For Goods Offered From Within the Philippines Name of Bidder: __________________________________ ITB Number ITB 15 – 0070-A Price Schedule No. 1 "BIDDING PER ITEM" 1 2 3 4 5 Item No. Description Unit ABC Qty. Unit Price EXW per Item 1 NECKLACE, 18K Necklace with Pendant South Cotabato Logo, 3 grams gold per necklace 8,000.00 3 pcs 2 RING, 18K Ring with South Cotabato logo, 4 grams gold per ring BRACELET, 18k Bracelet with South Cotabato logo, 7 grams gold per bracelet 10,500.00 25 pcs 14,000.00 15 pcs RING, 18K Ring with South Cotabato logo, 10 grams gold per ring 17,500.00 2 pcs 3 4 6 7 8 9 Unit prices per Sales & Other Total Price Cost of Local Total Price Item final taxes payable delivered final Labor, Raw EXW per Item Destination per item if Material & (cols. 4 X 5) destination and (col. 8+ 9 unit of other Contract is Component X 4) incidental services awarded x-x-x nothing follows x-x-x Additional Requirements (Please indicate): 1. Brand name, If no brand, state "none" 2. Country of manufacture or origin of item; i.e. local (or RP), or if foreign origin, specify country *Non Compliance with the above requirements will be basis for Ineligibility Note: The design of the items will be provided by the end user. Note: Payment for Provincial Government Employees Loyalty Service Tokens to be awarded on Sept.1, 2015. Source of Fund: 1032-HRMD-969-Service Tokens-MOOE-15-05-1290 Approved Budget: P531,500.00 REQUIRED BID SECURITY: 1. Bid Securing Declaration. 2. 2% Cash or cashier's/manager's check issued by a Universal or Commercial Bank. P 10,630.00 3. 2% Bank draft/guarantee or irrevocable letter of credit issued by a Universal or Commercial Bank. P 10,630.00 4. 5% Surety bond callable upon demand issued by a surety or insurance company duly certified by the Insurance Commission as authorized to issue such security P 26,575.00 5. Any combination of the foregoing. Proportionate to the share of form with respect to the total amount of security. Prepared by: bac-jack; PR.No. 15 - 0554 Name and Signature of Bidder Page 1 of 1 10