(CR:OPDS-2021-03-18-001)

2021-04-08-175
 ANNEX A.1.1
DOCUMENTARY REQUIREMENTS CHECKLIST
FALGU (Construction, Concreting, Rehabilitation, Repair, or
Improvement of Local Infrastructure)
REGION : ______________________________________________________
PROVINCE : ______________________________________________________
NAME OF LGU : ______________________________________________________

PROGRAM / PROJECT
Construction, concreting, rehabilitation, repair or improvement of any of the following:
(a) Local Roads and / or Bridges �
(b) Public Market �
(c) Slaughterhouse �
(d) Multi – purpose Buildings / Halls �
(e) Multi – purpose Pavements �
(f) Drainage Canals �
(g) Sea Wall / Rivel Wall �
(h) Water System including Level 1 stand alone water points �
(i) Evacuation Center �
(j) Public Park �
(k) Fish Port �
(l) Post-Harvest Facilities composed of Ice Plant and Cold Storage Facility �

Project Title : _____________________________________________________

Project Location : ______________________________________________________
Amount Requested : ______________________________________________________
Target Beneficiary : ______________________________________________________

FOR FUND RELEASE (Based on LBC 131):

AVAILABILITY
DOCUMENTARY REQUIREMENTS REMARKS
YES NO
(A) Signed request letter by the LCE stating the
following:
1. Program / Project Title;
2. Project Location, and
3. Amount � �
Note: If the request covers two (2) or more
programs or projects, list of programs/ projects in
order or priorities shall be attached.
(B) Duly notarized Omnibus Sworn Statement
(OSS) – Annex B1 � �
(C) Signed LGU Contact Details by the LCE –
Annex B2 � �
(D) Report on Fund Utilization and Status of
Program / Project Implementation – Annex C
� �
Note: Applicable only if LGU is a recipient of FYs
2016 – 2020 LGSF – FA.
(E) Certification attesting that the balances from
FYs 2016 – 2019 LGSF – FA have already
been returned to the National Treasury.
� �
Note: Applicable only if LGU is a recipient of FYs
2016 – 2019 LGSF – FA and has an unobligated
balances.
(F) Proof of reversion of unobligated balances
(e.g., disbursement voucher / check, deposit
slip, or official receipt from BTr).
� �
Note: Applicable only if LGU is a recipient of FYs
2016 – 2019 LGSF – FA and has an unobligated
balances.

PROJECT IMPLEMENTATION (Based on LBC 131):

AVAILABILITY /
DOCUMENTARY REQUIREMENTS APPLICABILITY REMARKS
YES NO
(A) Sanggunian Resolution endorsing the
following projects:
1. ______________________
2. ______________________ � �
3. ______________________

(B) Approved Local Development

Investment Program highlighting the
inclusion of the proposed programs / � �
projects.

(C) Approved Annual Investment Program

highlighting the inclusion of the proposed
programs / projects.
� �
(D) Approved Detailed Engineering Design
(DED) with POW and Detailed
Estimates.

� �
Note: DED shall be in accordance with the
design plan, specifications and such other
standards and policies of the National
Government.
(E) Certification on Capability to Implement
the Program / Project issued by DPWH in � �
 case to be implemented by
Administration.

Note: As stipulated in Section 3 of Appendix 1

of R.A 9184 (Procurement Law)
(F) No right-of-way issue

� �
Note: Proof that there is no right-of-way issue
shall be attached.
(G) Proof that the LGU has secured all the
necessary clearance or certification from
various National Agencies as prescribed
by law (e.g., ECC, CNC, Water Permit,
� �
NIPAS etc)

(H) Project is not located in the following:

(1) Privately-owned land;
(2) Not in the critical geo-hazard areas
or no-build zones identified and/or
certified by MGB hazard map;
(3) Within the territorial jurisdiction of � �
the LGU.

Note: Proof that the project is not located in the

above-mentioned shall be provided by the
LGU.

PROJECT EXECUTION:
Documentary Completeness and Accuracy (DCA) and Timeliness (T)

DOCUMENTARY AVAILABILITY / APPLICABILITY

REMARKS
REQUIREMENTS YES NO Actual Date
PRE-PROCUREMENT
(A) Notice of Authority to Debit
Account Issued (NADAI)
� �
Note: Include NADAI No. in the
Remarks.
(B) Confirmation on the Receipt of
Fund. � �
(C) Proof on the transfer of Fund to
LGU Trust Fund � �
Note: Per Section 3.17 of LBC 131
PROCUREMENT STAGE
TARGE ACTUA
YES NO
T L
(A) ITB Posting in PHILGEPS
� �
(B) Opening of Bids
� �
(C) Issuance of Notice of Award
(NOA) � �
(D) Issuance of Notice to Proceed
(NTP) � �
PROJECT IMPLEMENTATION
 (A) Project Signboard per COA
Circular 2013-004 � �
(B) Request for Work Inspection.
� �
(C) Concrete Pouring Permit
� �
(D) Site Instruction
� �
(E) For Water Supply Projects,
Water Source Validation
Certification issued by the
Municipal Engineer indicating
that the water source/s is/are
� � N/A N/A

feasible for supplying water to

the intended beneficiaries

(F) Notice of Defects or

Deficiencies � �
(G) Certificate of Completion
� �
AFTER DEFECTS AND LIABILITY PERIOD (DLP)
(A) Certificate of Final Acceptance
� �
(B) Approved Annual Investment
Program highlighting the
inclusion of maintenance or
repair cost as stated in the � � N/A N/A
Omnibus Sworn Statement of
the LGU.

PROJECT EXECUTION:
Quality

✔ For this part, the Quality Assurance and Assessment Report (QAAR) Tools shall be used
in ensuring that the quality of the projects has been monitored and compliance to National
Government Standards as stated in the Omnibus Sworn Statement of the LGU.

COMPLIANCE REMARKS
POSTING AND REPORTORIAL REQUIREMENTS
YES NO

A. Compliance to the posting requirements prescribed under RA

No. 9184 and its 2016 Revised IRR and all relevant policies issued � �
by the GPPB

B. Quarterly report/s on fund utilization and status of the � �

program/project implementation

C. Compliance to DILG policy on Full Disclosure Policy

 C.1 Posting of report/s in at least three (3) conspicuous
public spaces in the province � �

C.2 Posting of report/s in the LGUs Website within 20

calendar days from end of each quarter � �

4. Written Notice Upon posting on the LGUs website to the

Secretary of DBM, Secretary of DILG, Speaker of the House of � �
Representatives, President of the Senate of the Philippines,
Chairperson of the House of Committee on Appropriations and
Chairperson of the Senate Committee on Finance based on
Section 6.4 of LBC 131

MONITORED BY:
_____________________________
MLGOO

_____________________________
PROVINCIAL ENGINEER

ACKNOWLEDGED BY:

_____________________________
LOCAL CHIEF EXECUTIVE / LGU REPRESENTATIVE
 ANNEX A.1.2
DOCUMENTARY REQUIREMENTS CHECKLIST
FALGU (Vehicles)
REGION : ______________________________________________________
PROVINCE : ______________________________________________________
NAME OF LGU : ______________________________________________________

PROGRAM / PROJECT
Purchase of the following:
(a) Ambulance �
(b) Truck �
(c) Mini dump truck �
(d) Multi – purpose vehicle �
(e) Multicab �

Amount Requested : ______________________________________________________

Target Beneficiary : ______________________________________________________

FOR FUND RELEASE (Based on LBC 131):

AVAILABILITY
DOCUMENTARY REQUIREMENTS REMARKS
YES NO
(A) Signed request letter by the LCE
stating the following:
1. Program / Project Title;
2. Project Location, and
3. Amount
� �
Note: If the request covers two (2) or more
programs or projects, list of programs/
projects in order or priorities shall be
attached.
(B) Signed LGU Contact Details by the
LCE – Annex B2 � �
(C) Duly notarized Omnibus Sworn
Statement (OSS) – Annex B3 � �
(D) Project Profile for Vehicles – Annex
B4 � �
(E) Inventory of Motor Vehicles – Annex
B5

(F) Report on Fund Utilization and Status

of Program / Project Implementation
– Annex C
� �
Note: Applicable only if LGU is a recipient
of FYs 2016 – 2020 LGSF – FA.
(G) Certification attesting that the
balances from FYs 2016 – 2019 � �
 LGSF – FA have already been
returned to the National Treasury.

Note: Applicable only if LGU is a recipient

of FYs 2016 – 2019 LGSF – FA and has an
unobligated balances.
(H) Proof of reversion of unobligated
balances (e.g., disbursement voucher
/ check, deposit slip, or official receipt
from BTr).
� �
Note: Applicable only if LGU is a recipient
of FYs 2016 – 2019 LGSF – FA and has an
unobligated balances.

PROJECT IMPLEMENTATION (Based on LBC 131):

AVAILABILITY /
DOCUMENTARY REQUIREMENTS APPLICABLITY REMARKS
YES NO
(A) Sanggunian Resolution endorsing the
following projects:
1. ______________________
2. ______________________ � �
3. ______________________

(B) Approved Local Development

Investment Program highlighting the
inclusion of the proposed programs / � �
projects.

(C) Approved Annual Investment

Program highlighting the inclusion of
the proposed programs / projects.
� �

PROJECT EXECUTION:
Documentary Completeness and Accuracy (DCA) and Timeliness (T)

AVAILABILITY /
DOCUMENTARY
APPLICABILITY REMARKS
REQUIREMENTS
YES NO Actual Date
PRE-PROCUREMENT
(A) Notice of Authority to Debit
Account Issued (NADAI)
� �
Note: Include NADAI No. in the
Remarks.
(B) Confirmation on the Receipt of
Fund. � �
(C) Proof on the transfer of Fund to
LGU Trust Fund � �
Note: Per Section 3.17 of LBC 131
 (D) Authority to Purchase
Motorized Vehicle (APMV) /
Confirmation Letter issued by � �
DBM.

PROCUREMENT STAGE
TARG ACTU
ET AL
(A) ITB Posting in PHILGEPS
� �
(B) Opening of Bids
� �
(C) Issuance of Notice of Award
(NOA) � �
(D) Issuance of Notice to Proceed
(NTP) � �
PROJECT IMPLEMENTATION
(A) Certificate of Acceptance
� �

PROJECT EXECUTION:
Quality

AVAILABILITY
DOCUMENTARY REQUIREMENTS REMARKS
YES NO
(I) Profile of Newly Delivered Vehicles
� �

COMPLIANCE REMARKS
POSTING AND REPORTORIAL REQUIREMENTS
YES NO

A. Compliance to the posting requirements prescribed under RA

No. 9184 and its 2016 Revised IRR and all relevant policies issued � �
by the GPPB

B. Quarterly report/s on fund utilization and status of the � �

program/project implementation

C. Compliance to DILG policy on Full Disclosure Policy

C.1 Posting of report/s in at least three (3) conspicuous

public spaces in the province � �

C.2 Posting of report/s in the LGUs Website within 20

calendar days from end of each quarter � �
 4. Written Notice Upon posting on the LGUs website to the
Secretary of DBM, Secretary of DILG, Speaker of the House of � �
Representatives, President of the Senate of the Philippines,
Chairperson of the House of Committee on Appropriations and
Chairperson of the Senate Committee on Finance based on
Section 6.4 of LBC 131

MONITORED BY:
_____________________________
MLGOO

_____________________________
PROVINCIAL ENGINEER

ACKNOWLEDGED BY:

_____________________________
LOCAL CHIEF EXECUTIVE / LGU REPRESENTATIVE
 ANNEX A.1.3
DOCUMENTARY REQUIREMENTS CHECKLIST
FALGU (Street lightning or Barangay Electrification)

REGION : ______________________________________________________
PROVINCE : ______________________________________________________
NAME OF LGU : ______________________________________________________

PROGRAM / PROJECT
(a) Street Lighting or barangay electrification �

Project Title : ______________________________________________________

Project Location : ______________________________________________________
Amount Requested : ______________________________________________________
Target Beneficiary : ______________________________________________________

FOR FUND RELEASE (Based on LBC 131):

AVAILABILITY
DOCUMENTARY REQUIREMENTS REMARKS
YES NO
(A) Signed request letter by the LCE
stating the following:
1. Program / Project Title;
2. Project Location, and
3. Amount
� �
Note: If the request covers two (2) or more
programs or projects, list of programs/
projects in order or priorities shall be
attached.
(B) Duly notarized Omnibus Sworn
Statement (OSS) – Annex B6 � �
(C) Signed LGU Contact Details by the
LCE – Annex B2 � �
(D) Report on Fund Utilization and Status
of Program / Project Implementation
– Annex C
� �
Note: Applicable only if LGU is a recipient
of FYs 2016 – 2020 LGSF – FA.
(E) Certification attesting that the
balances from FYs 2016 – 2019
LGSF – FA have already been
returned to the National Treasury.
� �
Note: Applicable only if LGU is a recipient
of FYs 2016 – 2019 LGSF – FA and has an
unobligated balances.
(F) Proof of reversion of unobligated
balances (e.g., disbursement voucher � �
 / check, deposit slip, or official receipt
from BTr).

Note: Applicable only if LGU is a recipient

of FYs 2016 – 2019 LGSF – FA and has an
unobligated balances.

PROJECT IMPLEMENTATION (Based on LBC 131):

AVAILABILITY /
DOCUMENTARY REQUIREMENTS APPLICABILITY REMARKS
YES NO
(A) Sanggunian Resolution endorsing the
following projects:
1. ______________________
2. ______________________ � �
3. ______________________

(B) Approved Local Development

Investment Program highlighting the
inclusion of the proposed programs / � �
projects.

(C) Approved Annual Investment

Program highlighting the inclusion of
the proposed programs / projects.
� �
(D) Approved Detailed Engineering
Design (DED) with POW and
Detailed Estimates.

Note: DED shall be in accordance with the � �

design plan, specifications and such other
standards and policies of the National
Government.
(E) Certification on Capability to
Implement the Program / Project
issued by DPWH if to be
implemented by Administration. � �
Note: As stipulated in Section 3 of Appendix
1 of R.A 9184 (Procurement Law)
(F) No right-of-way issue

� �
Note: Proof that there is no right-of-way
issue shall be attached.
(G) Proof that the LGU has secured all the
necessary clearance or certification
from various National Agencies as
prescribed by law (e.g., ECC, CNC,
� �
etc)
PROJECT EXECUTION:
Documentary Completeness and Accuracy (DCA) and Timeliness (T)

AVAILABILITY /
DOCUMENTARY APPLICABILITY
REMARKS
REQUIREMENTS Target Date
YES NO
Actual Date
PRE-PROCUREMENT
(A) Notice of Authority to Debit
Account Issued (NADAI)
� �
Note: Include NADAI No. in the
Remarks.
(B) Confrmation on the Receipt of
Fund.
� �
Note: Per Section 3.17 of LBC 131
(C) Proof on the transfer of Fund to
LGU Trust Fund � �
PROCUREMENT STAGE
(A) ITB Posting in PHILGEPS
� �
(B) Opening of Bids
� �
(C) Issuance of Notice of Award
(NOA) � �
(D) Issuance of Notice to Proceed
(NTP) � �
PROJECT IMPLEMENTATION
(A) Project Signboard per COA
Circular 2013-004 � �
(B) Request for Work Inspection.
� �
(C) Concrete Pouring Permit
� �
(D) Notice of Defects or
Deficiencies � �
(E) Certificate of Completion
� �
AFTER DEFECTS AND LIABILITY PERIOD (DLP)
(A) Certificate of Final Acceptance
� �
(B) Approved Annual Investment
Program highlighting the
inclusion of maintenance or
repair cost as stated in the � � N/A N/A
Omnibus Sworn Statement of
the LGU.
 COMPLIANCE REMARKS
POSTING AND REPORTORIAL REQUIREMENTS
YES NO

A. Compliance to the posting requirements prescribed under RA

No. 9184 and its 2016 Revised IRR and all relevant policies issued � �
by the GPPB

B. Quarterly report/s on fund utilization and status of the � �

program/project implementation

C. Compliance to DILG policy on Full Disclosure Policy

C.1 Posting of report/s in at least three (3) conspicuous

public spaces in the province � �

C.2 Posting of report/s in the LGUs Website within 20

calendar days from end of each quarter � �

4. Written Notice Upon posting on the LGUs website to the

Secretary of DBM, Secretary of DILG, Speaker of the House of � �
Representatives, President of the Senate of the Philippines,
Chairperson of the House of Committee on Appropriations and
Chairperson of the Senate Committee on Finance based on
Section 6.4 of LBC 131

MONITORED BY:
_____________________________
MLGOO

_____________________________
PROVINCIAL ENGINEER

ACKNOWLEDGED BY:

_____________________________
LOCAL CHIEF EXECUTIVE / LGU REPRESENTATIVE
 ANNEX A.1.4
DOCUMENTARY REQUIREMENTS CHECKLIST
FALGU (Others)
REGION : ______________________________________________________
PROVINCE : ______________________________________________________
NAME OF LGU : ______________________________________________________

PROGRAM / PROJECT
(a) Purchase of Medical Equipment �
(b) Financial Assistance for health and sports program �
(c) Assistance programs and projects for education, health and social protection in light of the
COVID-19 pandemic �
(d) Assistance to indigent individuals in any of the following forms:
d.1. medical �
d.2. burial �
d.3. transportation �
d.4. food assistance �
d.5. cash for work �
d.6. educational assistance �

Project Title : ______________________________________________________

Project Location : ______________________________________________________
Amount Requested : ______________________________________________________
Target Beneficiary : ______________________________________________________

FOR FUND RELEASE (Based on LBC 131):

AVAILABILITY
DOCUMENTARY REQUIREMENTS REMARKS
YES NO
(A) Signed request letter by the LCE
stating the following:
1. Program / Project Title;
2. Project Location, and
3. Amount
� �
Note: If the request covers two (2) or more
programs or projects, list of programs/
projects in order or priorities shall be
attached.
(B) Duly notarized Omnibus Sworn
Statement (OSS) – Annex B3 � �
(C) Signed LGU Contact Details by the
LCE – Annex B2 � �
(D) Project Profile / Proposal – Annex B7

(E) Report on Fund Utilization and Status

of Program / Project Implementation
– Annex C
� �
 Note: Applicable only if LGU is a recipient
of FYs 2016 – 2020 LGSF – FA.
(F) Certification attesting that the
balances from FYs 2016 – 2019
LGSF – FA have already been
returned to the National Treasury.
� �
Note: Applicable only if LGU is a recipient
of FYs 2016 – 2019 LGSF – FA and has an
unobligated balances.
(G) Proof of reversion of unobligated
balances (e.g., disbursement voucher
/ check, deposit slip, or official receipt
from BTr).
� �
Note: Applicable only if LGU is a recipient
of FYs 2016 – 2019 LGSF – FA and has an
unobligated balances.

PROJECT IMPLEMENTATION (Based on LBC 131):

AVAILABILITY /
DOCUMENTARY REQUIREMENTS APPLICABILITY REMARKS
YES NO
(A) Sanggunian Resolution endorsing the
following projects:
1. ______________________
2. ______________________ � �
3. ______________________

(B) Approved Local Development

Investment Program highlighting the
inclusion of the proposed programs / � �
projects.

(C) Approved Annual Investment

Program highlighting the inclusion of
the proposed programs / projects.
� �

PROJECT EXECUTION:
Documentary Completeness and Accuracy (DCA) and Timeliness (T)

AVAILABILITY /
DOCUMENTARY APPLICABILITY
REMARKS
REQUIREMENTS Target Date
YES NO
Actual Date
PRE-PROCUREMENT
(A) Notice of Authority to Debit
Account Issued (NADAI)
� �
Note: Include NADAI No. in the
Remarks.
 (B) Confirmation on the Receipt of
Fund.
� �
Note: Per Section 3.17 of LBC 131
(C) Proof on the transfer of Fund to
LGU Trust Fund � �
PROCUREMENT STAGE
(A) ITB Posting in PHILGEPS
� �
(B) Opening of Bids
� �
(C) Issuance of Notice of Award
(NOA) � �
(D) Issuance of Notice to Proceed
(NTP) � �
PROJECT IMPLEMENTATION
(A)

(B)

(C)

(D)

COMPLIANCE REMARKS
POSTING AND REPORTORIAL REQUIREMENTS
YES NO

A. Compliance to the posting requirements prescribed under RA

No. 9184 and its 2016 Revised IRR and all relevant policies issued � �
by the GPPB

B. Quarterly report/s on fund utilization and status of the � �

program/project implementation

C. Compliance to DILG policy on Full Disclosure Policy

C.1 Posting of report/s in at least three (3) conspicuous

public spaces in the province � �

C.2 Posting of report/s in the LGUs Website within 20

calendar days from end of each quarter � �

4. Written Notice Upon posting on the LGUs website to the

Secretary of DBM, Secretary of DILG, Speaker of the House of � �
Representatives, President of the Senate of the Philippines,
Chairperson of the House of Committee on Appropriations and
Chairperson of the Senate Committee on Finance based on
Section 6.4 of LBC 131
MONITORED BY:
_____________________________
MLGOO

_____________________________
PROVINCIAL ENGINEER

ACKNOWLEDGED BY:

_____________________________
LOCAL CHIEF EXECUTIVES / LGU REPRESENTATIVE
 ANNEX A.2.1
DOCUMENTARY REQUIREMENTS CHECKLIST
Support to the Barangay Development Program
REGION : ________________________________________
PROVINCE : ________________________________________
LOCAL GOVERNMENT UNIT : ________________________________________
BARANGAY (ANNEX A DBM LBC 135) : ________________________________________

PROGRAM / PROJECT (INFRASTRUCTURE PROJECTS)

A. Farm-to-Market Roads �
B. School Buildings �
C. Water and Sanitation System �
D. Health Stations �
E. Rural Electrification �
F. Reconstruction, Rehabilitation, Repair and other similar projects in connection with the occurrence
of natural or human-induced calamities, epidemics, crises resulting from armed conflicts, insurgency, �
terrorism and other catastrophes
G. Housing �

AVAILABILITY
DOCUMENTARY REQUIREMENTS REMARKS
YES NO
PRE-IMPLEMENTATION
A. Signed request letter by the Punong Barangay containing the
following details:
1. Program / Project Title;
2. Project Location, and
� �
3. Amount

Note: If the request covers two (2) or more programs or projects, list of
programs/ projects in order or priorities shall be attached.
B. Project is included in the Enhanced Barangay Development Plan and
� �
incorporated in the Annual Investment Plan
C. Duly notarized Omnibus Sworn Statement (OSS) – Annex B1
� �
DBM LBC 135
D. Signed LGU Contact Details by the LCE – Annex B2 DBM
� �
LBC 135

AVAILABILITY / APPLICABILITY
DOCUMENTARY
Target Date REMARKS
REQUIREMENTS YES NO
Actual Date
PRE-PROCUREMENT
1. Notice of Authority to Debit
Account Issued (NADAI)
� �
Note: Include NADAI No. in the
Remarks.
2.Confirmation on the Receipt of
Fund. � �
3. Proof on the transfer of Fund to
LGU Trust Fund
� �
Note: Per Section 4.8 of DBM LBC
135
 PROCUREMENT STAGE
Mode of Implementation: By Contract By Administration
IF BY CONTRACT
1. ITB Posting in PHILGEPS � �
2. Opening of Bids � �
3. Issuance of Notice of Award
(NOA) � �
4. Issuance of Notice to Proceed
(NTP) � �

AVAILABILITY
IMPLEMENTATION STAGE REMARKS
YES NO
1. Compliance of the project on following (in coordination with the DILG
Provincial Engineer):
1.A National Standards for Specific Project � �
1.B Applicable Provisions of 2021 GAA (RA 11518) � �
1.C Provisions on the DBM LBC 135 � �
AVAILABILITY
REPORTORIAL REQUIREMENTS REMARKS
YES NO
1. Compliance to the posting requirements prescribed under RA No. 9184
� �
and its 2016 Revised IRR and all relevant policies issued by the GPPB
2. Quarterly report/s on fund utilization and status of the program/project
� �
implementation (ANNEX C DBM LBC 135)
3. Compliance to DILG policy on Full Disclosure Policy

3.1 Posting of report/s in at least three (3) conspicuous public spaces in

� �
the province (one of which shall be in the beneficiary barangay)
3.2 Posting of report/s in the LGU’s Website within 20 calendar days from
� �
end of each quarter
4. Receiving copy of the Notice of posting of report in LGU’s website for
the following:

Note : kindly indicate date of notice in remark

4.1 Secretary of DBM � �
4.2 Secretary of DILG � �
4.3 Chairperson of NTF-ELCAC � �
4.4 Speaker of the House of Representatives � �
4.5 President of the Senate of the Philippines � �
4.6 Chairperson of the House of Committee on Appropriations on Finance � �

MONITORED BY:
_____________________________
MLGOO/CITY/PROVINCIAL DIRECTOR

_____________________________
PROVINCIAL ENGINEER

ACKNOWLEDGED BY:

_____________________________
LOCAL CHIEF EXECUTIVE / LGU REPRESENTATIVE
 ANNEX A.2.2
DOCUMENTARY REQUIREMENTS CHECKLIST
Support to the Barangay Development Program
REGION : ________________________________________
PROVINCE : ________________________________________
LOCAL GOVERNMENT UNIT : ________________________________________
BARANGAY (ANNEX A DBM LBC 135) : ________________________________________

PROGRAM / PROJECT (NON-INFRASTRUCTURE PROJECTS)

A. COVID-19 Vaccination, immunization and other health related projects �
B. Agricultural, livelihood and technical vocational trainings/projects �
C. Assistance to Indigent individual or families in any of the following form of assistance:
D.1. Medical �
D.2. Burial �
D.3. Transportation �
D.4. Food �
D.5. Cash for Work �
D.6. Educational �

AVAILABILITY
DOCUMENTARY REQUIREMENTS REMARKS
YES NO
PRE-IMPLEMENTATION
A. Signed request letter by the Punong Barangay containing the
following details:
1. Program / Project Title;
2. Project Location, and
3. Amount � �

Note: If the request covers two (2) or more programs or projects, list of
programs/ projects in order or priorities shall be attached.
B. Duly notarized Omnibus Sworn Statement (OSS) – Annex B3
� �
DBM LBC 135
C. Signed LGU Contact Details by the LCE – Annex B2 DBM LBC
� �
135

AVAILABILITY / APPLICABILITY
DOCUMENTARY
Target Date REMARKS
REQUIREMENTS YES NO
Actual Date
PRE-PROCUREMENT
1. Notice of Authority to Debit Account
Issued (NADAI)
� �
Note: Include NADAI No. in the
Remarks.
2.Confirmation on the Receipt of Fund. � �
3. Proof on the transfer of Fund to LGU
Trust Fund
� �
Note: Per Section 4.8 of DBM LBC 135
PROCUREMENT STAGE
Mode of Implementation: By Contract By Administration
 IF BY CONTRACT
1. ITB Posting in PHILGEPS � �
2. Opening of Bids � �
3. Issuance of Notice of Award (NOA) � �
4. Issuance of Notice to Proceed (NTP) � �

AVAILABILITY
IMPLEMENTATION STAGE REMARKS
YES NO
1. Compliance of the project on following (in coordination with
the DILG Provincial Engineer):
1.A National Standards for Specific Project � �
1.B Applicable Provisions of 2021 GAA (RA 11518) � �
1.C Provisions on the DBM LBC 135 � �

AVAILABILITY
REPORTORIAL REQUIREMENTS REMARKS
YES NO
1. Compliance to the posting requirements prescribed under RA No. 9184
� �
and its 2016 Revised IRR and all relevant policies issued by the GPPB
2. Quarterly report/s on fund utilization and status of the program/project
� �
implementation (ANNEX C DBM LBC 135)
3. Compliance to DILG policy on Full Disclosure Policy
3.1 Posting of report/s in at least three (3) conspicuous public spaces in
� �
the province (one of which shall be in the beneficiary barangay)
3.2 Posting of report/s in the LGU’s Website within 20 calendar days
� �
from end of each quarter
4. Receiving copy of the Notice of posting of report in LGU’s website for
the following:

Note : kindly indicate date of notice in remark

4.1 Secretary of DBM � �
4.2 Secretary of DILG � �
4.3 Chairperson of NTF-ELCAC � �
4.4 Speaker of the House of Representatives � �
4.5 President of the Senate of the Philippines � �
4.6 Chairperson of the House of Committee on Appropriations on
� �
Finance

MONITORED BY:
_____________________________
CITY/PROVINCIAL DIRECTOR

_____________________________
PROVINCIAL ENGINEER

ACKNOWLEDGED BY:

_____________________________
LOCAL CHIEF EXECUTIVE / LGU REPRESENTATIVE
 ANNEX A.2.3
TECHNICAL COMPLIANCE REQUIREMENTS CHECKLIST
Support to the Barangay Development Program
INFRASTRUCTURE PROJECT
REGION : _____________________________________
PROVINCE : _____________________________________
LOCAL GOVERNMENT UNIT : _____________________________________
BARANGAY (ANNEX A DBM LBC 135) : _____________________________________

AVAILABLE
SPECIFIC REQUIREMENTS REMARKS
YES NO
BUILDING
A. Program of Work
Note: If the request covers two (2) or more programs or projects, list of � �
programs/ projects in order or priorities shall be attached.
B. Detailed Unit Price
C. Analysis Technical Specification
D. Complete Technical Drawing Plans (Architectural, Civil/Structural,
Sanitary/Plumbing, Electrical, Mechanical)
E. Geotagged Photos of the site
F. Vicinity Map/ Digitized Map
ROAD
A. Program of Works
B. Detailed Unit Price Analysis
C. Complete Technical Drawing Plans (Plans and Profiles; Typical
Roadway Sections and Details; Other component structures such as
Slope Protection/ Canals/ Box Culverts whichever is applicable)
D. Technical Specifications
E. Geotagged Photos of Site (at least 3 sections of the road)
F. Vicinity Map/Digitized Map
WATER AND SANITATION SYSTEMS
G. Program of Work
H. Detailed Unit Price Analysis
I. Simplified Feasibility Study
J. Complete Technical Drawing Plans (Plans and Profiles; Plan,
Elevation and Details of Intake Structure/ Reservoir/Elevated Water
Tank; Details of Wells and Pump House; Details of Trench, Thrust
Blocks, Pipe Bridge, Tap stands if Level II or Stub-outs if Level III)
K. Technical Specifications
L. Water Source Validation Report (with Potability Test Result and
Quantity of Discharge)
M. Hydraulic Analysis
N. Geotagged Photos of Water Source and Site
O. Application of Water Rights from National Water Resources Board
MONITORED BY:

_____________________________
CITY/PROVINCIAL DIRECTOR

_____________________________
PROVINCIAL ENGINEER

ACKNOWLEDGED BY:

_____________________________
LOCAL CHIEF EXECUTIVE / LGU REPRESENTATIVE
 ANNEX A.3
DOCUMENTARY REQUIREMENTS CHECKLIST
DISASTER REHABILITATION AND RECONSTRUCTION
ASSISTANCE PROGRAM
REGION : ______________________________________________________
PROVINCE : ______________________________________________________
NAME OF LGU : ______________________________________________________

PROGRAM / PROJECT
Construction, concreting, rehabilitation, repair or improvement of any of the following:
(a) Shelter and Resettlements �
(b) Public Infrastructure (i.e., Roads, Bridges, Flood Control and Public Buildings, and Multi
Purpose Buildings/ Evacuation/ Quarantine Facilities) �
(c) Education and Health Facilities �
(d) Agriculture (i.e., Crops, Livestocks, Fisheries) �
(e) Social Protection �

Project Title : _____________________________________________________

Project Location : ______________________________________________________
Amount Requested : ______________________________________________________
Target Beneficiary : ______________________________________________________

AVAILABILITY
REMARKS
YES NO
PRE-IMPLEMENTATION (Based on LBC 134)
A. Approved Local Disaster Risk Reduction and Management
Plan (LDRRMP)
� �
Note: LDRRMP should include the projects to be implemented
B. Approved Local Development Investment Program (LDIP)
highlighting the inclusion of the proposed programs / projects. � �
C. Approved Annual Investment Program (AIP) highlighting the
inclusion of the proposed programs / projects. � �
D. Approved Detailed Engineering Design (DED) with POW and
Detailed Estimates.

� �
Note: DED shall be in accordance with the design plan, specifications
and such other standards and policies of the National Government.
E. Report on Fund Utilization and Status of Program / Project
Implementation – Annex C

Note: Applicable only if LGU is a recipient of FYs 2016 – 2020 LGSF

– FA.
F. Proof that the LGU has secured all the necessary clearance or
certification from various National Agencies as prescribed by
law (e.g., ECC, CNC, Water Permit, Permit to Cut Trees, PCA, � �
NIPAS etc)

G. Project is not located in the following:

(1) Privately-owned land; � �
 (2) Not in the critical geo-hazard areas or no-build zones
identified and/or certified by MGB hazard map;
(3) Within the territorial jurisdiction of the LGU. Listed in the
Road Inventory.

Note: Proof that the project is not located in the above-mentioned shall
be provided by the LGU.
H. Certification indicating that the project is not fully covered by other
sources of funds � �

PROJECT EXECUTION:
Documentary Completeness and Accuracy (DCA) and Timeliness (T)

AVAILABILITY /
DOCUMENTARY
APPLICABILITY REMARKS
REQUIREMENTS
YES NO Actual Date
PRE-PROCUREMENT
(A) Notice of Authority to Debit
Account Issued (NADAI)
� �
Note: Include NADAI No. in the
Remarks.
(B) Confirmation on the Receipt of
Fund. � �
(C) Proof on the transfer of Fund to
LGU Trust Fund
� �
Note: Per Section 3.17 of LBC 131
PROCUREMENT STAGE
Target Actual
(A) ITB Posting in PHILGEPS
� �
(B) Opening of Bids
� �
(C) Issuance of Notice of Award
(NOA) � �
(D) Issuance of Notice to Proceed
(NTP) � �
PROJECT IMPLEMENTATION
(A) Project Signboard per COA
Circular 2013-004 � �
(B) Request for Work Inspection.
� �
(C) Concrete Pouring Permit
� �
(D) Site Instruction
� �
(E) Certificate of Completion
� �
AFTER DEFECTS AND LIABILITY PERIOD (DLP)
(A) Certificate of Final Acceptance
� �
(B) Approved Annual Investment
Program highlighting the � � N/A N/A
 inclusion of maintenance or
repair cost as stated in the
Omnibus Sworn Statement of
the LGU.

PROJECT EXECUTION:
Quality

✔ For this part, the Quality Assurance and Assessment Report (QAAR) Tools shall
be used in ensuring that the quality of the projects has been monitored and
compliance to National Government Standards as stated in the Omnibus Sworn
Statement of the LGU.

COMPLIANCE REMARKS
POSTING AND REPORTORIAL REQUIREMENTS
YES NO

A. Compliance to the posting requirements prescribed under RA

No. 9184 and its 2016 Revised IRR and all relevant policies issued � �
by the GPPB

B. Quarterly report/s on fund utilization and status of the � �

program/project implementation

C. Compliance to DILG policy on Full Disclosure Policy

C.1 Posting of report/s in at least three (3) conspicuous

public spaces in the province � �

C.2 Posting of report/s in the LGUs Website within 20

calendar days from end of each quarter � �

4. Written Notice Upon posting on the LGUs website to the

Secretary of DBM, Speaker of the House of Representatives, � �
President of the Senate of the Philippines, Chairperson of the
House of Committee on Appropriations and Chairperson of the
Senate Committee on Finance based on Section 6.4 of LBC 134
MONITORED BY:

_____________________________
MLGOO

_____________________________
PROVINCIAL ENGINEER

ACKNOWLEDGED BY:

_____________________________
LOCAL CHIEF EXECUTIVE / LGU REPRESENTATIVE
 ANNEX A.4
DOCUMENTARY REQUIREMENTS CHECKLIST
LGSF - ASSISTANCE TO CITIES (AC)
(Green Open Spaces or Active Mobility Infrastructure)
REGION : _____________________________________
PROVINCE : _____________________________________
NAME OF LGU (ANNEX B, DBM LBC 133) : _____________________________________

PROJECT TYPE

Green Open Spaces (Refer to BMB Technical Bulletin 2018-02) �

�
a. Public Park / Plaza

b. Arboretum / Botanical Garden �

c. Others ________________________

Active Mobility Infrastructure (Refer to DPWH DO 88 s2020) �

�
a. Bicycle Lane/s

b. Bicycle Rack/s �
c. Pedestrian Footpath / Walkway �
d. Shared Walkway and Bike Path �
e. Others ________________________

DOCUMENTARY REQUIREMENTS (Based on LBC 133)

TYPES OF DOCUMENTS COMPLIANCE REMARKS

YES NO

A. Request letter addressed to the Secretary of DBM,

signed by the LCE stating the following: � �
1. Program / Project Title;
2. Project Location, and
3. Fund Allocation
 B. Project Brief (Annex C, DBM LBC 133)
� �

C. Duly notarized Omnibus Sworn Statement (OSS) –

(Annex D, DBM LBC 133) � �

c.1 Sanggunian Resolution endorsing the project(s)

included on the duly approved LDIP and AIP � �

c.2 Site Development Plan

· Detail Drawings and Specifications

� �

· Program of Works
� �

· Detailed Estimates
� �

c.3 Mode of Implementation

· By Contract
� �

· By Administration
� �
(Note: If By Administration should be in accordance w/ Appendix 1 of
the 2016 IRR RA 9184)

c.4 Road-Right of Way (RROW) -(If Applicable)

· Deed of Donation/Sale/Writ of Execution

� �

· Minutes of Public Consultation/Hearing

� �

c.5 Permits and Clearances (If Applicable)

· ECC or CNC (Environmental Compliance

from DENR) � �

· Permit to Cut Trees (If Applicable

DENR/PCA) � �

c.6 Location of the Project

· Not privately owned

� �
 · With Certification from MGB (project
location is not included on hazard areas � �
/no-build zones)

· Within Territorial jurisdiction of the LGUs

� �

c.7 Fund(s) to maintain and repair of the project

� �

c.8 Not funded by other Agencies or Program

� �

D. Report on Fund Utilization of previous LGSF-AC and

Status of Program / Project Implementation (Finance � �
Committee)

Note: Applicable only if LGU is a recipient of FYs 2018 – 2020

LGSF – AC

E. Certification from Local Finance Committee attesting

that the balances from FYs 2018 – 2019 LGSF – AC � �
have already been returned to the National Treasury

Note: Applicable only if LGU is a recipient of FYs 2018 – 2020

LGSF – AC

F. Proof of reversion of unobligated balances (e.g.,

disbursement voucher / check, deposit slip, or official � �
receipt from BTr).

Note: Applicable only if LGU is a recipient of FYs 2018 – 2020

LGSF – AC

Note: Consistent with the SP No.4, FY 2021 GAA, the DILG shall be responsible for the monitoring
and evaluation of the actual project implementation, including the documentary requirements to
be submitted by the LGUs to be used for said monitoring and evaluation covered by LGSF.
 COMPLIANCE REMARKS

DESIGN CONSIDERATIONS
YES NO

A. Conformance of the design, concept and

requirements:

Note: (Check boxes or provide inputs if included on the

design)

a.1 Design for the Environment

· Site Attribute Types

1. Ecosystem Type
(Lowland, Upland, Wetland, Coastal, Riverine, [please input]
Lacustrine/ Lakeshore or Palustrine/
Swampland/ Marshland)

2. Topography (Rolling or Flat Terrain)

[please input]

3. Biological Features (Refer to BMB

Technical Bulletin 2018-02) � �

4. Physical Features (land use / land

classification based on CLUP or Zoning [please input]
Ordinance)

5. Freshwater sources (surface or

subsurface water, etc) [please input]

6. Culture and Heritage

[please input]

· Design Concept (green or blue

infrastructures)

1. Green Infrastructure
� �
2. Blue Infrastructure
� �

a. Both (Green and Blue)

� �

· Minimize waste generation,

maintenance, and sustainability

1. Energy efficient site lighting

� �
2. Re-use storm water for landscape
irrigation � �

3. Material Selection for long-lasting,

resource-efficient and all weather � �

a.2 Design for the People

· Preferably within Local Public

Transport Route Plan (LPTRP) � �

· Compliant to DPWH DO 88 for the

Design � �

· Monitoring Checklist of LGUs

Establishment of Cycling Lanes and � �
Walking Paths (DILG MC 2020-100)

PROJECT IMPLEMENTATION

DOCUMENTARY REQUIREMENTS AVAILABILITY / REMARKS

APPLICABILITY

YES NO

PRE-PROCUREMENT
A. Notice of Authority to Debit Account Issued
(NADAI) � �

Note: Include NADAI No. in the Remarks.

PROCUREMENT STAGE

A. Procurement Timelines �
�

B. Notice of Award (NOA)

� �

C. Contract Agreement � �

D. Notice to Proceed (NTP)

� �

IMPLEMENTATION STAGE

1. Pre-Construction Conference
� �

2. As-Stake Survey
� �

3. Approved Site Development Plan

� �

4. Detailed Drawings
� �
5. Program of Works and Detailed Estimates
� �
6. Construction Schedule
� �

7. Quality Control Plan

� �
 8. Test Results
� �

9. Statement of Work Accomplished (SWA)

� �

10. Progress Photos

� �

POST IMPLEMENTATION STAGE

1. Punch List � �

2. Final Inspection Report

� �

3. Certificate of Completion
� �

4. Certificate of Acceptance
� �

5. Warranty Security
� �

· For the Quality Assurance Inspection, the Quality Assurance and Assessment
Report (QAAR) Tools shall be used in ensuring that the quality of the projects has
been monitored and compliance to National Government Standards.
·

REPORTORIAL REQUIREMENTS COMPLIANCE REMARKS

YES NO

1. Compliance to the posting requirements prescribed under RA � �

No. 9184 and its 2016 Revised IRR and all relevant policies issued
by the GPPB

2. Quarterly report/s on fund utilization and status of the � �

program/project implementation

3. Compliance to DILG policy on Full Disclosure Policy

 3.1 Posting of report/s in at least three (3) conspicuous
public spaces in the province � �

3.2 Posting of report/s in the LGUs Website within 20

calendar days from end of each quarter � �

4. Written Notice upon posting of reports on the LGU’s website � �

address to the following as stated on Sec. 6.4 of the DBM LBC No.
133.

(Secretary of DBM, Secretary of DILG, Speaker of the House of

Representatives, President of the Senate of the Philippines,
Chairperson of the House of Committee on Appropriations and
Chairperson of the Senate Committee on Finance)

MONITORED BY:

_____________________________

CLGOO

_____________________________

DILG RO/PO ENGINEER

ACKNOWLEDGED BY:

_____________________________

LOCAL CHIEF EXECUTIVE / LGU REPRESENTATIVE

 ANNEX A.5
DOCUMENTARY REQUIREMENTS CHECKLIST
CMGP
REGION : ______________________________________________________
PROVINCE : ______________________________________________________
NAME OF LGU : ______________________________________________________

PROGRAM / PROJECT
Construction, concreting, rehabilitation, repair or improvement of any of the following:
(a) Local Roads and / or Bridges �
(b) Stand Alone Bridge Component �

Project Title : _____________________________________________________

Project Location : ______________________________________________________
Amount Requested : ______________________________________________________
Target Beneficiary : ______________________________________________________

FOR FUND RELEASE :

AVAILABILITY
REQUIREMENTS REMARKS
YES NO
A. Compliance to the latest Seal of
Good Financial Housekeeping � �
(GFH)
B. Submission to DBM Public
Financial Management � �
Improvement Plan (PFMIP)
C. Notarized Omnibus Sworn
Statement (OSS)
c.1 Sanggunian Resolution
endorsing the project(s)
included on the latest � �
LRNDP, duly approved LDIP
and AIP
c.2 Detailed Engineering Design
(DED)
● Detail Drawings � �
● Program of Works � �
● Detailed Estimates � �
c.3 Mode of Implementation
● By Contract � �
● By Administration
(Note: Should be compliant w/ Appendix 1 of � �
the 2016 IRR RA 9184)
c.4 Road-Right of Way (RROW)
● Deed of
Donation/Sale/Writ of � �
Execution
● Minutes of Public
� �
Consultation
 c.5 Environmental Compliance
/Other Agencies compliance
● ECC or CNC � �
● Permit to Cut Trees (If
Applicable) � �
(DENR or PCA permit for Coconut Trees)
● NHCP Certification (If
applicable)
(Historical/Heritage Zone /structures)

c.6 Location of the Project

● Not privately owned � �
● With MGB Certification
(not included on hazard � �
areas /no-build zones)
● Updated Local Road
� �
Inventory
c.7 Fund(s) to maintain and repair
� �
of the project
c.8 Not funded by other Agencies
� �
or Program
● DPWH Certification for
no overlapping
(A) Report on Fund Utilization and Status
of Program / Project Implementation
– Annex C
� �
Note: Applicable only if LGU is a recipient
of FYs 2016 – 2020 LGSF – FA.
(B) Certification attesting that the
balances from FYs 2016 – 2019
LGSF – FA have already been
returned to the National Treasury.
� �
Note: Applicable only if LGU is a recipient
of FYs 2016 – 2019 LGSF – FA and has an
unobligated balances.
(C) Proof of reversion of unobligated
balances (e.g., disbursement voucher
/ check, deposit slip, or official receipt
from BTr).
� �
Note: Applicable only if LGU is a recipient
of FYs 2016 – 2019 LGSF – FA and has an
unobligated balances.

PROJECT IMPLEMENTATION:
AVAILABILITY /
DOCUMENTARY REQUIREMENTS APPLICABILITY REMARKS
YES NO
(A) Sanggunian Resolution endorsing the
following projects:
1. ______________________
2. ______________________ � �
3. ______________________
(B) Approved Local Development
Investment Program highlighting the
inclusion of the proposed programs / � �
projects.

(C) Approved Annual Investment

Program highlighting the inclusion of
the proposed programs / projects.
� �
(D) Approved Detailed Engineering
Design (DED) with POW and
Detailed Estimates.

� �
Note: DED shall be in accordance with the
design plan, specifications and such other
standards and policies of the National
Government.
(E) No Road Right-of-Way issue
Certification
� �
Note: Proof that there is no right-of-way
issue shall be attached.
(F) Proof that the LGU has secured all the
necessary clearance or certification
from various National Agencies as
prescribed by law (e.g., ECC, CNC, � �
Water Permit, Permit to Cut Trees,
PCA, NIPAS etc)

(G) Project is not located in the following:

(1) Privately-owned land;
(2) Not in the critical geo-hazard
areas or no-build zones identified
and/or certified by MGB hazard
map;
(3) Within the territorial jurisdiction � �
of the LGU. Listed in the Road
Inventory.

Note: Proof that the project is not located

in the above-mentioned shall be provided
by the LGU.
(H) Maintenance Budget for all Fair to
good roads

Note: LFC Certification for Budget

� �
Maintenance and AMWP should be
provided
(I) Certification indicating that the project
is not fully covered by other sources � �
of funds
(J) CMGP Site Validation Form
Accomplished by the CMGP
Provincial Engineer
� �
Note: Validation Form should have
signature of the Engineer who assessed the
project site and the Provincial Director
PROJECT EXECUTION:
Documentary Completeness and Accuracy (DCA) and Timeliness (T)

AVAILABILITY /
DOCUMENTARY
APPLICABILITY REMARKS
REQUIREMENTS
YES NO Actual Date
PRE-PROCUREMENT
(A) Notice of Authority to Debit
Account Issued (NADAI)
� �
Note: Include NADAI No. in the
Remarks.
(B) Confirmation on the Receipt of
Fund. � �
(C) Proof on the transfer of Fund to
LGU Trust Fund
� �
Note: Per Section 3.17 of LBC 131
PROCUREMENT STAGE
Target Actual
(A) ITB Posting in PHILGEPS
� �
(B) Opening of Bids
� �
(C) Issuance of Notice of Award
(NOA) � �
(D) Issuance of Notice to Proceed
(NTP) � �
PROJECT IMPLEMENTATION
(A) Project Signboard per COA
Circular 2013-004 � �
(B) Request for Work Inspection.
� �
(C) Concrete Pouring Permit
� �
(D) Site Instruction
� �
(E) Certificate of Completion
� �
AFTER DEFECTS AND LIABILITY PERIOD (DLP)
(A) Certificate of Final Acceptance
� �
(B) Approved Annual Investment
Program highlighting the
inclusion of maintenance or
repair cost as stated in the � � N/A N/A
Omnibus Sworn Statement of
the LGU.
PROJECT EXECUTION:
Quality

✔ For this part, the Quality Assurance and Assessment Report (QAAR) Tools shall
be used in ensuring that the quality of the projects has been monitored and
compliance to National Government Standards as stated in the Omnibus Sworn
Statement of the LGU.

MONITORED BY:
_____________________________
MLGOO

_____________________________
PROVINCIAL ENGINEER

ACKNOWLEDGED BY:

_____________________________
LOCAL CHIEF EXECUTIVE / LGU REPRESENTATIVE