Annex 2: PRICE breakdown



Annex 1: TECHNICAL OFFERMedicinesItem No.Item DescriptionSpecifications/RequirementsUnit measureSpecifications offered by supplier (including Manufacturer Company name/Product Name)Expiry date, Notes, remarks, ref to documentation: QC,GMP, COPPAcetylcysteine 200mg/5ml granules Acetylcysteine 200mg/5ml granules SyrupAcetylsalicylic acid (Coated Aspirin) 100mg Acetylsalicylic acid (Coated Aspirin) 100mg TabAcetylsalicylic acid (Coated Aspirin) 500mg Acetylsalicylic acid (Coated Aspirin) 500mg TabActivated charcoal 500mg Activated charcoal 500mg TabAdrenalin 0.0005%+Lidocaine 2% in 50ml Adrenalin 0.0005%+Lidocaine 2% in 50ml VialAdrenalin 0.00125%+Lidocaine dental 2% injection solutionAdrenalin 0.00125%+Lidocaine dental 2% injection solutionAmpAluminium hydroxide 200mg+Magnesium hydroxide 200mg Aluminium hydroxide 200mg+Magnesium hydroxide 200mg TabAluminium hydroxide 500mg Aluminium hydroxide 500mg TabAmiodarone 150mgAmiodarone 150mgAmpAmikacin 100mg/ml, in 2ml Amikacin 100mg/ml, in 2ml AmpAminophylline 100mg Aminophylline 100mg TabAminophylline 25mg/ml, in 10ml Aminophylline 25mg/ml, in 10ml AmpAmitriptylline 25mg Amitriptylline 25mg TabAmoxicillin 250mg CapAmoxicillin 250mg CapCapAmoxicillin 500mg CapAmoxicillin 500mg CapCapAmoxicillin 125mg + Clavulanic acid 31.25mg/5ml, in 60ml bottle,Amoxicillin 125mg + Clavulanic acid 31.25mg/5ml, in 60ml bottle,SuspAmoxicillin 500mg+Clavulanic acid 125mg (Co-amoxiclav) Amoxicillin 500mg+Clavulanic acid 125mg (Co-amoxiclav) TabAmpicillin 1g Ampicillin 1g VialAnti-D immunoglobulin (human) 250mcg per dose, in 1 dose Anti-D immunoglobulin (human) 250mcg per dose, in 1 dose VialArtemether 80mg/ml, 1ml, Artemether 80mg/ml, 1ml, AmpAtenolol 100mg Atenolol 100mg TabAtenolol 50mg Atenolol 50mg TabAtropine sulfate 1mg/ml, in 1ml Atropine sulfate 1mg/ml, in 1ml AmpBeclomethason dipropionate 50mcg per dose, nasal sprayBeclomethason dipropionate 50mcg per dose, nasal spraySprayBenzoic Acid 6%+Salicylic acid 3% topical Oint Benzoic Acid 6%+Salicylic acid 3% topical Oint OintBiperiden 5mg/ml 1ml AmpBiperiden 5mg/ml 1ml AmpAmpBisacodyl 5mg TabBisacodyl 5mg TabTabBupivacaine 5mg/ml, 4ml AmpBupivacaine 5mg/ml, 4ml AmpAmpCalcium Gluconate 10% 10ml AmpCalcium Gluconate 10% 10ml AmpAmpCalamine (Zn0 + Fe203) Lotion: 8%Calamine (Zn0 + Fe203) Lotion: 8%LotionCaptopril 25mg TabCaptopril 25mg TabTabCarbamazepine 200mg TabCarbamazepine 200mg TabTabCefazolin 1g VialCefazolin 1g VialVialCefotaxime 1g Vial + WaterCefotaxime 1g Vial + WaterVialCefotaxime 500mg Vial+ WaterCefotaxime 500mg Vial+ WaterVialCeftriaxone 1g Vial + WaterCeftriaxone 1g Vial + WaterVialCeftriaxone 500mg Vial +WaterCeftriaxone 500mg Vial +WaterVialChloramphenicol 0.5% in 2.5ml bottle, ophthalmic dropChloramphenicol 0.5% in 2.5ml bottle, ophthalmic dropDropChloramphenicol 0.5%+Dexamethasone 0.1% in 10ml bottle, ophthalmic dropChloramphenicol 0.5%+Dexamethasone 0.1% in 10ml bottle, ophthalmic dropDropChlorhexidine Digluconate 5% Topical SolChlorhexidine Digluconate 5% Topical SolSolChloroquine 150mg TabChloroquine 150mg