annex 2: price - acbar: home page · web viewcover slide cover slide box distal water 5 lit distal...

AF274MO-2017-300, 302-KBL

Annex 1: TECHNICAL OFFERMedical Supplies

Item

No.Item

DescriptionSpecifications/Requirements

Unit measu

re

Specifications offered by supplier

(including Manufacturer

Company name/Product

Name)

Expiry date,

Notes, remarks, ref

to documentatio

n: QC,GMP, COPP

1. Adhesive plaster 2.5cmx5m, Cloth Adhesive plaster 2.5cmx5m, Cloth Roll

2. Adhesive plaster 5cmx5m, Cloth Adhesive plaster 5cmx5m, Cloth Roll

3. Chamber Set Chamber Set piece

4. Chest Drain Tub (Bottle) Chest Drain Tub (Bottle) piece

5. Chromic Catgut, Size 1/0 (35mm) Piece 70cm

Chromic Catgut, Size 1/0 (35mm) Piece 70cm piece

6. Chromic Catgut, Size2/ 0 (35mm) Piece 70cm

Chromic Catgut, Size2/ 0 (35mm) Piece 70cm piece

7. Chromic Catgut, Size 3/0 (25mm) Piece 70cm

Chromic Catgut, Size 3/0 (25mm) Piece 70cm piece

8. Chlorine, 30% bleeching Powdwr Chlorine, 30% bleeching Powdwr kg

9. Colostomy Bag (38mm) Colostomy Bag (38mm) piece

10. Colostomy Bag (40mm) Colostomy Bag (40mm) piece

11. Cord Clamp Cord Clamp piece

AF274MO-2017-300, 302-KBL

12. Cotoon Wool (Surgical), 400g Cotoon Wool (Surgical), 400g Roll

13. Dethermy Set Dethermy Set piece

14. DisposabelThoracic Catheter With Trocar sterile, CH 20

DisposabelThoracic Catheter With Trocar sterile, CH 20 piece







18. Disposible iv Needle G 20 100pcs/box

Disposible iv Needle G 20 100pcs/box Box-100





21. Disposable Syringe 5ml Disposable Syringe 5ml piece

22. Disposable Syringe 10ml Disposable Syringe 10ml piece

23. ECG paper, Roll shieler ECG paper, Roll shieler Roll

24. Elastic Bandage 7,5 cm*5m(Small)

Elastic Bandage 7,5 cm*5m(Small) Roll

25. Elastic Bandage 10cm *5m(Medium)

Elastic Bandage 10cm *5m(Medium) Roll

26. Elastic Bandage 15cm*5m (Large) Elastic Bandage 15cm*5m (Large) Roll

27. Endo Tracheal Tube with Cuff, Size 3

Endo Tracheal Tube with Cuff, Size 3 piece

28. Endo Tracheal Tube with Cuff, Size - 4

Endo Tracheal Tube with Cuff, Size - 4 piece

AF274MO-2017-300, 302-KBL







32. Foly Catheter, FR 6 Foly Catheter, FR 6 piece








40. Gauze compress Sterile 10cmx10cm, 100 Pc/Box

Gauze compress Sterile 10cmx10cm, 100 Pc/Box Box-100

41. Gauze malmal, 40 yard * 70cm Gauze malmal, 40 yard * 70cm 40yard

42. Gauze paraffine 30Pc/box Gauze paraffine 30Pc/box 30 pc/box

43. Gloves None Sterile (Roberry), 50 Pair/Box

Gloves None Sterile (Roberry), 50 Pair/Box Box/50 pair

44. Gloves sterile surgical. Size--7, Pair

Gloves sterile surgical. Size--7, Pair Pair

45. Gloves sterile surgical. Size--7.5, Pair

Gloves sterile surgical. Size--7.5, Pair Pair

AF274MO-2017-300, 302-KBL

46. Gloves sterile surgical. Size--8, Pair

Gloves sterile surgical. Size--8, Pair Pair

47. IV Canula G--No--20 IV Canula G--No--20 piece



50. Naso Gastric Tube Size-CH 6 Naso Gastric Tube Size-CH 6 piece







57. Parafin Liquide 60ml/bottle Parafin Liquide 60ml/bottle Bottle

