Sample Forms - Duty Free Philippines



Notice of Procurement through

Alternative Method

PROVISION OF DFPC HEALTHCARE SERVICES

HRMD1705

Duty Free Philippines Corporation (DFPC) through its 2018 Corporate Budget intends to apply the sum of Forty Five Million Pesos (PhP45,000,000.00) being the Approved Budget for the Contract (ABC) to payments under the contract for the Provision of DFPC Healthcare Services. Bids received in excess of the ABC shall be automatically rejected at bid opening.

DFPC now invites bids for Provision of Healthcare Services. Prospective bidders must have at least five (5) years experience in providing corporate healthcare services. The prospective bidder should be duly licensed to operate as HMO by the Bureau of Health Facilities and Services of the Department of Health (DOH). The description of an eligible bidder is contained in the Bidding Documents, particularly, in Section II. Instructions to Bidders.

Bidding will be conducted through open competitive bidding procedures using the non-discretionary “pass/fail” criterion as specified in the 2016 Revised Implementing Rules and Regulations (IRR) of Republic Act (RA) 9184, otherwise known as the “Government Procurement Reform Act”.

Bidding is restricted to Filipino citizens/sole proprietorships, partnerships, or organizations with at least sixty percent (60%) interest or outstanding capital stock belonging to citizens of the Philippines, and to citizens or organizations of a country the laws or regulations of which grant similar rights or privileges to Filipino citizens, pursuant to RA 5183.

Pursuant to Section 53.1 of the Revised Implementing Rules and Regulations (IRR) of Republic Act No. 9184 (RA 9184), the DFPC may directly negotiate with a technically, legally and financially capable supplier after two (2) failed biddings.

Interested bidders may obtain further information from DFPC and inspect the Bidding Documents at the address given below from 9:00AM – 5:00PM, Mondays thru Fridays.

A complete set of Bidding Documents may be acquired by interested bidders on 16 January 2018 from the address below.

It may also be downloaded free of charge from the website of the Philippine Government Electronic Procurement System (PhilGEPS) and the website of the Procuring Entity.

Please refer to the listed bidding schedule below and will be held at the address given below:

|ACITIVITY |DATE |

|Submission of Eligibility Requirements |On or before 23 January 2018 |

|Negotiation on Technical and Financial Requirements |24 January 2018, 10:00AM |

|Submission of Best Offer based on the Final Technical and Financial |26 January 2018, 10:00AM |

|Requirements | |

Eligibility documents may be submitted prior to the prescribed schedule and must be completed prior to the date of Negotiations which will then be subject to evaluation.

Best offer will be opened in the presence of the Bidders’ representatives who choose to attend. Late submission of best offer shall not be accepted.

DFPC reserves the right to reject any and all bids, declare a failure of bidding, or not award the contract at any time prior to contract award in accordance with Section 41 of RA 9184 and its IRR, without thereby incurring liability to the affected bidder or bidders.

BAC Secretariat

Duty Free Philippines

EHA Bldg, Fiesta Mall, Columbia Complex

Ninoy Aquino Ave., Parañaque City

(632) 552-4343; (632) 552 4337 loc. 3096 / 3039

Telefax No. (632) 552-4345, 879-3664,

552 4399 loc 834

Email: bacsecretariat@.ph

(Sgd.) MICHAEL JAMES V. CHUA

BAC Chairperson

III. Bid Data Sheet

|ITB Clause | |

|1.1 |The PROCURING ENTITY is DUTY FREE PHILIPPINES CORPORATION |

| |The name of the Contract is Provision of DFPC Healthcare Services. |

| |The identification number of the contract is HRMD1705. |

|1.2 |The lot and reference is: |

| |Memorandum HRMD-ESD-BENEFITS SECTION (17)-022 |

|2 |The Funding Source: |

| |The Government of the Philippines (GOP) through the 2018 Corporate Budget of DUTY FREE PHILIPPINES CORPORATION in |

| |the amount of: |

| |Forty Five Million Pesos (PhP45,000,000.00) |

| |The name of the project is : |

| |PROVISION OF DFPC HEALTHCARE SERVICES (HRMD1705) |

|3.1 |No further instructions. |

|5.1 |No further instructions. |

|5.2 |Foreign bidders, except those falling under ITB Clause 5.2(b), may not participate in this Project. |

|5.4 |Bidder must have completed, within the period specified in the Invitation to Bid and ITB Clause 12.1(a)(ii), a |

| |single contract that is similar to this Project, equivalent to at least fifty percent (50%) of the ABC or: |

| |Twenty Two Million Five Hundred Thousand Pesos (PhP22,500,000.00). |

| |For this purpose, similar contract shall refer to provision of corporate healthcare services. |

|7 |No further instructions. |

|8.1 |Subcontracting is not allowed. |

|8.2 |Not applicable. |

|9.1 |The Date and Venue of the Negotiation is: |

| |24 January 2018, 10:00AM |

| |DUTY FREE PHILIPPINES CORPORATION |

| |EHA Building, Fiestamall, |

| |Columbia Complex, Ninoy Aquino Ave. |

| |Parañaque City |

|10.1 |The PROCURING ENTITY’s address is: |

| |Duty Free Philippines Corporation Ground Floor, EHA Building, Fiestamall, Columbia Complex, Ninoy Aquino Avenue, |

| |Parañaque City |

| |MICHAEL JAMES V. CHUA |

| |BAC Chairperson |

| |Thru: BAC Secretariat |

| |Tele No : 552 4337 loc 3039/3096, 552 4343 |

| |Fax No. 879 3664 / 552 4345 / 552 4399 loc. 834 |

| |bacsecretariat@.ph |

|12.1(a) |No further instructions. |

|12.1(a)(ii) |The bidder’s SLCC similar to the contract to be bid should have been completed within the last five (5) years |

| |(2013-2015) prior to the deadline for the submission and receipt of bids. |

|13.1 |Proposed Rates for Section IX Employee-Paid Dependents (Refer to Annex 1 of Section IX, original). |

|13.1(b) |No further instructions. |

|13.1(c) |No additional requirements. |

|13.2 |The ABC is |

| |Forty Five Million Pesos (PhP45,000,000.00) |

| |Any Bid with a financial component exceeding this amount shall not be accepted. |

|15.4(a)(iv) |No incidental services are required. |

|15.4(b) |No incidental services are required. |

|16.1(b) |The Bid prices for Goods and services supplied from outside of the Philippines shall be quoted in Philippine Pesos.|

|16.3 |Not applicable. |

|17.1 |Bids will be valid until 26 May 2018. |

|20.3 |Each Bidder shall submit one (1) original and three (3) copies of the first and second components of its bid. |

|21 |The Address for Submission of Best Offer is: |

| |DUTY FREE PHILIPPINES CORPORATION |

| |Ground Floor EHA Building, Fiestamall, |

| |Columbia Complex, Ninoy Aquino Ave., Parañaque City |

| |The deadline for Submission of Bids is on |

| |26 January 2018 at 10:00AM. |

|24.1 |The place of Bid Opening is |

| |Duty Free Philippines Corporation, EHA Building, Fiestamall, Columbia Complex, Ninoy Aquino Avenue, Parañaque City|

| |The date and time of Bid opening is on: |

| |26 January 2018 at 10:15AM. |

|24.2 |No further instructions. |

|24.3 |No further instructions. |

|27.1 |No further instructions. |

|28.3(a) |Partial bid is not allowed. The goods are grouped in a single lot and the lot shall not be divided into sub-lots |

| |for the purpose of bidding, evaluation, and contract award. |

|28.4 |No further instructions. |

|29.2 |2016 Income Tax Return (form 1701/1702) with Audited Financial Statement. |

| |Business Tax Return (forms 2550M/2551M and 2550Q/2551Q) for the last six (6) months (July to December 2017) prior |

| |to opening of Bids filed thru Electronic Filing and Payment System (EFPS). |

| |Only tax returns filed and taxes paid through the BIR Electronic Filing and Payment System (EFPS) shall be |

| |accepted. |

| |Updated General Information Sheet received by the SEC. |

| |BIR Certificate of Registration. |

|32.4(f) |No additional requirement. |

V. Special Conditions of the Contract

|GCC Clause | |

|1.1(g) |The PROCURING ENTITY is Duty Free Philippines Corporation. |

|1.1(i) |The Supplier is _______________________ |

|1.1(j) |The Funding Source is: |

| |The Government of the Philippines (GOP) through the Corporate Budget of Duty Free Philippines Corporation 2018 |

| |in the amount of : |

| |Forty Five Million Pesos (PhP45,000,000.00) |

|1.1(k) |The Project Site is : |

| |DUTY FREE PHILIPPINES CORPORATION, Ground Floor, EHA Building, Fiestamall, Columbia Complex, Ninoy Aquino |

| |Avenue, Parañaque City |

|2.1 |No further instructions. |

|5.1 |The PROCURING ENTITY’s address for Notices is: |

| |DUTY FREE PHILIPPINES CORPORATION, EHA Building, Fiestamall, Columbia Complex, Ninoy Aquino Ave., Parañaque City|

| |Vicente Pelagio A. Angala Maria Teresa C. Panopio |

| |Chief Operating Officer HRMD Manager-OIC |

| |Tel. Nos. (632) 879-3559 Tel. Nos. (632) 552 4346 |

| |Fax No. (632) 552 4301 panopiomc@.ph |

| | |

| |The Supplier’s address for Notice is: |

| |___________________________________________________ |

| |___________________________________________________ |

| |___________________________________________________ |

| |___________________________________________________ |

| |___________________________________________________ |

| |___________________________________________________ |

| | |

|6.2 |Services To Be Rendered and Documents |

| |Delivery of Services shall be made by the SUPPLIER in accordance with the terms specified in the Schedule of |

| |Requirements. |

| |I. Membership |

| |For purposes of determining eligibility of members, the following provisions shall govern: The age to be |

| |considered for purposes of enrolment is the age in years, regardless of the months or days, except in the case |

| |of newly born children. |

| |The enrolment of the Immediate Dependent Members shall follow the hierarchy: |

| |Married Principal Members - spouse first, followed by the eldest child, second child and so on. |

| |Single Principal Members - parents first, followed by the eldest sibling, second to the eldest sibling, and so |

| |on. |

| |2.3 Single-Parent Principal Members - eldest child first, followed by second child and so on, then last, |

| |parents. |

| |Hierarchy shall be waived for members covered by our previous SUPPLIERs for the last three (3) years. For this |

| |purpose, proof of membership shall be submitted. Hierarchy shall not apply under the following circumstances: |

| |Spouse working or living abroad or covered by another SUPPLIER or separated (legally or de facto); |

| |Children studying or living abroad or covered by another SUPPLIER |

| |Members who reach the age of ineligibility within the contract year shall remain covered until the contract |

| |expires, provided the full contract premium for the said members have been paid. |

| |Principal members who changed their civil status during the contract period may opt to enroll their former |

| |immediate dependents, if any, as specified in Section IX - Employee-Paid Dependents under Item I.1.1 for the |

| |remaining period of the contract. |

| |Enrolment shall be for a period of thirty (30) days following the commencement of the contract. Should a member |

| |be classified as Senior Citizen (SC) under R.A. 9994 and/or persons with disability (PWD) under R.A. 7277, he/ |

| |she shall submit a photocopy of his/her OSCA/PWD ID. |

| | |

| |Members who will be enrolled during the contract period shall be entitled to full coverage. Enrolment of |

| |additional members after the enrolment period shall only be allowed for the following: |

| |Newly regularized employees as Principal Members and their immediate dependents. |

| |Newly born children of the enrolled Principal Member. Member to submit thru DFPC a copy of birth certificate. |

| |Spouse of newly-wed Principal Member. Member to submit copy of marriage certificate. |

| |Effectivity of any request for additions in membership shall commence upon receipt of the letter endorsement |

| |report of the Procuring Entity. |

| |Severance of the principal member’s employment with the PROCURING ENTITY shall automatically terminate his/her |

| |coverage including that of his/her dependents. |

| |Any deletion in membership before the expiry date of the contract, shall entitle the PROCURING ENTITY to a |

| |refund of the unused premium, provided that the SUPPLIER shall be informed before the member’s resignation date |

| |or end of his contract. Refund shall be done two months after receipt of ID and the written request for refund. |

| |Computation of the PRO-RATE REFUND FOR UNUSED MEMBERSHIP FEES shall be according to the following formula: |

| |REFUND OF UNUSED MEMBERSHIP FEES = (Total Quarterly Premium Paid x Number of day unused) / 90 days. |

| |PHILHEALTH BENEFITS |

| |The healthcare program shall be net of Philhealth benefits. Should the member be unable to claim said Philhealth|

| |benefits, the amount corresponding to the same shall be for the account of the member. |

| |For non-Philhealth members, an additional annual fee/quarterly fee upon enrollment is required. |

| |OTHER BENEFITS PROVIDED BY LAW |

| |BENEFITS UNDER SENIOR CITIZENS’ ACT. The SUPPLIER shall ensure that all Senior Citizens are granted the |

| |corresponding discounts on all medical benefits. For this purpose, the SUPPLIER shall notify the hospitals, |

| |clinics and doctors of the members’ classification based on submitted master list and documents. |

| |BENEFITS UNDER THE MAGNA CARTA FOR DISABLED PERSONS. The SUPPLIER shall ensure that all Persons with Disability |

| |are granted the corresponding discounts on all medical benefits. For this purpose, the SUPPLIER shall notify the|

| |hospitals, clinics and doctors of the members’ classification based on submitted master list and documents. |

| |Procuring Entity shall submit proof of such classification to the SUPPLIER during enrollment. |

| |CLAIMS FOR REIMBURSEMENTS |

| |Emergency Care shall be one hundred percent 100% reimbursable in hospitals/clinics whether accredited or not |

| |accredited. |

| |Availment of healthcare services which cannot be provided by the SUPPLIER’s medical specialist/s, service units,|

| |accredited hospitals or medical centers and dental clinics, shall be reimbursed one hundred percent (100%), but |

| |not to exceed the amount of maximum benefit limit. |

| |Subject to the provision on Maternity Assistance, SUPPLIER agrees to reimburse hospital bills inclusive of |

| |professional fees. |

| |PROCURING ENTITY shall file Claims for Reimbursement within thirty (30) days from issuance of the official |

| |receipt/invoice. In the event that a required document is unavailable due to causes beyond the control of the |

| |claimant, the SUPPLIER shall be notified as such. The PROCURING ENTITY shall immediately submit to the SUPPLIER |

| |the said document as soon as it becomes available. |

| |Payment shall be made within thirty (30) days from filing of Claims for Reimbursement. Any request for |

| |reconsideration shall be submitted within thirty (30) days from receipt of the notice of disapproval or partial |

| |reimbursement, which in turn shall be ruled upon by the SUPPLIER within a maximum period of fifteen (15) days, |

| |otherwise, the request for reconsideration shall be deemed approved. |

| |PENALTY CLAUSE |

| |Failure of the SUPPLIER to reimburse claims on time as prescribed in section IV shall be subject to penalty of |

| |1% of the reimbursable amount per day. This shall be automatically deducted from the receivable of the SUPPLIER.|

| | |

| |PRE-EXISTING CONDITIONS AND DREADED ILLNESSES |

| |All pre-existing conditions including dreaded illnesses are covered by the SUPPLIER up to the maximum benefit |

| |limit, per illness, per member per year subject to item 1.4 of Schedule of Requirements under Medical Services. |

