PROCUREMENT REQUEST FORM FOR DIAGNOSTICS

INSTRUCTIONS ON HOW TO COMPLETE THIS FORM

Please ensure that all required information is provided to enable us to provide you with a responsive Quote.

Please note that any Quote issued based on the information contained in this Procurement Request Form shall be subject to the terms of the Project Agreement signed between you and UNOPS/GDF.

SECTION 1. CLIENT INFORMATION & FUNDING SOURCE

Requestfrom

Name of Institution
Address

(hereinafter “Client”)

Submitted to

Global Drug Facility

(hereinafter “GDF”)

Funding Source

Source of funding for product request / Check applicable option (√)
The Global Fund
USAID
Government
UNITAID
Other, please specify source:
______

SECTION 2. contactDETAILS(Please provide contact details of priNcipal recIpient incase source of funding is Global Fund)

Please ensure that full contact details are provided below, including full mailing address, telephone, fax, and email.

Country:
Organization:
Address:
Contact Person
Position:
Telephone:
Fax:
Email:
1)Name and full contact details of Consignee (organization receiving the goods) / Organization:
Address:
Name:
Position:
Telephone:
Fax:
e-mail:
2)Full contact details of party to be notified(person/authority responsible for productsshipment authorization)
Note: Above person will be contacted via email when shipment is ready to be shipped. Authorization will be required before the shipment is dispatched. / Name:
Position:
Organization:
Address:
Telephone:
Fax:
e-mail:
3)Full contact details of Payer
The person in charge of managing payment related to this procurement form / Name:
Position:
Organization:
Address:
Telephone:
Fax:
e-mail:
4)Other contacts to be copied in communication related to this procurement form / Name:
Organization:
e-mail:
Name:
Position:
Organization:
e-mail:

SECTION 3: DELIVERY & IMPORTATION DETAILS

The Preferred date(s) of Delivery specified by the Programme should indicate when the Programme needs productsto arrive in-country to ensure sufficient stockare maintained at the central, regional and peripheral programme levels. The GDF will undertake best efforts to accommodate preferred delivery date(s). GDF will provide updates on the Estimated Time of Arrival (ETA) as such information becomes available.

It is recommended to place a request for products at least 6 months before the Preferred Delivery Date.

1)Period in which products will be used
2)Preferred delivery date (date the products are required, considering standard lead-time 4-6 months from receipt of funds for products)
3)Note: In case split shipments are required, a preferred delivery date for each of the shipments should be indicated (please note comment above).
4)Preferred port of delivery
5)Preferred Incoterm / CIP/CIF
Standard DAP: The clientis responsible for customs clearance and offloading at the delivery address
DAP + Customs clearance and offloading at delivery address: GDF/IDA will arrange customs clearance (with their customs broker) and offloading at the delivery address
If DAP delivery is requested, please fill out the contact details of the contact person responsible for all (pre-)clearance documents (e.g. NOC, NOL, legalization of documents, registration documents for import purposes):
Name:
Telephone:
E-mail:
6)Preferred mode of shipment / Air Sea Overland
7)Documentation needed to accompany consignment. / Airway bill/bill of lading
Certificate of analysis (analytical batch certificate)
Certificate of origin
Packing list
Invoice
Gift certificate
COPP
GMP Certificate
Other documents or requirements (such as original documents, etc)
8)Please confirm that no special pre-shipment inspections are required in addition to the pre-shipment inspection that will be carried out by the GDF agent. / NO, GDF inspections are sufficient
YES, Special pre-shipment inspection requirements Please specify:
9)Advance notice required by consignee before delivery / week(s)
10)Special requirements concerning markings on outer cartons.
11)Details of additional requirement such as language labelling requirements
12)Can shipments arrive outside of regularworking hours (09.00 - 17.00 h / Mon-Fri). If no, please state the hours. / Yes No

SECTION 4:REGISTRATION DETAILS

Information on products registration is critical to ensure timely delivery of products. Please ensure that the section below is complete with accurate, up-to-date information.

1)Is registration required for the products to be delivered?
Time required for registration? / Yes No
Number of weeks required for registration:
2)Can importation of products into the country be made prior to or during registration (where applicable)? / Before During Neither
3)If registration is required: Registration dossier for the application to be sent to: / Name:
Title:
Organization:
Address:
Telephone:
Fax:
Email:
4)If registration is required:
a)Is it possible to obtain a waiver for registration?
b)Does a fast-track mechanism exist for the registration of the products:
Recomended by WHO;
authorized for marketing by a stringent regulatory authotity;
approved by the Expert Review Panel (ERP) / Yes No
Number of weeks required for waiver:
Yes No
Number of weeks to fast-track:
List of documents required:
for waiver:
-
-
-
for fast-track registration:
-
-
5)Other important information concerning diagnostics registration that may affect shipments.

