Drugs and Medicines for Bulalacao Community Hospital Pharmacy use

REQUEST TO SUBMIT PROPOSAL/QUOTATION (Small Value Procurement - Sec. 34.1) Date : Company / Store Name and Address Please quote your lowest price on the items listed below, subject to the Terms and Conditions and submit your quotation duly signed by your authorized representative on the deadline of submission of this quotation together with the documentary requirements in the return sealed envelope to wit: 1. All entries must be typewritten or handwritten. 7. Documentary Requirements: 2. The Approved Budget for the Contract is Php 689,318.26 A. Mayor's/Business Permit 3. Delivery period within seven (7) calendar days B. PhilGeps Registration Certificate upon receipt of Approved NTP C. Income/Business Tax Return for 4. Deadline of submission of quotation/proposal ABCs above 500K not later than D. Omnibus Sworn Statement 5. Price validity shall be for a period of thirty (30) calendar days. for ABCs above P50K 6. Suppliers/Bidders shall submit original brochures showing certifications of the product being offered. JOSIE ANN L. MARCA,MD,MMHoA,CHA,DipHLM BAC Chairperson for Health Item No. Qty. Unit of Issue Goods and its Specification Unit Cost Total Cost 1 50 pcs Bisacodyl 5mg Suppository _________ _________ 2 50 pcs Bisacodyl 10mg Suppository _________ _________ 3 2 pcs Carbamazepine 100mg/5ml Syrup 120ml _________ _________ 4 30 pcs Amiodarone 50mg/ml 3ml Ampule _________ _________ 5 500 pcs Ampicillin 250mg Vial _________ _________ 6 30 pcs Atropine 1mg/ml Ampule _________ _________ 7 30 pcs Aminophylline 25mg/ml 10ml Ampule _________ _________ 8 100 pcs Ascorbic Acid Ampule _________ _________ 9 500 pcs Citicoline Ampule _________ _________ 10 1000 pcs Hydrocortisone 100mg Vial _________ _________ 11 30 pcs Epinephrine 1mg/ml Ampule _________ _________ 12 300 pcs Furosemide 10mg/ml Ampule _________ _________ 13 10 pcs Haloperidol 5mg/ml Ampule _________ _________ 14 3000 pcs Hyoscine- NBB Ampule _________ _________ 15 60 pcs Iron Sucrose 20mg/ml Ampule _________ __