TabTabChloroquine 50mg/5ml 60ml SyrChloroquine 50mg/5ml 60ml SyrSyrupChlorphenamine maleate 10mg/ml , in 1ml AmpChlorphenamine maleate 10mg/ml , in 1ml AmpAmpChlorphenamine maleate 4mg TabChlorphenamine maleate 4mg TabTabChlorpromazine 100mg TabChlorpromazine 100mg TabTabCiprofloxacin 2mg/ml 100ml VialCiprofloxacin 2mg/ml 100ml VialVialCloxacillin 500mg VialCloxacillin 500mg VialVialDexamethasone 4mg /ml 1ml AmpDexamethasone 4mg /ml 1ml AmpAmpDiazepam 5mg TabDiazepam 5mg TabTabDiazepam 5mg/ml 2ml Amp (Valum/Martin Dow)Diazepam 5mg/ml 2ml Amp (Valum/Martin Dow)AmpDiclofenac 25mg/ml 3ml AmpDiclofenac 25mg/ml 3ml AmpAmpDiphenhydramine chloride 14mg/5ml, 90ml SyrDiphenhydramine chloride 14mg/5ml, 90ml SyrSyrupDobutamine Injection: 12.5 mg/ml in 20 ml Dobutamine Injection: 12.5 mg/ml in 20 ml VialDopamine 40mg/ml 5ml AmpDopamine 40mg/ml 5ml AmpAmpDoxycycline 100mg CapDoxycycline 100mg CapCapEphedrine Hcl 3mg/ml, in 10ml , AmpEphedrine Hcl 3mg/ml, in 10ml , AmpAmpEpinephrine (Adrenaline) 0.1% in 1ml AmpEpinephrine (Adrenaline) 0.1% in 1ml AmpAmpFerrous Sulphate 200mg TabFerrous Sulphate 200mg TabTabFerrous Sulphate 60mg+Folic Acid 0.4mg TabFerrous Sulphate 60mg+Folic Acid 0.4mg TabTabFlumazenil 0.1mg/ml, in 10ml , AmpFlumazenil 0.1mg/ml, in 10ml , AmpAmpFluoxetine 20mg CapFluoxetine 20mg CapCapEnoxaparine 100mg/ml (LMWH)Enoxaparine 100mg/ml (LMWH)AmpFolic Acid 5mg TabFolic Acid 5mg TabTabPlasma (Hemaccel), in 500ml bottle, infusion SolPlasma (Hemaccel), in 500ml bottle, infusion SolInfusion SolFurosemide 10mg/ml, in 2ml Amp (Lasix)Furosemide 10mg/ml, in 2ml Amp (Lasix)AmpGentamicin 0.3% in 5ml bottle, ophthalmic dropGentamicin 0.3% in 5ml bottle, ophthalmic dropDropGentamicin 20mg/ml, 2ml AmpGentamicin 20mg/ml, 2ml AmpAmpGentamicin 40mg/ml, 2ml AmpGentamicin 40mg/ml, 2ml AmpAmpGlucose 10% 1000ml IV infusion+IV SetGlucose 10% 1000ml IV infusion+IV SetInfusion SolGlucose 10% 500ml IV infusion+IV SetGlucose 10% 500ml IV infusion+IV SetInfusion SolGlucose 4%+Sodium Chloride 0.18% 500ml IV infusion+IV SetGlucose 4%+Sodium Chloride 0.18% 500ml IV infusion+IV SetInfusion SolGlucose 5% 1000ml IV infusion+IV SetGlucose 5% 1000ml IV infusion+IV SetInfusion SolGlucose 5% 500ml IV infusion+IV SetGlucose 5% 500ml IV infusion+IV SetInfusion SolGlucose 25% 20ml Glucose 25% 20ml VialGlucose 5%+Sodium Chloride 0.9% 1000ml IV infusion+IV SetGlucose 5%+Sodium Chloride 0.9% 1000ml IV infusion+IV SetInfusion SolGlucose 5%+Sodium Chloride 0.9% 500ml IV infusion+IV SetGlucose 5%+Sodium Chloride 0.9% 500ml IV infusion+IV SetInfusion SolGlyceryl trinitrate 10 mg/10 ml Glyceryl trinitrate 10 mg/10 ml AmpGriseofulvin 500mg TabGriseofulvin 500mg TabTabHaloperidol 5mg TabHaloperidol 5mg TabTabHaloperidol 5mg/ml, 1ml AmpHaloperidol 5mg/ml, 1ml AmpAmpHydrochlorothiazide 50mg TabHydrochlorothiazide 50mg TabTabHydrocortisone Acetate 1% 15g OintHydrocortisone Acetate 1% 15g OintOintHydrogen peroxide 6% topical Solution 500mlHydrogen peroxide 6% topical Solution 500mlSolutionIbuprofen 200mg TabIbuprofen 200mg TabTabIbuprofen 400 mg TabIbuprofen 400 mg TabTabInsulin (regular) 100IU/ml, 