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RFQ REMINDERS

1. Read the RFQ document thoroughly to ensure that you fully understand the RFQ
process and requirements.

2. The accom plished Official Price Offer Form and Alternative Price Offer Form will
only be submitted in EXCEL FORMAT and saved in the USB. DO NOT PRINT these
documents.

3. Suppliers can submit one (1) USB for all Scanned and Soft Copy of RFQ
Documents (Commercial Proposal, Alternative Proposal and Technical
Requirements), Supplier Accreditation Documents and Data Protection Vendor
Consent Form. However, ensure that documents will be placed under the correct folder
as instructed in the RFQ document package. All scanned or soft copies should be properly
named inside each folder. In case the documents will not fit in one USB, you may
provide additional USB as needed.

4. Formulary Inclusion Guidelines and Application Forms of each MPHHI hospital and
Medexpress are included in the RFQ document. This is for reference only and need not be
submitted with your RFQ Proposals. You may refer to these documents in case you will
submit your products for formulary inclusion.

5. In case there are required documents that are not applicable to your product, insert a
letter stating why these documents cannot be submitted.

6. PRINT A COPY OF THE CHECKLIST included in the RFQ document, accomplish it and
submit it along with your RFQ proposal

a. RFQ Medicine Proposal Checklist


b. Supplier Accreditation Checklist
METRO PACIFIC HOSPITAL HOLDINGS INC (MPHHI) HOSPITAL GROUP
RFQ MEDICINE PROPOSAL CHECKLIST

Company Name: NAYELI'S MARKETING Date Submitted: MAY 2019

COMMERCIAL PROPOSAL
I. Hard Copy X Duly signed RFQ Proposal Cover Letter in company letterhead
X Duly signed Supplier Proposal in company letterhead
X Generic Principal Approval Form for medicines in Official Price Offer
X Notarized Letter of Undertaking on Acceptance of Medicine Sourcing RFQ Procedures
X Notarized Letter of Assurance
X Supplier Top Management Data Sheet
X Notarized Letter of Undertaking on Senior Citizen Discount Reimbursement
II. Soft Copy in USB X Scanned copy of Duly signed RFQ Proposal Cover Letter in company letterhead
X Scanned copy of Duly signed Supplier Proposal in company letterhead
X Scanned copy of Generic Principal Approval Form for medicines in Official Price Offer
Scanned copy of Notarized Letter of Undertaking on Acceptance of Medicine Sourcing RFQ
X Procedures
X Scanned copy of Notarized Letter of Assurance
X Scanned copy of Supplier Top Management Data Sheet

X Scanned copy of Notarized Letter of Undertaking on Senior Citizen Discount Reimbursement


X Accomplished Official Price Offer Form in excel format
Refer to Annex H of your RFQ Document for the Submission Guide

ALTERNATIVE PROPOSAL
I. Hard Copy X Duly signed Supplier Proposal in company letterhead
X Generic Principal Approval Form for medicines in Official Price Offer
II. Soft Copy in USB X Scanned copy of Duly signed Supplier Proposal in company letterhead
X Scanned copy of Generic Principal Approval Form for medicines in Official Price Offer
X Accomplished Alternative Price Offer Form in excel format
Refer to Annex I of your RFQ Document for the Submission Guide

TECHNICAL DOCUMENT
I. Hard Copy X Certificate of Product Registration (CPR)
N.A Certificate of Pharmaceutical Products (CPP)
X Evaluation report of drugs for formulary (Product Monograph)
X Current Certificate of Good Manufacturing Practices (CGMP)
N.A Certificate of Patent Registration issued by IPO of the Philippines for new drugs
Copy of the Off Patent Certification from the Intellectual Property Office of the Bureau of
N.A Patents or any certification from the company that states that the innovator medication/
reference drug is off-patent
X At least 2 clinical trials for safety and efficacy for new / innovator drugs (preferably Phase 3
RCT, peer-reviewed, published)
N.A Bioavailability and/or bioequivalence report using Filipino subjects for generic equivalents in
capsule & tablet forms
II. Soft Copy in USB X Scanned copy of Certificate of Product Registration (CPR)
N.A Scanned copy of Certificate of Pharmaceutical Products (CPP)
X Scanned copy of Evaluation report of drugs for formulary (product monograph)
X Scanned copy of Current Certificate of Good Manufacturing Practices (CGMP)
N.A
Scanned copy of Certificate of Patent Registration issued by IPO of the Philippines for new drugs
Scanned copy of the Off Patent Certification from the Intellectual Property Office of the Bureau
N.A of Patents or any certification from the company that states that the innovator medication/
reference drug is off-patent
Scanned copy of at least 2 clinical trials for safety and efficacy for new / innovator drugs
X
(preferably Phase 3 RCT, peer-reviewed, published)
Scanned copy of Bioavailability and/or bioequivalence report using Filipino subjects for generic
N.A
equivalents in capsule & tablet forms
Refer to Annex C of your RFQ Document for the Submission Guide
In case there are required documents that are not applicable to your product, insert a letter stating why these documents
cannot be submitted

