CONTROL No. PhilGEPS-Goods-030-2017

REQUEST FOR QUOTATION (RFQ) No. 038-2017 Procurement of Various Printable Forms

The Department of Health Treatment and Rehabilitation Center - Dagupan (DOH TRC - Dagupan) through its Bids

and Awards Committee for Goods and Supplies (BAC-GAS) will undertake an Alternative Method of Procurement

– Small Value Procurement for the “Procurement of Various Printable Forms”, in accordance with Section 53.9

of the 2016 Revised Implementing Rules and Regulations of Republic Act No. 9184.

Name of Project Procurement of Various Printable Forms

Approved Budget

for the Contract PHP 250, 000.00

Location DOH TRC - DAGUPAN, Sitio Palatong, Bonuan Binloc, Dagupan City, Pangasinan

Payment Government Terms – ADA (Land Bank of the Philippines)

Delivery Date Five (5) Working Days upon receipt of Purchase Order (PO)

TERMS AND CONDITIONS

1. Interested suppliers are required to submit their valid and current (a) 2017 Mayor’s Permit, (b) PhilGEPS

Registration Number, (c) BIR Registration Certificate and (d) Price Quotation Form (Annex “A”) and (e)

Omnibus Sworn Statement

2. Submission of quotation and eligibility is on or before 2:00 pm of March 20, 2017 at Office of the Bids and

Awards Committee, Administrative Building, DOH TRC Complex, Bonuan Binloc, Dagupan City, Pangasinan

2400. Open submission may be submitted, manually or electronically through bac.trcdagupan@gmail.com.

3. Quotations shall be inclusive of delivery, applicable taxes and other indirect costs, those exceeding the

Approved Budget for the Contract (ABC) shall be automatically disqualified.

4. BAC reserves the right to reject any or all Quotations, to waive any minor defects therein, to annul the

procurement process, to reject all Quotations at any time prior to the contract award, without thereby incurring any

liability to the affected Bidder(s), and to accept only the offer that is most advantageous to the Government.

5. BAC assumes no responsibility whatsoever to compensate or indemnify Bidders for any expenses incurred in the

preparation of their Quotation.

For inquiry, you may contact us at tel. no. (075) 653-9876.

Very Truly Yours,

SGD.

ROGELIO O. GARCIA JR., MD

BAC Chairperson

Annex “A”

PRICE QUOTATION FORM

Control Code: PhilGEPS-Goods-030-2017

______________________

Date

TO : THE BIDS AND AWARDS COMMITTEE

DOH Treatment and Rehabilitation Center – Dagupan

Bonuan Binloc, Dagupan City Pangasinan 2400

THRU : MADONNA N. DELA CRUZ, MD

Head, BAC Secretariat

Gentlemen,

After having carefully read and accepted the terms and conditions stipulated in the request for Quotation (RFQ)

No. 030-2017, hereunder is our financial proposal inclusive with VAT and other incidental costs for the subject

procurement identified below:

A. APPROVED BUDGET FOR CONTRACT:

TWO HUNDRED FIFTY THOUSAND PESOS ONLY (PHP 250,000.00)

ITEM

NO. ITEM AND DESCRITION QUANTITY UNIT PRICE TOTAL PRICE

1 Property Card 2000 pcs

2 Stock Card 1000 pcs

3 Property Sticker 2000 pcs

4 Supplies Ledger Card 1000 pcs

5 PPE Ledger Card 2000 pcs

6 Registry of Heritage Asset 250 pcs

7 Index of Payment 5000 pcs

B. TOTAL BID QUOTATION AMOUNT IN FIGURES:

PLEASE WRITE THE TOTAL BID QUOTATION AMOUNT IN WORDS:

We undertake, if our Quotation or bid is accepted, to accomplish the procurement project within five (5) Working

Days from the receipt of Purchase Order (PO).

The above-quoted price is inclusive of all cost and applicable taxes.

AUTHORIZED REPRESENTATIVE

Signature : _________________________________________

Printed Name : _________________________________________

Date : _________________________________________

Company Name : _________________________________________

Contact Details : _________________________________________

(Telephone / Facsimile / Mobile / Email)

Annex “C”

IMPORTANT : IMAGES ATTACHED MAY NOT REPRESENT THE ACTUAL SIZE OF THE

FORMS AS REQUIRED BY THE END – USER, SUPPLIERS ARE ADVISED TO VISIT THE

CENTER AND SECURE A COPY.

INSPECTION COMMITTEE AND END – USER RESERVES THE RIGHT TO REJECT

PRINTED FORMS THAT ARE NON-COMPLYING TO FORMAT, SIZE, PAPER THICKNESS AND

THE LIKE.