10ml VialInsulin (regular) 100IU/ml, 10ml VialVialInsulin Humuline(70/30) 100IU/ml, 10ml VialInsulin Humuline(70/30) 100IU/ml, 10ml VialVialIsoflurane in 250 milliliter, gas Isoflurane in 250 milliliter, gas bottlKetamin 50mg/ml 10ml VialKetamin 50mg/ml 10ml VialVialKetoconazole , 20% 30g, topical cream Ketoconazole , 20% 30g, topical cream OintLabetololLabetololAmpLidocaine 2% in 15g tube, topical gelLidocaine 2% in 15g tube, topical gelTubeLidocaine 2% in 50ml VialLidocaine 2% in 50ml VialVialLindane Lotion: 1% Lindane Lotion: 1% bottlMagnesium Sulfate 500mg/ml (50%) 10ml AmpMagnesium Sulfate 500mg/ml (50%) 10ml AmpAmpMannitol 20% 500ml Infusion +IV SetMannitol 20% 500ml Infusion +IV SetInfusion SolMethyldopa 250mg TabMethyldopa 250mg TabTabMethylergometrine 0.2mg TabMethylergometrine 0.2mg TabTabMethylrosaniline (Gentian Violet) 1% in 25ml bottle, topical SolMethylrosaniline (Gentian Violet) 1% in 25ml bottle, topical SolSolMetoclopramide 5mg/ml, in 2ml AmpMetoclopramide 5mg/ml, in 2ml AmpAmpMetronidazole 200mg TabMetronidazole 200mg TabTabMetronidazole 400mg TabMetronidazole 400mg TabTabMetronidazole 5mg/ml, in 100ml bottle, infusion SolMetronidazole 5mg/ml, in 100ml bottle, infusion SolSolMisoprostol 200mcg TabMisoprostol 200mcg TabTabMorphine (sulfate,hydrochloride) 10mg/ml, in 1ml AmpMorphine (sulfate,hydrochloride) 10mg/ml, in 1ml AmpAmpMultivitamin TabMultivitamin TabTabNaloxone 400mcg/ml (0.4mg/ml) in 1ml AmpNaloxone 400mcg/ml (0.4mg/ml) in 1ml AmpAmpNeostigmine methylsulfate2.5mg/ml, in 10ml AmpNeostigmine methylsulfate2.5mg/ml, in 10ml AmpAmpNitrofurantoin 100mg Tab/CapNitrofurantoin 100mg Tab/CapTabNystatin 100,000IU 30ml Oral Topical DropNystatin 100,000IU 30ml Oral Topical DropDropNystatin 100,000IU Oral Tab Nystatin 100,000IU Oral Tab TabNystatin 100,000IU Vaginal Tab/ovule suppositoryNystatin 100,000IU Vaginal Tab/ovule suppositoryTabNystatin 500,000IU Tab, oralNystatin 500,000IU Tab, oralTabOmeprazole 40mg/mlOmeprazole 40mg/mlVialOxytocine 10IU/ml in 1ml AmpOxytocine 10IU/ml in 1ml AmpAmpPancuronium Bromide (Pavulon) 2mg/ml, 2ml AmpPancuronium Bromide (Pavulon) 2mg/ml, 2ml AmpAmpParacetamol 100mg TabParacetamol 100mg TabTabParacetamol 120mg/5ml, 60ml SyrParacetamol 120mg/5ml, 60ml SyrSyrupPenicillin Benzyl (Peni G crystal) 5MU VialPenicillin Benzyl (Peni G crystal) 5MU VialVialPenicillin V Potassium 250mg TabPenicillin V Potassium 250mg TabTabPenicillin V Potassium 500mg Penicillin V Potassium 500mg TabPethidine 100mg/ml, 1ml AmpPethidine 100mg/ml, 1ml AmpAmpPhenobarbital 100mg TabPhenobarbital 100mg TabTabPhenobarbital 15mg TabPhenobarbital 15mg TabTabPhenobarbital 200mg/ml, 1ml AmpPhenobarbital 200mg/ml, 1ml AmpAmpPhytomenadione (Vit K) 10mg/ml, 5ml Amp (50mg/5ml)Phytomenadione (Vit K) 10mg/ml, 5ml Amp (50mg/5ml)AmpPolymyxin 10000IU+Bacitracin 500IU per gram, in 6g tube, ophthalmic ointPolymyxin 10000IU+Bacitracin 500IU per gram, in 6g tube, ophthalmic ointTubePovidone-Iodine 10% Topical Sol 450mlPovidone-Iodine 10% Topical Sol 450mlSolPrednisolone 0.5% 5ml eye DropsPrednisolone 0.5% 5ml eye DropsDropPrednisolone 