| |ROOM AND BOARD |

| |Room and Board, as described in Section VII -Technical Specifications, under Item II, will be based on the room |

| |classifications of the hospitals regardless of their rates. |

| |Member is given an option to downgrade his/her accommodation with the specified room classification as the |

| |highest. |

| |In case of non-availability of room plan during confinement, member may occupy the next higher room |

| |classification without being liable to incremental charges and excess in room and board until appropriate room |

| |becomes available, provided that the member secures a certification from the admitting section that there is no |

| |room available within the member’s plan. Failure to transfer upon availability of a room corresponding to the |

| |member’s plan shall make the member liable for said incremental charges and excess in room and board rate from |

| |the day the room becomes available up to the member’s date of discharge. |

| |LIMITATION IN SUPPLIER’S SERVICES |

| |The SUPPLIER shall not be held responsible for the following: |

| |Delay or failure to render services due to major disasters, brownouts or epidemics affecting facilities or |

| |personnel. |

| |Unusual circumstances such as complete or partial destruction of facilities, war, riots, disability of a |

| |significant number of SUPPLIER’s personnel or similar events which result in delay to provide services. |

| |A Member’s refusal to receive the recommended treatment for personal reasons, for which SUPPLIER’s Accredited |

| |Physicians believe no professionally acceptable alternative treatment exists. |

| |PAYMENT SCHEDULE |

| |The SUPPLIER shall submit the Statement of Account at the end of each quarter. |

| |Quarterly payment shall be due not later than sixty (60) days from the submission of an invoice and statement of|

| |account. |

| |OTHER PROVISIONS |

| |Open-door-policy where Members can avail of Healthcare Services (as described in Section VI Schedule of |

| |Requirements) from any of the SUPPLIER’s accredited hospitals/clinics nationwide. |

| |For medical services requiring confinement in a medical facility, hospital, or clinic, no deposit shall be |

| |required. |

| |If a member is referred by the SUPPLIER-accredited Physician to a non-accredited Specialist, the latter’s full |

| |professional fee for the administration of the required medical services shall be for the account of the |

| |SUPPLIER. |

| |The SUPPLIER shall provide an itemized monthly (calendar month) utilization report for principals and dependents|

| |(separate reports for company paid and employee paid) via e-mail to the Procuring Entity showing among others |

| |ID Number, Age, Availments: Check-in date, Check-out date, Diagnosis, Type of Availment, Name and Classification|

| |of Provider, Member’s Expenses for Room and Board, medicines & medical supplies, professional fees/doctors’ |

| |fees, Member’s Deductions which include Philhealth, Senior Citizens, Persons with Disability and other |

| |discounts, and total amount billed, see Annex A on MONTHLY REPORT. The monthly utilization report of the |

| |preceding month shall be submitted within fifteen (15) days of the following month. Should there be unreported |

| |availments, adjustments can be made immediately in the succeeding month. |

| |The SUPPLIER shall provide a quarterly (three month period) summary utilization report of principal members and |

| |dependents (separate reports for company paid and employee paid), both in hard and soft copies to the Procuring |

| |Entity based on the format provided by Procuring Entity. The QUARTERLY SUMMARY UTILIZATION REPORT shall contain |

| |the summary of availments for the given quarter and shall include the following info: Name of member, date of |

| |availment, diagnosis, total amount paid by supplier, total utilization per member/illness, MBL, running MBL. |

| |Refer to Annex B. The quarterly utilization report shall be submitted within thirty (30) days from end of the |

| |third month. |

| |The enrolment of a member under this contract shall, at all times, be honored regardless of the number of |

| |coverage the member may have with the same SUPPLIER-HMO or with other HMOs. |

| | |

| |ADDITIONAL MEMBERSHIP UNDER SECTION IX - EMPLOYEE-PAID DEPENDENTS |

| |The Principal Member may opt to enroll additional dependents as defined under Section IX - Employee-Paid |

| |Dependents. A separate agreement, with the same terms and conditions EXCEPT MATERNITY as this agreement, shall |

| |be entered into by the SUPPLIER and PROCURING ENTITY to cover these additional dependents. |

| |EFFECTIVITY AND DURATION OF THIS AGREEMENT |

| |The effectivity of this contract shall be upon issuance of the Notice to Proceed. |

| |The duration of this contract shall be for one (1) year. |

|10.4 |Not applicable. |

|10.5 |Payment using LC is not allowed. |

|11.3 |Maintain the GCC Clause. |

|13.4(c) |No further instructions. |

|16.1 |None. |

|17.3 |Not applicable. |

|17.4 |Not applicable. |

|21.1 |No additional provision. |

VI. Schedule of Requirements

I. SCOPE OF SERVICES

SUPPLIER shall arrange for the following Healthcare services using its Medical Service Units, Accredited Hospitals or Medical Centers, to all members and employee-dependents enrolled by the Procuring Entity for a period of one (1) year. The services shall include:

1. MEDICAL SERVICES

As prescribed by the SUPPLIER’s Accredited Physician/Specialist/Coordinator, all medical services for the diagnosis, treatment and procedures for all types of illnesses, diseases and accidents related injuries shall be covered up to the Maximum Benefit Limit (MBL), per illness, per member unless specified under dreaded illnesses, limitations and/or exclusions under 1.4, 1.5 and 1.6 of this title. Under no circumstances shall the member be required to pay in advance any cost due and for the account of the SUPPLIER.

1. INCLUSIONS:

The medical services shall include, but not necessarily limited to the following:

1. Access to hospital facilities including necessary supplies ordinarily provided by hospitals and clinics.

2. Administration of Drugs and Medications including supplemental vitamins and minerals when prescribed during confinement.

3. Administration of first passive and active dose of anti-rabies, anti-venom and anti-tetanus.

4. Administration of Steroid Shots and its costs as prescribed by accredited specialist.

5. Processing/Screening and infusion of human blood products.

6. Professional Medical Services.

7. Laboratory/Radiology/Diagnostic Procedures including skin tests.

8. Modern/Complex diagnostic/Rehabilitation and Therapeutic modalities, examinations/treatment and interventional surgical procedures.

2. PROCEDURE FOR AVAILMENT:

To avail of the medical services, the members shall, except in emergency cases, secure the issuance of a Letter of Authorization (LOA) from the following:

1. Supplier’s Clinics.

2. Accredited Clinics.

3. Accredited Hospitals.

4. Accredited Coordinators.

3. MODES OF AVAILMENT:

The medical services can be availed of under any of the modes as follows:

1. OUT-PATIENT- Availment of all medical services as described above, except prescribed home-medication, not requiring confinement in a medical facility, clinic or hospital.

2. IN-PATIENT- Availment of all medical services which requires confinement in a medical facility, clinic or hospital.

3. EMERGENCY CARE- Availment of all medical services in any hospital or clinic by a member who is in imminent danger of losing one’s life or any part of the body or is in severe pain that requires medical attention or relief without delay subject to the following conditions:

1. Emergency Care in Accredited Hospitals/Clinics.

2. Emergency Care in Non-Accredited Hospitals/Clinics- The SUPPLIER agrees to reimburse one hundred percent (100%) of the total hospital bills inclusive of professional fees. Emergency care may include the confinement of the member until such time that the member has been issued a clearance for transfer to an accredited hospital/clinic by the attending physician of the non-accredited hospital/clinic.

The SUPPLIER shall pay the said amount when it is verified that the SUPPLIER’s facilities were not used because in doing so it would entail a delay resulting in death, serious disability or significant jeopardy to the member’s condition, or the choice of hospital was beyond the control of the member or the member’s family. Follow-up care/consultations in non-accredited hospitals/clinics shall not be covered.

3. Emergency Care in a Foreign Country- In the event that a principal member is in need of emergency care in a foreign territory, the SUPPLIER shall reimburse in Philippine currency 100% of the total hospital bills and professional fees for a maximum of USD 1,000 or its equivalent, provided the MBL for such illness has not yet been exceeded.

