RFQ No 1833-XX

Request for Quotations (RFQ)

Iron and Folic Acid Tablet

for Twenty Districts in East Java and East Nusa Tenggara

RFQ No 1833-XX

Issued by the Nutrition International (Formerly known as the

Micronutrient Initiative)

Deadline for receipt of proposals at the NI:

July 30, 2018

12:00 West Indonesia Standard Time

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1.0 GENERAL SCOPE

1.1 Nutrition International (Formerly known as the Micronutrient Initiative) “NI”

(http://www.nutritionintl.org) is working in partnership with the Government of Indonesia
to implement a project aimed for prevention and reduction of Iron Deficiency Anaemia
(IDA) among school-going adolescent girls, in selected districts in two provinces of
Indonesia: East Java and East Nusa Tenggara. Currently, the Central Government
provides 20-25 per cent of total Iron Folic Acid (IFA) supplements (52 tablets per year;
each tablet containing 60 milligram elemental iron and 400 microgram folic acid) for each
school-going adolescent girl based on the National Guidelines (2016). There are,
however, challenges in this, such that the districts do not always have sufficient budgets
to procure their total requirement, coupled with delays in receiving additional funds from
the Central or Provincial levels, stock-outs and supply-chain issues in the field.
Therefore, NI will provide the District Health Offices with the IFA tablet to fill the gaps
between the needs and the availability at the districts.

1.2 The Nutrition International Indonesia Office invites Requests for Quotations (RFQ) for
the manufacture and supply of up to 5,831,000 IFA tablets for this project.
1.3 All enquiries regarding this RFQ should be directed to the NI in writing by email to
proposalsindonesia@nutritionintl.org before July 16, 2018. Questions received
thereafter will not be answered.

2.0 ELIGIBILITY OF BIDDERS

2.1 Bids are invited directly from pharmaceutical manufacturers, herein referred to as
Bidders. Companies which have been Blacklisted/de-registered or process of such
or any other penal action have been initiated against them by the Government of
Indonesia are barred from submitting a quotation.

2.2 Bidders shall submit an affidavit sworn stating that “the company has not been
blacklisted/de-registered/barred by Government of Indonesia.

2.3 Bidders will be required to demonstrate to the NI that they are able to meet all the
requirements of this RFQ; are technically, managerially and financially able to perform
and complete any resulting Contract; and will be production-ready at the time of expected
award of Contract. These factors will be considered in the bid evaluation.

2.4 Bidders must disclose in their bid details of any circumstances, including personal,
financial and business activities that will, or might, give rise to a conflict of interest. This
disclosure must extend to all personnel proposed to undertake the work.

2.5 Bidders must submit a signed original letter of bidder certification as per Attachment B.

2.6 Where bidders identify any potential conflicts they must state how they intend to avoid
any impact arising from such conflicts. NI reserves the right to reject any bids which, in
the NI’s opinion, give rise, or could potentially give rise to, a conflict of interest.

2.7 Bidders must have a minimum three year old Manufacturing License for IFA tablet with
the latest license renewal certificate and product list. In case of importers, all quoted
products should be accompanied by their invoice, statement and import licence showing

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that the quoted products have been imported and sold in Indonesia for a minimum for
last three years. The Manufacturing Licence/Import Licence must be valid on the last
date of submitting the quotation. The Import Licence should be issued by the competent
Drug Licensing Authority (Indonesia).

2.8 Annual turnover of the company or companies should be a minimum of IDR 2 billion
in each of the last three consecutive Financial Years 2015, 2016, and 2017. The last
three financial years of an Audited Annual Report showing details of their annual turnover
should be submitted. An Auditor / CA Certificate of turnover will not be accepted.

2.9 The income tax return report for assessment years 2015, 2016, and 2017 should be
submitted.

2.10 Bidders should submit their Sales Tax Registration Certificate.

2.11 Bidders should submit their Certificate of large scale manufacturing /production capacity
of drugs/pharmaceuticals issued by concerned Licencing Authority from the Drugs
Regulatory Authority.

2.12 Where IFA tablet are imported, the manufacturing license of the country of origin,
registration and import license of importers must be attached in the Technical Bid.

2.13 The successful bidder will be asked to submit the license for manufacturing of IFA tablet
from the appropriate national authority prior to award of the contract.

