UNOPS eSourcing v2017.

Section III: Returnable Bidding Forms

eSourcing reference: [Insert UNOPS tender reference number]
Note to Bidders: The following returnable forms are part of this RFQ and must be completed and returned by
bidders as part of their quotation. Instructions to complete each Form are highlighted in blue in each Form.
Please complete the Returnable Biding Forms as instructed and return them as part of your quotation by
uploading them against their specific Document Checklist in the UNOPS eSourcing system.

This Section comprises the following Returnable Bidding Forms:

o Form A: Quotation Submission Form
o Form B: Price Schedule Form
o Form C: Technical Quotation Form
o Form D: Previous Experience Form
o Form E: Self Disclosure Form
o Form F: Joint Venture Partner Information Form
o Form G: Manufacturer’s authorization form
o Form H: Bid Securing Declaration
o FORM I: Independent Bid Declaration
o FORM J: United Nations Supplier Code Of Conduct Declaration

1
UNOPS eSourcing v2017.1

2
 UNOPS eSourcing v2017.1

Form A: Quotation submission form

Bidders are requested to complete this form, sign it and return it as part of their bid submission. The bidder
shall fill in this form in accordance with the instructions indicated. No alterations to its format shall be permitted
and no substitutions shall be accepted.
Date: [Insert submission date]
Subject: Quotation for the supply of [Insert a brief description of goods/services] in [Name of
country/city], RFQ Case No. [Insert RFQ ref number], dated [insert date]

We, the undersigned, declare that:

a. We offer to supply in conformity with the bidding documents, including the UNOPS General
Conditions of Contract;
b. Our quotation shall be valid for the period of time of [insert number of days which shall not be less
than the specified in the Tender Particulars section, Period of Validity of Quotations] from the date
fixed for the submission deadline as set out in the RFQ, and it shall remain binding upon us and may
be accepted at any time before the expiration of that period;
c. We have no conflict of interest in any activity that would put it, if selected for this assignment, in a
conflict of interest with UNOPS[If you have any actual or potential conflict of interest as defined in
Article 3 of Section II: Instructions to Bidders, please disclose it here];;
d. Our firm confirms that the offeror and sub-contractors have not been associated, or had been
involved in any way, directly or indirectly, with the preparation of the design, terms of references
and/or other documents used as a part of this solicitation;
e. Our firm, its affiliates or subsidiaries—including any subcontractors or suppliers for any part of the
Contract—has not been declared ineligible by UNOPS, nor is included in the suspended/ineligibility
list of the UN/PD, other UN Agencies, the UN Security Council, and the World Bank, in accordance
with Instructions to Bidders Article 3, Eligibility;
f. We embrace the UN Supplier Code of Conduct and adhere to the principles of the UN Global
Compact;
g. We have not declared bankruptcy, are not involved in bankruptcy or receivership proceedings, and
there is no judgment or pending legal action against them that could impair their operations in the
foreseeable future;
h. We have not offered and will not offer fees, gifts and/or favours of kind in exchange for this RFQ and
will not engage in any such activity during the performance of any Contract awarded.
I, the undersigned, certify that I am duly authorized by [insert full name of bidder] to sign this quotation and
bind [insert full name of bidder] should UNOPS accept this quotation:

Name: [complete]
Title: [complete]
Date: [complete]
Signature: _____________________________________________________________
Provide the name and contact information for the primary contact from your company for this quotation:
Name: [complete]
Title: [complete]
Email address: [complete]
Telephone: [complete]

3
 UNOPS eSourcing v2017.1

Form B: Price Schedule Form

Bidders shall fill in this Price Schedule Form in accordance with the instructions indicated.
**Please fill in all your prices in the attached excel sheet and send it as (excel book) along with the below table**

RFQ reference no: [Insert UNOPS tender reference number]

Currency USD

Bills of quantity Lot# 1: Supply ,delivery of Medical Equipment for Several

Hospitals – Multiple Cities in Yemen.

Lahj Abyan Taiz

No. Item Name

Ibn Khaldoon Al Razi Al Thawrah
Hospital Hospital Hospital

1 Endoscopy System with Accessories 1 1 1

Unit Price Total Price

No. Item Unit Qty
DAP DAP
1.1 Endoscopy System with Accessories Each 3 insert insert
Total insert

Payment terms 30 days accepted: ☐ Yes

Bidder’s discount for accelerated payment: ____% of total firm price for each calendar day less than thirty
(30) days

List of subcontractors or suppliers

Bidder must identify the names of all subcontractors/suppliers who will be providing good/services under this
Contract and the type of work being subcontracted, if applicable.

(A) _[Full legal name and address of subcontractors]___________

(B) _________________________________________________

(C) _________________________________________________

I, the undersigned, certify that I am duly authorized by [insert full name of Bidder] to sign this quotation and
bind [insert full name of Bidder] should UNOPS accept this quotation:

Name : _____________________________________________________________

4
 UNOPS eSourcing v2017.1

Title : _____________________________________________________________

Date : _____________________________________________________________

Signature : _____________________________________________________________

5
 UNOPS eSourcing v2017.1

Form C: Technical Quotation Form

RFQ reference no: [Insert UNOPS tender reference number]

Name of Bidder: [insert name of Bidder]

Is quotation
Item UNOPS minimum technical compliant? Details of goods offered.
Qty.
No requirements Bidder to Bidder to complete
complete
1.1 Endoscopy System with Accessories
☐ Yes ☐ No Insert details of goods
offered, including
specifications and
brand/model offered if
applicable.

It is mandatory to send the

brochures / data sheet of the
1.1.1 Name of Manufacturer 3
product and identify the page
number in that brochures to
conform to the required
specs.

Fill all required details as

mentioned above for all the
cells below
1.1.2 Model/ catalogue number ☐ Yes ☐ No
1.1.3 Country of Origin for the offered model ☐ Yes ☐ No
Equipment offered must be covered by at ☐ Yes ☐ No
1.1.4 least a 2 years full warranty starting the date
of installation and Final Acceptance
Valid EU CE or US FDA regulatory approval as ☐ Yes ☐ No
1.1.5
Medical Devices or as “IVD” as applicable
1.1.6 A High-definition mobile ☐ Yes ☐ No
endoscopy workstation tower is
required to comprise the
following items and to conform to
the minimal specifications
outlined for each item.
It is made of the following
components:
1) Video flexible
gastroscope
2) Video flexible

6
 UNOPS eSourcing v2017.1

colonoscope
3) Processor with light
source
4) Medical Monitor
5) Image archiving system
6) Printer
7) Trolley
Item # 1: Full HD High-definition ☐ Yes ☐ No
1.1.7 standard video flexible gastroscope of
the following specifications:
a) The entire gastroscope must be ☐ Yes ☐ No
1.1.8 submersible with easy grip
control
b) Optical system: ☐ Yes ☐ No
i. Viewing direction:( forward ☐ Yes ☐ No
viewing )
1.1.9
ii. Field of view : ≥ 140° ☐ Yes ☐ No
iii. Depth of field: ( 5 - 100 ) mm ☐ Yes ☐ No
or better
c) Insertion tube section:
i. Outer diameter of insertion ☐ Yes ☐ No
1.1.10 tube: ≤ 10 mm
ii. Working length : ≥ 1000 mm ☐ Yes ☐ No
iii. Total length: ≥ 1300 mm ☐ Yes ☐ No
d) Working channel with a ☐ Yes ☐ No
1.1.11
diameter: ( 2.8 - 3.2 ) mm
e) Tip deflection: ☐ Yes ☐ No
i. Up : ≥ 210° ☐ Yes ☐ No
1.1.12 ii. Down : ≥ 90° ☐ Yes ☐ No
iii. Left : ≥ 100° ☐ Yes ☐ No
iv. Right : ≥ 100° ☐ Yes ☐ No
1.1.13 f) Distal cap / cover : Removable ☐ Yes ☐ No
g) Air-water-suction valves : ☐ Yes ☐ No
1.1.14
Autoclavable
h) Brushes : Included for all ☐ Yes ☐ No
1.1.15
channels
i) Compatible with ETO, plasma ☐ Yes ☐ No
1.1.16 sterilization (preferable) &
liquid reprocessing methods
j) Case with complete accessories ☐ Yes ☐ No
kit should be provided,
1.1.17
including valves etc. (provide
complete list)
1.1.18 Item #2: High definition standard video ☐ Yes ☐ No
flexible colonoscope of at least the
following specifications:

7
 UNOPS eSourcing v2017.1

a) The entire colonoscope must ☐ Yes ☐ No

1.1.19 be submersible with easy grip
control.
b) Optical system: ☐ Yes ☐ No
i. Viewing direction: ( forward ☐ Yes ☐ No
viewing )
1.1.20
ii. Field of view : ≥ 140° ☐ Yes ☐ No
iii. Depth of field: ( 5 - 100 ) ☐ Yes ☐ No
mm or better
c) Insertion tube section: ☐ Yes ☐ No
i. Outer diameter of insertion ☐ Yes ☐ No
tube: ≤ 13 mm
1.1.21
ii. Working length : ≥ 1600 ☐ Yes ☐ No
mm
iii. Total length: ≥2000 mm ☐ Yes ☐ No
d) Working channel with a ☐ Yes ☐ No
1.1.22
diameter: (3.7 - 4.2) mm
e) Tip deflection: ☐ Yes ☐ No
i. Up : ≥ 180° ☐ Yes ☐ No
1.1.23 ii. Down : ≥ 180° ☐ Yes ☐ No
iii. Left : ≥ 160° ☐ Yes ☐ No
iv. Right : ≥ 160° ☐ Yes ☐ No
1.1.24 f) Distal cap / cover : Removable ☐ Yes ☐ No
g) Air-water-suction valves : ☐ Yes ☐ No
1.1.25
Autoclavable
h) Brushes : Included for all ☐ Yes ☐ No
1.1.26
channels
i) Compatible with ETO, plasma ☐ Yes ☐ No
1.1.27 sterilization (preferable) &
liquid reprocessing methods.
j) Case provided with complete ☐ Yes ☐ No
accessories kit should be
1.1.28
provided, including valves etc.
(provide complete list)
Item # 3: A high definition digital video ☐ Yes ☐ No
processor (CCU) with integrated or
detached xenon or LED light Source with
1.1.29
the following specifications:
(all needed accessories should be
included)
1.1.30 a) Image video processor (CCU): ☐ Yes ☐ No
i. Hue adjustment: ☐ Yes ☐ No
automatic and
manual control
ii. Illumination ☐ Yes ☐ No
adjustment:
automatic and

8
 UNOPS eSourcing v2017.1

manual control
iii. White balance ☐ Yes ☐ No
iv. Video gain: ☐ Yes ☐ No
automatic
v. Sharpness: ☐ Yes ☐ No
low/medium/hig
h
b) Xenon or LED light source: ☐ Yes ☐ No
i. 300 watt xenon ☐ Yes ☐ No
lamp for Xenon
light source
ii. Efficient & silent ☐ Yes ☐ No
cooling fan
iii. Lamp life: ≥ ☐ Yes ☐ No
1.1.31 500hr for Xenon
light source or
specify LED
lifespan if using
an LED light
source.
iv. Bulb life ☐ Yes ☐ No
indicator
Item # 4: LCD or LED Color Medical ☐ Yes ☐ No
Monitor (mounted on cart):
a) Medical grade ☐ Yes ☐ No
b) Not less than 24 inch diameter ☐ Yes ☐ No
c) Color systems ☐ Yes ☐ No
1.1.32
d) High definition image display ☐ Yes ☐ No
e) DVI output (to provide ☐ Yes ☐ No
completely digital signal)
f) Flicker free ☐ Yes ☐ No
g) Low radiation ☐ Yes ☐ No
1.1.33 Item # 5: Image archiving system: ☐ Yes ☐ No
a) Provides acquisition of still ☐ Yes ☐ No
images and video clips
b) Standard of file formats ☐ Yes ☐ No
c) Easy to use software ☐ Yes ☐ No
d) Window based software ☐ Yes ☐ No
e) Compatibility with a variety of ☐ Yes ☐ No
printers and DVD recorders
f) Stores still images and videos ☐ Yes ☐ No
directly to a DVD
g) The computer shall be of the ☐ Yes ☐ No
latest model and specifications
(Please specify the
details ,brand and model)
h) The computer shall be of a very ☐ Yes ☐ No

