HEALTHNEr·:;rrPO

I ANNEX 1-c Quotation Request Form t.) "-;!1.;1 .:.....IJ.i..,>J ,.).)l

All lnterestad Suppliers <.l~j r~ ""' ""~ rY" '-I 17/Nov/2020-12:00 PM <V/A/In~ .1; \ r .;,ct..""".._.. jJJ

Ten days After the Signing PO Jl..lf ) ..sl....:-1 .)1 A! j.JJ oJ

HealthNet TPO Office Dehburi, Deh Naw, District 3 Street No.5 Ho use No. 144, kabul WVNI.healthnettpo.org Email :Security@healthneupoar.org Ph: 0789880772

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RFQ No. AF296MO- 2020-457 -KBL

Vendor Name:~JIJ fu

Deadline:tY ~ u:!,._. ut..JJ ~~ Delivery Date: I.)"'~\ t.t'..l..L_p.:i t~l:i

Delivery locatfon:U"~I ts".lL_p.:i J- Health Net TPO Kunar Provincial Office, Kunar, Afghanistanu~"llil •fo ._,;s.;;,yJ fo

Dear Sir/ Madam, Please send/ provide us with your quotation for the following items below;

Item No. Quantity Unit Procurement Item

1 7SOO Tab Acetyl salicylic acid (Aspirin) 100mg 2 50000 Tab Acetyl Salicylic Acid (Aspirin) 500mg

Adrenaline injection 1 mg (as hydrochloride or hydrogen tartrate) in 1"-3 so Amp

ml

4 30000 Tab Aluminum Hydroxide 200mg +Magnesium Hydroxide 200mg chewable tablet.

5 750 Syrup Aluminum Hydroxide 225mg + Magnesium Hydroxide 200mg/5ml susoension

6 10000 Tab Aluminum Hydroxide 500mg 7 so Amp Aminophylline 25mg/ml in 10ml 8 2SOO Tab Aminophylline 100mg 9 15000 Tab Amitriptyline 25mg (hydrochloride)

10 40000 Cap/Tab Amoxicillin (anhydrous) 250mg 11 soooo Cap/Tab Amoxicillin (anhydrous) 500mg 12 1SOO Syrup Amoxici llin (anhydrous) powder for oral suspension 125 mg/5ml

13 1250 Vial Ampicillin (as sodium sa lt) powder for injection 500mg +water 14 1000 Tab Atenolol 1 OOmg 15 so Amp Atropine 1mg/ml 16 250 Ointment Benzoic Acid + Salicylic Acid cream or ointment 6% + 3% 17 250 Ointment Betamethasone + Neomvcin Cream 1% + 0.5 % 18 150 Vial Calcium Gluconate lniection 10% 10ml solution 19 5000 Tab Carbamazepine 200m>t 20 2SOO Tab Chloramphenicol 250mg 21 100 Via l Chloramphenicol 1 g 22 100 Syrup Chloramphenicol suspension 125mg/5ml 23 7SOO Tab Chloroquine (as phosphi;\te or sulfate ) 150m& - -

_11 1~0 Amn rhlnrnhPnir~ minf' M~IP~IP 10mnlml in 1ml

- 25 30000 T• u !Ciilwulit:lllr dllll llt' Mdl!::<i l t: <111 111 26 sooo Tab Ciprofloxacin 250mg

___! I ~ "" top Llona~lllm bLJUmg J:U z~u >UI Klll~t:l luLlul t: ~UU111l • >d 29 10000 Sachet Condoms

ilO ~000 Gyrup Cu-ld111uxazule (Sulfamethuxazole + Trlmethoprlm) suspension 200mg + 40mg/5 ml

31 50000 Tab Co-trimoxazole (Sulfamethoxazole + Trimethoprim) 1 OOmg + 20mg

32 100000 Tab Co-trimoxazole (Sulfamethoxazole + Trimethoprim) 400mg + 80mg

33 200 - Vial Deoot MedroxY Progestrone A~et~\e CDMPAl 1 ~Om2iml in 1 ml aq uu A111D DiQteoom 5me/ml i n 2ml 35 sooo Tab Diazepam 5mg 36 1500 Amp Diclofenac 25mg/ ml in 3ml i 7 liOOO Gap/ Tab DDll"GYGllno ·JOOmQ (h.,drochlorldo) 38 100 /\mp Ergometrine (hydrogen maleate) 200mlcrogram 39 1000 syrup Erythrornycln(Ethyl succinate) ·JOOmg/"lmlln 100ml

