NAME & ADDRESS DepED, Pagadian City

OF
MURICAY ELEMENTARY SCHOOL AGENCY CONTROL No.
Division
REQUESTING
AGENCY
Muricay, Pagadian City AGENCY CONTROL No.
CONTACT NO. 0909-222-0348 / SCHOOL PRINCIPAL

AGENCY PROCUREMENT REQUEST PS APR No. 2020 - 05 - 000

TO: PROCUREMENT SERVICE

Department of Budget and Management, RO - IX MAY 15, 2020
Zamboanga Sibugay Sub-Depot DATE
Ipil, Zamboanga Sibugay
ACTION REQUESTED ON THE ITEM(S) LISTED BELOW
( ) Please furnish 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____________________,20______
( ) Please issue common-use supplies/materials per PS Price List as of________________,20_____
( ) Please issue Certificate of Price Reasonableness
( ) Please furnish us with your latest/updated price list
( ) Others (Specify)___________________________________________________________________
IMPORTANT!! PLEASE SEE INSTRUCTIONS/CONDITIONS AT THE BACK OF ORIGINAL COPY

ITEM No. ITEM and DESCRIPTION/SPECIFICATION/STOCK NO. QUANTITY UNIT UNIT PRICE AMOUNT

MARCH REQUEST
1 cement 10 bag
2 sand 3 cu.m
3 gravel 4 cu.m
4 steel bars 8 m2 25 length
5 tie wire 1 kg
6 computer table 1 pc
APRIL REQUEST
7 Biogesic 500 tabs
8 alcohol 70% 500 ml 20 bot
9 safeguard 20 pack
10 zonrox 20 bot
11 tissue paper 20 roll
12 efficasent oil 20 bot.
13 hollowblocks 350 pcs
14 cement 15 bag
15 tarpaulin (B.E, Oplan B.E) 2 set
16 streamer (B.E, Oplan B.E) 2 set
XXX
TOTAL AMOUNT - - - - - -
NOTE: ALL SIGNATURE MUST BE OVER PRINTED NAME
STOCKS REQUESTED ARE CERTIFIED FUNDS CERTIFIED AVAILABLE: APPROVED:

TO BE WITHIN APPROVED PROGRAM:

SADDAM E. CAUGAN MAIMONA A. LIWA SHEILA B. LEONARDO, EdD

Designated School Supply Officer Designated School Bookkeeper Elementary Head Teacher-1

AGENCY PROPERTY/SUPPLY OFFICER AGENCY CHIEF ACCOUNTANT AGENCY HEAD/AUTHORIZED SIGNATURE

( ) FUNDS DEPOSITED WITH PS ( ) ___________ CHECK No. _______________ IN THE AMOUNT OF____________
_________________________________________________________(p____________________) ENCLOSED.
PS FORM NO.001 Sham