9
 UNOPS eSourcing v2017.1

well-known robust brand

Item # 6: Color printer: ☐ Yes ☐ No
A high resolution & color video printer
1.1.34
from any well know company (Please
specify the brand and model)
Item # 7: Original mobile cart to suit the ☐ Yes ☐ No
above system and consists of the
following specifications:
a) Antistatic, anti-scratch castors ☐ Yes ☐ No
b) Locking brakes ☐ Yes ☐ No
1.1.35 c) Cable channel with shockproof ☐ Yes ☐ No
plugs
d) With 3 to 4 shelves, and ☐ Yes ☐ No
preferably drawer(s)
All accessories (connect cable, plugs, ☐ Yes ☐ No
etc.,..) needed for the offered system to
be included
1.1.36 Leakage tester ☐ Yes ☐ No
Online UPS (Please specify the brand and ☐ Yes ☐ No
1.1.37
model)
Electrical characteristics
A 220-240V, 50Hz single-phase electrical. ☐ Yes ☐ No
1.1.38 Compliant with IEC 60601 or equivalent
Built-in protections against over-voltage and ☐ Yes ☐ No
over-current line conditions.
Safety and standards
ISO 13485 or 9001 certification of the ☐ Yes ☐ No
Manufacturer’s QMS, issued by EU Notified
1.1.39 Bodies or by an IAF recognized/accredited
Conformity Assessment Body
Copy of the above mentioned certificates ☐ Yes ☐ No
shall be included in the offer
1.1.40 The estimated life span : 8 -10 years ☐ Yes ☐ No
The product to be supplied shall be new, ☐ Yes ☐ No
1.1.41 unused and conform to the standards as
specified in technical specifications.
Transport, handle and store all products and ☐ Yes ☐ No
materials in accordance with the
1.1.42 manufacturer’s recommendations and in a
manner that prevents damage or
deterioration or excessive distortion.
The equipment proposed shall be of highest ☐ Yes ☐ No
quality and produced by well known
1.1.43 manufacturers. The equipment shall carry the
name and quality label of the manufacturer
and fulfill the standards in force.
Technical offers must include brochures, data ☐ Yes ☐ No
1.1.44
sheets and complete technical specifications.
1.1.45 Upon delivery of the system, the supplier ☐ Yes ☐ No
should show official documents showing the

10
 UNOPS eSourcing v2017.1

country of origin and the date of

manufacturing the system as stated by the
manufacturer, associated with the serial
number.
All equipment to be brand new, and latest in ☐ Yes ☐ No
1.1.46
design and technology.
Supplier must include full installation, ☐ Yes ☐ No
acceptance testing, safety checks and
commissioning of the system for clinical use
as per the manufacturer’s recommended
procedures. All the equipment and tools to
1.1.47
be used in these steps shall be the
responsibility of the supplier to provide. The
installation engineer/technician as well as the
end-user should be trained and authorized by
manufacturer to do the installation.
The staff training in operation and ☐ Yes ☐ No
1.1.48
maintenance shall be provided
Supplier should deliver with the machines all ☐ Yes ☐ No
operator manuals, service manuals,
1.1.49
engineering schematics, and all documents
and software media relevant to the machines
To submit a spare part pricelist with the part ☐ Yes ☐ No
1.1.50 number valid for 7 years starting date after
the warranty completion

General Requirement
The authorization of manufacturer included in your
1 ☐ Yes ☐ No Insert details
offer
The model of equipment that is in the submitted
2 ☐ Yes ☐ No Insert details
offer , it should be still producing.
The equipment shall include a non-removable label
3 that state the country of manufacture (i.e. Made ☐ Yes ☐ No Insert details
in…).
If the manufacturer plans to stop production of the
awarded equipment referenced herein and/or to
produce improved models before the delivery date,
4 the Supplier shall notify UNOPS of this fact and ☐ Yes ☐ No Insert details
provide the option of upgrading its purchase. It will
be UNOPS decision to upgrade the equipment or to
keep the originally ordered one.
Quality Assurance and Standards conformity
Quality assurance tests shall be performed at the
manufacturer site, prior to shipment. It shall insure
5 ☐ Yes ☐ No Insert details
high quality, proper and reliable functionality, and
applicable standards conformity..

11
 UNOPS eSourcing v2017.1

Quality assurance test certificates shall indicate the

serial number of the medical equipment tested,
6 ☐ Yes ☐ No Insert details
date of the test, types of tests, and acceptance
criteria.
All equipment shall pass the Quality assurance tests
successfully, and the test certificates shall be duly
7 stamped by the manufacturer. Quality assurance ☐ Yes ☐ No Insert details
test certificates shall be submitted to UNOPS,
whenever requested.
Full functionality

The offered medical equipment shall include a full

set of compatible parts, components, accessories,
software, hardware, hardware/software interfaces,
8 ☐ Yes ☐ No Insert details
start-up consumables and howsoever required to
put the medical equipment into fully operational
condition.
Any parts, components, adapters, software,
hardware etc, that are not mentioned in the
detailed technical offer or purchase order, but
9 required to put the product into fully operational ☐ Yes ☐ No Insert details
condition shall be deemed part of the awarded
medical equipment and must be provided by the
Supplier at no additional cost.
All medical equipment shall contain the latest
10 software version at the time of shipment, wherever ☐ Yes ☐ No Insert details
applicable.
All medical equipment, or its component, that will
be permanently built-in or mounted on floor, wall or
ceiling shall include all needed fixtures, supports,
11 arms, mounting parts/interfaces, finishing seals, and ☐ Yes ☐ No Insert details
howsoever required to mount the unit and
complete the installation, as per the manufacturer
recommendation, and to the satisfaction of UNOPS.
The Supplier shall be responsible to coordinate and
liaise with UNOPS, the Consultant, Contractor, sub-
contractors and suppliers of other medical
12 ☐ Yes ☐ No Insert details
equipment, to provide complete, integrated and
fully functional and coordinated solutions wherever
applicable.
The Supplier shall provide fully functional batteries
13 for all equipment with internal batteries to the end- ☐ Yes ☐ No Insert details
user at the time of taking over.
For equipment that requires water for its operation,
the Supplier must stipulate the minimum and
14 recommended acceptable water quality ☐ Yes ☐ No Insert details
requirements. Hoses, adapters, filters etc shall be
provided (wherever applicable).

12
 UNOPS eSourcing v2017.1

All electrically operated equipment must be

15 designed to run on the Yemeni standard AC power ☐ Yes ☐ No Insert details
(voltages and frequencies)
Equipment operated at 110V (with and without
16 ☐ Yes ☐ No Insert details
transformers) shall NOT be acceptable.
All Electrically operated equipment should comply
17 with IEC 60601 or equivalent ☐ Yes ☐ No Insert details

Packaging, Shipping, Storage and Delivery

The equipment package shall be well labeled, with

18 ☐ Yes ☐ No Insert details
instructions for handling, lifting, etc.
The equipment package shall be labeled with the
19 Supplier name, Manufacturer, model number, and ☐ Yes ☐ No Insert details
date of manufacture.
The supplier shall print a thermal stickers of the
logo that shall be labelled on all equipment and
20 ☐ Yes ☐ No Insert details
the shipping boxes and cartons during delivery
processes.
The equipment shall be packaged in a way to
withstand handling, loading, unloading,
21 ☐ Yes ☐ No Insert details
temperature, humidity and other extremes likely to
be encountered during shipping and transport.
The Supplier shall be responsible for shipping and
delivery and installing of the equipment to the
22 specified location as in the tender invitation and ☐ Yes ☐ No Insert details
within the time frame stipulated in the tender
invitation.
The Supplier shall be responsible to provide
appropriate store for the medical equipment until
the site is ready for immediate assembling and start
23 ☐ Yes ☐ No Insert details
up. The equipment shall be stored in supplier’s
stores and delivered on demand to UNOPS projects’
sites.
All equipment shall be preserved and packaged in
accordance with the manufacturer's standard
24 ☐ Yes ☐ No Insert details
practices, and to avoid damage to the system while
in transport and shipment to its final destination.
The Supplier is responsible for loading, unloading,
25 rigging and inside delivery of the medical equipment ☐ Yes ☐ No Insert details
to its final destination room inside the building.
26 The Supplier shall be responsible for taking all ☐ Yes ☐ No Insert details
appropriate actions to ensure that equipment can
be brought safely into the facility and to the
allocated locations. It shall be the responsibility of
the Supplier to deliver all equipment in good
condition. Any equipment damaged in shipping,
transportation, or rigging shall be promptly replaced

13
 UNOPS eSourcing v2017.1

regardless of the status of any claims filed against

the carrier.
During the warranty period, and if deemed
necessary, the Supplier shall relocate the equipment
27 ☐ Yes ☐ No Insert details
to other locations at no additional cost.

Assembling

The Supplier shall assemble, mount, configure,

calibrate, test and commission the medical
28 equipment as per the published manufacturer’s ☐ Yes ☐ No Insert details
instructions, applicable international & local
standards, and to the satisfaction of UNOPS.
Only experienced and qualified engineers shall
assemble the medical systems and equipment.
Competency and Training certificates for the
29 ☐ Yes ☐ No Insert details
installer, issued and letter headed by the
manufacturer, shall be submitted whenever
requested by UNOPS.
The Supplier’s work-in-progress activities (delivery,
storage, rigging, assemble, inspection, etc) shall be
subjected to verification, at any time by UNOPS.
30 UNOPS will notify the Supplier of any observed ☐ Yes ☐ No Insert details
deficiencies or non-conformity, which could cause
suspension of acceptance of the proposed system
until corrective action has been demonstrated
Assembling, Testing & Commissioning inspection (ATCI)

After assembling and prior to conducting the

‘Assembling, Testing & Commissioning Inspection
(ATCI)’, the Supplier shall undertake its own pre-
checks to verify that the equipment, its assembling
31 ☐ Yes ☐ No Insert details
and its performance conform to the published
manufacturer’s specifications. All required parts,
accessories and start-up consumables shall be
included.
Only experienced and qualified engineers shall
conduct the Assembling, Testing & Commissioning.
32 Competency certificate, issued by the manufacturer, ☐ Yes ☐ No Insert details
shall be submitted during the inspection, whenever
requested.
Assembling, Testing & Commissioning Inspection
shall demonstrate proper and safe Assembling and
operation of the medical equipment as per the
33 ☐ Yes ☐ No Insert details
published manufacturer’s specifications and
protocols, applicable standards, and to the
satisfaction of UNOPS.
34 Whenever deemed necessary by UNOPS, the ☐ Yes ☐ No Insert details

14
 UNOPS eSourcing v2017.1

Supplier shall provide testing equipment, analyzers

etc to verify proper function/performance of the
equipment as per the published manufacturer’s
specifications. All testing equipment, tools,
analyzers, etc used for testing of medical equipment
and systems shall be calibrated as per its
manufacturer recommendation. Certificate of valid
calibration shall be provided upon request.
The Supplier shall submit a printed list of Serial
35 Numbers of all equipment assembled, and its ☐ Yes ☐ No Insert details
location (room number).
Assembling, Testing & Commissioning Inspection
36 forms/checklists shall be filled by the Supplier, and ☐ Yes ☐ No Insert details
submitted to UNOPS.
Training

Following a successful Assembling, Testing &

Commissioning inspection, the Supplier shall
conduct training sessions for the clinical staff onsite.
This training shall be scheduled at the convenience
of the clinical staff. Training shall be for an
37 appropriate period for the medical system. Training ☐ Yes ☐ No Insert details
shall include, but not be limited to, training for( One
BioMedical Engineer and Two users ) Following the
completion of training, the Supplier shall, if
requested, certify that trained personnel have
completed the training program.
The Supplier shall submit a detailed description of
the scheduled training for the clinical personnel and
the technical training for biomedical engineers for
all supplied equipment ( One BioMedical Engineer
38 and Two users ) . This should include, but not ☐ Yes ☐ No Insert details
limited to, detailed description of the training,
location, scheduled time, duration, content,
qualifications of instructor, and a list of who should
attend the training.
The Supplier shall provide local service training for 2
39 biomedical engineers, unless otherwise instructed ☐ Yes ☐ No Insert details
by UNOPS.
Manuals

The Supplier shall provide 1 original user manuals

40 ☐ Yes ☐ No Insert details
and 1 original technical service manuals.
Soft copy of user and service manuals (on CD) shall
41 ☐ Yes ☐ No Insert details
be also provided.
Technical service manuals shall include spare parts
42 lists, electronic circuits schematic diagrams, and ☐ Yes ☐ No Insert details
detailed troubleshooting guides (where applicable).

15
 UNOPS eSourcing v2017.1

Infection control

Cleaning, disinfecting and/or sterilization of all

medical equipment must comply with the Disease
43 ☐ Yes ☐ No Insert details
Control (CDC) guidelines or equivalent international
standards.
The Supplier must provide the published
44 manufacturer’s method statement for cleaning for ☐ Yes ☐ No Insert details
all medical equipment.
The Supplier shall specify appropriate cleaning
45 ☐ Yes ☐ No Insert details
methods, procedures, and agents.
Warranty and Maintenance:

The Supplier shall provide full warranty for 2 year,

as stipulated in the Invitation to Bid. The warranty
46 shall cover free maintenance/labor and free spare ☐ Yes ☐ No Insert details
parts throughout the warranty period. The warranty
period shall include manufacturer defects.
The Supplier shall provide stickers/labels on each
equipment, stating the name of local agent, email,
phone and fax numbers, as well as the dates for
47 ☐ Yes ☐ No Insert details
scheduled preventive maintenance during the free
warranty period, as well as the expiration date of
the warranty period.
The Supplier shall conduct scheduled Preventive
Maintenance (PM) according to the manufacturer
48 ☐ Yes ☐ No Insert details
recommendations, applicable standards, and
accrediting agencies.
Documented PM reports shall be submitted, and
49 signed by the biomedical engineers/technicians ☐ Yes ☐ No Insert details
onsite.
Response to service calls by factory-trained service
engineers shall be within 1 day. If the Supplier fails
50 to adhere to this requirement, then the free ☐ Yes ☐ No Insert details
warranty period for the affected equipment shall be
extended 1 week per each incident.
The Supplier shall fix malfunctioning equipment
51 within a maximum of 1 week from the date of ☐ Yes ☐ No Insert details
notification.
The Supplier shall replace or repair all defective
equipment and software, and shall correct any
52 defects -without charges for parts or labor- both ☐ Yes ☐ No Insert details
during and after regular working hours, during the
warranty period.
53 The following effectiveness level provisions shall apply to ☐ Yes ☐ No Insert details
the medical equipment during the warranty and
subsequent support periods. Uptime is defined as the
state when the system is working and/or available for
use, to UNOPS/MOH satisfaction. Downtime is defined as

16
 UNOPS eSourcing v2017.1

the state when the system is NOT operable due to

breakdown, performance of repairs, or failure to perform
according to specifications. The period of downtime shall
be from notification of the manufacturer's service
representative until the equipment is returned/presented
to the designated UNOPS/MOH representative properly
functioning and ready for use.
Scheduled routine preventive maintenance,
scheduled upgrades of equipment or software, and
54 ☐ Yes ☐ No Insert details
external failures (i.e., due to power loss etc) shall
not be considered downtime.
Preventive maintenance work, software upgrades
and other non-urgent services shall be performed at
55 ☐ Yes ☐ No Insert details
predetermined times convenient to UNOPS/MOH.
These times may include off-hours.
Supplier shall provide a replacement of any
defective equipment or components that cannot be
repaired or corrected to the satisfaction of
UNOPS/MOH during the warranty or service
contract period. The replacement/substituted
56 ☐ Yes ☐ No Insert details
equipment shall be technically equivalent and with
similar quality of the defective equipment.
Replacement shall be limited to 3 months, as the
original defective equipment must be fixed within
this period.
All warranties and rights shall be transferable from
UNOPS to the Ministry Of Health (MOH) upon
57 ☐ Yes ☐ No Insert details
transfer of ownership, the date of which shall be
agreed between UNOPS and the MOH.
The Supplier should submit a confirmation letter
58 that spare parts are available at least 7 years after ☐ Yes ☐ No Insert details
the expiration of the warranty period.
The Supplier shall submit a complete priced spare
parts list, and priced consumables/reagents list
where applicable, (prices in USD and include
customs fees, sales tax and any other fees, taxes or
59 ☐ Yes ☐ No Insert details
governmental or non-governmental charges). In
case any spare part is needed during this period and
is not included in the list submitted in the tender, it
will be supplied to MOH free of charge..