58. Plaster of Paris (Medium sze ) Plaster of Paris (Medium sze ) Roll

59. Plaster of Paris (Large size ) Plaster of Paris (Large size ) Roll

60. Spinal Needle (BD) G No:22 -- Piece

Spinal Needle (BD) G No:22 -- Piece piece

61. Spinal Needle (BD) G No:25 -- Piece

Spinal Needle (BD) G No:25 -- Piece piece

62. Suction Catheter Dispossibale CH-8

Suction Catheter Dispossibale CH-8 piece

AF274MO-2017-300, 302-KBL







66. Surgical Blades G 10, 100 piece/Box

Surgical Blades G 10, 100 piece/Box Box-100





69. Suture Proline No- 2/0 --75 cm -- Piece (Cutting)

Suture Proline No- 2/0 --75 cm -- Piece (Cutting) piece

70. Suture Proline No-4/0 --75 cm -- Piece Round

Suture Proline No-4/0 --75 cm -- Piece Round piece

71. Suture Proline No-5/0 --75 cm -- Piece Round (Etticone)

Suture Proline No-5/0 --75 cm -- Piece Round (Etticone) piece

72. Suture Proline No-6/0 --75 cm -- Piece Round( Etticone)

Suture Proline No-6/0 --75 cm -- Piece Round( Etticone) piece

73. Suture Vicryl (Round/B) No.0 --90cm

Suture Vicryl (Round/B) No.0 --90cm piece

74. Suture Vicryl (Round/B) No.1 --90cm

Suture Vicryl (Round/B) No.1 --90cm piece

75. Suture Vicryl (Round/B) No.4/0 --70cm

Suture Vicryl (Round/B) No.4/0 --70cm piece

76. Suture Vicryl (R/B) No.5/0 --70cm

Suture Vicryl (R/B) No.5/0 --70cm piece

77. T Tube diffferance size(8,10,12,14)

T Tube diffferance size(8,10,12,14) Tub

78. Tape for autoclove test Roll Tape for autoclove test Roll Roll

79. Tangue Depressor ,100pcs/Box Tangue Depressor ,100pcs/Box 100pcs/Box

AF274MO-2017-300, 302-KBL

80.Tube Universal aultoclavable 7mm, With Bubble, 30 M / Roll

Tube Universal aultoclavable 7mm, With Bubble, 30 M / Roll Roll

81. Tube Tracheotomy with Cuff size 3,4,5,6,7,8-Piece

Tube Tracheotomy with Cuff size 3,4,5,6,7,8-Piece Piece

82. Urine Bag 2000 cc-Bag Urine Bag 2000 cc-Bag Bag

83. X. Ray Fillm 10x12, 100Pc/Box simple size AGFA

X. Ray Fillm 10x12, 100Pc/Box simple size AGFA Box-100





86. X-Ray Film 8x10 Digital 100Pc/Box AGFA

X-Ray Film 8x10 Digital 100Pc/Box AGFA Box100

87. Amelgum, Bottle Amelgum, Bottle Bottle

88. Argenat, Bottle Argenat, Bottle Bottle

89. Arsanic Bottle Arsanic Bottle Bottle

90. CHKM Bottle CHKM Bottle Bottle

91. TSR TSR Bottle

92. TKF TKF Bottle

93. Matrex Box Matrex Box Bottle

94. Marcure Marcure Bottle

95. Coversal Past, Bottle Coversal Past, Bottle Bottle

96. Eugenol Cement, Powder/Pack Eugenol Cement, Powder/Pack Pack

AF274MO-2017-300, 302-KBL

97. Freeze (Dental Needal), 12Pcs/Box

Freeze (Dental Needal), 12Pcs/Box Pc

98. G.C Glassonomer Cutting Cement G.C Glassonomer Cutting Cement Pc

99. Glassnomer, Bottle Glassnomer, Bottle Bottle

100.Dental Cortrige Dental Cortrige Pc

101.Nerve needle 100pc/box Nerve needle 100pc/box Box

102.Glassnomer restorative Cement 10 gm, Powder/Pack

Glassnomer restorative Cement 10 gm, Powder/Pack Pack

103.Billirobin , Kit (Diasys Direct and Total large )

Billirobin , Kit (Diasys Direct and Total large ) Kit

104.Alchol Methylated 1000ml/bottle

Alchol Methylated 1000ml/bottle bottle

105.A S O 100 test/kit A S O 100 test/kit Kit

106.Alkaline Phaspatase Diasys Alkaline Phaspatase Diasys Kit

107.Anti Human globuline Anti Human globuline bottle

108.Blue Tape 1000Pcs/pack Blue Tape 1000Pcs/pack Pack

109.Cover slide Cover slide Box

110.Distal Water 5 Lit Distal Water 5 Lit Bottle

111.Filter Peaper 100pc Filter Peaper 100pc 100pc

112.Geimza stain 100ml Merck Geimza stain 100ml Merck bottle

113.SGOT Kit Diasys SGOT Kit Diasys Kit

AF274MO-2017-300, 302-KBL

114.SGPT kit Diasys SGPT kit Diasys Kit

115.Wooden stick 100/pack for lab Wooden stick 100/pack for lab Pack-100

116.CRP kit CRP kit kit

117.Uric Acid 2X50ml for (Rayto Chemistry 240) machin

Uric Acid 2X50ml for (Rayto Chemistry 240) machin Kit

118.Calcium 3x50 ml for (Rayto Chemistry 240) machine

Calcium 3x50 ml for (Rayto Chemistry 240) machine Kit

119.R F 100 test/kit R F 100 test/kit Kit

120.Total Protien 2x50 ml for (Rayto Chemistry 240) machine

Total Protien 2x50 ml for (Rayto Chemistry 240) machine

Kit

121.Blood Bag Triple 500ml Blood Bag Triple 500ml Bag

122.Blood Bag Double 500ml Blood Bag Double 500ml Bag

123.Blood Group Antisera (D), (Digast)

Blood Group Antisera (D), (Digast) kit

124.Blood Group Antisera (ABD), Set (Digast)

Blood Group Antisera (ABD), Set (Digast) kit

125.Blood Collcting Tube EDTA, 3ml

Blood Collcting Tube EDTA, 3ml Pc

126.Infusion set for Blood Transfusion Bag

Infusion set for Blood Transfusion Bag pcs

127.Cholestrol kit, 600ml/Kit Diasys Cholestrol kit, 600ml/Kit Diasys Kit

128.Creatine, Creatine, Kit

129.Glucose Diasys Tset, 1000cc/Kit

Glucose Diasys Tset, 1000cc/Kit Kit

AF274MO-2017-300, 302-KBL

130.Hbs Ag, Strip SD Hbs Ag, Strip SD Strip

131.HCV, Strip SD HCV, Strip SD Strip

132.HIV, Strip SD HIV, Strip SD Strip

133.Pregnency Strips Pregnency Strips Strip

134.Syphlis(VDRL), Strip SD Syphlis(VDRL), Strip SD Strip

135.Toxo Plasmosis, Kit Toxo Plasmosis, Kit Kit

136.Triglyceriod, 6*100ml/kit (Diasysy)

Triglyceriod, 6*100ml/kit (Diasysy) Kit

137.Urea, 100ml/Kit Crysent Urea, 100ml/Kit Crysent Kit

138.Urine strip (Combin- 10), 100 Pcs/Bottle

Urine strip (Combin- 10), 100 Pcs/Bottle Bottle

139.Yellow Type, 1000Pcs/pack Yellow Type, 1000Pcs/pack Pack

140.Hematocrit HCL (Tube), 10 bottle / box

Hematocrit HCL (Tube), 10 bottle / box Box

141.Hematology Analizer Kit (Rayto RT-7600)

Hematology Analizer Kit (Rayto RT-7600) Kit

Evaluation Committee

Notes:_______________________________________________________________________________________________________________________

AF274MO-2017-300, 302-KBL

Annex 2: PRICE BREAKDOWNPage No 01 of______

PUBLICATION REFERENCE: AF274MO-2017- 300, 302-KBL

PRICE BREAKDOWNA B C D E F G

Item NO. Quantity Measure Item Description

Unit Cost With Delivery (Incoterm and Destinations Specified in

ITT)

