Term of Reference Procurement of Medical Mask

No Product Name Specificaon QTY Unit Notes 1 Surgical Mask 3 Ply Surgical 3341 box - Packing per delivery address in Mask with carton box with ACTION sticker earloop; 1 - Sticker provided by Hivos - Delivery area: Jakarta Timur, Kab. box = 50 , Kab. Lombok Timur, pieces Yogyakarta, Makassar

Background The goods listed in this term of reference is/are required to support the ACTION Project – Active Citizens Building Solidarity and Resilience in Response to COVID-19. The project’s main objectives is to enhance poor and marginalised community resilience and solidarity in responding to the impacts of pandemics.The project is implemented by a consortium where Hivos as the coordinator to lead other members consisting of 5 national NGOs, namely : SAPDA, KAPAL Perempuan, CISDI, PUPUK, and PAMFLET. This project targets marginalized and high-risk populations in rural and urban areas in two phases. Phase one focuses on activities response, such as health care, and water and sanitation systems. Phase two addresses the social and economic recovery phase. The project will be implemented in 5 provinces in , which included Jakarta, South Sulawesi, Yogyakarta, West Nusa Tenggara, and West . The duration of ACTION is in 24 months. The distribution of Medical Mask is related to the Outcome I: Community-based emergency health responses amplified, and coordination with government initiatives improved

Eligibility This procurement request is on equal terms for all legally-constituted companies that can provide the requested products and have legal capacity to deliver in Indonesia. Tenderers must state their nationality in their tenders and provide the usual proof of nationality under their national legislation. Tenderers are requested to state the origin of the goods, and the selected contractor will have to prove the origins of the goods. Exceptions shall be made where goods may originate from any country, in which case no certificate of origins needs to be submitted.

In this specific quotation, tenderers located in the delivery area are preferables to ensure the safety measure and schedule of the delivery.

Principles The contract shall be awarded to the tender offering best value for money (i.e. the tender offering the best price-quality ratio).

Objective To obtain goods listed in this Term of Reference to support Activity Code : Activity 1.6.2: Support CSOs and CBOs to produce and distribute high quality and effective PPE and sanitation equipment Based on this listed requirement:

STAGE 1 STAGE 2 STAGE 3 Recipient Delivery Point Contact Surgical Mask Surgical Mask Surgical Mask Puskesmas Selong

Jl. Ahmad Yani No.100, Sandubaya, Selong, Kabupaten Ridwan,SH. Lombok Timur, Nusa Tenggara Bar. 83612 0877-6330-1668 105 Puskesmas Denggen

Rakam, Selong, East Lombok dr. Kiki Regency, West Nusa Tenggara 83671 0819-1797-4452 105 Puskesmas Montong Betok

JL Pariwisata Joben, Montong Betok, Montong Gading, Nauli Kabupaten Lombok Timur, Nusa Tenggara Bar. 83663 0878-6349-7781 105

Puskesmas Lenek Moh.Wilni, Lenek, Aikmel, East Lombok Amd.Kes Regency, West Nusa Tenggara 83661 0819-3315-2706 105 Puskesmas Ballaparang Suhaemi Jl. NIkel III No.1, Balla Parang, (085757436403) Kec. Rappocini, Kota Makassar, dan Warda Sulawesi Selatan 90231 (085343581441) 105 dr.Tri Raparti Arifin Puskesmas Tamangapa (kepala Jl. Tamangapa Raya No.264, Puskesmas) Tamangapa, Kec. Manggala, Kota No.Hp: Makassar, Sulawesi Selatan 90235 08164390293 105 Puskesmas Tamalate

Jl. Dg Tata 1 Blok G.5/8, Suryani Mannuruki, Kec. Tamalate, Kota Makassar, Sulawesi Selatan 90224 081342389977 105 Puskesmas Kaluku Badoa

Jl. Butta Butta Caddi No.15, Nurmiati, BSC, Kaluku Bodoa, Kec. Tallo, Kota SKM,M.Kes Makassar, Sulawesi Selatan 90215 08124231293. 105 Puskesmas Pulo Gadung

Jalan Kayu Putih Selatan III No.2B, RT.8/RW.5, Pulo Gadung, RT.8/RW.5, Pulo Gadung, Kec. Pulo Gadung, Kota Jakarta Timur, Daerah Khusus Ibukota Jakarta 13260 to be confirmed 105 Puskesmas Jatinegara l. Matraman Raya No. 220, J akarta Timur, DKI Jakarta, Indonesia 13310 to be confirmed 105

Puskesmas Duren Sawit

Jl. H. Dogol No.15A, RT.7/RW.16, Duren Sawit, Kec. Duren Sawit, Kota Jakarta Timur, Daerah Khusus Ibukota Jakarta 13420 to be confirmed 105 Puskesmas Bojong Gede

Jl. Raya Bojong Gede No.27, Bojong Baru, Kec. Bojong Gede, Imas Bogor, Jawa Barat 16920 085921222157 105 Puskesmas Bojong Gede (KHUSUS FO)

Jl. Raya Bojong Gede No.27, Bojong Baru, Kec. Bojong Gede, Imas Bogor, Jawa Barat 16920 085921222157 4 Puskesmas Cirimekar dr. Rika Sri Ratna Jl. Kayu Manis, RT.005/RW.004, (Kepala Cirimekar, Cibinong, Bogor, Jawa Puskesmas) Barat 16915 081310367385 105 Puskesmas Cirimekar (KHUSUS FO) dr. Rika Sri Ratna Jl. Kayu Manis, RT.005/RW.004, (Kepala Cirimekar, Cibinong, Bogor, Jawa Puskesmas) Barat 16915 081310367385 3 Puskesmas Pabuaran Indah

Perumahan Bukit Pabuaran Indah, dr. Prita (Kepala Blk. H, Pabuaran, Cibinong, Bogor, Puskesmas) Jawa Barat 16916 0816-1353-542 105 Puskesmas Kota Gede I

Jl. Kemasan No.12, Prenggan, Kec. Kotagede, Kota Yogyakarta, Ninda Daerah Istimewa Yogyakarta (Aspak Medis) 55173 089627456686 105

Puskesmas Jetis

Jl. Pangeran Diponegoro No.91, Bumijo, Kec. Jetis, Kota Yuni Listianingsih Yogyakarta, Daerah Istimewa (Apoteker) Yogyakarta 55231 085237462734 105 Puskesmas Wirobrajan

Jl. Dorodasih, Patangpuluhan, Wirobrajan, Kota Yogyakarta, Eko Pratiwi Daerah Istimewa Yogyakarta (apoteker) 55251 08122798329 105

Kantor Desa Lenek Desi Utari Ningsih Dusun Gubuk Baret, Desa Lenek (Kasi Kesra) Kalibambang, Kecamatan Lenek Kabupaten Lombok Timur - NTB 0819-1828-0468 2

Kantor Kelurahan Selong

Jln. R. Soeprapto, Selong, Lombok Hj. Yuhanun Timur - NTB (Kasi Kesra) (Samping TPU Selong/Eks. Kantor BPPD Lotim) 0819-9772-7200 18 Kantor Desa Montong Betok

Jln. Pariwisata Joben, Desa Rony Farick Ziarh Montong Betok Kec.Montong (Sekdes) Gading Kab.Lombok Timur - NTB 0877-6181-6848 3

Rumah Field Officer Jakarta Timur Ditya Ayu Dwiputri Jalan H. Wahab I No. 20A, (FO Jaktim) Jatibening Baru, Pondok Gede, Bekasi, Jawa Barat 17412 08568574901 23

Rumah FO Yogyakarta

Gang Gede No 407 Sorowajan Dani Baru RT 17/12 Banguntapan, Catrianiningsih Bantul, Yogyakarta 55198 087773009533 23 Kantor Kelurahan Pabuaran Suradi Supriadi Jl. Pabuaran, Pabuaran, Kec. (Lurah Pabuaran) Bojong Gede, Bogor, Jawa Barat +62812-1356-186 16921 8 2 Rumah FO Makassar

BTN Minasa Upa Blok D1 No.20 Kel.Gunung Sari, Kec.Rappocini Kota Makassar, 90222 Achriani Kebutuhan: 2 Volunteer 0811408882 14 Kos FO Bogor

Perumahan BTN Bambu Kuning Blok G2/16 Kecamatan Bojong Gede, Kabupaten Bogor Ellif Vicha Arynta 16920 081556778434 14

Kantor CISDI

Jl. Probolinggo No. 40C RT.01/02, Kel. Gondangdia, Kec. Menteng, Jakarta Pusat, DKI Ulfa Mahmudah Jakarta 10350 085716313165 45 45 Kantor HIVOS Witra +62 18 Office Park, 15th floor, Unit B | 877-8840-0660 Jl. TB Simatupang No.18 Catharina Jakarta Selatan 12520 Indonesia 0818519598 148 148

Kantor KAPAL Perempuan

Jl. Kalibata Timur Raya No.5, Rt.003 Rw.10, Kel.Kalibata, Kec.Pancoran, Eci Jakarta Selatan +62 DKI Jakarta – 12740, Indonesia 812-1201-9492 30 30 FO KAPAL Perempuan Lombok Timur Alamat: Jl.RA. Kartini No. 16A, Kelurahan Rakam, Kecamatan Selong, Kabupaten Lombok Timur, Rosita Indonesia 83619 081997617111 82 82 FO KAPAL Perempuan Makassar Alamat: Jl.Hertasning, Perumahan Rizky Awalita Taman Yasmin Indah Blok A1 (Rere) No.6, Makassar 082311147894; 50 50 Kantor PAMFLET

Jl. Mimosa IV, RT.6/RW.4, Pejaten Bar., Kec. Ps. Minggu, Kota Astried Permata Jakarta Selatan, Daerah Khusus +62 Ibukota Jakarta 12740, Indonesia 878-8880-3312 90 90 Kantor PUPUK

Jl. Permata Taman Sari Raya Kav.6 | Kota Bandung Provinsi Bena Bahtiar +62 Jawa Barat Indonesia 40293 856-2412-7286 125 125 Kantor SAPDA

Perumahan Pilahan Permai Blok Soleh C-39, Rejowinangun, Kotagede, (081326586345) Yogyakarta. Mico 55171 (08174115225) 155 155

TOTAL Jumlah 2301 315 725

Estimated delivery date: a) STAGE 1:15 March 2021

b) STAGE 2: 28 April 2021 c) STAGE 3: 30 June 2021 Content of Quotation Quotations should be submitted in a single e-mail and must contain: a) Description and photos of the item/s requested b) Price quotation inclusive of tax c) Delivery method and Expected Time of Arrival d) Payment terms

Questions Questions or request for further clarifications should be submitted in writing to the contact person below:

Name Catharina Utami Organization Hivos Email [email protected]

Instructions for Submission Quotations have to be sent by e-mail to the contact person indicated above c [email protected] no later than 3 March 2021 at 23:59 WIB w ith subject: “A CTION - Quotation - [Item]” Award The ACTION consortium shall award a Purchase Order to the lowest priced bidder whose quotation has been determined to be substantially compliant with other documents requested. If the tenderer’s offer is selected, the consortium may ask the tenderers to submit additional documents for approval like: product quality certificates, manufacturing license, country of origin, product brochures, etc.