Agency : LGU TANAUAN, LEYTE – SB OFFICE Agency :

Address : 888 REAL ST. BRGY. BUNTAY TANAUAN, LEYTE Account No.
Contact # :
Agency Control No.
AGENCY PROCUREMENT REQUEST PS APR NO.

( Date Prepared)
PROCUREMENT SERVICES
DBM COMPOUND, RR ROAD
Cristobal St., Paco, Manila
ACTION REQUESTED ON THE ITEM (S) LISTED BELOW
( ) Please furnish us with Price Estimate ( for office equipment/furniture & supplementary items)
( ) Please furnish for our agency the equipment or furniture & supplementary items for your estimates
(PS RAD No. ___________) attached dated ___________.
( ) Please issue common-use supplies/materials per PS price lists as of __________.
( ) Please issue Certificate of Price Reasonableness.
( ) Please furnish with your latest/updated price list.
( ) Others ( Specify)
______________________________________________________

Item Code ITEM & DESCRIPTIONS/SPECIFICATIONS/STOCK NO. QTY. Unit Unit Price AMOUNT

1. Book paper, long 25 Reams

2. Book paper,short 25 Reams
3. Correction tape 10 Pcs.
4. Post it,2x3 5 Pads
5. Calculator, Compact, Electronic 12 digits cap 1 Pc.
6. Staple Wire No. 35 3 Box
7. Epson, T6641 (Black) 5 Bottle
8. Expanding Envelope 5 Pcs.
9. Local Government Code 1 Pc.
10. Alcohol,68%-70% Scented,500ml 10 bottles
11. Ballpeen (black) 5 box
12. Flash Drive (USB) 16 GB 1 Pc.
13 Paper Clip, Vinyl plastic coat, length, 32mm min 2 Pcs.
14. Brown Envelop, Long 50 Pcs.
15 Marker Flourescent, 3 assorted color 5 set
16. Signpen (black 0.5 needle tip) liquid gel 10 box
17. Paper Fastener plastic 5 box
18. Tissue Paper,12 rolls/pack 5 roll
19. Dishwashing Liquid 250ml 1 bottle
20. Pencil #2 10 box
21. Ballpen (blue) 5 box
22. Permanent Marker, Black Fine Type 10 Box
23. Toilet Bowl Cleaner 3 Bottle
24. Ink for Stamp Pad, purple or violet 2 Pc.
25. Stapler #35 (heavy duty) 2 Pc.
26. Toilet Deodorizer 6 Pc.
.27. Broom Soft ( Tambo) weight 250 2 Pc.

NOTED: ALL SIGNATURES MUST BE OVER PRINTED NAME

STOCK REQUESTED ARE CERTIFIED FUNDS CERTIFIED AVAILABLE APPROVED
TO BE WITHIN APPROVE PROGRAM

MICHELLE ALBANO SOYOSA CHARITO P. MARTIJA HON. RONALD E. FLORES, MD.

PROPERTY COSTUDIAN/DESIGNATE IOC-MUNICIPAL BUDGET MUNICIPAL VICE -MAYOR
( ) FUNDS DEPOSITED WITH PS ( ) ________CHECK NO._________IN THE AMOUNT OF: __________
( p _________) ENCLOSED.