Operations Dept. May 2014 1

KITCHEN CITY EXPRESS FORM PRCH- 20140526-01 ACCREDITATION OF SUPPLIERS

DIRECTION: Fill- up necessary fields and tick boxes as appropriate. Leave items blank if not applicable.

SECTION 1 GENERAL INFORMATION ___________________ Date APPLICATION IN ACCREDITATION OF :_____________________________

(Specify good/ service)

Corporation Partnership Sole Proprietorship Others_________ 1.1 Name of Firm : ________________________

a) Office Address : ________________________ b) Phone Number(s) : ________________________ c) Fax Number : ________________________ d) Email Address :________________________

1.2 Suppliers Category

Local Manufacturer Dealer Service Establishment Consolidator Local Distributor Contractor Foreign Supplier Others

1.3 Manager of the Firm

a) Name : ___________________________ b) Designation : ___________________________ c) Phone Number : ___________________________ d) Signature : ___________________________ e) E-mail Address : ___________________________

1.4 Authorized Representative

a) Name : ___________________________ b) Designation : ___________________________ c) Phone Number : ___________________________ d) Signature : ___________________________ e) E-mail Address : ___________________________

SECTION 2 COMPANY PROFILE 2.1 Registration/Licenses: (Submit copies of the following):

Registration/ License #

Place of Registration

Date of Registration

Expiration Date

1. DTI Business Name Registration

2. CTC of SEC Registration

3. CTC of Articles of Incorporation and By-Laws

4. Mayors Permit/Municipal License

5. BIR VAT Registration Certificate

6. Sample of D/R, SI and OR

Operations Dept. May 2014 2

2.2 Ownership

NAME(S) of Owner/Stockholders TIN Number 1.

2.

3.

4.

5.

6.

2.3 Extent of Filipino ownership on the firms assets: _______% 2.4 Description and location of Shops/ Facilities/ Service Centers/ Branches:

Description (include area in m2)

Address No. of Employees

B. SECTION 3 GOODS AND SERVICES B.3.1 SERVICE CONTRACTOR B.3.2 Registration Certificate from the Department of Labor and Employment (DOLE) B.3.3 Code of Conduct, Safety Code and Drug-Free Workplace Policy B.3.4 DOLE Certification of Attendance to Orientation Seminar for Department Order No. 18-A B.3.5 Manpower Complement and Trade Certificates/Training

B3.6 Goods Specification

B.3.6.1 Product Description-Physical Attributes (Appearance/Odor/Texture/Size/Weight)

B.3.6.2 Technical Specification (Shelf life/Storage/Handling)

B.3.6.3 Packaging

B3.7 Transportation-Delivery Vehicle

B3.8 Pictures of Products

3.1 Items Supplied

Name

Description

After Sales Service Description(s)

Operations Dept. May 2014 3

SECTION 4 FINANCES

Previous Year Current Year

Total Current Assets P P

Total Current Liabilities P P

Bank Information

Name of Bank and Branch Credit Limit Account Officer and Contact Number

P

P

PRE-QUALIFICATION REQUIREMENTS

Letter of Intent addressed as follows :

Thru : Joyce Suapengco Head Procurement

To : ________________ Team Leader Vendor Development Team

Application for Vendor Accreditation Form

Company Profile

Company Website Address (if applicable)

Three (3) Years Audited Financial Statements (Balance Sheets, Profit & Loss Statement

and Annual Income Tax Return)

Latest Meralco Bill of all Offices/Plants/Warehouses within Meralco Franchise Area

List of Products/Services Applied for Accreditation

Official Representative, e-Mail Address, Telephone and Fax Numbers

NOTES : 1. Submission of pre-qualification requirements must be completed within five (5)

working days from the date of application to Procurement.

2. Vendors who passed the Pre-Screening shall submit the Basic Requirements

within ten (10) working days from the date of application to Procurement.

3. Failure to comply with this Guidelines will automatically close the pending

application for vendor accreditation

BASIC REQUIREMENTS

DTI Registration Certificate (Sole Proprietorship or Partnership)

SEC Registration Certificate with Articles of Incorporation or Partnership/By-Laws &

General Information Sheet (Corporation)

Mayors/Business Permit

BIR Certificate of Registration (BIR Form 2303)

Table of Organization/Functional Chart

Employees Curriculum Vitae (Key Officers & Technical Personnel)

Notarized List of Owned Tools, Equipment, Machines & Vehicles (w/copy of OR/CR)

Supply Record for the Past 5 Years of every Product/Service Offered (indicating Client

Name, quantity, type, rating, Project Name, scope and cost of project/supply

Operations Dept. May 2014 4

contract) Disclosure by Key Officers of their Relatives in Urban

Chef/Apollo/Artemis/Kitchen City Express within the 2nd

Degree of Consanguinity

and Affinity

Office/Plant/Warehouse Location Map and Photos Pictures of Products/Description/SPECS/Packaging/Shelf Life/Storage Payment for Food Safety Seminar of Php 3,500 Attendance of Food Safety Seminar

Payment of Accreditation Fee of Php 5,000.00 (Non-refundable) SUB CONTRACTOR Registration Certificate from the Department of Labor and Employment (DOLE) Code of Conduct, Safety Code and Drug-Free Workplace Policy DOLE Certification of Attendance to Orientation Seminar for Department Order No. 18-A Manpower Complement and Trade Certificates Rental Fee

PEST CONTROL SUPPLIER/CONTRACTOR

Pest Control License from Fertilizers and Pesticide Authority (FPA)

For Fumigator, FPA Fumigator License

Registration Certificate from the Department of Labor and Employment (DOLE)

Code of Conduct, Safety Code and Drug-Free Workplace Policy

DOLE Certification of Attendance to Orientation Seminar for Department Order No. 18-A

Manpower Complement and Trade Certificates SUPPLIER OF FIRE EXTINGUISHER (MANUFACTURER OR IMPORTER) Certificate of Safety Inspection by the Chief, Fire Department/Unit of the City or Municipality where the principal place of business is located. ADDITIONAL REQUIREMENTS: (AS NEEDED)

Product Sample

ISO Certification

Product Standards

Certified Test Reports (from Independent Testing Parties) for every product offered

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Certificate of Distributorship (For Local Vendor with Foreign Principal)

Technical Brochures/Catalogues for product offered

Technical Data Sheet

*A non- refundable application fee of P_________ is payable upon submission of this accreditation form. *Validity of accreditation is one (1) year from date of approval. Thus accreditation may be renewed every year. *Kindly Fill-up and return this application form to:

Joyce Suapengco Purchasing Manager

Urban Chef Bagsakan Road Cor. Avocado Road

FTI Complex Taguig City

A F F I D A V I T

I hereby certify that all information provided herein is true and correct, and I hold myself liable for any misrepresentation or false statement made herein.

In witness thereof, I have hereunto affixed my signature this ____ day of _________, 2014____ at

_______________________, Philippines. __________________ Affiant Republic of the Philippines ) PROVINCE/CITY OF ) S.S. SUBSCRIBED AND SWORN TO before me this _____ day of ___________, 200__ at ___________________, affiant exhibited to me his/her Community Tax Certificate No. ___________ issued at ________________on _____________________.

NOTARY PUBLIC