Purchase Order: KJB Store

PURCHASE ORDER
Tampilisan, Zamboanga del Norte

LGU
Supplier KJB STORE P.O. No.
Address Pob.Tampilisan,Z.N. Date
Mode of Procurement:
Gentlemen:
Please furnish this office the following articles subject to the terms and conditions contained herein:
Place of Delivery: Delivery Term:

Date of Delivery: Immediately Payment Term:
Item No. Unit Quantity Item Description Unit Cost Amount

1 sack 20 rice 290.00 5,800.00
(Total Amount in Words) 5,800.00

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:
ANGELES R. CARLOTO II
KJB STORE Municipal Mayor
(Signature Over Printed Name) (Authorized Official)
Date
(In case of Negotiated Purchase pursuant toSection 369 (a) of RA 7160, this portion must
be accomplished).
Approved to be purchased thru negotiated

purchase per Sanggunian Res. No. ______.
Certified Correct:
Secretary to the Sanggunian Date:

5,800.00
INSPECTION & ACCEPTANCE REPORT
Tampilisan,Zamboanga del Norte
LGU
Supplier Desoy Enterprises O.R. No.
PO No. Date Invoice No. Date
Requesitioning Office/Dept. DEP ED
Item No. Unit Description of Supplies Quantity Unit Cost Total

1 10 cement 32 290.00 9,280.00
2 4 8 mm steel bar 8 98.00 784.00
3 200 #4 CHB 100 14.00 1,400.00
4 2 tie wire # 16 1 86.00 86.00
5 1 cw nails # 4 1/2 75.00 37.50
6 10 cw nails # 3 1/2 75.00 37.50
7 2 porcelain toilet bowl 1 1,200.00 1,200.00
8 2 solvent 1 85.00 85.00
9 2 fine sand 1 1,000.00 1,000.00
10 1 G.I. 12 Cor 2 400.00 800.00
11 2 hinges 2 1/2 1 90.00 90.00
12 2 umbrella nails 1 100.00 100.00
14,900.00
INSPECTION ACCEPTANCE
Date Received:
Inspected, verified and found OK X Complete
as to quantity and specifications. Partial
ALBERTO L. ACAS
Assessment Clerk II
X
MILLERB.MAGHANOY
CYNTHIA D. ABIL Admin Aid G VI/ GSO Designate
RCO II
LOLITA B. DELLABA FERMIN C. CABABAT

Bookeeper II Head Teacher I
LGU

1 bags cement -
2 length 8 mm steel bar -
3 pcs. #4 CHB -
4 kgs. tie wire # 16 -
5 kgs. cw nails # 4 -
6 kgs. cw nails # 3 -
7 pc. porcelain toilet bowl -
8 can solvent -
9 cum fine sand -
10 sheets G.I. 12 Cor -
11 pair hinges 2 1/2
12 kl umbrella nails
-
Date Received:
ALBERTO L. ACAS
Assessment Clerk II
X
MILLERB.MAGHANOY
RCO II
LOLITA B. DELLABA FE P. HANDUMON

LGU

1 sheets marine plywood 1/4 10 470.00 4,700.00
2 sheets marine plywood 1/4 class B 4 355.00 1,420.00
3 pcs. #4 CHB 200 15.00 3,000.00
4 kgs. cw nails # 2 1/2 2 75.00 150.00
5 liter gutter seal 1 420.00 420.00
6 length 8 mm def. bar 10 97.00 970.00
7 kgs. cwn #2 2 74.00 148.00
8 kgs. cwn # 1 1/2 2 68.00 136.00
9 gals Choco Brown QDE Trint 2 800.00 1,600.00
10 liter Paint Thinner 1 450.00 450.00
12,994.00
Date Received:
ALBERTO L. ACAS
Assessment Clerk II
X
MILLERB.MAGHANOY
RCO II

