COPY NO.

1- TECHNICAL COMPONENT

NAME OF THE PROJECT:

PURCHASE OF MEDICINES FOR EMERGENCY/
DISASTER/ EPIDEMIC VICTIMS

NAME, ADDRESS, AND CONTACT OF THE BIDDER:

LHUNDREN DRUGSTORE
TORRIJOS ST. ZONE 5
BANGUED, ABRA
09675182960

BIDS AND AWARDCS COMMITTEE

MUNICIPALITY OF TUBO, ABRA

SOLICITATION NUMBER 2020113

IDENTIFICATION NO.

DO NOT OPEN BEFORE FEBRUARY 3,2020 ( 9:00 AM)

TAB Requirements under
Class “ A” Documents
Legal Documents
PhilGEPS Certificate of Registration and
A Membership ( Platinum) with Annex A and
updated Eligibility Document/s, if already expired
 Statement of all On-going and completed
Government and Private Contract, including
contracts awarded but not yet started, if any
B whether or not similar in nature and complexity to
the contract to be bid; with contract and Notice to
Proceed indicating the amount of contract and
value of outstanding contracts.
THE BIDS AND AWARDS COMMITTEE
Municipality of Tubo, Abra
Project Reference Number: 6794574
Invitation to Bid No. ________________
Name of Project: Purchase of Medicine for Emergency/ Disaster/ Epidemic victims
Location of the Project: Municipality of Tubo, ABra

List of all On-going Government & Private Contracts

Business Name: LHUNDREN DRUGSTORE
Business Address: TORRIJOS ST. ZONE 5, BANGUED, ABRA

a. Owner’s Value of
a. Date Awarded
Name of Name Outstanding
Bidder’s Role b. Date Started % of
Contract/ Project b. Address Nature of Work Works
c. Date Accomplishment
Cost c. Telephone Undelivered
Completion
Nos. % Portion
GOVERNMENT:
NONE/ NO ON GOING

PRIVATE:
NONE/ NO ON GOING
Total Cos

Note: This statement shall be supported with:

Notice of Award
Contract, Purchase of Order
Submitted by : BOOTS C. Santos
( Printed Name & Signature)
Designation : Proprietor
Date : January 03, 2020
THE BIDS AND AWARDS COMMITTEE
Municipality of Tubo, Abra
Project Reference Number: 6794574
Invitation to Bid No. _______________
Name of Project: Purchase of Medicine for Emergency/ Disaster/ Epidemic victims

Location of the Project: Municipality of Tubo, Abra

Statement of all Completed Government and Private Contracts Similar in Nature within the Relevant Period ( 2 Years)

Contract to be Bid : PURCHASE OF MEDICINE FOR EMERGENCY/ DISASTER/ EPIDEMIC VICTIMS

Business Name : LHUNDREN DRUGSTORE
Business Address : TORRIJOS ST. ZONE 5, BANGUED, ABRA

Name and Location a. Owner’s Title of the Contractor’s Role a. Total Contract Value
of Project Name project in the (whether sole at Award
b. Address Contract Nature of Work contractor, b. Total Contract Value
c. Telephone subcontractor, or a at Completion
Nos. partner in a JV) c. Contract Duration
Description %
GOVERNMENT:
Purchase of a. Municipality Purchase of
medicines- of Piddig Medicines a. Php 796,120.50
Wholesaler/ Sole
Municipality of b. Brgy. Anao, 100 % b. Php 796,120.50
Retailer Contractor
Piddig Piddig Ilocos c. 30 days
Norte
a. Municipality
Supply & delivery of Supply &
of Manabo, a. Php 299,990.00
Drugs & medicines- delivery of Wholesaler/ Sole
Abra 100 % b. Php 299,990.00
Municipality of Drugs & Retailer Contractor
b. Manabo, Abra c. 30 days
Manabo Medicines
c. 09956538805
 a. Municipality
Supply & a. Php 99,994.00
Supply & delivery of of Manabo,
delivery of Wholesaler/ Sole b. Php 99,994.00
Drugs & medicines- Abra 100 %
Drugs & Retailer Contractor c. 30 days
Manabao, Abra b. Manabo, Abra
Medicines
c. 09956538805
Medical materials/
Medical a. Php 522,480.00
supplies &
a. SDO, Abra materials/ b. Php 522,480.00
Equipment for the
b. Bangued, equipments for Wholesaler/ Sole c. 30 days
First Aid Kits/ Bags 100 %
Abra the First Aid Retailer Contractor
of Schools –
c. 752-5358 kits/ bags of
Department of
school
Education-SDO Abra
Purchase of a. Municipality of
a. Php 499,896.00
Medicines- Santiago Purchase of Wholesaler/ Sole
100 % b. Php 499,896.00
Municipality of b. Santiago, Ilocos Medicines Retailer Contractor
c. 7 days
Santiago Sur
PRIVATE:
NO/ NONE ON GOING

Attachments:
Contract and Notice to Proceed indicating the amount of contract and value of outstanding contracts.

Submitted by : BOOTS C. Santos

(Printed Name & Signature)
Designation : Proprietor
Date : January 03,2020
 Statement of the Bidder’s Single Largest
Completed Contract (SLCC) similar to the
contract to be bid, in accordance with ITB Clause
5, within two (2) years from the date of bid
C submission. Must be 25% of the ABC (expendable
supplies) and 50% of the ABC (services and non
the value of previous completed contract with end
user’s certificate of acceptance or official receipts
or sales invoice issued for the Contract.
THE BIDS AND AWARDS COMMITTEE
Municipality of Tubo, Abra
Project Reference Number: 6794574
Invitation to Bid No. _______________
Name of Project: Purchase of Medicine for Emergency/ Disaster/ Epidemic victims
Location of the Project: Municipality of Tubo, Abra

Statement identifying the Bidder’s Single Largest Completed Contract ( SLCC) similar in nature within the
relevant period (2 years)
Business Name: LHUNDREN DRUGSTORE