1.4 DREADED ILLNESSES- Principal members diagnosed with cancer, cardiovascular diseases and chronic kidney diseases shall be entitled to an additional 20% of Maximum Benefit Limit per aforementioned illness.

1.5 LIMITATIONS- All medical services shall be subject to the Maximum Benefit Limit (MBL) provided in the Technical Specifications, except for the following:

1.5.1 Medically prescribed sleep study and sclerotherapy are each covered up to Twenty Thousand Pesos (PhP20,000.00).

1.5.2 Medically prescribed cauterization of warts in all parts of the body are covered up to Fifteen Thousand Pesos (PhP15,000.00) inclusive of facial warts which is covered up to Three Thousand Pesos (PhP3,000.00).

1.5.3 Implants, artificial aids, prosthetic devices and corrective appliances including lens for post cataract extractions (implants for brevity) are each covered up to Forty Thousand Pesos (PhP40,000.00). Eyeglasses, contact lenses, hearing aids, dentures and dental braces are not covered.

1.5.4 Availment of Executive Check Up shall be allowed to any Supplier’s accredited hospitals and clinics except for the six (6) major hospitals namely: Asian Hospital, Alabang, Muntinlupa City, Makati Medical Center, Makati City, Cardinal Santos Medical Center, San Juan City, St. Luke’s Medical Center, Quezon City & Global City and the Medical City, Pasig City.

1.6 EXCLUSIONS- Medical services availed under any of the circumstances/conditions

as follows:

1.6.1 Use by a member from a non-accredited physician/hospital or other provider of care except as described in the emergency care in non-accredited hospital or referred to by an accredited Specialist /Coordinator.

2. Plastic and reconstructive surgery for cosmetic purposes and for physical congenital deformities and abnormalities.

3. Dermatological care for aesthetic purposes such as chemical treatment for skin tags, xanthelesma, keloids, scars, etc. or any exposed areas of the body. Surgery for purposes of beautification.

4. Corrective eye surgery for error of refraction including laser surgery for correction of myopia and hypermyopia.

5. Experimental medical procedures like accupuncture, accupressure, reflexology and chiropractics.

6. Services to diagnose and/or reverse infertility or fertility and virility potency (erectile dysfunction).

7. Medical expenses incurred by donor of organ transplantation.

8. Diagnostics for hypersensitivity and desensitization treatment EXCEPT for Allergen test.

9. Purchase or lease of durable medical equipments, oxygen dispensing equipment and oxygen except during hospital confinement under the Hospital Confinement Benefit.

10. Psychiatric and psychological illnesses including neurotic and psychotic behavior disorders.

11. Treatment for any chemical dependencies or deliberate overdose reaction for the use of drugs.

12. Hormonal therapy.

13. Developmental disorders and eating disorders.

14. Any disease acquired through active sexual lifestyle with multiple partners such as AIDS (except if secondary to accidental needle injection or blood transfusion, which is covered up to maximum benefit limit per member), Hepatitis B (except through other forms of transmission which shall be covered up to a maximum benefit limit per member), condyloma, gonorrhea, syphilis, herpes etc. and their attendant complications.

15. Physical examinations required for obtaining or continuing employment, insurance or government licensing.

16. Injuries or illnesses resulting from participation in war-like or combat operations, riots, insurrection, rebellion, strikes and other civil disturbances.

17. Treatment of self inflicted injuries or injuries attributable to the member’s own misconduct, gross negligence, use of alcohol and/or drugs, vicious or immoral habits, commission of a crime, violation of a law or ordinance, unnecessary exposure to imminent danger or hazard to health or engagement to extreme sports.

18. Custodial, domiciliary care, convalescent and intermediate care.

19. Temporal mandibular joint disease surgery (TMJ) done by dental practitioner.

20. Circumcision except for correction of phymosis.

21. Prescribed take home medicines on an out-patient basis.

22. Treatment of injuries sustained in an accident if the member or his guardian fails or refuses to execute the deed of Subrogation (if applicable). The SUPPLIER shall be subrogated to the right of the member up to the extent of actual cost incurred by the SUPPLIER in connection with medical services rendered to such member.

23. Professional fees in Medico – legal cases.

24. Laboratory examinations for screening of sexually related illnesses.

25. All other items not directly related to the medical management of the confined member such as services of a private nurse or doctor, use of extra bed or other appliances, and extra food for companion.

2. MATERNITY ASSISTANCE

1. Maternity Assistance shall include the following services:

1. Room and Board.

2. Use of the labor, delivery/operating and recovery rooms.

3. ICU confinement.

4. Medical Profession services.

5. Administration of drugs and medications including human blood products.

6. All laboratory examinations (including VDRL) except for pregnancy test and ultrasound to determine sex. Laboratory examination costs are deductible from the limit set in Item 2.2.

7. Pediatric Care is covered while mother is still confined in the hospital, also deductible from the limit as provided below except for illness/complications suffered by the newly-born. If child is pre-enrolled, medical services required for such illnesses/complications shall be subject to child’s Maximum Benefit Limit (MBL).

8. Prenatal consultations and one (1) postnatal consultation per member (not deductible from the maternity benefit limit).

2.2 Maternity Assistance may be availed of by female principal members or legal spouses of married male principal members, and subject to the following limits:

|Type of Delivery |Maternity Assistance Limit |

| |per member |

|Caesarian Section | PhP 40,000.00 |

|Normal Spontaneous Delivery | 30,000.00 |

|Miscarriage | 20,000.00 |

|Complications of pregnancy | 15,000.00 |

|Threatened Abortion | 10,000.00 |

3. Complication of pregnancy shall refer to conditions but not limited to Abruptio Placenta, Placenta Previa, Post Partum Atony, H-Mole, Hyperemesis Gravidarum, Ecclampsia, Ectopic Pregnancy.

4. Expenses incurred relative to the availment of the maternity assistance under the following conditions shall be subject to reimbursement based on the HMO Relative Value and to the maternity assistance limit:

1. Confinement in a Non-Accredited Hospital and attended to by a Non-Accredited Doctor.

2. Confinement in a Non Accredited Hospital and attended to by an Accredited Doctor.

3. Confinement in an Accredited Hospital and attended to by a Non Accredited Doctor.

3. DENTAL SERVICES

1. The following dental care services may be availed by the members from any of the SUPPLIER’s accredited dentists and dental clinics and not limited to dental associations/organizations/classifications/groups:

1. Consultations and oral examinations.

2. Twice a year prophylaxis.

3. Unlimited temporary fillings.

4. Permanent light cure filling is covered up to five (5) surfaces per member.

5. Simple tooth extractions only, complicated cases not covered.

6. Annual scaling and polishing.

7. Orthodontic and aesthetic consultation and oral examination.

8. Gum treatment except alveolectomy and gingivectomy.

9. Adjustment of dentures.

10. Recementation of loose jackets, crowns, in-lays and on-lays.

11. Treatment of mouth lesions wounds and burns.

12. Emergency desensitization of hypersensitive teeth.

2. Retainer dentist to be stationed at Procuring Entity’s Head Office Clinic three times (3x) a week at eight (8) hours per visit.

4. ANNUAL PHYSICAL EXAMINATION (APE)

1. Annual Physical Examination (APE) shall be provided to the principal members (Rank & File and Supervisors) only by the SUPPLIER’s designated Medical Service Units which shall include the following:

1. Taking of medical history.

2. Physical Examination.

3. Complete Blood Count.

4. Urinalysis (urine examination).

5. Fecalysis (stool examination).

6. Chest X-ray.

7. Electrocardiogram (for members age 35 and above, or if indicated).

8. Pap’s Smear (for women age 35 and above, or if indicated).

9. Eye refraction.

10. Management of Health Problems.

2. Upon payment of the 2nd quarter premium, APE shall be conducted at the SUPPLIER’s Head Office Clinic or at the PROCURING ENTITY’s premises through the SUPPLIER Mobile Medical Team, to be scheduled for a minimum of fifty (50) principal members.