40 500 Cycle Ethinylestradiol 30microgram + Levonorgestrel 150microgram tablet

41 100000 Tab Ferrous Sulfate 60mg+ Folic Acid 400mcg 42 50000 Tab 1'11rrou5 Sulfat11 60rnw .IU 1UUUU lob 1-lUoxethie LUmg 44 7SOOO - · Tab Folic Acid 5mg 4~ oUU lab Furosemide 20mg 46 1SOO Amp Gentamicin (as sulfate] 1 Omg/ml in 2ml 47 1500 Amp Gentamicin (as sulfate) 40mg/ml in 2ml ~8 100 sol Glucose 10% 500ml isotonic • set 49 250 sol Glucose 5% 500ml isotonic + set 50 250 sol Glucose 5% 1000ml isotonic+ set 51 2SO sol Glucose 5% + Sodium Chloride 0. 9% 500ml +set 52 3000 Tab Hydrochlorothiazide 50mg 53 150 Vial Hydrocortisone 100mg (as sodium succinate) 54 40000 Tab Ibuprofen 200mg 55 25 Piece Implant (Jeddall 56 500 cap Iodine 200mg 57 50 Piece IUD (Cuppr-Tl 58 40 Vial Lidocaine injection solution 2% in vial 20ml 59 75 Gel Lidocaine Topical forms 2% (hydrochloride) 60 150 Bottle Lindane lotion 1%

Low Osmolarity ORS 20.5gr/liter Glucose anhydrous 13.5g, Sodium 61 6000 Sachet chloride 2.6g, Trisodium citrate dihydrate 2. 9 gm, Potasium chloride

1 .5g for one liter 62 100 Amp Magnesium Sulfate 500mg/ml in 20ml

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Company I Unit Cost AFN I Total Cost AFN

Please provide the quotation in your company letterhead, but stamp and sign this RFQ for acceptance the terms and conditions. J~ ~ 0'"_,.-u tni..>J \.1 JP,. ~ t ) l.11.l J u-'1!1 ..utw ~ u~ '.) f.J,s UiiJ ~ t:.Jl '.1 t..>i ~ u t..>i 4.) .:.....t.P-.>~ t.;.,! ~JJ ,Jul~ ~.I.JIJ t:.Jl

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63 6000 Tab Mebendazole 1 OOmg 64 40 Amp Meglumine antimonate 85mg/ml 65 300 Tab Mesoprostol 200mcg 66 sooo Tab MethylDopa 250mg 67 200 Amp Metoclopramide (hydrochloride) Smg/ml in 2ml 68 2500 Tab Metoclopramide tablet 10 mg (hydrochloride) 69 150 Vial Metronidazole injection 500 mg in 100 ml vial 70 1000 Syrup Metronidazole (as benzoate) 200mg /Sml 71 35000 Tab Metronidazole 200mg 72 40000 Tab Metronidazole 400mg 73 100000 Tab Multi-micronutrients (Multi Vitamin) 74 500 Cap/Tab Nifedipine 1 Omg 75 1SOO Tab Nitrofurantoin 1 OOmg 76 1500 Tab Nystatin 100 000 IU (coated tablet) 77 1500 Tab Nystatin 500 000 IU (coated tablet) 78 250 Drop Nystatin 100 000 IU/ml 79 150 Ointment Nystatin 100 000 IU vaginal 80 1000 Tab Nystatin 100 000 IU vaginal 81 1750 Amp Oxvtocin 10 IU in 1ml 82 4000 Syrup Paracetamol (acetaminoohenl 120 mg/5ml 83 50000 Tab Paracetamol lacetaminoohenl 100mg 84 150000 Tab Paracetamol (acetaminophen\ 500mg 85 2000 Tab Phenobarbital 1 OOmg 86 250 Tab Phenobarbital 15mg

07 500 Syrup Phenoxy Methyl Penicillin (Penicillin Vas potassium salt) 250mg/5ml

88

1 'innn T1h RhAnr" l ' ~~e th l<l Penicil lin (Penicillin V ~~ r nnrrlum.n lt) 5nnmo rtlnnn_ ---I-----T~~~h----~p~,~-in-l~~n,"~i ,-1~-1~r.~,n--1o ----~--------~--------~--~~--~---------------------------------------------4

