PURCHASE REQUEST

(Applicable only to All Equipment)

Entity Name: Zamboanga City Medical Center Fund Cluster: __________________

Office/Section : PR No.: ______________ Date: ____________
Responsibility Center Code : ___________
Stock/
Property Unit Item Description Quantity Unit Cost Total Cost
No.
I. General Description of the Equipment

II. Technical Specifications

III. Accessories

IV. Warranty

VI. Requirements if declared as Lowest Calculated

Bidder (LCB), if applicable:
(a) Valid License to Operate (LTO) issued by the Food
and Drug Administration (FDA)
(b) Certificate of Compliance to:
(b.1) ISO 13485 : Quality Management System -
requirements for regulatory purposes
(b.2) IEC 60601-1: Medical Electrical Equipment
(Basic Safety and Essential Performance) and other
medical electrical safety requirements specific to the
equipment to be bid;
(c) Certificate of Product Registration or Exemption
issued by FDA-Center for Device Regulation Radiation
Health and Research (CDRRHR)

(d) Proof (such as sales invoice) that the Brand/Model

has been sold to other health facilities and/or hospitals

(e) Certification that the trainings on the operations and

basic maintenance for end-users and Biomedical Section
personnel shall be conducted
(e) Certification from the Manufacturer:
(e.1) That the bidder has the the engineer's trained
and capable for corrective and preventive maintenance
for bid model. Service engineer/s should be presently
employed by the bidder or authorized by the
manufacturer (attached proof of employment or
authorization)
(e.2) That the equipment is brand new, unused and
not a discontinued model or was never listed in any
product recall worldwide

ZCMC-F-PROC-08 Rev. 0 Effectivity date: August 1, 2017 Page 1 of 3

 (e.3) Certificate guaranteeing the availability of spare
parts and/or accesories for the next five (5) years after
the expiration of the warranty period
(e.4) That the terms and conditions stated in the
contract shall be honored by the manufacturer in the
event that a change of exclusive distributorship will
occur during the duration of the said contract
(e.5) Proof (such as sales invoice) that the brand has
been in the local market for at least ten (10) years or in
the international market for at least twenty (20) years
prior to the opening of bids
(e.6) Certificate of exclusive
distributorship/authorized distributorship from the unit
manufacturer mentioning the name of the Philippine
representative;
(e.7) That the terms and conditions stated in the
contract shall be honored by the manufacturer in the
event the change of exclusive distributorship will occur
during the duration of the said contract.
VII. Requirements if Awarded the contract:
(a) Affidavit of Undertaking as to the following if
awarded the contract: (Applicable to medical electrical
equipment only):
(a.1) The Supplier will enter into a preventive
maintenance service contract for the duration of the
period of warranty without cost to the Procuring Entity
except as otherwise stated in the Special Conditions of
Contract

(a.2) That the Supplier shall upon receipt of

verbal/written notice, telephone calls or short messaging
services the Supplier shall, within the period specified in
the SCC and with all reasonable speed, repair or replace
the defective Goods or parts thereof, without cost to the
Procuring Entity

(a.3) The Supplier shall be liable for loss of income

that could have been made had the equipment been
properly maintained or adequately and timely repaired

(a.4) Applicable to medical electrical equipment

only: Sworn Affidavit of Undertaking that the Bidder
shall provide the Procuring Entity during the warranty
period Service Engineer/s for preventive
maintenance/correction of defects within 2 days upon
verbal notification. The affidavit must be supported by
the Engineer’s, Curriculum Vitae with certificates of
training specific to the specific to the type and brand of
equipment with inclusive dates of training

(a.5) Applicable to medical electrical equipment

only: Certification that the bidder will provide during
delivery, installation, or commissioning of equipment,
Certificate of Calibration with traceability to SI Units as
maintained by the National Metrology Institute or
appropriate national, international, intrinsic, or mutual
consent standard. The certificate should indicate the
measurement result and associated uncertainty of
measurement.
ZCMC-F-PROC-08 Rev. 0 Effectivity date: August 1, 2017 Page 2 of 3
 (b) Location, contact number of the Service Center of
the bidder
(c) Certification from the bidder of the 95% uptime
guarantee for the equipment offered within the warranty
period. Accumulated downtime in excess of 5% shall be
added to the warranty period

(d) Certification that the bidder shall be responsible for

the notification, transportation, delivery, installation and
commissioning at no cost to the Procuring Entity

(e) Copy of Operations Manual and Service Manual, if

applicable
(e.1) One (1) hard to be submitted during the
opening of bids and Two (2) hard copies to be submitted
during post-qualification

This is to certify that the herein requested item/s

is/are in the Annual Procurement Plan _______

ROWENA A. ABBILANI
Supervising Administrative Officer - Procurement

Purpose: _____________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________

Requested by: Approved by:

Signature : _________________________
Printed
_________________________ ROMEO A. ONG, MD, MHA
Name :
Designatio _________________________ Medical Center Chief II
n(Adopted
: from Goverment Accounting Manual : Appendix 60)

ZCMC-F-PROC-08 Rev. 0 Effectivity date: August 1, 2017 Page 3 of 3