Business Address: TORRIJOS ST. ZONE 5, BANGUED, ABRA

Name of Client a. Owner’s Title of a. Total Contract

Name the Contractor’s Role Value at Award
b. Address project in a. Date Awarded (whether sole b. Total Contract
Nature of
c. Telephone the b. Contract contractor, Value at
Work
Nos. Contract Effectivity subcontractor, or Completion
a partner in a JV) Contract
Duration
GOVERNMENT: Description %
Municipality of a. Municipality Purchase a. Php 796,120.50
a. December 15,
Piddig of Piddig of b. Php 764,275.68
Wholesaler/ 2017 Sole 100
b. Brgy. Anao, Medicines c. 15 days
Retailer b. December 18, Contractor %
Piddig
2017
Ilocos Norte
 PRIVATE:
NO/ NONE ON
GOING
Note: This statement shall be supported with:
Notice of Award
Notice to Proceed, Contract
Owner’s Certificate of Acceptance, or Certificate of Completion, or
Official Receipt ( OR) of last payment made relative to the contract

Submitted by : BOOTS C. Santos

( Printed Name & Signature)
Designation : Proprietor
Date : January 03,2020

-
 The prospective bidder’s computation of Net
financial Contracting Capacity ( NFCC) which
must be at least equal to the ABC to be bid (
supported by the Latest Audited Financial
D
Statements and Income Tax Return) or
Committed line of Credit from a Universal or
Commercial Bank which must be equal to 10% of
the ABC to be bid.
 Financial Documents for Eligibility Check

Summary of the Applicant’s Supplier’s/ Distributor assets and liabilities on the basis of the
attached income tax return stamped “ RECEIVED” by the Bureau of Internal Revenue or BIR
authorized collecting agent, for the immediately preceding year.

YEAR 2018
1. Total Assets 1,041,016.61
2. Current Assets 974,016.61
3. Total Liabilities 110,899.06
4. Current Liabilities 110,899.06
5. Total net Word (1-3) 930,117.61
6. Current Net Working or Net Working Capital (2-4) 863,117.55
The Net Financial Contract Capacity ( NFCC), which must be at least equal to the ABC to be
bid, based on the above data is calculated as follows:

(Current Asset ₱ 974,016.61 MINUS Current Liabilities ₱ 110,899.06) (15) MINUS- 0

On-going) The value of outstanding or uncompleted portions of the projects,
including awarded contracts yet to be started.

NFC= (current asset minus current liabilities (15) minus the value of all outstanding or
uncompleted portions of the projects under going contracts, including awarded
contracts yet to be started.

NFCC= ₱ 12,946.763.25 TWELVE MILLION NINE HUNDRED FORTY SIX

THOUSAND SEVEN HUNDRED SIXTY THREE PESOS AN
TWENTY FIVE CENTAVOS.

Or;
If the prospective bidders ops to submit a Committed Line of Credit (CLC, it must be at least
equal to ten (10%) of the Abc to be bid and shall be confirmed or authenticated by a local
universal or commercial bank.

Herewith attached are certified true copies of the Income Tax Return and Audited Financial
Statement: stamped “RECEIVED” by the BIR authorized collecting agent or the immediately
preceding.

Submitted by:

LHUNDREN DRUGSTORE
Name of Supplier/ Distributor/ Manufacturer

BOOTS C. SANTOS
Printed Name and Signature of Authorized Representative
Date: February 3, 2020

NFCC COMPUTATINO:
974,016.61 Current Assets MINUS
110,899.06 Current Liabilities
X 15
Php 12,946,76.25
 LHUNDREN DRUGSTORE
Torrijos St. Zone 5, Bangued, Abra Tel. No.: 09675182960

_________________________________________
THE REVENUE DISTRICT OFFICER
Revenue District No. 1
BUREAU OF INTERNAL REVENUE
Bangued, Abra

Gentlemen:

I have the honor to herewith, the print out of BIR form 1701 with attachment filed through
EFPS for the year ended December 2019.

Please find the attached copies in order.

For your information and guidance.

Very truly yours,

BOOTS C. SANTOS
Taxpayer
 Other Technical Documents

Bid Security, bidder can choose one (1) below (

in the prescribed form, amount and validity
period)
F
a. Bid Securing Declaration- duly notarized
and dry sealed
Bid Securing Declaration

( REPUBLIC OF THE PHILIPPINES)

CITY/ MUNICIPALITY OF ) S.S.
x------------ BANGUED, ABRA-----------x

Invitation to Bid No ___________

HON. GUILBERT P. BALLANGAN

Municipal Mayor
Tubo, Abra

I, BOOTS C. SANTOS, the undersigned, declare that:

1. I understand that, according to your conditions, bids must be supported by a Bid

Security, which may be in the form of a Bid- Securing Declaration.

2. I accept that: (a) I will be automatically disqualified from the bidding for any contract
with any procuring entity for a period of two (2) years upon receipt of your
Blacklisting Order; and (b) I will pay the applicable fine provided under Section 6 of
the Guidelines on the Use of Bid Securing Declaration, within fifteen (15) days from
receipt of the written demand by the procuring entity for the commission of acts
resulting to the enforcement of the bid securing declaration under Section 23.1 (b),
34.2 40.1 and 69.1, except 69.1 (f) of the IRR of RA 9184; without prejudice to other
legal actions the government may undertake. If I have committed any of the following
actions:

3. I understand that this Bid-Securing Declaration shall cease to be valid on the

following circumstances:

a) Upon the expiration of the bid validity period, or any extension thereof
pursuant to your request.

b) I am declared ineligible or post-disqualified upon receipt of your notice to such

effect, and (i) I failed to timely file a request for reconsideration (ii) I filed to
avail a waiver to avail of said right:

c) I am declared as the bidder with the Lowest Calculated and Responsive Bid/
Highest Rated and Responsive Bid, and I have furnished the performance
security and signed the Contract.

IN WITNESS WHEREOF, I have hereunto set my hand/s this _________________ at

______________________.

BOOTS C. SANTOS
Owner
Affiant
 SUBSCRIBED AND SWORN to before me this _________________ at Bangued, Abra,
Philippines. Affiant is personally known to me and was identified by me through competent
evidence of identity as defined in the 2004 Rules and Notarial Practice (AM. No. 02-8-13-
SC). Affiant/s exhibited to me his TIN No. 944-499-152-000 with his photograph and
signature appearing thereon, with no. _______________________ and his Community Tax
Certificate No. ____________ issued on ____________________ at _________________________.