Total Cost with delivery (Incoterm and Destinations Specified in ITT)

Currency According to

ITT

1. 20,000 Roll Adhesive plaster 2.5cmx5m, Cloth2. 12,000 Roll Adhesive plaster 5cmx5m, Cloth3. 3,500 piece Chamber Set

AF274MO-2017-300, 302-KBL4. 500 piece Chest Drain Tub (Bottle)5. 2,800 piece Chromic Catgut, Size 1/0 (35mm) Piece 70cm6. 2,400 piece Chromic Catgut, Size2/ 0 (35mm) Piece 70cm

7. 1,200 pieceChromic Catgut, Size 3/0 (25mm) Piece 70cm

8. 500 kg Chlorine, 30% bleeching Powdwr9. 100 piece Colostomy Bag (38mm)10. 100 piece Colostomy Bag (40mm)11. 20,000 piece Cord Clamp12. 1,600 Roll Cotoon Wool (Surgical), 400g13. 1,600 piece Dethermy Set

14. 80 pieceDisposabelThoracic Catheter With Trocar sterile, CH 20




18. 20 Box-100 Disposible iv Needle G 20 100pcs/box19. 20 Box-100 Disposible iv Needle G 22 100pcs/box20. 20 Box-100 Disposible iv Needle G 24 100pcs/box21. 300,000 piece Disposable Syringe 5ml22. 150,000 piece Disposable Syringe 10ml23. 1,400 Roll ECG paper, Roll shieler24. 20,000 Roll Elastic Bandage 7,5 cm*5m(Small)25. 6,000 Roll Elastic Bandage 10cm *5m(Medium)26. 34,000 Roll Elastic Bandage 15cm*5m (Large)27. 400 piece Endo Tracheal Tube with Cuff, Size 328. 130 piece Endo Tracheal Tube with Cuff, Size - 4

29. 800 piece Endo Tracheal Tube with Cuff, Size - 5

30. 3,600 piece Endo Tracheal Tube with Cuff, Size - 6

31. 3,200 piece Endo Tracheal Tube with Cuff, Size - 7

32. 80 piece Foly Catheter, FR 633. 600 piece Foly Catheter, FR 1034. 800 piece Foly Catheter, FR 12

AF274MO-2017-300, 302-KBL35. 400 piece Foly Catheter, FR 1436. 4,800 piece Foly Catheter, FR 1637. 3,200 piece Foly Catheter, FR 1838. 400 piece Foly Catheter, FR 2039. 400 piece Foly Catheter, FR 22

40. 4,600 Box-100Gauze compress Sterile 10cmx10cm, 100 Pc/Box

41. 8,000 40yard Gauze malmal, 40 yard * 70cm42. 800 30 pc/box Gauze paraffine 30Pc/box43. 10,000 Box/50 pair Gloves None Sterile (Roberry), 50 Pair/Box44. 18,000 Pair Gloves sterile surgical. Size--7, Pair45. 10,000 Pair Gloves sterile surgical. Size--7.5, Pair46. 10,000 Pair Gloves sterile surgical. Size--8, Pair47. 32,000 piece IV Canula G--No--2048. 40,000 piece IV Canula G--No--2249. 36,000 piece IV Canula G--No--2450. 800 piece Naso Gastric Tube Size-CH 651. 400 piece Naso Gastric Tube Size-CH 852. 400 piece Naso Gastric Tube Size-CH 1053. 1,200 piece Naso Gastric Tube Size-CH 1254. 400 piece Naso Gastric Tube Size-CH 1655. 800 piece Naso Gastric Tube Size-CH 1856. 800 piece Naso Gastric Tube Size-CH 2057. 1,200 Bottle Parafin Liquide 60ml/bottle58. 10,000 Roll Plaster of Paris (Medium sze )59. 10,000 Roll Plaster of Paris (Large size )60. 400 piece Spinal Needle (BD) G No:22 -- Piece61. 400 piece Spinal Needle (BD) G No:25 -- Piece62. 800 piece Suction Catheter Dispossibale CH-863. 1,300 piece Suction Catheter Dispossibale CH-1064. 800 piece Suction Catheter Dispossibale CH-1265. 3,000 piece Suction Catheter Dispossibale CH-1466. 80 Box-100 Surgical Blades G 10, 100 piece/Box67. 80 Box-100 Surgical Blades G 11, 100 piece/Box

