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' Vendor Name: Deadline: Delivery Date: Delivery Location :

Dear Sir/ Madam,

ANNEX 1-c Quotation Request Form

AU Interested bidders

Jun ,2,2019 at 11:00AM local time.

One week after signing the PO

Hea\thNet TPO Office, Nangahar Regional Hospital, N.araston Square, District·), Jalalabad Afghanistan.

HealthNet TPO Office

Dehburi , Deh Naw,District 3 Street No.5 House No. 144, kabul www.healthnettpo.org Email:farooq@healthnettpoaf.org Email:khalilmohmmand@healthneltpoaf.org Ph : 0789880790-0789880715 RFQ No. AF298M0-2019-240-KBL

Please send/ provide us with your quotation for the following items below;

Item No. Quantity Unit Procurement Item Company j Unit Cost AFN j Total Cost AFN

1 3 Bottle Bowine Serum Albumin 1 Oml Please provide the quotation in your company letterhead, but

2 15 Bottle Alchol Methylated, 1 OOOmllbottle stamp and sign this RFQ for acceptance the terms and conditions.

3 4 Kit Alkaline Phasphatase, Kit

~ 30 Bollle Anti D, Bottel

5 2 Kit ASO, 100 test I Kit

6 0 f(il BlllltuiJiu,l<ll

7 1600 Bag Blood Bag 250m!

8 3000 Bag Blood Bag 500ml

9 100 Bag Blood Bag 100 ml

10 300 Bag Blood Bag Double

11 300 Bag Blood Bag Triple

12 6000 set Bloode Transruslon set

13 2000 Tube Blood Collctlng Tube EDTA, Jml Pc

14 150 Kit Blood Group Antisera (A,B), Set

15 300 Kit Blood Group Antisera (A,B,D), Set

16 20 Pack Blue Type, 500P/pack

17 2 Kit Brucolla TPst, t<lt

18 3 Kit Cholestrol kit, 400mi/Kit

19 18 box Cover s lide , 100 Pes/Box

20 7 Kit Creatine, I Lit

21 5 Bottle Galmza staln,1000mllbottle

22 4000 Tube Glass tub, Sml

1l ~ I'll Olu u u (100) Tu i 1 1000u /l lil

24 70 stripe Glucose test Strips, 1362 Code no 50 piece/ box

25 13000 stripe Hbs Ag, Strip

26 13000 stripe HCV, Strip

27 8800 stripe HIV, Strip

28 500 stripe Pregnency Strips

29 2 Kit RF 100 test, klt/100 test

30 170 Box Slide Microscopic, 72piece/box

31 3000 pes Stool container, block Color Pes

32 7600 stripe Syphlis(VDRL), Strip

33 2 Kit Total proten 100ml

34 2 Kit Toxo Plasmosls, Kit

35 3 Kit Triglyceriod, 6"1 OOmllkit

36 50 Kit Urea, 200mi/Kit

37 2 Kit Uric Acid, Kit

38 5000 pes Urine container, Pes

39 64 Bottle Urine strip (Combin-10), 100 Pes/Bottle

40 5 Kit Widal test TO TH, Kit

41 ~u !Jack Vellow 'type, 1M6ilcs/pack

~2 13 BoUle 01~1•1 W•ler, SUI

43 16 Bottle Soda lime powder 5kg

44 5 Kit Calcium kit

45 70 Tube Sodium citrate 3.8%, Tube

46 8 Pack Filter paper, pack

47 2 Bottle Cedar wood oil, Bottle

48 20 Roll C B C printing paper

49 5 Kit Electric Regent

50 3 Kit SGOT,Kit

51 3 Kit SGPT, Kit

52 7 Bottle Anti humman gluboline, Bottle ' 53 250 Tube ESRtube I _...., 54 2 Pes W B C counting chamber I ,.

