RATE CONTRACT Procurement of 100 mCi F-18 FDG for PET-CT Imaging for the DEPARTMENT OF NUCLEAR MEDICINE

Sr. Details of the documents to be submitted Page Remarks

1 Form-A : Check List [on the Letter Head of the bidder]

2 Form-B : Details of the bidder [on the Letter Head of the bidder]

3 Form-C : Details of the Original Manufacturers [on the Letter Head of the bidder]

3.1 Copy of Bid Security (Demand Draft)

4 Form-D : Tender Acceptance Form [on the Letter Head of the bidder]

5.01 Form-E : Authorization Certificate [write here the name of the Authorization Certificate issuer-1]

5.01a Bidders who are participating through the Indian Importers, must include the Original Manufacturer’s Authorization Certificate issued to those importers. [if applicable]

5.02 Form-E : Authorization Certificate [write here the name of the Authorization Certificate issuer-2]

5.02a Bidders who are participating through the Indian Importers, must include the Original Manufacturer’s Authorization Certificate issued to those importers. [if applicable]

5.03 Form-E : Authorization Certificate [write here the name of the Authorization Certificate issuer-3]

5.03a Bidders who are participating through the Indian Importers, must include the Original Manufacturer’s Authorization Certificate issued to those importers. [if applicable]

5.xx and so on… [bidder can add more rows as per number of Authorization Certificates issued to them]

6 Form-F : No Debarment / Non-Blacklisting Certificate [on ₹ 500/- Non-Judicial Stamp Paper]

7 Form-G : No Case Pending Declaration [on ₹ 500/- Non-Judicial Stamp Paper]

8 Form-H : No Deviation Certificate [on ₹ 500/- Non-Judicial Stamp Paper]

9 Form-I : Price Justification Certificate [on ₹ 500/- Non-Judicial Stamp Paper]

10 Form-J : Land Border Declaration [on ₹ 500/- Non-Judicial Stamp Paper]

11 Form-K : Self-Certification regarding Local Content [on ₹ 500/- Non-Judicial Stamp Paper]

12 Form-L : Bank Details / Mandate Form [on the Letter Head of the bidder]

14 Valid Registration Certificate / Certificate of Incorporation of the bidder’s firm

15 GST Registration Certificate of the bidder’s firm

16 PAN Card of the bidder’s firm

17 Bidder’s Income Tax Return Acknowledgement for Last Three Assessment Years: 2022-23, 2023-24 & 2024-25

18.1 Bidder’s Profit & Loss A/c and Balance Sheet (F.Y. 2021-22)

18.2 Bidder’s Profit & Loss A/c and Balance Sheet (F.Y. 2022-23)

18.3 Bidder’s Profit & Loss A/c and Balance Sheet (F.Y. 2023-24)

19.a.1 Write the name of the issuer of Authorization Certificate-1 If the Authorized Distributor of any Company is participating in this Tender, additionally, he will be required to submit the following documents from the Principal Manufacturer / Indian Subsidiary / Indian Agent / Importer: · Form-F : No Debarment / Non-Blacklisting Certificate [on ₹ 500/- Non-Judicial Stamp Paper]

19.a.2 Write the name of the issuer of Authorization Certificate-1 If the Authorized Distributor of any Company is participating in this Tender, additionally, he will be required to submit the following documents from the Principal Manufacturer / Indian Subsidiary / Indian Agent / Importer: · Form-J : Land Border Declaration [on ₹ 500/- Non-Judicial Stamp Paper]

19.b.1 Write the name of the issuer of Authorization Certificate-2 If the Authorized Distributor of any Company is participating in this Tender, additionally, he will be required to submit the following documents from the Principal Manufacturer / Indian Subsidiary / Indian Agent / Importer: · Form-F : No Debarment / Non-Blacklisting Certificate [on ₹ 500/- Non-Judicial Stamp Paper]

19.b.2 Write the name of the issuer of Authorization Certificate-2 If the Authorized Distributor of any Company is participating in this Tender, additionally, he will be required to submit the following documents from the Principal Manufacturer / Indian Subsidiary / Indian Agent / Importer: · Form-J : Land Border Declaration [on ₹ 500/- Non-Judicial Stamp Paper]

19.c.1 Write the name of the issuer of Authorization Certificate-3 If the Authorized Distributor of any Company is participating in this Tender, additionally, he will be required to submit the following documents from the Principal Manufacturer / Indian Subsidiary / Indian Agent / Importer: · Form-F : No Debarment / Non-Blacklisting Certificate [on ₹ 500/- Non-Judicial Stamp Paper]

19.c.2 Write the name of the issuer of Authorization Certificate-3 If the Authorized Distributor of any Company is participating in this Tender, additionally, he will be required to submit the following documents from the Principal Manufacturer / Indian Subsidiary / Indian Agent / Importer: · Form-J : Land Border Declaration [on ₹ 500/- Non-Judicial Stamp Paper]

19…. and so on… (bidder can add more rows as per number of issuer of Authorization Certificates)

20 Bidder’s valid Drug Licenses issued by the Central / State Drug Controller.

21 Valid Licenses / Certificates as per US-FDA / European CE / Equivalent Indian Standards (wherever applicable).

22 Import Licenses issued to the Authorized Agent / Importer by the Government of India or Manufacturing License issued by CDSCO as the case may be.

23 This NIT Document and its Corrigendum (issued by the institute), all pages duly signed and stamped.

24 Any other relevant document (left to be included in this list).

TOTAL NUMBER OF PAGES IN TECHNICAL BID DOCUMENT

Name of the Firm:

S.No. Item Code Item Name Specifications Make Model Price / Unit (Excl. GST) GST % Price / Unit (Incl. GST) Pack size MRP

1 1 F-18 FDG (Fluro-Deoxy-Glucose) pack of 100 mCi pre-calibrated for 09:30 am As per NIT

Calculation of Local Content

Name of Manufacture Calculation by Manufacturer

(Cost per unit of product)

Cost Component Cost (Domestic Component) Cost (Imported Component) Total Cost (INR/ US $) Percentage of Local Content

A B C=a+b D=(a/c)*100

III. Total Cost

(Excluding tax and duties)

I. Cost (Domestic Component): Sum of the costs of all inputs which go into the product (including duties and taxes levied on procurement of inputs except those for which credit/ set-off can be taken) which have not been imported directly or through a domestic trader or an intermediary.

I. Cost (Imported Component): Sum of the costs of all inputs which go into the product (including duties and taxes levied on procurement of inputs except those for which credit/ set-off can be taken).

Bidder must submit financial bid in .xls (Excel workbook 97-2003 workbook) only