CBIM 2021 Form C-3

Community Operation and Maintenance/Project Implementation Program

Department of Social Welfare and Development

KALAHI-CIDSS NCDDP Additional Financing

COMMUNITY OPERATION AND MAINTENANCE/PROJECT IMPLEMENTATION PROGRAM

C.Y. 2022

Name of Sub-Project : PROVISION AND INSTALLATION OF CUSTOMIZED CONTAINER VAN AS TEMPORARY ISOLATION FACILITIES WITH AMENITIES
Physical Target : 1 - UNIT
Barangay : POBLACION 1
Municipality/Province : LEBAK, SULTAN KUDARAT

A. ORGANIZATIONAL AND FINACIAL ASPECTS

RESPONSIBLE
CAPABILITY BUILDING ACTION PLAN/ ACTIVITIES SCHEDULE BUDGET FUND SOURCE
ATTACHED THE FOLLOWING DOCUMENTS PERSON/UNIT
1. Name of O & M Group / Association formed: Formulation of O&M Organization BLGU & BDC TWG not required not required
BARANGAY SALAMAN OPERATION AND MAINTENANCE GROUP
Preparation & Formulation of O & M Policy and Guidelines in
2. O & M Group / Association Accrediation (Brgy/Municipal) accordance with the IATF and DOH Standards
Oct.-22 BDC-TWG O&M not required not required
Basic Orientation on Management, Maintenance, and Safe O&M Group, BNS, MHO not required BLGU
3. Policy and Guidelines Plan or By laws formulated & ratified by G.A keeping procedures of amenities/facilities Dec-22 representative, MLGU
Basic Orientation on Health Protocol
4. O & M Group Structure or Organizational Structure and List of Officers -Proper use of PPEs and Disinfectants BHERT, MHO not required BLGU
- Proper sanitation and proper waste disposal Dec-22

Every Month (2022)

5. List of members (if necessary) O&M Group Regular Monthly Meeting
Every quarter on the following years
BLGU, O&M Group, BHW, BNS not required not required

Project Monitoring and Sustainability KC NCDDP AF/ MLGU/ BLGU not required not required
6 months after date of turn-over
B. FINANCIAL AND OTHER SUPPORTS

Attached proof of commitment and O and M funding arrangement(Resolution, Certicifation, etc.

B. PHYSICAL/TECHNICAL ASPECT
RESOURCES NEEDED
WORK ITEM PHYSICAL ACTIVITIES TO Source Of Fund EXPECTED
FREQUENCY LABOR MATERIALS REMARKS
DESCRIPTION SCOPE BEUNDERTAKEN Total OUTPUT
No. Rate Cost Qty, Price Cost Barangay Municipal Provincial
1. Structure
a. Roofing 18 sq.m Repainting/ Sealing As need arises 1 350 350.00 1.00 700.00 700.00 1,050.00 1,050.00 Aesthetic/Safety
b. Ceiling 18 sq.m Replacement As need arises 1 350 350.00 2.00 500.00 1,000.00 1,350.00 1,350.00 Aesthetic
c. Wall 27 sq.m. Repainting As need arises 1 350 350.00 2.00 800.00 1,600.00 1,950.00 1,950.00 Aesthetic
d. Door Accesories 1 pc Door Knobs As need arises 1 350 350.00 2.00 350.00 700.00 1,050.00 1,050.00 Safety
3 pc Hinges As need arises 1 350 350.00 6.00 100.00 600.00 950.00 950.00 Safety
e. Water Accesories 1 pc Faucet As need arises 1 350 350.00 3.00 100.00 300.00 650.00 650.00 Safety
1 length Pipeline As need arises 1.00 250.00 250.00 250.00 250.00 Safety
1 lot Water fiitings/accessories As need arises 1.00 450.00 450.00 450.00 450.00 Safety
f. Beds 1 set Repair/Retrofit As need arises 1 350 350.00 2.00 400.00 800.00 1,150.00 1,150.00 Safety
g. Tables and Chairs 1 set Repair/Retrofit As need arises 1 350 350.00 2.00 400.00 800.00 1,150.00 1,150.00 Safety
Total 10,000.00 10,000.00

Prepared by : Reviewed by :

MYRNA CASTAŇEDA EMMANUEL B. SUMUGAT

Operation and Maintenance Group Chairperson Barangay Chairman
Date : ____________________ Date : ____________________

Recommending Approval : Approved by:

ALPEE JOHN E. TABIEROS, CE BELTRAN L. HORTILANO FREDERICK F. CELESTIAL

Technical Facilitator BDC-TWG Chairman Municipal Mayor
Date : ____________________ Date : ____________________ Date : ____________________

ATTACH THE FOLLOWING DOCUMENTS

1. Proof of formation and registration/accreditation 2. Financial Aspect and Other Support
-  Name of Community Association formed - Proof of commitments and O&M funding arrangement (Resolution,
-  Vision, Mission, Goal and Objectives certification, etc.)
-  Agreed Tariff Arrangement
-  Policies and By-Laws formulated and ratified by GA
-  Organizational Structure and list of officers
-  List of member