PURCHASE ORDER

Provincial Government of Sorsogon

LOCAL GOVERNMENT OF SORSOGON
Supplier: P.O. No._________________

Address: Date:

Mode of Procurement
Place of Delivery: BULAN MEDICARE HOSPITAL Delivery Term: ________________

Date of Delivery: Payment Term: ________________

Item Unit Qty. DESCRIPTION Unit Cost Amount

No.
MEDICAL SUPPLIES

1. bottle 10 Alcohol 70%, Ethyl 500ml bottle 107.70 2154.00

2. gallon 6 Alcohol 70%, Ethyl gallon 440.00 2640.00
3. roll 3 Cotton 400mg roll 197.40 592.20
4. box 5 Disposable Syringe w/Needle 10cc,100's box 375.00 1875.00
5. box 10 Disposable Syringe w/Needle 3cc,100's box 260.00 2600.00
6. box 10 Disposable Syringe w/Needle 1cc,100's box 260.00 2600.00
7. roll 10 Elastic Bandage 2" roll 230.00 2300.00
8. roll 10 Elastic Bandage 4"roll 230.00 2300.00
9. roll 2 Gauze Roll 28*24*36*100 roll 1341.00 2682.00
10. box 10 Hypo Allergenic Plaster 1"*12 box 535.80 5358.00
11. box 15 Hypo Allergenic Plaster 1/2"*24 box 564.00 8460.00
12. box 5 Insulin Syringe 0.5cc,100's box 785.00 3925.00
13. pc 300 IV Cannulas G22 pcs 18.33 5499.00
14. pc 300 IV Cannulas G24 pcs 18.33 5499.00
15. pc 400 IV Cannulas G26 pcs 18.33 7332.00
16. pc 40 Leukoplast 1.25cm x 1m pcs 60.00 2400.00
17. pc 200 Macroset pcs 15.51 3102.00
18. pc 200 Microset pcs 16.92 3384.00
19. pc 7 Plaster of Paris 4" pcs 150.00 1050.00
20. pc 24 Silk 1/0 ,cutting pcs 105.00 2520.00
21. pc 20 Soluset.Microdrops pcs 126.90 2538.00
22. box 5 Surgical Gloves,6.5", 50's box 660.00 3300.00
23. box 5 Surgical Gloves,7", 50's box 660.00 3300.00
24. box 2 Topical Anesthesia box 400.00 800.00
25. gallon 2 Cidex sterilizing solution gallon 1,500.00 3,000.00
26. box 10 Clean Gloves, unsterile ,large 50's box 550.00 5,500.00
27. box 10 Clean Gloves, unsterile ,medium 50's box 550.00 5,500.00

(Sub-Total Amount in words) *Ninety Two Two Hundred Ten and 20/100* TOTAL 92,210.20
In case of failure to make full delivery within the time specified above, a penalty of one-tenth (1/10) of one percent
for everyday of delay shall be imposed.

Conforme:
____________________________
Signature Over Printed Name

____________________________
Date

(In case of Negotiated Purchased pursuant to Section 369 (a) RS 7160, this portion must be accomplished)

Approved per Sangguniang Resolution No.____________________

CERTIFIED CORRECT: ____________________________

Secretary to the Sanggunian