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Government of Karnataka
BELGAUM INSTITUTE OF MEDICAL SCIENCES, BELGAUM
TU
TE OF ME
D
IC
L
SCI
ENC ES
B E LG A U M
I
ST
A
IN
AUTONOMOUS INSTITUTE
(Registered Under Societies Registration Act)
Dr. B. R. Ambedkar Road, Belgaum – 590 001.
Phone No: 0831-2420320, Fax: 0831-2420173
e.mail : [email protected]
TENDER DOCUMENT
For HOSPITAL SOFTWARE MANAGEMENT, NETWORKING &
MAINTENANCE OF HARDWARE AND SOFTWARE.
The tender documents can be downloaded from our
Website: https://www.eproc.karnataka.gov.in/
TIME TABLE
Commencement of download of e-Tender Form
18-01-2014 at 11:00 a.m.
from website- https://eproc.karnataka.gov.in
Last Date for pre-bid Queries on or before
28-01-2014 at 4:00 p.m.
Pre-bid Meeting
Last Date for Uploading of Tender in
e-procurement platform on or before
Opening of Techno-Commercial Bid
E.M.D.
03-02-2014 at 11:00 a.m.
19-02-2014 till 3:00 p.m.
21-02-2014 at 3:00 p.m.
Rs.1,00,000.00
Signature of the Tenderer
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BELGAUM INSTITUTE OF MEDICAL SCIENCES, BELGAUM.
PHONE NO: 0831-2420320, Fax: 0831-2420173
TENDER NOTIFICATION
No: BIMS/GNL(2)/05/2013-14
Dated: 16-01-2014
INVITATION FOR TENDER
The Director, Belgaum institute of medical sciences, Belgaum, hereby invites tenders
under e-tendering system from eligible tenders, as detailed in the document of this Tender, as
per the Karnataka Transparency in Public Procurement Act 1999 and Rules 2000, thereunder
(Under Two Cover System).
The Tenderers should have Annual Turnover for last three years i.e. for 2010-11,
2011-12 & 2012-13 of not less than Rs. 50.00 Lakhs per Annum certified by Chartered
Accountant, are eligible to participate in this Tender.
a) The term ‘Authorized Signatory’, means a Proprietor /Proprietreix, or a Managing partner
or an whole-time employee, in executive cadre, in a Proprietorship Concern / Partnership
Firm or a person who is working as Managing Director / Director Finance / Director
Marketing / General Manager / Assistant General Manager / Manager / Company
Secretary in the Tenderer Company, who has authority to take decision on the spot with
regard to all the aspects of the Tender.
b) The term “PURCHASER” for the purpose of placing the order, accepting / rejecting the
goods, payments and sending samples, for testing by the Director, Belgaum institute of
medical sciences, Belgaum and any other agency authorized by the Institute, who are
bound by the Contract in pursuance of this Tender.
c) The term “TENDERER” means one who is participating in this tender, as per the
eligibility condition.
d) The term “TENDERER” refers to the successful Tenderer who has entered into an
agreement with Director, Belgaum Institute Of Medical Sciences, Belgaum for the
purpose of providing service as detailed in the tender document.
e) The Director, Belgaum Institute Of Medical Sciences, Belgaum shall be the Tendering
Authority for the purpose of this tender.
3. Tenders of only those Tenderers who fulfil the Terms and Conditions of this tender will be
considered for evaluation.
The tenders will undergo evaluation at every stage of processing and any tender found at
any stage, not in conformity with the stipulated tender conditions including specifications
/ found to have uploaded defective and incomplete documents / samples of formats found
not in conformity with the specifications or found defective either physically or
analytically, will be rejected.
4. Interested eligible Tenderers may obtain further information from the Office of the
Director, Belgaum institute of medical sciences, Belgaum. Ph: 0831-2420320, Fax:
0831-2420173.
Signature of the Tenderer
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5.
Schedule of Events:-
Commencement of download of e-Tender Form
from website- https://eproc.karnataka.gov.in
Last Date for pre-bid Queries on or before
18-01-2014 at 11:00 a.m.
Last Date for Uploading of Tender in
e-procurement platform on or before
Opening of Techno-Commercial Bid
E.M.D.
19-02-2014 till 3:00 p.m.
Pre-bid Meeting
28-01-2014 at 4:00 p.m.
03-02-2014 at 11:00 a.m.
21-02-2014 at 3:00 p.m.
Rs.1,00,000.00
(b)
Venue: Office of the Director, Belgaum Institute Of Medical Sciences, Belgaum.
Dr. B. R. Ambedkar Road, Belgaum.
Ph: 0831-2420320, Fax: 0831-2420173
(c )
Opening of Financial Bid/Commercial Bid:Price Bid of only those Techno-Commercially responsive Tenderers will be opened
on a date notified or on any further date to be notified/ informed to the TechnoCommercially responsive Tenderers.
Validity of Contract – On Contract basis for a period of 12 months extendable by 6
months from the date of issue of Award of Rate Contract.
(d)
(e)
Validity of the Tender : Tenders shall remain valid for 180 days (One hundred and
eighty days) after the deadline for submission of tenders prescribed by the purchaser,
a Tender valid for shorter period shall be rejected by the purchaser, as NonResponsive.
6.
Completed Tender document shall be uploaded through e-tendering system using their
user ID and to be addressed to the Office of the Director, Belgaum Institute Of
Medical Sciences, Belgaum, in the manner described under instructions in Section– II,
on or before the last date and time stipulated.
Signature of the Tenderer
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Clause Topic Page
SECTION II: INSTRUCTIONS TO TENDERERS
TABLE OF CLAUSES
A. Introduction
1. Eligible Tenderer
2. Cost of Tendering
B. Tender Documents
3. Contents of Tender Documents
4. Clarification of Tender Documents
5. Amendment of Tender Documents
C. Preparation of Tenders
6.. Language of Tender
7. Documents Comprising the Tender
8.. Tender Form
9. Tender Prices
10. Tender Currency
11. Documents Establishing Tenderer’s Eligibility and Qualifications
12. Documents Establishing Goods Eligibility and Conformity to Tender Documents
13. Earnest Money Deposit
14. Period of Validity of Tenders
15. Format and Signing of Tender
D. Submission of Tenders
16. Sealing and Marking of Tenders
17 Deadline for submission of Tenders
18. Late Tenders
19 Modification and Withdrawal of Tenders
E. Tender Opening and Evaluation of Tenders
20 Opening of Tenders by the Purchaser
21 Clarification of Tenders
22 Preliminary Examination
23 Evaluation and Comparison of Tenders
24 Contacting the Purchaser
F. Award of Contract
25 Post-qualification
26 Award Criteria
27 Purchaser’s Right to Vary Quantities at Time of Award
28 Purchaser’s Right to Accept any Tender and to Reject any or all Tenders
29 Notification of Award
30 Signing of Contract
31 Performance Security
32 Corrupt and Fraudulent Practices
Signature of the Tenderer
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SECTION II: INSTRUCTION TO TENDERERS
A. Introduction
1. Eligible Tenderers
1.1 Tenderers should not be associated, or have been associated in the past, directly or
indirectly, with a firm or any of its affiliates which have been engaged by the Purchaser
to provide consulting services for the preparation of the design, specifications, and other
documents to be used for the procurement of the goods to be purchased under this
Invitation of Tenders.
1.2 Bidders shall not be under a declaration of ineligibility for corrupt and fraudulent
practices issued by Government of Karnataka
2. Cost of Tendering:
2.1 The Tenderer shall bear all costs associated with the preparation and submission of its
tender, and Director, B.I.M.S. Belgaum, hereinafter referred to as "the Purchaser", will in no
case be responsible or liable for these costs, regardless of the conduct or outcome of the
tender process.
B. The Tender Documents
3. Contents of Tender Documents
3.1 The goods required, tendering procedures and contract terms are prescribed in the tender
documents. In addition to the Invitation for Tenders, the tender documents include:
(a) Instruction to Tenderers (ITT) ;
(b) General Conditions of Contract (GCC) ;
(c) Special Conditions of Contract (SCC) ;
(d) Schedule of Requirements;
(e) Technical Specifications;
(f) Tender Form and Price Schedules;
(g) Earnest Money Deposit Form;
(h) Contract Form;
(i) Performance Security Form;
(j) Performance Statement Form;
(k) Manufacturer’s Authorization Form; and
Equipment and Quality Control Form
3.2 The Tenderer is expected to examine all instructions, forms, terms, and specifications in
the tender documents. Failure to furnish all information required by the tender
documents or submission of a tender not substantially responsive to the tender
documents in every respect will be at the Tenderer’s risk and may result in rejection of
its tender.
4. Clarification of Tender Documents
4.1 A prospective Tenderer requiring any clarification of the tender documents may notify the
Purchaser in writing or by telex or cable or fax at the Purchaser's mailing address
indicated in the Invitation for Tenders. The Purchaser will respond in writing to any
request for clarification of the tender documents which it receives no later than 15 days
prior to the deadline for submission of tenders prescribed by the Purchaser. Written
copies of the Purchaser's response (including an explanation of the query but without
identifying the source of inquiry) will be sent to all prospective tenderers which have
received the tender documents.
Signature of the Tenderer
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5.
Amendment of Tender Documents (l)
5.1
At any time prior to the deadline for submission of tenders, the Purchaser may, for
any reason, whether at its own initiative or in response to a clarification requested by
a prospective tenderer, modify the tender documents by amendment. All addendums
and amendments will be notified in the e-procurement portal.
5.2 DELETED
5.3 In order to allow prospective tenderers reasonable time in which to take the amendment
into account in preparing their tenders, the Purchaser, at its discretion, may extend the
deadline for the submission of tenders.
C. Preparation of Tenders
6. Language of Tender
6.1 The tender prepared by the Tenderer, as well as all correspondence and documents
relating to the tender exchanged by the Tenderer and the Purchaser, shall be written in
English language. Supporting documents and printed literature furnished by the
Tenderer may be in another language provided they are accompanied by an accurate
translation of the relevant passages in the English language in which case, for purposes
of interpretation of the Tender, the translation shall govern.
7. Documents Constituting the Tender
7.1 The tender prepared by the Tenderer shall comprise the following components, which are
to be uploaded in the e-procurement portal.
(a) A Tender Form and a Price Schedule completed in accordance with ITT Clauses 8, 9 and
10;
(b) Documentary evidence established in accordance with ITT Clause 11 that the Tenderer is
eligible to tender and is qualified to perform the contract if its tender is accepted;
(c) Documentary evidence established in accordance with ITT Clause 12 that the services to
be provided by the are in conformity to the tender document; and
(d) Earnest money deposit furnished in accordance with the conditions of the e-procurement
portal.
8. Tender Form
8.1 The Tenderer shall complete the Tender Form and the Price Schedule furnished in the
tender documents, indicating the service to be provided, a brief description description
of the service etc,.
