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ANNEX 4:
SUPPLIER QUOTATION - REHABILITATION EQUIPMENT
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HI'S REQUIREMENTSBIDDER'S RESPONSE
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HI Billing Address: GIA Tower, G17 Floor (G1711-13A), Sopheak Mongkul Steet, Koh Pich City, Sangkat Tonle Bassac, Khan Chamkarmon, Phnom Penh, Cambodia.
Supplier Name: ….......................................................................................................................................................................
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Delivery Address: Destination provinces in the Rehabilitation Center at Siem Reap, Takeo, Prey Veng , Kien Klang, Kratie, and Kampong Cham.Quotation Date: ….....................................................................................................................................................................
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Contact Name for the delivery: Mr.Rathanak SOK/HI Logistics Manager
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No.Item DescriptionRemarkQTYUnitTechnical specificationsBrandModelPriceAmountLife span
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1Sach Foot / Syme Foot- Material: Rubber/Solid Ankle Cushioned Heel
- One side: Left / Right
- Size: 16 cm 		170PC0
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2Sach Foot / Syme Foot- Material: Rubber/Solid Ankle Cushioned Heel
- One side: Left / Right
- Size: 19 cm 		170PC0
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3Sach Foot / Syme Foot- Material: Rubber/Solid Ankle Cushioned Heel
- One side: Left / Right
- Size: 22 cm 		170PC0
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4Sach Foot / Syme Foot- Material: Rubber/Solid Ankle Cushioned Heel
- One side: Left / Right
- Size: 23 cm 		170SET0
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5Sach Foot / Syme Foot- Material: Rubber/Solid Ankle Cushioned Heel
- One side: Left / Right
- Size: 23.5 cm 		170PC0
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6Sach Foot / Syme Foot- Material: Rubber Feet
- One side: Left / Right
- Size: 24 cm 		170PC0
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7Sach Foot / Syme Foot- Material: Rubber/Solid Ankle Cushioned Heel
- One side: Left / Right
- Size: 25 cm 		170PC0
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8Sach Foot / Syme Foot- Material: Rubber/Solid Ankle Cushioned Heel
- One side: Left / Right
- Size: 26 cm 		170PC0
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Price Door to Door including insurance, to the unloaded destination (PP, other provinces)
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CurrencyUSD
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Delivery lead time( to be specified by the supplier)
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Warranty( to be specified by the supplier)
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Payment terms( to be specified by the supplier)
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Payment modalityBank transfer or cheque
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Tender validility( to be specified by the supplier)
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Production capacity( to be specified by the supplier)
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Source of commodity ( to be specified by the supplier)
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Nationality of the bidder( to be specified by the supplier)
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Other…..........................
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Other…......................................
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* The bidders can also attach your bid price using the company’s own template (Proposal/Quotation) and letterhead, however, all the required information must be addressed.
* If any discrepancy information between the Supplier Quotation and your proposal/quotation, the Supplier Quotation will be valid
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SUPPLIER Name, Signature and Stamp
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