Witness my hand and seal this ______________ day of ___________, 2020.

Doc. No. ____________;

Page No.____________;
Book No.____________;
Series of ____________;
 Section VII. Technical Specification
Item Specification Statement of Compliance
Bidders must state here either “
Comply” or “ no Comply” against
each of the individual
parameters of each
Specification stating the
corresponding performance
parameter of the equipment
offered. Statement of “ Comply”
must be supported by evidence
in a Bidders bid and cross-
referenced to the evidence.
Evidence shall be in the form of
manufacturer’s un-amended
sales literature, unconditional
statements of specification and
compliances issued by the
manufacturer, samples,
independent test data etc., as
appropriate. A statement that is
not supported by evidence or is
subsequently found to be
contradicted by the evidence
presented will render the Bid
under the evaluation liable for
rejection. A statement either in
the Bidders statement either in
the Bidders statement of
compliances of supporting
evidence that is found to be false
either during Bid evaluation, of
the Contract may be regarded as
fraudulent and render the
bidder or a supplier liable for
prosecution subject to the
provisions of ITB Clause 3.1 (a)
(ii) and or GCC Clause 2.1 (a) (ii).
1. Cetirizine 10mg tab COMPLY
2. Cetirizine 5mg/5ml COMPLY
3. Cetirizine 2.5mg/ml COMPLY
4. Loratadine 10mg tab COMPLY
5. Brompheniramine + Phenylephrine Drops COMPLY
6. Chlorphenamine 4mg Tablet COMPLY
7. Chlorphenamine 2.5mg/5ml COMPLY
8. Diphenhydramine 50mg/ml/Amp COMPLY
9. Diphenhydramine 50mg Capsule COMPLY
10. Diphenhydramine 25mg Capsule COMPLY
11. Diphenhydramine 12.5mg/5ml COMPLY
12. Prednisone 10mg/5ml COMPLY
13. Hydrocortisone 100mg/ml COMPLY
14. Amoxicillin 500mg Capsule COMPLY
15. Amoxicillin 250mg Capsule COMPLY
16. Amoxicillin 250mg/5ml COMPLY
17. Amoxicillin 100mg/ml COMPLY
18. Ampicillin 500mg COMPLY
19. Azithromycin 500mg COMPLY
20. Cefalexin 500mg Capsule COMPLY
21. Cefalexin 250mg/5ml COMPLY
22. Cefalexin 100mg/ml COMPLY
23. Ceftriaxone 1g COMPLY
24. Chloramphenicol 500mg Capsule COMPLY
25. Ciprofloxacin 500mg Tablet COMPLY
26. Cloxacillin 500mg Capsule COMPLY
27. Cloxacillin 250mg/5ml COMPLY
28. Cotrimoxazole 800mg tab COMPLY
29. Cotrimoxazole 400mg/5ml COMPLY
30. Co-amoxiclav 500mg/125mg Tablet COMPLY
31. Co-amoxiclav 250mg/125mg Tablet COMPLY
32. Doxycycline 100mg Capsule COMPLY
33. Erythromycin Eye ointment COMPLY
34. Erythromycin 200mg/5ml COMPLY
35. Erythromycin 500mg Tablet COMPLY
36. Erythromycin 250mg Tablet COMPLY
37. Metronidazole 500mg/100ml COMPLY
38. Metronidazole 500mg Tablet COMPLY
39. Metronidazole 125mg/5ml COMPLY
40. Loperamide 2mg Capsule COMPLY
41. Isosorbide dinitrate 5mg Tablet COMPLY
42. Fenofibrate 200mg Capsule COMPLY
43. Captopril 25mg Tablet COMPLY
44. Clonidine75mcg Tablet COMPLY
45. Methyldopa 250mg Tablet COMPLY
46. Propranolol 40mg tab COMPLY
47. Digoxin 250mcg COMPLY
48. Polymyxin + Neomycin + Dexamethasone eyedrops COMPLY
49. Aluminum Magnesium Hydroxide 200/100mg Tablet COMPLY
50. Omeprazole 20mg Cap COMPLY
51. Metoclopromide 10mg Tablet COMPLY
52. Metoclopromide 5mg/ml x 2ml/amp COMPLY
53. Metoclopromide 5mg/5ml COMPLY
54. Domperidone 10mg Tablet COMPLY
55. Hyoscine N Butylbromide 10mg Tablet COMPLY
56. Hyoscine N Butylbromide 20mg/ml x Amp COMPLY
57. Furosemide 40mg Tablet COMPLY
58. Magnesium Sulfate 500mg/ml COMPLY
59. Oxytocin 10iu/ml Amp. COMPLY
60. Tranexamic acid 500mg Capsule COMPLY
61. Vit. K / Phytomenadione 2mg/0.2ml Paed amp COMPLY
62. Paracetamol 500mg Tablet COMPLY
63. Paracetamol 150mg/ml x 2ml/amp COMPLY
64. Paracetamol 250mg/5ml COMPLY
65. Paracetamol 100mg/ml COMPLY
66. Lidocaine 2% Sol'n (20mg/ml) x 50ml COMPLY
67. Celecoxib 200mg cap COMPLY
68. Ibuprofen 400mg Tablet COMPLY
69. Ibuprofen 200mg Tablet COMPLY
70. Ibuprofen 100mg/5ml COMPLY
71. Mefenamic Acid 250mg cap COMPLY
72. Mefenamic Acid 500mg cap COMPLY
73. Diclofenac Sodium 50mg Tablet COMPLY
74. Diclofenac Sodium 25mg/ml x 3ml COMPLY
75. Allopurinol 300mg Tablet COMPLY
76. Colchicine 500mcg tab COMPLY
77. Salbutamol 2mg Tablet COMPLY
78. Salbutamol 1mg/ml Nebule COMPLY
79. Meclizine 25mg Tablet COMPLY
80. Betahistine 12mg Tablet COMPLY
81. Cinnarizine 25mg Tablet COMPLY
82. Itraconazole 100mg Capsule COMPLY
83. Ketoconazole 2% cream 15g COMPLY
84. Nystatin 100,000 units/ml COMPLY
85. Dexamethasone 4mg/ml COMPLY
86. Dexamethasone 500mcg Tablet COMPLY
87. Ipratropium+Salbutamol Nebule COMPLY
88. Lagundi 300mg/5ml COMPLY
89. Lagundi 600mg Tablet COMPLY
90. Paracetamol+Phenylpropanolamine+Chlorphenamine COMPLY
325/25/2mg (Symdex)
91. Terbutaline 2.5mg/ml Solution COMPLY
92. Terbutaline 2mg Tablet COMPLY
93. Calcium Gluconate 100mg/ml (10%) COMPLY
94. Isoxsuprine HCl 10mg Tablet COMPLY
95. Methylegometrine 200mcg/ml COMPLY
96. Lactulose 3.3g/5ml COMPLY
97. Simeticone 40mg/ml COMPLY
98. Permethrin shampoo 10mg/ml 60ml COMPLY
99. Ascorbic Acid 500mg Tablet COMPLY
100. Ferrous Sulfate+Folic Acid+Vit. B Capsule COMPLY
101. Multivitamins Capsule COMPLY
102. Multivitamins Syrup 120ml COMPLY
103. Multivitamins+ Iron Cap COMPLY
104. Vit. B complex Cap COMPLY
105. 70% Ethyl Alcohol 500ml COMPLY
106. Iodine 10% Solution 120ml COMPLY
107. Hydrogen Peroxide 120ml COMPLY
108. Gauze rolls COMPLY
109. Cotton rolls COMPLY
110. Digital Thermometer COMPLY
111. Face mask COMPLY
112. Nasal Cannula COMPLY
113. Nebulizer kit w/ mask adult COMPLY
 114. Nebulizer kit w/ mask pedia COMPLY
115. Elastic Bandage ( 5cm x 1.6m) COMPLY
116. Plaster 1 Inch ( Microphore ) COMPLY
117. Plaster 1/2 Inch ( Microphore ) COMPLY
118. Sterile Lubricating/ KY Jelly COMPLY
119. Sterile Surgical Gloves (size 6.5) COMPLY
120. Sterile Surgical Gloves (size 7) COMPLY
121. Sterile Water for Injection COMPLY
122. Unsterile Surgical Gloves w/ powder (Medium) COMPLY
123. Unsterile Surgical Gloves w/ powder (Large) COMPLY
124. Surgical Sutures Chromic 3-0 round needle COMPLY
125. Surgical Sutures Chromic 4-0 round needle COMPLY
126. Surgical Sutures Silk 3-0 cutiing needle COMPLY
127. Surgical Sutures Silk 4-0 cutiing needle COMPLY
128. Syringe 1ml 25Gx5/8" COMPLY
129. Syringe 3ml 23Gx1" COMPLY
130. Urine Strips (4 parameters) COMPLY
131. Cotton Swab COMPLY
132. Vacutainer Tube (red Top) COMPLY
133. Vacutainer Tube (violet Top) COMPLY
134. Pregnancy Test Kit COMPLY
135. Glucose Reagent 120ml COMPLY
136. Uric Acid Reagent 120ml COMPLY
137. Cholesterol Reagent 120ml COMPLY
138. Triglyceride Reagent 120ml COMPLY
139. BUN Reagent 120ml COMPLY
140. Creatinine Reagent 120ml COMPLY
141. HDL Cholesterol Reagent 120ml COMPLY
142. Micropipette Tips (Blue) COMPLY
143. Micropipette Tips (Yellow ) COMPLY
144. 12mm x 75mm Round Tube COMPLY
145. HBsAg Kit COMPLY
146. RPR Kit COMPLY
147. Hemoglobin Analyzer (w/100's strips) COMPLY
148. WBC Diluting Fluids 500ml COMPLY
149. Autolancet Pricker COMPLY

LHUNDREN DRUGSTORE
SUPPLIER

BOOTS C. SANTOS
(Signature)
 Production/ Delivery Schedule
H
 LHUNDREN DRUGSTORE
Torrijos St. Zone 5, Bangued, Abra Tel. No.: 09675182960

THE BIDS AND AWARDS COMMITTEE

MUNICIPALITY OF TUBO, ABRA

Subject: Production Delivery Schedule

Dear Sirs/ Madam,

This has reference to the bidding for Procurement of Medicines for emergency/
disasters/ epidemic victims scheduled on February 3, 2020.;

Please be informed that we will deliver the required GOODS within 180 days after receipt
of the corresponding Purchase Order ( PO) or needed by the end-user.

Very truly yours,

BOOTS C. SANTOS
Proprietor
 Section VI. Schedule of Requirements
The delivery schedule expressed as week/ months stipulates hereafter a delivery
date which is the date of delivery to the project site.

Item No. Particulars/ Description Qty. Unit Delivered,

Days/
Weeks/
Months
1. Cetirizine 10mg tab 50 Box
2. Cetirizine 5mg/5ml 288 Btls.
3. Cetirizine 2.5mg/ml 288 Btls.
4. Loratadine 10mg tab 50 Box
5. Brompheniramine + Phenylephrine Drops 144 Btls.
6. Chlorphenamine 4mg Tablet 200 Box
7. Chlorphenamine 2.5mg/5ml 288 Btls.
8. Diphenhydramine 50mg/ml/Amp 20 Box
9. Diphenhydramine 50mg Capsule 50 Box
10. Diphenhydramine 25mg Capsule 50 Box
11. Diphenhydramine 12.5mg/5ml 288 Btls.
12. Prednisone 10mg/5ml 432 Btls.
13. Hydrocortisone 100mg/ml 50 Btls.
14. Amoxicillin 500mg Capsule 200 Box
15. Amoxicillin 250mg Capsule 20 Box
16. Amoxicillin 250mg/5ml 288 Btls.
17. Amoxicillin 100mg/ml 288 Btls.
18. Ampicillin 500mg 10 Vial
19. Azithromycin 500mg 50 Box
20. Cefalexin 500mg Capsule 200 Box
21. Cefalexin 250mg/5ml 288 Btls.
22. Cefalexin 100mg/ml 288 Btls.
23. Ceftriaxone 1g 50 Vial
24. Chloramphenicol 500mg Capsule 10 Box
25. Ciprofloxacin 500mg Tablet 50 Box
26. Cloxacillin 500mg Capsule 10 Box
27. Cloxacillin 250mg/5ml 50 Btls.
28. Cotrimoxazole 800mg tab 50 Box
29. Cotrimoxazole 400mg/5ml 288 Btls.
30. Co-amoxiclav 500mg/125mg Tablet 20 Box
31. Co-amoxiclav 250mg/125mg Tablet 20 Box
32. Doxycycline 100mg Capsule 5 Box
33. Erythromycin Eye ointment 20 Tube
34. Erythromycin 200mg/5ml 288 Btls.
35. Erythromycin 500mg Tablet 150 Box
36. Erythromycin 250mg Tablet 20 Box
37. Metronidazole 500mg/100ml 50 Btls.
38. Metronidazole 500mg Tablet 50 Box
39. Metronidazole 125mg/5ml 144 Btls.
40. Loperamide 2mg Capsule 30 Box
41. Isosorbide dinitrate 5mg Tablet 10 Box
42. Fenofibrate 200mg Capsule 50 Box
43. Captopril 25mg Tablet 10 Box
44. Clonidine75mcg Tablet 4 Box
45. Methyldopa 250mg Tablet 10 Box
46. Propranolol 40mg tab 5 Box
47. Digoxin 250mcg 4 Box
48. Polymyxin + Neomycin + Dexamethasone eyedrops 100 Btls.
49. Aluminum Magnesium Hydroxide 200/100mg Tablet 200 Box
50. Omeprazole 20mg Cap 100 Box
51. Metoclopromide 10mg Tablet 50 Box
52. Metoclopromide 5mg/ml x 2ml/amp 20 Box
53. Metoclopromide 5mg/5ml 144 Btls.
54. Domperidone 10mg Tablet 50 Box
55. Hyoscine N Butylbromide 10mg Tablet 50 Box
56. Hyoscine N Butylbromide 20mg/ml x Amp 40 Box
57. Furosemide 40mg Tablet 20 Box
58. Magnesium Sulfate 500mg/ml 20 Btls
59. Oxytocin 10iu/ml Amp. 10 Box
60. Tranexamic acid 500mg Capsule 30 Box
61. Vit. K / Phytomenadione 2mg/0.2ml Paed amp 10 Box
62. Paracetamol 500mg Tablet 200 Box
63. Paracetamol 150mg/ml x 2ml/amp 40 Box
64. Paracetamol 250mg/5ml 288 Btls.
65. Paracetamol 100mg/ml 288 Btls.
66. Lidocaine 2% Sol'n (20mg/ml) x 50ml 6 Box
67. Celecoxib 200mg cap 30 Box
68. Ibuprofen 400mg Tablet 50 Box
69. Ibuprofen 200mg Tablet 50 Box
70. Ibuprofen 100mg/5ml 288 Btls.
71. Mefenamic Acid 250mg cap 30 Box
72. Mefenamic Acid 500mg cap 100 Box
73. Diclofenac Sodium 50mg Tablet 100 Box
74. Diclofenac Sodium 25mg/ml x 3ml 10 Box
75. Allopurinol 300mg Tablet 40 Box
76. Colchicine 500mcg tab 10 Box
77. Salbutamol 2mg Tablet 100 Box
78. Salbutamol 1mg/ml Nebule 40 Box
79. Meclizine 25mg Tablet 30 Box
80. Betahistine 12mg Tablet 30 Box
81. Cinnarizine 25mg Tablet 50 Box
82. Itraconazole 100mg Capsule 30 Box
83. Ketoconazole 2% cream 15g 20 Tube
84. Nystatin 100,000 units/ml 10 Btls.
85. Dexamethasone 4mg/ml 5 Amp.
86. Dexamethasone 500mcg Tablet 100 Box
87. Ipratropium+Salbutamol Nebule 10 Box
88. Lagundi 300mg/5ml 144 Btls.
89. Lagundi 600mg Tablet 10 Box
90. Paracetamol+Phenylpropanolamine+Chlorphenamine 10 Box
325/25/2mg (Symdex)
91. Terbutaline 2.5mg/ml Solution 10 Btls.
92. Terbutaline 2mg Tablet 50 Box
93. Calcium Gluconate 100mg/ml (10%) 5 Btls.
94. Isoxsuprine HCl 10mg Tablet 4 Box
95. Methylegometrine 200mcg/ml 1 Box
96. Lactulose 3.3g/5ml 30 Btls.
97. Simeticone 40mg/ml 10 Btls.
98. Permethrin shampoo 10mg/ml 60ml 10 Btls.
99. Ascorbic Acid 500mg Tablet 50 Box
100. Ferrous Sulfate+Folic Acid+Vit. B Capsule 10 Box
101. Multivitamins Capsule 50 Box
102. Multivitamins Syrup 120ml 144 Btls.
103. Multivitamins+ Iron Cap 100 Box
104. Vit. B complex Cap 30 Box
105. 70% Ethyl Alcohol 500ml 200 Btls.
106. Iodine 10% Solution 120ml 10 Box
107. Hydrogen Peroxide 120ml 4 Box
108. Gauze rolls 4 Rolls
109. Cotton rolls 4 Rolls
110. Digital Thermometer 10 Pcs
111. Face mask 4 Box
112. Nasal Cannula 30 Pcs
113. Nebulizer kit w/ mask adult 20 Pcs
114. Nebulizer kit w/ mask pedia 20 Pcs
115. Elastic Bandage ( 5cm x 1.6m) 300 Pcs
116. Plaster 1 Inch ( Microphore ) 5 Box
117. Plaster 1/2 Inch ( Microphore ) 5 Box
118. Sterile Lubricating/ KY Jelly 10 Tube
119. Sterile Surgical Gloves (size 6.5) 15 Box
120. Sterile Surgical Gloves (size 7) 15 Box
121. Sterile Water for Injection 10 Btls.
122. Unsterile Surgical Gloves w/ powder (Medium) 20 Box
123. Unsterile Surgical Gloves w/ powder (Large) 20 Box
124. Surgical Sutures Chromic 3-0 round needle 15 Box
125. Surgical Sutures Chromic 4-0 round needle 15 Box
126. Surgical Sutures Silk 3-0 cutiing needle 15 Box
127. Surgical Sutures Silk 4-0 cutiing needle 15 Box
128. Syringe 1ml 25Gx5/8" 20 Box
129. Syringe 3ml 23Gx1" 20 Box
130. Urine Strips (4 parameters) 5 Btls.
131. Cotton Swab 5 Pack
132. Vacutainer Tube (red Top) 10 Box
133. Vacutainer Tube (violet Top) 10 Box
134. Pregnancy Test Kit 5 Box
135. Glucose Reagent 120ml 10 Box
136. Uric Acid Reagent 120ml 10 Box
137. Cholesterol Reagent 120ml 10 Box
138. Triglyceride Reagent 120ml 10 Box
139. BUN Reagent 120ml 10 Box
140. Creatinine Reagent 120ml 10 Box
141. HDL Cholesterol Reagent 120ml 10 Box
142. Micropipette Tips (Blue) 4 Bag
 143. Micropipette Tips (Yellow ) 2 Bag
144. 12mm x 75mm Round Tube 10 Box
145. HBsAg Kit 2 Box
146. RPR Kit 4 Box
147. Hemoglobin Analyzer (w/100's strips) 1 Box
148. WBC Diluting Fluids 500ml 2 Btls.
149. Autolancet Pricker 30 Pack

