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PHILIPPINE HEALTH INSURANCE CORPORATION
PhilHealth Regional Oflice I
Healthline (075) 515-3333 www.philhealth.gov.ph
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July 26,2013
ATTENTION : ALL SUPPLIERS
please quote your lowest price subject to the attached Request for
Quotation for First Quarter IT Supplies of PhilHealth Regional Office 1. We
witt Oe pleased to receive your quotation in the attached official form, duly signed
by you or your representative, enclosed in a sealed envelope together with the
fol
lowing documentary requirements
:
a. Business/Mayor's Permit
b. Recent BIR and DTI/SEC Registration
c. PhilHealth Certificate of Good Standing
d. PhiIGEPS Registration Certificate
e. Tax Clearance
Sealed Price Quotation must be delivered on August 6t 2OL3 1:3O p.m. at
PhilHealth Regional Office 1, EMDC Building, Francisco Q. Duque Jr. Road,
Tapuac District, Dagupan City. Quotations will be opened in the presence of the
bidders.
Fufthermore, please be informed that we will select the successful offer on the
basis of such best and final offer which meets the minimum technical requirement
and does not exceed the Approved Budget for the Contract amounting to Six
Hundred Eleven Thousand Three Hundred Four and 5Ol1OO Pesos
(P611,3O4.sO).
For details you may contact Joann E. Morillo or Engr. loselito N. Dela Cruz of the Bids
and Awards Committee at Tel. No. (075)515 3333 loc. 101 or 198.
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MARrc/il M. ARZADoN, MD
Chairpefi$n
Bids and Awards Committee
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Republic of the Philippines
PHILIPPINE HEATTH INSURANCE CORPORATION
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REQUEST FOR QUOTATION
OFFICE/DEPARTMENT:
Control No.:
1. All entries must be typewritten or wratten legibly in print
2. Except for custom-made items, delivery period shall be within
the approved Purchase order.
_
BAC-RFQ 2013-004
calendar days from receipt of
3. Standard warranty period: (from date of acceptance by PhilHealth)
For Supplies & Materials: at least six (6) months
For Equipment: at least one (U year
4. Pricevalidityshall be fora period of 30 calendardays
5. Valid & Current Mayor's Permit/Municipal License
GoodStanding
6. Recent BlR,DTI/SECRegistrationCertificateandPhilHealthCertificateof
7. PhiIGEPS Registration Certificate
8. Tax Clearance
(eg.Swatches, sample materials, lay-out, etc.)
9.
Others:_
ln accordance with the General Conditions, please quote your lowest price on the item/s listed in the matrix below &
state the shortest time delivery. This has been posted in the G-EPS website from July 26-August 1, 2013.
Official Canvasser
Date:
Date:
PhilHealth Regional Office
TO:
1
(Agency)
EMDC Building, Francisco Q. Duque Jr. Road, Tapuac District, Dagupan City
(Address)
ATTENTION: Bids and Awards Committee
(Procurement Section)
After having carefully read and accepted your General Conditions, please refer to the price quotation we have indicated on the
space provided for:
Item No.
Unit
Qtv
Unit Price
Description
2
iel
lT
2
t9
Jnit
3
6
Jnit
4
2
.lnit
Monitor, LCD l7 Monilor, Colored
UPS Uninterupiible Power Supply, APC 600VA
UPS Unintenuptible Power Supply, 500VA
5
23
Jnit
UPS
6
20
Jnit
Keyboord,
7
2
Jox
CABLE UTP, CAT 5
8
250
rc
CD RECORDABLE 800M8. with cose
5
-on
CONIACT CLEANER 10 ozl2839, SPRAY POW-R- WASH PR
10
2
]ox
DISKETTE
LL
3
lnk Cortridge Hp Oflicejet 6000 no. 920. Block
t2
2
13
2
-o
-o
-o
t4
2
lo
lnk Cortridge Hp Officejel 6000 no. 920, Yellow
15
2
15
2
L7
5
rc
Moinlenonce
2
)c
PHOTO CONDUCTOR KII For LEXMARK Prinler, E230/232 Monc
Slondord Printer, 30K poges yield, 5% COVERAGE, Model: E230
R., Conneclors . RJ 45
)c
rc
1
9
18
19
240
20
50
2L
50
Unintetruptible Power Supply, 650 VA
PS2
ESI
605
3.5 HD, IO'S
lnk Cortridge Hp Oflicejel 6000 no.920, Cyon
lnk Cortridge Hp Oflicejel 6000 no. 920, Mogent
INK CARIRIDGE(For HP Deskjel Printer,Model 5740 no.94
INK CARTRIDGE(For HP Deskje'l Prinler,Model 5740 no.95)
Kit for HP 4250N/4015
5
-o
Conneclors, RJ I l, for Hondsel
Conneclors, RJ I l, for modulor box
IONER CARIRIDGE For EPSON Printer, Model:
23
25
l3
lo
Ioner Cqrtridge for
l
-o
IONER CARIRIDGE Toner for Loserjel Prinler M602 CE 390 A
24
l
25
l
26
l
22
Total Price
IOOLS Coble/Link Tesler
RJ
RJ
EPL-6200, SO50l6Z
HP Loseriel Nelwork Prinler 4015n, cc364A
:o
lo
Toner Cortridoe, Toner CC53lA, cyon
-o
Toner Cortridqe, Toner CC533A, mogento
Toner Corlridge, Toner CC532A, yellow
Waranty:
Items aveilable until:
l/We bind ourselves that the prices quoted above are the lowest we can offer and are applicable from
to
Business Address:
Corporate Name
Tel. nos./Fax no.:
Signature over Printed Name o, Authorized Representative
Email Address:
Tax ldentification Number
INSTRUCTIONS ON HOW TO USE THIS FORM:
form shall be filled up by the buyer-canvasser and the Procurement Section head.
for procurement with specifications,
3. lt is important also to get the commitment ofthe supplieras to delivery time.
4. Supplier fills up the available supplies / materials with corresponding price per item.
5. This form shall be prepared in 3 coipies distributed as follows:
1, This
2. List down all items
1
1 copy - PRID
copy - Comptrollership Dept.
1 copy - COA