Omnibus Sworn Statement REPUBLIC OF THEPHILIPPINES CITY/MUNICIPALITY OF TACURONG CITY) S.S PROJECT NAME: SUPPLY AND DELIVERY OF ASSISTIVE DEVICES FOR INDIGENT SENIOR CITIZENS OF MIDSAYAP, COTABATO REQ No. 2024-032 AFFIDAVIT. |, Jeanette E. Durana, of Legal age, married, Filipino and residing at Agduma. Cruz Subdivision, Tacurong City, after having been duly sworn in accordance with law, do hereby depose and state that: 1 | am sole proprietor or authorized representative of Jeanette Pharmacy Medical Supply and Equipment With the office address at Public Market, Lambayong Sultan Kudarat, ‘As the owner and sole proprietor, and authorized representative of Jeanette Pharmacy Medical Supply and Equipment, | have full power and authority to do, execute and perform any and alll acts necessary to participate, submit the bid, and to sign and execute the ensuing contract for SUPPLY AND DELIVERY OF ASSISTIVE DEVICES FOR INDIGENT SENIOR CITIZENS OF MIDSAYAP, COTABATO . as shown in the attached duly notarized Special Power of Attorney. Jeanette Pharmacy Medical Supply and Equipment is not “blacklisted” or barred from bidding by the government of the Philippines or any of its agencies, offices, corporation, Local Government Units , foreign Government /foreign or International financial instruction whose blacklisting whose blacklisting rules have been recognized by the Government Procurement Policy Board, by itself or by relation, membership, association, affiliation, pr controlling interest with another blacklisted person or entity as defined and provided for in the Uniform Guidelines on Blacklisting Each of the documents submitted in satisfaction of the iding requirements is an authentic copy of the original complete, and all statement and information provided therein are true and correct; Jeanette Pharmacy Medical Supply and Equipment is authorizing the Head of the Procuring Entity to its duly authorized Representative(s) to verify all the documents submitted; ‘The owner or sole proprietor is not related to the Head of the Procuring Entity, members of the Bids and ‘Awards Committee (BAC), the Technical Working Group, and the BAC Secretariat, the Head of the Project Management Office or the end-user unit, and the project consultant by consanguinity or affinity up to the third civil degree; Jeanette Pharmacy Medical Supply and Equipment complies with the existing labor laws and standards; and Jeanette Pharmacy Medical Supply and Equipment is aware of and has undertaken the following responsibilities as Bidder: a) Carefully examine all of the Bidding Documents; b) Acknowledge all conditions, local or otherwise, affecting the implementation of the Contact; ©) Made an estimate of the facilities available and needed for the contract to be bid, if any and; d) Inquire or secure Supplemental /Bids Bulletin (S) issued for SUPPLY AND DELIVERY OF ASSISTIVE DEVICES FOR INDIGENT SENIOR CITIZENS OF MIDSAYAP, COTABATO9. Jeanette Jeanette Pharmacy Meda! Sup and Eupment i Be or py deco ety, any emi amount fee or any frm of orien, pecan or cere to any person oF afc BeOMS! resentative of the government in elation fo ny procurement projector att 10. Incase adva nt was riven, failure to perform or deliver any of t tt kings Inthe contract shal be sufficient ‘rminal ability for swindling or the commission ‘of fraud with unfaithfulness or al ia ‘any payment received by a person or inder an obligation involving the duty to deliver cer is ro th judice of yublic and the int of the Philippines pursuant to article 315 of Act Nc as ded, ‘or the Revised Penal Code. 11. That 1am executing this affidavit to attest the above facts and for such other lawful purposes this may Serve; IN WITNESS WHEREOF | have hereunto set my head this__day _,2024 at Tacurong City Philippines ’ JEANETTE EISURANA, RPH Bidders Reprederfiative/Authorized Signatory Tin:443-540-740 suescusen AND SWORN to before me tis FEBy bff out ___ TABURONG CTT _ Philippines. Affiant/s is/are personally known to me and was/were identified by me through competent evidence of identity as defined in the 2004 Rules on Notarial Practice (A.M. No. 02-8-13-SC). Affiant/s exhibited to me his/ner [insert type of government identification card used], with his/her photograph and signature appearing thereon, wi th no. and his/her Community Tax Certificate No. issued on__at Witness my hand and seal this __day of FEB 1) “cl. NAME OF NOTARY PUBLIC Serial