ANSWER SHEETS
PROPOSAL FORM
The PROPOSAL FORM must be completed, signed and returned to UNICEF.
Proposals must be made in accordance with the instructions contained in this
REQUEST. UNICEF shall not pay any costs incurred in the preparation or
submission of proposals.
TERMS AND CONDITIONS OF LONG TERM ARRANGEMENT
Any supply arrangement resulting from this REQUEST shall contain the UNICEF
General Terms and Conditions and any other terms and conditions specified in this
REQUEST.
INFORMATION
Any request for additional information regarding this REQUEST must be forwarded
in writing to the attention of Contracts Specialist, Mr. Guillermo Gimeno (email:
ggimeno@unicef.org) with specific reference to this REQUEST, so that the query
may be answered in the normal course of business.
The Undersigned, having read the Instructions to Proposers of this REQUEST RFPDAN-2015-502048 and all related documents hereby offers to supply the goods
and contributions to meet the overall objectives sought in accordance with any
specifications stated and subject to all Terms and Conditions set out or specified
in this REQUEST.
Signature: _________________________________________________
Date: ____________________________________________________
Name & Title: ______________________________________________
Company: _________________________________________________
Postal Address: _____________________________________________
Tel No: __________________________________________________
Fax No: ___________________________________________________
E-mail :___________________________________________________
Validity of Offer: ____________________________________________
RFP-DAN-2015-502048
page 3 of 7
TECHNICAL AND FINANCIAL MANDATORY
REQUIREMENTS SHEET
Please include a response to the following.
1. Does each product offered have WHO pre-qualification?
2. If the answer to the above is “No”, then please provide a list of alternative
presentations of the offered products and/or of other products for which
your company has obtained WHO pre-qualification.
3. Please provide your United Nations Global Marketplace (UNGM) registration
number:
If your company has not yet registered through the UNGM, please submit
an application through the UNGM website at
http://www.ungm.org
under
http://www.ungm.org/Registration/RegisterSupplier.aspx.
Instructions are provided on the website.
4. Have you provided audited financial statements to UNICEF in the past 12
months?
If not, please proceed as per clause 2.14.2.
RFP-DAN-2015-502048
page 4 of 7
QUALITATIVE PROPOSAL SHEET
Please provide response to the following in your proposal together with
any other information deemed relevant.
1. Indicate the number of years of experience that your company has of
production and delivery of the offered product(s).
2. Provide a list of the names of regulatory bodies where your products are
registered as well as original date of registration. Please confirm willingness
to pursue the registration of the vaccine in Armenia.
3. Please indicate factors influencing your price setting.
4. In the past, how has your company been able to maintain the quality level for
the supplied products? If your company has faced quality problems, please
provide frequency and explanations as well as measures taken for
improvement.
5. Please inform of any other contractual obligations influencing the ability to
offer to UNICEF such as marketing agreements, International Property (IP)
Rights, etc.
RFP-DAN-2015-502048
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QUANTITATIVE PROPOSAL SHEET
Meningococcal ACYW Conjugate for Nigeria and Armenia
In compliance with terms and conditions of this Request for Proposal and all
sections hereto, the undersigned offers the supply of the vaccine in quantities, at
prices and within the number of days indicated below:
100,000 doses of Meningococcal ACYW Conjugate vaccine for Nigeria
55,000 doses of Meningococcal ACYW Conjugate vaccine for Armenia
Presentation
(e.g. singledose vial, multidose vial)
Quantity in
doses
Unit price per
dose USD
Total
amount
USD
Conditions /
Discounts*
Please indicate in the columns “Conditions/Discounts” if there are any
conditions/discounts associated with the price offered in your proposal. Please
outline the details of the conditions/discounts below:
*
INCOTERMS (2010) FCA Nearest International Airport (Name Airport):

Vaccine Vial Monitors: Yes:
Advise price implication for VVM:
No:

Maximum shelf life for offered products (months):
Normal shelf life at time of shipment (months):
Delivery preparation lead time
Please indicate the time required from receipt of our purchase order for
preparation of delivery (administration of order, packing, markings, etc.) ready
for shipment (days):
Country of Origin:
WHO pre-qualified product: Yes:

No:

Additional comments:
RFP-DAN-2015-502048
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QUANTITATIVE PROPOSAL SHEET
Meningococcal ACYW polysaccharide for Nigeria and
Armenia
In compliance with terms and conditions of this Request for Proposal and all
sections hereto, the undersigned offers the supply of the vaccine in quantities, at
prices and within the number of days indicated below:
100,000 doses of Meningococcal ACYW Polysaccharide vaccine for Nigeria
55,000 doses of Meningococcal ACYW Polysaccharide vaccine for Armenia
Presentation
(e.g. singledose vial, multidose vial)
Quantity in
doses
Unit price per
dose USD
Total
amount
USD
Conditions /
Discounts*
Please indicate in the columns “Conditions/Discounts” if there are any
conditions/discounts associated with the price offered in your proposal. Please
outline the details of the conditions/discounts below:
*
INCOTERMS (2010) FCA Nearest International Airport (Name Airport):

Vaccine Vial Monitors: Yes:
Advise price implication for VVM:
No:

Maximum shelf life for offered products (months):
Normal shelf life at time of shipment (months):
Delivery preparation lead time
Please indicate the time required from receipt of our purchase order for
preparation of delivery (administration of order, packing, markings, etc.) ready
for shipment (days):
Country of Origin:
WHO pre-qualified product: Yes:

No:

Additional comments:
RFP-DAN-2015-502048
page 7 of 7
PACKING DETAILS SHEET
The Proposer is requested to provide UNICEF with packing details for each
vaccine product offered using this SHEET.
a. Name of Vaccine:
b. Please advise if this vaccine is packed using ice packs or dry ice. If the
vaccine is packed using dry ice, please advise of any plans to change to
packing with ice packs. Also please advise of any effect this would have
on quantity, weight and dimension.
c. Please specify type of Time temperature monitoring device:
Unit Price (USD/ Euro):
d. Standard EXPORT Packing Dimensions and Weight:
Total No. of Doses per EXPORT Packing:
Vaccine
Diluent
Total no. of vials per EXPORT Packing:
Dimensions:
Length:
Width:
Height:
Gross Weight:
Net Weight:
Number of inner
Packing:
cartons
per EXPORT
e. Standard INNER CARTON Packing Dimensions and Weight:
Total No. of Doses per inner carton:
Vaccine
Diluent
Total no. of vials per inner carton:
Dimensions:
Length:
Width:
Height:
Gross Weight:
Net Weight:
RFP-DAN-2015-502048
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COMMERCIAL TERMS SHEET
In compliance with the Instructions to Proposers of this Request for
Proposal and all sections hereto, the undersigned offers the supply of
the vaccine under the conditions and in quantities, at prices and within
the number of days as indicated in the QUALITATIVE PROPOSAL SHEET
AND QUANTITIVE PROPOSAL SHEET(S); and the undersigned accepts
in full the TERMS and CONDITIONS.
Signature: ________________________________________________
Date: ____________________________________________________
Name & Title: ______________________________________________
Company: _________________________________________________
Please indicate which of the following terms of payment are offered under this
proposal:
10 days 3.0% _____
15 days 2.5% _____
30 days net _____
Other_____
20 days 2.0% _____
Any requested EXCEPTIONS or CLARIFICATIONS are to be defined
below (additional pages may be attached):
RFP-DAN-2015-502048
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