9. Tender Prices.
9.1 The Tenderer shall quote for the complete requirement of the service specified under
schedule of requirements at Annexure – I on a single responsibility basis, failing which
such tenders will not be taken into account for evaluation and will not be considered for
award
9.2 Prices indicated on the Price Schedule shall be uploaded as per the format of the e-portal.
(i) the price of the service quoted should include all duties and sales and other taxes already
paid or payable.
a. DELETED
b. DELETED
(ii) DELETED
(iii) DELETED
Signature of the Tenderer
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(iv) the price of other incidental services listed in Clause 4 of the Special Conditions of
Contract.
9.3 The Tenderer’s separation of the price components in accordance with ITT Clause 9.2
above will be solely for the purpose of facilitating the comparison of tenders by the
Purchaser and will not in any way limit the Purchaser's right to contract on any of the
terms offered.
9.4 Prices quoted by the Tenderer shall be fixed during the Tenderer’s performance of the
Contract and not subject to variation on any account. A tender submitted with an
adjustable price quotation will be treated as non-responsive and rejected, pursuant to
ITT Clause 22.
10. Tender Currency
10.1 Prices shall be quoted in Indian Rupees:
11. Documents Establishing Tenderer's Eligibility and Qualifications
11.1 Pursuant to ITT Clause 7, the Tenderer shall furnish, as part of its Tender, documents
establishing the Tenderer’s eligibility to tender and its qualifications to perform the
Contract if the tender is accepted.
11.2 The documentary evidence of the Tenderer's qualifications to perform the Contract if its
tender is accepted, shall establish to the Purchaser's satisfaction:
(a) that, in the case of a Tenderer offering to supply goods under the contract which the
Tenderer did not manufacture or otherwise produce, the Tenderer has been duly
authorized (as per authorization form in Section XIII) by the goods' Manufacturer
or producer to supply the goods in India.
(The item or items for which Manufacturer’s Authorization is required should be specified)
[Note: Supplies for any particular item in each schedule of the tender should be from one
manufacturer only. Tenders from agents offering supplies from different
manufacturer's for the same item of the schedule in the tender will be treated as nonresponsive.]
(b) that the Tenderer has the financial, technical, and production capability necessary to
perform the Contract and meets the criteria outlined in the Qualification requirements
specified in Section VII. To this end, all tenders submitted shall include the following
information:
(i) The legal status, place of registration and principal place of business of the company or
firm or partnership, etc.;
(ii) Details of experience and past performance of the tenderer on equipment offered and on
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those of similar nature within the past three/five years and details of current contracts
in hand and other commitments (suggested proforma given in Section XII);
12. DELETED
Signature of the Tenderer
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13. Earnest Money Deposit/ Bid security1.The Tenderer can pay the Earnest Money Deposit (EMD) of Rs.1,00,000.00 (Rupees
One Lakh only) in the tender (Exclusive of Tax, duties & other charges) in the eprocurement portal using any of the following payment modes: Credit Card
 Direct Debit
 National Electronic Fund Transfer (NEFT)
 Over the Counter (OTC)
OTC Designated Bank Branches listed in Annexure-II can be obtained through website
http://eproc.karnataka.gov.in in bidders section where a bidders section where a bidder
can make a payment.
The Tenderer’s Bid will be evaluated only on confirmation of receipt of the payment
Earnest Money Deposit (EMD) in the GOK’s central pooling A/C held at ICICI Bank.
EMD amount will have to be submitted by the bidder taking into account the following
conditions :
a. EMD will be accepted only in the form of electronic cash (and not through Bank
Guarantee) and will be maintained in the Govt.’s central pooling account at ICICI
Bank until the contract is closed.
b. The entire EMD amount for a particular tender has to be paid in a single transaction.
c. The EMD money received for all the tenders floated through the e-Procurement
platform will be collated and maintained in a central pooling account.
REFUND OF EMD
The EMD money will be kept in the central pooling account until the tender is
awarded to the successful Tenderer.
Based on the instructions of Tender Accepting Authority (TAA) the EMD amount of the
unsuccessful Tenderers will be refunded to the respective Bank a/c’s of the Tenderer
registered in the e-Procurement system.
14. Period of Validity of Tenders
14.1 Tenders shall remain valid for 180 days after the deadline for submission of tenders
prescribed by the Purchaser, pursuant to ITB Clause 17. A tender valid for a shorter
period shall be rejected by the Purchaser as non-responsive.
14.2 In exceptional circumstances, the Purchaser may solicit the Tenderer's consent to an
extension of the period of validity. The request and the responses thereto shall be made
in writing (or by cable or telex or fax). The earnest money deposit provided under ITT
Clause 13 shall also be suitably extended. A Tenderer may refuse the request without
forfeiting its earnest money deposit. A Tenderer granting the request will not be
required nor permitted to modify its tender.
15. Format and Signing of Tender
15.1 The Tenderer shall upload all the documents original / notarized copy in the eprocurement portal.
Signature of the Tenderer
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D. Submission of Tenders
16. The Tenderers are advised to upload all the corresponding documents, which are
necessary for establishing their eligibility for the award of contract in the eprocurement portal.
16.1 DELETED.
16.2 DELETED:
16.3 DELETED
16.4 DELETED.
16.5 DELETED.
17. Deadline for Submission of Tenders
17.1 Tenders must be received by the Purchaser at the E-PORTAL not later than the time and
date specified in the Invitation for Tenders (Section I). In the event of the specified date
for the submission of Tenders being declared a holiday for the Purchaser, the Tenders
will be received upto the appointed time on the next working day.
17.2 The Purchaser may, at its discretion, extend this deadline for submission of tenders by
amending the tender documents in accordance with ITB Clause 5, in which case all
rights and obligations of the Purchaser and Tenderers previously subject to the deadline
will thereafter be subject to the deadline as extended.
18. DELETED
19. Modification and Withdrawal of Tenders
19.1 The Tenderer may modify or withdraw its tender after the tender's submission, provided
that written notice of the modification or withdrawal is received by the Purchaser prior
to the deadline prescribed for submission of tenders.
19.2 DELETED.
19.3 No tender may be modified subsequent to the deadline for submission of tenders.
19.4 No tender may be withdrawn in the interval between the deadline for submission of
tenders and the expiration of the period of tender validity specified by the Tenderer on
the Tender Form. Withdrawal of a tender during this interval may result in the
Tenderer's forfeiture of its earnest money deposit, pursuant to ITT Clause 13.7.
E. Tender Opening and Evaluation of Tenders
20. Opening of Tenders by the Purchaser
20.1 The Purchaser will open all technical bid of the tenders, in the presence of Tenderers’
representatives who choose to attend, at —— hours on ——, in the office of the
Director, B.I.M.S. Belgaum.
The Tenderers' representatives who are present shall sign a register evidencing their
attendance. In the event of the specified date of Tender opening being declared a
holiday for the Purchaser, the tenders shall be opened at the appointed time and
location on the next working day.
20.2 The price bids of the technically approved tenders will be opened on the dates to be
notified.
20.3 DELETED.
20.4 The Purchaser will prepare minutes of the tender opening.
Signature of the Tenderer
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21. Clarification of Tenders
21.1 During evaluation of tenders, the Purchaser may, at its discretion, ask the Tenderer for a
clarification of its tender. The request for clarification and the response shall be in
writing and no change in prices or substance of the tender shall be sought, offered or
permitted.
22. Preliminary Examination
22.1 The Purchaser will examine the tenders to determine whether they are complete,
whether any computational errors have been made, whether required sureties have been
furnished, whether the documents have been properly signed, and whether the tenders
are generally in order.
22.1.1 DELETED.
22.2 DELETED.
22.3 DELETED.
22.4 DELETED..
22.5 If a tender is not substantially responsive, it will be rejected by the Purchaser and may
not subsequently be made responsive by the Tenderer by correction of the nonconformity.
23. Evaluation and Comparison of Tenders
23.1 The Purchaser will evaluate and compare the tenders which have been determined to be
substantially responsive, pursuant to ITT Clause 22 for each schedule separately. No
tender will be considered if the complete requirements covered in the schedule is not
included in the tender. However, as stated in ITT Clause 9, Tenderers are allowed the
option to tender for any one or more schedules and to offer discounts for combined
schedules. These discounts will be taken into account in the evaluation of the tenders
so as to determine the tender or combination of tenders offering the lowest evaluated
cost for the Purchaser in deciding award(s) for each schedule.
23.2 The Purchaser's evaluation of a tender will exclude and not take into account:
(a) any allowance for price adjustment during the period of execution of the Contract, if
provided in the tender.
23.3. The tenders are evaluated as per the prices quoted in the price schedule as
per the e-procurement portal of the technically qualified tenderers.
(a) DELETED.
(b) DELETED.
(c) DELETED.
(d) DELETED.
(e) DELETED.
(f) DELETED.
(g) DELETED.
23.4 DELETED.
Signature of the Tenderer
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24. Contacting the Purchaser
24.1 Subject to ITT Clause 21, no Tenderer shall contact the Purchaser on any matter relating
to its tender, from the time of the tender opening to the time the Contract is awarded. If
the tenderer wishes to bring additional information to the notice of the purchaser, it
should do so in writing.
24.2 Any effort by a Tenderer to influence the Purchaser in its decisions on tender evaluation,
tender comparison or contract award may result in rejection of the Tenderer's tender.
F. Award of Contract
25. Postqualification
25.1 In the absence of prequalification, after the examinataion of the technical bid, the price
bids of technically qualified tenders will be opened as per the e-portal the Purchaser
will determine to its satisfaction whether the Tenderer that is selected as having
submitted the lowest evaluated responsive tender meets the criteria specified in ITT
Clause 11.2 (b) and is qualified to perform the contract satisfactorily.
25.2 The determination will take into account the Tenderer's financial, technical and
capabilities. It will be based upon an examination of the documentary evidence of the
Tenderer's qualifications submitted by the Tenderer, pursuant to ITT Clause 11, as well
as such other information as the Purchaser deems necessary and appropriate.
25.3 An affirmative determination will be a prerequisite for award of the Contract to the
Tenderer. A negative determination will result in rejection of the Tenderer's tender, in
which event the Purchaser will proceed to the next lowest evaluated tender to make a
similar determination of that Tenderer's capabilities to perform the contract
satisfactorily.
26. Award Criteria
26.1 Subject to ITT Clause 28, the Purchaser will award the Contract to the successful
Tenderer whose tender has been determined to be substantially responsive and has been
determined as the lowest evaluated tender, provided further that the Tenderer is
determined to be qualified to perform the Contract satisfactorily.
27. Purchaser's right to vary Quantities at Time of Award
27.1 The Purchaser reserves the right at the time of Contract award to increase or decrease by
up to 25 percent of the quantity of goods and services originally specified in the
Schedule of Requirements without any change in unit price or other terms and
conditions.
28. Purchaser's Right to Accept Any Tender and to Reject Any or All Tenders
28.1 The Purchaser reserves the right to accept or reject any tender, and to annul the
tendering process and reject all tenders at any time prior to contract award, without
thereby incurring any liability to the affected Tenderer or Tenderers.