5. ANNUAL EXECUTIVE CHECK-UP (ECU)

1. Executive Check-up (ECU) to be provided to forty five (45) principal members, Manager category at the clinics/hospitals except in the six (6) major hospitals, namely, ASIAN Hospital and Medical Center, St. Luke’s Medical Center-Quezon City, St. Luke’s Medical Center-Global City, Taguig City, The Medical City General Hospital, Cardinal Santos and Makati Medical Center. It shall include the following procedures:

1. Comprehensive Physical Examination.

2. Complete Blood Count.

3. Blood Chemistry (FBS, BUN, BUA, Creatinine, Cholesterol, Sodium, Potassium, Total Protein, Albumin, Calcium, Alkaline, Phosphatase, Total Bilirubin, SGOT, SGPT, HDL/LDL, Triglycerides, PSA).

4. Urinalysis.

5. Fecalysis, w/ Occult Blood.

6. Chest X-ray.

7. Electrocardiogram.

8. Spirometry.

9. Pap’s Smear and Mammography for female.

10. Whole abdomen ultrasound, to include pelvis for female & prostate for male.

11. Treadmill Stress Test.

2. SUPPLIER shall arrange the ECU with accredited clinics/hospitals except for the six (6) major hospitals as provided above (1.5.4) for the following locations: Manila, Quezon City, Paranaque, Mandaluyong, Pasig, Makati, Alabang and provincial areas. Procuring Entity may schedule the ECU immediately upon payment of the 2nd quarter premium.

3. Should there be more than forty five (45) principal members who will avail of the ECU, SUPPLIER shall assist PROCURING ENTITY in the scheduling of the ECU at the prescribed clinics upon request, however, actual expenses shall be charged directly to the Procuring Entity.

6. OTHER SERVICES

6.1 Provide Preventive Health Care services to all members:

6.1.1 Counseling on health habits, diet and Family Planning.

6.1.2 Wellness Program (6 times a year).

6.2 Ambulance services shall be covered on a reimbursement basis up to Five Thousand Pesos (PhP5,000.00) per conduction from location to hospital including transfer of patient to another hospital as per medical advice.

3. Secure GROUP LIFE INSURANCE for all members with benefits as follows

|Schedule of Insurance Benefits |

| |Principal Members |Immediate |

| | |Dependents |

|Death |PhP 50,000.00 |PhP 50,000.00 |

|Loss of both hands |20,000.00 |20,000.00 |

|Loss of both feet |20,000.00 |20,000.00 |

|Loss of sight (both eyes) |20,000.00 |20,000.00 |

|Loss of one hand & one foot |20,000.00 |20,000.00 |

|Loss of one hand & sight of one eye |20,000.00 |20,000.00 |

|Loss of one foot & sight of one eye |20,000.00 |20,000.00 |

|Loss of one hand or one foot |10,000.00 |10,000.00 |

|Loss of sight of one eye |10,000.00 |10,000.00 |

The claim must be filed within sixty (60) days from the occurrence of death or dismemberment.

For this purpose, the member should designate his/her beneficiary in the enrollment form (to be provided by the Supplier) at the commencement of the contract. Should his/her beneficiary be a minor, a trustee should be named in the same enrolment form.

Payment of claims shall be made within fifteen (15) days from receipt of complete requirements.

Payment made by SUPPLIER under this section shall not be considered as availed medical services, thus, not form part of the utilization.

The member will not be entitled to the insurance benefit if the cause of death is among those listed in the exclusions under item 1.6.

II. manpower

1. The SUPPLIER agrees to provide the following personnel to be stationed at PROCURING ENTITY’s Head Office Clinic in Parañaque City:

|Position |Qty |Schedule |

|Dentist |1 |Eight (8) hours a day, three times (3x) a week. |

|Nurse |1 |Eight (8) hours a day, five times (5x) a week. |

|Doctor |1 |Eight (8) hours a day, five times (5x) a week. |

1. The assigned/stationed doctor shall provide his/her own medical equipment and be authorized by the SUPPLIER to issue the necessary Letter of Authority (LOA) for members’ availment of out-patient medical services under the following circumstances:

1. Referral to accredited specialist.

2. Request for laboratory/diagnostic procedures required by a duly accredited specialist. Copy of the request shall be attached to the LOA.

3. Request for laboratory/diagnostic procedures as recommended in the results of the annual medical check-up of the member.

4. Request for laboratory/diagnostic procedures required for his/her assessment of the member-patient.

2. The assigned/stationed nurse shall also be authorized to issue LOA but shall be limited to referrals to specialist/s and requests for laboratory/diagnostic procedures, examination by an accredited physician.

3. The assigned/stationed dentist shall provide his/her own dental equipment and materials.

2. The SUPPLIER shall designate an Account Officer who shall be responsible for answering queries, problems etc., concerning HMO matters. Attend to reimbursement of employees’ hospital bills and other charges but not necessarily stationed at DFP Medical Clinic.

3. The SUPPLIER shall ensure proper dissemination of DFPC HMO package to its customer care and/or call-center agents and hospitals.

III. ACCREDITED MEDICAL INSTITUTIONS AND PHYSICIANS

1. The SUPPLIER shall maintain its accreditation with Metro Manila Hospitals, including but not necessarily limited to the following hospitals/clinics as enumerated below:

1. ASIAN Hospital and Medical Center – Alabang, Muntinlupa City

2. Capitol Medical Center – Quezon Ave., Quezon City

3. Cardinal Santos Medical Center (Colinas Verdes Hospital Managers Corp)– Wilson St., San Juan City

4. De Los Santos Medical Center – E. Rodriguez Ave. Quezon City

5. Dr. Victor R. Potenciano Medical Center - Edsa, Mandaluyong City

6. Makati Medical Center – Legaspi Village, Makati City

7. Manila Doctor’s Hospital – U.N. Avenue, Manila

8. The Medical City Hospital and Medical Center – Ortigas Avenue, Pasig City

9. MPI – Medical Center Muntinlupa – Putatan, Muntinlupa City

10. Olivarez General Hospital, Inc. – Dr. A. Santos Avenue, Paranaque City

11. Our Lady of Lourdes Hospital (East Manila Hospital)– P. Sanches St., Sta. Mesa, Manila

12. University of Perpetual Help DALTA Medical Center – Alabang Zapote Rd., Las Pinas City

13. St. Luke’s Medical Center – E. Rodriguez Avenue, Quezon City

14. St. Luke’s Medical Center - Global City – Taguig City

15. University of Santo Tomas Hospital – Sampaloc, Manila

16. San Juan de Dios Hospital & Medical Center – Roxas Blvd., Pasay City

17. National Kidney and Transplant Institute – East Ave., Quezon City

18. Philippine Heart Center – East Ave., Quezon City

19. The Premier Medical Center – Sto. Nino, Paranaque City

2. The SUPPLIER shall maintain its accreditation with at least one (1) hospital per Provincial Store Location; except for Cebu Store where the SUPPLIER shall maintain its accreditation with at least two (2) hospitals from the list below:

1. Angeles University Foundation Hospital & Medical Center – Angeles City, Pampanga

2. Mother Theresa of Calcutta Medical Center – San Fernando, Pampanga

3. V.L. Makabali Mem. Hospital – San Fernando, Pampanga

4. Cebu Doctors University Hospital - Osmeña Blvd., Cebu City

5. Chong Hua Hospital – Fuente Osmeña Ave., Cebu City

6. Perpetual Succour Hospital – Gorordo Ave., Cebu City

7. Davao Doctor’s Hospital, Poblacion District – Davao City

8. San Pedro Hospital of Davao City Inc. - C. Guzman St., Davao City

9. Ricardo Limso Medical Center- Surgery & Pediatrics Clinic. – V. Ilustre St., Davao City

10. De La Salle University Medical Center – Dasmariñas, Cavite City

11. Our Lady of the Pillar Medical Center – Imus, Cavite City

12. Medical Center Imus - Imus, Cavite City

13. Divine Grace Medical Center. – Gen. Trias, Cavite City

14. Perpetual Help Medical Center – Binan, Laguna

15. Los Baños Doctors Hospital & Medical Center – Los Baños, Laguna

16. MMG-Medical Mission Group Hospital & Health Services Cooperative – Burgos cor. Madrid Sts. Puerto Princesa City, Palawan

17. Adventist Hospital Palawan – San Pedro, Puerto Princesa City, Palawan

18. RTN Foundation Inc. – Bataraza, Palawan

19. Aklan Cooperative Mission Hospital – Roxas Ave. Ext., Andagao, Kalibo, Aklan

20. MMG Aklan Specialty Clinic Medical Center. – San Lorenzo Drive, Aklan

21. Iloilo Doctor’s Hospital – West Ave., Molo, Iloilo City

22. Iloilo Mission Hospital – Mission Road, Jaro, Iloilo City

23. St. Paul’s Hospital of Iloilo, Inc. – Gen. Luna St., Iloilo City

24. The Medical City – Brgy. Tap-Oc, Molo, Iloilo City

25. St. Paul Hospital - Bulacan Inc., Bocaue, Bulacan

26. Our Lady of Mercy General Hospital. Inc. – Pulilan, Bulacan

27. Manila East Medical Center, Taytay, Rizal

28. Antipolo Doctors Hospital – M.L. Quezon Ave., Extension Dalig Antipolo City

29. Bio-Clinica Labortory - Silay, Bacolod City

30. THERE PEIA Medica Laboratorio – Burgos St. Bacolod City

31. Bacolod Adventist Medical Center – Taculing, Bacolod City

32. Our Lady of Mercy Specialty Hospital – Eroreco, Bacolod City

33. The Doctors Hospital Inc. – Benigno Aquino Drive, Bgy Villamonte, Bacolod City

3. For the whole duration of the Contract, the SUPPLIER must maintain accreditation of at least twelve (12) different types of specialists for in-patient and out-patient per hospital located in Metro Manila, Cebu and Davao as enumerated under items 1 and 2. However, for other provincial hospitals, each accredited hospital shall maintain one (1) doctor/coordinator. The types of specialists may include, but not necessarily limited to the following:

1. Cardiologist

2. Endocrinologist

3. Diabetologist

4. ENT (Otorhinolaryngologist)

5. Gastroenterologist

6. OB Gynecologist

7. Anesthesiologist

8. Surgeon

9. Pediatrician

10. Intensivist

11. Oncologist

12. Ophthalmologist

13. Pulmonologist

14. Hematologist

15. Nephrologist

16. Orthopedic – Rehab Medicine

17. Urologist

➢ National Kidney & Transplant Institute and Philippine Heart Center need not comply with the “twelve (12)-specialist requirement”.

Implementation Schedule:

Commencement of healthcare services shall be thirty (30) days from the receipt of the Notice to Proceed.

_____________________________ _____________________________

Signature over printed name Position

Duly authorized to sign this compliance to the Schedule of Requirements for and on behalf of

________________________.

VII. TECHNICAL SPECIFICATIONS

Bidders must state here either “Comply” or “Not Comply” against each of the individual parameters of each Specification stating the corresponding performance parameter of the equipment offered. Statements of “Comply” or “Not Comply” must be supported by evidence in a Bidders Bid and cross-referenced to that evidence. Evidence shall be in the form of manufacturer’s un-amended sales literature, unconditional statements of specification and compliance issued by the manufacturer, samples, independent test data etc., as appropriate. A statement that is not supported by evidence or is subsequently found to be contradicted by the evidence presented will render the Bid under evaluation liable for rejection. A statement either in the Bidders statement of compliance or the supporting evidence that is found to be false either during Bid evaluation, post-qualification or the execution of the Contract may be regarded as fraudulent and render the Bidder or supplier liable for prosecution subject to the provisions of ITB Clause 3.1 (a.2) and/or GCC Clause 2.1 (a.2).

|Minimum Specification |STATEMENT OF COMPLIANCE |

| | |

|Matrix of Members | |

| | |

|MEMBER CLASSIFICATION | |

|MEMBER | |

| | |

| | |

|PRINCIPAL | |

|0 | |

|0 | |

|1 | |

|1 | |

|0 | |

|1 | |

|1 | |

|859 | |

|DEPENDENTS | |

| | |

| | |

|MALE | |

|FEMALE | |

|MALE | |

|FEMALE | |

| | |

|A. COO | |

| | |

| | |

| | |

| | |

| | |

| | |

|Age Bracket : 00-25 | |

| | |

| | |

|1 | |

| | |

| | |

|26-39 | |

| | |

| | |

| | |

| | |

| | |

|40-59 | |

| | |

|1 | |

| | |

| | |

|1 | |

| | |

|60-65 | |

| | |

| | |

| | |

| | |

| | |

|Subtotal | |

|1 | |

|0 | |

|1 | |

|1 | |

| | |

|B. Manager | |

| | |

| | |

| | |

| | |

| | |

|Age Bracket : 00-25 | |

| | |

| | |

|27 | |

|28 | |

| | |

|26-39 | |

|1 | |

|0 | |

|0 | |

|4 | |

| | |

|40-59 | |

| | |

|19 | |

|34 | |

|14 | |

|10 | |

| | |

|60-65 | |

|4 | |

|8 | |

|4 | |

|1 | |

| | |

|Subtotal | |

|24 | |

|42 | |

|45 | |

|43 | |

| | |

|C. Supervisor | |

| | |

| | |

| | |

| | |

| | |

|Age Bracket : 00-25 | |

|4 | |

|2 | |

|115 | |

|123 | |

| | |

|26-39 | |

|28 | |

|34 | |

|15 | |

|14 | |

| | |

|40-59 | |

| | |

|95 | |

|93 | |

|47 | |

|74 | |

| | |

|60-65 | |

|4 | |

|14 | |

|18 | |

|16 | |

| | |

|Subtotal | |

|131 | |

|143 | |

|195 | |

|227 | |

| | |

|D. Rank & File | |

| | |

| | |

| | |

| | |

| | |

|Age Bracket : 00-25 | |

|8 | |

|28 | |

|269 | |

|225 | |

| | |

|26-39 | |

|54 | |

|67 | |

|40 | |

|37 | |

| | |

|40-59 | |

| | |

|265 | |

|132 | |

|88 | |

|234 | |

| | |

|60-65 | |

|18 | |

|11 | |

|38 | |

|28 | |

| | |

|Subtotal | |

|345 | |

|238 | |

|435 | |

|524 | |

| | |

| | |

| | |

| | |

| | |

| | |

| | |

|TOTAL ENROLLEES | |

|501 | |

|423 | |

|676 | |

|795 | |

| | |

| | |

|GRAND TOTAL | |

|924 | |

|1471 | |

| | |

|Note: Figures stated above are subject to change. | |

|Basis 2nd Quarter Billing (as of 31 March 2017 pax count) | |

| | |

|1. MEMBERSHIP: | |

| | |

|1.1 PRINCIPAL MEMBER | |

|Permanent or regular employees of the Procuring Entity, 18 to 65 years old with the following classifications: | |