Delivery requirements and Comparative Data Table:

UNOPS Requirements Is quotation Details

17
 UNOPS eSourcing v2017.1

compliant? Bidder
Bidder to complete
to complete
Bidder shall deliver the goods
Delivery time 120 Days after Contract ☐ Yes ☐ No Insert details
signature.
Delivery at Place DAP to Several
Delivery place Hospitals – Multiple Cities in
and Yemen.
☐ Yes ☐ No Insert details
Incoterms Unloaded, customs cleared
rules Incoterms rules as per
Incoterms 2020.
Consignee
details
At the time the Contract is
awarded, UNOPS reserves the
right to vary the quantity of the
UNOPS Right goods and associated
to vary services specified above, ☐ Yes ☐ No Insert details
requirements provided this does not exceed
+/- [20%] , without any change
in the unit prices or other terms
and conditions of the RFQ.

00ax: +45 45 33 75 01
The offered goods and related services (if applicable) are in accordance with the required specifications and
requirements specified in Section II: Schedule of Requirements.

☐ Yes ☐ No
ANY DEVIATION MUST BE LISTED BELOW:
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_____________________________________________________________________________

Name : _____________________________________________________________

Title : _____________________________________________________________

Date : _____________________________________________________________

Signature : _____________________________________________________________

18
 UNOPS eSourcing v2017.1

Form D: Previous Experience Form

RFQ reference no: [Insert UNOPS tender reference number]

Name of Bidder: [insert name of Bidder]

Year
Total Contract Identification and Title and
Description of project
Country amount of Contact details of Client
services/goods was
Contract (Name, Address, telephone, email, fax)
undertaken

Name : _____________________________________________________________

Title : _____________________________________________________________

Date : _____________________________________________________________

Signature : _____________________________________________________________

19
Form E: Self Disclosure Form
RFQ reference no: [insert RFQ reference No.]
Name of Bidder: [insert name of Bidder]
Ref
Critical area Response Comments
.

Has the entity or individual declared bankruptcy, or been involved

[If the response is ‘Yes’, provide an
in bankruptcy or receivership proceedings, or is there any judgment
1 Select explanation here.]
or pending legal action against them, which could impair operations
in the foreseeable future;

Has the entity or individual been found (or is awaiting a judgment [If the response is ‘Yes’, provide an
2 or administrative decision) in breach of their obligations relating to Select explanation here.]
the payment of taxes or social security contributions?

Has the entity or individual been found (or is awaiting a judgment or

[If the response is ‘Yes’, provide an
administrative decision) guilty of misconduct for the violation of
3 Select explanation here.]
applicable laws, regulations or ethical standards of the profession to
which they belong?

4 Select [If the response is ‘Yes’, provide an

Has the entity or individual engaged, or attempted to engage, in any explanation here.]
Proscribed Practices in the past?

For the purposes of this provision, “Proscribed Practices” are

defined in the UNOPS Operational Instruction on Vendor Sanctions
and include the following:

● A corrupt practice: the offering, giving, receiving, or soliciting,

directly or indirectly, anything of value to influence improperly
the actions of another party;
 UNOPS eSourcing v2017.1

Ref
Critical area Response Comments
.

● A fraudulent practice: any act or omission, including a

misrepresentation, that knowingly or recklessly misleads, or
attempts to mislead, a party to obtain a financial or other
benefit or to avoid an obligation;

● A coercive practice: an act or omission that impairs or harms,

or threatens to impair or harm, directly or indirectly, any party
or the property of the party to improperly influence the actions
of a party;

● A collusive practice: an arrangement between two or more

parties designed to achieve an improper purpose, including
influencing improperly the actions of another party;

● An unethical practice: Conduct or behaviour that is contrary to

the conflict of interest, gifts and hospitality, post-employment
provisions or other published requirements of doing business
with UNOPS; and

● Obstruction: Acts or omissions by a Vendor that prevent or

hinder UNOPS from investigating instances of possible
Proscribed Practices.

Has the entity or individual unduly obtained, or attempted to

unduly obtain, any confidential information in connection with this [If the response is ‘Yes’, provide an
5 procurement process and any agreement that may be awarded as Select explanation here.]
a result of this process?

6 Does the entity or individual have a conflict of interest, as provided Select [If the response is ‘Yes’, provide an
in the Instructions to bidders, Article 3 “Bidder eligibility”, that may

21
 UNOPS eSourcing v2017.1

Ref
Critical area Response Comments
.

prevent them from entering into an agreement with UNOPS, or that

may in any way jeopardize their performance in carrying out their explanation here.]
obligations under the agreement?

Has the entity or individual been found (or is awaiting a judgment

or administrative decision) to be involved in any of the following:

● Fraudulent practice;
● Corrupt practice; [If the response is ‘Yes’, provide an
7 ● Affiliation with a criminal organization; Select explanation here.]
● Money laundering;
● Terrorist financing;
● Child labour; or
● Human trafficking?

Has the entity or individual had significant performance issues in

[If the response is ‘Yes’, provide an
the past that led to the early termination of a legal commitment or
8 Select explanation here.]
the application of damages or other contractual penalties, or that
were discovered following inspections, audits or investigations?

Has the entity or individual committed any financial irregularity,

[If the response is ‘Yes’, provide an
resulting from an act or omission or the inclusion of an unjustified
9 Select explanation here.]
item of expenditure outside a contractual engagement that had the
effect of prejudicing their use of public funds?

10 Has the entity or individual been found (or is awaiting a judgment Select [If the response is ‘Yes’, provide an
or administrative decision) to have created an entity in a different

22
 UNOPS eSourcing v2017.1

Ref
Critical area Response Comments
.

jurisdiction with the intent of circumventing fiscal, social or any

explanation here.]
other legal obligations in the jurisdiction of their registered office,
central administration or principal place of business?