91 150 Amp/vial Rabies vaccine 92 1000 Cap Retinol (vitamin AI 200 000 IU (as oalmitatel 1110mg)

93 100 Inhaler Salbutamol inhalation (aerosol) 100 microgram (as sulfate) per dose

94 25 sol Salbutamol respirator solution 5mg/ml (as sulfate) Di 1~uo ~wuu ~albutamol2mg/5m l (al Julfat~ )

96 75 amp sa lbutamol inj 97 15000 Tab Salbutamol 4mg 98 7on Ointment Si(ver Su\f~di~~in !; Cr!;nm 1 ?il 50Rr ~q ?nn rnl r f.ldium Chloride 0 . ~~ ~OOml • rot 100 25 Amp Sodium Bicarbonate 8.4% (840 mR) in 20ml

1--"'1 0"'1~1----'J:.::S __ -t-----'V-'-'ia::..l ----FS,o_,_dl,_,·u"-'m=StiQQgluconatc 1 OOmg/ ml_,i..._n -'1..,.00...._m"'l'-------------10Z 2000 Oinlmenl Tetracycline hydrochloride eye ointment 1%

f-.:::10:.:::3'-lf--"5-'"oo,__ __ +-----'T-"'a b,__ __ --+'T~r"-i h'-"e-""xy_,(:!heni d l 2m 104 100 Amp Phytonadione (Vitamin K) 10mg/ml ------------ --105 20000 Tab Zinc Dispersible 20mg 106 6 Roll AUTOClAVE INDICATOR ADHESIVE ROLL WITH COLOR 107 300 Roll BANDAGE CREPE (ElASTIC BANDAGE) 7.5CMX5M ROLL 108 300 Roll BANDAGE CREPE (ElASTIC BANDAGE) 15CMX5M ROLL 109 12 piece CATHETER URINARY FOLEY BALLOON STERILE S.U. CHB 110 12 piece CATHETER URINARY FOLEY BALLOON STERILE S.U. CH10 111 12 piece CATHETER URINARY FOLEY BALLOON STERILE S.U. CH12 112 12 piece CATHETER URINARY FOLEY BALLOON STERILE S.U. CH16 113 50 kg CHLORINE RELEASING POWD 1 G/L POWD 114 150 pack-100 COMPRESS GAUZE 10 CM, STERILE 115 100 Roll COTTON WOOL, HYDROPHILIC ROLL 400 G 116 50 vard-40 GAUZE METRIC ABSORBENT 90CMX91M ROLL 117 60 Box/100 GLOVE, EXAMINATION NITRILE S.U. NON STERILE MEDIUM 118 500 pair GLOVES SURGICAL, lATEX S.U. STERILE PAIR 7.5 119 250 pair GLOVES SURGICAL lATEX S.U. STERILE PAIR 8.5 120 200 piece IV CATHETER INJECTION PORT S.U. 18 G PENK ill 3uu p1ece IV CATHETER INJECl iON PURT S.U. 20 G PENK llJ ooo _piooo IV C.\TIICTD1 l~lJCCTiml 1'011T · ~.U. i!i! G OLUC 123 HIOO niere IV CATIICTCR INJECTIOt~ PORT 5.U. Z4 G YCLLOW 124 25 pack-50 Mask disoosable 125 500 piece NEEDLE S.U. LUER, 23 G BLUE SC IM CHILD I ~~./ . " ';,., \ 126 100 piece SAFETY BOX SHARP CONTAINER FOR DISPOSING NEEDLE 127 4 Pack/100 SCALPEL N" 3 BlADE S.U. STERILE N" 10 I >! \ \ 128 4 Pack/100 SCALPEL N" 4 BlADE S.U. STERILE N" 22 I I _ . . ' " -, \ '" \ 129 5 piece SUT. ABS. BRAIDED (2/0) SPOOL W /0 NEEDLE (Cromie 2/0) l c- \ l" t l L J i :.:il 130 2 piece SUT. ABS. RAPID, BRAIDED (3/0) NEEDLE 1/2 26MM TRI (Cromie 3/0)