Please sign below and send it to the following address or to your focal point in GDF:

Global Drug Facility

Stop TB Partnership Secretariat, c/o UNOPS

Email:

Signature:

Name:

Tittle:

(Authorised Official)

Date

TB DIAGNOSTICS PRODUCT SPECIFICATIONS AND QUANTITIES TO SUPPLY

The Diagnostics catalogue has been redesigned and enhanced to become more user-friendly and practical in 2018. The diagnostic equipment and reagents, laboratory supplies and ancillary devices in the catalogue are now categorized by testing type or use, allowing for easier selection of products to equip and maintain clinical laboratories, from decentralized facilities that perform smear microscopy and automated molecular testing to reference laboratories that perform line probe assays, mycobacterial culture, drug susceptibility testing and species identification.

New product-specific recommendations have also been added to guide the user in the selection of items during the ordering process. Technical specifications have been aligned and updated, including product packaging and transport types, manufacturer product codes, quality assurance registrations, and other product information fields. As a final new feature, when the user enters the desired quantities into the catalogue, a linked summary sheet allows for automated calculation of costs overall and by supplier, as well as total volumes of goods for planning of transport.

All diagnostics products available through the GDF procurement mechanism are listed in the GDF Diagnostics Catalogue Excel spreadsheet that can be downloaded from the link below. Please fill the column “Quantity to order” (column J) and submit the completed spreadsheet with the Procurement Request Form to GDF.

ELECTRIC DETERMINANTS FOR THE USE OF ELECTRIC DIAGNOSTIC EQUIPMENT AT DESTINATION

Please indicate the type of electric socket outlet prevailing in your country / laboratory setting.
B
D
E
G
I
J
Other (please specify):______/ TYPE B : North American Grounded 2 parallel flat prongs "American" type with an earth connector / TYPE D : India / Sri Lanka / Nepal / Namibia 3 large round pins in a triangular pattern with earth connector QAD Code: 100-3897
TYPE E : Europe / Schuko (Germany) 2 parallel prongs with a female earth connector QAD Code: 100-0471 / TYPE G : UK 3 large flat prongs "British" type - BS 1363 system QAD Code: 100-0475
TYPE I : Australia / China / Fiji / New Zealand flat prongs, inverted "V" positioned with earth connector QAD Code: 100-0471CN / TYPE J : Switzerland 3 round prongs - "Swiss" type QAD Code: 100-0471CH

Please also indicate for your country / laboratory setting:

Voltage (V): ______

Frequency (Hz): ______

ANNEX I – WARRANTY CONDITIONS FOR GENEXPERT EQUIPMENT

Notwithstanding any provision to the contrary in the Agreement documents, the warranties for the Goods sold to UNOPS/Stop TB-GDF by Supplier shall be limited to the following:

(a) Supplier warrants to the Client Institution that the GeneXpert instrument product is (i) free from liens and encumbrances at the time of shipment to purchaser, and (ii) will operate or perform substantially in conformance with the Supplier’s published specifications and be free from defects in material and workmanship, when subjected to normal, proper and intended usage by properly trained personnel, for two (2) years from the date of shipment of the Goods from the Supplier’s shipment facility (“Start Date”). Absent an agreement between the parties for an extension of warranty, in no event will the initial warranty period exceed two (2) years from the Start Date. The second year of warranty for GeneXpert instruments is only valid if the GeneXpert is calibrated at the end of its first year of service. Calibration cost is not included in the initial cost of the system. Consumables are expressly excluded from this warranty; reagents are only guaranteed for the period of time specified on the label.

(b) This warranty does not apply to any damages or defects resulting from any causes external to Supplier’s Goods, excluding ordinary wear and tear but including those arising from: (i) mishandling, misuse, abuse, or negligence by the Client Institution, (ii) exposure to extremes in temperature, humidity, physical or electrical power or transportation, (iii) alteration from the Goods’ original state, (iv) repair or modification by a party other than Supplier without Supplier’s prior written approval, (v) improperly storage, installation, operation, or maintenance in a manner inconsistent with Supplier’s instructions, and (vi) removal or alteration of the Goods’ serial numbers. Supplier does not warrant that the Goods are error-free or will accomplish any particular result. Supplier’s sole and exclusive remedy for breach of any warranty shall be, at Supplier’s option, (i) repair of the defective instrument(s), or (ii) replacement of the defective instrument(s). THESE EXPRESS WARRANTIES, INCLUDING THE REMEDIES SET FORTH HEREIN, ARE EXCLUSIVE AND ARE IN LIEU OF ANY AND ALL OTHER WARRANTIES, EXPRESS OR IMPLIED. NO WARRANTY OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE IS INTENDED OR GIVEN. IN THE CASE OF GOODS OTHER THAN THOSE OF SUPPLIER’S OWN MANUFACTURE, SUPPLIER MAKES NO WARRANTIES, EXPRESS, STATUTORY, OR IMPLIED.

