Province Of Iloilo Tender

Description Price Schedule / Bid Tender Name Of Bidder: _____________________________________________ Bid No.: Cdh-24-1566-b Complete Bid Partial Bid 1 2 3 4 5 6 7 8 9 10 11 12 Item Description Quantity Unit Estimated Unit Cost Brand Name (indicate Model Number If Equipment) (indicate N/a If No Brand) Unit Price Per Item Transportation And All Other Costs Incidental To Delivery, Per Item Sales And Other Taxes Payable If Contract Is Awarded, Per Item Cost Of Incidental Services, If Applicable, Per Item Total Unit Price (col 7+8+9+10) Total Price Delivered Final Destination (col 11) X (col 3) 1 Amikacin (as Sulfate) 50 Mg./ml., 3ml/vial 200 Vial Php.60.00 2 Ampicillin (as Sodium Salt) 250mg. (im,iv) 1000 Vial Php.20.00 3 Ampicillin + Sulbactam 500 Mg Ampicillin + 250mg. Sulbactam (im,iv) (as Sodium Salt) Per Vial 2500 Vial Php.40.00 4 Ceftazidime (ceftazidime) 1g Vial (im,iv) As Pentahydrate 1000 Vial Php.45.00 5 Ceftriaxone As Disodium/sodium Salt) 1g Vial + 10ml. Diluent (iv) 2500 Vial Php.45.00 6 Cefuroxime 750 Mg Vial (im,iv) 5000 Vial Php.45.00 7 Ciprofloxacin 2mg/ml. Vial (iv Infusion) (as Lactate) 300 Vial Php.40.00 8 Hydrocortisone 100mg. Vial (iv) (as Sodium Succinate) Or Its Equivalent 3500 Vial Php.50.00 9 Metronidazole 5mg/ml. 100ml. Vial (iv Infusion) 2500 Vial Php.40.00 10 Omeprazole Powder, 40mg. Vial + 10ml. Solvent Amp/vial (iv) 3500 Amp/ Vial Php.45.00 11 Paracetamol 150mg/ml., 2ml Amp Solution For Injection (im/iv) 1000 Vial Php.12.00 12 Ranitidine (as Hydrochloride) 25 Mg/ml., 2 Ml. Amp/vial (im, Iv, Iv Infusion) 1000 Amp/ Vial Php.23.78 Abc: Nine Hundred Ninety Four Thousand Seven Hundred Eighty Pesos (php.994,780.00) ____________________________________ Name Of Establishment ____________________________________ Signature Over Printed Name Of Proprietor Or Authorized Representative Statement Of Single Largest Completed Contract (slcc) Similar To The Contract To Be Bid Bidder’s Name: Email Address: Bidder’s Address: Fax Number: Tel. Number Name Of Project Amount Of Contract Date Of Contract Effectivity Owner’s Name And Address Delivery Period Date Of Delivery Date Of Acceptance Signature Over Printed Name Attachments: 1. Purchase Order (po) 2. Acceptance And Inspection Report (air) Statement Of All On-going Government And Private Contracts (including Contracts Awarded But Not Yet Started, If Any, Whether Similar Or Not Similar In Nature And Complexity To The Contract To Be Bid) Bidder’s Name: Email Address: Bidder’s Address: Fax Number: Tel. Number: Name Of Project/s Amount Of Contract Date Of Contract Effectivity Owner’s Names And Address Delivery Period (indicate All Delivery Periods If Staggered Delivery Allowed) End Of Delivery Period Value Of Outstanding Contracts (indicate If Partial Delivery Allowed) No. Of Days From End Of Delivery Period Days Of Approved Extension/ Suspension, If Any Total Value Of Outstanding Contracts (php) Signature Over Printed Name Fill Up All The Columns Accordingly Disclaimer: Non-disclosure Of All On-going Contracts And Details Thereof Is Grounds For Ineligibility And Disqualification.