AF274MO-2017-300, 302-KBL68. 80 Box-100 Surgical Blades G 21, 100 piece/Box

69. 3,800 pieceSuture Proline No- 2/0 --75 cm -- Piece (Cutting)

70. 1,500 pieceSuture Proline No-4/0 --75 cm -- Piece Round

71. 1,200 pieceSuture Proline No-5/0 --75 cm -- Piece Round (Etticone)

72. 1,000 pieceSuture Proline No-6/0 --75 cm -- Piece Round( Etticone)

73. 3,000 piece Suture Vicryl (Round/B) No.0 --90cm74. 5,000 piece Suture Vicryl (Round/B) No.1 --90cm75. 800 piece Suture Vicryl (Round/B) No.4/0 --70cm76. 800 piece Suture Vicryl (R/B) No.5/0 --70cm77. 80 Tub T Tube diffferance size(8,10,12,14)78. 400 Roll Tape for autoclove test Roll79. 400 100pcs/Box Tangue Depressor ,100pcs/Box

80. 34 RollTube Universal aultoclavable 7mm, With Bubble, 30 M / Roll

81. 300 pieceTube Tracheotomy with Cuff size 3,4,5,6,7,8-Piece

82. 24,000 Bag Urine Bag 2000 cc-Bag

83. 80 Box-100X. Ray Fillm 10x12, 100Pc/Box simple size AGFA



86. 120 Box100 X-Ray Film 8x10 Digital 100Pc/Box AGFA87. 24 Bottle Amelgum, Bottle88. 16 Bottle Argenat, Bottle89. 8 Bottle Arsanic Bottle90. 16 Bottle CHKM Bottle91. 8 Bottle TSR92. 8 Bottle TKF93. 8 Bottle Matrex Box94. 8 Bottle Marcure95. 16 Bottle Coversal Past, Bottle96. 16 Pack Eugenol Cement, Powder/Pack97. 32 12Pcs/Box Freeze (Dental Needal), 12Pcs/Box

AF274MO-2017-300, 302-KBL98. 16 Pc G.C Glassonomer Cutting Cement99. 8 Bottle Glassnomer, Bottle100. 8 Pc Dental Cortrige101. 8 Box Nerve needle 100pc/box

102. 8 PackGlassnomer restorative Cement 10 gm, Powder/Pack

103. 28 KitBillirobin , Kit (Diasys Direct and Total large )

104. 36 bottle Alchol Methylated 1000ml/bottle

105. 2 Kit A S O 100 test/kit

106. 4 Kit Alkaline Phaspatase Diasys

107. 9 bottle Anti Human globuline

108. 36 Pack Blue Tape 1000Pcs/pack

109. 80 Box Cover slide

110. 40 Bottle Distal Water 5 Lit

111. 32 100pc Filter Peaper 100pc

112. 12 bottle Geimza stain 100ml Merck

113. 8 Kit SGOT Kit Diasys

114. 8 Kit SGPT kit Diasys

115. 600 Pack-100 Wooden stick 100/pack for lab

116. 8 kit CRP kit

117. 3 KitUric Acid 2X50ml for (Rayto Chemistry 240) machin

118. 5 KitCalcium 3x50 ml for (Rayto Chemistry 240) machine

119. 2 Kit R F 100 test/kit

120. 3Kit

Total Protien 2x50 ml for (Rayto Chemistry 240) machine

121. 400 Bag Blood Bag Triple 500ml

122. 400 Bag Blood Bag Double 500ml

123. 222 kit Blood Group Antisera (D), (Digast)

124. 222 kit Blood Group Antisera (ABD), Set (Digast)

