Professional Documents
Culture Documents
CERTIFICATION
Remarks:
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Remarks:
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● CY 2020 LDRRM Fund: Utilization of the 70% component for Preparedness (Current Fund)
Amount allocated for LDRRMF CY 2020 : PhP ___________________
(Preparedness component)
Amount utilized (as of Dec. 31, 2020) : PhP ___________________
Department of the Interior and Local Government
CY 2021 Seal of Good Local Governance
(For Field Test Purposes Only)
In percent : ______%
● Utilization of funds from Provision of Potable Water Supply-Sagana at Ligtas na Tubig sa Lahat
(SALINTUBIG) projects (Cut-off: December 31, 2020)
Remarks:
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
Department of the Interior and Local Government
CY 2021 Seal of Good Local Governance
(For Field Test Purposes Only)
● Utilization of fund appropriated for the conservation and preservation of cultural property,
CY 2019 (Cut-off: December 31, 2019)
● Utilization of fund appropriated for youth development, CY 2019 (Cut-off: December 31, 2019)
This Certification is issued for the purpose of the Seal of Good Local Governance assessment.
______________________________________ ______________________________________
Signature over Printed Name Signature over Printed Name
INSTRUCTIONS
For the C/MLGOO:
(1) Ask the BPLO for the month and day of CY 2021 1 st quarter with the highest volume of transaction for business permits for both new and
renewal.
(2) Review database, record book or copy of application forms.
(3) Get sample transactions, at least 50% each for new business and renewal. Maximum number of samples for each is 50.
(4) Record the samples and their processing time.
Sample Transactions:
Not more than 2 working days Not more than 1 working day
from application to release? from application to release?
Application No. Application No.
Yes No Yes No
1. ☐ ☐ 1. ☐ ☐
2. ☐ ☐ 2. ☐ ☐
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Notes: (1) For business renewals: If application is filed in the morning, permit is released on the same day; if application is filed in the afternoon,
permit is released on the morning of the following day. (2) For new business: Application filed on Day1 should be released not later than Day 3.
(3)Weekends not counted.
_____________________________________________________ ______________________________________________________
Signature over Printed Name of C/MLGOO Signature over Printed Name of BPLO
Attested by:
______________________________________________
Signature over Printed Name
City/Municipal Mayor
CERTIFICATION
☐ Approved Local Disaster Risk Reduction and Management (LDRRM) Plan as integrated in CY
2021 Annual Budget and CY 2021 Annual Investment Program.
This Certification is issued for the purpose of the Seal of Good Local Governance assessment.
______________________________________ ______________________________________
Signature over Printed Name Signature over Printed Name
CERTIFICATION
This is to certify that the Local School Board (LSB) Plan for CY 2019 of City/Municipality of
_______________________________ has the following status of implementation (Please supply required
data):
Accordingly, the said Plan completed, or its fund utilized for, the following items (tick appropriate
item(s)):
CY 2020 CY 2021
☐ July ☐ January
☐ August ☐ February
☐ September ☐ March
☐ October
☐ November
☐ December
This Certification is issued for the purpose of the Seal of Good Local Governance assessment.
Certified By:
_____________________________________________
Signature over Printed Name
CERTIFICATION
This is to certify that the City/Municipality of _______________________________ has (Please tick
available item(s)):
☐ GAD Plan and Budget for CY 2019 that has been reviewed and was found fully compliant in form
and content per PCW-DILG-DBM-NEDA JMC No.: 2016-01
☐ GAD Plan and Budget for CY 2019 that has been submitted to this Office for review
This Certification is issued for the purpose of the Seal of Good Local Governance assessment.
Certified by:
______________________________________
Signature over Printed Name
City/Municipal LGOO
Official Release of this Certification
(Please affix stamp of DILG RO/PO below)
Form CM 2F
DRRM Office
CERTIFICATION
_____ % of barangays with approved Community-Based Disaster Risk Reduction and Management
(CBDRRM) Plans. Attached is the list of barangays with approved CBDRRM Plans; and
This Certification is issued for the purpose of the Seal of Good Local Governance assessment.
_______________________________________ ________________________________________
Signature over Printed Name Signature over Printed Name
Period/years covered by
# Name of Barangay
CBDRRM Plan
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
_______________________________________ ________________________________________
Signature over Printed Name Signature over Printed Name
CERTIFICATION
This Certification is issued for the purpose of the Seal of Good Local Governance assessment.
Issued on ________th of ____________, 2021.
________________________________________
__________________________________________
Department of the Interior and Local Government
CY 2021 SGLG Assessment
CERTIFICATION
☐ The LGU has provided logistical support to the PNP Local Police Office/Station in CY 2020.
Accordingly, the following are the forms of support given (please tick applicable choices only) :
☐ Ammunition ☐ Police station
☐ Communication ☐ Supplies
☐ Vehicle ☐ Others (please specify): _________________
☐The LGU has supported the organization of the Barangay Peacekeeping Action Teams, barangay
tanods, and/or any similar unit.
Relatively, the LGU has (please supply required data):
_____% of barangays with organized BPATs, barangay tanods and/or similar unit; and
_____% of the barangays with trained BPATs, barangay tanods and/or similar unit.
This Certification is issued for the purpose of the Seal of Good Local Governance assessment.
__________________________________________
Signature over Printed Name
CERTIFICATION
This is to certify that the City/Municipality of ______________________________ has (please supply the
following information):
_____ % of barangays have their respective violence against women and children (VAWC) desks
This Certification is issued for the purpose of the Seal of Good Local Governance assessment.
__________________________________________ ________________________________________
Signature over Printed Name Signature over Printed Name
CERTIFICATION
This is to certify that the City/Municipality of ______________________________ has (please supply the
following information):
● Local revenue growth, CYs 2017 - 2019
This Certification is issued for the purpose of the Seal of Good Local Governance assessment.
________________________________________
__________________________________________
Signature over Printed Name Signature over Printed Name
CERTIFICATION
☐ Safe Closure and Rehabilitation Plan for controlled/open dumpsite that is (please tick applicable condition):
☐ Approved; Date of approval: __________________________
With percent-completion of: __________________________ as of
__________________________
☐ Currently being drafted with DENR’s technical assistance
This Certification is issued for the purpose of the Seal of Good Local Governance assessment.
__________________________________________ ________________________________________
Signature over Printed Name Signature over Printed Name