Republic of the Philippines

Department of Health
BAGUIO GENERAL HOSPITAL AND MEDICAL CENTER
Baguio City
Form No.:
DEVICE / SUPPLY SPECIFICATIONS AND
SUPPLIER'S PROPOSAL Revision No.: Ø
Effectivity Date:

Item #
Quantity
Unit of Measure
Name of Manufacturer
Brand
Country of Origin
Model

CONSIGNEE'S REQUIREMENTS PROPOSAL

A. Technical Specifications
1.
2.
3.
4.
5.

B. Terms
1. Minimum Inventory
2. Delivery
3. Shelf life
4. Recall & Replacement
5.

C. Financial Offer
1. Unit Price
2. Total Price
3. Payment period/ conditions
4.

D. Additional Document for Item

1. Certificate of Product Registration
2. Brochure
3. ISO/ IEC Certificate
4. WHO Pre-qualification certificate listing
5.

In the capacity of [title or other appropriate designation] duly authorized to

sign proposal for and on behalf of:
Name of Company
Signature over Printed Name
Complete Office Address
Contact #/ Fax #
E-mail address

Page 1 of 1