29. Notification of Award
29.1 Prior to the expiration of the period of tender validity, the Purchaser will notify the
successful tenderer in writing by registered letter or by cable/telex or fax, to be
confirmed in writing by registered letter, that its tender has been accepted.
29.2 The notification of award will constitute the formation of the Contract.
29.3 Upon the successful Tenderer's furnishing of performance security pursuant to ITT
Clause 31, the Purchaser will promptly notify the name of the winning Tenderer to
each unsuccessful Tenderer and will discharge its earnest money deposit, pursuant to
ITT Clause 13.
Signature of the Tenderer
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29.4 After notification of award, the PURCHASER will promptly publish the grounds on
which the tender is selected and the reasons for other tenders which are not selected.
30. Signing of Contract
30.1 At the same time as the Purchaser notifies the successful tenderer that its tender has been
accepted, the Purchaser will send the Tenderer the Contract Form provided in the
tender documents, incorporating all agreements between the parties. 30.2 Within 21
days of receipt of the Contract Form, the successful Tenderer shall sign and date the
Contract and return it to the Purchaser.
31. Performance Security
31.1 Within 21 days of the receipt of notification of award from the Purchaser, the successful
Tenderer shall furnish the performance security in accordance with the Conditions of
Contract, in the Performance Security Form provided in the tender documents or in
another form acceptable to the Purchaser.
31.2 Failure of the successful Tenderer to comply with the requirement of ITT Clause 30.2 or
ITT Clause 31.1 shall constitute sufficient grounds for the annulment of the award and
forfeiture of the earnest money deposit, in which event the Purchaser may make the
award to the next lowest evaluated Tenderer or call for new tenders.
32 Corrupt or Fraudulent Practices
32.1 The Government requires that Tenderers/ Suppliers/ Contractors observe the highest
standard of ethics during the procurement and execution of Government financed
contracts. In pursuance of this policy, the Government :
(a) defines, for the purposes of this provision, the terms set forth as follows :
(i) “corrupt practice” means the offering, giving, receiving or soliciting of any thing of value
to influence the action of a public official in the procurement process or in
contract execution; and
(ii) “fraudulent practice” means a misrepresentation of facts in order to influence a
procurement process or the execution of a contract to the detriment of the
Government, and includes collusive practice among Tenderers (prior to or
after tender submission) designed to establish tender prices at artificial noncompetitive levels and to deprive the Government of the benefits of free and
open competition;
(b) will reject a proposal for award if it determines that the Tenderer recommended for award
has engaged in corrupt or fraudulent practices in competing for the contract in
question;
(c) will declare a firm ineligible, either indefinitely or for a stated period of time, to be
awarded a Government financed contract if it at any time determines that the firm
has engaged in corrupt or fraudulent practices in competing for, or in executing, a
Government-financed contract.
32.2 Furthermore, Tenderers shall be aware of the provision stated in sub-clause 4.4 and subclause 23.1 of the General Conditions of Contract.
Signature of the Tenderer
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SECTION III: GENERAL CONDITIONS OF CONTRACT
TABLE OF CLAUSES
Clause
1. Definitions
2. Application
3. Standards
4. Use of Contract Documents and Information; Inspection and Audit by Government
5. Patent Rights
6. Performance Security
7. Inspection and Tests
8. Packing
9. Delivery and Documents
10. Insurance
11. Transportation
12. Incidental Services
13. Spare Parts
14. Warranty
15. Payment
16. Prices
17. Change Orders
18. Contract Amendments
19. Assignment
20. Subcontracts
21. Delays in Supplier's Performance
22. Liquidated Damages
23. Termination for Default
24. Force Majeure
25. Termination for Insolvency
26. Termination for Convenience
27. Settlement of Disputes
28. Limitation of Liability
29. Governing Language
30. Applicable Law
31. Notices
32. Taxes and Duties
Signature of the Tenderer
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SECTION III – GENERAL CONDITIONS OF CONTRACT
General Conditions of Contract
1. Definitions
1.1 In this Contract, the following terms shall be interpreted as indicated:
(a) "The Contract" means the agreement entered into between the Purchaser and the Supplier,
as recorded in the Contract Form signed by the parties, including all the attachments
and appendices thereto and all documents incorporated by reference therein;
(b) "The Contract Price" means the price payable to the Supplier under the Contract for the
full and proper performance of its contractual obligations;
(c) "The Goods" means all the equipment, machinery, and/or other materials which the
Supplier is required to supply to the Purchaser under the Contract;
(d) "Services" means services ancillary to the supply of the Goods, such as transportation and
insurance, and any other incidental services, such as installation, commissioning,
provision of technical assistance, training and other obligations of the Supplier
covered under the Contract;
(e) “GCC” means the General Conditions of Contract contained in this section.
(f) “SCC” means the Special Conditions of Contract.
(g) “The Purchaser” means the organization purchasing the Goods, as named in SCC.
(h) “The Purchaser’s country” is the country named in SCC.
(i) “The Supplier” means the individual or firm supplying the Goods and Services under this
Contract.
(j) “The Government” means the Government of Karnataka State.
(k) “The Project Site”, where applicable, means the place or places named in SCC.
(l) “Day” means calendar day.
2. Application
2.1 These General Conditions shall apply to the extent that they are not superseded by
provisions in other parts of the Contract.
3. Standards
3.1 The services to be provided under this Contract shall conform to the standards mentioned
in the Technical Specifications in the tender document.
4. Use of Contract Documents and Information; Inspection and Audit by the
Government
4.1 The Supplier shall not, without the Purchaser's prior written consent, disclose the
Contract, or any provision thereof, or any specification, plan, drawing, pattern, sample
or information furnished by or on behalf of the Purchaser in connection therewith, to
any person other than a person employed by the Supplier in performance of the
Contract. Disclosure to any such employed person shall be made in confidence and shall
extend only so far as may be necessary for purposes of such performance.
4.2 The Supplier shall not, without the Purchaser's prior written consent, make use of any
document or information enumerated in GCC Clause 4.1 except for purposes of
performing the Contract.
4.3 Any document, other than the Contract itself, enumerated in GCC Clause 4.1 shall remain
the property of the Purchaser and shall be returned (in all copies) to the Purchaser on
completion of the Supplier's performance under the Contract if so required by the
Purchaser.
Signature of the Tenderer
15
4.4 The supplier shall permit the Government to inspect the Supplier’s accounts and records
relating to the performance of the Supplier and to have them audited by auditors
appointed by the Government, if so required by the Government.
5. Patent Rights
5.1 The Supplier shall indemnify the Purchaser against all third-party claims of infringement
of patent, trademark or industrial design rights arising from use of the Goods or any part
thereof in India.
6. Performance Security
6.1 Within 21 days of receipt of the notification of contract award, the Supplier shall furnish
Performance Security to the Purchaser for an amount of 5% of the Contract Value, valid
up to 60 days after the date of completion of performance obligations including
Warranty obligations. In the event of any correction of defects or replacement of
defective material during the Warranty period, the Warranty for the corrected/replaced
material shall be extended to a further period of 12 months and the Performance
Security for proportionate value shall be extended 60 days over and above the initial
Warranty period.
6.2 The proceeds of the performance security shall be payable to the Purchaser as
compensation for any loss resulting from the Supplier's failure to complete its
obligations under the Contract.
6.3 The Performance Security shall be denominated in Indian Rupees and shall be in the form
of Demand Draft of Nationalised / Scheduled Banks, drawn in favour of Director B
.I.M.S. Belgaum, payable at Belgaum,
6.4 to 14.5 DELETED.
15. Payment
15.1 The method and conditions of payment to be made to the Supplier under this Contract
shall be specified in the SCC.
15.2 The Supplier's request(s) for payment shall be made to the Purchaser in writing,
accompanied by an invoice describing, as appropriate, the Goods delivered and the
Services performed, and by documents, submitted pursuant to GCC Clause 9, and upon
fulfillment of other obligations stipulated in the contract.
15.3 Payments shall be made promptly by the Purchaser but in no case later than sixty (60)
days after submission of the invoice or claim by the Supplier.
15.4 Payment shall be made in Indian Rupees.
16. Prices
16.1 Prices payable to the supplier as stated in the contract shall be firm and are valid for 12
months (extendable for 6 months) during the performance of the contract.
17. Change Orders
17.1 The Purchaser may at any time, by written order given to the Supplier pursuant to GCC
Clause 31, make changes within the general scope of the Contract in any one or more of
the following:
(a) DELETED;
(b) DELETED;
(c) DELETED;
(d) the Services to be provided by the Supplier.
17.2 DELETED
18. Contract Amendments
18.1 Subject to GCC Clause 17, no variation in or modification of the terms of the Contract
shall be made except by written amendment signed by the parties.
Signature of the Tenderer
16
19. Assignment
19.1 The Supplier shall not assign, in whole or in part, its obligations to perform under the
Contract.
20. Subcontracts
20.1 The Supplier shall not sub contract all or any of the services mentioned in the Annexure
– I.
20.2 DELETED.
21. Delays in the Supplier's Performance
21.1 Providing of the Services shall be made by the Supplier in accordance with the time
schedule specified by the Purchaser in the Schedule of Requirements.
21.2 DELETED.
21.3 DELETED.
22. Liquidated Damages
22.1 Subject to GCC Clause 24, if the Supplier fails to perform the Services within the
period(s) specified in the Contract, the Purchaser shall, without prejudice to its other
remedies under the Contract, deduct from the Contract Price, as liquidated damages, a
sum equivalent to 0.5% of the delivered price of the delayed Goods or unperformed
Services for each week or part thereof of delay until actual delivery or performance, up
to a maximum deduction of 10% of the Contract Price.. Once the maximum is reached,
the Purchaser may consider termination of the Contract pursuant to GCC Clause 23.
23. Termination for Default
23.1 The Purchaser may, without prejudice to any other remedy for breach of contract, by
written notice of default sent to the Supplier, terminate the Contract in whole or part:
(a) if the Tenderer fails to deliver any or all of the services within the period(s) specified in
the Contract, or within any extension thereof granted by the Purchaser pursuant to
GCC Clause 21; or
(b) if the Tenderer fails to perform any other obligation(s) under the Contract.
(c) DELETED.
23.2 DELETED.
24. Force Majeure
24.1 Notwithstanding the provisions of GCC Clauses 21, 22, 23, the Supplier shall not be
liable for forfeiture of its performance security, liquidated damages or termination for
default, if and to the extent that, its delay in performance or other failure to perform its
obligations under the Contract is the result of an event of Force Majeure.
24.2 For purposes of this Clause, "Force Majeure" means an event beyond the control of the
Supplier and not involving the Supplier's fault or negligence and not foreseeable. Such
events may include, but are not limited to, acts of the Purchaser either in its sovereign or
contractual capacity, wars or revolutions, fires, floods, epidemics, quarantine restrictions
and freight embargoes.
24.3 If a Force Majeure situation arises, the Supplier shall promptly notify the Purchaser in
writing of such conditions and the cause thereof. Unless otherwise directed by the
Purchaser in writing, the Supplier shall continue to perform its obligations under the
Contract as far as is reasonably practical, and shall seek all reasonable alternative means
for performance not prevented by the Force Majeure event.
Signature of the Tenderer
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25. Termination for Insolvency
25.1 The Purchaser may at any time terminate the Contract by giving written notice to the
Supplier, if the Supplier becomes bankrupt or otherwise insolvent. In this event,
termination will be without compensation to the Supplier, provided that such
termination will not prejudice or affect any right of action or remedy which has accrued
or will accrue thereafter to the Purchaser.
26. Termination for Convenience
26.1 DELETED.
26.2 DELETED:
27. Settlement of Disputes :
27.1 The Purchaser and the supplier shall make every effort to resolve amicably by direct
informal negotiation any disagreement or dispute arising between them under or in
connection with the Contract.
27.2 If, after thirty (30) days, the parties have failed to resolve their dispute or difference by
such mutual consultation, then either the Purchaser or the Supplier may give notice to
the other party of its intention to commence arbitration, as hereinafter provided, as to the
matter in dispute, and no arbitration in respect of this matter may be commenced unless
such notice is given.
27.2.1 Any dispute or difference in respect of which a notice of intention to commence
arbitration has been given in accordance with this Clause shall be finally settled by
arbitration. Arbitration may be commenced prior to or after delivery of the Goods under the
Contract.
27.2.2 Arbitration proceedings shall be conducted in accordance with the rules of procedure
specified in the SCC.
27.3 Notwithstanding any reference to arbitration herein,
(a) the parties shall continue to perform their respective obligations under the Contract unless
they otherwise agree; and
(b) the Purchaser shall pay the Supplier any monies due the Supplier.
28. Limitation of Liability
28.1 Except in cases of criminal negligence or willful misconduct, and in the case of
infringement pursuant to Clause 5,
(a) the Supplier shall not be liable to the Purchaser, whether in contract, tort, or otherwise, for
any indirect or consequential loss or damage, loss of use, loss of production, or loss
of profits or interest costs, provided that this exclusion shall not apply to any
obligation of the Supplier to pay liquidated damages to the Purchaser; and
(b) the aggregate liability of the Supplier to the Purchaser, whether under the Contract, in tort
or otherwise, shall not exceed the total Contract Price, provided that this limitation
shall not apply to the cost of repairing or replacing defective equipment.
29. Governing Language
29.1 The contract shall be written in English language. Subject to GCC Clause 30, English
language version of the Contract shall govern its interpretation. All correspondence and
other documents pertaining to the Contract which are exchanged by the parties shall be
written in the same language.
30. Applicable Law
30.1 The Contract shall be interpreted in accordance with the laws of the Union of India.
Signature of the Tenderer
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31. Notices
31.1 Any notice given by one party to the other pursuant to this Contract shall be sent to other
party in writing or by cable, telex or facsimile and confirmed in writing to the other
Party’s address specified in SCC.
31.2 A notice shall be effective when delivered or on the notice's effective date, whichever is
later.
32. Taxes and Duties
32.2 Suppliers shall be entirely responsible for all taxes, duties, license fees, octroi, road
permits, etc., incurred until delivery of the contracted Goods to the Purchaser.
Signature of the Tenderer
19
SECTION-II
SPECIAL CONDITIONS OF CONTRACT.
1.1
The Tenderer shall be uploaded only if the Tenderer is agreeable to all the Terms and
Conditions of this Tender, which includes the Description and Specifications of the
services / items mentioned therein.
The Tenderer shall upload the tenders through e-tendering system using User’s ID and
Digital Signature Certificate for Techno-Commercial and Price Bids.
Services / Items required are listed in Annexure-1.
a.
b.
1.2
Irrespective of the terms and conditions the Tenderer may have specified, only the
terms and conditions specified in this tender shall be binding on the Tenderer and the
tendering authority.
2.
The Tenderer shall upload the tender in the manner described here under: -
A.
TECHNO-COMMERCIAL BID SHALL CONTAIN DOCUMENTS LISTED
UNDER TECHNICAL QUALIFICATION CRITERIA.
A.3.
Original Certificate of Incorporation signed by the Registrar of Companies (ROC) in
case of a company/firm. Original proprietoryship Certificate in case of a proprietary
firm, place of registration and principal place of business of the company / firm.
A.4 Copy of Sales Tax/VAT Registration Certificate along with Commodity
Description of the Tenderer is to be uploaded.
A.5 Copy of PAN Card of the Tenderer is to be uploaded.
A.6 Sales Tax Clearance Certificate
Sales Tax cleared up to 31-03-2013 of the Tenderer as per Annexure-III or in the valid
format of the Commercial Tax Department, for preceding three years i.e. for the years
2010-11, 2011-12 & 2012-13 is to be uploaded,
A.7 Annual Turn over Statement.
For preceding three financial years 2010-11, 2011-12 & 2012-13 i.e. for 31-03-2011, 3103-2012 & 31-03-2013 of the Tenderer should up load the copy of Annual Turn over
Statement along with his Annual Turn over certified by Commercial Tax Officer/Charted
Accountant as per Annexure-IV is to be uploaded.
A.8 Balance sheet and Profit & Loss Account.
The tenderer should upload the Balance Sheet and Profit & Loss account for preceding
three financial years 2010-11, 2011-12 & 2012-13 i.e., for 31-03-2011, 31-03-2012 & 3103-2013 of the Tenderer certified by Chartered Accountant.
Signature of the Tenderer
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A.9-a) Tender Offer Form
Tender Offer Form with an undertaking to abide by the terms and conditions of the
tender in the format as per Annexure –IX-Part-I, of the Tenderer is to be uploaded.
A.9-b) Declaration From
Declaration from the Tenderer in the format as per Annexure-IX Part II of the
Tenderer is to be uploaded.
A.10. Seal and Signature
The tender document shall have Seal and Signature on all pages including the
Annexures by the authorized signatory [Vide Section I, 1 (a)].
A.11. The Documents/Certificates should be:-
a) The Documents uploaded should be clearly visible failing which such documents
shall not be considered.
b) The documents uploaded in general documents should be named individually.
A.12. Solvency Certificate:
The Tenderer should upload the Solvency Certificate (addressed to the Director,
BIMS Belgaum) from Nationalised / Scheduled Bank in respect to this tender in original
equal to 10% of bid value or Rs.5,00,000 whichever is higher.
A.13. Submission of Original Documents
The original documents uploaded under Technical Bid should be produced before the
Tender Committee on the date to be notified later.
B. PRICE BID SHALL CONTAIN THE DOCUMENTS LISTED HEREUNDER:
B.1 (i) PRICE SCHEDULE
a) Price Schedule format shall be furnished in the e-procurement platform.
The rate quoted for the service detailed in the tender document as per Annexure
– I, which shall be inclusive of Excise duty, and local Sales tax / VAT and any
other taxes etc,.
b-1) The rate quoted in the e-procurement platform format should be for the service. The
Tenderers are strictly prohibited to change/alter specification or unit size given in the
e-procurement platform format otherwise the rates offered will not be considered.
b-2) The services mentioned in the Tender Document should be taken into consideration,
while quoting the rates.
B.2
Both the Technical Bid & Commercial Bid for providng the services shall have to be
uploaded under appropriate headings.
a) In the event of any discrepancy with respect to the rates quoted the Purchaser
reserves the right to accept the lowest rate.
b) All pages of the Tender except for printed literature if any enclosed shall carry the
full signature of the person signing the Tender.
Signature of the Tenderer
21
Annexure – 1
HOSPITAL SOFTWARE MANAGEMENT, NETWORKING &
MAINTENANCE OF HARDWARE AND SOFTWARE.
1. Services to be provided along with efficient personnel for the
following counters.
a. Causalty – 3 Shifts.
Round the Clock
b. Maternity – 3 Shifts.
(i)
Billing Counter– 3 Nos.
(ii) OPD Counter – 3 Nos.
(iii) IPD Counter – 2 Nos.
General Shift 8:30 a.m. to 4:00 p.m.
(iv) MRD Counter – 2 Nos.
(v) Medical Store – 2 Nos.
(vi) Laboratory – 2 Nos.
Works to be carried out and reports to be generated for the following.
I.
Registration & Medical Records Department:
A.
Out Patient Registration
1.
Out Patient Registration Castewise New
2.
Out Patient Registration Castewise Old
3.
Out Patient Registration Report
4.
Cash Receipt Details
5.
Medico Legal Cases
6.
108 (Ambulance) Help Shifted Patient
7.
Any other Schemes subsequently implemented by Govt.
8.
O.P. Agewise Statistics (As per WHO pattern)
9.
O.P. Sexwise Statistics (As per WHO pattern)
10.
Patient Alpha Index
11.
O.P. Service wise Statistics
12.
O.P. Geographical wise Statistics
13.
New Government Schemes
14.
O.P. New & Old Department Statistics wise
15.
Yashaswini
16.
Rashtriya Bima Yojane
17.
Suvarna Arogya Chaitanya
18.
Senior Citizens (Giriatric)
19.
Defence ECHS Scheme
Signature of the Tenderer
22
B.
In Patient Registration
1.
Castewise New I.P. Registration
2.
Castewise Old I.P. Registration
3.
Renewal admissions
4.
Change of ward
5.
General admissions
6.
Daily In Patient Registration Report
7.
Daily Cash Receipt Vouchers
8.
Death Registration Enquiry
9.
Daily Discharge Report
10.
Daily Hospital Deaths
11.
Daily Medico Legal Cases
12.
Daily I.P. Ward Details
13.
Daily On Diseases Group
14.
Daily On Diseases Name
C.
D.
15.
Daily Yashaswini I.P. Details
16.
Daily Rashtriya Bima Yojane I. P. Details
17.
Daily Suvarna Arogya Chaitanya I. P. Details
18.
Daily Senior Citizens (Giriatric) I. P. Details
19.
Daily Defence ECHS Scheme I. P. Details
20.
Daily 108 (Ambulance) Help Shifted Patient Details
21.
Any other Schemes (implement) subsequently
22.
I.P. Dept. wise Statistics
23.
I.P. Agewise Statistics
24.
I.P. Sexwise Statistics
25.
I.P. Patient enquiry
26.
Ward side Bed Management
Loan Register Details.
Census (midnight)
1.
Remaining patients
2.
Admissions
3.
Transfer In
4.
Discharges
5.
Transfer Out
6.
Deaths
7.
Total
Signature of the Tenderer
23
E.
Daily Discharge Entries
1.
Relieved
2.
Cured
3.
Unchanged
4.
A.M.A.
5.
Worse
6.
Total Discharge list with details
7.
Expired
8.
Others
F.
Daily Accession Register
G.
Certificate Module.
1.
All types of Certificates, Monthly Reports & Issued
Certificates.
H.
Monthly Report & Issued Certificates Statistics (As per
M.C.I. norms) & Government Requirement
I.
Hospital Re-visits
1.
O. P. Details of daily Re-visits
2.
I. P. Patients Re-visits details
II.
Patients Billing
1.
Cash Receipts
2.
Cash Payment
3.
Account Settlement
4.
Daily Inward Vouchers
5.
Daily General Cash Ledger
6.
Daily Cash Collection Summary Investigationwise
7.
Viewed off Summary
8.
Doctorwise receipts etc.
9.
Monthly Cash Receipts Statement
III.
Birth & Death Registration
1.
Birth Details Register
2.
Statistical of Birth Census by Sex
3.
Statistical of Births by Method of Delivery
4.
Hospital Death Registration
5.
Statistical of Death Census by Sex
6.
Birth Report from Entries.
7.
Still Birth Entries
8.
Death Entries
9.
Birth & Death Certificates
Signature of the Tenderer
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IV.
Casualty / Emergency Registration.
1.
O.P. Registration Statistics by Sex / by Caste
2.
I. P. Registration Statistics by Sex / by Caste
3.
Daily Cash Receipts
4.
Daily Casualty Process
5.
O.P. Details statistics
6.
I.P. Details Statistics
V.
Labor Ward Registration
1.
Patients Management
2.
Births
3.
Deaths
VI.
I.C.D. 10th Edition Coding
1.
Surgical & Diagnostic Coding
2.
Diagnostic Index
3.
Operational Index
4.
Physicians Index
VII.
Diagnostic Departments - Central Lab
1.
Pathology
a.
Histo pathology
b.
Haemetology
c.
Cytogenetic
d.
Cyto pathology
2.
3.
4.
5.
Microbiology
Bio-Chemistry
Blood Collection Centre
a.
Requisition / Reporting
b.
New Requisiton Statistics
c.
Test Requested Details
d.
Requisition by Departmentwise Details
e.
Tests Conducted Daily Report
f.
Pending Requisition Report
g.
Test Confirmation Report
h.
Print new Requisiton Format
i.
Print Test Requested Format
Lab Investigation statistics As per M.C.I.
Signature of the Tenderer
25
VIII.
Yashaswini / Rashtriya Bima Yojane / Defence ECHS Scheme
Credit Billing Statement
1.
Day Book
2.
Inward Vouchers Daily
3.
Print Beneficiaries List
4.
General Ledger Department wise
5.
Monthly Statement Department wise
6.
Monthly Statement Branch wise
IX.
Radio Diagnosis
1.
2.
3.
4.
5.
6.
7.
X.
Dialysis
XI.
Blood Bank
XII.
Diet
X-Ray
Ultra Sound
CT Scanning
Mammography
Daily Reporting Diagnostic wise
Monthly Reporting Diagnostic wise
Radiological Investigations Statistics as per M.C.I.
1.
2.
Dialysis Registration and Report
Monthly Report
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Donors Registration
Daily Voluntary Blood Donors Census
General Reports
Statistical Report on Voluntary Blood Donors by Sex
Blood Group Inventory
Blood Collection Details
Lab Test Reports
Blood Requisition Ledger
Blood Issue Ledger
Expired Blood Group List
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Daily Diet Requisiton by Ward
Process Diet Roll
Process Diet Articles
Process Admission Statistics
Process Discharge Statistics
General Stock Ledger
Diet Distribution List Daily
Query Patient Diet Roll – Daily by Ward
Query Patient Diet Roll – Daily by Department
Total Diet Monthly
Total Diet by Ward Monthly
Diet Articles Monthly
Signature of the Tenderer
26
XIII.
Drugs & Chemicals
1.
Stock Register of Drugs & Chemicals
2.
Daily Expenditure
3.
Daily Local Purchase
4.
Monthly Expenditure
5.
Requirements
6.
Supply from District Drugs Logistic Society
7.
Daily Indent
8.
V.I.P. Kits etc.
XIV.
Equipments / Instruments
1.
Stock Register of major and minor equipments /
instruments
2.
Repair of major and minor equipments / instruments
3.
Purchase of major and minor instruments / equipments
4.
Annual Maintenance Contract of major equipments
XV.
Consolidated Report
1.
Daily Consolidated Report
2.
Monthly for respected wards
XVI.
Administration System
1.
Set-up of Hospital Information
2.
General Master
3.
Department / Unit Details
4.
Doctors Details
5.
Set-up User Charges
6.
I.C.D. Disease Codes
7.
Set-up Statistical Heads
8.
Set-up Voucher Type
XVII. Waste Management
1.
Colour Coding
2.
Daily Collection – Solid waste / Bio-waste
3.
Daily disposal
4.
Monthly disposal
5.
Monthly Report
XVIII. FORMATS
1.
2.
3.
4.
Out Patient Record
O.P. Follow Up Sheet
Cash Receipt
Admission Record
Signature of the Tenderer
27
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
Maternity Admission Sheet
Neonatal Unit
Ophthalmology
Cross Reference Form
Consent Form for Anaesthesia, Operation Etc.
Case Summary & Discharge Record
History
Doctor’s Order
Progress Notes
Nurses Notes
Treatment Chart
Tablets / Injections
Culture for A.F.B.
Requisition for dept. of Pathology
Requisition for Dept. of Radiology
Requisition for Dept. of Pathology - Haematology
Requisition for Dept. of Microbiology
Clinical Bio-chemistry Laboratory
Requisition for Dept. of Radio – Diagnosis
Requisition for Dept. of Surgery
Requisition for Dept. of Haemodialysis Record
Discharge Order
Any other formats suggested by the authorities.
3. The following expenditure should be met out for the maintenance by the
tenderer:
a) Maintenance and repairs if any of the Computers, servers.
b) Maintenance of Hospital Software
c) Network repair and maintenance.
d) UPS including batteries repairs and maintenance.
e)
All Stationeries for printed forms, printer ribbons, cartridge, etc.,
4. Pertaining to any Hospital management, permanent software as described in
Annexure-I a permanent software installed & facilitate for all networking in full
pledged. After completion of tender period the software will not be returned.
They can be coded. The tenderer will have no right on the installed software.
The software shold be of following specification.
a. The solution must be built on Client Server Technology with 3-tier
architecture.
Signature of the Tenderer
28
b. The Database platform should be Oracle 12i or above.
c. The solution must have cleared tests on Microsoft Windows 2003
Server, Windows XP, Windows 2000 and Windows NT. (Install
latest version if required)
d. The software should integrate activities of all the Depts.
5. Software and server managements are to be looked after by the tenderer and
he is solely responsible for its maintenance.
6. Skilled and qualified computer operators are to be provided for work.
7. The management and operations should work for all the 24 hours.
8. After completion of tender period the tender may be extended for 6 months.
9. The personnel engaged in the hospital management and software and
networking services must be provided uniform and identity card.
10. The personnel should work under the directions of Asst. Medical Record
Officer or other higher officers.
11. The tenderer is responsible for any problematic deviations or lapses for that
tenderer is only responsible and liable for any losses.
12. The tenderer should make the arrangements to carry forward the existing data
of our hospital management and make available the same as and when
required.
Signature of the Tenderer
29
TI
TU
TE OF ME
DI
C
L
SC I
ENC ES
B E LG A U M
S
A
IN
FORMAT-1
BELGAUM INSTITUTE OF MEDICAL SCIENCES
HOSPITAL, BELGAUM
(Autonomous Medical Institution, Government of Karnataka)
Dr. B. R. Ambedkar Road, Belgaum.
Phone No. 0831-2420173/2420320
OUT PATIENT SLIP
O.P.R. No.:
Date:
Name
:
Dept.:
Address
:
Contact No.:
Age
:
Sex:
Unit:
Category (Caste):
Occupation:
BPL Card No.:
Others:
Reg. Charges:
Defence / Sr. Citizen / Yashaswini / Rashtriya Arogya Beema / Suvarna Arogya
Chaitanya
Signature of the Tenderer
30
IT
UTE
OF M
E
DI
C
L
SC I
ENC ES
B E LG A U M
ST
A
IN
FORMAT-2
BELGAUM INSTITUTE OF MEDICAL SCIENCES
HOSPITAL, BELGAUM
(Autonomous Medical Institution, Government of Karnataka)
OP FOLLOW UP SHEET
Signature of the Tenderer
31
IT
UTE
OF M
E
DI
C
L
SC I
ENC ES
B E LG A U M
ST
A
IN
FORMAT-3
BELGAUM INSTITUTE OF MEDICAL SCIENCES
HOSPITAL, BELGAUM
(Autonomous Medical Institution, Government of Karnataka)
Cash Receipt
OP / IP No.:
Income Group:
Name:
Age:
Receipt No.:
Counter No.:
Sex:
Sl.
DOA:
DOD:
Date:
Days:
Description
Amount
No.
Rs.
Ps.
TOTAL
Rupees in words:
Cashier Signature
Signature of the Tenderer
AL
ENCES
SCI
BELGAUM I
N
32
OF M
UTE
ED
IT
IC
ST
FORMAT-4
BELGAUM INSTITUTE OF MEDICAL SCIENCES
HOSPITAL, BELGAUM
SYMBOL
(Autonomous Medical Institution, Government of Karnataka)
ADMISSION RECORD
Name of Patient
Service & Unit
Age
Sex
Marital Status
Hospital No.
Ward
Bed
Religion
Income
Father's / Husband's Name
Address
Occupation
Door No.
District
Street
Village
State
Town
Post
M.R.D. No.
Readmission
Telephone No.
Address
Telegraphic
Head of Service
Date of Admission
Nearest Police Station
Emergency Address
Date of Discharge
Status
Hospital Days
A. General
B. Staff
Defficiency Checked by
C. Staff Dependent
D. Student
Provisional / Admission
Diagnosis
FINAL DIAGNOSIS
Write
Principal
Diagnosis
First
(In block letters)
International Code
Secondary Diagnosis
& Complications (In
block letters)
Date
CREATIVE
PROCEDURES
POST-OPERATIVE
INFECTION
Consulations
RESULT
*CAUSE OF
DEATH
Cured
Relieved
Unchanged
A.M.A.
NIL / PRESENT / TYPE OF
DOMINENT ORGANISM
PRESENT
Otherwise
Autopsy
Signature of
Registrar
Worse
Expired*
*State the disease, injury or complication which caused death. This does NOT mean the mode of
dying, such as, heart failure, respiratory failure etc.
Yes
No
Signature of
Head of Unit
MEDICAL RECORD DEPARTMENT USE ONLY
No. of Sheets in recors
Lab. Reports
Biopsy Reports
Admission Order
Hosp-MRD No.
Admission
Diagnosis
X-ray Reports
EKG/EEG Reports
Discharge Note
Checked by
Hosp-MRD No.
