between competitors
‘‘Business interest’’ means —
(a) a right or entitlement to share in profits, revenue or assets of an entity;
(b) a real or personal right in property;
(c)a right to remuneration or any other private gain or benefit, and includes any interest
contemplated in paragraphs (a), (b) or (c) acquired through an intermediary and any
potential interest in terms of any of those paragraphs;
“Consortium or Joint Venture” means an association of persons for the purpose of combining their
expertise, property, capital, efforts, skill and knowledge in an activity for the execution of a
contract;
‘‘Employee’’ means a person employed by the Institution, whether permanently or temporarily, including
—
(a) an employee as contemplated in section 8 of the Public Service Act;
(b) a person appointed in terms of section 12A of the Public Service Act;
Page 16 of 27
(c) a person transferred or seconded to the Institution or a provincial public entity in terms of
section 15 of the Public Service Act; and
(d) an educator as defined in the Employment of Educators Act, 1998 (Act 76 of 1998), and
includes a member of the board or other controlling body of a provincial public entity;
‘‘entity’’ means any —
(a) association of persons, whether or not incorporated or registered in terms of any law,
including a company, corporation, trust, partnership, close corporation, joint venture or
consortium; or
(b) sole proprietorship;
‘‘entity conducting business with the Institution’’ means an entity that contracts or applies or tenders for
the sale, lease or supply of goods or services to the Province
“Family member” means a person’s —
(a) spouse; or
(b) child, parent, brother or sister, whether such a relationship results from birth, marriage
or
adoption;
‘‘intermediary’’ means a person through whom an interest is acquired, and includes—
(a) a person to whom is granted or from whom is received a general power of attorney; and
(b) a representative or agent;
“Institution” means —
Provincial Government of the Western Cape
“Provincial Government Western Cape (PGWC)” means
(a) the Institution of the Western Cape, and
(b) a provincial public entity;
“RWOPS” means — Remunerative Work Outside the Public Service
‘‘spouse’’ means a person’s —
(a) partner in marriage;
(b) partner in a customary union according to indigenous law; or
(c) partner in a relationship in which the parties live together in a manner resembling a marital
partnership or customary union;
4.
Any legal person, including persons employed by the Institution, or their family members, 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 employed by the PG, or to their
family member, it is required that the bidder or his/her authorised representative declare his/her
position in relation to the evaluating/adjudicating authority where the bidder is employed by the
Institution; and/or
5. The bid of any bidder may be disregarded if that bidder or any of its directors have abused the
institution’s supply chain management system; committed fraud or any other improper conduct in
relation to such system; or failed to perform on any previous contract.
6. Section 4 (1) (b) (iii) of the Competition Act No. 89 of 1998, as amended, prohibits an agreement
between, or concerted practice by firms, or a decision by an association of firms, if it is between
parties in a horizontal relationship and if it involves collusive bidding (or bid rigging). Collusive bidding
is a pe se prohibition meaning that it cannot be justified under any grounds.
Page 17 of 27
7. Communication between partners in a joint venture or consortium will not be construed as collusive
bidding
8. In addition and without prejudice to any other remedy provided to combat any restrictive practices
related to bids and contracts, bids that are suspicious will be reported to the Competition
Commission for investigation and possible imposition of administrative penalties in terms of section 59
of the Competition Act No 89 of 1998 and or may be reported to the National Prosecuting Authority
(NPA) for criminal investigation and or may be restricted from conducting business with the public
sector for a period not exceeding ten (10) years in terms of the Prevention and Combating of
Corrupt Activities Act No 12 of 2004 or any other applicable legislation.
SECTION A: DETAILS OF THE ENTITY
A1.
A2.
Name of the Entity
Entity registration Number
(where applicable)
A3.
Entity Type
A4.
Tax Reference Number
A5.Full details of directors, shareholder, member, partner, trustee, sole proprietor or any persons
with a right or entitlement to share in profits, revenue or assets of an entity, of the entity should be
disclosed in the Table A below.
TABLE A
FULL NAME
DESIGNATION
(Where
a
director is a
shareholder,
both should be
confirmed.)
IDENTITY NUMBER
PERSONAL TAX
PERCENTAGE
REFERENCE NO.
INTEREST IN
THE ENTITY
Page 18 of 27
SECTION B: DECLARATION OF THE BIDDER’S INTEREST
To disclose relationships between the bidding entity and persons listed in Table A and
any employees of the Institution; and to restrict business interest of Institution employees’
according to section 2 (1) of the Western Cape Procurement (Business Interest of
Employees) Act of 2010, bidding entity must give the following details. An Institution
employee taking remunerative work outside public enterprise should first obtain
necessary approval (RWOP), failure to submit proof of such authority, where applicable,
may result in the disqualification of the bid.
B1.
B2.
Are any persons listed in Table A employees of the Institution?
Are any employees of the entity also employees of the Institution?
NO YES
(If yes complete Table B and attached “RWOP”)
Are any family members of the persons listed in Table A employees of the
B3.
NO YES
(If yes, complete Table B and attached “RWOP”)
NO YES
Institution?
(If yes complete Table B)
Page 19 of 27
TABLE B
Details of persons connected with the bidder who are employees of the Institution as defined
should be disclosed in Table B below.
FULL NAME OF IDENTITY
PROVINCIAL
DESIGNATION / INSTITUTION
PERCENTAGE
INSTITUTION
DEPARTMENT/
RELATIONSHIP
EMPLOYEE
INTEREST
ENTITY OF
TO BIDDER**
NO./PERSAL
NUMBER
EMPLOYEE
EMPLOYMENT
NO.(Indicate if
not known)
SECTION C: PERFORMANCE MANAGEMENT AND BIDDER’S PAST SUPPLY CHAIN
MANAGEMENT PRACTICES
To enable the prospective bidder to provide evidence of past and current performance with the
Institution.
