ANNEX 2: Offer Forms

Supplier’s Offer Form

From:	MDS LTD	
Supplier’s Representative:	Nika Bulia	
Title/Position:	Director	
Address:	Tskhneti highway 15, Tbilisi, Georgis	
Email:	david@vivagroup.ge	

To:	The Ministry of Internally Displaced Persons from Occupied Territories, Labour, Health and Social Affairs (MoIDPLHSA)	
Purchaser’s Representative:	Giorgi Tsotskolauri	
Title/Position:	Deputy Minister	
Address :	Address: 144, Ak. Tsereteli ave. Tbilisi, Georgia, email: info@moh.gov.ge  	
Invitation for Direct Contracting Ref No.:	COVID19/G/DC-03	
Date of Offer:	5/14/2020	

Dear Giorgi Tsotskolauri:
SUBMISSION OF OFFER
1.	Conformity and no reservations 
In response to the above invitation for direct contracting, we offer to supply the Goods: described in Annex 2.1: Technical Specifications and deliver the Related Services,” as per this invitation subject to any negotiations that may be carried out to finalize the contract. 

Annex 2.1: Technical Specifications

HAMILTON-T1 INTERNATIONAL (PN 161006 + 161950 CUSTOMIZING INTERNATIONAL)                                                                                    	
1X (T1 HW-OPTION UNIVERSAL CONFIGURATION)	
1X (T1 SW-OPTION NIV / NIV-ST)	
1X (T1 HW-OPTION UNIVERSAL MOUNT)	
2X (PATIENT BREATHING SET (A0), HME, ADULT, REUSABLE.)	
2X (FLOW SENSOR 1.88M, ADULT, AUTOCLAVABLE)	
1X (C1/T1/MR1 EXPIRATORY VALVE WITH MEMBRANE, AUTOCLAVABLE)	
1X (NEO B-SET 1.50M, SINGLE USE (INCL FLOW SENSOR, Y-PIECE AND CONNECTORS)	
1X (C1/T1/MR1 NEONATAL EXPIRATORY VALVE WITH MEMBRANE, AUTOCLAVABLE)	
1X (HOSE, OXYGEN SUPPLY, WHITE, ID 6.5 MM, 4M)	
1X (PLATFORM C DISS CONNECTOR O2)	
1X (ADAPTER, OXYGEN, DISS (FOR US VERSION)	
1X (T1/C1 O2 DISS CONNECTOR 90 DEGREES)	
1X (POWER CORD, EU ANGLED 2-PIN PLUG (CONTINENTAL EUROPE)	
1X (NIV MASKS, SIZE M, ADULT/PEDIATRIC, REUSABLE & NON-VENTED)	
1X (T1 CARRYING DEVICE)	
1X (T1 WALL MOUNT PLATE)	
1X (NIV MASKS, SIZE S, ADULT/PEDIATRIC, REUSABLE & NON-VENTED)	
1X (FLOW SENSOR 1.88M, ADULT, AUTOCLAVABLE)   	
1X (PATIENT BREATHING SET (A0), HME, ADULT, REUSABLE.)	

Note: for more detailed information see the attached file: HAMILTON-T1 Technical specification for SW 2.2.x
2.	Eligibility 
If awarded the Contract, the Goods and Related Services that we supply shall be sourced from an eligible country.
We, along with any of our subcontractors, suppliers, consultants, manufacturers, or service providers for any part of the contract, are not subject to, and not controlled by any entity or individual that is subject to, a temporary suspension or a debarment imposed by the World Bank Group or a debarment imposed by the World Bank Group in accordance with the Agreement for Mutual Enforcement of Debarment Decisions between the World Bank and other development banks. Further, we are not ineligible under the Purchaser’s Country laws or official regulations or pursuant to a decision of the United Nations Security Council.

3.	Offered Price
The total price of our offer is 313,476.00 $.
4.	Validity of the Offer 
Our offer shall be valid until 18.06.2020.  
5.	Commissions, gratuities, fees
We have paid, or will pay the following commissions, gratuities, or fees with respect to this offer.
[If none has been paid or is to be paid, indicate “none.”]
Name of Recipient	Address	Reason	Amount	
none	None	none	none	

				
6.	Not Bound to Accept 
We understand that you reserve the right to:
a.	accept or reject the offer, and 
b.	annul the direct contracting process at any time prior to the award of the Contract.
7.	Fraud and Corruption 
We hereby certify that we have taken steps to ensure that no person acting for us, or on our behalf, engages in any type of Fraud and Corruption.
On behalf of the Supplier:
Name of the person duly authorized to sign the offer on behalf of the Supplier: Nika Bulia
Title of the person signing the offer: Director
Signature of the person named above: [insert signature of person whose name and capacity are shown above]
Date signed [insert date of signing] day of [insert month], [insert year]
Price Schedules
[The following forms may be used by the Supplier for submitting its offer. The forms may also be used for the contract subsequent to any negotiations.]
Price Schedule 1	
Goods to be supplied from outside the Purchaser’s country 	
1	2	3	4	5	6	7	8	9	
Line Item	Description of Goods 	Country of Origin	Delivery Date as defined by Incoterms	Quantity and physical unit	Unit price 
CIP (Tbilisi, Georgia)	CIP (or FCA as applicable) Price per line item	[FOR CIP, IF REQUIRED] Price per line item for inland transportation and other services required in the Purchaser’s Country to convey the Goods to their final destination specified in the invitation for direct contracting	Total Price per Line item 	
N°									

	1X HAMILTON-T1 INTERNATIONAL (PN 161006 + 161950 CUSTOMIZING INTERNATIONAL)    	

	 

	

	 

	 

 

 

 

 

 

	 

	 

	
 	1X (T1 HW-OPTION UNIVERSAL CONFIGURATION)								
 	1X (T1 SW-OPTION NIV / NIV-ST)								
 	1X (T1 HW-OPTION UNIVERSAL MOUNT)								
 	1X (PATIENT BREATHING SET (A0), HME, ADULT, REUSABLE.)								
 	1X (FLOW SENSOR 1.88M, ADULT, AUTOCLAVABLE)								
 	1X (C1/T1/MR1 EXPIRATORY VALVE WITH MEMBRANE, AUTOCLAVABLE)								
 	1X (NEO B-SET 1.50M, SINGLE USE (INCL FLOW SENSOR, Y-PIECE AND CONNECTORS)								
 	1X (C1/T1/MR1 NEONATAL EXPIRATORY VALVE WITH MEMBRANE, AUTOCLAVABLE)								
 	1X (HOSE, OXYGEN SUPPLY, WHITE, ID 6.5 MM, 4M)								
 	1X (PLATFORM C DISS CONNECTOR O2)								
 	1X (ADAPTER, OXYGEN, DISS (FOR US VERSION)								
 	1X (T1/C1 O2 DISS CONNECTOR 90 DEGREES)								
 	1X (POWER CORD, EU ANGLED 2-PIN PLUG (CONTINENTAL EUROPE)								
 	1X (NIV MASKS, SIZE M, ADULT/PEDIATRIC, REUSABLE & NON-VENTED)								
 	1X (T1 CARRYING DEVICE)								
 	1X (T1 WALL MOUNT PLATE)								
 	1X (NIV MASKS, SIZE S, ADULT/PEDIATRIC, REUSABLE & NON-VENTED)								
		Switzerland	From 16.06.2020 to 23.06.2020	5	15,100.00$	75,500.00$	0	75,500.00$	
	1X HAMILTON-T1 INTERNATIONAL (PN 161006 + 161950 CUSTOMIZING INTERNATIONAL)    	 

 

	 

 

 

	

	 

 

 

 

 

 

	 

	
 	1X (T1 HW-OPTION UNIVERSAL CONFIGURATION)								
 	1X (T1 SW-OPTION NIV / NIV-ST)								
 	1X (T1 HW-OPTION UNIVERSAL MOUNT)								
 	1X (PATIENT BREATHING SET (A0), HME, ADULT, REUSABLE.)								
 	1X (FLOW SENSOR 1.88M, ADULT, AUTOCLAVABLE)								
 	1X (C1/T1/MR1 EXPIRATORY VALVE WITH MEMBRANE, AUTOCLAVABLE)								
 	1X (NEO B-SET 1.50M, SINGLE USE (INCL FLOW SENSOR, Y-PIECE AND CONNECTORS)								
 	1X (C1/T1/MR1 NEONATAL EXPIRATORY VALVE WITH MEMBRANE, AUTOCLAVABLE)								
 	1X (HOSE, OXYGEN SUPPLY, WHITE, ID 6.5 MM, 4M)								
 	1X (PLATFORM C DISS CONNECTOR O2)								
 	1X (ADAPTER, OXYGEN, DISS (FOR US VERSION)								
 	1X (T1/C1 O2 DISS CONNECTOR 90 DEGREES)								
 	1X (POWER CORD, EU ANGLED 2-PIN PLUG (CONTINENTAL EUROPE)								
 	1X (NIV MASKS, SIZE M, ADULT/PEDIATRIC, REUSABLE & NON-VENTED)								
 	1X (T1 CARRYING DEVICE)								
 	1X (T1 WALL MOUNT PLATE)								
 	1X (NIV MASKS, SIZE S, ADULT/PEDIATRIC, REUSABLE & NON-VENTED)								
		Switzerland	From 30.06.2020 to 07.07.2020	5	15,100.00$ 	75,500.00$ 	0	75,500.00$
	