·. ~ 55 3 box/150 tube Centerfuge tube I I

\ ~ /~ ! '"\ ~ ~ ,.. ~ ' ---56 11 Kit C B C medianic _l-1.-: ,_ u : -- ·- L. '--I o • ..J <:~AI )V ~

57 3 Kit Protambine cell count (PT) I .,f _1,__~ -' 58 25 stripe Rubilla strip <.._ .,...E;:;?" 11 59 25 Bottle Amelgum, Bottle 28g ~/~ - 9

' 60 6 Bottle Arsenic, Bottle /,;.;;;z /

~Pap1ol2

61 13 Bottle Argenat, Bottle

62 6 Pack C.H.K.M ( Dental cement), Powder/Pack

63 12 Bottle Coversal Past, Bottle

64 6 Bottle Eugenol, 15ml Bottle

65 8 Pack Eugenol Cement, Powder/Pack

66 23 Box/12pcs Freeze (Dental Needal), 12Pcs/Box

67 12 Pack G.C Glassonomer Cutting Cement

68 9 Bottle Glassnomer, Bottle

69 12 Pack Glassnomer restorative Cement 10 gm, Powder/Pack

70 14 Bottle Lidocain Spray 10%, Bottle

71 6 Box Matrex, Box

72 6 Box Nerve Needle, 100Pcs/Box

73 6 Bottle T. K. F, Bottle

74 6 Bottle T. S. R, Bottle

75 12 Pack Zink Phasphate cement, Powder/Pack

76 23 Amp dental cartaige, Piece

77 7 Bottle Mercure

78 6 Bottle Composlt set powder

79 2500 Box Gloves None Sterile (Roberry), 50 Pair/Box

GRAND TOTAL AFN Annex 1. N/A Required documents for the supplter quallflcatton: The supplier has to submit t he following documents a long with the quotation 1. Business Lfcence from Ministry of Commerce or AISA for pharmaceutlcal lmport. 2. Copy of three yea~ relevant contracts. ) .Providing of samples for medicines and medical supplie& along with quota tion fs essentli'll. 4GMPCOPP and Quality Control Docu ts for drugs are essential.

Oate:28 /05/20 19

Terms and Co ndition

Payment: The payment will be done 1()()% after the 130ods rece ipt, Inspected, quatlty checked and accepted by HNTPO Tax: 2% tall: amount will be deducted from the tota( cost of the bid price from registered suppliers with AISA or f.ICJC &. 7% from unre giste red suppUers as Afghanistan government tax law. Waranty:Suppllers has to provide one year waranty for all items In the RFQ.. Penll lly: For eliCh delayed d&y In pe:formllly the contract odllgallons a ~pedfic JJe rU~olty which Is 0. t% of the total contract v&lue will appUed to !.he supplier's payments. Delivery LOClltlon : All HOOds to be de livered no later than spesifi ed period from the date or sign ing of purChase order.

Please sta te II eoods are available ex-stock or state production timelramc Delivery Time: If the Items are not delivered according to the delivery ti me, HNTPO has the rights to cancel the purchase order.

and the company will be black-listed with HNTPO for future business. Experience: The company should have at least three years similar experience and the copy or contracts shou ld be submitted. In oterm· T~ aoo w111 be delivered under DDP ln<:ote nns 2.010 to HHTPO ofrke tulna• rfllr Rqion~ l Hosplt.l. l, Mu.•ston Squuc, District J,JI I•llbld Afahanlst.n. Inspection: The ~oods will be lns~cted accordin~ to the specification by HNTPO technical team. ~ld V~\i~llv ; Th ~~~ m1~1 ~ v~li~ f~r ~Q ~A~ (rqm lh~ j~llmlsslqn ~~~~; Submission Procedure: Ptease flU the above RFQ, sign and stamp It for finat submission to HNTPO office before the deadline . Ar:r.n llnt"'htlltv: All 111f" hlr111nnmw-nl ~ mtrit hP o;trmmr rl ;,nrl 'i ltnwr1 hw thP ;,ttthnrl7Pr1 rrnw~Pntr.tho'P nf thP rnmn~n11 Currency: The bid must be quoted In Afghan Curre ncy. Rights : HNTPO has the right to Increase , decrease the quantity . Packlns: All goods must be packed for suitable air/sea or road transportation Including rough handling to final destination Marking: All the boxes must be marked with Health Net TPO delivery address

I ftOifllftlff>'AII rtnrumnnf' m11rklnn 11nrt l '! hnlint 'hn11lrl fiiWHif in rnKIIIh

NOTE: Thl!~. I!~. Lo c~1 Llfy IJy Lh~ SUIJ!Jiier Lhatlhe above lenns and conditions are acceptable to us and we have no objection.

Submitted by: Name: ______________________________________________________ ___

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