C1.
Did the entity conduct business with the Institution in the last twelve months?
(If yes complete Table C)
NO YES
Page 20 of 27
C2. Table C
Complete the below table to the maximum of the last 5 contracts.
NAME OF
PROVINCIAL
TYPE OF SERVICES
CONTRACT /
PERIOD OF VALUE OF
CONTRACTOR
DEPARTMENT
OR COMMODITY
ORDER NUMBER
CONTRACT CONTRACT
OR
PROVINCIAL
ENTITY
C3.
Is the entity or its principals listed on the National Database as companies or
persons prohibited from doing business with the public sector?
Is the entity or its principals listed on the National Treasury Register for Tender
NO YES
NO
YES
Defaulters in terms of section 29 of the Prevention and Combating of
Corrupt Activities Act (No. 12 of 2004)?
C4. (To access this Register enter the National Treasury’s website,
www.treasury.gov.za, click on the icon “Register for Tender Defaulters”
or submit your written request for a hard copy of the Register to
facsimile number (012) 3265445.)
If yes to C3 or C4, were you informed in writing about the listing on the
C5.
database of restricted suppliers or Register for Tender Defaulters by National
NO
YES
NO
YES
Treasury?
Was the entity or persons listed in Table A convicted for fraud or corruption
during the past five years in a court of law (including a court outside the
Republic of South Africa)?
C6.
Page 21 of 27
SECTION D: DULY AUTHORISED REPRESENTATIVE TO DEPOSE TO AFFIDAVIT
The form should be signed by a duly authorised representative of the entity before a
commissioner of oaths.
I, ..…………………………………………………......................................... hereby swear/affirm;
i. that the information disclosed above is true and accurate;
ii. that I understand the content of the document;
iii. the entity undertakes to independently arrive at any offer at any time to the
Institution
without
any
consultation,
communication,
agreement
or
arrangement with any competitor. In addition, that there will be no
consultations, communications, agreements or arrangements with any
competitor regarding the quality, quantity, specifications and conditions or
delivery particulars of the products or services to the Institution.
iv. that the entity or its representative are aware of and undertakes not to disclose
the terms of any bid, formal or informal, directly or indirectly, to any competitor,
prior to the awarding of the contract.
__________________________________
DULY AUTHORISED REPRESENTATIVE’S
SIGNATURE
I certify that before administering the oath/affirmation I asked the deponent the following
questions and wrote down his/her answers in his/her presence:
1.1 Do you know and understand the contents of the declaration?
ANSWER: ……………………
1.2 Do you have any objection to taking the prescribed oath?
ANSWER: ……………………..
1.3 Do you consider the prescribed oath to be binding on your conscience?
ANSWER: …………………….
1.4 Do you want to make an affirmation?
ANSWER: …………………….
2. I certify that the deponent has acknowledged that he/she knows and understands the
contents of this declaration, which was sworn to/affirmed before me and the deponent’s
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signature/thumbprint/mark was place thereon in my presence.
………………………………………………………………………………….
SIGNATURE
FULL NAMES
Commissioner of Oaths
Designation (rank) ………………………….ex officio: Republic of South Africa
Date: ………………………………Place ………………………………
Business Address: …………………………………………………………………
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Call for Service:
Reference: CFSR1
ANNEXURE H: APPLICATION FOR AUTHORISATION|NURSING ACT 33 OF 2005, SECTION 56(6)
First of all it is important to note that although the Act commenced on 16 December 2006, section 56 of the
Act only came into operation on 17 March 2008. Section 56(6) deals with the requirements for nurses, in
various fields to, inter alia, keep, supply and administer medicines.
The relevant parts of section 56(6) of the Act, read as follows:
“(6)
Despite the provisions of this Act, the said Medicines and Related Substances Act, 1965, the
Pharmacy Act, 1974 (Act 53 of 1974), and the Health Professions Act, 1974 (Act 56 of 1974), a nurse who is in
the service of…
(d)
an organisation performing any health service designated by the Director- General after
consultation with the South African Pharmacy Council referred to in section 2 of the Pharmacy Act, 1974,
and who has been authorised by the … the medical practitioner in charge of such organisation, … may in
the course of such service perform with reference to…
(iii) the keeping of prescribed medicines and their supply, administering or prescribing on the prescribed
conditions,
any act which the said … medical practitioner … may, after consultation with the Council, determine in
general or in a particular case or in cases of a particular nature, if the services of a medical practitioner or
pharmacist, as the circumstances may require, are not available.”
It follows that the requirements for a nurse in private practice (or organisation as the Act refers to) to keep,
supply, administer or prescribe on prescribed conditions, medicine is as follows:
1. The nurse should be part of an organisation which performs a health service designated by the
Director-General of the National Department of Health, after consultation with the SA Pharmacy
Council;
2. the medical practitioner in charge of the organisation may authorise the nurse to perform any act in
general or in particular, but only after consultation with the Nursing Council; and
3. the nurse may not perform such authorised acts if the services of a medical practitioner or
pharmacist, as the circumstances may require, are available.
Furthermore the steps to obtain Authorisation are as follows:
1. The private party need to apply to the National DG to be recognized as an organization designated
to perform a health service, after consultation with the Pharmacy Council (the DG of the National
Department of Health);
2. The organization(private party) then approve/authorize their own staff to perform the service, only
after consultation with the Nursing Council;
3. The person within the organization who authorizes the staff must be a medical practitioner.;
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Call for Service
Reference: CFSR1
ANNEXURE I: DRAFT ADVERTISEMENT
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ANNEXURE J: WESTERN CAPE PROVINCE MAPS
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