LGU

1 sheets marine plywood 1/4 10 470.00 4,700.00
2 sheets marine plywood 1/4 class B 4 355.00 1,420.00
3 pcs. #4 CHB 200 15.00 3,000.00
4 kgs. cw nails # 2 1/2 2 75.00 150.00
5 liter gutter seal 1 420.00 420.00
6 length 8 mm def. bar 10 97.00 970.00
7 kgs. cwn #2 2 74.00 148.00
8 kgs. cwn # 1 1/2 2 68.00 136.00
9 gals Choco Brown QDE Trint 2 800.00 1,600.00
10 liter Paint Thinner 1 450.00 450.00
11 gals Davies Flatwhite enamel 2 800.00 1,600.00
12 pcs. Paint Brush #4 2 98.00 196.00
13 pcs. Paint Brush #4 2 80.00 160.00
14,950.00
Date Received:
ALBERTO L. ACAS
Assessment Clerk II
X
MILLERB.MAGHANOY
RCO II

PURCHASE ORDER
LGU
Supplier DESOY ENTERPRISES P.O. No.
Gentlemen:


1 sheets 10 marine plywood 1/4 470.00 4,700.00
2 sheets 4 marine plywood 1/4 class B 355.00 1,420.00
3 pcs. 200 #4 CHB 15.00 3,000.00
4 kgs. 2 cw nails # 2 1/2 75.00 150.00
5 liter 1 gutter seal 420.00 420.00
6 length 10 8 mm def. bar 97.00 970.00
7 kgs. 2 cwn #2 74.00 148.00
8 kgs. 2 cwn # 1 1/2 68.00 136.00
9 gals 2 Choco Brown QDE Trint 800.00 1,600.00
10 liter 1 Paint Thinner 450.00 450.00
11 gals 2 Davies Flat whitte enamel 800.00 1,600.00
12 pcs. 2 Paint Brush #4 98.00 196.00
13 pcs. 2 Paint Brush #4 80.00 160.00

Very truly yours,
Conforme:
DESOY ENTERPRISES Municipal Mayor
Date
be accomplished).

Certified Correct:

14,950.00
PURCHASE ORDER
LGU
Supplier DESOY ENTERPRISES P.O. No.
Gentlemen:
Place of Delivery: DILG Delivery Term:


1 pcs. 273 #4 CHB 14.00 3,822.00
2 length 16 9 mm steel bar 190.00 3,040.00
3 sheet 12 # 10 G.I. Sheet 247.00 2,964.00
4 kgs. 1 umbrella nails # 2 70.00 35.00
5 kgs. 1 cw nails # 1 70.00 70.00
6 kgs. 1 cw nails # 2 65.00 65.00
7 kgs. 1 cw nails # 3 68.00 68.00
8 bags 6 cement 290.00 1,740.00
9 pairs 6 hinges 4x4 130.00 780.00
10 kgs. 1/2 tie wire # 16 120.00 60.00
11 meter 40 hose black 24.00 960.00
12 length 2 PVC Pipe # 4 490.00 980.00
13 pcs. 3 PVC Elbow 4x90 95.00 285.00

Very truly yours,
Conforme:
DESOY ENTERPRISES Municipal Mayor
Date
be accomplished).

Certified Correct:

14,869.00
LGU - TAMPILISAN Purchase Request No.
Bids And Awards Committee Office of the:
Tampilisan, Zambo. Norte
REQUEST FOR QUOTATION
Date: ____________________
Quotation No.______________
Please quote your lowest price on the item/s listed below, subject to the General Condition on the
Philippine Bidding Documents on Goods, stating the shortest time of delivery and submit your quotation duly
signed by your representative not later than ________________________.
VIGILUS D. CREDO
NOTE: BAC Chairman
1. ALL ENTRIES MUST BE TYPEWRITTEN
2. DELIVERY PERIOD WITHIN SEVEN (7) CALENDAR DAYS
3. WARRANTY SHALL BE FOR A PERIOD OF THREE (3) MONTHS FOR SUPPLIES & MATERIALS, ONE (1) YEAR FOR
EQUIPMENT, FROM DATE OF ACCEPTANCE BY THE PROCURING ENTITY
4. PRICE VALIDITY SHALL BE FOR A PERIOD OF THIRTY (30) CALENDAR DAYS
5. G-EPS REGISTRATION CERTIFICATE SHALL BE ATTACHED UPON SUBMISSION OF THE QUOTATION, IF AVAILABLE.
6. BIDDERS SHALL SUBMIT ORIGINAL BROCHURES SHOWING CERTIFICATIONS OF THE PRODUCT BEING OFFERED.
ITEM
ITEM & DESCRIPTION QTY. Unit Unit Price TOTAL
NO.
1 14 BladeJaloucoat Frame 8 sets
2 1/4 DG 21 X22 112 pcs.
3 0.40 x.40 tile 850 pcs.
4 Portland Cement 50 bags
5 Fines sand 2 cum
6 Tile Grout 6 kilo
7 Diamond Cutter 2 pcs.
Brand and Model :

Delivery Period :
Warranty :
Price Validity :
After having carefully read and accepted your General Conditions, I / We quote you on
the item at prices noted above.
Printed Name/Signature
Tel. No/Cellphone No.
Date
PURCHASE REQUEST
LGU
PR No.: Date:
Department: DILG SAI No.: Date:
Section: OR No. Date:
Item Unit of Estimated Estimated

Quantity Item Description
No. Issue Unit Cost Cost
1 1 pc Ink for Epson L210 Black 700.00 700.00
2 5 reams US Bondpaper Long 210.00 1,050.00
3 5 reams Us Bondpaper Short 200.00 1,000.00
2,750.00
Purpose: For the use in the Office of the DILG.
Requested by: Cash Availability: Approved by:

Signature:
Printed Name: JENEFER B. PAQUIBOT OLIVIA G. EBORDE ANGELES R. CARLOTO II
Designation: MLGOO Municipal Treasurer Municipal Mayor
2,750.00
PURCHASE ORDER
LGU
Supplier JUSTINE CATERING & FOOD SERVICE P.O. No.
Gentlemen:


1 pax 24 meals 250.00 6,000.00

Very truly yours,
Conforme:
JUSTINE CATERING & FOOD SERVICE Municipal Mayor
Date
be accomplished).

Certified Correct:

6,000.00
Republic of the Philippines
PROVINCE OF ZAMBOANGA DEL NORTE
MUNICIPALITY OF TAMPILISAN
No.:
OBLIGATION REQUEST
PAYEE KJB STORE
OFFICE
ADDRESS Pob. Tampilisan, Z.N.
Responsibilit ACCOUNT
PARTICULARS F.P.P AMOUNT
y Center CODE
Php 26,000.00
Rice for Feeding of Elem. Students

for 20 Barangay
TOTAL Php 26,000.00

A. CERTIFIED: B. CERTIFIED:
X Charges to appropriation/allotment necessary,
lawful and under my direct supervision Existence of available appropriation
Supporting documents valid, proper and legal
Signature Over Signature Over

Printed Name ANGELES R. CARLOTO II Printed Name GRACE A. GUMANSING
Position Municipal Mayor Position Municipal Budget Officer
Date Date

No.:
OBLIGATION REQUEST
PAYEE KJB STORE
OFFICE
ADDRESS Pob. Tampilisan, Z.N.
Responsibilit ACCOUNT
PARTICULARS F.P.P AMOUNT
y Center CODE
Php 26,000.00
Rice for Feeding of Elem. Students

for 20 Barangay
TOTAL Php 26,000.00

A. CERTIFIED: B. CERTIFIED:
Charges to appropriation/allotment necessary,
lawful and under my direct supervision Existence of available appropriation
Supporting documents valid, proper and legal
Signature Over Signature Over

Printed Name ANGELES R. CARLOTO II Printed Name GRACE A. GUMANSING
Position Municipal Mayor Position Municipal Budget Officer
Date Date
DISBURSEMENT VOUCHER No.
MODE OF Check Cash Other

PAYMENT
PAYEE JUSTINE CATERING & FOOD SERVICE TIN/Employee No.: Obligation Request No.
RESPONSIBILITY CENTER
ADDRESSPob. Tampilisan, Z.N.
Office/Unit/Project: Code:
EXPLANATION AMOUNT
To payment of meals during Counselling, Intervention forlow to moderate Risk
Drug
Dependents on April 25, 2018 per supporting papers, here attached in the
amount of Php 6,240.00
Less: 6,240.00 x 4% 249.60
Total Amount due this Voucher . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Php 5,990.40

A CERTIFIED: B CERTIFIED:
Funds Available
Supporting documents complete and paper
Signature Signature
Printed Date: Printed Date:
SHERRY LOU P. DAPROSA CYNTHIA D. ABIL
Name Name
Municipal Accountant Acting Municipal Treasurer
Position Position
(Head,Accounting Unit/Authorized Representative) (Head,Treasury Unit/Authorized Representative)
APPROVED FOR PAYMENT: RECEIVED PAYMENT:
C D
Signature Check No.: Bank Name: Date:
Printed Date: Signature
Name Printed Nam Date:
JUSTINE CATERING & FOOD SERVICE
Municipal Mayor OR. No./Other Documents JEV No. Date:
Position
(Local Chief Executive/Authorized Representative)
FOR ACCOUNTING/PRE-AUDIT PERSONNEL USE ONLY:

CHECKLIST: MANDATORY MINIMUM SUPPORTING DOCUMENTS FOR COMMON TRANSACTIONS
(Maintenance & Other Operating Expenses/Capital Outlay)
I. TRAVELS 2 ALTERNATIVE MODE OF PROCUREMENT
Travel Order or Memorandum by the LCE authorizing the travel 2.a
Approved Itinerary (Appendix A) Purchase Request
Tickets (Original) for Plane, Bus, Ships Fare or equivalent Purchase Order/Letter Order/Contract,duly received
Certificate of Travel Completed (Appendix B) by bidder/supplier
Certificate of Appearance (Appendix C), or its equivalent Certificate of Acceptance
Liquidation Report-in case of cash advance Inspection Report/Waiver of Inspection
Receipts, in case of actual travel claims Result of Test Analysis (if subject to test)
Original Invoice:
Accomplishment Report -Charge Invoice/Sales Invoice
RER (optional)-For reimb. Of expenses above P 75.00 (COA Cir. 96-005) -Delivery Receipt
II. PURCHASES Canvass sheet/price quotation
1 COMPETITIVE BIDDING: Abstract/summary of canvass
Purchase Request (PR)/RIS-Original Certificate of emergency purchase-in the absence of
Purchase Order (PO)/Letter Order (LO)/Contract, duly received by canvass if amount is below 1,000.00
bidder NEGOTIATED PROCUREMENT/NEGOTIATED CONTRACT
Inspection and Acceptance Report/Waiver of Inspection Negotiated Procurement:
Original Invoice: Purchase Request
Delivery Receipt Purchase Order/Letter Order/Contract(contract)
Sales Invoice/Charge Invoice duly received by bidder/supplier
Stock Position Sheet Certificate of Authority to negotiate/enter into negotiated
Result of test analysis by proper government, if subject to test contract.
Copy of Advertisement/Invitation to bid Delivery Receipt
Bidder's Bond Sales Invoice/Original Invoice
Notice/Letter of Award Certificate of Acceptance & Inspection Report
Performance Bond Result of Test Analysis (if subject to test)
Abstract of Bids supported by: Certificate of failure of bidding for the second time from BAC
Bid tenders of other participants Canvass sheet/price quotation
Acceptance of bid/proposal Abstract/summary of canvass
BAC recommendation-Award of the LCRB/HRRB to the LCE Negotiated Contract: (in addition to the above)
TWG recommendation Notice to commence to work
ailure of bidding for the second time from BAC
***Computation***
Php #REF!
ABSTRACT OF PERSONAL CANVASS/ BIDS FOR THE SUPPLY AND DELIVERY
PR No.
ABSTRACT OF BIDS OPENED ON: ,2018. TIME: AM/PM
IN THE BAC OFFICE, TAMPILISAN, ZAMBOANGA DEL NORTE.
Article/ Services Requisitioned DEALERS FURNISHED

JUSTINE CATERING & FOD SUPPLI LPC HP
Q U AN T I T Y
ITEM NO. DESCRIPTION Poblacion,Tampilisan Z.N. Poblacion Tampilisan,Z.N. Poblacion,Tampilisan Z.N.
No. Unit of Issue Unit Price Total Amount Unit Price Total Amount Unit Price Total Amount
1 24 pax meals 250.00 6,000.00 255.00 6,120.00 260.00 6,240.00
THIS IS TO CERTIFY that the requirements of R.A. No. 9184 otherwise known Total 6,000.00 Total 6,120.00 Total 6,240.00
as the Government Procurement Reform Act ( Rule XVI - Sec.52 ) had been complied with. WE HEREBY CERTIFY to the correctness and authenticity of the above Abstract
of Bids to the best of our knowledge.
ANGELES R. CARLOTO II ADELBERTO G. SAMUYA

BIDS AND AWARDS COMMITTEE: Municipal Mayor Municipal Civil Registrar
(Requesting Officer) ( Member )
VIGILUS D. CREDO GRACE A. GUMANSING GODFREY B. GIMON RENE R. MANAIT

Municipal Engineer MBO Municipal Assessor MPDC
(Chairman) ( Vice Chairman ) ( Member ) ( Member )
6,000.00 6,120.00 6,240.00
LGU
Supplier O.R. No.
Requesitioning Office/Dept.

1 unit LED Rechargeable 1 1,399.00 1,399.00
2 pcs. Styro 2 58.00 116.00
3 pcs. double sided tape 3 25.00 75.00
4 pcs. Nylon 5 20.00 100.00
5 doz. Construction paper 1 24.00 24.00
6 pc. cutter 1 10.00 10.00
7 pcs. illustration board 3 40.00 120.00
8 pcs. plastic cover 5 20.00 100.00
9 box paper fastener 10 35.00 350.00
10 ream Construction paper 2 188.00 376.00
11 doz. photo paper 1 124.00 124.00
12 gal mineral water 110 15.00 1,650.00
13 doz. milo 22g 1 81.00 81.00
14 doz. kopiko brown 2 62.00 124.00
15 doz. creamy white 1 58.50 58.50
16 pcs. san mig original 10 4.85 48.50
17 pc. padlock 1 138.00 138.00
4,894.00
Date Received:
ALBERTO L. ACAS
Assessment Clerk II
X
MILLERB.MAGHANOY
RCO II
LOLITA B. DELLABA CARMEL MATHILDA B. LADEZA

Bookeeper II Municipal Health Officer

Purchase Order: KJB Store

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Purchase Order: KJB Store

Uploaded by

Copyright:

Available Formats

PURCHASE ORDER

Tampilisan, Zamboanga del Norte

Place of Delivery: Delivery Term:

Item No. Unit Quantity Item Description Unit Cost Amount

(Total Amount in Words) 5,800.00

Approved to be purchased thru negotiated

Secretary to the Sanggunian Date:

Item No. Unit Description of Supplies Quantity Unit Cost Total

LOLITA B. DELLABA FERMIN C. CABABAT

Item No. Unit Description of Supplies Quantity Unit Cost Total

LOLITA B. DELLABA FE P. HANDUMON

Item No. Unit Description of Supplies Quantity Unit Cost Total

LOLITA B. DELLABA FE P. HANDUMON

Item No. Unit Description of Supplies Quantity Unit Cost Total

LOLITA B. DELLABA FE P. HANDUMON

Place of Delivery: Delivery Term:

Item No. Unit Quantity Item Description Unit Cost Amount

(Total Amount in Words) 14,950.00

Approved to be purchased thru negotiated

Secretary to the Sanggunian Date:

Place of Delivery: DILG Delivery Term:

Item No. Unit Quantity Item Description Unit Cost Amount

(Total Amount in Words) 14,869.00

Approved to be purchased thru negotiated

Secretary to the Sanggunian Date:

Brand and Model :

Tel. No/Cellphone No.

Item Unit of Estimated Estimated

Purpose: For the use in the Office of the DILG.

Requested by: Cash Availability: Approved by:

Place of Delivery: Delivery Term:

Item No. Unit Quantity Item Description Unit Cost Amount

(Total Amount in Words) 6,000.00

Approved to be purchased thru negotiated

Secretary to the Sanggunian Date:

Rice for Feeding of Elem. Students

TOTAL Php 26,000.00

Signature Over Signature Over

Republic of the Philippines

Rice for Feeding of Elem. Students

TOTAL Php 26,000.00

Signature Over Signature Over

DISBURSEMENT VOUCHER No.

MODE OF Check Cash Other

Less: 6,240.00 x 4% 249.60

Total Amount due this Voucher . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Php 5,990.40

FOR ACCOUNTING/PRE-AUDIT PERSONNEL USE ONLY:

Article/ Services Requisitioned DEALERS FURNISHED

ANGELES R. CARLOTO II ADELBERTO G. SAMUYA

VIGILUS D. CREDO GRACE A. GUMANSING GODFREY B. GIMON RENE R. MANAIT

Item No. Unit Description of Supplies Quantity Unit Cost Total

LOLITA B. DELLABA CARMEL MATHILDA B. LADEZA

You might also like