131 2500 piece SYRINGE DISPOSABLE 10ML PCS 132 50 piece SYRINGE DISPOSABLE 20ML PCS 133 1500 piece SYRINGE DISPOSABLE 2ML PCS 134 6000 piece SYRINGE DISPOSABLE 5ML PCS 135 750 piece TAPE ADHESIVE ROLL 5 CM X 5M 136 150 Pack/100 TONGUE DEPRESSOR WOOD NON STERILE 137 6 piece TUBE GASTRIC (FEEDING) CONICAL TIP 120/125 CM CH06 138 6 piece TUBE GASTRIC (FEEDING). CONICAL TIP, 120/125 CM CH08 139 9 piece TUBE GASTRIC (FEEDING) CONICAL TIP 120/125 CM CH12 140 6 piece TUBE GASTRIC (FEEDING). CONICAL TIP 120/125 CM, CH14 141 6 piece TUBE GASTRIC (FEEDING), CONICAL TIP 120/125 CM CH16 /1 142 6 piece TUBE SUCTION, CONICAL TIP 50 CM, SINGLE USE, CH08 , ;; 143 6 piece TUBE SUCTION CONICAL TIP 50 CM, SINGLE USE CH10 .• !%\ 144 9 piece TUBE SUCTION , CONICAL TIP 50 CM SINGLE USE, CH14

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145 9 146 soo 147 7

148 2S 149 2S 150 2S 151 2S 152 4 153 1 154 s 155 600 156 1000 157 1S 158 10 159 10 160 20 161 2 162 1 163 2 164 2 165 s 1p6 2S

GRAND TOTAL AFN Annex 1. N/A

piece

Amp solution

Piece

Piete Box/200pe Box/72pe

KIT Box/100 Box/SO

Pes Pes

Box/100 Box/100

SOOml/bottle Box/SO BOX/40 Box/100 box/40

Box100 strip SOOml/bottle

pes

Required documents for the supplier qualifi

TUBE SUCTION CON ICAL TIP water for injection Sml Dettol solution 450ml BLOOD BAG SOOML with set BLOOD BAG ZSOML with set BLOOD LANCETS BOX, 72 SLIDES GLASS blood group anti sera A B.D EDTA (ANTI CUAGULANT TUBE! Face mask disposable STOOL CONTAINER Urine container Test Urine strips (Combin 3) Test Urine strips (Combin 10) WBC Solution TEST PREGNANCY 20-ZSMU/ML HIV STRIPS Svplis strips HCV Strip HBS Strip Stain Logul iodine ESR pipit

The supplier has to submit the following documents along with the quotation

1. Business Licence from Ministry of Commerce or AISA. 2. Copy of three year relevant contract.

50 CM, SINGLE USE CH16

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Terms and Condition ~\.ll:,_y1

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Samples: For medicines and medical supplies samples are required to be submited along with the quotation to Kabul office logistics/procurement department for selection, samples of medical equipment .~.J.+. .uJ.-. .JI ._r. ~U..:J. <\...o,...o_,. ..,a~ .1-.ji\A ..:..S.~~~~J f'\~ J.l..r.J.:. I.S_h.!L.c"~l ,J.,.:: •JIJ J.ipJ..,J..:;.lii.._.JJl _,1:.1.:;..~ ~ _foJ,_r1.5.).1J/~j)UW,hJ~..._.IJtJl•l_,... ~IJU...I j\.F.,r.h ~J-<"""1"';:0.1 JI.A IJ J UIJ! ;-.J_,...J

Payment: The payme nt will be done 100% after the goods receipt, inspected, quality checked and accepted. ,J~I.T'"GbY.lf-ii~J.fiJ.:J~.J!J.,..&i• ~ , ..,.~~ jl A! J1JjjiJ..L.:.v-~l..::.u~ \ • · ZU"~I ~~IJJ1

TilXi l~ ux llmount will bo rlnrhtr.tnrt frnm thn tntnl nnd nf th, hiri rri lll'l frnm rr~&i11Mrr:l1 '"l'l'li fiP \'li th Alfi.A. nr Mnr n 7?(. frnm unrnsht H t\ rt " 'l'l'lit~n ftl .M8hl'ln1Jt " flnv• rnm nt l ~ I • .uJ..+.~J~Yi:.j.)!C-~J ~ti:~tU"".J...I..s;~..:..JJ.l..:..tJ.~~~~~,Ai~ ~4Jw.:.UI;l...o:!I•;Uif..:!J U~ I"~..:..;IjJ4W_J:f.jlp,~I"_;:-.U~~·~JI;4t...

