ITEM NO. ITEM & SPECIFICATION QTY/UNIT BRAND & MODEL OFFERED UNIT PRICE TOTAL PRICE 1 Sodium Ascorbate with Zinc (100 pcs/box) 190 box
2 Mueller tape 1and 1/2 inch 20 pcs
3 PERSKINDOL Cool Spray Bottle 250ml 50 botls 4 Aluminum Hydroxide Simeticone
178mg/233mg/30mg chewable tablet 100 pcs/box 5 box 5 Mefenamic acid 500mg/cap 100pcs/box 25 box 6 Elastic Bandage, 2 in x 5 yd, clip type 80 pc 7 Elastic Bandage, 3 in x 5 yd, clip type 50 pc 8 Benzydamine 3mg Lozenge, 8 lozenges/sheet 25 sheet
9 Cetirizine 10mg/tab 100pcs/box 10 box
10 Carbocisteine 500mg/tab 100pcs/box 15 box
11 Cefalexin 500mg/tab 100pcs/box 10 box
12 Paracetamol
Phenylpropanolamine+Chlorpenamine,325mg/tab 100pcs/box (Symdex D)
15 box 13 Clarithromycin 500mg /tab 30pcs/box 10 box
14 Cloxacillin 500mg 100pcs/box 10 box
15 Hyoscine-N-Butylbromide 10mg/tab 100pcs/box 8 box
16 Paracetamol 500mg/100tab/box 15 box
17 Loperamide 2mg/cap 100pcs/box 10 box
18 Methyl salicylate camphor + menthol (50ml) 30 btls 19 Adhesive Bandage, antiseptic, wash proof, 50
strips/box 20 box
20 Fiberglass cast ( 2 inches) 1 box
21 Fiberglass cast ( 3 inches) 1 box
22 Ketorolac 30mg/amp 10 pc/box 2 box
23 Hyoscine-N-Butylbromide 20mg/ml 10
Ampule/box 2 box
NOTE:
1. EXPIRATION DATE MUST BE AT LEAST 2 YEARS FROM THE DATE OF DELIVERY
2. WITH LICENSE TO OPERATE ISSUED BY FDA 3. BY LOT
Canvassed by:
JAM 11-28-2022
NOTE: Please attach brochure and indicate days of delivery
4. Forthwith submit the accomplished quotation duly signed by your representative.
Revision: 1
6. All items must conform with the internationally accepted standard and sub-standard items shall not be accepted.
Accomplished by:
BulSU-OP-PU-03F3
Name and Signature ABC: 191,275.00
Republic of the Philippines BULACAN STATE UNIVERSITY
City of Malolos, Bulacan
Quotation No. 22-11-828
Purchase Request No. F-2022-11-0555
**Mandatory to fill in**
COMPANY NAME:
CONTACT No.
REQUEST FOR QUOTATION FOR THE PROCUREMENT OF GOODS AND SERVICES
TIN No.
Purpose: For SCUAA use Address:
Supplier's Representative (Print name and Signature) Date Accomplished : ___________________________
By the authority of the University President.
DR. DOLLY P. MAROMA BAC Chairman 2. It is mandatory to indicate the brand and/or model of the items being offered and to attach a brochure thereof 3. Indicate the warranty period in cases of equipment or whenever applicable.
5. Suppliers are required and mandated to attach and submit the following documentary requirements:
a) Valid Mayor's/ Business Permit; b) BIR Certificate of Registration; c) Authority to Print Receipt; d) PhilGEPS Membership Certificate and e) Omnibus Sworn Statement
EMAIL ADDRESS:
PhilGEPS Registration No.
1. Please quote your lowest price on the item/s listed below comprising the necessary taxes.
Delivery Period: 7 Calendar Days upon receipt of Purchase Order
INSTRUCTIONS TO SUPPLIERS:
whenever applicable