LHUNDREN DRUGSTORE
SUPPLIER

BOOTS C. SANTOS
(Signature)
 Manpower Requirements for the goods to be
I delivered
 LHUNDREN DRUGSTORE
Torrijos St. Zone 5, Bangued, Abra Tel. No.: 09675182960

THE BIDS AND AWARDS COMMITTEE

MUNICIPALITY OF TUBO, ABRA

Subject: Manpower Requirements

Dear Sirs/ Madam,

This has reference to the bidding for Procurement of Medicines for emergency/
disasters/ epidemic victims scheduled on February 3, 2020.;

Please be informed that we shall engage 3 manpower for the delivery of the GOODS needed
by the end-user with the following functions:

One (1) Checker

One (1) Driver
One (1) Helper

Very truly yours,

BOOTS C. SANTOS
Proprietor
 After Sales Service
J
 LHUNDREN DRUGSTORE
Torrijos St. Zone 5, Bangued, Abra Tel. No.: 09675182960

THE BIDS AND AWARDS COMMITTEE

MUNICIPALITY OF TUBO, ABRA

Subject: After Sales Service

Dear Sirs/ Madam,

This has reference to the bidding for Procurement of Medicines for emergency/
disasters/ epidemic victims scheduled on February 3, 2020.;

Please be informed that we will undertake to assist the end-user of the project in regard to
after sales services of the GOODS supplied and delivered by the undersigned.

Very truly yours,

BOOTS C. SANTOS
Proprietor
 Duly signed and Notarized Omnibus Sworn
Statement in accordance with 25.3 of the IRR of
K RA 9184 and using the form prescribed in Section
VII on Bidding Forms
 Omnibus Sworn Statement

REPUBLIC OF THE PHILIPPINES )

CITY/ MUNICIPALITY OF BANGUED, ABRA

AFFIDAVIT

I, BOOTS C. SANTOS, of legal age, married, Filipino citizen, and residing at

_____________________________ after having been duly sworn in accordance with law, do hereby
depose and state that:

1. I am the owner and sole proprietor of LHUNDREN DRUGSTORE, with office address
at Torrijos St. Zone 5, Bangued, Abra.

2. As the owner and sole proprietor of LHUNDREN DRUGSTORE, I have full power and
authority to do, execute and perform any and all acts necessary to represent in the
bidding Procurement of Medicines for emergency/ disasters/ epidemic victims.

3. LHUNDREN DRUGSTORE is not “blacklisted” or barred from biding by the

Government of the Philippines or any of its agencies, offices, corporations, or Local
Government Units, foreign government / foreign or international financing
institution whose blacklisting rules have been recognized by the Government
Procurement Policy Board;

4. Each of the documents submitted in satisfaction of the biddings requirements is an

authentic copy of the original, complete and all statements and information provided
therein are true and correct.

5. LHUNDREN DRUGSTORE, is authorized the Head of the Procuring Entity or its duly
authorized representative(s) to verify all the documents submitted.

6. I am not related to the Head of the Procuring Entity, members of the Bids and Awards
Committee (BAC), the Technical Working Group, and the BAC Secretarial, the head of
the Project Management Office or the end-user unit, and the project consultants by
consanguinity or affinity up to the third civil degree;

7. LHUNDREN DRUGSTORE complies with existing labor laws and standards; and

8. LHUNDREN DRUGSTORE is aware of and has undertaken the following

responsibilities as a Bidder.

a. Carefully examine all of the Bidding Documents ;

b. Acknowledge all conditions, local or otherwise, affecting the implementation of
the Contract;

c. Made an estimate of the facilities available and need for the contract to be bid,
if any; and

d. Inquire or secure Supplemental/ Bid Bulletin (s) issued for Procurement of

Medicines for emergency/ disasters/ epidemic victims.
LHUNDREN DRUGSTORE did not give or pay directly or indirectly, any commission,
amount fee; any form of consideration, pecuniary or otherwise, to any person or official,
personnel or representative of the government in relation to any procurement project or
activity.

IN WITNESS WHEREOF, I have hereunto set my hand this _________________ day of

___________________ 20___ at _______________________, Philippines.

____________________________________________
Bidder’s Representative/ Authorized Signatory

SUBSCRIBED AND SWORN to me this _____________ day of _________________ in

___________________________________, Philippines. Affiant exhibiting to me her
________________________________ issued on __________________.

Doc. No. ____________;

Page No.____________;
Book No.____________;
Series of ____________;
Municipality of Tubo, Abra Contract Reference Number: __________
Name of the Contract :___________________

Standard Form Number: SF-INFR

Revised on: August 11, 2004

CERTIFICATION AS TO COMPLIANCE OF EXISTING LABOR LAWS AND STANDARDS

(Procurement of Medicines for emergency/ disasters/ epidemic victims)

(Municipality of Tubo, Abra)

Date of Opening of Bids: ________________

I, BOOTS S. SANTOS, legal, age, with residence and address at ______________________________,

after having duly sworn to in accordance with law, hereby depose and say:

That I am the sole proprietor of LHUNDRED DRUGSTORE

That our firm/ company shall abide with the existing labor laws and standards, rules and
regulations of the Department of Labor and Employment (DOLE) in connection with the
implementation of the project.
That if our Firm/ Company violates any rule and regulations as prescribed for the DOLE, I
will accept sanctions that may be imposed in our firm.