3.0 GENERAL CONSIDERATIONS

3.1 Bidders are responsible for all costs associated with bid preparation and submission.

3.2 All prices in the bid shall be valid for a period of 120 Days after the Closing Date of the
RFQ.

3.3 If NI selects a bidder(s) to supply IFA tablet, the selected bidder(s) will be notified by NI
and must enter into a Contract with NI. In the event of a Contract award, all the terms
and conditions of this RFQ and its Annexes, including the bidder’s response, will form
part of the Contract, unless otherwise negotiated.

3.4 All Bidders must submit references from at least 3 clients within the last 2 years. The
format for submission of references is attached at Attachment F.

4.0 PROCEDURES FOR SUBMISSION OF BID

4.1 Bidders must respond to all the requirements stated in this RFQ. A non-responsive bid
may result in the rejection. Should the NI identify errors or inconsistencies in the Bid,
then NI may provide the bidder with an opportunity to correct any such errors or
inconsistencies in its Bid. A bidder may be invited to resubmit the corrected form and/or
provide the additional information.

4.2 Bidders who do not comply with such requests within the timeframe communicated by NI
will have their Bids rejected and will be so informed.

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4.3 All bidders must submit Technical and Financial bids in separate envelopes. The
financial bids of ONLY those companies who qualify in the technical bid will be opened
and all unopened financial bids will be returned to the bidder.

4.4 Separately sealed Technical and Financial Bids must be delivered to NI by post in a
sealed package marked CONFIDENTIAL by July 30, 2018. Technical Bids should
contain all information mentioned in this RFQ except for price component, which should
be enclosed in a separately sealed envelope titled Financial bid (Attachment D). On the
outside of the sealed package, and on both inner envelopes, Bids are to be prominently
marked with the Bid title and with Technical and Financial Bids with the full legal
name and return address of the bidder. Technical Bids will be opened first and evaluated
in accordance with stated criteria, while financial bids will be kept sealed. Financial bids
of only Technically Qualified bidders will be opened after Technical Evaluation is
concluded.

4.5 Late Bids will not be accepted in any circumstances. Bid submissions received after the
specified date or by e-mail or fax will be disqualified.

4.6 NI will treat all Bids as confidential and will not disclose the information contained therein
to any third party except if required to disclose pursuant to an order of any Court of
competent jurisdiction in order to fulfill the Court Order.

4.7 NI will review all bids and advise all bidders on the status of their bid within 15 working
days after the closing date.

4.8 NI reserves the right to reject or accept any quotation in whole or in part and to reject all
quotations at any time without assigning any reason whatsoever before award of
Contract.

5.0 SCOPE OF RFQ

5.1 SUPPLY REQUIRED: Iron and folic acid tablets with the composition of 60 mg
elemental iron (as fumarate, sulphate or gluconate) and 0.4 mg folic acid and meeting
the specifications detailed in Attachment A.

5.2 QUANTITIES AND DELIVERY SCHEDULE REQUIRED: The total number of tablets
required is estimated to be up to 5,831,000 IFA tablets. The full consignment of supply
is expected to be delivered to 20 districts by 30 September 2018.
The delivery schedule in Attachment E must be completed and submitted as part of the
bid. It is the responsibility of the primary bidder to ensure strict adherence to the delivery
schedule. Any delay on part of the delivery is the sole responsibility of the bidder.
The quantities in the Delivery Schedule are estimates for the purpose of this RFQ. Any
change in the dates on the Delivery Schedule at the time of contract award will be
considered only in agreement with the NI.
DELIVERY DETAILS: The consignees for the tablets will be the Head of Pharmacy
Installation of District Health Office. At the time of their arrival at destination, the IFA
tablets must have 5/6 of the 2 year shelf life (24 months). Unless advised otherwise by
NI, no consignment will be accepted having a shelf life of less the above.

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5.3 TITLE, RISK AND INSURANCES: The supply and subsequent transfer of the IFA
tablets will be completed only upon the acceptance of the packs by the Consignees after
verification of the contents and documents accompanying each shipment. All risks,
liabilities and obligations in the IFA tablets as related to production and shipment to
prescribed final destination prior to the acceptance of the products shall be borne by
bidder.

