Bidding per item



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For Goods Offered From Within the Philippines

Name of Bidder: __________________________________



ITB Number

ITB 16 - 0041

Price Schedule No. 1

"BIDDING PER ITEM"

5

Unit Price EXW

per Item


10

9

8

7

6

4

3

1

Total Price delivered final Destination (col. 8+ 9

X 4)


Sales & Other taxes payable per item if Contract is awarded

Unit prices per Item final destination and unit of other incidental services

Total Price EXW per Item

(cols. 4 X 5)



Cost of Local Labor, Raw Material & Component

Qty.

Unit ABC

Description

Item No.

2

DENTAL CHAIR, Fully Automated, Plain, w/out Accessories

1

650,000.00

1 unit

DRY HEAT STERILIZER, Double Door, UV and Heat Sterilizer

2

15,000.00

1 unit

SURGICAL HAND PIECE, Low Speed (Dental Hand piece)

3

3,000.00

1 unit

SURGICAL HAND PIECE, High Speed (Dental hand piece)

4

3,000.00

1 unit

ORAL SURGERY BUR, C1TS (Low speed)

5

100.00

10 pcs

ORAL SURGERY BUR, C33TS (High speed)

6

100.00

10 pcs

LUXATOR, Straight

7

1,000.00

1 pc


Note: For use of NDH.

Additional Requirements (Please indicate):

1. Brand name, If no brand, state "none"

2. Country of manufacture or origin of item; i.e. local (or RP), or if foreign origin, specify country


*Non Compliance with the above requirements will be basis for Ineligibility

Source of Fund: CY 2016 20% LDF-3.2.2.4-LDF-16-05-1216

Approved Budget: P674,000.00

Name and Signature of Bidder

Prepared by: bac-jack; PR.No. 16 - 0535

REQUIRED BID SECURITY:

1. Bid Securing Declaration.


2. 2% Cash or cashier's/manager's check issued by a Universal or Commercial Bank.

P 13,480.00

3. 2% Bank draft/guarantee or irrevocable letter of credit issued by a Universal or Commercial Bank.

P 13,480.00

4. 5% Surety bond callable upon demand issued by a surety or insurance company duly certified by the Insurance Commission as authorized to issue such security

P 33,700.00

5. Any combination of the foregoing. Proportionate to the share of form with respect to the total amount of security.

Page 1 of 2

For Goods Offered From Within the Philippines


Name of Bidder: __________________________________



ITB Number

ITB 16 - 0041

Price Schedule No. 2

"BIDDING PER ITEM"

5

Unit Price EXW

per Item


10

9

8

7

6

4

3

1

Total Price delivered final Destination (col. 8+ 9

X 4)


Sales & Other taxes payable per item if Contract is awarded

Unit prices per Item final destination and unit of other incidental services

Total Price EXW per Item

(cols. 4 X 5)



Cost of Local Labor, Raw Material & Component

Qty.

Unit ABC

Description

Item No.

2

AIRCONDITIONER, Window type, 2HP

8

26,000.00

1 unit

x-x-x nothing follows x-x-x


Note: For use of NDH.

Additional Requirements (Please indicate):

1. Brand name, If no brand, state "none"

2. Country of manufacture or origin of item; i.e. local (or RP), or if foreign origin, specify country


*Non Compliance with the above requirements will be basis for Ineligibility

Source of Fund: CY 2016 20% LDF-3.2.2.4-LDF-16-05-1216

Approved Budget: P26,000.00

Name and Signature of Bidder

Prepared by: bac-jack; PR.No. 16 - 0535

REQUIRED BID SECURITY:

1. Bid Securing Declaration.


2. 2% Cash or cashier's/manager's check issued by a Universal or Commercial Bank.

P 520.00

3. 2% Bank draft/guarantee or irrevocable letter of credit issued by a Universal or Commercial Bank.

P 520.00

4. 5% Surety bond callable upon demand issued by a surety or insurance company duly certified by the Insurance Commission as authorized to issue such security

P 1,300.00



5. Any combination of the foregoing. Proportionate to the share of form with respect to the total amount of security.

Page 2 of 2


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