	1X HAMILTON-T1 INTERNATIONAL (PN 161006 + 161950 CUSTOMIZING INTERNATIONAL)                                                                 	 

 

 

 

 

 

	

	

	 

 

 

 

 

 

	 

	
 	1X (T1 HW-OPTION UNIVERSAL CONFIGURATION)								
 	1X (T1 SW-OPTION NIV / NIV-ST)								
 	1X (T1 HW-OPTION UNIVERSAL MOUNT)								
 	2X (PATIENT BREATHING SET (A0), HME, ADULT, REUSABLE.)								
 	2X (FLOW SENSOR 1.88M, ADULT, AUTOCLAVABLE)								
 	1X (C1/T1/MR1 EXPIRATORY VALVE WITH MEMBRANE, AUTOCLAVABLE)								
 	1X (NEO B-SET 1.50M, SINGLE USE (INCL FLOW SENSOR, Y-PIECE AND CONNECTORS)								
 	1X (C1/T1/MR1 NEONATAL EXPIRATORY VALVE WITH MEMBRANE, AUTOCLAVABLE)								
 	1X (HOSE, OXYGEN SUPPLY, WHITE, ID 6.5 MM, 4M)								
 	1X (PLATFORM C DISS CONNECTOR O2)								
 	1X (ADAPTER, OXYGEN, DISS (FOR US VERSION)								
 	1X (T1/C1 O2 DISS CONNECTOR 90 DEGREES)								
 	1X (POWER CORD, EU ANGLED 2-PIN PLUG (CONTINENTAL EUROPE)								
 	1X (NIV MASKS, SIZE M, ADULT/PEDIATRIC, REUSABLE & NON-VENTED)								
 	1X (T1 CARRYING DEVICE)								
 	1X (T1 WALL MOUNT PLATE)								
 	1X (NIV MASKS, SIZE S, ADULT/PEDIATRIC, REUSABLE & NON-VENTED)								
		Switzerland	From 12.08.2020 - to 20.08.2020 	10	15,658.00$	156,580.00$ 	0	156,580.00$	
 	1X (FLOW SENSOR 1.88M, ADULT, AUTOCLAVABLE)   			

	

	 

	

	

	
 	1X (PATIENT BREATHING SET (A0), HME, ADULT, REUSABLE.)								
		 
Switzerland	From 12.08.2020 - to 20.08.2020	10	589.60$	5,896.00$	0	5,896.00$	
	Offered Price
(VAT included)	 313,476.00$	

Price Schedule 2
Goods to be supplied from within the Purchaser’s country
1	2	3	4	5	6	7	8	9	
Line Item
N	Description of Goods 	Delivery Date as defined by Incoterms	Quantity and physical unit	Unit price EXW 	Total EXW price per line item
(Col. 45)	[ IF REQUIRED] 
Price per line item for inland transportation and other services required in the Purchaser’s Country to convey the Goods to their final destination as specified in the invitation for direct contracting	Sales and other taxes payable per line item if Contract is awarded 	Total Price per line item
(Col. 6+7)	
[insert number of the item]	[insert name of Good]	[insert quoted Delivery Date/ quoted phased Delivery dates if applicable]	[insert number of units to be supplied and name of the physical unit]	[insert EXW unit price]	[insert total EXW price per line item]	[insert the corresponding price per line item]	[insert sales and other taxes payable per line item if Contract is awarded]	[insert total price per item]	

									
	Offered Price		

Price Schedule 3			
Related Services [If applicable]			
Service	Description of Service	Quantity required	Physical Unit	Place where Services shall be performed	Completion Period of Services	Unit price 	Total Price per Service 	
							(Col. 5*6 or estimate)	
1	In-person user training or on-line training adequate to meet the needs of all operators.	1	20	TBD	Within 15 days from receipt of Goods	free	free	

Price Schedule 4
Total Price
The total cost for the supply and delivery of the Goods, and related Services is as follows:
Price Schedule 	Amount	
Goods: Price Schedule 1	 313,476.00$	
Goods: Price Schedule 2		
Related Services: Price Schedule 3	0	
Total Price	313,476.00$