IN FATHER WHEREOF, I hereunto affixed my signature this ____________ day of _____ at

__________________, Philippines.

BOOTS C. SANTOS
Owner
Affiant

REPUBLIC OF THE PHILIPPINES )

CITY OF ______________________ ) S.S.

SUBSCRIBED AND SWORN to me this _____________ day of _________________ in

___________________________________, Philippines. Affiant exhibiting to me her
________________________________ issued on __________________.

Doc. No. ____________;

Page No.____________;
Book No.____________;
Series of ____________;
 COPY NO. 1- FINANCIAL COMPONENT

NAME OF THE PROJECT:

PURCHASE OF MEDICINES FOR EMERGENCY/ DISASTER/
EPIDEMIC VICTIMS

NAME, ADDRESS, AND CONTACT OF THE BIDDER:

LHUNDREN DRUGSTORE
TORRIJOS ST. ZONE 5
BANGUED, ABRA
09675182960

BIDS AND AWARDCS COMMITTEE

MUNICIPALITY OF TUBO, ABRA

SOLICITATION NUMBER 2020113

IDENTIFICATION NO.

DO NOT OPEN BEFORE FEBRUARY 3,2020 ( 9:00 AM)

L Duly Signed Bid Form
 Bid Prices Per Price Schedule for Goods Offered
M
within the Philippines
 FOR GOODS OFFERED FROM WITHIN THE PHILIPPINES