No. of Commission Notary Public for ‘nti Roll of Attorneys No. PTR No. [date issued], [place issued) 1BP No. [date issued}, [place issued] Doc. No. Page No. Book No. Alera Series of Tor ho. 3 MCLE Cog ID". Rol Nor 38788;eee Petes cut cd Medea) Cee ag CT | To whom it may concern, | Pursuant to the revenue code of this Municipality/city, aft requirements, Permit is hereby granted to the herein Taxpayer fer payment of taxes, fees and charges, etc., and compliance with existing JEANETTE PHARMACY MEDICAL SUPPLY & EQUIPMENT & GENERAL MERCHANDISE | Business Name | RETAIL SALE OF DRUGS AND PHARMACEUTICAL GOODS RETAIL SALE OF MEDICAL, SURGICAL AND. PRT OREOrC GOODS/INSTRUMENTS AND DENTAL ‘SUPPLII RETAIL SALE OF ELECTRONIC LOAD RETAIL SALE OF OTHER CLOTHING, FOOTWEAR AND LEATHER ARTICLES IN SPECIALIZED SS, N.E.C. OTHER RETAIL SALE OF NEW GOODS IN SPECIALIZED STORES, NEC WHOLESALE OF MEDICINAL AND PHARMACEUTICAL PRODUCTS | RETAIL SALE OF BOOKS, NEWSPAPERS AND STATIONERY IN SPECIALIZED STORES | Lne of Business POBLACION(PUBLIC MARKET), LAMBAYONG, SULTAN KUDARAT Business Address | hie PERMIT can be revoked any time If any of the Conditions and Provisions set forth by the Code is violated andi the peace and order, heaith, nt, safety and securty ofthe public are at stake. SEANETTE EVANGELISTA DURANA —_-126508-00176 2024-1206508000-0271 Owners Name Business 1D No, ‘business Permit No. | 44 3-S40-720-00000 ‘Sole Proprietorship 00000000 Renewal | usness TN ype of Business WY TI Registration No. “ype of Applicaton | isn 2024-01-22 Vaid Ul 2024-12-31 —=AinewePlateNo, 0231 No.of Emoloyees 2 oct nec 4374256 | bes ‘oR Date 2024-01-21 | iN Se ' * Nand e J sano oF ree oun ey Cv ayo Permit Fee Municipal Treasurer Garbage Fee tam} Inspection Fee a ‘ceupational Tax mao} Eraronmental Certificate Fee 7am. sa 22,000.00 000 00 Total m409.00 "fie ony 20 the fon Years on atten a ed a te os hee a ref 24 pr 4. ro hanes tana elena cette te ft os ety omnes, rome Ye Eaten,— This certifies that JEANETTE PHARMACY, MEDICAL SUPPLY & EQUIPMENT (REGIONAL) REGION Xil (SOCCSKSARGEN) name registered in this office pursuant to the provisions of Act 3883, as amended 47 and Republic Act No. 863, and in compliance with the applicable rules and regulations prescribed by the Department of Trade and Industry. This certificate issued to JEANETTE EVANGELISTA DURANA is valid from 31 January 2024 to 31 January 2029 subject to continuing compliance with the above-mentioned laws and all applicable laws of the Philippines, unless voluntarily cancelled In testimony whereof, | hereby sign this Certificate of Business Name Registration and issue the same on 26 January 2024 in the Philippines. ALFREDO E. PASCUAL Secretary Business Name No.5706780 This certificate is not a license to engage in any kind of business and valid only at the scope indicated herein. QFYC508815807285Republic of the Philippines Department of Budget and Management PROCUREMENT SERVICE CERTIFICATE OF PHILGEPS REGISTRATION (Platinum Membership) THIS IS TO CERTIFY Trap JEANETTE PHARMACY, MEDICAL SUPPLY & EQUIPMENT PUBLIC MARKET POBLACION , Lambayong , Sultan Kudarat , Region XII, Philippines ‘ered in the Philipp pursuant to Section 8.5.3 otherwise known as the Gov ine Government Electronic Procurement System (PhiIGEPS) on 26-May-2014 Of the Revised Implementing Rules and Regulations of Republic Act No. 9134 vernnient Procurement Reform Act. \wther certifies that JEANETTE PHARMACY, MEDICAL SUPPLY & EQUIPMENT has submitied ‘ed eligibility documenus in the PhilGEPS Supplier Registry as listed in Annex A, which document is ‘hed hereto and made an integral part hereof, ‘he purpose of updating this Certificate, all Class “A” eligibility documenis covered by Section 8.5.2 of the sed Implementing Rules and Regulations of Republic Act No. 9184 supporting the veracity, authenticity ani icity of this Certificate shall remain current and updated. The failure by the prospective Bidder to update thi Certificate with the current and updated Class “A” eligibility documents shail result in the automatic suspension of ws validity until such time that all ofthe expired Class “A” eligibility documents has been updated. 