DATA PROTECTION VENDOR CONSENT FORM


I. Hard Copy X Notarized Copy of the Data Protection Vendor Consent Form
II. Soft Copy in USB X Scanned Copy of Notarized Copy of the Data Protection Vendor Consent Form
Refer to the file Data Protection Consent Form Guidelines of your RFQ Document for the Submission Guide
METRO PACIFIC HOSPITAL HOLDINGS INC. (MPHHI) HOSPITAL GROUP
SUPPLIER ACCREDITATION CHECKLIST FOR DISTRIBUTORS
COMPANY NAME: NAYELI'S MARKETING
______________________________________________ MAY 2019
Date Submitted: _______________________________
COMPANY TYPE (Tick appropriate box): Corporation Partnership X Single/Sole Proprietorship

PRODUCT/SERVICES OFFERED (Tick appropiate box)


Non-Medical Supplies, Furniture & Equipment X Drugs & Medicines
Medical Supplies Medical Equipment, Instruments & Devices
Building/Construction/Renovation Manpower Services/Agencies
Fabricators / Printers / Service Shops / Laundry Services Kitchen Supplies/Perishable Food Items
Others (Pls. specify) ________________________________________________________________________

GENERAL DOCUMENTARY REQUIREMENTS

1 Accomplished Supplier Registration Form 17 Audited Financial Statements (FS) & Copy of Latest
2 Company Profile with History Income Tax Return over the last 3 Fiscal Years
3 List of Products and/or Services using MPHHI Format *for new companies, financial forecast for the next
4 Letter of Undertaking-Acceptance of MPHHI Hospital Group's 3 consecutive years (ie. Balance Sheet, Income
Supplier Accreditation Process Statement, Owner's Equity & Cash Flow)
5 Table of Organization (T.O.) 18 Photocopy of Invoice, Delivery Receipt, Provisional

6 Management Profile & Key Personnel (at least 5) Receipt & Official Receipt w/ Tax or bearing TIN

7 Location Map (Head Office,Warehouse,Manufacturing Facilities) 19 Certificate of Exclusive / Authorized Distributorship


8 List of Top 10 Customers (part of Supplier Registration Form) from Principal / Manufacturer together with list of
9 List of 5 Major Suppliers (part of Supplier Registration Form) pertinent products authorized for distribution
10 Proof of Business Address (Transfer Certifucate of Title (TCT) 20 License to Operate (LTO) Expiration Date: ____________
Lease Agreement, Billing Statement) valid at least 3 months from date of submission

11 Valid Owner's Identification (i.e. Driver's License, Passport, 21 Quality Management Documents (ISO Certificates,
NBI Clearance, etc.) DENR Permits & Licenses for EMS related)
12 Business Permit/Mayor's Permit/Sanitary Permit 22 Certificate of Good Credit Standing from at least
13 BIR Certificate of Registration (Form 2303) 2 Major Banks

14 Securities & Exchange Commission (SEC) Reg. (SEC 23 List of Sales and Collection Representatives
Certificate, Articles of Incorporation and By Laws with copy of ID with picture of sales representative/s
for Corporations and Partnerships) or & payment collector/s assigned to MPHHI Hospitals
DTI Registration (for Sole/Single Proprietorship) 2 Major Banks

15 Annual Income Tax Returns (BIR Form 1701 or 1702) 24 Returns Policy
for the last 3 years with BIR Stamp
16 General Information Sheet (GIS) with SEC Stamp

I hereby certify that all information provided are true and correct. I hereby authorize Metro Pacific Hospital Holdings, Inc. (MPHHI) to verify any and all information
furnished by me. In this connection, I hereby expressly waive any and all statutory or regulatory provisions governing confidentiality of such information if applicable. I
fully understand that any misrepresentation of failure to disclose information as required herein may cause the disapproval of this application and removal from the list of
accredited suppliers of MPHHI Hospital Group.

Prepared by: Authorized Representative:

JONED THERESE V. MANALO JOAN V. MANALO


_______________________________ _______________________________
Signature over Printed Name Signature over Printed Name

SUBMISSION GUIDELINES

Important: 1. Certificates and permits must be certified true copies.


2. Original copies of certificates, permits and other documents may be requested for validation.
3. Updated documents should be provided to Procurement in case of changes in the previous documents submitted.
METRO PACIFIC HOSPITAL HOLDINGS INC. (MPHHI) HOSPITAL GROUP
SUPPLIER ACCREDITATION CHECKLIST FOR DISTRIBUTORS
COMPANY NAME: NAYELI'S MARKETING
______________________________________________ MAY 2019
Date Submitted: _______________________________

ADDITIONAL / SECONDARY DOCUMENTARY REQUIREMENTS

1 Building, Construction & Renovation Contractors


1.1 Philippine Contractors Accreditation Board (PCAB) Certification
1.2 Certificates of Accreditation from other companies
1.3 List of Tools and Equipment owned by the company
1.4 List of at least ten (10) completed projects and at least ten (10) on-going projects for the last five (5) years
indicative of the ff: Client Name to include Contact Person & Contact Details, Project Nature, Project Location,
Project Value, Start Date, Target Date of Completion or Date Completed.
2 X Drugs and Medicine - submit as part of MPHHI RFQ Technical Requirement & Hospital Formulary Inclusion

3 Fabricators / Printers / Service Shops / Laundry Services


3.1 List of machines and equipment (with corresponding brand / capacity whether owned or leased)
4 Fire Extinguisher
4.1 License from Bureau of Product Standards - DTI
4.2 Report of Analysis from Philippine Institute of Pure and Applied Chemistry (PIPAC)
5 Kitchen Supplies / Perishable Food Items
5.1 Sanitary Permit / Health Certificate issued by Municipal Health Officer
5.2 National Meat Inspection Service (NMIS) Certificate
6 Manpower Services/Agencies or those that are covered by DOLE DO 18-A
6.1 DOLE Certificate of Registration or DOLE Certificate of Exemption Expiraton Date: _______________________
whichever is applicable( for manpower services/agencies or those that are covered by DOLE DO 18-A)
6.2 Certificate of Government Remittances (SSS, Pag-ibig, Philhealth, TIN) to be submitted monthly
6.3 Certification of 201 File Checklist (Certifying that the following pertinent documents are on-file with the agency)
6.3.1 Employment Contract
6.3.2 Updated Resume and Application Form with the Agency
6.3.3 Clearances (Barangay, Police, NBI) whichever is applicable
6.3.4 Medical Exam Results (Chest X-Ray, Drug Test, Urinalysis, CBC, Fecalysis)
6.3.5 Diploma and Transcript of Records
6.3.6 Background Investigation Result
7 Medical Gases
7.1 License from Bureau of Product Standards - DTI
7.2 Certificate of Current Good Manufacturing Practices from FDA
8 Medical Instruments & Medical Equipment - suppliers must also comply with MPHHI Request for Information (RFI) process
8.1 Certificate of Product Registration, if applicable
8.2 List of hospitals with existing installations in the Philippines
8.3 List of Certificates of Memberships/Affiliations
8.4 List of Authorized Accredited Service Centers
8.5 List of After Sales Services
9 Medical Supplies
9.1 Certificate of Product Registration, if applicable
9.2 Materials Safety Data Sheet, if applicable
10 Preventive Maintenance Service (PMS)
10.1 Result of evaluation of Output Verification done by Bio-Med Section for the medical testing device to be used for
rendering PMS and Calibration
10.2 Certificate of Calibration Trainings Attended (Competence / Biomedical Equipment Servicing, etc).
11 Radioactive Material
11.1 License from Philippine National Research Institute (PNRI)
12 Implantable Medical Devices
12.1 Certificate of Product Registration (CPR). If not available, submit the following:
a) US FDA (and/or EU EMEA approval)
b) Pending local FDA CPR application
c) License to Operate (updated)