For Goods Offered From Within the Philippines
Name of Bidder: __________________________________
ITB Number
ITB 14 - 0127
Price Schedule No. 1
"BIDDING PER ITEM"
1
2
3
4
5
Item
No.
Description
Unit ABC
Qty.
Unit Price
EXW
per Item
1
ATS, 1500 "u"
50.00
50 amps
2
ATS, 3000 "IU'
65.00
50 amps
3
AMBROXOL, 15mg/5ml, syrup, 60ml
13.75
30 btls
4
500.00
10 box
5
ACETYLCYSTEINE, 600mg effervescent
tab, 10’s
AMBROXOL, 30 mg, tabs 100's
50.00
6 box
6
AMBROXOL DROPS, 6mg/ml, 15 ml
13.00
30 btls
7
AMLODIPINE, 10mg tablet, 100's
150.00
10 box
8
AMPICILLIN, 250mg
7.25
200 vls
9
AMPICILLIN, 500mg
6.30
200 vls
10 AMPICILLIN, 1 gram
14.50
300 vls
11 ASCORBIC ACID, 500mg, tab, 100's
100.00
2 box
12 AZITHROMYCIN, tablet, 500mg, 3's
135.00
20 box
13 BACILLUS CLAUSI, 2 billion/5ml
18.00
14 BETAHISTINE DIHL, 16mg, tablet, 100's
600.00
400
bottles
1 box
15 BETAHISTINE DIHL, 24mg, tablet, 100's
800.00
1 box
16 BISACODYL, 5mg tablet 100's
500.00
1 box
17 BULAMIRATE CITRATE, 50mg tablet,
100's
18 CARBOCISTEINE, 100mg/5ml syrup,
60ml
19 CARBOCISTEINE, 500mg capsule, 100's
300.00
2 box
15.00
10 btls
120.00
5 box
20 CAPTOPRIL, 25mg, tablet, 100's
350.00
3 box
21 CEFACLOR, 250mg/5ml, susp., 60ml
150.00
10 btls
22 CEFACLOR, 125mg/5ml, susp., 60ml
48.00
20 btls
23 CEFACLOR, 50mg/50ml drops, 20ml
48.00
20 btls
24 CEFALEXIN, 100mg/ml, drops/10ml
25.00
10 btls
25 CEFALEXIN, 250mg/5ml/susp., 60ml
35.00
20 btls
26 CEFALEXIN, 125mg/5ml, suspension,
60ml
27 CEFUROXIME, 250mg/5ml susp.
20.00
10 btls
95.00
10 btls
28 CEFUROXIME, 500mg capsule, 100's
1,000.00
10 box
29 CELECOXIB, 200mg capsule, 30's
80.00
10 box
30 CELECOXIB, 100mg capsule, 30's
150.00
5 box
31 CITICOLINE SODIUM, 250mg/ml
190.00
10 amps
32 CHLORAMPHENICOL, 1gm, vial, 10's
160.00
1 box
33 CETIRIZINE, 5mg/5ml, syrup, 60ml
80.00
10 btls
Page 1 of 7
6
7
8
9
10
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
unit of other
(col. 8+ 9
Contract is
Component
incidental services
X 4)
awarded
For Goods Offered From Within the Philippines
Name of Bidder: __________________________________
ITB Number
ITB 14 - 0127
Price Schedule No. 1
"BIDDING PER ITEM"
1
2
3
4
5
Item
No.
Description
Unit ABC
Qty.
Unit Price
EXW
per Item
34 CO-AMOXICLAV, 250mg/5ml susp.,
60ml
35 CO-AMOXICLAV, 125mg/5ml susp.,
60ml
36 CLOXACILLIN, 500 mg cap, box of 100s
150.00
10 btls
130.00
10 btls
500.00
5 box
37 CLOXACILLIN, 250mg/5ml suspension,
60ml
38 COTRIMOXAZOLE, 800mg/160mg,
tablet, 100's
39 DOMPERIDONE, 50mg/ml susp., 60ml
20.00
10 btls
150.00
2 box
175.00
5 btls
40 DIPHENHYDRAMINE, 12.5ml/5ml, 60ml
15.00
5 btls
41 DOMPERIDONE, 10mg, tab, 100s
100.00
2 box
42 DOXOPHYLLINE, 400mg, tab 100s
300.00
3 box
43 ESSENTIALE FORTE, tablet, 100's
500.00
2 box
44 EPINEPHRINE HCL
20.00
30 rolls
45 FERROUS SULFATE+FOLIC
ACID+VITAMIN B COMPLEX
CAPSULE, 100's
180.00
8 box
46 FERROUS SULFATE, syrup, 60ml, 220mg/5ml
15.00
20 btls
47 FUROSEMIDE, 40mg tablet, 100's
50.00
1 box
48 FUROSEMIDE, 20mg/2ml
15.00
30 amps
49 GLIPIZIDE, 5mg tablet, 100's
600.00
2 box
50 GUIAFENESIN, syrup 100mg/5ml
15.00
10 btls
51 HYDROCORTISONE, 100mg, vial, 10's
350.00
5 box
52 HYDROCORTISONE, 250mg vial, 10's
280.00
10 box
53 HYDROCORTISONE, 500mg, vial, 10's
600.00
10 box
54 HYOSCINE N-BUTYL BROMIDE,
20mg/mL, 1mL
55 HYOSCINE N BUTYL BROMIDE, 10mg
tabs 100s
56 IBUPROFEN, 400mg tablet, 100's
25.00
150 amps
200.00
5 box
500.00
5 box
57 IBUPROFEN, 200mg, tablet, 100's
300.00
3 box
58 IPRATROPIUM + SALBUTAMOL,
500mcg/2.5ml nebule, 35's
59 KETOROLAC, 30mg/ml
1,225.00
50 box
50.00
50 amps
60 LACTULOSE, 3.3mg/5ml syrup, 60ml
60.00
5 btls
61 LAGUNDI, 600mg, tab., 100's
300.00
5 box
62 LAGUNDI, 300mg/5ml, syrup, 60ml
35.00
10 btls
63 MEBENDAZOLE, 100mg/5ml,
suspension
18.00
10 btls
Page 2 of 7
6
7
8
9
10
Unit prices per Sales & Other Total Price
Cost of Local Total Price
Item final
Labor, Raw EXW per Item
taxes payable delivered final
Destination
Material &
per item if
(cols. 4 X 5) destination and
unit of other
(col. 8+ 9
Component
incidental services Contract is
X 4)
awarded
For Goods Offered From Within the Philippines
Name of Bidder: __________________________________
ITB Number
ITB 14 - 0127
Price Schedule No. 1
"BIDDING PER ITEM"
1
2
3
4
5
Item
No.
Description
Unit ABC
Qty.
Unit Price
EXW
per Item
64 MECLIZINE HCL, 25mg tablet, 100's
200.00
2 box
65 MEPTIN, 500mcg tablet, 100's
200.00
1 box
66 METFORMIN, 500mg, tablet, 100's
500.00
1 box
67 METHYLDOPA, 250mg, tablet, 100's
500.00
1 box
68 METOCLOPRAMIDE, 5mg/ml
15.00
50 amps
69 METOCLOPROMIDE, 10mg, tab, 100's
200.00
1 box
70 METRONIDAZOLE, 125mg/5ml susp.,
60ml
71 NYSTATIN, Oral Drops, 100,000 u/ml, 12 doses
15.00
30 btls
270.00
5 btls
72 OFLOXACIN, 400mg tablet, 100's
500.00
1 box
73 NIFEDIPINE, 5mg, tabs, 100's
500.00
2 box
74 OMEPRAZOLE, 20mg capsule 100's
430.00
1 box
75 OMEPRAZOLE, 40mg, capsule, 20's
100.00
2 box
76 ORAL REHYDRATION SALT, 25’s
25's``````````````````````````````````````````````````
77 OXYTOCIN, 10"iu", 1ml
```````````````````````````````````````````````````````
500 mg tab, 100's
78 PARACETAMOL,
```````````````````````````````````````````````````````
```````````````````````````````````````````````````````
79 PARACETAMOL, 250mg/5ml susp.,
```````````````````````````````````````````````````````
60ml
```````````````````````````````````````````````````````
125mg/5ml, syrup,
80 PARACETAMOL,
```````````````````````````````````````````````````````
60ml
```````````````````````````````````````````````````````
100mg/ml, drops, 15ml
81 PARACETAMOL,
```````````````````````````````````````````````````````
```````````````````````````````````````````````````````
1
PARACETAMOL,
300mg/ml, 2ml
82 `````````
125.00
10 box
25.00
100 amps
100.00
5 box
19.00
30 btls
18.00
30 btls
15.00
20 btls
15.00
50 amps
83 PREDNISONE, 20mg. tablet, 100's
300.00
1 box
84 PHENYLPROPANOLAMINE TABLET,
100's
85 PHENYLPROPANOLAMINE SYRUP,
12.5mg/5ml syrup, 60ml
86 PHENYLPROPANOLAMINE DROPS,
6.25mg/ml drops, 10ml
87 RANITIDINE, 50mg/2ml
100.00
5 box
15.00
20 btls
12.00
20 btls
15.00
150 amps
88 RACECADOTRIL, 100mg capsule, 45's
675.00
3 box
89 SALBUTAMOL SULFATE
BROMHEXINE HYDROCHLORIDE
GUAIFENESIN, 2mg/4mg/100mg/100ml
syrup, 60ml
30.00
30 btls
90 SALBUTAMOL SULFATE
BROMHEXINE HYDROCHLORIDE
GUAIFENESIN, capsule, 100's
500.00
5 box
91 SALBUTAMOL SULFATE
GUAIFENESIN, 60ml, 100mg/5ml
18.00
20 btls
1,000.00
3 box
92 SECNIDAZOLE, 500mg tablet, 50's
Page 3 of 7
6
7
8
9
10
Unit prices per Sales & Other Total Price
Cost of Local Total Price
Item final
Labor, Raw EXW per Item
taxes payable delivered final
Destination
(cols. 4 X 5) destination and
Material &
per item if
unit of other
(col. 8+ 9
Component
incidental services Contract is
X 4)
awarded
For Goods Offered From Within the Philippines
Name of Bidder: __________________________________
ITB Number
ITB 14 - 0127
Price Schedule No. 1
"BIDDING PER ITEM"
1
2
3
4
5
Item
No.
Description
Unit ABC
Qty.
Unit Price
EXW
per Item
93 TETANUS TOXOID, 0.5ml
50.00
150 amps
94 TRANEXAMIC ACID, 500mg caps, 100's
500.00
3 box
95 TRIMETAZIDINE DIHCL, 35mg tablet
100's
96 VITAMIN A, C, E TO ZINC CAPSULE,
100's
97 VITAMIN B 12 CAPSULE, 100's
500.00
1 box
300.00
8 box
600.00
5 box
98 ZINC SULFATE, 27.5mg/ml, oral drops
15ml
99 ZINC SULFATE, 55mg/ml syrup, 60ml
12.00
50 btls
15.00
50 btls
100 CEFALEXIN, 500mg cap.,100's
500.00
10 box
101 CEFUROXIME, 750mg
35.00
300 vls
102 CEFTRIAXONE, 1 grm
35.00
100 vls
103 CLONIDINE, 150mcg/mL
110.00
20 amps
104 AMLODIPINE, 5mg, 100's
100.00
2 box
105 CO-AMOXICLAV, 625mg, 20's
300.00
20 box
106 MULTIVITAMINS W/ IRON SYRUP, 60
ml
20.00
30 btls
6
7
8
9
Unit prices per Sales & Other Total Price
Cost of Local Total Price
Item final
Labor, Raw EXW per Item
taxes payable delivered final
Destination
(cols. 4 X 5) destination and
Material &
per item if
unit of other
(col. 8+ 9
Component
incidental services Contract is
X 4)
awarded
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
3. Expiration date not less than one (1) year from date of delivery
*Non Compliance with the above requirements will be basis for Ineligibility
Note: For use of PMH.
Source of Fund: TRUST FUND - LBP - 0752 - 1037 - 55
Approved Budget: P221,977.50
REQUIRED BID SECURITY:
1. Bid Securing Declaration.
2. 2% Cash or cashier's/manager's check issued by a Universal or Commercial Bank.
P 4,439.55
3. 2% Bank draft/guarantee or irrevocable letter of credit issued by a Universal or Commercial Bank.
P 4,439.55
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 11,098.88
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. 14 - 0858
Name and Signature of Bidder
Page 4 of 7
10
For Goods Offered From Within the Philippines
Name of Bidder: __________________________________
ITB Number
ITB 14 - 0127
Price Schedule No. 2
"BIDDING PER ITEM"
1
2
3
4
5
Item
No.
Description
Unit ABC
Qty.
Unit Price
EXW
per Item
107 PLAIN NSS, 1L
44.00
800 btls
108 D5 NORMOSOL M, 1L
44.00
200 btls
109 D5 0.9 NaCl, 1 Liter
44.00
1000 btls
110 D5LR, 1L
44.00
1500 btls
111 D5LR, 500cc
44.00
300 btls
112 D5IMB, 500cc
44.00
500 btls
113 D5 0.3 NaCl, 500cc
44.00
500 btls
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
(cols. 4 X 5) destination and
Material &
unit of other
(col. 8+ 9
Contract is
Component
incidental services
X 4)
awarded
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
3. Expiration date not less than one (1) year from date of delivery
*Non Compliance with the above requirements will be basis for Ineligibility
Note: For use of PMH.
Source of Fund: TRUST FUND - LBP - 0752 - 1037 - 55
Approved Budget: P211,200.00
REQUIRED BID SECURITY:
1. Bid Securing Declaration.
2. 2% Cash or cashier's/manager's check issued by a Universal or Commercial Bank.
P 4,224.00
3. 2% Bank draft/guarantee or irrevocable letter of credit issued by a Universal or Commercial Bank.
P 4,224.00
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 10,560.00
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. 14 - 0858
Name and Signature of Bidder
Page 5 of 7
10
For Goods Offered From Within the Philippines
Name of Bidder: __________________________________
ITB Number
ITB 14 - 0127
Price Schedule No. 3
"BIDDING PER ITEM"
1
2
3
4
5
Item
No.
Description
Unit ABC
Qty.
Unit Price
EXW
per Item
114 STERILE WATER FOR INJECTION,
100ml
115 IV INFUSION SET, Macroset
65.00
100 btls
25.00
50 pcs
116 DISPOSABLE GLOVES, medium 100's
200.00
10 box
117 DISPOSABLE FACE MASK, 50's
150.00
20 box
118 DISPOSABLE GLOVES, large, box of
100's
119 ELASTIC BANDAGE, size 2"
200.00
10 box
20.00
20 rolls
120 ELASTIC BANDAGE, size 4"
25.00
20 rolls
121 FOLEY CATHETER, FR 16
30.00
50 pcs
122 FOLEY CATHETER, FR 18
30.00
50 pcs
123 GLOVES, size 7 1/2, 50's
850.00
10 box
124 GLOVES, size 7, 50's
850.00
20 box
125 GLOVES, size 6 1/2, 50's
850.00
10 box
126 HEPLOCK
48.00
100 pcs
127 IV CANNULA, g-20, 100's
3,000.00
10 box
128 IV CANNULA, G-24, 100's
3,000.00
10 box
129 IV CANNULA, G-22,100's
3,000.00
5 box
130 IV CANNULA, G-26, 100's
3,000.00
1 box
131 IV CANNULA, G-18, 100's
3,000.00
5 box
132 IV INFUSION SET, microset
25.00
50 pcs
133 MEDICINE CUP, 30ml
7.00
500 pcs
134 OXYGEN CANNULA, adult
20.00
100 pcs
135 OXYGEN CANNULA, pedia
20.00
100 pcs
136 OXYGEN CANNULA, neonate with mask
85.00
100 pcs
137 POVIDONE IODINE, 10% Solution, 5
liters
138 SOLUSET
1,400.00
3 gals
98.00
200 pcs
139 SOAKING SOLUTION, 3 liters/gallon
780.00
5 gals
140 APPLICATOR STICKS, sterile, 100's
275.00
5 box
141 DISPOSABLE SYRINGE 3cc WITH
NEEDLE, 100's
142 ADHESIVE PLASTER, Hospital size
10 rolls/tube assorted, 4x1.25cm, 3x2.5
cm, 2x5cm, 1x7.5cm
275.00
5 box
1,700.00
10 tubes
143 DISPOSABLE SYRINGE 5cc WITH
NEEDLE, 100's
144 DISPOSABLE SYRINGE 10cc WITH
NEEDLE, 100's
145 DISPOSABLE NEEDLE, g. 23 100's
300.00
10 box
400.00
5 box
150.00
5 box
146 DISPOSABLE NEEDLE, G-26,100's
150.00
10 box
Page 6 of 7
6
7
8
9
10
Unit prices per Sales & Other Total Price
Cost of Local Total Price
Item final
Labor, Raw EXW per Item
taxes payable delivered final
Destination
(cols. 4 X 5) destination and
Material &
per item if
unit of other
(col. 8+ 9
Component
incidental services Contract is
X 4)
awarded
For Goods Offered From Within the Philippines
Name of Bidder: __________________________________
ITB Number
ITB 14 - 0127
Price Schedule No. 3
"BIDDING PER ITEM"
1
2
3
4
5
Item
No.
Description
Unit ABC
Qty.
Unit Price
EXW
per Item
5.00
192 pcs
147 SUTURE NEEDLE, size 18, 12's
6
7
8
9
Unit prices per Sales & Other Total Price
Cost of Local Total Price
Item final
Labor, Raw EXW per Item
taxes payable delivered final
Destination
Material &
per item if
(cols. 4 X 5) destination and
unit of other
(col. 8+ 9
Contract is
Component
incidental services
X 4)
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
3. Expiration date not less than one (1) year from date of delivery
*Non Compliance with the above requirements will be basis for Ineligibility
Note: For use of PMH.
Source of Fund: TRUST FUND - LBP - 0752 - 1037 - 55
Approved Budget: P223,360.00
REQUIRED BID SECURITY:
1. Bid Securing Declaration.
2. 2% Cash or cashier's/manager's check issued by a Universal or Commercial Bank.
P 4,467.20
3. 2% Bank draft/guarantee or irrevocable letter of credit issued by a Universal or Commercial Bank.
P 4,467.20
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 11,168.00
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. 14 - 0858
Name and Signature of Bidder
Page 7 of 7
10