Institutional Strengthening

APR FORM revised March 2007
NAME AND ADDRESS : UNIVERSITY OF SOUTHEASTERN PHILIPPINES AGENCY : USeP-Obrero

OF REQUESTING Obrero Campus, Bo. Obrero, Davao City ACCT. CODE
AGENCY AGENCY CONTROL No.
TEL. NOS.
AGENCY PROCUREMENT REQUEST PS APR No. dtd
To: THE PROCUREMENT SERVICE

DBM Compound, RR Road Date Prepared __________
Cristobal St., Paco Manila
PLEASE CHECK (/) APPROPRIATE BOX ON ACTION REQUESTED ON THE ITEM/S LISTED BELOW
[ ] Please issue common-use supplies/materials per Price List No.___________________ dated___________________

Mode of delivery: [ ] Pick-up (Fast Lane) [ ] Pick-up (Schedule) [ ] Delivery (door-to-door)
In case fund is not sufficient: [ ] Reduce Quantity [ ] Bill Us [ ] Charge to Untilized Deposit, APR No.:______________ Date________________
[ ] Please purchase for our agency non-common items. Attached herewith:

[ ] Complete Specifications [ ] Obligation Request (ObR) y_____________________
[ ] Certificate of Budget Allocation (CBA) [ ] Payment ____________________
IMPORTANT!! PLEASE SEE THE INSTRUCTIONS/CONDITIONS AT THE BACK HEREOF
ITEM No. ITEM AND DESCRIPTION SPECIFICATIONS/STOCK No. QUANTITY UNIT UNIT PRICE AMOUNT
OVERALL AMOUNT P 0.00

NOTE: ALL SIGNATURES MUST BE OVER PRINTED NAME
STOCKS REQUESTED ARE CERTIFIED TO BE FUNDS CERTIFIED AVAILABLE APPROVED:
WITHIN APPROVED PROGRAM:
QUIRICO LAURENTE ROLANDO B. ENRIQUEZ RODULFO C. SUMUGAT

Agency Property Supply Officer Agency Chief Accountant Agency Head /Authorized signature
[ ] FUNDS DEPOSITED WITH PS [ ] _______________ CHECK No._______________

IN THE AMOUNT OF :____________________________________________________(P______________) ENCLOSED
re
COA Prescribed Form
PURCHASE REQUEST
Republic of the Philippines
University of Southeastern Philippines
Obrero Campus, Bo. Obrero, Davao City
Department: Human Resources Division PR No.: Date:

Section: SAI No.: Date:
Stock Unit Total

No. Unit Item Description Quantity Cost Cost
1
1
1
Purpose:
Requested by: Approved by:
Signature:
Printed Name: MARIVIC I. DUMARAN RODULFO C. SUMUGAT
Designation: Administrative Officer V-HRD VP for Administration
COA Prescribed Form
PURCHASE REQUEST
Department: Human Resources Division PR No.: Date:

Section: SAI No.: Date:
Stock Unit Total

No. Unit Item Description Quantity Cost Cost
1 pcs 1/2 plastic molding 15
2 pcs Utility box 8
3 unit One Gang Outlet 8
4 meter Flat cored # 16 20
5 Box tox w/ flat head metal screw size 3/4 1
6 pcs 3 pin adaptor outlet (note see attachment) 8
-------- nothing follows ------------
Purpose: for Biometric installation of this University
Requested by: Approved by:
Signature:
Printed Name: MARIVIC I. DUMARAN RODULFO C. SUMUGAT
Designation: Administrative Officer V-HRD VP for Administration
Republic of the philippines
UNIVERSITY OF SOUTHEASTERN PHILIPPINES
Obrero Campus, Bo. Obrero Davao City
Request for Quotation
Date:
______
Company Name : __________________________________________
Address: _____________________________________________________________________________
Please quote your lowest price on the items / listed below, subject to the General Condition on the last page, stating the shortest time of
delivery and submit your quotation duly signed by your representative not later than ________________________________ in the return envelope
attached herewith
MARIVIC I. DUMARAN
Administrative Officer V-HRD
Note : 1. All entries must be typewritten.

2. Delivery Period within ___________ calendar days.
3. Warranty shall be for a period of six ( 6 ) months for supplies and materials, one ( 1 ) year for
Equipment, from date of acceptance by the procuring entity.
4. Price validity shall be a period of 30 calendar days.
5. G-EPS Registration Certficate shall be attached upon submission of the Quotation.
6. Bidders shall submit Original Brochures showing certification of the product being offered (optional).
7. Mode of delivery: [ ] Pick-up (Schedule) [ ] Door to Door Delivery
Item No. Unit ITEM AND DESCRIPTION QTY. UNIT PRICE TOTAL AMOUNT
After having carefully read and accepted your General Condition, I / We quote you on the item at prices noted above.
Printed Name / Signature
Canvassed By: Tel. No. / Cellphone No.
____________________________
Authorized Canvasser TIN No. of Establishment
Date
1. Quotations and other requirements stated below shall be submitted to the University of Southeastern Philippines, Bo. Obrero Davao City,
Philippines on the date and time stated in this RFQ.
2. Supplier shall submit the following requirements :

a. Duly signed Request for Quotation. Prices shall be quoted in Philippine Pesos. Statement of Compliance must be accomplished by supplier
b. Valid Mayor's Permit
c. Original Brochures or certificates of the items offered showing its performance characteristics or specifications, if applicable
Price validity shall be 30 calendar days from the deadline of submission of quotation.
Ocular Inspection
Upon the decision of the End-User and BAC, the supplier and its concerned premises may be subjected to ocular inspection and approval
by the End-User and/or TWG Inspections of the BAC prior to the award.
Award
The supplier that submitted the lowest calculated responsive quotation, and passed the ocular inspection conducted by the End-User and
BAC prior to the event, if any, shall be awarded the contract.
Evaluation of Quotations
Quotations shall be compared and evaluated of the basis of the following criteria:
1. Completeness of Submission
2. Compliance with Item & Description Requirements
3. Price
Instructions
1. Supplier shall be responsible for the (source (s) of its goods/services/equipment, and which shall be in accordance with the schedule
and specifications of the RFQ or contract. Failure of the supplier to comply with this provision shall be ground for cancellation of the
award or purchse order issued to the supplier.
2. Supplier that accepted an award, purchase order, or contract but failed to deliver the required goods/services/equipment within the
time called for in the award, purchase order, or contract shall be disqualified from participating in USEP or any of USEP Campuses future
procurement activities. This is without prejudice to the imposition of other sanctions prescribed under R.A.9184 and its IRR-A against
the supplier.
3. All duties, excise, and other taxes, and revenue charges shall be paid by the supplier.
4. All transactions are subject to withholding of credible Government Taxes per revenue regulation(s) of the Bureau of Internal Revenue
Liquidation Damages
A penalty of one-tenth of one percent (0.001) of the total value of the undelivered goods/services/equipment shall be cahrged as liquidated
damages for every day of delay of the delivery of the Purchased goods/services/equipment.
Warranty
Supplier warrants that all goods/services/equipment to be provided are of acceptable industry standard.
Payment
Payment shall be made only upon a certification by the Head of the Procuring Entity to the effect that the GOODS have been rendered or
delivered in accordance with the terms of this Contract and have been duly inspected and accepted.
ABSTRACT OF BIDS AND AWARDS

Opened at _Records Office at 3:00 on October 9, 2013
Item
No. Qty. Unit PARTICULARS REMARKS

- -
-
-
-
-
-
oxoxoxoxoxoxo
Grand Totals - - -
Item Nos. 1 Awarded to: Amount -
Item Nos. Awarded to: Amount
Prepared by:
Ms. JESUSA M. BULAONG