5.3.1 If it is the bidder’s practice to insure its products prior to shipping, the
manufacturer should do so. NI shall not be liable for any loss or damage to the
consignment supply during shipment.

5.3.2 Bidders shall provide the NI with a valid copy of their General Liability Insurance
and Product Liability Insurance Certificate.

5.3.3 NI may at its own cost conduct independent third party laboratory testing to be
performed as deemed necessary to assure that the goods conform to the
prescribed technical requirements for the each batch produced against its final
ordered quantities. Complete Test Protocol and samples are taken and sent to the
laboratory (identified by the NI) by the Inspecting Officer duly sealed and signed
by him or his authorized representative. The entire shipment shall only be
delivered upon successfully passing all test protocols defined for the product. In
case of failure to pass the third party laboratory testing of the product, NI reserves
the right to reject the entire shipment without being liable for any kind of payment
against the shipment of the product.

6.0 QUALIFICATION AND SUBMISSION REQUIREMENTS

6.1 TECHNICAL SPECIFICATION OF PRODUCT: Bidders must be capable of

manufacturing and supplying the product in accordance with the technical specifications
and quality standards (see Attachment A).

6.1.1 Bidders must submit proof of two (2) years shelf life for IFA tablets in accordance
to technical specifications listed in Attachment A.

6.2 TABLE OF INGREDIENTS: Bidders are required to fill out the Table of Ingredients,
Materials and Suppliers, listing all the ingredients and excipients used to make up the
IFA tablets and the primary and secondary, tertiary and quaternary packaging to be used
in Attachment C.

6.2.1 Bidders are required to disclose the names and addresses of intended material
suppliers, and for ensuring that supplier(s) of all excipients used conform to all
requirements stated in this RFQ.

6.3 GOOD MANUFACTURING PRACTICE: The IFA tablets are to be considered a

pharmaceutical product and must be manufactured in accordance with prevailing Good
Manufacturing Practices (GMP) Standards for pharmaceutical products by the National
Health Regulatory Authorities authorizing them to manufacture, package, label, test and
sell IFA tablets as per pharmaceutical product GMP included in Schedule 29 of the
National Formulary of Medicine. and/or by an internationally recognized authority (e.g.
WHO, UNICEF Supply Division Copenhagen, US FDA or a regulatory authority that is a
member of the Pharmaceutical Inspection Cooperation Scheme [PIC/S]).

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6.3.1 Bidders must submit valid proof of GMP compliance issued by the relevant national
health regulatory authorities and/or internationally recognized authority to
demonstrate the above criteria. An already existing valid International GMP
certification is highly desirable.

6.3.2 If IFA tablets are found to be Not of Standard quality (NSQ), then every sub-
standard batch will be taken back by the Bidder at its own cost and the NI shall not
be responsible for any damage during this period. The payment of the NSQ drugs
(both used and unused) will not be made to the Bidder, if the payment is already
made, the same shall be deducted from the pending bills. In no circumstances
request for replacement of sub-standard consignment by the Bidder shall be
entertained. Bidders found to be supplying sub-standard IFA tablets shall be
blacklisted and barred from applying for any subsequent RFQ issued by the NI.

6.4 PRICING TABLE:

6.4.1 The quoted price in the financial bid should not be more than the price quoted in
any other Government/organization for supply. The financial bid shall not be
accepted if the quoted price is found to be more.

6.4.2 All prices shall be firm and fixed until completion of contract and will remain firm
for any amendment of contract. Prices in currency other than Indonesia Rupiah
(IDR) will not be accepted

6.4.3 Bidders must quote the unit price for each tablet. Part prices for individual items in
the tablet will not be accepted.

6.4.4 Unit prices must cover all expenses and charges of whatever nature including but
not limited to production, quality assurance, packaging (including labels), sales
tax, VAT, excise duty or customs duty packing, freight, insurance up to the
Pharmacy Warehouse of District Health Office in the district in accordance with
terms and conditions as set out in this RFQ, and preservation in accordance with
standard commercial practices, unless otherwise specified.