Delivery Location: All goods to be delivered to HN TPO office in Kunar Office no later than spesified period from the date of signing of purchase order . . J.j,_:. iJ o.ltl ~y..j ..:-1 o..l..!. ~ .lb;!_,.i r;_,.i ;:. 4$ ~J.l;y..j l)l..j l.i'lh.. jS ).l ~ ..:J.A ....._.,..fl.:~~ .:~b;!.J,i J.o~ V"'41 rW : ~oLI:'_po::i J.:o....

Delivery Time: If the Items arc not delivered according to the delivery time, HNTPO has the rights to cancel the purchase order and the company will be black-listed with HNTPO for future business. ,.);~(o~~J ~JP'A ~ c.,U,., r.!.r- ....__,... l tJ' 1.5~ J ~~ ..:,}l.tla... J.l 1!2 ,.fl M-' &- j l G ~ ~.,.!., ~ G .:~l.lJ~ ti .ljl .ll..~ ,, Li J ~ cJA ~,.. J..i_,..:J O.lb ~~ ~ wt....J, c.l_t,~ .!li.);LJ J..~ 1.)"41 ~JJ-"'J.l :._;.JJ:y.j ~l,j

Warranty: Suppliers has to provide at least one year warranty for all quoted items of medical equipment. .:~ ; 1.1.! ":!~,1.&-if :l_pjtS"_, ~ jt ..ot...S:! ~~ J!l J..> ~~ ~ ~l.. r~' t_,j o~:l ":!~' r.J.:- 1.5\AI ..:.sp : (LfJ!J'}~Lo..o

Experience: The company should have at least three years similar experience and the copy of contracts should be submitted.

lncoterm: The goods will be delivered under DDP lncoterms 2020 to HNTPO Kunar Provincial Office , Kunar , Afghanistan . • .l,j.,..:.IJ"' e .l!J J.,._p.j uu......"\.i.!l .y.s. .y.s. ~'iJ flJ ~ cjJ~ 2020 Jl....o .a.u... U.J4.:i vlW' ~ ~~~ DDP ~;.!. ~ JbJI_j J.ol..!. ~~ rLo:i :UJ~ ,}WI ~ ~~~

Inspection: The goods will be inspected according to the specification by HNTPO technical team.

Bid Validity: The bid must be valid for 30 days from the submission date :

Submission Procedure: Please fill the above RFQ,. sign and stamp it for final submission to HNTPO office before the deadline . .l,l;l.l.,IJ,.~~yo U:!I•J.:I~ c.~l ~_F j1 J.iJ•J.JAi-*'"J"L...:-1 IJ~J'"~I t.;J~I;I~IP,.Jl~~ .. J~~J,.........lhl : t,;j~IJI JU...I ~~IJ"',

Accountability: All the bid documents must be stamped and signed by the authorized representative of the company.

Currency: The bid must be quoted in Afghan Currency.

Rights: HNTPO has the right to increase , decrease the quantity . ~w :l~j ~-' ts'!J ~.; c-.~y>-;:. r;,i zr.>..c... \)"'~, {.lt.u.:iJ ;I..W .u :.JI:li.P _,, i..i J cJ cJA ~,.. :J~

Packing: All goods must be packed for suitable air/sea or road transportation including rough handling to final destination • .:oj~ ~ b t..Jb~y..l J;- Jt ...,..41 J~l d.$..!..!.~ .u..!.U b....,._~.;.. t.S~ ~ ~~;.:o;T J..l.!. V"'~l :1.5~ ~

Marking: All the boxes must be marked with Health Net TPO delivery address

Language:AII documents, markings and labeling should appear in English.

NOTE: This is to certify by the supplier that the above terms and conditions are acceptable to us and we have no objection.

Submitted by: t5~,.>lJU...lo~J4:l.J1

Name:,...l

Signature: c.~l

Stamp: <ow

Position: <i,l;.J _ ________________ _

Date:C,.) ' - -----------------