(c) Return of Goods. To obtain warranty service, the Client Institution shall promptly notify Supplier of any non-conformance or defects in Goods, and provide the Supplier with a reasonable opportunity to inspect such Goods. Goods shall not be returned without Supplier's prior authorization, as evidenced by a Return Material Authorization (“RMA”) number issued by Supplier. Once a RMA number is obtained, the Client Institution shall return Goods in accordance with instructions issued by Supplier. The RMA number must appear on the shipping label and all paperwork associated with the return. The Client Institution shall identify the date of purchase, return shipping address, model or part number, description, and serial number, if applicable, for each of the Goods returned along with an explanation of the non-conformance or defect. Issuance of a RMA number by Supplier does not necessarily mean Supplier agrees that returned Goods are defective or covered under warranty, or that Goods will be repaired or replaced at no cost to the Client Institution. Shipping costs, duties, taxes and insurance of returned Goods are the responsibility of the Supplier. For Goods under warranty, repaired or replaced Goods shall be returned to the Client Institution at Supplier’s expense. If any Goods returned by the Client Institution are found not to be defective, the Client Institution shall be so notified and such Goods shall be returned to the Client Institution at its expense or the expense of the client to which the Goods were supplied, as applicable.

ANNEX II – PROCEDURE FOR INSPECTION OF GENEXPERT EQUIPMENT

  1. For deliveries to the port of entry (EXW, FCA, CIP etc. Incoterms® 2010 orders) the consignee or its representative clears the Goods from customs and arranges for transport to the consignee’s address as indicated in the Direct Procurement Request Form.
  1. In the case of visible, non-negligible transport damages to the Goods, the consignee, the Client Institution’s personnel or other representatives (together hereinforth the “Recipient”) will report the damage to the insurer and the Supplier on a form provided to the consignee within the time periods specified as follows:

For recognizable damages, a report must be filed immediately with the insurance. For hidden damages, a report must be filed within:

  1. Ten (10) calendar days for international air freight
  2. Three (3) business days for international sea freight
  3. Seven (7) calendar days for international road transport
  1. Upon the arrival of the Goods at the consignee’s address, the Recipient inspects the Goods and verifies that the Goods are in a satisfactory condition.
  1. Inspection and verification of the Goods shall be made as soon as reasonably practicable after receipt, normally within five (5) working days. If this period is exceeded it will be incumbent upon the Recipient to demonstrate that exceptional circumstances prevailed, preventing inspection and verification. This regulation shall, however, be without prejudice to the time periods listed under point 2) to be respected for hidden damages under the insurance terms. These time periods remain applicable for insurance cases. Note in particular that for sea freight, hidden damages must be reported to the insurance within three (3) working days.
  1. Inspection and verification shall include commissioning (start-up) and basic functioning of the equipment (Systems).
  1. Any malfunctioning under point 5) shall be reported to Supplier and the insurance company within the time frames indicated in points 4) and 2) above, respectively.
  1. Malfunctioning beyond basic functioning, involving the operational and functional status of the Goods, which is detectable after the period indicated in point 4) shall be:
  1. Promptly reported to the Supplier; and
  2. To the insurance within the time frame indicated in point 2) above.
  1. Upon report of malfunctioning, the Supplier shall have the choice to conduct an investigation, either remotely or via its representatives. The Recipient shall cooperate in a timely and accommodating manner throughout this process.
  1. Whether or not the Supplier chooses to conduct an investigation, the Supplier shall communicate its conclusion and proposition for resolution within ten (10) calendar days upon receiving the report of malfunctioning, however the choice of corrective action(s) shall be at the sole discretion of UNOPS/Stop TB-GDF or the Client Institution, as applicable. Proposed corrective action(s) may include but not be limited to repair, replacement, exchange, or destruction of the Goods. Any corrective action shall include coverage by the Supplier of return transport costs and customs duties (import, re-export) as well as a time schedule for the corrective action(s).

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February 2018