6.4.5 The Pricing Table at Attachment D must be completed and submitted as part of
the Bid.

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7.0 SUBMISSION OF BID

7.1 BID responses and all requisite documentation must be received by NI no later July
30, 2018 by post at addresses provided below:

Nutrition International
Gedung Wirausaha, 2nd Floor
Jl. H.R. Rasuna Said Kav. C.5
Jakarta, 12940, Indonesia
Email: proposalsindonesia@nutritionintl.org
Phone : +62 21 527 7644
Fax : +62 21 527 7645

7.2 In summary, to be considered responsive, a Bid must include one (1) complete set each of
technical and financial documents listed below, and conform to the REQUIREMENTS for
each document that follow:

7.2.1 Technical bid includes:

i. Attachment B: Bidder certification

ii. Copy of manufacturing/import licenses (see section 2.7)
iii. Proof of stability (see section 6.1.1).
iv. Proof of GMP compliance (see 6.3.1)
v. Attachment C: Table of Ingredients, Materials and Suppliers
vi. Attachment E: Delivery Schedule (see 5.2)
vii. General Liability and Product Liability Insurance (see 5.3.2)
viii. Certificate of analysis report
ix. Client references (Attachment F)

7.2.2 Financial bid consists of:

i. Pricing Table (Attachment D) –

ii. Income tax returns for 3 years
iii. VAT/sales tax certificate
iv. Three years annual audited accounts ( see section 2.10)
v. Affidavit of non- blacklisting

8.0 CRITERIA FOR REVIEW

The proposal evaluation will be as follows:

8.1. Evaluated as having “met” or “not met”:

a) Compliance with required specifications and quality standards;

b) Submission of all required certifications including International GMP certificate and/or
documentation;
c) Acceptability of audited financial statements.

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Note: These criteria must be met in order for the bidder to be considered for an award. NI
reserves the right to require further information and assurances, including but not limited to,
performance securities.

8.2. Rated requirements:

a) Delivery schedule;
b) Price;
c) Bidder’s service record, and/or prior performance;

Note: The rated requirements will be scored on a point basis and successful bidders should
obtain 60% or more scores in the technical proposal to be declared qualified.

8.3 Evaluation of Bids and the Contract award selection will be made by NI on quality and
Cost based selection method, wherein 60% weightage will be given to Technical Section
and 40% weightage to Financial Section. Financial Scores will be calculated on the basis
of following formula:

Financial Score= (Lowest Quoted Price of Qualified Bidder / Quoted Price of Qualified
Bidder) x 100

Total Score will be calculated as follows:-

Total Score= Technical Score x 60% + Financial Score x 40%

An award will be made based on the bidder with the highest total score.

8.4 Awards may be made on the total offer, or parts thereof. Quantities may also be
increased or decreased, without issuing another request for proposals, based on
available budget and to satisfy NI’s needs.

8.5 NI reserves the right to:

8.5.1 Accept or reject any and all proposals, and/or to annul the RFQ process and reject all
proposals at any time, prior to Contract award, without thereby incurring any liability to
the affected bidder(s) or any obligation to inform the affected bidder(s), of the grounds
for NI's actions;

8.5.2 Select one, or more than one, bidder to supply the total Quantities Required

8.5.3 Amend this RFQ at any time.

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ATTACHMENT A
TERMS OF REFERENCE/TECHNICAL SPECIFICATIONS
Procurement of Iron and Folic Acid Tablet
for Twenty Districts in East Java and East Nusa Tenggara

Project: DFAT-MITRA Youth

A. Background
Nutrition International ”NI” is implementing MITRA Youth, a project supporting Weekly Iron Folic
Acid Supplementation (WIFAS) for prevention and reduction of Iron Deficiency Anaemia (IDA)
among school-going adolescent girls, in selected districts in two provinces of Indonesia: East
Java and East Nusa Tenggara. MITRA Youth is supported by Department of Foreign Affairs and
Trade (DFAT) Australia.
Currently, the Central Government provides 20-25 per cent of total IFA supplements (52 tablets
per year; each tablet containing 60 milligram elemental iron and 400 microgram folic acid) for
each school-going adolescent girl based on the National Guidelines (2016). There are, however,
challenges in this, such that the districts do not always have sufficient budgets to procure their
total requirement, coupled with delays in receiving additional funds from the Central or
Provincial levels, stock-outs and supply-chain issues in the field. Therefore, NI will provide the
DHOs with the WIFAs to fill the gaps between the needs and the availability at the districts.
Nutrition International will follow its procurement procedures including open bidding through
Requests for Quotation (RFQ) from companies, considering that in-country production of IFA
supplements has no international Good Manufacturing Practice (GMP) fulfilling requirements,
Nutrition International would also do the third party laboratory test for the IFA supplements
supply which will be distributed to schools.
NI is looking for a suitable agency for procuring IFA tablets. The product specifications and
other requirements are mentioned below.

B. Objective of the Contribution

The NI’s overall objective is to provide this In-Kind Contribution of IFA tablets to District Health
Offices for implementation of WIFAS program for adolescent girls in 20 districts.

C. Specifications

1. FINISHED PRODUCT

1.1. Iron and Folic Acid tablets with the composition of 60 mg elemental iron (as fumarate,
sulphate or gluconate) and 0.4 mg folic acid.
1.2. IFA tablets must be suitable for shipment, storage and use in countries that have adverse
climatic and storage conditions (e.g. high temperature and humidity, etc. herein considered
as Climatic Zones IVa and/or IVb).
1.3. The product must be packed in aluminium Strips.
1.4. The product shelf life stability must be demonstrated with results of stability studies

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conducted under long-term testing conditions for climatic Zone IVb countries (30°C and
75% RH). Proof of shelf life stability is required.

1.5. The tablet must be sugar coated.

Item no. Product Type Description

Item 1 Iron and Folic Acid Tablets Dark red tablet

10 Tablets per aluminium Strip. Each tablet contains: 60 mg equivalent

Elemental Iron and 0.4 mg Folic Acid.
Cardboard box containing 100
tablets total (10 Strips of 10
tablets each)
Desired Shelf Life: minimum
24 months

1.6. Tablets must be dark red in colour.

1.7. The product must contain a shelf-life of a minimum 24 months.

2. PACKING, SHIPPING AND LABELING INSTRUCTIONS

2.1 General Requirements

i. The packing (e.g. strips, boxes, labels) must be of a sturdy export quality and of a
commercial standard that will provide adequate protection of the goods for carriage by
air, sea and/or road to final destinations worldwide, including remote locations under
adverse climatic and storage conditions, and high humidity

ii. The packaging unit must be strong, and resistant to puncturing.

iii. Deliveries to any destination must be packed and palletized in the most cost-effective
way to minimize freight costs.

iv. Packing List: All markings must be reflected in the packing list to be completed at time
of shipment. The packing list shall indicate weights and volumes, description of the
goods, manufacturing batch number, quantity per batch, expiry date. One copy of the
packing list must be included with the shipment and another copy shall accompany the
shipping documents.

2.2 Packing
10 Tablets per aluminium Strip/Transparent PVC Blister.
Cardboard box containing 100 tablets total (10 Strips of 10 tablets each).

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2.3 Labeling Requirements for Indonesia:

The name of the product‒ brand and generic/International Non-proprietary Name (INN);
Brand name: Tablet Tambah Darah Ferrous Fumarate-Folic Acid
Registered in National FDA

2.4 Pharmaceutical form and route of administration;

Administration route: Oral

2.5 Qualitative and quantitative composition of active ingredient(s), preservative(s), and

antioxidant (s);
Formula: Each tablet contains:
COMPOSITION
Each film coated tablet contains:
Ferro Fumarate equivalent to Fe elemental ……………………………………. 60 mg
Folic acid …………………………………………………………………………. 0,40 mg

2.6 Directions to consult the package insert or the carton label for complete directions
for use. These must include the following:
i. INDICATIONS: To reduce the risk of anaemia, especially in non-pregnant
adolescent girls and adult women of reproductive age

ii. RECOMMENDED DOSAGE: One weekly tablet, preferably after a main meal

iii. SIDE EFFECT: Gastrointestinal disturbance: vomiting, nausea, epigastric pain,

constipation of diarrhea.

iv. WARNING AND PRECAUTION

 Blackening of feces may also occur
 Caution used in gastrointestinal ulcer, colitis ulceration acute, enteritis.
 Stopped treatment if caused gastrointestinal disturbance.
 Prolonged administration may lead to iron conglomeration.

v. CONTRA INDICATIONS for the following:

 Primary hemochromatosis,
 patient receiving repeated blood transfusion
 Patient with hypersensitive

2.7 Handling and storage conditions: Store at temperature no greater than 30 ºC ,

protected from light.

2.8 License number of the manufacturer: Registered in National FDA

2.9 Batch number to be printed on the package

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2.10 Manufacturing date to be printed on the package

2.11 Expiry date to be printed on the package

2.12 Name and address of manufacturer

D. Third party testing

NI may conduct independent laboratory testing to be performed as deemed necessary to assure
that the goods conform to the prescribed requirements. Complete Test Protocol and samples
are taken and sent to the laboratory (identified by the NI) by the Inspecting Officer duly sealed
and signed by him or his authorized representative.

E. Deliverables

1. Proof of receipt from the following District Health Offices:

No District Shipment address # of tablet # of boxes

East Java
Jl. Letkol Istiqlah No. 42,
Singonegaran, Kecamatan
1 Banyuwangi 825,700 8,257
Banyuwangi, Kabupaten
Banyuwangi, Jawa Timur 68415
Jl. Piere Tendean No. 5, Badean,
Bondowoso Kecamatan Bondowoso, Kabupaten 302,000 3,020
Bondowoso, Jawa Timur 68214
Jl. Gunung Arjuno no. 09 (Timur 370,400
Situbondo 3,704
Kantor SAMSAT) Situbondo
Lumajang Jl. Mahakam 103 Lumajang 428,500 4,285
Jl. Ciliwung, Jemberlor, Patrang,
Jember Kabupaten Jember, Jawa Timur 556,200 5,562
68118
Jl. Basuki Rahmat Gedung Terpadu
Ponorogo 489,200 4,892
Lt.1-2
Jl. Ronggowarsito 109 (Selatan RSU
Ngawi 392,900 3,939
Suroto Ngawi), Kab. Ngawi
UPT Gudang Farmasi Dinas
Kesehatan Pacitan Jl. Sasuit Tubun
Pacitan 228,300 2,283
No. 1 Telp. 0357881292, Kabupaten
Pacitan, Jawa Timur 63513
Sampang Jl. Keramat no. 4a Sampang 384,300 3,843
Jl. Raya Ketengan, Burneh, Jawa 410,000
Bangkalan 41,000
Timur 69112
Sub Total 4,387,500 43,875
East Nusa Tenggara
Gudang Farmasi Kabupaten- Dinas
Ende 187,300 1,873
Kesehatan Kabupaten Ende

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Jl. Melati, Kelurahan Mautapaga

Kecamatan Ende Timur RT 02 RW
01
Gudang Farmasi Kabupaten - Dinas
Kesehatan Kabupaten Nagekeo, Jl.
Nagekeo Moh. Hatta, Kompleks Civic Centre 966,00 966
Mbay, Kelurahan Lape Kecamatan
Aesesa Kode Pos 86472
Gudang Farmasi Kabupaten - Dinas
Ngada Kesehatan Kabupaten Ngada 107,300 1,073
Jl. Gajah Mada No.2 86411
Gudang Farmasi Kabupaten - Dinas
Sabu Raijua Kesehatan Kabupaten Sabu Raijua 53,500 535
Jl. El Tari Seba 85391
Gudang Farmasi Kab SBD - Dinas
Kesehatan Kabupaten Sumba Barat
Sumba Barat
Daya, 225,700 2,257
Daya
Jl. Ir. Soekarno, Kadula. Kecamatan
Kota Tambolaka, Sumba Barat Daya
Gudang Farmasi Kabupaten - Kantor
Malaka Dinas Kesehatan Malaka, 128,300 1,283
Kaletek, Betun.
Gudang Farmasi Kota Kupang -
Kota Kupang Kelurahan Lasiana Kecamatan 313,400 3,134
Kelapa Lima Kota Kupang
Gudang Farmasi Kabupaten - Dinas
Alor Kesehatan Kabupaten Alor, 123,400 1,234
Jl. Prof. DR. WZ. Johanes
Gudang Farmasi Kabupaten Sumba
Tengah - Kompleks Pemerintahan
Sumba Makatul, Dinas Kesehatan
43,300 433
Tengah Kabupaten Sumba Tengah
Jl. Wallolung, Waibakul, Sumba
Tengah
Instalasi Farmasi Dinas Kesehatan
Manggarai Kabupaten Manggarai Barat, Jl. 164,700
1,647
Barat Frans Nala Desa Batu Cermin Kec
Komodo Kab. Manggarai Barat
Sub Total 1,443,000 14,430
TOTAL 5,831,000 58,310

2. One full set of originals of the following documentation:

a. Bill of Lading
b. Packing list, including weights and volumes, description, quantity per batch, expiry date
c. Certificate of Origin
d. Signed commercial invoice
e. Certificate of Analysis

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ATTACHMENT B
LETTER OF BIDDER CERTIFICATION

Re: RFQ No. XXXX dd/mm/yr

Dear Nutrition International

We have examined the information provided in your Request for Quotation (RFQ) and offer to
undertake the work described in accordance with requirements as set out in the RFQ. This
proposal is irrevocable for a period of 120 days after the deadline for submission of proposals
and we confirm that this proposal will remain binding upon us and may be accepted by you at
any time before its expiry date.

We acknowledge, that we are not involved in any collusion or arrangement with any other
Respondent in connection with this RFQ. We have no knowledge of and have made no
comparison of the information in our Proposal with the information contained in any other
Proposal. All statements and responses to this RFQ are true and accurate.

We confirm that to the best of our knowledge at the time of this submission all suppliers named
in the proposal will be available to undertake the supply. We agree to bear all costs incurred by
us in connection with the preparation and submission of this proposal and to bear any further
pre-contract costs.

I confirm that I have the authority of [Company Name] to submit this proposal and to clarify any
details on its behalf.

SIGNED

Company Name

Print Name and Title

Signature of Proposer

Date

I have authority to bind the Proposer

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ATTACHMENT C
TABLE OF INGREDIENTS, MATERIALS AND SUPPLIERS

Bidders must list all excipients in descending order (by weight) and the intended sources of supply.
Material(s) to be supplied: Material Supplier:
Name and address of plant from which materials will be
supplied
1a) Ingredients: Ferro Fumarate equivalent to Fe elemental

1b) Ingredients: Folic acid

2) Primary Packaging (aluminium Strip/Transparent PVC Blister)

3) Secondary Packaging (Cardboard box containing 100 tablets total (10 Strips of 10 tablets each))

4) Tertiary packaging (boxes)

5) Quaternary packaging (boxes)

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ATTACHMENT D
PRICING TABLE

Company name and full address: _________________________________________

Price validity period: _____________________________________________

Contact Person (Name, title and signature):________________________________

We hereby offer to sell to the Nutrition International (NI), in accordance with the terms and
conditions set out in this RFQ, the supplies listed herein and on any attached sheets at the
price(s) and conditions set out therefore. We warrant that the cost of freight, insurance and
packing is included in the cost offered for the items.

Product Quantity Price per Total Price IDR

Offered tablet
Iron and Folic Acid tablets with the
composition of 60 mg elemental iron
(as fumarate, sulphate or gluconate)
and 0.4 mg folic acid

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 RFQ No 1833-XX

ATTACHMENT E
DELIVERY SCHEDULE

Estimated Quantity of Expected

Shipment

Expected
Tablets to be shipped arrival date
District Shipment Shipping Other
(approximately) at
destination address Date from Details
Consignee’s
No.

# of tablet # of boxes Manufacturer

location
East Java
Jl. Letkol
Istiqlah No. 42,
Singonegaran,
Kecamatan
Banyuwangi Banyuwangi, 825,700 8,257
Kabupaten
Banyuwangi,
Jawa Timur
68415
Jl. Piere
Tendean No. 5,
Badean,
Kecamatan
Bondowoso Bondowoso, 302,000 3,020
Kabupaten
Bondowoso,
Jawa Timur
68214
Jl. Gunung
Arjuno no. 09
370,400
Situbondo (Timur Kantor 3,704
SAMSAT)
Situbondo
Jl. Mahakam
Lumajang 428,500 4,285
103 Lumajang
Jl. Ciliwung,
Jemberlor,
Patrang,
Jember 556,200 5,562
Kabupaten
Jember, Jawa
Timur 68118
Jl. Basuki
Rahmat
Ponorogo 489,200 4,892
Gedung
Terpadu Lt.1-2
Jl.
Ronggowarsito
109 (Selatan
Ngawi 392,900 3,939
RSU Suroto
Ngawi), Kab.
Ngawi
UPT Gudang
Farmasi Dinas
Pacitan Kesehatan 228,300 2,283
Pacitan Jl.
Sasuit Tubun

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 RFQ No 1833-XX

No. 1 Telp.
0357881292,
Kabupaten
Pacitan, Jawa
Timur 63513
Jl. Keramat no.
Sampang 384,300 3,843
4a Sampang
Jl. Raya
Ketengan, 410,000
Bangkalan 41,000
Burneh, Jawa
Timur 69112
Sub Total 4,387,500 43,875
East Nusa Tenggara
Gudang
Farmasi
Kabupaten-
Dinas
Kesehatan
Kabupaten
Ende Ende 187,300 1,873
Jl. Melati,
Kelurahan
Mautapaga
Kecamatan
Ende Timur RT
02 RW 01
Gudang
Farmasi
Kabupaten -
Dinas
Kesehatan
Kabupaten
Nagekeo, Jl.
Nagekeo Moh. Hatta, 966,00 966
Kompleks Civic
Centre Mbay,
Kelurahan
Lape
Kecamatan
Aesesa Kode
Pos 86472
Gudang
Farmasi
Kabupaten -
Dinas
Ngada Kesehatan 107,300 1,073
Kabupaten
Ngada
Jl. Gajah Mada
No.2 86411
Gudang
Farmasi
Sabu Raijua Kabupaten - 53,500 535
Dinas
Kesehatan

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RFQ No 1833-XX

Kabupaten
Sabu Raijua
Jl. El Tari
Seba 85391
Gudang
Farmasi Kab
SBD - Dinas
Kesehatan
Kabupaten
Sumba Barat
Daya,
Sumba
Jl. Ir. 225,700 2,257
Barat Daya
Soekarno,
Kadula.
Kecamatan
Kota
Tambolaka,
Sumba Barat
Daya
Gudang
Farmasi
Kabupaten -
Malaka Kantor Dinas 128,300 1,283
Kesehatan
Malaka,
Kaletek, Betun.
Gudang
Farmasi Kota
Kupang -
Kota Kelurahan
313,400 3,134
Kupang Lasiana
Kecamatan
Kelapa Lima
Kota Kupang
Gudang
Farmasi
Kabupaten -
Dinas
Alor Kesehatan 123,400 1,234
Kabupaten
Alor,
Jl. Prof. DR.
WZ. Johanes
Gudang
Farmasi
Kabupaten
Sumba Tengah
- Kompleks
Pemerintahan
Sumba
Makatul, Dinas 43,300 433
Tengah
Kesehatan
Kabupaten
Sumba Tengah
Jl. Wallolung,
Waibakul,
Sumba Tengah

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 RFQ No 1833-XX

Instalasi
Farmasi Dinas
Kesehatan
Kabupaten
Manggarai
Manggarai Barat, Jl. Frans
164,700 1,647
Barat Nala Desa
Batu Cermin
Kec Komodo
Kab.
Manggarai
Barat
Sub Total 1,443,000 14,430
TOTAL 5,831,000 58,310

District Estimated Expected Expected arrival date Other

Shipment

destination Quantity of Shipping Date at Consignee’s Details

No.

Tablets to be from location

shipped Manufacturer
(approximately)

Page 20 of 21
RFQ No 1833-XX

ATTACHMENT F
BIDDER CLIENT REFERENCES

Reference no. 1
Name of Client: ________________________________
Contact person: ________________________________
Contact information: ________________________________
Email: ________________________________
Telephone: ________________________________
Product supplied: ________________________________
No. of years in business with client: ________________________________
Start/End date of contract:

Contract Value: ________________

Reference no. 2
Name of Client: ________________________________
Contact person: ________________________________
Contact information: ________________________________
Email: ________________________________
Telephone: ________________________________
Product supplied: ________________________________
No. of years in business with client: ________________________________
Start/End date of contract:

Contract Value: ________________

Reference no. 3

Name of Client: ________________________________

Contact person: ________________________________

Contact information: ________________________________

Email: ________________________________
Telephone: ________________________________
Product supplied: ________________________________
No. of years in business with client: ________________________________
Start/End date of contract:

Contract Value: ________________

Page 21 of 21