Name of Bidder LHUNDREN DRUGSTORE Invitation to Bid No. 2018-A7171-30

1 2 3 4 5 6 7 8 9 10
It Description Cou Quantity Unit Cost Tot Unit Sales Total
e ntry Price of al prices and price
m of EXW local pric per item other deliver
Orig Per Labo e final taxes ed
in Item r, EX destinat payabl Final
raw W ion and e per Destina
mate per unit item if tion
rial, ite price of contrac
and m other t is
com (col incident awarde
pone s. al d
nt 4x5 services
)
Cetirizine 10mg tab 50 Box 135 4,500
Cetirizine 5mg/5ml 288 Btls. 35 10,080
Cetirizine 2.5mg/ml 288 Btls. 35 10,080
Loratadine 10mg tab 50 Box 355 17,750
Brompheniramine + Phenylephrine 144 Btls. 35 5,040
Drops
Chlorphenamine 4mg Tablet 200 Box 45 9,000
Chlorphenamine 2.5mg/5ml 288 Btls. 25 7,200
Diphenhydramine 50mg/ml/Amp 20 Box 480 9,600
Diphenhydramine 50mg Capsule 50 Box 120 6,000
Diphenhydramine 25mg Capsule 50 Box 85 4,250
Diphenhydramine 12.5mg/5ml 288 Btls. 25 7,200
Prednisone 10mg/5ml 432 Btls.
Hydrocortisone 100mg/ml 50 Btls. 50 2,500
Amoxicillin 500mg Capsule 200 Box 190 38,000
Amoxicillin 250mg Capsule 20 Box 125 2,500
Amoxicillin 250mg/5ml 288 Btls. 25 7,200
Amoxicillin 100mg/ml 288 Btls. 20 5,760
Ampicillin 500mg 10 Vial 180 1,800
Azithromycin 500mg 50 Box 225 16,250
Cefalexin 500mg Capsule 200 Box 315 63,000
Cefalexin 250mg/5ml 288 Btls. 36 10,368
Cefalexin 100mg/ml 288 Btls. 23 6,624
Ceftriaxone 1g 50 Vial 240 1,200
Chloramphenicol 500mg Capsule 10 Box 720 7,200
Ciprofloxacin 500mg Tablet 50 Box 225 11,250
Cloxacillin 500mg Capsule 10 Box 375 3,750
Cloxacillin 250mg/5ml 50 Btls. 48 2,400
Cotrimoxazole 800mg tab 50 Box 190 9,500
Cotrimoxazole 400mg/5ml 288 Btls. 36 10,368
Co-amoxiclav 500mg/125mg Tablet 20 Box 250 5,000
Co-amoxiclav 250mg/125mg Tablet 20 Box 195 3,900
Doxycycline 100mg Capsule 5 Box 180 900
Erythromycin Eye ointment 20 Tube 210 4,200
Erythromycin 200mg/5ml 288 Btls. 48 13,824
Erythromycin 500mg Tablet 150 Box 525 78,750
Erythromycin 250mg Tablet 20 Box 420 8,400
Metronidazole 500mg/100ml 50 Btls. 48 2,400
Metronidazole 500mg Tablet 50 Box 130 6,500
Metronidazole 125mg/5ml 144 Btls. 28 4,032
Loperamide 2mg Capsule 30 Box 85 2,550
Isosorbide dinitrate 5mg Tablet 10 Box
Fenofibrate 200mg Capsule 50 Box 260 13,000
Captopril 25mg Tablet 10 Box 120 1,200
Clonidine75mcg Tablet 4 Box 870 3,480
Methyldopa 250mg Tablet 10 Box 600 6,000
Propranolol 40mg tab 5 Box 150 750
Digoxin 250mcg 4 Box 445 1,780
Polymyxin + Neomycin + 100 Btls. 135 13,500
Dexamethasone eyedrops
Aluminum Magnesium Hydroxide 200 Box 80 16,000
200/100mg Tablet
Omeprazole 20mg Cap 100 Box 150 15,000
Metoclopromide 10mg Tablet 50 Box 145 7,250
Metoclopromide 5mg/ml x 2ml/amp 20 Box 60 1,200
Metoclopromide 5mg/5ml 144 Btls. 23 3,312
Domperidone 10mg Tablet 50 Box 140 7,000
Hyoscine N Butylbromide 10mg 50 Box 480 24,000
Tablet
Hyoscine N Butylbromide 20mg/ml x 40 Box 300 12,000
Amp
Furosemide 40mg Tablet 20 Box 95 1,900
Magnesium Sulfate 500mg/ml 20 Btls. 100 2,000
Oxytocin 10iu/ml Amp. 10 Box. 150 1,500
Tranexamic acid 500mg Capsule 30 Box 500 15,000
Vit. K / Phytomenadione 2mg/0.2ml 10 Box 300 3,000
Paed amp
Paracetamol 500mg Tablet 200 Box 70 14,000
Paracetamol 150mg/ml x 2ml/amp 40 Box 80 3,200
Paracetamol 250mg/5ml 288 Btls. 20 5,760
Paracetamol 100mg/ml 288 Btls. 20 5,760
Lidocaine 2% Sol'n (20mg/ml) x 50ml 6 Box 510 3,060
Celecoxib 200mg cap 30 Box 280 8,400
Ibuprofen 400mg Tablet 50 Box 110 5,500
Ibuprofen 200mg Tablet 50 Box 135 6,750
