LGU SAN PABLO

PURCHASE REQUEST
Department: DILG PR No. _______________________ Date: ____________
Section : No. _______________________ Date: ____________

Stock Unit Item Description Qty Unit Cost Total Cost

No.
1 Particulate Respirator 7021 FFPA 70 pcs

2 3-ply Face Masks 24 boxes

3 Medical Grade Full Protection Face Shield 200 pcs

4 Protective Goggles 100 pcs

5 Nonwoven shoe cover 100 pcs

6 Nonwoven head cover 100 pcs

7 Coverall Clothing nonwoven fabric, 60 gsm 50 pcs

8 Medical Grade Protective Suit /Hazmat 24 pcs

9 Sterile Latex Examination Gloves 12 boxes

10 Boots 6 pairs

11 Infrared Thermal Scanner 15 pcs

12 Bleach 3 gal

13 Alcohol 2 gal

14 Liquid Handsoap 2 gal

15 Disinfectant 3 gal

TOTAL

Purpose: Personal protective equipment for MDM Team

REQUESTED BY: APPROVED BY:

Signature;
Printed Name: CATHERINE ANN L. HERRERA DANILO A. TAUCAN
Designation: OIC-MLGOO Municipal Mayor
 INSPECTION AND ACCEPTANCE REP0RT
LGU-San Pablo
Agency
Supplier: IAR No. _______________ Date: __________________
PO No. ______ Date: __________ Invoice No: _______________ Date:
Item Unit Description Qty

INSPECTION ACCEPTANCE

Date Inspection : Date Received

__________________________ :________________________

Inspected, verified and found in Complete

order
As to qualified and specified

Partial (pls. specify

quantity)

DANILO LUMAYAS MARIA GENNA FE M. ISHMAEL

Inspection Officer/Inspecting Committee Property officer
 Republic of the Philippines
PROVINCE OF ZAMBOANGA DEL SUR
Municipality of San Pablo
DISBURSEMENT VOUCHER No.
Mode of Payment Check Cash Others
Payee: TIN/Employee No. Obligation Request No.

Address: San Pablo, Zamboanga del Sur Responsibility Center

Office/Unit Project: Code:

EXPLANATION AMOUNT

Amount due this Voucher:

P
A. Certified B. Certified
Allotment obligation for the purpose of indicated above FUNDS AVAILABLE
Supporting documents complete

Signature
Signature:
:
Printed Printed
Name: ANGELITA L. YOSOYA Name:
Position: MAA IV/OIC OIC Municipal
(Head Accounting Unit Authorized Position: Date:
Representative) Treasurer
C. Approved for Payment: D. Received Payment:
Check No: Bank Name:
Signature
: Signature:
Printed Printed
Name: DANILO A. TAUCAN Name:
Position: Municipal Mayor
(Agency Head/Authorized Position: OIC-MLGOO Date:
Representative)

O.R. No./Other Documents JEV No. Date: