QUOTATION FORM

Date : ………. / ……….. / …………….. (DD/MM/YYYY) Category: OFFICE & HYGIENE

PD Reference: SO-MO-00943

Tentative Quantity Available

N° Item Description Unit Unit Price Currency ACF Remarks
Quantity in Stock
Bucket
G00686 - HTH 70% - Prices should include Delivery to ACF identified delivery
1 4.00 of 45
(spec: Description : HTH CHLORINE 70% / extra: FOR SC's) location with in the Banadir region
kg
G00580 - Mosquito net
- Prices should include Delivery to ACF identified delivery
2 (spec: Type : Circular / Size : XL / Impregnated : Long-term impregnated / extra: 3 to 894.00 pc
location with in the Banadir region
5 years impregnated (LLITN))

G00997 - Blanket
- Prices should include Delivery to ACF identified delivery
3 (spec: Thickness : Medium / Dimension : Single / Material : woollen blanket / 1000.00 pc
location with in the Banadir region
Color/Pattern : yellow and gary / )

DELIVERY CONDITIONS:
- Delivery adress: ACF Office at KM-5, NEAR LIBYAN EMBASSY, Mogadishu , SOMALIA
- The given unit price on the quotation must include transportation cost (packing, loading, unloading, Customs Fees/Duties & Charges, Clearing and Freight charges & any other associated cost) upto the ACF
Identified Delivery Location.
- All the deliverable items should conform to the generally accepted Hygiene manufacturing conditions.

SELECTION CRITERIA
1. Offer / Quotation Validity: □ 6 Months □ If Not, Specify: ………………………………
2. Applicable VAT on the Supplies: □ Including □ Not Applicable in Somalia
3. Delivery Lead Time (in Days) : □ Specify (Days): ………………………………..
4. Payment Condition: □ After Complete Delivery □ If Not, Specify: ………………………………
5. Modality of Payment: □ Bank Transfer □ Galaxy Star International
6. Valid Company Registration with Local Authority: □ Yes (Attached) □ No (Not Attached)
7. Quotation Format: □ ACF Quotation Form □ Company Letter Head
8. Previous Similar Supply Experience with other NGO's / Agencies (Include Purchase
Orders/Conracts): □ Yes □ No □ If Yes, Specify ………………………………
Supplier' details:

Name of the company: Signature:

Contact person:
Phone number:
Address: Stamp:

ACF-IN - Kit Log V3_0