|Chief Operating Officer | |

|Managers | |

|Supervisors | |

|Rank and File | |

|1.2 IMMEDIATE DEPENDENT OF MARRIED PRINCIPAL MEMBER | |

|1.2.2 The legal spouse up to 65 years old. | |

|1.2.3 Newly born children up to 25 years old, unemployed and unmarried. | |

|1.3 IMMEDIATE DEPENDENT OF SINGLE PRINCIPAL MEMBERS | |

|1.3.1 Parents up to 65 years old. | |

|1.3.2 Siblings (Full) 15 days to 25 years old, unemployed and unmarried. | |

|1.4 IMMEDIATE DEPENDENT OF SINGLE PARENT PRINCIPAL MEMBERS | |

|1.4.1 Newly born children up to 25 years old, unemployed and unmarried. | |

|1.4.2 Parents up to 65 years old. | |

|II. ROOM AND BOARD AND MAXIMUM BENEFIT LIMIT | |

| | |

| | |

|MEMBER CLASSIFICATION | |

| | |

|ROOM AND BOARD | |

| | |

|MAXIMUM BENEFIT LIMIT PER YEAR | |

| | |

| | |

|PRINCIPAL | |

|DEPENDENTS | |

| | |

|COO | |

|LARGE PRIVATE | |

|1,000,000.00 | |

|160,000.00 | |

| | |

|MANAGERS | |

|LARGE PRIVATE | |

|220,000.00 | |

|160,000.00 | |

| | |

|SUPERVISORS | |

|REGULAR PRIVATE | |

|190,000.00 | |

|130,000.00 | |

| | |

|RANK AND FILE | |

|REGULAR PRIVATE | |

|170,000.00 | |

|110,000.00 | |

| | |

|Note: See SCC 6.2 Clause V. Room and Board | |

|Member is given an option to downgrade his/her room accommodation with the abovementioned classification as the | |

|highest. | |

Additional Documentary Requirements to be submitted on the date of Opening of Bids:

1. Valid and current certificate of clearance to operate as HMO from the Bureau of Health Facilities and Services of the Department of Health (DOH) or Certificate of Authority issued by the Insurance Commission (IC).

2. Latest and updated list of accredited hospitals and clinics in Metro Manila and Provincial Hospitals, including but not necessarily limited to the following hospitals/clinics as enumerated below (hard copy and soft copy)

Metro Manila Hospitals - Refer to the list enumerated in the Schedule of Requirements under III.1

Provincial Hospitals at least one (1) hospital per Provincial Store Location; except for Cebu Store where the SUPPLIER shall maintain accreditation with at least two (2) hospitals. Refer to Schedule of Requirements under III.2

3. 2016 or 2017 Certificate of Good Standing from at least ten (10) in Metro Manila hospitals and one (1) per provincial location hospitals (Cavite, Laguna, Rizal, Pampanga, Cebu City, Davao City, Kalibo, Iloilo, Bacolod City and Puerto Princesa) of the mentioned Metro Manila and provincial hospitals.

4. Latest and updated list of accredited specialists for in-patient and out-patient of at least twelve (12) different types of specialists per hospital located in Metro Manila, Cebu and Davao as enumerated under item 2. The types of specialists may include, but not necessarily limited to the following:

a. Cardiologist

b. Endocrinologist/Diabetologist

c. ENT (Otorhinolaryngologist)

d. Gastro Enterologist

e. OB Gynecologist

f. Anesthesiologist

g. Surgeon

h. Pediatrician

i. Oncologist

j. Ophthalmologist

k. Pulmonologist

l. Hematologist

m. Nephrologist

n. Orthopedic – Rehab Medicine

o. Urologist

➢ National Kidney Institute and Philippine Heart Center need not comply with the “twelve (12)-specialist requirement”.

5. Latest and updated list (hard and soft copy) of at least one hundred thirty (130) accredited dentists in Metro Manila and at least seventy five (75) in the Provincial Hospitals/Clinics.

________________________________ _____________________________

Signature over printed name Position

Duly authorized to sign this compliance to the Technical Specifications for and on behalf of

________________________.

Bidding Form No. 1

FINANCIAL DOCUMENTS FOR ELIGIBILITY CHECK

| | |Year 20___ |

|1 | Total Assets | |

|2 | Current Assets | |

|3 | Total Liabilities | |

|4 | Current Liabilities | |

|5 | Net Worth (1-3) | |

|6 | Net Working Capital (2-4) | |

The Net Financial Contracting Capacity (NFCC) based on the above data is computed as follows:

NFCC = [(Current assets – current liabilities) (15)] minus value of all outstanding or uncompleted portions of the projects under ongoing contracts including awarded contracts yet to be started coinciding with the contract to be bid.

The values of the domestic bidder’s current assets and current liabilities shall be based on the latest Audited Financial Statements submitted to the BIR.

NFCC = PhP ____________________________________

Submitted by:

_____________________________________________

Name of Bidder

_____________________________________________

Signature of Authorized Representative over Printed Name

Date: __________________________

Bidding Form No. 2

Page 1 of 3

Omnibus Sworn Statement

REPUBLIC OF THE PHILIPPINES )

CITY/MUNICIPALITY OF ______ ) S.S.

AFFIDAVIT

I, [Name of Affiant], of legal age, [Civil Status], [Nationality], and residing at [Address of Affiant], after having been duly sworn in accordance with law, do hereby depose and state that:

1. Select one, delete the other:

If a sole proprietorship: I am the sole proprietor or authorized representative of [Name of Bidder] with office address at [address of Bidder];

If a partnership, corporation, cooperative, or joint venture: I am the duly authorized and designated representative of [Name of Bidder] with office address at [address of Bidder];

2. Select one, delete the other:

If a sole proprietorship: As the owner and sole proprietor, or authorized representative of [Name of Bidder], I have full power and authority to do, execute and perform any and all acts necessary to participate, submit the bid, and to sign and execute the ensuing contract for [Name of the Project] of the [Name of the Procuring Entity], as shown in the attached duly notarized Special Power of Attorney;

If a partnership, corporation, cooperative, or joint venture: I am granted full power and authority to do, execute and perform any and all acts necessary to participate, submit the bid, and to sign and execute the ensuing contract for [Name of the Project] of the [Name of the Procuring Entity], as shown in the attached [state title of attached document showing proof of authorization (e.g., duly notarized Secretary’s Certificate, Board/Partnership Resolution, or Special Power of Attorney, whichever is applicable;)];

3. [Name of Bidder]is not “blacklisted” or barred from bidding by the Government of the Philippines or any of its agencies, offices, corporations, or Local Government Units, foreign government/foreign or international financing institution whose blacklisting rules have been recognized by the Government Procurement Policy Board;

4. Each of the documents submitted in satisfaction of the bidding requirements is an authentic copy of the original, complete, and all statements and information provided therein are true and correct;

5. [Name of Bidder]I is authorizing the Head of the Procuring Entity or its duly authorized representative(s) to verify all the documents submitted;

6. Select one, delete the rest:

If a sole proprietorship: The owner or sole proprietor is not related to the Head of the Procuring Entity, members of the Bids and Awards Committee (BAC), the Technical Working Group, and the BAC Secretariat, the head of the Project Management Office or the end-user unit, and the project consultants by consanguinity or affinity up to the third civil degree;

Bidding Form No. 2

Page 2 of 3

If a partnership or cooperative: None of the officers and members of [Name of Bidder] is related to the Head of the Procuring Entity, members of the Bids and Awards Committee (BAC), the Technical Working Group, and the BAC Secretariat, the head of the Project Management Office or the end-user unit, and the project consultants by consanguinity or affinity up to the third civil degree;

If a corporation or joint venture: None of the officers, directors, and controlling stockholders of [Name of Bidder] is related to the Head of the Procuring Entity, members of the Bids and Awards Committee (BAC), the Technical Working Group, and the BAC Secretariat, the head of the Project Management Office or the end-user unit, and the project consultants by consanguinity or affinity up to the third civil degree;

7. [Name of Bidder] complies with existing labor laws and standards; and

8. [Name of Bidder] is aware of and has undertaken the following responsibilities as a Bidder:

a) Carefully examine all of the Bidding Documents;

b) Acknowledge all conditions, local or otherwise, affecting the implementation of the Contract;

c) Made an estimate of the facilities available and needed for the contract to be bid, if any;

d) Inquire or secure Supplemental/Bid Bulletin(s) issued for the [Name of the Project]; and

e) Responsible for any erroneous interpretation or conclusion out of the data furnished by the PROCURING ENTITY.

