Item Requested Quantity Unit Cost Total Cost. 1 unit per Kit

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1 RFQ GHSC_PSM_2017_Medical-Equipment-Mozambique No Kit Item & Description Item Requested Quantity Unit Cost Total Cost Goods Total 1 Kits must be sterile packed in plastic bags. Items can be packed inside instrument tray Kit 1,750 1a Surgical instrument tray, with cover, rectangle, with perforated bottom -(inox) -165x90x27mm -Stainless steel Each 1 unit per Kit Forceps Hemoestat: (similar to Medicon ) Delivery Kit -straight, kelly 1b -140mm -Martensitic Stainless Steel, blunt Each 2 unit per Kit 1c Mayo dissecting scissors, (similar to Medicon ) -straight -140 mm -Martensitic Stainless Steel, blunt Each 1 unit per Kit 2 Kits must be sterile packed in plastic bags. Items can be packed inside instrument tray. 1 Kit 1,500 2a Angular Episiotomy scissors, -Braun : (if it needs to be BBRAUN then indicate Braun's item code) -145 mm - Martensitic Stainless steel Each 1 unit per Kit 2b Tissue Forceps: (similar to Medicon ) -spring-type -1X2 teeth -Martensitic Stainless steel -145mm Each 1 unit per Kit 2c Mayo-Hegar Needle holder: (similar to Medicon ) -straight -160 mm -Martensitic Stainless steel Each 1 unit per Kit Intrument and Dressing Tray Covered (With lid), with perforated bottom -Stainless steel -310x195x63mm 2d Each 1 unit per Kit 2e Mayo Scissors: (similar to Medicon ) -Curved -210 mm -Martensitic Stainless steel Each 1 unit per Kit Dressing Forceps Episiotomy Kit -Standard 2f -250 mm -Martensitic Stainless steel Each 1 unit per Kit 2g Sponge Holding Forceps : (similar edicon code ) -Straight -200 mm - Martensitic Stainless steel Each 4 unit per Kit 2h Mayo-Hegar Needle holder : (similar to Medicon ) -straight -Broad-jaw -200 mm - Martensitic Stainless steel Each 1 unit per Kit 2i Forceps Uterine tenaculum pozzi: (similar to Medicon ) -280mm -Curved - Martensitic Stainless steel Each 1 unit per Kit 2j Graves Vaginal Speculum -Bi-Valve - Austenitic Stainless steel Each 3 units per Kit (one small, one medium, one large) 2k Vaginal Speculum: (similar to Medicon ) -Double ended -Sims -165mm -Size 3 - Austenitic Stainless steel Each 1 unit per Kit 3 Kits must be sterile packed in plastic bags. Items can be packed inside instrument tray. 1 Kit 1,250 3a Intrument and Dressing Tray, with perforated bottom and cover. -Covered (with lid) -Stainless steel -350x195x63mm Each 1 unit per Kit Vaginal Retractor (Sims Type) -Size 5 3b -Austenitic Stainless steel Each 3 units per Kit (one small, one medium, one large)

2 3c 3d 3e 3f PPIUD Kit Sponge Holding Forceps: (similar to Medicon ) -200 mm - Martensitic Stainless steel Each 2 units per kit Long Placental Forceps (Kelly placental forceps) - Curved, serrated, fenestrated jaw mm - Martensitic Stainless steel Each 1 unit per Kit Gynecological Scissors, Curved -200mm -Sims Type -Blunt/Blunt -Martensitic Stainless steel Each 1 unit per Kit Sponge Bowl Bacin : -600ML -Stainless steel Each 1 unit per Kit 4 Kits must be sterile packed in plastic bags. Items can be packed inside instrument tray. 1 Kit 300 kits 4a 4b Caesarean-section kit 4c 4d 4e 4f Example of Caesarean kit as recommended by MSF BASKET, INSTRUMENTS, for sterilization, wired 24x25x10 cm 1 CLAMP, TOWEL, BACKHAUS, 13 cm (similar to Medicon ) 4 FORCEPS, HAEMOST. BENGOLEA, 20 cm, curved, serrated (similar to Medicon ) 2 FORCEPS, HAEMOST., KELLY, 14 cm, curved (similar to Medicon ) 2 FORCEPS, HAEMOST. KOCHER, 14 cm, 1x2 teeth straight (similar to Medicon ) 2 FORCEPS, DRESSING, STANDARD, straight, 14.5 cm (similar to Medicon ) 1 FORCEPS, TISSUE GRASPING, DUVAL, 23 cm, jaws 20 mm (similar to Medicon ) 4 FORCEPS, TISSUE, STAND, 1x2 teeth, straight 14.5 cm (similar to Medicon ) 1 GALIPOT, stainless steel 100 ml, 8 cm 1 NEEDLE HOLDER, MAYO-HEGAR, standard, 18 cm (similar to Medicon ) 1 RETRACTOR, ABD. GOSSET, 2 blades 58 mm + centr. bl. (similar to Medicon ) 1 RETRACTOR, FARABEUF, doub. end., pair, 15 cm (similar to Medicon ) 1 SCALPEL HANDLE, nº4 standard (similar to Medicon ) 1 SCISSORS, METZEMBAUM, curved, 18 cm (similar to Medicon ) 1 SCISSORS, MAYO, curved 17 cm, (similar to Medicon ) 1

3 Annex 5 Price Quotation Form Name of Offeror: Contact Name Company Address Date of the quotation: Currency of quotation : Validity of quotation: USD See additional tabs for Price Quotations and Product List Vendor Comments: *Note: Please add any additional lines as necessary. In case of discrepancy between unit price and total, the unit price shall prevail. I hereby certify that the company mentioned above, which I am duly authorized to sign for, has reviewed RFQ GHSC_PSM_Medical-Equipment- Mozambique including all annexes, amendments to the RFQ document (if applicable), and the responses provided by Chemonics International, Inc., on clarification questions from the prospective service providers. Further, the company accepts the Chemonics International, Inc., General Conditions Name and title Date and place

4 RFQ GHSC_PSM_2017_Medical-Equipment-Mozambique No Item & Description Item Requested Quantity Unit Cost Total Cost Goods Total 4 Tape Umbilical, Cotton, non-sterle, 3mm wide X 100ml spool each 8,000 5 Plasic aprons 90X110 cm washable, PVC (Pack of 3 units) Packs of 3 units 1, Macintosh Sheeting/Hospital Rubber Sheeting, superior extra quality superior (double leaf) autoclavable, width 90 cm (meters). Mutli-use, resuable meters 3,000 Tape measure, Vinyl, guided 150 cm on one side, guided 60" on the other side. CE Certification each 2,000

5 RFQ GHSC_PSM_2017_Medical-Equipment-Mozambique No Item & Description Item Requested Quantity Unit Cost Total Cost Goods Total 8 9 Sphygmomanometer, electronic type -Latex free -nylon cuff -Index and Range Markings -artery indicator mark -gaugeholder -Cuff Range:10"-16" -CE Certificate -ISO ISO Each 300 Pinard Aluminium Fetoscopes -CE Certificate -ISO ISO13485 Each Vacuum Extractor Set, manual operated -Complete with 3 S.S. Cups, (40, 50, 60mm): Please include full description of the vaccum extractor with number of handles, suction cup, trap cup with lid, wire disks, tubes, wires, O-rings for fluid trap cup, brushes -PVC pressure tube -Traction Handle -Suction Pump Spare parts: 1 cup, 1 trap lid, 1 trap cup, 1 to 2 belt disks, 1 to 2 belts, 1 to 2 tubes, 1 to 2 O-rings for trap -CE Certificate - ISO Each 400

6 RFQ GHSC_PSM_2017_Medical-Equipment-Mozambique No Item & Description Item Requested Quantity Unit Cost Total Cost Goods Total New-Born Heating Lamp -Adjustable height and light intensity -Mobile Stand VM V Each 300 Examination Light on mobile stand -220 V. Arm -105 cm articulated, spring loaded arm with on/off switch and incorporayed electronical transformer -Bulb: 12 V/20W, halogen, light intensity: lux at 50 cm -Mobile stand with five swivel castors -Reflector adjustable for positioning LED Lamp, 17 Watts Longevity of LED : between and hours Dual intensity set-up: 50% or 100% switch on the top of the lamp Illuminated field to 30 ( LUX) cm : Ø 20 cm White light similar to that of the day : 5000 K Mobile trolley with 5 antistatic castors Power cable lenght 3 meters Warranty 5 years Each Gynecological examination table/delivery Bed/Table -Stainless steel tubular frame -Foam cushions, 5 cm thick, covered with fire-retardant, cleanable synthetic upholstery (laminated fabric) -Size: 1680X600X800mm -with 3 Sections: adjustable Back rest, seat & leg rest to varying positions -Framework made of Stainless Steel -Supplied with SS Bowl, two leg holders and a stand infusionwheel; -Adjustable headrest -Pair of leg supports (stirrups are not very comfortable and not suitable in case of long-lasting operation; i.e. curettages) -Removable stainless steel pan -Foldaway feet for transport -Weight: ± 50 kg -Mounted on protective stumps -Freight saving knockdown construction. -Delivered folded in a box Each Medical Examination Table, Foldable - Welded stainless steel tubular frame - High density foam cushions (ideally 30 kg/m³): covered with fire-retardant, cleanable upholstery (laminated fabric) thickness: minimum 5 cm - dismountable, with loose covers - 3 jointed sections: back equipped with handles, with adjustable height and sitting angle seat entirely foldaway or removable leg rest - Trendelenburg's position up to ± 30º (position in which the patient is lying inclined, with the head down), adjustable by gas strut - Standard DIN rails (32 x 8 mm) on both sides of the table, which allow the accessories to be fixed -With 2 Sections, drop leaf section removable and adustable to 6 positions above and bellow horizontal. -Complete with polyurethane filled pad covered with waterproof, washable materials. detachable heel stirrups and leg holders with canvas straps. Legs on 4 rubber feet. -Metallic. : -Height: 75 to 80 cm - Width: 65 cm minimum (allowing a comfortable position in lateral decubitus) - Back length: ± 85 cm (allowing sitting and semi-sitting position) - Seat length: ± 30 cm - Leg rest length: ± 70 cm - Total length: ± 190 cm Each 600

7 16 Simple Hospital Bed -adult size Chromium plated frame Headboard and footboard (plain or mesh) Epoxy coated grid base Manual backrest Bed height: ± 55 cm - Sleep surface: 200 x 80 cm -Manually adjustable height with a hand adjuster - With wheels and brakes Each 2, Hospital Bed mattress -adult size, approximate dimensions 193x90x10 -Premium-grade cotton and high density urethan foam, interfufted to elminate compoent shifting and increase the life of the mattress -10cm thickness - vinyl waterproof, acid resisant, antistatic and anitbaterial cover that is complaiant with fire code regulations Each 2,500 Simple Hospital Overbed Table -steel -with wheels and brakes -adjustable height Each 1,500

8 RFQ GHSC_PSM_Medical-Equipment-Mozambique No Item & Description Item Requested Quantity Unit Cost Total Cost Goods Total Rubber suction bulb for newborn -to remove mucous from newborns *transparent silicone *easy to open, close, clean and disinfect *ergonomic and easy grip each 3,500 Neonatal resuscitation Kit *Baby resuscitator model *2 face masks (infant size) *suction bulb *reusable 1 Kit 5 Resuscitator *triangular mask (adult size) *silicone *reusable each 650

Beds and Related Equipment for HSP

Beds and Related Equipment for HSP ITEM NUMBER TOTAL QTY BS-01 Single bed & Matress 28 BS-02 Double bed & Matress 2 BS-03 Bed for medical examination 4 BS-04 Folding bed 13 BS-05 3 sections hospital bed