Tender Form DELH I STA TE CA N CER IN ST IT U T E

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ANNEXURE-IIICHECK LIST FOR PREQUALIFICATION/TECHNICAL BIDTENDER ENQUIRY NO. 04/2009DATED: _______________Due on 21.08.2009 Valid upto 20.08.2011NOTE: Tenderers must ensure that the following documents/information aresubmitted along with the pre-qualification bid. FAILURE TO SUBMIT ANYONE OF THE ESSENTIAL DOCUMENTS SHALL RENDER THE BIDDISQUALIFIED.Sl No. Documents to be submitted YES NO1.23.4.56.7.8.9.10.Tender fee (if downloaded from website)EMDOriginal Tender Form duly signed & stampedProof of Mfg Drugs since last 5 yearsCopy of ITR (latest) & PANVAT Clearance Cert./Assessment Order (latest)Copy of Valid Drug LicenseWHO/GMP Certificate (if applicable)Undertaking on the Non Judicial Stamp Paper of Rs. 10/-Pre received Challan (No format prescribed) for refund ofEMDDated: _________Signature of the TendererName & address of the tenderer with stamp:For official use onlyPQB ACCEPTED / REJECTEDIf rejected, then the reason thereof: _______________________________________________________________________________________________________________________________________(To be signed by the Tenderer, if present, as well as by the DSCI Official in case of rejection of the PQB)Signature (Tenderer)Dated:Signature (DSCI Official)SIGNATURE SEAL OF THE FIRM Page 14 of 16
ANNEXURE- IVTENDER ENQUIRY NO. 04/2009DATED: _______________Due on 21.08.2009 Valid upto 20.08.20111. Inj Epirubicin50mg2. Inj Epirubicin10mg3. Inj. Carboplatin 450mg4. Inj Gemcitabine200mg5. Inj Gemcitabine1.0gm6. Inj Goserelin 3.6mg7. Inj Goserelin 10.8mg8. Inj Ifosfamide with mesna1gm.9. inj. Leucovorin (Calcium) - 50mg10. Inj Actinomycin –D 0.5mg11. Inj Amifostine 500mg12. Inj Amifostine 375mg13. Inj BCG14. Inj Idarubicin 5mg15. Inj Docetaxel with solvent 20mg16. Inj Docetaxel with solvent 80mgLIST OF ITEMS17. Inj Docetaxel with solvent 120mg18. Inj Decarbazine 200mg19. Inj Fludarabine 50mg20. Inj Sargramostin-(GM-CSF) 250mcg/vial21. Inj Oxaliplatin 50mg22. Inj Erythropoietin 10000I.U23. Inj Erythropoietin 20000I.U24. Inj Erythropoietin 40000I.U25. Inj. Melphalan 2mg26. Inj. Cytarabine 100mg27. Inj. Cytarabine 500mg28. Inj. Cytarabine 1gm29. Inj. Cytosine arabinoside, 100mg/vial30. Inj. Interferon 4.5m I.U31. Inj. Interferon 6.0m I.U32. Inj. Interferon 9.0m I.U33. Inj. L-Asparaginase 10,000 IU34. Inj. L-Asparaginase 5,000 IU35. Inj. Mitomycin C 10mg36. Inj. Topotecan 2.5mg, 2.5ml37. Inj. Vinorelbine 10mg38. Inj. Vinorelbine 50mg39. Inj. Vinblastine 10mg ,10ml vial40. Inj. Daunorubicin 20mg 10ml41. Inj Irinotecan 40mg 2ml42. Inj Irinotecan 100mg 5mlSIGNATURE SEAL OF THE FIRM Page 15 of 16
Page 1 and 2: GOVT. OF NCT OF DELHI
Page 3 and 4: 2. IMPORTANT INSTRUCTIONS TO BE NOT
Page 5 and 6: (iv)EACH PAGE SHOULD BE NUMBERED SE
Page 7 and 8: 5. PAYMENT TERMS AND CONDITIONS:1.
Page 9 and 10: CHAPTER - 5: Contract FormUNDERTAKI
Page 11 and 12: 8. Please confirm that you have rea
Page 13: ANNEXURE-IISPECIMEN FOR PRICE BIDTE

Tender Form DELH I STA TE CA N CER IN ST IT U T E

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