Administrative Aide III
We hereby certify that we have opened the bids in the presence of the Auditor of the School, certify the same to be authentic, true and correct. Awarded the same as indicated above to the bidder/and/or advantageous to the government.
Approved by:
DR. ANNWEDA C. MINA DR. EMILIA P. PACOY PROF. FELIMON P. PABLEO PROF. EDELIZA S. GONZALES PROF. RESTITUTA D. MACARAYO Dr. RODULFO C. SUMUGAT
BAC Chairman BAC Vice-Chairman BAC - Member BAC - Member BAC - Member Vice President for Administration
Authorized Official
COA Prescribed Form 3.3.2
Obrero Campus, Bo, Obrero, Davao City
No.
BUDGET UTILIZATION REQUEST Date:
Payee
Office
Address
Responsibility
Center Particulars Account Code AMOUNT
Total -
A. Certified B. Certified
Charges to appropriation/allotment necessary, lawful Budget available and earmarked/utilized for the
and under my direct supervision purpose as indicated above
Supporting documents valid, proper and legal
Signature Signature
Printed Name: MELANIE C. PAGKALIWAGAN Printed Name: HYACINTH JOY G. ROBLES
Position: Executive Assistant II Position: Administrative Officer V

Head, Requesting Office/ Authorized Representative Head, Budget Unit/ Authorized Representative
Date: Date:
No.
OBLIGATION REQUEST Date:
Payee Elvira C. Perez/Leonardo S. Perez
Office
Addres Tagum City

Responsibility
Center Particulars P.P.A Account Code AMOUNT
To payment of Terminal leave benefits

as per attached supporting document in the
amount of P…………………. 207,547.05
Total 207,547.05
Charges to appropriation/allotment necessary, lawful Allotment available and obligated for the purpose
and under my direct supervision as indicated above
Signature Signature
Printed Name: MARIVIC I. DUMARAN Printed Name: HYACINTH JOY G. ROBLES
Position: Administrative Officer V-HRD Position: Administrative Officer V

Date: Date:
No.
Payee RAYMUNDO L. GUARIÑO
Office
Addres Tagum City
Responsibility

amount of P…………………. 495,631.03
Total 495,631.03
Signature Signature
Date: Date:
No.
Payee REMEGIO R. GABUYA
Office
Addres
Responsibility

amount of P…………………. 124,345.39
Total 124,345.39
Signature Signature
Date: Date:
No.
Payee Dr. SURLITA M. SUMUGAT
Office
Addres MINTAL Davao City
Responsibility

amount of P…………………. 652,078.96
Total 652,078.96
Signature Signature
Date: Date:
No.
Payee ELMA T. RAMOS
Office
Addres
Responsibility

amount of P…………………. 207,547.05
Total 207,547.05
Signature Signature
Date: Date:
No.
Payee ALICIA T. MAGBALOT
Office
Addres
Responsibility

amount of P…………………. 550,322.86
Total 550,322.86
Signature Signature
Date: Date:
No.
Payee AMADO C. REMEDIO
Office
Addres
Responsibility

amount of P…………………. 745,847.48
Total 745,847.48
Signature Signature
Date: Date:

No.
Payee MARTINIANA C. OSORIO
Office
Addres
Responsibility

amount of P…………………. 337,824.48
Total 337,824.48
Signature Signature
Date: Date:

No.
Payee MAGDALINA S. LICAS
Office
Addres
Responsibility

amount of P…………………. 417,016.47
Total 417,016.47
Signature Signature
Date: Date:

No.
Payee
Office
Addres
Responsibility
Total -
Signature Signature
Date: Date:
PURCHASE ORDER
Supplier : P.O. No.:

Address : Date:
Tel./Fax No.: Mode of Procurement:
TIN :
Supplier is : ( ) Manufacturer ( ) Exclusive Distributor
Registered: ( ) SEC ( ) DTI
Gentlemen:
Please furnish this Office the following articles subject to the terms and conditions contained
herein:
Place of Delivery : Delivery Term :
Date of Delivery : Payment Term:
Stock Item Unit Description Unit Amount
No. No. QTY Cost
TOTAL AMOUNT -
1% -
5% 0.00
Total Amount in Words = Seventy thousand four hundred eighty five pesos and 90/100
In case of failure to make the full delivery within the time specified above, a penalty of one-tenth (1/10) of one
percent for every day of delay shall be imposed.
Very truly yours,
Conforme:
________________________________
Signature over Printed Name of Supplier Authorized Official
________________________________
Date
Funds Available: BUR NO./ObR No.:

Date:
ROLANDO B. ENRIQUEZ Amount: -
Accountant III
INSPECTION AND ACCEPTANCE REPORT
Supplier: IAR No.:
P.O.# Date: Inv./DR No.: Date:
Requisitioning Office/Dept.:
Stock No. Unit Description Qty.
INSPECTION ACCEPTANCE
Date Inspected: Date Received:

.
Inspected, verified and found Complete
in order as to quantity and
specifications Partial (pls. specify quantity)
GINA C. MALLO QUIRICO C. LAURENTE

Administrative Officer I Administrative Officer V
Inspector Property Officer
Received by:
COA Prescribed Form
ACKNOWLEDGEMENT RECEIPT FOR EQUIPMENT

NO.____________
Quantity Unit Description Property No.
Received by: Received From:
Signature over Printed Name Signature over Printed Name
Position /Office Position/Office
Date Date
COA Prescribed Form

Obrero Campus, Bo.Obrero, Davao City
INVENTORY CUSTODIAN SLIP

ICS No.:
Quantity Unit Description Inventory Estimated

Item No. Useful Life
Received by: Received from:
Signature Over Printed Name Signature Over Printed Name
Position/Office Position/Office
Date Date
For Use of Property Unit
REQUEST FOR PRE-REPAIR INSPECTION AND EVALUATION REPORT
DESCRIPTION OF PROPERTY:
Type: Brand/Made:
Serial/Engine No: Property No.
Acquisition Date: Acquisition Cost:
Date of Last Repair Nature of Last Repair:
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - -- - - - - - - - - - - - - - -- - - -- - - - - - - - -- - - - -- - - - -- - - - - - --
Defects/Complaints:
Nature and scope of work to be done:
Parts to be supplied/replaced:
Requested by:
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - -- - - - - - - - - - - - - - -- - - -- - - - - - - - -- - - - -- - - - -- - - - - - -
EVALUATION REPORT
Findings:
Pre-Inspected by:
Property Inspector
Post Repair:
Repair Shop/Supplier:
Job Order No: Date: Invoice No.:
P.O. No.: Date:
Date: Amount per Job Order Payable Amount
FINDINGS:
Inspected by:
Property Inspector Date
COA Prescribed Form
WASTE MATERIALS REPORT

Place of Storage Date
ITEMS FOR DISPOSAL

RECORD OF SALES
ITEM QTY. UNIT DESCRIPTION O.R. No. Amount
Totals -
Certified Correct: Disposal Approved:
Property Officer
CERTIFICATE OF INSPECTION
I hereby certify that the property enumerated above was disposed of as follows:
Item Destroyed
Item Sold at private sale
Item Sold at public auction
Item Transferred without cost to
Property Inspector: (Name & Signature) Witness to disposition:
Inspection Officer
No.
DISBURSEMENT VOUCHER
Date:
Mode of MDS Check Commercial Check ADA Others

Payment
TIN/Employee No. OR/BUR No.
Payee: COMPUTER WORLD MARKITING
Responsibility Center
Address: Jaltan Bldg. A Bonifacio St., Davao City Office/Unit/Project Code
EXPLANATION AMOUNT
To payment of three (3) Units of Biometric -Finger print scanner as per attached
suppurting document in the amount of P…………………. 70,485.90
Computation :
Amount per unit: P 24,995.00 X 3 = P 74,985.00
gross amount = P 74,985.00

less tax 1 % = P 749.85
5% = P 3,74.25
P 70,485.90
A Certified B Approved for Payment