5y submitting this Certificate, the Bidder certifies: 1. the authenticity, genuineness, validity, and completeness of the copy of the original eligibility document submitted; 2. the veracity of the statements and information contained therein; 4. that the Certificate is not a guaranty that the named registrant will be declared eligible without firs: ‘being determined ta be such for that particular bidding, nor is it ax evidence that the Bidder has passes! the post-qualification stage; and 4 that any finding of concealment, falsification, or misrepaesentation of any of the eligibility documents submitted, or the contents thereof shall be a ground for disqulali rh anh ification from further participation in the bidding process, without prejudice to the impasition of appropriate administrative, civil and erimiv,! penalty in accordance with the laws, This Certificate is valid until 08-Sep-2024 , Issued this OBth day of September 2023. This is a system gencrated certificate. No signature is requiredREMINDERS * ‘+ The PhilGEPS office shall not determine the eligibility of merchants. The PhilGEPS office's evaluation of the eligibility requirements shall be for the sole purpase of determuning the approval or disapproval of the merchant's application for registration. 4 merchant's registration and membership in the GOP-OMR is neither contract-specific nor understood 10 be tantamount 10 a finding of eligibility. Neither shall the merchant's successful registration in the GOP-OMR be relied upon to claim eligibility for the purpose of participation in any public bidding. * The determination of the eligibility of merchants, whether registered with the GOP-OMR or not, shall remain with the Bids and A t (BAC). The BACs determination of validity of the eligibility requirements shall to enable the merchant to participate in the public bidding process."Annex + List of Eligibility Documents JEANETTE PHARMACY, MEDIC. ‘AL SUPPLY & EQUIPMENT PUBLIC MARKET POBLACION Lambayong , Sultan Kudarat , Region XI! , Philippines Ti Centficate Number 0580509 es By / Signatory : RAMON M. LOPEZ DTI Certificate | Registration Date : 30-Jan-2019 | Expiration Date : 30-Jan-2024 Expiration Date : 31-Dec-2023 Permit Number : 0068 Mayors Permit | Place of Issue : LAMBAYONG, SULTAN KUDARAT Vissued By / Signatory : FERDINAND G, AGDUMA Issuance Date : 11-Jan-2023 Expiration Date : 31-Aug-2024 TCC Number : 18-109-08-31-R0998-2023-M Tax Clearance Issued By / Signatory : FELICIDAD P. YU 01C-CHIEF Issuance date : 31-Aug-2023 Date of Filing : 17-Apr-2023 |Current Asset : 10,337,406.00 Audited Financial Statement | Total Asset : 13,269,844.00 |Current Liabilities : 3,184,529.00,, Total Liabilities : 3,184.529.00 Name of Auditor: FRANCIS JONE B. BRAVANTE CPARepub af he Phitppines Region Xt Provine of Cotabato Mnicoay of Midsayan PR Number 0224-00206 ne:__ cara PRICE QUOTATION FORM TERNS AND CONDMTONS |. Bice snot provide conect ond accurteiniorction requ hs fom. |2 Pace quotaion/ rn! be vale or @ parc of hity (20) calendar days rem the dole of sbrsin, | pice quotations fo be denominated in PHippine Peso shal inchce a awes, dues and/or levies poysbie. i. Gvotation exceeding the Aprxoved Budget forthe Contract ABC) she rejected, 5. aware of Cantact shal be mace io the lowest quotation fer goods and services which comes wih the minmum techrical secifcatens and other tems cnd cordon state herein. Je Anynterinecone srasras or overarting sro be vai on The are signed & Fitoled by you Sr any of {Your duly urhortes representatives }. the General sevices Office (G50) shallhave the ght to inspect the goods s Non-evbmlson of etabiy docu lb. Vaudcted aamoges equvalen' to one tant (1/10) of one percent (1) ol he yotue of he goods not ‘calvered win the preseriood delve peed shol be imposed Per day of delay. GSO shat rescind he ‘conect once he curative cmcunt of Fauoted eomoges reaches ten percent (10%) othe amount ‘fhe contact without arejeice to other courses of action ard remedies pen 10H 1. Fall to folow hese Insuctions wil gully your atv quottin, After having ceretuly read and accepted the terms ond conciions in the Request for {Quotation hereunderis our qvetetion/t for the tem/s 0 tolows: [BEST AND FINAL OFFER tiem# | __Specficatin orem Descripfon | unt [avantly | Untrrice | TotlPace Irae aaa Cone Tae el Fh 4 [fotbie, padded Ames leg supsor foot plate | w |b,60 | 66,800 entero, wd 19 set wth, ea Wit , eos dt can (UHR Anam, Read 2 ponatie) pes w | Gav | &,ab0 TRE IF] ee Howard Swen Wedred Peto € Detvery Pero: Place of Delivery Warranty: Payment Ter: Very ly your, Wea &- DUpana Nome/signature of Representative q tA MAT CA + FoUeT. Nome of Company (06 3 2n4¢ Contact No, Date: