Purchase of Medicine for Mental Health Patients

MUNICIPAL GOVERNMENTOFMAMBAJAO Mambajao, Camiguin Standard Form Number: SF-GOOD-60 Revised on: May 24, 2004 Project Reference No. : _________ NameofProject: Purchase of Medicine for Mental Health Patients Mambajao, Camiguin REQUESTFORQUOTATION Supplier : ____________________________________ Address: _____________________________________ Date: __________________ Quotation No. :____________ Please quote your lowest price on the items listed below, subject to the General Conditions hereunder, stating the shortest time of delivery, and submit your quotation duly signed by your representative not later than October 13, 2026. SGD. TEDDYV. GALAGAR Procurement Officer ITEM NO. ITEM ANDDESCRIPTION QTY. UNIT UNIT PRICE 1 Fluphenazine Deconoate 25mg/ml 5’s amp 20 box 2 Resoeridone 10mg tab 100’s 20 box 3 Olanzapine 100mg tab 100’s 10 box 4 Diphenydramine 500mg capsule 100’s 15 box 5 Chlorpromazine 200mg tab (100’s) 10 box 6 Valporic Acid 250mg tablet (depomax) 20 box After having carefully read and accepted your General Conditions, I/We quote you on the item at prices noted above. _____________________ Printed Name/ Signature Canvasser: SGD. EARLINDOS. GAMAO Supply Officer III ______________________________ Tel. No./Cellphone No./Email address Date