Admission
Diagnosis
ADMISSION RECORD
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BELGAUM INSTITUTE OF MEDICAL SCIENCES
HOSPITAL, BELGAUM
(Autonomous Medical Institution, Government of Karnataka)
M¦àUÉAiÀÄ £ÀªÀÄÆ£É
CONSENT FORM
(gÉÆÃV¬ÄAzÀ CxÀªÁ CªÀ£À ¥Àæw¤¢ü¬ÄAzÀ vÀÄA©¸À¨ÉÃPÀÄ)
gÉÆÃVAiÀÄ ºÉ¸ÀgÀÄ Name of the Patient :
£Á£ÀÄ ................................................................................................................ ¸ÀAPÉÆÃZÀ«®èzÉ ªÀÄvÀÄÛ £À£Àß ¥ÀÆtðeÁÕ£À¢AzÀ
zÉÊ»PÀ gÉÆÃUÀ «zsÁ£À ¥ÀjÃPÉëUÉ gÀPÀÛ ¸ÀAAiÉÆÃd£ÉUÉ, ±À¸ÀÛçaQvÉìUÉ ªÉÊzÀågÀÆ CxÀªÁ EvÀgÀ, ¤±ÉÑÃvÀ£ÀUÉƽ¸ÀĪÀ aQvÉìUÁV ¸ÀA¥ÀÆtð
¸ÀªÀÄäw PÉÆqÀĪɣÀÄ ªÀÄvÀÄÛ EzÀPÉÌ ¸ÀA§A¢ü¹zÀ ±À¸ÀÛçaQvÉì ªÉÊzÀågÀÆ CxÀªÁ D¸ÀàvÉæUÉ ¸ÀA§A¢ü¹zÀ ¹§âA¢AiÀĪÀgÀÄ EzÀPÉÌ
ºÉÆuÉUÁgÀgÀ®è.
I ……………………………………………………………….. the under signed and in my full sense, give
my complete consent for my diagnostic examination, biospy, transfusion or operation under any type
of Anaesthesia and I agree that no reposibility will be attached to the surgeon or hospital staff.
¢£ÁAPÀ:
Date:
gÉÆÃVAiÀÄ ¸À»
gÉÆÃVAiÀÄ (¥Àæw¤¢üAiÀÄ ¸À»)
Signature of the Patient
Signature of the Patient (Representative)
INCOME DECLARATION
I………………………………….……..…… hereby declare that Sri / Smt ………………..…………………
is my relative and is wholly dependent on me and my annual income is Rs. …………………...
Date
Time
Signature of the Patient / Representative
AGAINST MEDICAL ADVICE
Ward No…………… Bed No……… Pt’s Name……………………………………Age…..…..Yrs. I am
responsible for taking the above patient out of hospital against the advice of the Doctor In-charge of
the Case.
Date
Time
Signature of the Patient / Representative
REQUISITION FOR SPECIAL WARDS
Recommended
for
admission
of
Rs…………….
Special
ward.
Name
of
the
Patient……………………………... I.P. Reg. No………………… Dt. Of Admn………………….… Name
of Unit….……………………………….
Provnl. iagnosis…………………………………………………………………………………………………...
Note: Please mention the name of the Doctor in Block letters
Signature of the Unit Head
ALLOTMENT OF SPECIAL ROOMS (WARDS)
Alloted special room (ward) bed No…..………… of Ground / I / II flor of Rs……………. per day
on……………..….. at…………….…..
Date
Collected
Time
a
sum
Rs……………………..
Superintendent
BIMS Hospital, Belagavi
(Of the use of hospital office)
Rs……..…………..…
advance
towards
on…………………………..vide
the
special
Receipt
room
(Ward)
of
No…………….……..
Date………………….. and entered in the register against the serial No……………….. of 20 .
Date
Time
Asst. Administrative Officer,
BIMS Hospital, Belagavi
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FORMAT-5
BELGAUM INSTITUTE OF MEDICAL SCIENCES
HOSPITAL, BELGAUM
(Autonomous Medical Institution, Government of Karnataka)
MATERNITY ADMISSION SHEET
Name
Age
Service
Sex
Ward
Mar. Status
Bed
Admission
Date
In Pregnancy
In Labour
L.M.P.
Occ.
Time
Religion
Examined on admission by
Post-natal
Hosp. No.
Income
Student(s)
Reason for admission
E.D.D.
Maturity on admission
CLASSIFICATION OF PRESENT PREGNANCY:
Antenatal Period
Delivery
Puerperium
Infant
Classification
History of present pregnancy / Antenatal care received:
(P.T.O.)
Signature of the Tenderer
35
PAST OBSTETRIC HISTORY:
Pregnancy
Month
Year
Health
Facility
A.N.
Health
P.O.G.
Personal history
Labour
Duration
in hours
Puerperium
Type of
Delivery
Marital history
Infant
Alive or
Still birth
Weight
Sex
Present
health
Family history
Bowels:
Micturation:
Previous illness / Operations:
On examination
Anaemia
Oedema
Varicose veins
Breasts
R.S.
C.V.S.
At Discharge:
Mother
Obstetric Examination
Hight
Weight
B.P.
Baby
Signature of Doctor
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FORMAT-6
BELGAUM INSTITUTE OF MEDICAL SCIENCES
HOSPITAL, BELGAUM
SYMBOL
(Autonomous Medical Institution, Government of Karnataka)
DEPARTMENT OF PEDIATRICS
NEONATAL UNIT
MOTHER’S DETAILS
Name:
Age:
Hosp. No.:
O.G. Unit:
BABY’S DETAILS
Type of Delivery:
Indication:
Consanguinity:
Date & Time of Delivery:
Booked / Unbooked:
Apgar at 1’
Immunized / Unimmunized
Resuscitation:
Para Gravida:
Suctions / O2 by mask / Mounth to mouth:
Previous Still Births:
Intubation and IPPR:
Mother’s Weight:
Bicarbonate / Lethidrone:
L.M.P.
Sex of the Baby:
E.D.D.
Maturity:
Hb:
Congenital Anomalies:
Blood Group:
Anal Patency:
V.D.R.L.:
Oesophageal Patency:
Other Tests:
Respiratory Distress:
Toxemia:
Cyanosis:
Hydramnios:
Any Other:
P.I.H.
Cord Blood collected / Not collected:
A.P.R.
Investigations on Blood:
Any other illness:
Gastric Aspirate ME -
5’
10’
Birth Weight:
Presentation:
Culture -
Time of Membrane Rupture:
Any Other:
Liquor Quality:
Diagnosis: Term / Pre term / Post term
Quantity:
Male / Female
Drugs to the Mother:
AG / LGA / SGA
Any evidence of Foetal Distress:
ADVICE:
Problem:
1. Keep the baby warm – Covering / Warmer / Incubator
2. Umblical Care
3. Inj. Vitamin K______ mg. I.M. stat
4. Transfer to Nursery / Mother’s side
5. Feeding – Oral / Intragastric / I.V. Fluids
6. Drugs
Signature of the Tenderer
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FORMAT-7
BELGAUM INSTITUTE OF MEDICAL SCIENCES
HOSPITAL, BELGAUM
SYMBOL
(Autonomous Medical Institution, Government of Karnataka)
DEPARTMENT OF OPHTHALMOLOGY
Name:
Hospital No.
Complaints
:
Present History
:
Past History
:
GENERAL EXAMINATION
:
PALLOR:
OEDEMA:
SYSTEMIC EXAMINATION
:
Cardiovascular system
:
Respiratory system
:
Respiratory system
:
Alimentary system
:
Central Nervous system
:
B.P.
PULSE:
[P.T.O.]
Signature of the Tenderer
38
RIGHT EYE
Position of Head
:
Position of Eye Ball
:
Ocular Movements
:
Visual Acuity
:
Retinoscopy + BCVA
:
Eye Brows, Eye Lashes
:
Lids
:
Conjuctiva Cornea
:
Anterior Chamber
:
Iris
:
Lens
:
Pupil
:
Pupillary Reactions
:
Ciliary Tenderness
:
Introcular Pressure
:
Lacrimal Sac
:
Fundus Examination
:
Silt Lamp Examination
:
LEFT EYE
DIAGNOSIS:
Signature of the Tenderer
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SYMBOL
FORMAT-8
BELGAUM INSTITUTE OF MEDICAL SCIENCES
HOSPITAL, BELGAUM
(Autonomous Medical Institution, Government of Karnataka)
Cross Reference Form
Referring Unit:
Referred Unit:
Name:
Age:
Service
Ward
Bed
Sex:
Mar. Status Hosp. No.
Occ.
Our Findings:
Our Problem:
Your Findings:
Your Advice:
Income
Note: 1. Reference from and to Head Units
2. No formal correspondence permitted please.
Signature of the Tenderer
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FORMAT-9
BELGAUM INSTITUTE OF MEDICAL SCIENCES
HOSPITAL, BELGAUM
SYMBOL
(Autonomous Medical Institution, Government of Karnataka)
CONSENT FORM FOR ANAESTHESIA, OPERATION Etc.,
I, ………………………………………………………………………………………..
Hosp. No……………………………………………… in my full senses hereby given my
complete consent for …………………………………………………. or any other
procedure deemed fit which is a / an diagnostic procedure / biopsy / transfusion /
operation to be performed on me / my son / daughter /
……………………………………………...
age
……………………..
my ward
under
any
anaesthesia deemed fit. The nature and the risks involved in the procedure have
been explained to me to my satisfaction.
Date:
Guardian
Signature / Thumb Impression of the Patient /
Signature of Witness:
Guardian :
Name:
Relationship:
Designation:
Full Address:
Signature of the Tenderer
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FORMAT-10
BELGAUM INSTITUTE OF MEDICAL SCIENCES
HOSPITAL, BELGAUM
SYMBOL
(Autonomous Medical Institution, Government of Karnataka)
CASE SUMMARY & DISCHARGE RECORD
NAME
AGE
SERVICE
WARD
SEX
BED
MAR. STATUS
HOSP. NO.
OCC. RELIGION INCOME
PRESENTING SYMPTOMS
PHYSICAL FINDINGS
CLINICAL IMPRESSION
INVESTIGATIONS
TREATMENT
OPERATIVE FINDINGS
BIOPSY REPORT
COURSE IN HOSPITAL
Including Post-operative
FINAL DIAGNOSIS
1. Primary disease
2. Complication
3. Subsidiary disease
CONDITION AT DISCHARGE
RECOMMENDATIONS
Other Side:
CASE SUMMARY &
MR-2 FOLLOW-UP
DISCHARGE RECORD
[P.T.O.]
Signature of the Tenderer
42
FOLLOW-UP CLINIC
Date
Notes
Signature
Note:
It is suggested that notes on follow-up of hospitalized patients be
recorded on this form in addition to or in place of notes etc., on the Out-patients
Record. If further treatment is indicated as an ambulatory patient, then Outpatient Record should be used.
Other Side:
CASE SUMMARY &
FOLLOW -UP CLINIC
DISCHARGE RECORD
Signature of the Tenderer
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FORMAT-11
BELGAUM INSTITUTE OF MEDICAL SCIENCES
HOSPITAL, BELGAUM
(Autonomous Medical Institution, Government of Karnataka)
HISTORY
Name
Age
Ward
Bed No.
Sex
I.P. Reg. No. ____________
Marital Status:
Occupation:
Date & Time
PHYSICAL EXAMINATION ON REVERSE SIDE
[P.T.O.]
Signature of the Tenderer
44
PHYSICAL EXAMINATION
Pulse:
Resp.:
BP:
Weight:
GENERAL
SYSTEMIC
PROVISIONAL DIAGNOSIS
Note: Kindly use only prescribed forms meant for the use of doctors to write about the patients progess and treatment.