Ibuprofen 100mg/5ml 288 Btls. 68 19,584
Mefenamic Acid 250mg cap 30 Box 105 3,150
Mefenamic Acid 500mg cap 100 Box 130 13,000
Diclofenac Sodium 50mg Tablet 100 Box 105 10,500
Diclofenac Sodium 25mg/ml x 3ml 10 Box 400 4,000
Allopurinol 300mg Tablet 40 Box 340 13,600
Colchicine 500mcg tab 10 Box 160 1,600
Salbutamol 2mg Tablet 100 Box 38 3,800
Salbutamol 1mg/ml Nebule 40 Box 330 13,200
Meclizine 25mg Tablet 30 Box 330 9,900
Betahistine 12mg Tablet 30 Box 1,800 54,000
Cinnarizine 25mg Tablet 50 Box 150 7,500
Itraconazole 100mg Capsule 30 Box
Ketoconazole 2% cream 15g 20 Tube 98 1,960
Nystatin 100,000 units/ml 10 Btls. 110 1,100
Dexamethasone 4mg/ml 5 Amp. 130 650
Dexamethasone 500mcg Tablet 100 Box 95 9,500
Ipratropium+Salbutamol Nebule 10 Box 480 4,800
Lagundi 300mg/5ml 144 Btls. 45 6,480
Lagundi 600mg Tablet 10 Box 315 3,150
Paracetamol+Phenylpropanolamine 10 Box 210 2,100
+Chlorphenamine 325/25/2mg
(Symdex)
Terbutaline 2.5mg/ml Solution 10 Btls. 38 380
Terbutaline 2mg Tablet 50 Box 135 6,750
Calcium Gluconate 100mg/ml (10%) 5 Btls. 390 1,950
Isoxsuprine HCl 10mg Tablet 4 Box 375 1,500
Methylegometrine 200mcg/ml 1 Box 300 300
Lactulose 3.3g/5ml 30 Btls. 180 5,400
Simeticone 40mg/ml 10 Btls.
Permethrin shampoo 10mg/ml 60ml 10 Btls.
Ascorbic Acid 500mg Tablet 50 Box 100 5,000
Ferrous Sulfate+Folic Acid+Vit. B 10 Box 270 2,700
Capsule
Multivitamins Capsule 50 Box 100 5,00
Multivitamins Syrup 120ml 144 Btls. 50 7,200
Multivitamins+ Iron Cap 100 Box 120 12,000
Vit. B complex Cap 30 Box 420 12,600
70% Ethyl Alcohol 500ml 200 Btls. 98 19,600
Iodine 10% Solution 120ml 10 Box 115 1,150
Hydrogen Peroxide 120ml 4 Box 55 220
Gauze rolls 4 Rolls 980 3,920
Cotton rolls 4 Rolls 180 720
Digital Thermometer 10 Pcs 85 850
Face mask 4 Box 90 360
Nasal Cannula 30 Pcs 35 1,050
Nebulizer kit w/ mask adult 20 Pcs 75 1,500
Nebulizer kit w/ mask pedia 20 Pcs 75 1,500
Elastic Bandage ( 5cm x 1.6m) 300 Pcs 30 9000
Plaster 1 Inch ( Microphore ) 5 Box 525 2625
Plaster 1/2 Inch ( Microphore ) 5 Box 525 2625
Sterile Lubricating/ KY Jelly 10 Tube 180 1,800
Sterile Surgical Gloves (size 6.5) 15 Box 645 9,675
Sterile Surgical Gloves (size 7) 15 Box 645 965
Sterile Water for Injection 10 Btls. 135 1,350
Unsterile Surgical Gloves w/ powder 20 Box 195 3,900
(Medium)
Unsterile Surgical Gloves w/ powder 20 Box) 195 3,900
(Large)
Surgical Sutures Chromic 3-0 round 15 Box 375 5,625
needle
Surgical Sutures Chromic 4-0 round 15 Box 375 5,625
needle
Surgical Sutures Silk 3-0 cutiing 15 Box 375 5,625
needle
Surgical Sutures Silk 4-0 cutiing 15 Box 375 5,625
needle
Syringe 1ml 25Gx5/8" 20 Box 225 4,500
Syringe 3ml 23Gx1" 20 Box 240 4,800
Urine Strips (4 parameters) 5 Btls. 675 3,375
Cotton Swab 5 Pack 38 190
Vacutainer Tube (red Top) 10 Box 675 6,750
Vacutainer Tube (violet Top) 10 Box) 675 6,750
Pregnancy Test Kit 5 Box 1,125 5,625
Glucose Reagent 120ml 10 Box
Uric Acid Reagent 120ml 10 Box
Cholesterol Reagent 120ml 10 Box
Triglyceride Reagent 120ml 10 Box
BUN Reagent 120ml 10 Box
Creatinine Reagent 120ml 10 Box
HDL Cholesterol Reagent 120ml 10 Box
Micropipette Tips (Blue) 4 Bag 825 3,300
Micropipette Tips (Yellow ) 2 Bag 825 1,650
12mm x 75mm Round Tube 10 Box
HBsAg Kit 2 Box 55
RPR Kit 4 Box 2,880 11,520
Hemoglobin Analyzer (w/100's 1 Box
strips)
WBC Diluting Fluids 500ml 2 Btls. 975 1,950
Autolancet Pricker 30 Pack 300 9,000
LHUNDREN DR UGSTORE
SUPPLIER

BOOTS C. SANTOS
(Signature)