I, the undersigned, hereby declare that the information provided is true and correct. I also understand that any willful dishonesty may
result in the refusal of this submission. I understand that engagement in any of the above critical areas may, at the discretion of UNOPS,
automatically result in the exclusion from this procurement process.

Name:

Title

Date: Sep 10, 2024

Signature

[Stamp this form with the official stamp of the bidder]

23
 UNOPS eSourcing v2017.1

Form F: Joint Venture Partner Information Form

The Bidder shall fill in this Form in accordance with the instructions indicated below.

RFQ reference no: [Insert UNOPS tender reference number]

Name of Bidder: [insert name of bidder]
Date: [insert submission date]

To be completed and returned with your Bid if the Bid is submitted as a Joint Venture/Consortium/Association.

JV / Consortium/ Association Information

Name [complete]

Names of each partner and contact

information
[complete]
(address, telephone numbers, fax
numbers, e-mail address)

Name of leading partner (with authority to

bind the JV, Consortium, Association
during the Bidding process and, in the
event a Contract is awarded, during
contract execution)

Proposed proportion of responsibilities

between partners (in %) with indication
[complete]
of the type of the goods/services to be
delivered by each

Signatures of all partners of the JV:

We hereby confirm that if the contract is awarded, all parties of the Joint Venture/Consortium/Association shall
be jointly and severally liable to UNOPS for the fulfillment of the provisions of the Contract.

Name of partner: ________________________ Name of partner: _________________________

Signature: ______________________________ Signature: _______________________________

Date: _______________________ Date: ________________________

Name of partner: ________________________ Name of partner: _________________________

Signature: ______________________________ Signature: _______________________________

Date: _______________________ Date: ________________________

24
 UNOPS eSourcing v2017.1

Form G: Manufacturer’s Authorization Form

A letter issued by the manufacturer authorizing the applicant to participate in this particular RFQ must be
submitted with the bid in the format provided in this Form.

To be eligible for delivery of goods, the bidder must be either the manufacturer of the offered goods or a sole
representative of the manufacturer to the United Nations. Should offers for a particular make and model be
received from more than one appointed representative, UNOPS reserves the right to select only one.

RFQ reference no: [Insert UNOPS tender reference number]

Name of Bidder: [insert name of bidder]
Date: [insert submission date]

To: [bidder to insert]

WHEREAS

We [insert complete name of manufacturer], who are official manufacturers of [insert type of goods
manufactured], having factories at [insert full address of manufacturer’s factories], do hereby authorize
[insert complete name of bidder] to submit a bid the purpose of which is to provide the following goods,
manufactured by us [insert name and or brief description of the goods], and to subsequently negotiate
and sign the contract.

We hereby extend our full guarantee and warranty in accordance with Clause 13 of the General Conditions for
Goods, with respect to the goods offered by the above firm.

Signed: [insert signature(s) of authorized representative(s) of the manufacturer]

Name: [insert complete name(s) of authorized representative(s) of the manufacturer]

Title: [insert title]

Dated on ____________ day of __________________, _______ [insert date of signing]

25
 UNOPS eSourcing v2017.1

Form H: Bid Securing Declaration

Date: [Insert date]

Tender reference number: [Insert UNOPS tender reference number]

We, the undersigned, declare that:

1. We understand that, according to your conditions, offers must be supported by a bid securing
declaration.

2. We accept that we could be declared ineligible to participate in future UNOPS tenders in accordance
with the regulations stipulated in the Procurement Manual section 3.3 Vendor Ineligibility if we violate
our obligation (s) under the conditions of the offer if:

(a) we withdraw our offer during the period of the offer validity specified by us in the offer submission
form; or

(b) we do not accept the correction of errors in accordance with the Instructions to Bidders in the
bidding documents; or

(c) after having been notified of the acceptance of our offer during the period of bid validity thereof, (i)
we do not execute or refuse to execute the Contract form, if required; or (ii) we do not supply or
refuse to provide the performance security.

3. We understand that this bid securing declaration will expire if we are not the successful bidders, and
when one of the following events occurs first: (i) we receive a copy of your notification with the name
of the successful bidder; or (ii) twenty-eight days have elapsed after the expiration of our offer.

I, the undersigned, certify that I am duly authorized by [insert full name of bidder] to sign this bid and bind
[insert full name of bidder] should UNOPS accept this bid:

Name : ___________________________________________________________

Title : _____________________________________________________________

Date : _____________________________________________________________

Signature : _________________________________________________________

26
 UNOPS eSourcing v2017.1

FORM I: INDEPENDENT BID DECLARATION

This document does not require notarization.

Bid for the supply of [[……….]] in [……….]], invitation to bid no.: [……….], dated [……….]

The undersigned, on submission of a bid for the competitive procurement process or invitation to bid
(hereinafter referred to as “the bid”) for the [insert brief description of the goods and/or services] in [name of
country/city] – invitation to bid no.: [insert invitation to bid ref. no.], in response to the call for bids made by the
United Nations Office for Project Services (UNOPS), I hereby make the following statements, which I declare
to be true and complete in all respects.
On behalf of [name of bidder or joint venture], hereinafter “the Bidder”, I declare that:

1. I understand that the bid submitted shall be disqualified if this statement is found not to be true and
complete in all respects.
2. I am authorized by the Bidder to sign this declaration and to submit the attached bid on behalf of the
Bidder.
3. Each person whose signature appears on the submitted bid has been authorized by the Bidder to
establish its terms and to sign it on behalf of the Bidder.
4. For the purposes of this statement and the bid submitted, I understand that the word “competitor”
shall include any natural or legal person, other than the Bidder, whether affiliated with the Bidder or
not, who:
a. has been asked to submit a bid in response to this invitation to bid
b. might potentially submit a bid in response to this invitation to bid, based on their qualifications,
skills or experience.
5. The Bidder discloses that (select the appropriate option from the following subsections, 5 (a) or 5
(b)):
a. The Bidder has submitted the bid independently and without consultation, communication,
agreement or arrangement with any competitor: YES ☐ NO ☐
b. The Bidder has entered into consultation, communication, agreement or arrangement with one
or more competitors with respect to this invitation to bid, full details of which the Bidder
discloses in the accompanying documents, including the names of the competitors and the
nature of and reasons for such consultation, communication, agreement or arrangement: YES ☐
NO ☐
6. In particular, and without limiting the generality of paragraphs 5 (a) or 5 (b) above, there has been
no consultation, communication, agreement or arrangement with any competitor with respect to:
a. prices
b. methods, factors or formulas used to calculate prices
c. the intention or decision to submit a bid or not, or
d. the submission of a bid that does not meet the specifications of the invitation to bid, except as
specifically disclosed under paragraph 5 (b) above.
7. In addition, there has been no consultation, communication, agreement or arrangement with any
competitor as to the quality, quantity, specifications or delivery details for the products or services
to which this invitation to bid relates as specifically disclosed under paragraph 5 (b) above.
8. The terms of the bid submitted have not been and shall not be knowingly disclosed by the Bidder,
whether directly or indirectly, to any competitor prior to the date and time of the official bid-
opening ceremony, or contract-awarding ceremony, whichever comes first.
9. I declare that the company I represent has commercial links with the following

27
 UNOPS eSourcing v2017.1

10. corporations: [indicate the corporations that may or may not submit a bid for the purpose of this
invitation to bid, detailing their commercial names and the type of links that exist with them. 1 If
there are no commercial links with any corporations, please enter “None”].

The above statements are also true and complete for the members of the joint venture: YES ☐ NO ☐ [If the
answer is NO, details must be included of the members for whom any of the above statements are not met.
This paragraph may be deleted if the Bidder is not a joint venture].

Name : _____________________________________________________________

Position : _____________________________________________________________

Date : _____________________________________________________________

Signature : _____________________________________________________________

1 Bidders with commercial links are required to clearly state such links. Failure to do so may be interpreted as
a proscribed practice as set out in Section 1.5.3.2 of the UNOPS Procurement Manual.

28
 UNOPS eSourcing v2017.1

FORM J: UNITED NATIONS SUPPLIER CODE OF CONDUCT

DECLARATION OF ELIGIBILITY

UNOPS expects all bidders to act in accordance with the highest ethical standards throughout the
competitive procurement process, as well as during the validity of any contract that may be awarded
to them through the process. Therefore, all bidders must declare and ensure the following.
If the bidder’s status in relation to this declaration changes, it must inform UNOPS immediately.
Failure to comply with this requirement shall automatically render the bidder ineligible. This document
does not require notarization.

Bid for the supply of […………] in [……………….], invitation to bid no.: [……….], dated [……….].

The undersigned, on submission of a bid for the competitive procurement process or invitation to bid
(hereinafter referred to as “the bid”) for the [insert brief description of the goods and/or services] in [name of
country/city] – invitation to bid no.: Invitation to bid no.: [insert invitation to bid ref. no.], in response to the call
for bids made by the United Nations Office for Project Services (UNOPS), I hereby make the following
statements:
a) We have not and shall not engage in proscribed practices in connection with the UNOPS competitive
procurement processes. For the purposes of this provision, a “proscribed practice” means any of
those listed on the UNOPS website under “Vendor Sanctions”, including those listed below:
● Corrupt practice: the offering, giving, receiving, or soliciting, directly or indirectly, of anything of
value to influence improperly the actions of another party.
● Fraudulent practice: any act or omission, including a misrepresentation, that knowingly or
recklessly misleads, or attempts to mislead, a party to obtain a financial or other benefit or to
avoid an obligation.
● Coercive practice: any act or omission that impairs or harms, or threatens to impair or harm,
directly or indirectly, any party or the property of the party to improperly influence the actions
of a party.
● Collusive practice: an arrangement between two or more parties designed to achieve an
improper purpose, including influencing improperly the actions of another party.
● Unethical practice: conduct or behaviour that is contrary to the conflict of interest, gifts and
hospitality, post-employment provisions or other published requirements of doing business with
UNOPS.
● Obstruction: acts or omissions by a vendor that prevent or hinder UNOPS from investigating
instances of possible proscribed practices.
b) We understand that in the event of any breach of these declarations or guarantees, UNOPS shall
have the right to reject any bid submitted by us and may terminate any contract awarded to us as a
result of any competitive procurement process, giving immediate notice thereof, and that UNOPS
shall not be liable for termination charges or any other charges. In addition, UNOPS may exclude us
from future work with the organization or other entities within the United Nations system.
c) We commit to adhering to the highest ethical standards during the execution of any contract, in
accordance with point 40. Ethics and corrupt practices of Section II: instructions to bidders of the
bidding document.
d) We understand that UNOPS may cancel or terminate the contract, without penalty and without

29
 UNOPS eSourcing v2017.1

notice, if we are found to have engaged in collusion, corrupt practices or unethical behaviour, and
may also declare us – both our organization and its board of directors and/or individual staff –
ineligible indefinitely or for a limited period of time. We understand that UNOPS may also cancel or
rescind contracts for the same reason.
e) We shall not employ, nor do we plan to employ, any person who has been a United Nations official
in the past year. If an employee has been a United Nations official, they shall have had no
professional relationship with us in the last three (3) years of their service with the United Nations.

The above statements are also true and complete for the members of the joint venture: YES ☐ NO ☐ [If the
answer is NO, details must be included of the members for whom any of the above statements are not met.
This paragraph may be deleted if the Bidder is not a joint venture].

Name : _____________________________________________________________
Position : _____________________________________________________________
Date : _____________________________________________________________
Signature : _____________________________________________________________

30