Katipunan Avenue, Loyola Heights

Quezon City, Philippines 1108

P.O. Box 154, Manila, Philippines
PHONE (+632) 426 6001 ext. 5100-5103
URL ls.ateneo.edu/oas
EMAIL msalita@ateneo.edu

LS FACILITIES / EQUIPMENT RESERVATIONS SUBMISSION FORM

(as of June 2010)

NOTE: Please fill out the checklist and attach all necessary documents. INCOMPLETE CHECKLIST
WILL NOT BE PROCESSED. Indicate N/A if not applicable. For activities with multiple venues,
please indicate the specific location of equipment requested. Thank you.

Request # ______________________________

A. REQUESTING PERSON / GROUP PARTICULARS

1. Sponsoring Office / Department / Program / Organization Ateneo Lex
2. Point Person Maria Isabel Lao Mayor
3. ID Number 122621
4. Contact Number/s 09209622450

B. ACTIVITY / EVENT PARTICULARS

1. Name of Event Business Ethics Debate
2. Nature of Event: Seminar / Workshop Concert / Musical Performance
Meeting / Gen. Assembly Exhibits Others (pls. specify): Competition_
Talk / Symposium Reception Purpose:
________________________________________
3. Date November 21-22, 2015
4. Main Venue Rizal Mini Theater (FH 101)
5. Break-out Rooms (if applicable) See Attached
6. Time (Start-End) inclusive of set-up / removal 6:00 am - 9:00 pm
7. Number of Participants 100
8. Outsiders [Participants including VIPs, Non-Participants, (Suppliers, To Follow
Contractors, Merchandisers) and vehicle model and plate numbers] - list to
be attached
9. Lay-out (to be attached) As is
10. Program Flow (include time and location) See Attached
11. Clearance letter from Jesuit Residence / Church of the Gesu / N/A
Office or Department affected
12. Mutual Agreement on swapping / exchange of venues (letter of N/A
agreement to be attached)

C. LOGISTICAL NEEDS Quantity / Venue For J.O. to UPPO*

1. Tables 4 / RMT
2. Monoblock Chairs 200 / RMT
3. Stands (Pls. specify if Graduation or Communion) N/A
4. Parking Stands N/A
5. Lectern / Podium N/A
6. Rolling Boards
7. Potted Plants N/A
8. Iwata Evaporative Fans N/A Control #s:

9. Streamers / Tarpaulins (indicate size / location) N/A

10. Directional Signs (along the road) N/A
11. Elevator Use (for Leong Hall / MVP-CSL Bldg.) N/A Time: _______ to _______ **
12. Holding Room for VIPs (indicate what room)
13. Stage (indicate size) N/A
14. Exhibit Blocks N/A
15. Others N/A

D. EQUIPMENT/ELECTRICAL NEEDS Quantity / Venue For J.O. to UPPO

1. LCD Projector 1/RMT

2. Projection Screen 1/RMT
3. PA / Sound System / Karaoke 1/RMT
4. Microphone 2/RMT
5. Microphone Stand 2/RMT
6. Additional Electrical Supply [for equipment that ***
will be brought in i.e. mobile sound system, theatrical
lights, personal karaoke, etc.] (to attach complete
equipment and wattage list)
7.Conference System
8. Others
E. PERSONNEL NEEDS Required Number Setup only Dedicated Overtime
1. Maintenance personnel / janitor
2. AVR Technician
3. Computer Technician
4. Others

F. SECURITY / PARKING NEEDS Required Number For J.O. to UPPO

1. Security Guards N/A **

2. Reserved Parking Slots (indicate location/s) N/A ****
3. Others N/A

G. FOOD / RECEPTION PARTICULARS Indicate Quantity if applicable

1. Name of Food Supplier Everything Bacon
2. Food to be served (Menu list to be attached for FQAs approval) FQA attached
3. Reception Venue Gonzaga 2nd floor
4. Time (set-up and removal) 11:00 AM-1:00PM
5. Lay-out with necessary clearance / approval by affected areas / offices / N/A
units
6. Outside Visitors / Catering Crews and Vehicle Model and Plate N/A
Numbers (list to be attached)
7. Monoblock chairs N/A
8. Potted Plants N/A
9. Rolling Boards N/A
10. Lights/Electrical Supply (to attach complete equipment & wattage list) N/A
11. Others N/A

H. CHARGES / RATES (For activities under Category B and with Overtime of Personnel)*****
Venue / Equipment / Furniture Rate per Hour Number of Hours Total Cost
1.
2.
3.
4.
5.
6.
7.
Sub-Total:
Overtime of Maintenance / Technician****** Rate per Hour Number of Hours Total Cost
1.
2.
3.
Sub-Total:
Overtime of Security Personnel****** Rate per Hour Number of Hours Total Cost
1.
2.
Sub-Total:
GRAND TOTAL:

* Requesting Group to prepare Job Order to Physical Plant Office for hauling and returning of equipment / furniture /
fixtures.
** Requesting Group to prepare Job Order to Physical Plant Office for the Security personnel
*** Requesting Group to prepare Job Order to Physical Plant Office for additional electrical supply.
**** Requesting Group to prepare Job Order to Physical Plant Office for the parking stands.
***** Final costs are subject to actual activity duration / logistical / personnel needs.
****** Fixed Overtime Rate of Personnel: (1) Maintenance-P200/hr (2) Technician-P300/hr (3) Security-P73.62/hr

Submitted by: Ernest Elach A. Eleazar I have read and understood the guidelines and will
comply as required.
Signature:
Date: Conforme: ___________________________

Activity Approved Remarks: Category

Ms. Marie Joy A. Adolfo
/ Endorsed by: Dean / Dept. Chair / Faculty / OSA Professional
Signature:
Date:

Approved by: Remarks: Janitor

Office of Administrative Services AV Tech.

Signature: Security
Date: Requestor
NOVEMBER 21

SEC A 116 A
SEC A 117 A
SEC A 123 A
SEC A 124 A
SEC A 208 A
SEC A 209 A
SEC A 210 A
SEC A 214 A
SEC A 215 A

NOVEMBER 22

SEC A 116 A
SEC A 117 A
SEC A 123 A
SEC A 124 A
SEC A 208 A
SEC A 209 A
SEC A 210 A
SEC A 214 A
SEC A 215 A

Note: No reservation number/s yet