3 - To be completed by Supplier Company Name of Supplier Company: ____________________ Office Telephone Number: __________________ Mobile Number: ______________________ Description of requirements medical items: – All prices should be in Birr Price offered should be valid for a period of three months. should be best and final offer and include all taxes. Please indicate separately if your specification is different compared to the one indicated on the table below. Quantity Origin of Expiry available supply Date Unit of with Unit Price PR # # Item description Specification measure Quantity supplier. in Birr Total Price in Birr Cotrimoxazole 240mg/5ml 100 ml 1 suspension bottle 700 2 ORS with Zinc Sachets 5000 Albendazole 100mg/5ml 20 ml 3 suspension bottle 300 Amoxacillin Suspension 100 ml 4 125mg/5ml bottle 1500 Amoxacillin Suspension 100 ml 5 250mg/5ml bottle 750 Delivery cost to GOAL Ethiopia HO, Addis Ababa kotabe warehouse Grand Total # 1 -5 Delivery time (Time between the placement of an order and delivery of medical items)_______________________________________________
3 - To be completed by Supplier Company Name of Supplier Company: ____________________ Office Telephone Number: __________________ Mobile Number: ______________________ Description of requirements – medical items: All prices should be in Birr Price offered should be valid for a period of three months. should be best and final offer and include all taxes. Please indicate separately if your specification is different compared to the one indicated on the table below. PR # # Item description Specification Origin of supply Expiry Date Unit of measure Quantity Quantity available with supplier. Unit Price in Birr Total Price in Birr 1 Cotrimoxazole 240mg/5ml suspension 100 ml bottle 700 2 ORS with Zinc Sachets 5000 3 Albendazole 100mg/5ml suspension 20 ml bottle 300 4 Amoxacillin Suspension 125mg/5ml 100 ml bottle 1500 5 Amoxacillin Suspension 250mg/5ml 100 ml bottle 750 Delivery cost to GOAL Ethiopia HO, Addis Ababa kotabe warehouse Grand Total # 1 -5 Delivery time (Time between the placement of an order and delivery of medical items)_______________________________________________
ITT_MedicalSupplies-_SEPT-2017_REF__PR__09-RDP-P-000690__09-RDP-P-000691__03-RUDP-P-000703__03-RUDP-P-000700_db_%28003%29_%282%29.docx