9. [Name of Bidder] did not give or pay directly or indirectly, any commission, amount, fee, or any form of consideration, pecuniary or otherwise, to any person or official, personnel or representative of the government in relation to any procurement project or activity.

IN WITNESS WHEREOF, I have hereunto set my hand this __ day of ___, 20__ at ____________, Philippines.

_____________________________________

Bidder’s Representative/Authorized Signatory

Bidding Form No. 2

Page 3 of 3

SUBSCRIBED AND SWORN to before me this ___ day of [month] [year] at [place of execution], Philippines. Affiant/s is/are personally known to me and was/were identified by me through competent evidence of identity as defined in the 2004 Rules on Notarial Practice (A.M. No. 02-8-13-SC). Affiant/s exhibited to me his/her [insert type of government identification card used], with his/her photograph and signature appearing thereon, with no. ________ and his/her Community Tax Certificate No. _______ issued on ____ at ______.

Witness my hand and seal this ___ day of [month] [year].

NAME OF NOTARY PUBLIC

Serial No. of Commission _______________

Notary Public for _______ until __________

Roll of Attorneys No. __________________

PTR No. ______ [date issued], [place issued]

IBP No. ______ [date issued], [place issued]

Doc. No. _______

Page No. _______

Book No. _______

Series of _______

Bidding Form No. 3

Bid Form

Date:

To: MICHAEL JAMES V. CHUA

Duty Free Philippines Corporation

Fiestamall, Columbia Complex,

Ninoy Aquino Avenue, Parañaque City

Gentlemen and/or Ladies:

Having examined the Bidding Documents including Bid Bulletin Numbers [insert numbers], the receipt of which is hereby duly acknowledged, we, the undersigned, offer to PROVISION OF DFPC HEALTHCARE SERVICES (HRMD1705) in conformity with the said Bidding Documents for the sum of [total bid amount in words and figures] or such other sums as may be ascertained in accordance with the Schedule of Prices attached herewith and made part of this Bid.

We undertake, if our Bid is accepted, to deliver the goods in accordance with the delivery schedule specified in the Schedule of Requirements.

If our Bid is accepted, we undertake to provide a performance security in the form, amounts, and within the times specified in the Bidding Documents.

We agree to abide by this Bid for the Bid Validity Period specified in BDS provision for ITB Clause 18.2 and it shall remain binding upon us and may be accepted at any time before the expiration of that period.

Until a formal Contract is prepared and executed, this Bid, together with your written acceptance thereof and your Notice of Award, shall be binding upon us.

We understand that you are not bound to accept the Lowest Calculated Bid or any Bid you may receive.

We certify/confirm that we comply with the eligibility requirements as per ITB Clause 5 of the Bidding Documents.

We likewise certify/confirm that the undersigned, [for sole proprietorships, insert: as the owner and sole proprietor or authorized representative of Name of Bidder, has the full power and authority to participate, submit the bid, and to sign and execute the ensuing contract, on the latter’s behalf for the Name of Project of the Name of the Procuring Entity] [for partnerships, corporations, cooperatives, or joint ventures, insert: is granted full power and authority by the Name of Bidder, to participate, submit the bid, and to sign and execute the ensuing contract on the latter’s behalf for Name of Project of the Name of the Procuring Entity].

We acknowledge that failure to sign each and every page of this Bid Form, including the attached Schedule of Prices, shall be a ground for the rejection of our bid.

Dated this ________________ day of ________________ 20______.

[signature] [in the capacity of]

Duly authorized to sign Bid for and on behalf of

Bidding Form No. 4

PRICE SCHEDULE

|1 |2 |3 |4 |5 |6 |

|Description |Quantity |Unit Price Per |Applicable Tax |Total Unit Price Per |Total Cost Per |

| | |Quarter | |Quarter |Quarter |

| | | | |(Col. 3 + 4) |(Cols. 5 x 2) |

|PRINCIPAL MEMBERS | | | | | |

|A. Chief Operating Officer |1 | | | | |

| | | | | | |

|B. Managers |66 | | | | |

| | | | | | |

|C. Supervisors |274 | | | | |

| | | | | | |

|D. Rank and File |583 | | | | |

| | | | | | |

|TOTAL |924 |Total Bid per Quarter (Principal Members) | |

|DEPENDENTS | | | | | |

|A. Chief Operating Officer |2 | | | | |

| | | | | | |

|B. Managers |88 | | | | |

| | | | | | |

|C. Supervisors |422 | | | | |

| | | | | | |

|D. Rank and File |959 | | | | |

| | | | | | |

|TOTAL |1,471 |Total Bid per Quarter (Dependents) | |

| | |TOTAL BID PER QUARTER | |

| | |(Principal + Dependents) | |

| |GRAND TOTAL (Total Bid per Quarter x 4) | |

_____________________________________ _____________________________

Signature over printed name Position

Duly authorized to sign this Price Schedule for and on behalf of ___________________

Date: ___________________________

Bidding Form No. 5

3 CONTRACT AGREEMENT FORM

THIS AGREEMENT made the _____ day of __________ 20_____ between Duty Free Philippines Corporation (hereinafter called “the Entity”) of the one part and [name of Supplier] of [city and country of Supplier] (hereinafter called “the Supplier”) of the other part:

WHEREAS the Entity invited Bids for certain goods and ancillary services, viz., [brief description of goods and services] and has accepted a Bid by the Supplier for the supply of those goods and services in the sum of [contract price in words and figures] (hereinafter called “the Contract Price”).

NOW THIS AGREEMENT WITNESSETH AS FOLLOWS:

1. In this Agreement words and expressions shall have the same meanings as are respectively assigned to them in the Conditions of Contract referred to.

2. The following documents shall be deemed to form and be read and construed as part of this Agreement, viz.:

a) the Supplier’s Bid, including the Technical and Financial Proposals, and all other documents/statements submitted (e.g. bidder’s response to clarifications on the bid), including corrections to the bid resulting from the Procuring Entity’s bid evaluation;

b) the Schedule of Requirements;

c) the Technical Specifications;

d) the General Conditions of Contract;

e) the Special Conditions of Contract;

f) the Performance Security; and

g) the Entity’s Notification of Award.

3. In consideration of the payments to be made by the Entity to the Supplier as hereinafter mentioned, the Supplier hereby covenants with the Entity to provide the goods and services and to remedy defects therein in conformity in all respects with the provisions of the Contract

4. The Entity hereby covenants to pay the Supplier in consideration of the provision of the goods and services and the remedying of defects therein, the Contract Price or such other sum as may become payable under the provisions of the contract at the time and in the manner prescribed by the contract.

IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed in accordance with the laws of the Republic of the Philippines on the day and year first above written.

Signed, sealed, delivered by the

(for the Entity)

Signed, sealed, delivered by the (for the Supplier)

[ACKNOWLEDGEMENT]

Bidding Form No. 6

Motion for Reconsideration

Date of Issuance

Mr. Michael James V. Chua

Duty Free Philippines Corporation

Fiestamall, Columbia Complex,

Ninoy Aquino Avenue, Parañaque City

Dear Madame:

In relation to the results of the Bid Opening/Post-Qualification conducted for the bidding of the (Name of Project) held on (date and time) at (venue) , we would like to request for reconsideration the decision of “Ineligibility” of our of our firm on the following grounds:

We are hoping for your consideration.

Very truly yours,

Name of the Representative of the Bidder

Position of the Representative

Name of the Bidder

Received by the BAC:

__________________________

Date:______________________

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