RATE CONTRACT REFILLING OF MEDICAL GAS CYLINDERS

Sr. Details of the documents to be submitted Page Remarks of the bidder

1st BID SECURITY

2nd Form-A: AUTHORIZATION CERTIFICATE

3rd Form-B: CONTACT DETAILS

4th Form-C: TENDER ACCEPTANCE CERTIFICATE

5th Form-D: NO DEVIATION CERTIFICATE

6th Form-E: RATE REASONABLENESS CERTIFICATE

7th Form-F: NO DEBARMENT / NON-BLACKLISTING CERTIFICATE

8th Form-G: INTEGRITY PACT

9th Form-H: LAND BORDER DECLARATION

10th Form-I: BANK DETAILS / MANDATE CERTIFICATE

11th Valid REGISTRATION CERTIFICATE / CERTIFICATE OF INCORPORATION

12th GST REGISTRATION CERTIFICATE

13th Valid DRUG MANUFACTURING OR SUPPLY LICENSE issued by CDSCO

14th PESO Certificate

15th Cylinder Testing & Hydrostatic Test Certification

16th Fire NOC & fire department clearance

17th OFFICE OR BRANCH OFFICE AT JODHPUR

18th INDIAN PHARMACOPEIA — 2022

19th FINANCIAL TURNOVER

20th INCOME TAX RETURN ACKNOWLEDGEMENT

21st PROFIT & LOSS A/C AND BALANCE SHEET

22nd EXPERIENCE

23rd NIT Document and its Corrigendum(s)

24th Any other relevant document

TOTAL NUMBER OF PAGES IN TECHNICAL BID DOCUMENT

CODE ITEM NAME Specifications Original Manufacture Firm's name Whether complying with NIT’s Specs (Yes/No) Mention here - if bidder is quoting their item with any different specification or size ?

01 Refilling of A-Type Medical Oxygen Cylinder Medical grade oxygen conforming to IP / BIS specifications, including filling, leak checking at valve, sealing, labeling, transportation handling, complete in all respects.

02 Refilling of B-Type Medical Oxygen Cylinder Medical grade oxygen conforming to IP / BIS specifications, including filling, leak checking at valve, sealing, labeling, transportation handling, complete in all respects.

03 Refilling of D-Type Medical Oxygen Cylinder Medical grade oxygen conforming to IP / BIS specifications, including filling, leak checking at valve, sealing, labeling, transportation handling, complete in all respects.

04 Refilling of A-Type Medical Nitrous Oxide (N₂O) Cylinder Medical grade N₂O conforming to IP / BIS specifications, including filling, leak checking at valve, sealing, labeling, and transportation handling, complete in all respects.

05 Refilling of D-Type Medical Nitrous Oxide (N₂O) Cylinder Medical grade N₂O conforming to IP / BIS specifications, including filling, leak checking at valve, sealing, labeling, and transportation handling, complete in all respects.

06 Refilling of D-Type Medical CO₂ Cylinder Medical grade Carbon Dioxide conforming to IP / BIS specifications, including filling, leak checking at valve, sealing, labeling, transportation handling, complete in all respects.

Bidder's Firm Name : The Rate column shall be mandatorily filled. Blank, empty, or zero (0) values are not permitted.

CODE Item Names Specifications Original Manufacture Firm's name Annual Qty. Rate (Exluding GST) Total Value

01 Refilling of A-Type Medical Oxygen Cylinder Medical grade oxygen conforming to IP / BIS specifications, including filling, leak checking at valve, sealing, labeling, transportation handling, complete in all respects. 400 1

02 Refilling of B-Type Medical Oxygen Cylinder Medical grade oxygen conforming to IP / BIS specifications, including filling, leak checking at valve, sealing, labeling, transportation handling, complete in all respects. 15000 1

03 Refilling of D-Type Medical Oxygen Cylinder Medical grade oxygen conforming to IP / BIS specifications, including filling, leak checking at valve, sealing, labeling, transportation handling, complete in all respects. 5000 1

04 Refilling of A-Type Medical Nitrous Oxide (N₂O) Cylinder Medical grade N₂O conforming to IP / BIS specifications, including filling, leak checking at valve, sealing, labeling, and transportation handling, complete in all respects. 30 1

05 Refilling of D-Type Medical Nitrous Oxide (N₂O) Cylinder Medical grade N₂O conforming to IP / BIS specifications, including filling, leak checking at valve, sealing, labeling, and transportation handling, complete in all respects. 10 1

06 Refilling of D-Type Medical CO₂ Cylinder Medical grade Carbon Dioxide conforming to IP / BIS specifications, including filling, leak checking at valve, sealing, labeling, transportation handling, complete in all respects. 10 1

Calculation of Local Content

Name of manufacturer Calculation by Manufacturer (Cost per unit of product)

Cost Component Cost (Domestic Component) (a) Total Cost (b) Percentage of Local Content c=(a/b)*100

III. Total Cost (Excluding tax and duties)

1. Cost (Domestic Component): Cost of domestic component may be calculated based on one of the followings depending on data available. Each of these calculations should provide consistent result.

a. 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) and have not been imported directly or through a domestic trader or an intermediary.

b. Ex-Factory Price of product minus profit after tax minus sum of imported Bill of Material used (directly or indirectly) as inputs in producing the product (including duties and taxes levied on procurement of inputs except those for which: credit/ set-off can he taken) minus warranty costs.

c. Market price minus post-production freight, insurance and other handling costs minus profit after tax minus warranty costs minus sum of Imported Bill of Material used as inputs in producing the product (including duties and taxes levied on procurement of inputs except those for which credit / set-off can be taken) minus sales and marketing expenses.

2. Total Cost: Total cost may be calculated based on one of the following depending on data available. Each of these calculations should provide consistent result.

a. 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).

b. Ex-Factory Price of product minus profit after tax, minus warranty costs.

c. Market price minus pent-production freight, insurance and other handling costs minus profit after tax, minus warranty costs minus sales and marketing expenses.

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