Appendix 11

OBLIGATION REQUEST AND STATUS Serial No. : SSP-2021-PTC-12

TECHNICAL EDUCATION AND SKILLS DEVELOPMENT AUTHORITY Date : 9/12/2021

PROVINCIAL TRAINING CENTER - CAGAYAN
Fund Cluster : SSP

Payee CRISTONN ELECTRICAL SUPPLIES

Office

Address Luna St., Tuguegarao City, Cagayan

Responsibility Center Particulars MFO/PAP UACS Object Code Amount

To payment for the Electrical Supplies for the 3020100002 P26,288.00

electrification of PTC Building as per attached supporting
documents

Total P26,288.00
A. Certified: Charges to appropriation/alloment are B. Certified: Allotment available and obligated
necessary, lawful and under my direct supervision;and for the purpose/adjustment necessary as
supporting documents valid, proper and legal indicated above

Signature : __ Signature : ______________________

__
__
Printed Name: FELICIDAD A. BADAJOS Printed Name ANNETTE B. ACORDA
__
Position : Supervising
__ TESD Specialist Position Administrative Officer V
Head,
__ Requesting Office/Authorized Representative Head, Budget Division/Unit/Authorized Representative
Date : 9/12/2021
__ Date : 9/12/2021
__
__
C. __ STATUS OF OBLIGATION
__Reference Amount
__ Balance
__ ORS/JEV/Check/ Obligation Payable Payment Due and
Date Particulars
__ Not Yet Due Demandab
ADA/TRA No.
__ le
__ (a) (b) (c) (a-b) (b-c)
09/12/21 __ SSP-2021-PTC-12 P26,288.00
09/12/21 _ SSP-2021-PTC-12 P26,288.00
 Appendix 32

TECHNICAL EDUCATION AND SKILLS DEVELOPMENT AUTHORITY Fund Cluster :

PROVINCIAL TRAINING CENTER - CAGAYAN
Date : 9/12/2021
DISBURSEMENT VOUCHER DV No. : SSP-2021-PTC-12

Mode of MDS Check P Commercial Check ADA Others (Please specify)

Payment
_________________
TIN/Employee No.: ORS/BURS No.:
Payee CRISTONN ELECTRICAL SUPPLIES
166-345-853-000 SSP-2021-PTC-12
Address
Luna St., Tuguegarao City, Cagayan
Responsibility
Particulars MFO/PAP Amount
Center
To payment for the Electrical Supplies for the electrification of PTC 3020100002 26,288.00
Building as per attached supporting documents

Total: P26,288.00
A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.

FELICIDAD A. BADAJOS
Supervising TESD Specialist

B. Accounting Entry:
Account Title UACS Code Debit Credit
P26,288.00 P26,288.00
P0.00 P0.00
Cash in Bank-Local Currency Account 10102020 P26,288.00

C. Certified: D. Approved for Payment

P Cash available
P Subject to Authority to Debit Account (when applicable)
P Supp
proper

Signature Signature

Printed
Printed Name
Name JOHN REIGHNELL R. BUENAVENTURA ROMEO O. TALOSIG,DPA
Administrative Officer IV Provincial Director
Position Position
Head, Accounting Unit/Authorized Representative Agency Head/Authorized Representative
Date 9/12/2021 Date 9/12/2021
E. Receipt of Payment JEV No.
Check/ Date : Bank Name & Account Number:
ADA No. : LBP SSP-2021-PTC-12
Date : Printed Name: Date
Signature :

Official Receipt No. & Date/Other Documents 9/12/2021

 Appendix 64
REPORT OF SUPPLIES AND MATERIALS ISSUED
Entity Name: TESDA - CAGAYAN PROVINCIAL OFFICE Serial No. : _______________________
Fund Cluster: Date :
To be filled up by the Supply and/or Property Division/Unit To be filled up by the Accounting Division/Unit
RIS/ICS Responsibility Quantity
Stock No. Item Unit Unit Cost Amount
No. Center Code Issued
Service Drop Line, # 2 Meter 160 ₱164.30 ₱26,288.00
x-x-x-nothing follows-x-x-x

₱26,288.00
Recapitulation: Recapitulation:
Stock No. Quantity Unit Cost Total Cost UACS Object Code

I hereby certify to the correctness of the above information. Posted by:

JOHN REIGHNELL R. BUENAVENTURA ANNETTE B. ACORDA

Administrative Officer V/Supply Date
Admin Officer IV
Officer
 Appendix 63
REQUISITION AND ISSUE SLIP
Entity Name: TESDA - CAGAYAN PROVINCIAL OFFICE Fund Cluster :
Division : Admin/Technical Responsibility Center Code : Admin/ Tech.
Office : CAGAYAN PROVINCIAL OFFICE RIS No. : 101-21-11-
Requisition Stock Available? Issue
Stoc
k Unit Description Quantity Yes No Quantity Remarks
No.
N/A Meter G.I Pipe, 1⅟₂" Dia., Schedule 40, 6 m 12

G.I. Elbow for 1⅟₂" Dia. Pipe 24

Flat Bar, 1⅟₂" x 3 3/16 x 6 m, Std 24

Electrode, E-6013, 2.5 mm Dia, 2.5 kg, Sp 4

Cyclone Wire, 2" x 2" hole, 120 cm Height 95

x-x-x-nothing follows-x-x-x

Purpose: For the Electrification of PTC BUILDING at Nassiping, Gattaran, Cagayan

Requested by: Approved by: Issued by: Received by:
Signature :
Printed Name : FELICIDAD A. BADAJOS ROMEO O. TALOSIG, DPA ANNETTE B. ACORDA ROBIN CONCORDIA

Designation : Center Administrator Provincial Director Acting Supply Officer Sr. TESD Specialist

Date :
 Appendix 61
PURCHASE ORDER
TESDA - CAGAYAN PROVINCIAL OFFICE
Carig Norte, Tuguegarao City
Tel. Number 377-0004
Supplier : CRISTONN ELECTRICAL SUPPLIES P.O. No. : 101-21-12
Address : Luna St., Tuguegarao City, Cagayan Date : 2-Dec-21
TIN : 166-345-853-000 Mode of Procurement : Small Value Proc.
Gentlemen:
Please furnish this Office the following articles subject to the terms and conditions contained herein:

Place of Delivery : TESDA Cagayan Provincial Office Delivery Term : FOB Destination
Date of Delivery : Payment Term : N/30

Stock/
Property Unit Description Quantity Unit Cost Amount
No.

Pcs G.I Pipe, 1⅟₂" Dia., Schedule 40, 6 m 12 ₱0.00

Pcs G.I. Elbow for 1⅟₂" Dia. Pipe 24 ₱0.00

Pcs Flat Bar, 1⅟₂" x 3 3/16 x 6 m, Std 24 ₱0.00

Box Electrode, E-6013, 2.5 mm Dia, 2.5 kg, Special 4 ₱0.00

Meter Cyclone Wire, 2" x 2" hole, 120 cm Height 95 ₱0.00

n/a

Box Blind Rivet, 3/16" x 1" Deep 1 ₱0.00

x-x-x-nothing follows-x-x-x

(Total Amount in Words) Twenty Six Thousand Two Hundred Eighty Eight Only ₱0.00

In case of failure to make the full delivery within the time specified above, a penalty of one-tenth (1/10) of one percent for every day of delay
shall be imposed on the undelivered item/s.
Conforme: Very truly yours,
_______________________________
Signature over Printed Name of Supplier ROMEO O. TALOSIG
Date:________________ Provincial Director

Fund Cluster : Fund 101-Regular ORS/BURS No. : 01101101-21-

Funds Availabl P0.00 Date of the ORS/BURS:

ANNETTE B. ACORDA Amount : ₱0.00

Administrative Officer V
Check#
 Appendix 62
INSPECTION AND ACCEPTANCE REPORT

Entity Name : TESDA - CAGAYAN PROVINCIAL OFFICE Fund Cluster :

Supplier : CRISTONN ELECTRICAL SUPPLIES IAR No. : 101-21-12

PO No./Date: 101-20-02-09A /Date: Date : 8-Dec-21
Requisitioning Office/Dept. : Admin/Technical Invoice No.:
Responsibility Center Code :Admin/Technical Date : 8-Dec-21

Stock/
Description Unit Quantity
Property No.
G.I Pipe, 1⅟₂" Dia., Schedule 40, 6 m Pcs 12
G.I. Elbow for 1⅟₂" Dia. Pipe Pcs 24
Flat Bar, 1⅟₂" x 3 3/16 x 6 m, Std Pcs 24
Electrode, E-6013, 2.5 mm Dia, 2.5 kg, Special Box 4
Cyclone Wire, 2" x 2" hole, 120 cm Height Meter 95
Blind Rivet, 3/16" x 1" Deep Box 1
x-x-x-nothing follows-x-x-x

INSPECTION ACCEPTANCE
Date Inspected : Date Received :

Inspected, verified and found in order as to Complete

quantity and specifications
Partial (pls. specify quantity)
ANNETTE B. ACORDA
Chairman

JOHN REIGHNELL R. BUENAVENTURA ANNETTE B. ACORDA

Member Admin Officer V

FELICIDAD A.BADAJOS
Member
End-user
 TESDA-OP-AS-04-F04
Rev. No. 00 - 03/01/17

ABSTRACT OF PRICE QUOTATION

Date:

FELICIDAD A.BADAJOS
Quotation

CRISTONN ELECTRICAL TRI-G GENERAL

Item IPOWER ELECRICAL SUPPLY
Qty. Unit Article/Description SUPPLIES MERCHANDISE
No.

UNIT PRICE TOTAL UNIT PRICE TOTAL UNIT PRICE TOTAL

G.I Pipe, 1⅟₂" Dia., Schedule 40, 6 m

12 Pcs
G.I. Elbow for 1⅟₂" Dia. Pipe
24 Pcs
Flat Bar, 1⅟₂" x 3 3/16 x 6 m, Std
24 Pcs
Electrode, E-6013, 2.5 mm Dia, 2.5 kg, Special
4 Box
Cyclone Wire, 2" x 2" hole, 120 cm Height
95 Meter
Blind Rivet, 3/16" x 1" deep
1 0
x-x-x-nothing follows-x-x-x

₱0.00 ₱0.00 ₱0.00

FELICIDAD A.BADAJOS MARIO G. HERTRUDES GIOVANNI G. VENTURA JOSEPHINE N. CABRERA

PTC Administrator BAC Member BAC Member BAC Chairperson
End-User
 TESDA-OP-AS-04-F03
Rev. No. 00 - 03/01/17

Annex "A"
PRICE QUOTATION FORM
Date:

MS. JOSEPHINE N. CABRERA

BAC, Chairman
TESDA-Cagayan Provincial Office
Carig Norte, Tuguegarao City

Madam:

After having carefully read and accepted the Terms and Conditions in the Request for Quotation, hereunder is our
quotation/s for the item/s as follows:
OFFER
REMARKS
APPROVED
BUDGET FOR Compliance with
ITEM DESCRIPTION QTY UNIT THE CONTRACT the Technical
(In Peso) Specifications
(please check) (Price/Others)
YES NO
G.I Pipe, 1⅟₂" Dia., Schedule 40, 6 m 12 Pcs [ ] [ ]
G.I. Elbow for 1⅟₂" Dia. Pipe 24 Pcs [ ] [ ]
Flat Bar, 1⅟₂" x 3 3/16 x 6 m, Std 24 Pcs [ ] [ ]
Electrode, E-6013, 2.5 mm Dia, 2.5 kg, Special 4 Box [ ] [ ]
Cyclone Wire, 2" x 2" hole, 120 cm Height 95 Meter [ ] [ ]
Blind Rivet 1 Box [ ] [ ]
x-x-x nothing follows x-x-x

Name of Business/Company

Signature over Printed Name

Office Telephone/Fax No.

Mobile No.

Email address
 Appe

PURCHASE REQUEST

Entity Name: TESDA - CAGAYAN PROVINCIAL OFFICE Fund Cluster:

Office/Section : PR Number: 101-21-12- Date:

TESDA-Cagayan Responsibility Center Code : Admin/Technical

Stock/ Property
Unit Item Description Quantity Unit Cost
No.
Unit Welding Machine with Accessories, AC/DC/Inverter, 250 amps, Portable 12 ₱10,000.00
Unit Electrode Oven, Heavy Duty 1 ₱4,200.00
Pcs Grinder 12 ₱3,109.00
Unit Exhaust Fan 1 ₱8,765.00
Set Oxy-Acetylene Set 2 ₱12,800.00
Cyl. Oxygen Tank, 50 Lbs 2 ₱7,800.00
Cyl. Acetylene Tank, 50 kg 2 ₱10,070.00
Unit Pedestal Grinder/Sander Combination, 14" Wheel Grinder Dia. 1 ₱12,990.00
Unit Bench Vice, Rotary, Heavy Duty, 8" Grip 10 ₱1,800.00
Unit Industrial Fan, 24 inch, heavy duty 1 ₱5,390.00
**** N o t h i n g F o l l o w s****

Purpose:
For SMAW NCI training Equipment

Requested by: Approved by:

Signature :
Printed Name : FELICIDAD A. BADAJOS ROMEO O. TALOSIG,DPA
Designation : Supervicing TESD Specialist Provincial Director
 Appendix 60

URCHASE REQUEST

PTC-SSP Fund
December 23, 2021

Total Cost

₱120,000.00

₱4,200.00

₱37,308.00

₱8,765.00

₱25,600.00

₱15,600.00

₱20,140.00

₱12,990.00

₱18,000.00
₱5,390.00
267,993.00

Approved by:

ROMEO O. TALOSIG,DPA
Provincial Director
 Appendix 59

INVENTORY CUSTODIAN SLIP

Entity Name: _PROVINCIAL TRAINING CENTER - CAGAYAN

Fund Cluster : ________________________________ ICS No : 101-21-12-

Amount Description Estimat

Quant Inventory ed
Unit
ity Item No. Useful
Unit Cost Total Cost Life
12 Pcs G.I Pipe, 1⅟₂" Dia., Schedule 40, 6 m
24 Pcs G.I. Elbow for 1⅟₂" Dia. Pipe
24 Pcs Flat Bar, 1⅟₂" x 3 3/16 x 6 m, Std
4 Box Electrode, E-6013, 2.5 mm Dia, 2.5 kg, Special
95 Meter Cyclone Wire, 2" x 2" hole, 120 cm Height
1 Box Blind Rivet, 3/16" x 1" deep
x-x-x nothing follows x-x-x

Received from: Received by:

ANNETTE B. ACORDA ROBINSON M. CONCORDIA

Administrative Officer V/ Supply Officer Senior TESD Specialist
_____________________ ________________
Date Date

JORDAN L. REYES
Contract of Service
________________
Date
 ANNUAL PROCUREMENT PLAN-COMMON SUPPLIES AND EQUIPMENT (APP-CSE) 2019 FORM
SUPPLEMENTAL

Introduction:
Listed in this template are all the common supplies and equipment (CSE) carried in stock by the Procurement Service (PS) that may be purchased by government agencies. Agencies must accomplish this form and submit in order to purchase CSEs from the PS.
Consistent with DBM Circular No. 2016-9 dated October 27, 2016 , the APP-CSE shall serve as the agency's APR for all its CSE requirements. Items in the template has been arranged in accordance with UNSPSC coding and this is in preparation for integration of the APP-
CSE template in the Modernized Government Electronic Procurement System (MGEPS).
Instructions:
1. Download the worksheet file APP-CSE 2019 template at www.ps-philgeps.gov.ph
2. Indicate the agency’s monthly requirement per item in the APP-CSE 2019 form.
3. The agency should indicate zero if an item is not being purchased by the agency or purchased for a particular month.
4. Agency must not delete any item in the template; neither should it include line items or revise the template.
5. An APP-CSE is considered incorrect or invalid if
a. form used is other than the prescribed format which can be downloaded only at www.ps- philgeps.gov.ph and;
b. correct format is used but fields were deleted and/or inserted in PART I of the template
6. Fill out your CSE requirements that are available for purchase in the PS under the PART I. For other Items that are not available from the PS but is regularly purchased by the agency from other sources, agency must indicate the items in the PART II and indicate
likewise the unit prices based on its last purchase.
7. Once accomplished and finalized, the APP-CSE 2019 form should be:
a. Saved using this format: APP2019_Name of Agency_Main or Regional Office (e.g. APP2019 _DBM_Central Office, APP2019 _DBM_Region IVA).
b. Printed and signed by the agency Property/Supply Officer, Budget Officer and Head of the Procuring Entity. An unsigned APP-CSE or that which lacks any of the three (3) signatures will be considered as an invalid submission.
8. The SIGNED COPY of the APP-CSE must be scanned and saved as pdf format. Together with the excel file, the signed copy in pdf format should be submitted using the online facility at PS website . Ensure that two files are submitted.
9. An agency may revise its APP-CSE during the year if there will be changes in its requirements. However, it should submit an original APP-CSE within the prescribed deadline. Agency may follow the same procedure as indicated in No. 7 when submitting the revised
copy.All requirements in excess of the quantities indicated in the original APP-CSE will not be served if not covered by a revised APP-CSE.
10. For further assistance/clarification, agencies may call the Marketing and Sales Division of the Procurement Service at telephone no.(02)689-7750 local 4019 and look for Ms. Evelyn I. Torres or Ms. Anna Liz C. Bona.

Departme TESDA, PROVINCIAL TRAINING CENTER - CAGAYAN

nt/ Agency Account Code: Contact Person: FELICIDAD A. BADAJOS
Bureau/
Office:
Region: REGION 02 Organization Type: Position: SUPERVISING TESD SPECIALIST
Address: CENTRO SUR, GATTARAN, CAGAYAN E-mail : fabadajos@tesda.gov.ph
Telephone/Mobile Nos: 09267600959

Total
Unit of
Monthly Quantity Requirement Total Price Amount
Item & Specifications Measure Q1 Q2 Q3 Q4
Quantity
Catalogue for the
Jan Feb Mar Q1 AMOUNT April May June Q2 AMOUNT July Aug Sept Q3 AMOUNT Oct Nov Dec Q4 AMOUNT
for the year
year

PART II. OTHER ITEMS NOT AVALABLE AT PS BUT REGULARLY PURCHASED FROM OTHER SOURCES (Note: Please indicate price of items)
Other Categories
1 Vehicle Unit 0 0 0.00 0 0.00 0 0.00 1 495,000.00 1.00 ### ###

A. TOTAL
B. ADDITIONAL PROVISION
₱ 495,000.00
FOR INFLATION (10% of ₱ 49,500.00
TOTAL)
C. GRAND TOTAL (A + B)
D. APPROVED BUDGET BY
₱ 544,500.00
THE AGENCY HEAD ₱ -
In Figures
G. MONTHLY andCASH
Words:
REQUIREMENTS ₱ -
G.1 Available at Procurement Service
Stores
#REF! #REF! #REF! #REF! #REF!
G.2 Other Items not available at PS but
regulary purchased from other sources
- - - 495,000.00 ₱ 495,000.00
TOTAL MONTHLY CASH
REQUIREMENTS
#REF! #REF! #REF! #REF! #REF!
*Agency must put the monthly requirement for air tickets both local and international.

We hereby warrant that the total amount reflected in this Annual Supplies/ Equipment Procurement Plan to procure the listed common-use supplies, materials and equipment has been included in or is within our approved budget for the year.

Prepared by: Certified Funds Available / Certified Appropriate Funds Available: Approved by:

PAUL RYAN C. ESTRELLA ANNETTE B. ACORDA ROMEO O. TALOSIG,DPA

Property/Supplier Officer Accountant / Local Budget Officer Head of Office/Agency

Date Prepared: ###

 ACKNOWLEDGEMENT RECEIPT FOR EQUIPMENT
No. : 101-
TECHNICAL EDUCATION AND SKILLS DEVELOPMENT AUTHORITY
CAGAYAN PROVINCIAL OFFICE
Tel. No. 877-0004/304-1533

Quantity Unit Description Property No.

#NAME? #NAME? #NAME?
#NAME? #NAME? #NAME?
95 Meter Cyclone Wire, 2" x 2" hole, 120 cm Height
x-x-x nothing follows x-x-x

Received by: Received from:

FELICIDAD A. BADAJOS ANNETTE B. ACORDA

Senior TESD Sepcialist Admin Officer V

Date Date