PR. NO.

Name of Supplier /

Representative & Signature :___________________________________________________________

Quantity Unit Agency Specification Bidders Specifications Unit Cost Total Cost50 pads Paracetamol1 bot Betadine1 pc Cotton

50 pcs Chewable Vitamins (Multi-Celine)50 pcs Mefenamic1 bot Alcohol1 bot Agua Oxinada1 pc Medicine Kit

50 sachet Colgate3 bot Queel Shampoo

25 packs Cotton Buds

4,000.00

not later than

Bid Opening:

NOTE: for

Republic of the Philippines Appendix 5

DEPARTMENT OF EDUCATION

Region IV - MIMAROPA

San Pedro Elementary SchoolRIZAL DISTRICT

QUOTATION FORM

Package:

Supplier:

Address:

Tel No :

In accordance with your Invitation for Sealed Quotations for the aboved mentioned package and

subject to all conditions and requirement thereof, we / I will perform the above service at a total cost in Philippines

Pesos of______________________________________________ down as follows: (P _____________) broken down follows:

Conformity with the specifications and at the price/s we have quoted above.

We understand that you are not bound to accept the lowest or any quotation that you received.

Date this _________ day of __________________________ , ___________.

MARIETTA S. HERRERA

Printed Name & Signature

This form to be submitted

HEAD TEACHER III

Position/Designation

Canvasser