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Please Accomplishment 5 (Five) Copies of This Form
Please Accomplishment 5 (Five) Copies of This Form
For APR
Agency Property Officer = Branch Clerk of Court/ OCC Assnt. COC
Agency Chief Acountant = Presiding Judge/ OCC-COC
Agency Head/ Authorized Signature = Executive Judge (SDO)
Agency Acct. Code = Will be assigned by PS
Agency Control No. = Will be assigned by the Branch
(Date Prepared)
PLEASE CHECK (√) APPROPRIATE BOX ON ACTION REQUESTED ON THE ITEMS/LISTED BELOW
[ ] Please issue common-use supplies/materials par 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 utilizatio Deposit, APR No. _______ Date _______
₱ ₱
Total Amount ₱
NOTE: ALL SIGNATURES MUST BE OVER PRINTED NAME
STOCKS REQUESTED ARE CERTIFIED TO BE WITHIN FUNDS VERIFIED AVAILABLE Approved:
APPROVED PROGRAM:
AGENCY PROPERTY OFFICER AGENCY CHIEF ACCOUNTANT AGENCY HEAD/ AUTHORIZED SIGNATURE
Stock No. Unit Item with Description/Specification Quantity Unit Cost Total Cost
₱ ₱
Grand Total ₱
Pupose: For Official use of (court station)
This is to certify that the above items are included and are within approved quantity and budget of this court's approved Project
Procurement Management Plan/Annual Procurement Plan for the current year.
Note: PR submitted to the SDO (EJ) for funding/budget puposes must be supported by the Abstract of Quotation/
Canvass (if there is more than 1 quotation) and Price Quotation Form/s.
Republic of the Philippines
Description of Items Unit Quantity (Supplier #1) (Supplier #2) (Supplier #3) (Supplier #4) (Supplier #5)
Unit Pice Total Price Unit Price Total Price Unit Pice Total Price Unit Pice Total Price Unit Pice Total Price
₱ ₱ ₱ ₱ ₱
Grand total
Note : Awarded to
(winning supplier)
Name Name
Signature Signature
Date Date
Republic of the Philippines
Judicial Region:
Court :
Station :
ACKNOWLEDGEMENT RECEIPT
Date :
(₱ ____________________)
(amount in words)
representing Maintenance and Other Operating Expenses (MOOE) allotment for the period
to
(month) (day) (month) (day) (year)
(___________ semester) of
(1st semester/2nd semester) (Court Station)
Received by:
Name of Officer :
Official Designation :
Court Station :
REQUISITION AND ISSUE SLIP (RIS)
Amount Estimated
Qty Unit Description/Item Issued ICS No.
Unit Cost Total Cost Useful Life
Date Date
* How to assign ICS No.
ICS-Court-Region-Station ID-Year Acquired-Chronologically assigned No. for every type/kind of Item Procured-Quantity
EX. ICS-RTC-R1-2-18-1 to 5
ICS-RTC Court
R1 Region
2 Station ID ([Please refer to "Station ID" file)
18 Year acquired (2018)
1 to 5 Purchased 5 units
Sir/Madam:
Please furnish this court/office the following articles subject to the terms and conditions contained herein.
In case of failure to make full delivery within the period specified above, a penalty of one tenth (1/10) of one percent (1%)
of the cost of the undelivered portion for every day of delay shall be imposed.
PRE-INSPECTION REPORT
Findings :
Date : Date :
Findings :
Date : Date :
Republic of the Philippines
Judicial Region:
Court :
Station :
REFUND RECEIPT
Date :
(₱ ____________________)
(amount in words)
(MOOE) allotted to
(month) (day) (month) (day) (year)
(___________ semester) of
(1st semester/2nd semester) (Court Station)
Received by:
Name of Officer :
Official Designation :
Court Station :
REPORT OF SUPPLIES AND MATERIALS ISSUED
Court Branch :
P.O. No.: Date:
To be filled up by the BCoC/OCC To be filled up in the Accounting Unit
Total Issued
Recapitulation Recapitulation
Unit Cost Total Cost UACS Object Code
COMPLETE
Amounting to ₱
(Total Amount in the P.O.)
I hereby certify to the correctness of the above information Posted by/ Date
Accounting Clerk
Clerk of Court
Date
PROJECT PROCUREMENT MANAGEMENT PLAN FORM FOR
LOWER COURTS
A-2 Bidding/Shopping
A. Basic Office Supplies UOM Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Total
1 Expediente Cover (250sheets/Pack) Pack
2 Stitching Needle Piece
3 Thread, Cotton Roll
4 Ballpen, Blue (50pcs/Box) Box
5 Onion Skin, Paper, Legal Ream
` 6 Mimeograph, Paper, Legal Ream
7 Ribbon for Manual Typewriter Roll
B. Small Office Device UOM Quantity C. Consumables (Printers and Fax) D. Other Supplies Quantity
1 Stapler, Ordinary Unit Brand Model UOM Quantity 1 Official Receipt (General Form)
2 Puncher Unit LX300 Cart 2 Official Receipt (ePayment)
3 Stapler, Big Unit FX2180 Cart 250pp
Civil Docket Book
4 Receiving Machine Unit 1 EPSON LQ300 Cart 3 500pp
Numbering 6 Digits Unit FX2175 Cart 250pp
5 Machine 4 Criminal Docket Book
8 Digits Unit LQ310 Cart 500pp
6 Dry Seal Unit TN 2060 Cart 5 Fiduciary Cash Book 200pp
7 Gavel and Mallet Unit DR3290 Drumkit G.F.
2 Brother
8 Emergency Light Unit TN3350 Cart 6 Judiciary Cash Book J.D.F.
9 Dater Unit TN2380/2060 Cart S.F.
10 Calculator, Solar Unit ML 4050N Cart 7 Bundy Card, Foldcote
11 Calculator w/ paper tape Unit 3 Samsung ML 2550 Cart 8 Catalog Card w/hole
12 Flash Drive/USB Unit MLT D1015 Cart Indoor
9 Philippine Flag
13 Digital Voice Recorder set Unit CF 280XC Cart Outdoor
14 External Hard Drive Unit P110635A Cart 10 Supreme Court Flag
Q7551A Cart 3x5
4 HP
26A Cart 11 Index Card 4x6
3005 Cart 5x8
Items needed but not included in the form 1020 Cart 12 Ink, Steno
Qnty. Item PG40 Cart S
5 Canon LBP3460 Cart M
13 Judicial Gown
JX210P Cart L
Ribbon Roll XL
6 Barcode
Sticker Pad 14 Thermal Paper
BK Brother LC57 15 Stenotype Pads
7 Fax Brother 878 16 Calculator Ribbon
Canon LBP 3460 17 Tally Ribbon (T6218)
18 Tally, Dascom Ribbon (1125)
19 Steel Belt, Horii 255
20 Detainee's Notebook
21 Rewritable DVD
` 22 Registry Return Receipt
E. Furniture (Pls. refer to attached technical specification) UOM Quantity G. Law Books
1 Senior Executive Table (For Judge) Unit Title/Edition/Year Author
2 Senior Executive Chair (For Judge) Unit 1
3 Junior Executive Table (For CoC) Unit 2
4 Junior Executive Chair (For CoC) Unit 3
5 Clerical Table Unit 4
6 Clerical Chair w/o armrest Unit 5
7 Clerical Chair w/ armrest Unit 6
8 Computer Table Unit 7
9 Long Table Unit 8
10 Gang Chair (3 seaters) Unit 9
11 Visitors Chair Unit 10
12 Sofa Unit 11
13 Filing Cabinet (4 drawers) Unit 12
14 Filing Cabinet (2 drawers) Unit 13
15 Card Catalog Cabinet Unit 14
16 Index Card Cabinet Unit 15
17 Typing Table Unit 16
18 Monoblock Chair Unit 17
19 Stand Fan Unit 18
20 Orbit Fan Unit 19
21 Wall Fan Unit 20
22 Storage Cabinet Unit
23 Vault Unit Prepared By:
24 Book shelf Unit Name and Signature
25 Open Type Steel Rack Unit Position:
26 Safe File Unit
Date:
F. Equipment UOM Quantity
1 Manual Typewriter Unit Reviewed by:
2 Biometric Unit Name and Signature
3 Fax Machine Unit Position:
4 Aircon Unit
5 Steno Machine Unit Date:
6 Duplo Machine Unit
7 Computer Unit
8 Printer Unit
Technical Specification
Vertical Filing Cabinet with four (4) Drawers
Technical Specification Steel Storage Cabinet
Vertical Filing Cabinet with Safety Vault
Steel Vertical Cabinet with Four (4)
Drawers; centralized locking system with Steel Storage Cabinet; two (2) steel swing
Steel vertical filing cabinet with top safet two (2) keys; powder coated finished with door type; five (5) adjustable shelves;
vault; top safety vault- inside door with one anti-rust protection; gauge- #20, size- at powder coated finish with anti-rust
(1) dial and one(1) key; outside door with least 52"H x 18"W x 24"D; color- light gray. protection; gauge - #20; size - at least
one (1) key; centralized locking system for 72"H x 35 ½"W x 18"D; color - light gray
the three (3) drawers; powder coated
finished with anti-rust protection; gauge -
#20; size - at least 52"H x 18"W x 24"D; color
- gray. First drawer, insulated with perlite to
safeguard records and valuables from 2 to 3
hours of fire. D = 22"; W = 15½" ; H = 10" Technical Specification
more or less. Distance from case to vault, at Vertical Filing Cabinet with Two (2) Drawers Technical Specification
least 3½".
Safe Vault
Steel vertical filing cabinet with two (2) drawers;
centralized locking system with two (2) keys,
powder coated finished with anti rust protection, single door; all fireproof; made from heavy duty
gauge - #20, size - at least 29"H x 18"W x 24"D; color Cold Rolled Sheet (CRS); GAUGE- #18 body and #14
Technical Specification - light gray door; insulated with perlite with 3 to 4 hours fire
Open Type Steel Rack resistant; with imported combination lock
provided with one dial and one key; painted with
powder coated- finshed with anti-rust protection;
color- dark gray; outside dimension- at least 24"H
Open type steel rack with five (5) adjustable steel x 17"W x 19 ½"D; inside dimension- at least 16½"H
shelf; heavy duty; 100 kg. capacity/shelf; x 12"W x 12"D.
dimension- at least L=900cm ; W=45 cm and Technical Specification
H=180cm Index Card Cabinet
Clerical Table
Specifications:
• 30mm postform with 2mm edgeband on sides
• Medium Density Fiber (MDF) Board, high pressure laminated table top,
with one (1) grommet hole on table top, scartchproof
• color: beige
• with beige steel leg powder coated finish
• with one (1) steel mobile drawer that has two (2) small drawers and one (1) file drawer,
with central locking system with keys
• metal gauge 0.7mm before coating
• at least with a dimension of 120cm W x 70cm D x 74cm H
Computer Table
Specifications:
• wood gain finish cherry
• tower tyoe computer table, with CPU holder
• with twin caster and with caster lock
• over -all metal frame in 1.2mm thick, gray metal frame
• at least with an over all dimension of 70cm L x 70cm W x 126cm H
Typing Table
Specifications:
• 30mm postform with 2mm edgehand on sides
• Medium Density Fiber (MDF) Board table top, high pressure laminated table top,
with one (1) shelf, powder coated finish, for typing paper (paper size: 8.5" x 13")
• color: beige
• light gray steel leg, with steel modesty front panel
• metal gauge 0.7mm before coating
• at least with a dimension of 60cm L x 60cm W x 74cm H
Long Table (for Court Room)
Specifications:
• 30mm postform with 2mm edgeband on sides
• Medium Density Fiber (MDF) Board table top, high pressure table top,
scratchproof, with second layer shelf, 2-3 seater
• color: beigie
• folding steel leg in powder coated finis with adjustable rubber footings
• metal gauge 0.7mm before coating
• at least with a dimension of 180cm W x 60cm D x 74cm H
Visitor's Chair
Specifications:
• Medium backrest without armrest;
• 4-legged guest chair in black frame
• Any standard leatherette upholstery (with foam: backrest and seat):
• Frame thickness 1.2mm;
• At least with a dimension of 53cm W X 40cm D X 40cm H.
Gang Chair
Specifications:
• 3-seater heavy duty power coated frame 5mm polypropelene materials
• on seat and back rest;
• With perforated backrest design;
• Black beam;
• Blue seat shell;
• Frame thickness 1.2mm; in royal blue 5mm thick PVC seat.
Sofa
Specifications:
• 3-seater sofa in black leatherette, firm cushion/foam;
• Without armrest on both sides;
• Wooden footings;
• Outer dimension with a least 164cm L x 80cm W x 80cm H.
PRICE QUOTATION FORM
Date:
Clerk of Court
After having carefully read and accepted the terms and conditions in the Request for Quotation,
we are submitting our proposal as follows:
Description of Items and Specifications Quantity Unit Price Total Bid Amount
₱ ₱
Position
Company Name
Company Address
Contact No.
Business/Mayor's Permit No.:
DTI or SEC Registration Certificate No.:
PhilGEPS Registration No. (If any)
REPORT OF WASTE MATERIALS
CERTIFICATE OF INSPECTOR
Item Destroyed
Item Sold at private sale
Item Sold at public auction
Item Transferred w/o cost to _______________________
Item Continued in service
Delivery Period : Within _______ clendar days upon receipt of the Purchase Order
Prospective bidders shall accomplish, provide correct and accurate information and submit
the duly signed Price Quotation form (attached herewith) in as sealed envelope not later than
__________________________________ Quotations submitted after the said deadline shall not be
(Time and Date detrmined buy the branch/OCC)
accepted.
Quotations must be valid for a period of thity (30) calendar days from the date of submission.
Award shall be made to the lowest quotation which complies with the minimum technical
spcifications and other terms and conditions stated herein. Any interlineations, erasures or overwriting
shall be void unless signed or initialled by the bidder or its duly authorized representative.
The ____________________________ shall have the right to inspect and/ or test the goods to
(Court, Branch, Station)
verify their conformity to the technical specifications. Liquidated damages equivalent to one- tenth of
one percent (0.0001%) of the value of the goods not delivered within the prescirbed delivery period
shall be imposed per day of delay. The _________________________________________ shall cancel the
(Court, Branch, Staion)
Purchase Order once the cumulative amount of liquidated damages reaches ten percent (10%) of
the amount, without prejudice to other courses of action and remedies open to it. The ___________
_______________________________ reserves the right to accept or reject any or all quotations and to
(Court, Branch, Station)
impose additional terms and conditions as it may deem proper.
Date
Very truly yours,