Republic of the Philippines

Depanment of Health
COTABATO REGIONAL AND MEDICAL CENTER
Sinsuat Avenue. RH 10, Cotabato City
Fax No. 064-421-2140 local 517/ email: procurement@crmc.doh.gov.ph
REQUEST FOR QUOTAT|oN (RFA)
CANVASS NO. 09-1301

Date: September 28, 2023

SIR/MAAM:
Please QUOTE YOUR LOWEST PRICE ON THE ITEM/S LISTED BELOW, subject to the ceneral Conditions
stated hereunder, stating the shortest time of delivery and submit your quotation duly signed by your representative not
later than 3 calendar days in the relurn envelope attached herewith.

ATTY. SITTIE RAY N TURING,

CHAI
PHILGEPS REF NO toJ ffi{q DATE OF OPENING
DATE OF PUBLICATION TII E OF OPENING:
ITEM NO. OTY. UNIT NAME AND DESCRIPTION OF ARTICLE BRAND OFFERET ABC NIT P TAL
1 4 PIECE OFFICE TABLE 0,000 00
PIECE bBoo.go'-
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2 4 COI\,4PUTER CHAIR

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2 Delivery period within 10 calendar days from receapt of Purchase Order
3 Warranty shall be for the period of six (6) months for supplies & materials, one (1) year for Equipment,
from date of acceptance.
4 Price quoted must not exceed the Approved Budget Ior the Contract (ABC)
5 Price validity shall be for lhe period ot 30 calendar days
6 lf applicable, bidder shall submit original brochures showing certilication of the product being offered.
7 For the procurement of Equipment, a 10olo retention money or special bank guarantee shall be required for conlract with amounl lo 50,000 and
above for supplier located in Cotabato City and 15,000 for suppliers outside Cotabato Cjty -t-'.-------l
8 Wrnnin S lier must have a Land Bank account lor online pa ent
ng carefully read and accepted your etal 0ns, quote you on I m at price noted above. We certify that UOur company is not blocklisted or
barred from bidding by the government or any of its agencies. We further certity that l/lve the officers or controlling stockholders ol our company is nol related to the
Head of the Procuring Entily, members of Bids and Awards Committee (BAC), and BAC Secretariat by consanguinity or affinity up to the third civil degree

Printed Name and Signatu16 ol Supplisr Certified true copy of Original Canvassed thru

Contact No./Address
SBIEDHE X. BANGEN SHIEDHE X, BANGEN
I]EAO, PROCUREMENT DEPARTMENI HEAD, PROCUREMENT DEPARTMENT
Date
FOR BIDS AND AWARD COMMITTEE

ATTY SITTIE RAYHANA M SANTURING. RCA

8AC CHAIRMAN
SCHEHERAZADE IBRAHIM'TAN, MD SOFIA DUMAMA.ALFONSO. RPh
BAC VICE.CHAIRMAN BAC MEMBER

HENRY MOWAMAR S, BIRUAR RN ROSARIO DC. ALOJIPAN. RN FEBE S ONG RNO VENUS S. MENDOZA, RMT
BAC MEMBER BAC MEMBER BAC MEI!1BER BAC MEMBER
SS-PRO-F-06 Rev. 2