125. 36,000 Pc Blood Collcting Tube EDTA, 3ml

126. 10,000 pcs Infusion set for Blood Transfusion Bag

127. 8 Kit Cholestrol kit, 600ml/Kit Diasys

128. 16 Kit Creatine,

AF274MO-2017-300, 302-KBL129. 16 Kit Glucose Diasys Tset, 1000cc/Kit

130. 33,000 Strip Hbs Ag, Strip SD

131. 40,000 Strip HCV, Strip SD

132. 20,000 Strip HIV, Strip SD

133. 2,100 Strip Pregnency Strips

134. 20,000 Strip Syphlis(VDRL), Strip SD

135. 3 Kit Toxo Plasmosis, Kit

136. 8 Kit Triglyceriod, 6*100ml/kit (Diasysy)

137. 100 Kit Urea, 100ml/Kit Crysent

138. 160 Bottle Urine strip (Combin- 10), 100 Pcs/Bottle

139. 80 Pack Yellow Type, 1000Pcs/pack

140. 10 Box Hematocrit HCL (Tube), 10 bottle / box

141. 32 Kit Hematology Analizer Kit (Rayto RT-7600)

Grand Total AFN

AF274MO-2017-300, 302-KBL

ANNEX 3: COMPANY INFORMATION TENDER PARTICIPANT.

Publication reference: AF274MO-2017-300, 302-KBL

A: HealthNet TPO Afghanistan office, House-144, Street-5, Sello Road District-3, Dehnaw, Dehburi, Kabul, Afghanistan

One signed original form must be supplied, together with the number of copies specified in the Instruction to Tenderers. The form must include a signed declaration using the annexed format from each legal entity making the application. Any additional documentation (brochure, letter, etc) sent with the form will not be taken into consideration.Applications being submitted by a consortium (i.e. either a permanent, legally-established grouping or a grouping which has been constituted informally for a specific tender procedure) must follow the instructions applicable to the consortium leader and its members.

An economic operator may, where appropriate and for a particular contract, rely on the capacities of other entities, regardless of the legal nature of the links which it has with them. It must in that case prove to the contracting authority that it will have at its disposal the resources necessary for performance of the contract, for example by producing an undertaking on the part of those entities to place those resources at its disposal. Such entities, for instance the parent company of the economic operator, must respect the same rules of eligibility and notably that of nationality, as the economic operator.

1 SUBMITTED BY

Name(s) of tenderer(s) Nationality2Leader

Member

Etc …

1 add/delete additional lines for members as appropriate. Note that a subcontractor is not considered to be a member for the purposes of this tender procedure. Subsequently, the data of the subcontractor must not appear in the data related to the economic, financial and professional capacity. If this tender is being submitted by an individual tenderer, the name of the tenderer should be entered as 'leader' (and all other lines should be deleted)2Country in which the legal entity is registered

AF274MO-2017-300, 302-KBL2 CONTACT PERSON

Name

Address

Telephone

FaxE-mail

3 ECONOMIC AND FINANCIAL CAPACITY

Please complete the following table of financial data3 based on your annual accounts and your latest projections. If annual accounts are not yet available for this year or last year, please provide your latest estimates, clearly identifying estimated figures in italics. Figures in all columns must be on the same basis to allow a direct, year-on-year comparison to be made (or, if the basis has changed, an explanation of the change must be provided as a footnote to the table). Any clarification or explanation which is judged necessary may also be provided.

Financial data Year before lastUSD

Last year

USD

This year

USD

Next year

USD

Average 4

USDAnnual turnover 5, excluding this contractCash and cash equivalents6 at beginning of yearNet cash from / (used in) operating, investing & financing activities7 excluding future contractsNet forecast cash from/ (used in) future contracts, excluding this contractCash and cash equivalents6 at end of year [i.e., the sum of the above three rows]

3 if this application is being submitted by a consortium, the data in the table above must be the sum of the data in the corresponding tables in the declarations provided by the consortium members – see point 7 of this tender form for a supply contract.

4 Amounts entered in the 'Average' column must be the mathematical average of the amounts entered in the four preceding columns of the same row.

5 The gross inflow of economic benefits (cash, receivables, other assets) arising from the ordinary operating activities of the enterprise (such as sales of goods, sales of services, interest, royalties, and dividends) during the year.

6 Cash and cash equivalents comprise cash on hand and demand deposits, together with short-term, highly liquid investments that are readily convertible to a known amount of cash and that are subject to an insignificant risk of changes in value. An investment normally meets the definition of a cash equivalent when it has a maturity of three months or less from the date of acquisition. Equity investments are normally excluded, unless they are in substance a cash equivalent (e.g. preferred shares acquired within three months of their specified redemption date). Bank overdrafts which are

AF274MO-2017-300, 302-KBLrepayable on demand and which form an integral part of an enterprise's cash management are also included as a component of cash and cash equivalents.

7 Operating activities are the main revenue-producing activities of the enterprise that are not investing or financing activities, so operating cash flows include cash received from customers and cash paid to suppliers and employees. Investing activities are the acquisition and disposal of long-term assets and other investments that are not considered to be cash equivalents. Financing activities are activities that alter the equity capital and borrowing structure of the enterprise. Interest and dividends received and paid may be classified as operating, investing, or financing cash flows, provided that they are classified consistently from period to period. Cash flows arising from taxes on income are normally classified as operating, unless they can be specifically identified with financing or investing activities.

AF274MO-2017-300, 302-KBL4 EXPERIENCEPlease complete a table using the format below to summarize the major relevant medical supplies contracts carried out in the course of the past 3 years by the legal entity or entities making this tender. The number of references to be provided must not exceed 5 for the entire tender

Ref # (maximum 5) Project Title …Name of legal entity Country Overall

supply value ( USD)

Proportion supplied by legal entity

(%)

No of staff provided

Name of client

Origin of funding

Dates Name of members if any

Detailed description of supply Related services provided… …

5 TENDERER'S DECLARATION(S)

To be completed and signed by the tenderer (including one from each member in a consortium).In response to your letter of invitation to tender for the above contract, we, the undersigned, hereby declare that:

1 We have examined and accept in full the content of the dossier for invitation to tender No <……………………………….> of <date>. We hereby accept its provisions in their entirety, without reservation or restriction.

2 We offer to deliver, in accordance with the terms of the tender dossier and the conditions and time limits laid down, without reserve or restriction:Lot no [….]: [description of supplies with indication of quantities and origin]Lot no [….]: [description of supplies with indication of quantities and origin]Lot No [….]: [………………………………………………………….……]Lot No [….]: [……………………………………………………………….]

3 The price of our tender excluding spare parts and consumables, if applicable [excluding the discounts described under point 4] is:Lot No 1: [……………………………………………..]Lot No 2: [……………………………………………..]Lot No 3: [……………………………………………..]

4 We will grant a discount of [%], or […………..] [in the event of our being awarded Lot No… and Lot No… ………].5 This tender is valid for a period of 90 days from the final date for submission of tenders.6 If our tender is accepted, we undertake to provide a performance guarantee of 10%, as required by your venerated organization.7 Our firm/company [and our subcontractors] has/have the following nationality:

<……………………………………………………………………>8 We are making this tender in our own right [as member in the consortium led by < name of the leader / ourselves >]*. We confirm that we are not

tendering for the same contract in any other form. [We confirm, as a member in the consortium, that all members are jointly and severally liable by law for the execution of the contract, that the lead member is authorised to bind, and receive instructions for and on behalf of, each member, that the execution of the contract, including payments, is the responsibility of the lead member, and that all members in the joint venture/consortium are bound

AF274MO-2017-300, 302-KBLto remain in the joint venture/consortium for the entire period of the contract's execution].

9 We are not in any of the situations excluding us from participating in contracts, which are listed in the general Instructions to Tenderers. In the event that our tender is successful, we undertake, if required, to provide the proof usual under the law of the country in which we are established that we do not fall into the exclusion situations listed in the ethical clauses of this tender, the date on the evidence or documents provided with this tender dossier.We also understand that if we fail to provide this proof or evidence of the financial and economic capacity and the technical and professional capacity according to the selection criteria within 15 calendar days after receiving the notification of award, or if the information provided is proved false, the award will be considered null and void.

10 We agree to abide by the ethics clauses in Clause 28 of the General Instructions to Tenderers and, in particular, have no potential conflict of interests or any equivalent relation in that respect with other candidates or other parties in the tender procedure at the time of the submission of this application.

11 We will inform the Contracting Authority immediately if there is any change in the above circumstances at any stage during the implementation of the contract. We also fully recognize and accept that any inaccurate or incomplete information deliberately provided in this application may result in our exclusion.