Cash available Seventy thousand four hundred eighty five pesos
Subject to Authority to Debit account (when applicable) and 90/100 only

Supporting Documents complete
Signature Signature
Printed Printed
Name MA. LUISA B. FAUNILLAN Name RODULFO C. SUMUGAT
Chief Administrative Officer VP for Administration
Position Position
Head, Accounting Unit/Authorized Representative Agency Head/Authorized Representative
Date: Date:
C. Received Payment JEV No.
Date Bank Name
Check/ADA
No.
Date Printed Name Date
Signature
Official Receipt/Other Documents

Institutional Strengthening

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APR FORM revised March 2007

NAME AND ADDRESS : UNIVERSITY OF SOUTHEASTERN PHILIPPINES AGENCY : USeP-Obrero

AGENCY PROCUREMENT REQUEST PS APR No. dtd

To: THE PROCUREMENT SERVICE

[ ] Please issue common-use supplies/materials per Price List No.___________________ dated___________________

[ ] Please purchase for our agency non-common items. Attached herewith:

IMPORTANT!! PLEASE SEE THE INSTRUCTIONS/CONDITIONS AT THE BACK HEREOF

OVERALL AMOUNT P 0.00

QUIRICO LAURENTE ROLANDO B. ENRIQUEZ RODULFO C. SUMUGAT

[ ] FUNDS DEPOSITED WITH PS [ ] _______________ CHECK No._______________

Department: Human Resources Division PR No.: Date:

Stock Unit Total

Requested by: Approved by:

Department: Human Resources Division PR No.: Date:

Stock Unit Total

Purpose: for Biometric installation of this University

Requested by: Approved by:

Request for Quotation

Note : 1. All entries must be typewritten.

Printed Name / Signature

Canvassed By: Tel. No. / Cellphone No.

2. Supplier shall submit the following requirements :

ABSTRACT OF BIDS AND AWARDS

No. Qty. Unit PARTICULARS REMARKS

Ms. JESUSA M. BULAONG

Printed Name: MELANIE C. PAGKALIWAGAN Printed Name: HYACINTH JOY G. ROBLES

Position: Executive Assistant II Position: Administrative Officer V

Payee Elvira C. Perez/Leonardo S. Perez

Addres Tagum City

To payment of Terminal leave benefits

Printed Name: MARIVIC I. DUMARAN Printed Name: HYACINTH JOY G. ROBLES

Position: Administrative Officer V-HRD Position: Administrative Officer V

OBLIGATION REQUEST Date:

Payee RAYMUNDO L. GUARIÑO

To payment of Terminal leave benefits

To payment of Terminal leave benefits

To payment of Terminal leave benefits

To payment of Terminal leave benefits

To payment of Terminal leave benefits

To payment of Terminal leave benefits

COA Prescribed Form 3.7.1

To payment of Terminal leave benefits

COA Prescribed Form 3.7.1

To payment of Terminal leave benefits

COA Prescribed Form 3.7.1

Supplier : P.O. No.:

Very truly yours,

Funds Available: BUR NO./ObR No.:

Supplier: IAR No.:

P.O.# Date: Inv./DR No.: Date:

Date Inspected: Date Received:

GINA C. MALLO QUIRICO C. LAURENTE

ACKNOWLEDGEMENT RECEIPT FOR EQUIPMENT

Quantity Unit Description Property No.

Received by: Received From:

Signature over Printed Name Signature over Printed Name

Position /Office Position/Office

Republic of the Philippines

INVENTORY CUSTODIAN SLIP

Quantity Unit Description Inventory Estimated

Received by: Received from:

Signature Over Printed Name Signature Over Printed Name

REQUEST FOR PRE-REPAIR INSPECTION AND EVALUATION REPORT

WASTE MATERIALS REPORT

[ ] Please issue common-use supplies/materials per Price List No._ dated_

[ ] FUNDS DEPOSITED WITH PS [ ] _ CHECK No._