Signature of the Tenderer
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SYMBOL
FORMAT-12
BELGAUM INSTITUTE OF MEDICAL SCIENCES
HOSPITAL, BELGAUM
(Autonomous Medical Institution, Government of Karnataka)
DOCTOR’S ORDER
I.P. Reg. No. __________
Name:__________________________ Age:_________ Ward:____________ Unit:_______
Date of
Order
Date of
Discontinuation
INSTRUCTIONS
Note: Every days order should be signed by the medical Attendent with Date & Time.
Signature of the Tenderer
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SYMBOL
FORMAT-13
BELGAUM INSTITUTE OF MEDICAL SCIENCES
HOSPITAL, BELGAUM
(Autonomous Medical Institution, Government of Karnataka)
PROGRESS NOTES
I.P. Reg. No. __________
Name:__________________________ Age:_________ Ward:____________ Unit:_______
Date of Order
Every days notes should be signed by the medical Attendent with Date & Time
Note: Please write only notes on the progress of the patient
Signature of the Tenderer
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SYMBOL
FORMAT-14
BELGAUM INSTITUTE OF MEDICAL SCIENCES
HOSPITAL, BELGAUM
(Autonomous Medical Institution, Government of Karnataka)
NURSES NOTES
I.P. Reg. No. __________
Pt. Name:_________________________ Age:_________ Ward:____________ Unit:______
Date
INSTRUCTIONS
Signature of the Tenderer
48
FORMAT-15
BELGAUM INSTITUTE OF MEDICAL SCIENCES
Unit / Ward
: ____________
Sl.
No.
1
LG AU M
: ____________
BE
I.P. Reg. No.
O F M
U T E
ED
IC
IE N C E S
: ____________
T
TI
SC
Date of Discharge
S
L
: ____________
A
Date of Admission
IN
Name of the Patient : ____________
HOSPITAL, BELGAUM
(Autonomous Medical Institution, Government of Karnataka)
Diagnosis:
TREATMENT CHART
NAME OF THE DRUGS
DATE
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Signature of the Doctor
Signature of the Staff Nurse
Signature of the Tenderer
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FORMAT-16
BELGAUM INSTITUTE OF MEDICAL SCIENCES
HOSPITAL, BELGAUM
(Autonomous Medical Institution, Government of Karnataka)
TABLETS / INJECTIONS
Name:
Countersigned
Hosp. No.:
Signature
Date:
Signature of the Tenderer
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BELGAUM INSTITUTE OF MEDICAL SCIENCES
HOSPITAL, BELGAUM
(Autonomous Medical Institution, Government of Karnataka)
CLINICAL DETAILS
PREVIOUS REPORT REF. NO.
DATE
SIGNATURE OF DOCTOR
NAME
AGE
MAR. STATUS
M/F
HOSP.
NO.
SERVICE
WARD
OCC.
REL.
INCOME
BED
DATE RECEIVED
SIGNATURE OF
BACTERIOLOGIST
NAME & DESIGNATION
IN BLOCK LETTERS
CULTURE FOR A.F.B.
FORMAT-18
BELGAUM INSTITUTE OF MEDICAL SCIENCES
HOSPITAL, BELGAUM
(Autonomous Medical Institution, Government of Karnataka)
SYMBOL
DEPARTMENT OF PATHOLOGY
REQUISITION FOR LABORATORY INVESTIGATIONS
Name of Patient
Ward & Bed No.
Age
Sex
Hosp. No.
Date
Income
Examination Required
Signature
Stool / Urine
Date
REPORT
For Professor of
Pathology
Signature of the Tenderer
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FORMAT-19
BELGAUM INSTITUTE OF MEDICAL SCIENCES HOSPITAL,
BELGAUM
(Autonomous Medical Institution, Government of Karnataka)
DEPARTMENT OF RADIOLOGY
REQUEST FOR DIAGNOSTIC X-RAY
Name of Patient ………………………........
Age ………………
Hosp. No. ……………………….
Unit ………........
Occ ………………
Income ………………………….
Ward / OPD ………….
Diagnosis
(For Departmental
Clinical History & Salient Findings
Use)
Radiological Investigation
X-Ray No.
Size & No.
of Films
Information desired
Date
Tech.
Signature of Requesting
Doctor
Designation
Signature of the Tenderer
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FORMAT-20
BELGAUM INSTITUTE OF MEDICAL SCIENCES HOSPITAL,
BELGAUM
(Autonomous Medical Institution, Government of Karnataka)
SYMBOL
DEPARTMENT OF PATHOLOGY – HAEMATOLOGY
REQUISITION FOR LABORATORY INVESTIGATIONS
Name of Patient:
Service:
OPD/Ward/Bed No.
Age & Sex:
Hosp. No.:
Date:
Income:
Clinical Diagnosis:
Lab No.:
Examination Required:
Signature of Doctor:
Hb: ………….…gm%
RBC: ……………. mill / cumm.
MCH ………………..pg
WBC: …….../cmm
MCHC ………………. gm%
N: ……….%
E: ……….%
PCV: …………….%,
MCH ……………..fl,
Retic Count: …………………..%
B: …………..%
L: …………%
M: ………%
Others …………………………………………………………………..…………….., AEC: ………………../cmm
PLATELETS: …………………………………./cmm
ESR: …………………mm/hr
Peripheral Smear Report:
RBC:
WBC:
Plt:
Parasite:
IMPRESSION:
Date:
For Professor of
Pathology
(P.T.O.)
Special Investigations:
Acid Elution Test :
LE Cell:
Alkali Denaturation Test :
BT : ………………..min / CT : …………………Min
Hb Electrophoresis :
Paracoagulation Test for FDP:
PT : Cont :
Test :
INR :
APTT : Cont : ………………. 1/2 pt + 1/2 cont
Test : …………….... 1/2 pt + ½ f VIII
: ……………… 1/2 pt + ½ f IX
Sickling Test :
HAM’S Test :
G6PD Test :
Others :
Osmotic fragility:
Cont MCF
Test MCF
For Professor of Pathology
Signature of the Tenderer
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FORMAT-21
BELGAUM INSTITUTE OF MEDICAL SCIENCES HOSPITAL,
BELGAUM
(Autonomous Medical Institution, Government of Karnataka)
DEPARTMENT OF MICROBIOLOGY
Investigation for Bacteriological Culture
Urine / Exudate / Stool / Blood / Anaerobic Culture
Name:
Age:
Sex :
Service:
Ward / OPD:
Bed :
Nature of specimen
Date and time of
collection
Investigation required
Previous Report Ref.
No.
Provisional Diagnosis
Details of antibiotics
given if any
Duration of illness
:
:
:
:
:
:
:
Hospital No. :
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
Signature and Designation
of the Doctor
Signature of the Tenderer
54
FORMAT-22
BELGAUM INSTITUTE OF MEDICAL SCIENCES HOSPITAL,
BEGLAUM
(Autonomous Medical Institution, Government of Karnataka)
OF M
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CLINICAL BIOCHEMISTRY LABORATORY
NCES
SCIE
BELGAUM I
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Name :
Age :
Hospital No. :
Sex :
Time of Receipt :
Biochemistry Lab No. :
Name of the test
Blood Glucose
Values
Normal range
70 - 100 mg/dL
Name of the test
Hepato-biliary profile
Values
Normal range
(Fasting)
Blood Glucose
70 - 140 mg/dL
T. Bilirubin
0.4 - 1.2
(Random)
mg/dL
Blood Glucose
(2 hr. postprandial)
<140 mg/dL
OGTT
Direct
0.1 04 mg/dL
Indirect
0.2 0.8 mg/dL
Total protein
6.3 - 8.3
gm/dL
Fasting
<126 mg/dL
Albumin
3.5 - 5.5
gm/dL
2 hr. postprandial
<140 mg/dL
Globulin
2.5 - 3.5
gm/dL
Renal Profile
AST
0 - 40 IU/L
Urea
15 - 40 mg/dL
ALT
0 - 45 IU/L
Creatinine
0.7 - 1.2 mg/dL
GGT
1 - 50 IU/L
Serum electrolytes
Na
K
+
Alkaline
135 - 145 mEq/L
+
3.5 - 5 mEq/L
CI
Lithium (therapeutic)
Calcium ionic
#
30 - 125 IU/L
Phosphatase
Myocardial profile
+
96 - 106 mEq/L
LDH
60 - 200 IU/L
0.6 - 1.2 mEq/L
CK total
20 - 170 IU/L
4.5 - 5.6 mg/dL
CK MB
<6 IU/L
Calcium total
9 - 11 mg/dL
Troponin T*
0 - 0.1 ng/mL
Inorganic phosphorus
2.5 - 4.5 mg/dL
Troponin I*
0 - 0.4 mg/mL
Magnesium*
1.8 - 3 mg /dL
Amylase
28 - 100 IU/L
1.5 - 6.0 mg/dL (F)
Acid phosphatase
1.5 - 4.5 U/L
Uric Acid
2.5 - 7.0 mg/dL
(M)
Prothrombin time
15-40 mg/dL
Glucose
40-70 mg/dL
Chloride
116-130 mEq/L
12 - 18 sec
(INR: 1-1.2)
CSF
Protein
+
OTHERS
Lipid Profile
Total cholesterol
<200 mg/dL
Triglycerides
<150 mg/dL
HDL – Chol
>40 mg/dL
LDL – Chol
<100 mg/dL
VLDL – Chol
<30 mg/dL
The reference ranges of various analytes in blood in adults (until otherwise specified) are reported.
Please discuss with biochemist on duty for any clarification.
#
Separate sample to be sent to EMS
Signature of the Tenderer
*Subject to availability of reagent kits
+
Collect sample to in special tubes containing sodium citrate
Signature of Biochemist
ENCES
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BELGAUM INSTITUTE OF MEDICAL SCIENCES HOSPITAL,
BELGAUM
SYMBOL
(Autonomous Medical Institution, Government of Karnataka)
B. R. Ambedkar Road, Belgaum
CLINICAL BIOCHEMISTRY LABORATORY – REQUISITION FORM
(For assays of routine investigations)
Name :
Age / Sex :
Hospital No. :
Marital Status / Occupation / Income :
Referred by (Unit / Ward No.) :
Provisional Diagnosis :
Treatment given :
Date and time of sample collection :
Anticoagulant : Added / Not added
* Please carry out investigations ticked on reverse and indicate results against each
* Please fix a date for the investigation(s) indicated
Signature of Doctor
Signature of the Tenderer
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AL
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BELGAUM INSTITUTE OF MEDICAL SCIENCES HOSPITAL,
BELGAUM
(Autonomous Medical Institution, Government of Karnataka)
DEPARTMENT OF RADIO – DIAGNOSIS
ECHOCARDIOGRAPHY / ULTRASONOGRAPHY REPORT
ECHO No. :
Date :
Name :
Age :
Sex :
Hosp. No.:
Address :
Mar. Status :
Service :
Ward / Bed :
REPORT :
DIAGNOSIS :
Signature
Detach Here
REQUISITION
(To be filled by Referring Unit)
ECHO No.:
Date :
Clinical Details :
Relevant Lab. Data :
Echo Examn. needed (Parts) :
Clinical Diagnosis :
Signature
Signature of the Tenderer
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FORMAT-24
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BELGAUM INSTITUTE OF MEDICAL SCIENCES HOSPITAL,
BELGAUM
(Autonomous Medical Institution, Government of Karnataka)
DEPARTMENT OF SURGERY
REQUISITION FOR UPPER GASTROINTESTINAL ENDOSCOPY
Name :
Age :
Sex :
Hosp. No.:
Address :
Mar. Status :
Service :
Ward / Bed :
Brief Clinical History :
Physical findings :
Investigations :
Radiological
Investigations :
Indications for Endoscopy :
Requested by :
Designation :
TO BE FILLED UP BY THE ENDOSCOPIST
Date of procedure and time :
Preparation of Patient :
(P.T.O.)
Signature of the Tenderer
58
ENDOSCOPY REPORT :
Premedication :
Date and time of procedure performed :
Endoscopy Number :
Photograph Number :
Whether Biopsy taken :
Performed by :
Designation :
Follow Up :
Signature of the Tenderer
59
ST
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C
A
SC I
B E LG A U M
L
IN
FORMAT-25
OF M
UTE
E
ENC ES
BELGAUM INSTITUTE OF MEDICAL SCIENCES HOSPITAL,
BELGAUM
(Autonomous Medical Institution, Government of Karnataka)
HAEMODIALYSIS RECORD
Name :
Age:
M/F
O.P. No.:
Date:
I.P. No.:
Pre-dialysis assessment :
Dialysis No.:
Pre-dialysis Weight :
Dialyser :
Dialysis Machine :
Weight gain
Hours of HD :
Accesses – AVF R/L
Ultrafiltration
:
Bicarbonate :
:
Heparin-Regular/Rigid/Free
:
- AVG R/L
- IJC
R/L
Blood flow rate
- FC
R/L
Dialysate flow rate :
- SC
R/L
Post dialysis weight :
HBsAG + / - HCV + / - HIV +
“Weight Loss”
Blood Transfusion
:
Dialysis started at :
Time
Diagnosis
B.P.
Blood flow
Heparin
Remarks
Dialysis closed at :
Medications given during HD :
Post dialysis Assessment :
Next Dialysis on :
Doctor’s Signature
DIALYSIS TECHNICIAN RECORD
1. Identity of dialysis & tubing checked by : 1)
2)
2. Dialysis Machine & tubing primed by :
3. Dialysis started by :
4. Dialysis closed by :
5. Dialysis machine checked after dialysis by :
6. After Dialysis, Dialyser and tubing washed by :
7. Dialyser re-use No. :
8. Blood tubing re-use No.:
9. Bundle volume of Dialyser after dialysis :
10. Time of wash of Dialyser and tubing :
Complications of HD :
Signature of the Tenderer
60
UTE
IT
ST
DISCHARGE ORDER
OF M
ED
IC
AL
ENCES
SCI
BELGAUM I
N
FORMAT-26
To,
The ward staff-Nurse (Incharge)
Please discharge the patient viz. Sri./Smt. _______________________________
from the bed number ____________________ on ____________________
at_____________.
Date___________________ Time __________
Signature of the Doctor
-------------------------------------------------------------The patient viz. Sri / Smt. _________________________________ has left the bed
& ward on __________________ at__________ AM / PM.
Date___________________ Time __________
Signature of the ward Staff Nurse
Signature of the Tenderer
61
ANNEXURE – II.
(ref-Section – II Clause No.A.1)
LIST OF ICICI BANK AS PER e-portal.
Signature of the Tenderer
62
ANNEXURE – III
(Ref. Section II Clause No.2.A- 6)
SALES TAX CLEARANCE CERTIFICATE
This is to certify that M/s ………………………………………………………who
is a registered dealer under VAT Act with regarding …………………………… having
VAT TIN NO.…………………………& CST TIN NO. ………………………………has
fixed Sales Tax return and tax cleared up to 31-03-2013 and no dues are outstanding for
the said period.
Signature & Seal
of the Commercial Tax
Authority.
Signature of the Tenderer
63
ANNEXURE -IV
(Ref.Section II - Clause 2.A-7)
ANNUAL TURN OVER STATEMENT
No: BIMS/GNL(2)/05/2013-14
Dated:
The Annual Turnover of M/s. ________________________________________
for the past three years are given below and certified that the statement is true and
correct.
_____________________________________________________________
Sl.No.
Financial years
(Rs)
Turnover in Lakhs
_____________________________________________________________
2010 – 2011 (31-03-2011)
2011 – 2012 (31-03-2012)
2012- 2013 (31-03-2013)
_________________________________________________________
Total Rs. _________________ Lakhs.
__________________________________________________________
Date:
Seal:
Signature of Commercial Tax Officer/ Chartered Accountant
(Name in Capital)
Signature of the Tenderer
64
ANNEXURE- IX PART-I
TENDER OFFER FORM
(Ref. Section II-Clause No. 2A-9 (a)
No: BIMS/GNL(2)/05/2013-14
Dated:
Affix the
Aaa
photograph
of
The Director,
the person
Belgaum Institute Of Medical Sciences,
signing the
Dr. B. R. Ambedkar Road,
document
Belgaum-590 001.
attested by a
Sir,
Gazeted
Having examined the tender documents in connection with the Supply
of Drugs,
Officer/Notary
Chemicals And Miscellaneous to your department under Bulk Purchase with staggered
supplies for one year (Extendable for three Months) called by you, I / We, the
undersigned offer to supply and deliver the above said items in conformity with the
terms and conditions of the tender at the rates quoted in the Annexure if the contract is
awarded in my / our favour.
To,
I / We understand that the quotation offered shall be valid for not more than 12
months (1 Year) from the date of award of tender and may be extended for 6 months.
I / We undertake if our quotation is accepted, I / We will enter into contract to
deliver the goods in accordance with the delivery schedule.
I / We agree to abide by this tender for the specified period.
I / We undertake to submit Security Deposit amount in accordance with the
terms and conditions of the tender if our offer is accepted.
I / We understand that you are not bound to accept the lowest or any quotations
you may receive.
Date:
Place:
Phone No:
Fax No:
Name and Address & Official:
Phone No.
of the person signing the
tender form:
Ph:
Signature:
Name in Capital
Capacity *:
Seal of the firm:
Residential:
Ph:
Signature of the Tenderer
65
ANNEXURE - IX PART-II
TENDER DECLARATION FORM
(Ref. Section II-Clause No.2.A-9 (b)
No: BIMS/GNL(2)/05/2013-14
Dated:
TENDER FOR SUPPLY OF DRUGS, CHEMICALS AND MISCELLANEOUS
FOR THE ONE YEAR
FORMAT OF UNDERTAKING TO BE FURNISHED BY THE TENDERER FOR
HAVING
ACCEPTED THE TERMS & CONDITIONS OF THE TENDER DOCUMENT.
To
The Director,
Belgaum institute of medical sciences,
Belgaum-590 001.
Sir,
In accordance with the terms and conditions of tender document for supply
of DRUGS, CHEMICALS AND MISCELLANEOUS for one year, I / We have
gone through all the terms & conditions and hereby agree to accept and undertake to
abide the same.
Further stating that firm is not Black Listed with any Government/Quasi
Government Organizations & the documents submitted in the Tender are not false/erroneous.
Date
Place
Signature
[
]
Name in capital
Seal of the Firm/Company.
Signature of the Tenderer
66
CONTRACT FORM
No: BIMS/GNL(2)/05/2013-14
Dated:
THIS AGREEMENT made on the ................................day of.........................2014
between ........................(Name of Purchaser with full address) of ..............(Country of
Purchaser) (Hereinafter called "the Purchaser") of the one part and .....................(Name of
Service provider) of .........................(Full address of Supplier) (Hereinafter called "the
Supplier") of the other part :
WHEREAS the Purchaser is desirous that certain Services viz., Hospital Software
Management, Networking & Maintenance Of Hardware And Software
(Brief Description
of the work and Services) and has accepted a Tender by the Service provider in the sum of
.................................................... (Contract Price in Words and Figures) (Hereinafter called
“the Contract Price").
NOW THIS AGREEMENT WITNESSETH AS FOLLOWS:1. In this Agreement words and expressions shall have the same meanings as are respectively
assigned to them in the Conditions of Contract referred to.
2. The following documents shall be deemed to form and be read and construed as part of this
Agreement, viz.:
(a).The Tender Form and the Price Schedule submitted by the Tenderer;
(b).The Schedule of Requirements;.
(c).The Section-I Invitation for Tenderers.
(d). The Section-II Terms and Conditions.
(e).The General Conditions of the Tender.
(f).The Special Conditions of Tender; and
(g).The Purchaser's Notification of Award.
3. In consideration of the payments to be made by the Purchaser to the Supplier as
hereinafter mentioned, the Supplier hereby covenants with the Purchaser to provide the
goods and services and to remedy defects therein in conformity in all respects with the
provisions of the Contract.
4. The Purchaser hereby covenants to pay the Supplier in consideration of the provision of
the goods and services and the remedying of defects therein, the Contract Price or such
other sum as may become payable under the provisions of the Contract at the times and in
the manner prescribed by the Contract.
5. Items described and listed in detail in this Tender and in which awarded to us, on Contract
basis for a period of 12 months extendable by six months from the date of issue of this
Contract Form.
Signature of the Tenderer
67
Brief particulars of the Service which shall be supplied/ provided by the Tenderer are as
under:
Sl
No
Total Value:
Schedule:
Brief Description Services
Total Price
Refer Delivery
IN WITNESS whereof the parties hereto have caused this Agreement to be
executed in accordance with their respective laws the day and year first above written.
Signed,
Sealed
and
said........................................
(For
the
Purchaser)
of:.......................................
Delivered
in
the
by
the
presence
Signed, Sealed and Delivered by the said
..................................................... (For the Supplier) in
the presence of:
………..................................................................
......................
Signature of the Tenderer
68
SPECIAL CONDITION
1) Tenderers should not be associated, or have been associated in
the past, directly or indirectly, with a firm or any of its affiliates
which have been engaged by the Purchaser to provide consulting
services for the preparation of the design, specifications, and
other documents to be used for the procurement of the goods to
be purchased under this Invitation of Tenders.
2) Bidders shall not be under a declaration of ineligibility for corrupt
and fraudulent practices issued by Government of Karnataka
3) The Bidder shall ensure credit of Tender Processing Fee and EMD
into the respective receiving bank accounts of e-Procurement on
or before the last date of bid submission.
4) The tenderer is required to ensure browser compatibility of the
computer well in advance to the last date and time for receipt of
tenders. The departments shall not be responsible for nonaccessibility of e-Procurement portal due to internet connectivity
issues and technical glitches.
Signature of the Tenderer

Forestry Department Manuguru Ref.No.MNG/FTY/F.18/2014/150 Dt

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