Medical Supplies

City Government of La Carlota Project Reference Number _________________________ Name of the Project _______________________ Location of the Project Standard Form Number: SF-GOOD-59 Revised on: May 24, 2004 Standard Form Title: REQUEST FOR QUOTATION Date: ______________ Quotation No.________ Company Name Address Please quote your lowest price on the item/s listed below, subject to the General Conditions on the last page, starting the shortest time of delivery and submit your quotation duly signed by your representative not later than _______________________________________ in the return envelope attached herewith. ALBERTO L. LORICO JR. CGDH-I/City Engineer BAC CHAIRMAN ITEM NO. ITEM & DESCRIPTION QTY UNIT UNIT PRICE 1 ASAT (GOT)FS 125ml 1 Kit P 2 Cholesterol FS 1000ml 1 Kit 3 Creatinine FS 1000ml 1 Kit 4 Glucose GOD FS 150ml 1 Kit 5 HDL-C Direct FS 125ml 1 Kit 6 Triglycerides FS 600ml 1 Kit 7 Urea FS 125ml 1 Kit 8 Potassium FS 125ml 1 Kit 10 TRULAB N 6x5ml 1 Kit 11 TRULAB P 6x5ml 1 Kit x-x-x-x-x-x Brand and Model : ________________________ Delivery Period : ________________________ Warranty : ________________________ Price Validity : ________________________ Name of the Procuring Entity Project Reference Number Name of the Project After having carefully read and accepted your General Conditions, I/We quote you on the item at prices noted above. _________________________ Printed Name / Signature _________________________ Tel. No. / Cellphone No.