Region I

SCHOOLS DIVISION OFFICE I PANGASINAN

Alvear St. Lingayen, Pangasinan
Tel. No./Fax No. (075) 522-202(OSDS); (075) 632-8385(ASDS)
E-mail: pangasinan1@deped.gov.ph; officeofthesdspangasinani@gmail.com

Appendix 62
INSPECTION AND ACCEPTANCE REPORT

Entity Name : NALSIAN ELEMENTARY SCHOOL Fund Cluster : 01101101

Supplier: COPYMATT OFFICE AND SCHOOL SUPPLIES TRADING IAR No.:

PO No./Date: 2021-09-0020/ 09-27-2021 Date: SEPTEMBER 27,2021
Requisitioning Office/Dept. : _______________________________ Invoice No. :
Responsibility Center Code : _______________________________ Date : SEPTEMBER 27,2021

Stock/
Description Unit Quantity
Property No.
1 Canon Pixma 790 Black btl 5
2 Canon Pixma 790 Cyan btl 6
3 Canon Pixma 790 Magenta btl 4
4 Canon Pixma 790 Yellow btl 5
5 Epson Ink 005 btl 2
6 Epson 003 Black btl 2
Epson 003 Yellow btl 1
Epson 003 Blue btl 1
HP GT53 Black btl 2
HP GT53 Magenta btl 1
HP GT53 Blue btl 1
HP GT53 Yellow btl 2
Epson 003 Black btl 5
Epson 003 Yellow btl 5
Epson 003 Blue btl 5
Epson 003 Magenta btl 5
Coupon Bond A4 ream 25
Paper Fastener box 5
PVC A4 pack 1
Ring Binder 1" pc 10
Laminating Film A4 pack 1
Stapler Wire #35 box 18
Arch File Folder Long pc 21
INSPECTION ACCEPTANCE
Date Inspected:
SEPTEMBER 27,2021 SEPTEMBER 27,2021

Inspected, verified and found in order as to Complete

quantity and specifications
Partial (pls. specify quantity)
1. LORILIE J. DAQUIOAG
2. GRAZIELA GAY M. RODRIGUEZ
3. MARJORIE C. CALIMLIM JERVIN J. CASTILLO
Name and Signature of Inspectorate Teams Supply and/or Property Custodian
 DEPARTMENT OF EDUCATION+A1:P27
Region I
SCHOOLS DIVISION OFFICE I PANGASINAN
Alvear St. Lingayen, Pangasinan
Tel. No./Fax No. (075) 522-202(OSDS); (075) 632-8385(ASDS)
E-mail: pangasinan1@deped.gov.ph; officeofthesdspangasinani@gmail.com

ABSTRACT OF CANVASS FORM

PROJECT TITLE: Purchase of Office Supplies

DATE: SEPTEMBER 28, 2021
IMPLEMENTING OFFICE: NALSIAN ELEMENTARY School
APPROVED BUDGET FOR THE CONTRACT: Php 26,086.25

NAME OF SUPPLIERS SUPPLIER 1 SUPPLIER 2 SUPPLIER 3

COPYMATT OFFICE & SUPPLIES TRADING

Amount of Quotation Php 26,086.25 Php Php

Remarks: LOWEST QUOTATION

RUELYN R. LUCIDO IMEE LYNN M. LABITAN CONNIE B. SANTOS JERVIN J. CASTILLO

BAC CHAIRMAN BAC MEMBER Head, BAC-TWG End-user