12 We note that the Contracting Authority is not bound to proceed with this invitation to tender and that it reserves the right to award only part of the contract. It will incur no liability towards us should it do so.

Name and first name: <[…………………………………………………………………>

Duly authorized to sign this tender on behalf of:<…………………………………………………………………………………… …>

Place and date: <…………………………………………………………….………….>]

Stamp of the firm/company:

This tender includes the following annexes:

[Numbered list of annexes with titles]

AF274MO-2017-300, 302-KBL

Annex 4: Declaration of eligibility.

………………………… (name) representing ……………………………………… (name of organizationdeclares by signing this document that the points hereunder mentioned are not applicable to the organization or will be in the near future:

That the organization is bankrupt or being wound up, are having their affairs administered by the courts, have entered into an arrangement with creditors, have suspended business activities or are in any analogous situation arising from a similar procedure provided for in national legislation or regulations;

That the organization is the subject of proceedings for a declaration of bankruptcy, for winding-up, for administration by the courts, for an arrangement with creditors or for any similar procedure provided for in national legislation or regulations;

That the organization has been convicted of an offense concerning professional conducted by a judgment which has the force of re judicatory;

That the organization is guilty of grave professional misconduct proven by any means which the Contracting Authority can justify;

That the organization does not have unfulfilled obligations relating to the payment of taxes/other applicable dues i.e. social security contributions in accordance with the legal provisions of the country where they are established;

That the organization has no unfulfilled obligations relating to the payment of taxes in accordance with the legal provisions of the country where they are established

That the organization is not guilty of serious misrepresentation in supplying the information required by the Contracting Authority as a condition of participation in an invitation to tender or contract;

That the organization has not been declared to be in serious breach of contract for failure to comply with obligations in connection with another contract with the same Contracting Authority or another contract financed with SEHAT funds;

That the organization is not in one of the situations allowing exclusion referred to the Ethics Clauses in connection with the Tender of the contract.

As so declared …………………………………………………..(city, date)

Signature.......................................................

Name: ………………………………...................

Position:............................................................

AF274MO-2017-300, 302-KBL

Annex 5: Tender Guarantee Form

Tender Guarantee (Bank Guarantee)

[The Bank shall fill in this Bank Guarantee Form in accordance with the instructions indicated.]

________________________________ [Bank’s Name, and Address of Issuing Branch or Office]

Beneficiary: ___________________ [Name and Address of Contracting authority]

Date: ________________

TENDER GUARANTEE No.: _________________

We have been informed that [name of the Tenderer] (hereinafter called "the Tenderer") has submitted to you its tender dated (hereinafter called "the Tender") for the execution of [Supply meidal supplies] under Invitation for Tenderer No.AF274MO-2017-300, 302-KBL.

Furthermore, we understand that, according to your conditions, tenders must be supported by a tender guarantee.

At the request of the Tenderer, we [name of Bank] hereby irrevocably undertake to pay you any sum or sums not exceeding in total an amount of [amount in figures] ([amount in words]) upon receipt by us of your first demand in writing accompanied by a written statement stating that the Tenderer is in breach of its obligation(s) under the tender conditions, because the Tenderer:

(a) has withdrawn its Tender during the period of bid validity specified by the Tenderer in the Form of Tender; or

(b) having been notified of the acceptance of its Tender by the Contracting Authority during the period of tender validity, (i) fails or refuses to execute the Contract Form; or (ii) fails or refuses to furnish the performance guarantee, if required, in accordance with the Instructions to Tenderers.

This guarantee will expire: (a) if the Tenderer is the successful tenderer, upon our receipt of copies of the contract signed by the Tenderer and the performance guarantee issued to you upon the instruction of the Tenderer; or (b) if the Tenderer is not the successful tenderer, upon the earlier of (i) our receipt of a copy of your notification to the Tenderer of the name of the successful Tenderer; or (ii) twenty-eight days after the expiration of the Tenderer’s Tender.

Consequently, any demand for payment under this guarantee must be received by us at the office on or before that date.

This guarantee is subject to the Uniform Rules for Demand Guarantees, ICC Publication No. 458. _____________________________ [signature(s)]

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