Drugs and Medicines for use of OMPH Patients.

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 533,400.00 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 15 vials Reteplase 10 units Lyophilized Powder _________ _________ for Injection x-x-x-x-x For use of OMPH Patients. After having carefully read and accepted your Terms and Conditions, I/We quote you on the item at prices noted above. Printed Name / Signature Tel. No./Cellphone No./e-mail address Position TIN No. This is to certify that the undersigned conducted this request for quotation/proposal for the above stated items. End User Representative