NAME and ADDRESS of REQUESTING AGENCY: AGENCY ACCT.

CODE:
DEPED, LANAO DEL NORTE
KAWIT ORIENTAL INTEGRATED SCHOOL(JHS) AGENCY CONTROL NO.:
AGENCY PROCUREMENT REQUEST PS APR NO.
To: THE PROCUREMENT SERVICE REGIONAL DEPOT 10
DBM RO - 10 Compound March 24,2021
Zone 1, National Highway, Bulua Date Prepared
9000 Cagayan de oro City
ACTION REQUESTED ON THE ITEM(S) LISTED BELOW
( ) Please furnished us with Price Estimate (for Office equipment/furniture & supplementary items)
( ) Please purchase for our agency the equipment/furniture/supplementary items per your price estimate
(PS RAD No. __________________attached) dated ________________________
( ) Please issue common-use supplies/materials per Price List as of___________________________
( ) Please issue Certificate of price Reasonableness
( ) Please furnish us with your latest/updated price List
( ) Others (Specify)_____________________________________________________

IMPORTANT !! PLEASE SEE THE INSTRUCTIONS/CONDITIONS AT THE BACK OF THE ORIGINAL COPY
ITEM. ITEM and DESCRIPTION/SPECIFICATIONS/STOCK NO. UNIT QUANTITY UNIT COST AMOUNT

1 Storage Box (100l) pcs 4

2 Stamp(Dry Seal) pcs 1
3 Foldable Table pcs 1
4 Led Bulb pcs 10
5 Fire Extinguisher, Dry Chemical, 4.5kgs unit 5
6 Paper, Multi-Purpose (Copy) A4, 70 Gsm ream 191
7 Paper, Multi-Purpose (Copy) Legal, 70 Gsm ream 10
8 Record Book, 300 Pages, Size: 214mm X 278mm Min book 10
9 Tape, Transparent, Width: 48mm (±1mm) roll 16
10 Clip, Backfold, All Metal, Clamping: 19mm (-1mm) box 10
11 Clip, Backfold, All Metal, Clamping: 32mm (-1mm) box 8
12 Paper Clip, Vinyl/Plastic Coat, Length: 32mm Min box 20
13 Paper Clip, Vinyl/Plastic Coat, Length: 50mm Min box 20
14 Stapler, Binder Type, Heavy Duty, Desktop unit 1
15 Clearbook, 20 Transparent Pockets, For Legal Size pcs. 40
16 Sign Pen, Black, Liquid/Gel Ink, 0.5mm Needle Tip pc. 24
17 Sign Pen, Blue, Liquid/Gel Ink, 0.5mm Needle Tip pc. 8
18 Sign Pen, Red, Liquid/Gel Ink, 0.5mm Needle Tip pc. 24
19 Push Pin box 20
20 Thumbtacks box 48
21 Sticky Notes pad 20
22 Folder (Long) pcs. 100
23 Expanded Envelope (Long) pcs. 200
24 Data Filer (40cmx24.5cmx11.5cm) pcs. 8
25 Plastic Envelope (Short) pcs. 216
26 Stapler (No. 35) pcs. 9
27 Staple Wire (No. 35) box 20
28 Staple Wire (No. 10) box 20
29 Steel Cabinet unit 1
30 Purchase Of 3 In 1 Printer pcs 3
31 Certificate Holder pcs 50
32 Medals pcs 100
33 Safe Guard Soap (Big) box 22
34 Liquid Hand Soap (500ml) Scented bottle 25
35 Unscented Alcohol gallon 28
36 Thermal Battery pcs 20
37 Face Mask box 20
38 Lysol (510g) bottle 12
39 Foot Operated Dispenser pcs 2
40 Brother Ink (Cyan) bottle 10
41 Brother Ink (Black) bottle 29
42 Brother Ink (Yellow) bottle 10
43 Brother Ink (Magenta) bottle 10
44 Epson Ink (Cyan)664 bottle 10
45 Epson Ink (Magenta)664 bottle 10
46 Epson Ink (Yellow)664 bottle 10
47 Epson Ink (Black)664 bottle 20

STOCKS REQUESTED ARE CERTIFIED TO BE FUNDS CERTIFIED AVAILABLE: APPROVED:

WITHIN APPPROVED PROGRAM

AMINAH P. BARAGONA KARLO A. ADALA MARK P. PAGUIDOPON

Administrative Officer 2 BOOKKEEPER AGENCY HEAD/
AUTHORIZED SIGNATURE
( ) FUNDS DEPOSITED WITH PD ( )________________________________ CHECK No.:___

IN THE AMOUNT OF: PHP

PR NO. 101-21-03-001
NAME and ADDRESS of REQUESTING AGENCY: AGENCY ACCT. CODE:
DEPED, LANAO DEL NORTE
KAWIT ORIENTAL INTEGRATED SCHOOL(ELEM.) AGENCY CONTROL NO.:
AGENCY PROCUREMENT REQUEST PS APR NO.
To: THE PROCUREMENT SERVICE REGIONAL DEPOT 10
DBM RO - 10 Compound March 24,2021
Zone 1, National Highway, Bulua Date Prepared
9000 Cagayan de oro City

ACTION REQUESTED ON THE ITEM(S) LISTED BELOW

( ) Please furnished us with Price Estimate (for Office equipment/furniture & supplementary items)
( ) Please purchase for our agency the equipment/furniture/supplementary items per your price estimate
(PS RAD No. __________________attached) dated ________________________
( ) Please issue common-use supplies/materials per Price List as of___________________________
( ) Please issue Certificate of price Reasonableness
( ) Please furnish us with your latest/updated price List
( ) Others (Specify)_____________________________________________________

IMPORTANT !! PLEASE SEE THE INSTRUCTIONS/CONDITIONS AT THE BACK OF THE ORIGINAL COPY
ITEM. ITEM and DESCRIPTION/SPECIFICATIONS/STOCK NO. UNIT QUANTITY UNIT COST AMOUNT

1 RECORD BOOK, 300 PAGES, size: 214mm x 278mm min book 10

2 BATTERY, dry cell, AAA, 2 pieces per blister pack pack 6
3 GLUE, all purpose, gross weight: 200 grams min jar 7
4 PAPER CLIP, vinyl/plastic coat, length: 32mm min box 12
5 PAPER CLIP, vinyl/plastic coat, length: 50mm min box 11
6 PHILIPPINE NATIONAL FLAG, 100% polyester piece 3
7 CLEARBOOK, 20 transparent pockets, for LEGAL size piece 33
8 SIGN PEN, BLACK, liquid/gel ink, 0.5mm needle tip piece 16
9 SIGN PEN, RED, liquid/gel ink, 0.5mm needle tip piece 16
10 Folder Long pack 4
11 Folder Short pack 4
12 plastic cover roll 4
13 thumbtacks box 1
14 Brother DCP-T420W Refill Tank Printer unit 2
17 Brother D60 Ink Black bottle 21
18 Brother BT 5000, Cyan bottle 14
19 Brother BT 5000, Magenta bottle 14
20 Brother BT 5000, Yellow bottle 14
21 Paper, Multi-purpose copy A4 70 gsm reams 200
22 Duct Tape 2" x 20 pcs 35
23 liquid soap bottle 38
24 alcohol gal 26
27 FIRE EXTINGUISHER, DRY CHEMICAL, 4.5kgs unit 5
28 CERTIFICATE HOLDER pcs 51
29 MEDALS pcs 70
30 RIBBONS pcs 140

STOCKS REQUESTED ARE CERTIFIED TO BE FUNDS CERTIFIED AVAILABLE: APPROVED:

WITHIN APPPROVED PROGRAM

AMINAH P. BARAGONA KARLO A. ADALA MARK P. PAGUIDOPON

Administrative Officer 2 BOOKKEEPER AGENCY HEAD/
AUTHORIZED SIGNATURE

( ) FUNDS DEPOSITED WITH PD ( )________________________________ CHECK No.:___

IN THE AMOUNT OF: PHP

PR NO. 101-21-03-001