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

Corporation

:_____________________________
(Specify good/ service)

Partnership

1.1 Name of Firm

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

Sole Proprietorship

Others_________

: ________________________
: ________________________
: ________________________
: ________________________
:________________________

1.2 Suppliers Category

Local Manufacturer
Service Establishment
Local Distributor
Foreign Supplier

Dealer
Consolidator
Contractor
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 #

1.
2.
3.

4.

5.

6.

Place of
Registration

DTI Business Name

Registration
CTC of SEC
Registration
CTC of Articles of
Incorporation and
By-Laws
Mayors
Permit/Municipal
License
BIR VAT
Registration
Certificate
Sample of D/R, SI
and OR

Operations Dept. May 2014

Date of
Registration

Expiration Date

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

Operations Dept. May 2014

Description

After Sales Service Description(s)

SECTION 4 FINANCES
Previous Year
Total Current Assets
Total Current Liabilities

Current Year

P
P

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

contract) Disclosure by Key Officers of their Relatives in Urban

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

nd

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

Operations Dept. May 2014

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

AFFIDAVIT
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

Operations Dept. May 2014