5mg Prednisolone 5mg TabPrimaquine 15mg Tab Primaquine 15mg Tab TabPromethazine 25mg TabPromethazine 25mg TabTabPropofulPropofulVialPropranolol 20mg Propranolol 20mg TabPropranolol 40mg Propranolol 40mg TabPromethazine 25 mg/ml Promethazine 25 mg/ml AmpQuinine dihydrochloride 300mg/ml, in 2ml Quinine dihydrochloride 300mg/ml, in 2ml AmpRanitidine 150mg Ranitidine 150mg TabRanitidine 25mg/ml, in 2ml Ranitidine 25mg/ml, in 2ml AmpRetinol (Vit A) 100,000 IU Retinol (Vit A) 100,000 IU TabRetinol (Vit A) 200,000 IU Retinol (Vit A) 200,000 IU CapRinger lactate 1000ml IV infusion+IV SetRinger lactate 1000ml IV infusion+IV SetInfusion SolRinger lactate 500ml IV infusion+IV SetRinger lactate 500ml IV infusion+IV SetInfusion SolSalbutamol 2mg/5ml, in 60ml Salbutamol 2mg/5ml, in 60ml SyrupSalbutamol 4mg Salbutamol 4mg TabSalbutamol 5mg/ml in 30ml Inhalation Sol (for Nublizer)Salbutamol 5mg/ml in 30ml Inhalation Sol (for Nublizer)SolSilver Sulfadiazine 1% Oint 250gSilver Sulfadiazine 1% Oint 250gCanSodium Bicarbonate 8.4% 10ml Sodium Bicarbonate 8.4% 10ml AmpSodium Chloride 0.9% 1000ml IV infusion (Normal Saline) + IV SetSodium Chloride 0.9% 1000ml IV infusion (Normal Saline) + IV SetInfusion SolSodium Chloride 0.9% 500ml IV infusion (Normal Saline)+IV SetSodium Chloride 0.9% 500ml IV infusion (Normal Saline)+IV SetInfusion SolStreptokinase 1.5 MU Streptokinase 1.5 MU VialSulphacetamide 10% 10ml Eye Sulphacetamide 10% 10ml Eye DropSulphacetamide 20% 10ml Eye Sulphacetamide 20% 10ml Eye DropSuxamethonium 50mg/ml 2mlSuxamethonium 50mg/ml 2mlAmpTetracaine 0.5% 15ml Eye Tetracaine 0.5% 15ml Eye DropTetracycline Eye 1% OintTetracycline Eye 1% OintOintThiopental Sodium 500mg Thiopental Sodium 500mg VialTramadol 100mg Tramadol 100mg TabTramadol 50mg/ml, in 2ml Tramadol 50mg/ml, in 2ml AmpTranexamic acid 50mg/ml, in 5ml Tranexamic acid 50mg/ml, in 5ml AmpTrihexyphenidyl 2mg Trihexyphenidyl 2mg TabValproic Acid (Sodium valproate) 200mg Valproic Acid (Sodium valproate) 200mg TabValproic Acid (Sodium valproate) 500mg Valproic Acid (Sodium valproate) 500mg TabVecuronium Bromide 10mg/ml, in 10ml Vecuronium Bromide 10mg/ml, in 10ml VialVecuronium Bromide 4mg/ml, in 2ml Vecuronium Bromide 4mg/ml, in 2ml AmpVencomycine 1gVencomycine 1gVialVerapamil 2.5mgVerapamil 2.5mgAmpWater for Injection 10ml Water for Injection 10ml AmpEvaluation Committee Notes:_______________________________________________________________________________________________________________________Annex 2: PRICE breakdownPage No 01 of______ PUBLICATION REFERENCE: AF274MO-2017- 301-KBLPRICE BREAKDOWNABCDefgItem NO.QuantityMeasureItem DescriptionUnit Cost With Delivery (Incoterm and Destinations Specified in ITT)Total Cost with delivery (Incoterm and Destinations Specified in ITT)Currency According to ITT8SyrupAcetylcysteine 200mg/5ml granules 8,000TabAcetylsalicylic acid (Coated Aspirin) 100mg 16,000TabAcetylsalicylic acid (Coated Aspirin) 500mg 20,000TabActivated charcoal 500mg 1,000VialAdrenalin 0.0005%+Lidocaine 2% in 50ml 800AmpAdrenalin 0.00125%+Lidocaine dental 2% injection solution260,000TabAluminium hydroxide 200mg+Magnesium hydroxide 200mg 120,000TabAluminium hydroxide 500mg 200AmpAmiodarone 150mg8,000AmpAmikacin 100mg/ml, in 2ml 5,000TabAminophylline 100mg 150AmpAminophylline 25mg/ml, in 10ml 180,000TabAmitriptylline 25mg 100,000CapAmoxicillin 250mg Cap200,000CapAmoxicillin 500mg Cap200SuspAmoxicillin 125mg + Clavulanic acid 31.25mg/5ml, in 60ml bottle,12,000TabAmoxicillin 500mg+Clavulanic acid 125mg (Co-amoxiclav) 16,000VialAmpicillin 1g 32VialAnti-D immunoglobulin (human) 250mcg per dose, in 1 dose 2,300AmpArtemether 80mg/ml, 1ml, 6,600TabAtenolol 100mg 8,000TabAtenolol 50mg 8,000AmpAtropine sulfate 1mg/ml, in 1ml 20SprayBeclomethason dipropionate 50mcg per dose, nasal spray800OintBenzoic Acid 6%+Salicylic acid 3% topical Oint 160AmpBiperiden 5mg/ml 1ml Amp1,000TabBisacodyl 5mg Tab1,300AmpBupivacaine 5mg/ml, 4ml Amp5,000AmpCalcium Gluconate 10% 10ml Amp260LotionCalamine (Zn0 + Fe203) Lotion: 8%4,000TabCaptopril 25mg Tab54,000TabCarbamazepine 200mg Tab4,200VialCefazolin 1g Vial8,500VialCefotaxime 1g Vial + Water4,000VialCefotaxime 500mg Vial+ Water48,000VialCeftriaxone 1g Vial + Water22,000VialCeftriaxone 500mg Vial +Water900DropChloramphenicol 0.5% in 2.5ml bottle, ophthalmic drop900DropChloramphenicol 0.5%+Dexamethasone 0.1% in 10ml bottle, ophthalmic drop100SolChlorhexidine Digluconate 5% Topical Sol8,000TabChloroquine 150mg Tab200SyrupChloroquine 50mg/5ml 60ml Syr1,000AmpChlorphenamine maleate 10mg/ml , in 1ml Amp48,000TabChlorphenamine maleate 4mg Tab12,000TabChlorpromazine 100mg Tab16,000VialCiprofloxacin 2mg/ml 100ml Vial12,000VialCloxacillin 500mg Vial4,000AmpDexamethasone 4mg /ml 1ml Amp12,000TabDiazepam 5mg Tab5,000AmpDiazepam 5mg/ml 2ml Amp (Valum/Martin Dow)32,000AmpDiclofenac 25mg/ml 3ml Amp500SyrupDiphenhydramine chloride 14mg/5ml, 90ml Syr800VialDobutamine Injection: 12.5 mg/ml in 20 ml 1,400AmpDopamine 40mg/ml 5ml Amp2,000CapDoxycycline 100mg Cap500AmpEphedrine Hcl 3mg/ml, in 10ml , Amp3,600AmpEpinephrine (Adrenaline) 0.1% in 1ml Amp280,000TabFerrous Sulphate 200mg Tab420,000TabFerrous Sulphate 60mg+Folic Acid 0.4mg Tab100AmpFlumazenil 0.1mg/ml, in 10ml , Amp15,000CapFluoxetine 20mg Cap400AmpEnoxaparine 100mg/ml (LMWH)40,000TabFolic Acid 5mg Tab1,600Infusion SolPlasma (Hemaccel), in 500ml bottle, infusion Sol18,000AmpFurosemide 10mg/ml, in 2ml Amp (Lasix)800DropGentamicin 0.3% in 5ml bottle, ophthalmic drop4,000AmpGentamicin 20mg/ml, 2ml Amp1,000AmpGentamicin 40mg/ml, 2ml Amp3,200Infusion SolGlucose 10% 1000ml IV infusion+IV Set3,200Infusion SolGlucose 10% 500ml IV infusion+IV Set9,000Infusion SolGlucose 4%+Sodium Chloride 0.18% 500ml IV infusion+IV Set12,000Infusion SolGlucose 5% 1000ml IV infusion+IV Set7,200Infusion SolGlucose 5% 500ml IV infusion+IV Set1,600VialGlucose 25% 20ml 3,600Infusion SolGlucose 5%+Sodium Chloride 0.9% 1000ml IV infusion+IV Set2,400Infusion SolGlucose 5%+Sodium Chloride 0.9% 500ml IV infusion+IV Set90AmpGlyceryl trinitrate 10 mg/10 ml 3,000TabGriseofulvin 500mg Tab10,000TabHaloperidol 5mg Tab100AmpHaloperidol 5mg/ml, 1ml Amp100TabHydrochlorothiazide 50mg Tab200OintHydrocortisone Acetate 1% 15g Oint200SolutionHydrogen peroxide 6% topical Solution 500ml80,000TabIbuprofen 200mg Tab135,000TabIbuprofen 400 mg Tab80VialInsulin (regular) 100IU/ml, 10ml Vial80VialInsulin Humuline(70/30) 100IU/ml, 10ml Vial80bottlIsoflurane in 250 milliliter, gas 6,500VialKetamin 50mg/ml 10ml Vial700OintKetoconazole , 20% 30g, topical cream 250AmpLabetolol2,600TubeLidocaine 2% in 15g tube, topical gel100VialLidocaine 2% in 50ml Vial550bottlLindane Lotion: 1% 1,000AmpMagnesium Sulfate 500mg/ml (50%) 10ml Amp1,200Infusion SolMannitol 20% 500ml Infusion +IV Set3,000TabMethyldopa 250mg Tab2,000TabMethylergometrine 0.2mg Tab1,200SolMethylrosaniline (Gentian Violet) 1% in 25ml bottle, topical Sol12,000AmpMetoclopramide 5mg/ml, in 2ml Amp40,000TabMetronidazole 200mg Tab40,000TabMetronidazole 400mg Tab32,000SolMetronidazole 5mg/ml, in 100ml bottle, infusion Sol12,000TabMisoprostol 200mcg Tab300AmpMorphine (sulfate,hydrochloride) 10mg/ml, in 1ml Amp100,000TabMultivitamin Tab2,000AmpNaloxone 400mcg/ml (0.4mg/ml) in 1ml Amp7,000AmpNeostigmine methylsulfate2.5mg/ml, in 10ml Amp4,000TabNitrofurantoin 100mg Tab/Cap600DropNystatin 100,000IU 30ml Oral Topical Drop200TabNystatin 100,000IU Oral Tab 400TabNystatin 100,000IU Vaginal Tab/ovule suppository1,200TabNystatin 500,000IU Tab, oral1,600VialOmeprazole 40mg/ml80,000AmpOxytocine 10IU/ml in 1ml Amp2,000AmpPancuronium Bromide (Pavulon) 2mg/ml, 2ml Amp48,000TabParacetamol 100mg Tab3,000SyrupParacetamol 120mg/5ml, 60ml Syr7,200VialPenicillin Benzyl (Peni G crystal) 5MU Vial16,000TabPenicillin V Potassium 250mg Tab16,000TabPenicillin V Potassium 500mg 20AmpPethidine 100mg/ml, 1ml Amp8,000TabPhenobarbital 100mg Tab6,000TabPhenobarbital 15mg Tab4,000AmpPhenobarbital 200mg/ml, 1ml Amp1,200AmpPhytomenadione (Vit K) 10mg/ml, 5ml Amp (50mg/5ml)500TubePolymyxin 10000IU+Bacitracin 500IU per gram, in 6g tube, ophthalmic oint5,600SolPovidone-Iodine 10% Topical Sol 450ml80DropPrednisolone 0.5% 5ml eye Drops1,600TabPrednisolone 5mg 1,000TabPrimaquine 15mg Tab 7,000TabPromethazine 25mg Tab600VialPropoful4,000TabPropranolol 20mg 3,000TabPropranolol 40mg 50AmpPromethazine 25 mg/ml 600AmpQuinine dihydrochloride 300mg/ml, in 2ml 16,000TabRanitidine 150mg 7,200AmpRanitidine 25mg/ml, in 2ml 4,000TabRetinol (Vit A) 100,000 IU 1,000CapRetinol (Vit A) 200,000 IU 42,000Infusion SolRinger lactate 1000ml IV infusion+IV Set20,000Infusion SolRinger lactate 500ml IV infusion+IV Set1,600SyrupSalbutamol 2mg/5ml, in 60ml 4,000TabSalbutamol 4mg 500SolSalbutamol 5mg/ml in 30ml Inhalation Sol (for Nublizer)2,000CanSilver Sulfadiazine 1% Oint 250g50AmpSodium Bicarbonate 8.4% 10ml 32,000Infusion SolSodium Chloride 0.9% 1000ml IV infusion (Normal Saline) + IV Set17,000Infusion SolSodium Chloride 0.9% 500ml IV infusion (Normal Saline)+IV Set20VialStreptokinase 1.5 MU 800DropSulphacetamide 10% 10ml Eye 800DropSulphacetamide 20% 10ml Eye 5,000AmpSuxamethonium 50mg/ml 2ml160DropTetracaine 0.5% 15ml Eye 1,600OintTetracycline Eye 1% Oint100VialThiopental Sodium 500mg 100TabTramadol 100mg 2,400AmpTramadol 50mg/ml, in 2ml 2,500AmpTranexamic acid 50mg/ml, in 5ml 8,000TabTrihexyphenidyl 2mg 1,000TabValproic Acid (Sodium valproate) 200mg 1,000TabValproic Acid (Sodium valproate) 500mg 600VialVecuronium Bromide 10mg/ml, in 10ml 4,000AmpVecuronium Bromide 4mg/ml, in 2ml 300VialVencomycine 1g90AmpVerapamil 2.5mg90,000AmpWater for Injection 10ml Grand Total AFNAnnex 3: Company information tender participant.Publication reference: AF274MO-2017-301KBLA: HealthNet TPO Afghanistan office, House-144, Street-5, Sello Road District-3, Dehnaw, Dehburi, Kabul, AfghanistanOne 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 aconsortium (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.1SUBMITTED BYName(s) of tenderer(s)Nationality2LeaderMember 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 registered2CONTACT PERSONNameAddressTelephoneFaxE-mail3ECONOMIC AND FINANCIAL CAPACITYPlease 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 dataYear before lastUSDLast yearUSDThis yearUSDNext yearUSDAverage 4USDAnnual 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 repayable 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.4EXPERIENCEPlease complete a table using the format below to summarize the major relevant medicines 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 tenderRef # (maximum 5)Project Title…Name of legal entityCountryOverall supply value ( USD)Proportion supplied by legal entity (%)No of staff providedName of clientOrigin of fundingDates Name of members if anyDetailed description of supplyRelated services provided……5TENDERER'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:1We 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.2We 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 [….]: [……………………………………………………………….]3The 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: [……………………………………………..]4We will grant a discount of [%], or […………..] [in the event of our being awarded Lot No… and Lot No… ………].5This tender is valid for a period of 90 days from the final date for submission of tenders.6If our tender is accepted, we undertake to provide a performance guarantee of 10%, as required by your venerated organization.7Our firm/company [and our subcontractors] has/have the following nationality:<……………………………………………………………………>8We 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 to remain in the joint venture/consortium for the entire period of the contract's execution].9We 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.10We 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. 11We 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.12We 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]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 establishedThat 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:............................................................Annex 5: Tender Guarantee FormTender 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 of medicines] under Invitation for Tenderer No.AF274MO-2017-301-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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