Official Canvass FormPage 1 of 2

F¥epublic ®f the Philippines• - ® ` RT rty RE,ff ,

East fi¥*nuS, Dili"an. Qu®=®n Cst#ttiSf¥ _ttl®f¥Tili BinylsiSesL

8th floor SSS BIdg. East Ave. Diliman QCTel. No. 922-3453 Fax No. 435-9827

CANVASSJune 14, 2019

REQ 2019-094Gentlemen :

Please furnish us with your quotation on or before June 17, 2019 for the supply,delivery and installation of brand new UPS Batteries at SSS Malabon Branch.

Description Qty. Unit Unit Cost Total Cost

12V, 26AH, Valve-Regulated Lead Acid (VRLA),

16 Pieces

maintenance-free batteries including batterywires and appropriate lugs/connectorsStandby Voltage: 13.5V-13.8VDimension: 166mm x 125mm x 174mm (+/-1-3mm).

Total Cost

Please see attached of the following:

• Terms of Reference (TOR)• Bidder's proposal

Note: Please accomplished the attached Bidder's Proposal

End User: SSS Malabon Branch.

Total Approved Budget for the Contract: Php60,800.00

The SSS shall withhold the VAT from the amounts payable to the supplier in accordance withthe BIR Regulations.

Price vali.dity: Three (3) months

This is to certify that my firm/company has paid/updated in all SSS Obligations / contributionpayments to the Social Security System.

Signature

Name of Owner/Company Rep

Business Name

Official Canvass FormPage 2 of 2

F=epuf215c Sf the Philippines•RE , ' I no RE

East jftrty€nue. Dilirir*art, Qu€=oll Ci€}ffnl¢F± fuesf¥TH E*I¥isi®N

TERMS AND CONDITIONS

1. Price quotation should be made with extra care taking into account the specifications and unit ofquantity to avoid errors.

2.:#Lftj?tyu%ag#jds:?ru:%Pemadewithextracaretakingintoaccountthespecificationsandunitof

3. AIl quotations in excess of the Approved Budget Contract shall be automatically rejected.

4. Supplier must present demo units of their offered units on the scheduled inspection, if required.

5. The supplier binds himself to this quotation.

6. Completion period: Seven (7) calendar days upon receipt of Purchase Order.

7, Quotations not using the prescribed/official canvass form shall automatically be disqualified.

8. Indicate the correct SSS Number of supplier/contractor in the quotation form.

9. Please make certain to aft:ix the signature of the owner, manager or any of its duly authorizedrepresentatives in a clear legible manner.

10. Supplier shall offer one (1 ) quotation only. Alternative bids shall be rejected.

11. Supplier shall be required to submit a Notarized Omnibus Sworn Statement upon notice by theBAC Division Secretariat.

12.Please send your QUOTATION/CANVASS to the above address or thru email atlobolm@sss.aov.Dh or ruiles®sss.aov.Dh with the following Eligibility Requirements, failure toattach the following legal documents shall be a ground for automatic disqualification of submittedquotation:

a) Registration Certificate from SEC, DTI for sole proprietorship, or CDA for cooperatives,or any proof of such registration.

b) Mayor's Permit issued by the city or municipality where the principal place of businessof the prospective bidder is located.

c) Valid Certificate of PhilGEPS Registration/Numberd) Latest Form SSS R5 Contributions Paymente) BIR Certificate of Registration (Form 2303)f) Latest Business/ Income Tax Return

Very truly yours,

EJi':

EVELYNLBX4cPDL°N£Chp

PLEASE SIGN YOUR :

NAME

BUSNAME

ADD

SS EMPLOYER ID NO :

TIN NO.

TEL/FAX NO.