For Goods Offered from Within the Philippines

For Goods Offered From Within the Philippines

Name of Bidder:

ITB Number

ITB 17 - 0016

Price Schedule No. 1

"BIDDING PER ITEM"

Page 1 of 11

For Goods Offered From Within the Philippines

Name of Bidder:

ITB Number

ITB 17 - 0016

Price Schedule No. 1

"BIDDING PER ITEM"

Page 2 of 11

For Goods Offered From Within the Philippines

Name of Bidder:

ITB Number

ITB 17 - 0016

Price Schedule No. 1

"BIDDING PER ITEM"

Page 3 of 11

For Goods Offered From Within the Philippines

Name of Bidder:

ITB Number

ITB 17 - 0016

Price Schedule No. 1

"BIDDING PER ITEM"

Page 4 of 11

For Goods Offered From Within the Philippines

Name of Bidder:

ITB Number

ITB 17 - 0016

Price Schedule No. 1

"BIDDING PER ITEM"

Page 5 of 11

For Goods Offered From Within the Philippines

Name of Bidder:

ITB Number

ITB 17 - 0016

Price Schedule No. 1

"BIDDING PER ITEM"

Page 6 of 11

For Goods Offered From Within the Philippines

Name of Bidder:

ITB Number

ITB 17 - 0016

Price Schedule No. 1

"BIDDING PER ITEM"

Additional Requirements (Please indicate):

1. Brand name, If no brand, state "none".

2. Country of manufacture or origin of item; i.e. local (or RP), or if foreign origin, specify country.

3. Expiration date not less than one (1) year from the date of delivery.

*Non Compliance with the above requirements will be basis for Ineligibility

Note: 15 days delivery period upon receipt of the Purchase Order.

Note: For use of SCPH.

(Signature)

(in the capacity of)

Duly authorized to sign Bid for and on behalf of

Source of Fund: SCPH - 4421 - 5 - 02 - 03 - 080 - MOOE - 17 - 02 - 1136

Approved Budget: P18,718,335.00

REQUIRED BID SECURITY:

1. Bid Securing Declaration.

2. 2% Cash or cashier's/manager's check issued by a Universal or Commercial Bank.

P 374,366.70

3. 2% Bank draft/guarantee or irrevocable letter of credit issued by a Universal or Commercial Bank.

P 374,366.70

4. 5% Surety bond callable upon demand issued by a surety or insurance company duly certified by the Insurance

Commission as authorized to issue such security

P 935,916.75

Prepared by: bac-jack; PR.No. 17 - 0108

Page 7 of 11

Name and Signature of Bidder

For Goods Offered From Within the Philippines

Name of Bidder:

ITB Number

ITB 17 - 0016

Price Schedule No. 2

"BIDDING PER ITEM"

Page 8 of 11

For Goods Offered From Within the Philippines

Name of Bidder:

ITB Number

ITB 17 - 0016

Price Schedule No. 2

"BIDDING PER ITEM"

Page 9 of 11

For Goods Offered From Within the Philippines

Name of Bidder:

ITB Number

ITB 17 - 0016

Price Schedule No. 2

"BIDDING PER ITEM"

Page 10 of 11

For Goods Offered From Within the Philippines

Name of Bidder:

ITB Number

ITB 17 - 0016

Price Schedule No. 2

"BIDDING PER ITEM"

Additional Requirements (Please indicate):

1. Brand name, If no brand, state "none".

2. Country of manufacture or origin of item; i.e. local (or RP), or if foreign origin, specify country.

3. Expiration date not less than one (1) year from the date of delivery.

*Non Compliance with the above requirements will be basis for Ineligibility

Note: 15 days delivery period upon receipt of the Purchase Order.

Note: For use of SCPH.

(Signature)

(in the capacity of)

Duly authorized to sign Bid for and on behalf of

Source of Fund: SCPH - 4421 - 5 - 02 - 03 - 080 - MOOE - 17 - 02 - 1136

Approved Budget: P6,602,754.00

REQUIRED BID SECURITY:

1. Bid Securing Declaration.

2. 2% Cash or cashier's/manager's check issued by a Universal or Commercial Bank.

P 132,055.08

3. 2% Bank draft/guarantee or irrevocable letter of credit issued by a Universal or Commercial Bank.

P 132,055.08

4. 5% Surety bond callable upon demand issued by a surety or insurance company duly certified by the Insurance

Commission as authorized to issue such security

P 330,137.70

Prepared by: bac-jack; PR.No. 17 - 0108

Page 11 of 11

Name and Signature of Bidder