Annex G-6

PURCHASE REQUEST
BUREAU OF FIRE PROTECTION-ARMM
(Agency)

PR No.: Date: ______

Department DILG SAI No.: Date:_______
Section Balabagan Fire Station ALOBS No.: Date:_______
Balabagan Lanao del Sur
Unit Stock Estimated Estimated
QTY ITEM DESCRIPTION
of Issue No. Unit Cost Cost
2 Pcs Tire Black 1,200.00 2,400.00
1 Pc Oil Filter 1,200.00 1,200.00
1 Pc Gear Oil 4ltrs 1,100.00 1,100.00
2 Pcs Break Fluid 550.00 1,100.00
3 Pcs Battery Solution 450.00 1,350.00
2 Pcs ATF Fluid 450.00 900.00

8,050.00
Purpose: 4th qtr Preventive Maintenance of issued Firetrucks to Balabagan FS

Requested by: Approved by:

Signature:
Printed Name: FO2 Abdulatip
FO2 Jiggy M LKayog BFP
Capundag SFO4 Joselito Oclarino BFP
Designation: Firetruck Operator Municipal Fire Marshal
 Republic of the Philippines
Department of the Interior and Local Government
BUREAU OF FIRE PROTECTION
BALABAGAN FIRE STATION
Balabagan, Lanao Del Sur

Date

CANVASS PROPOSAL
Gentlemen:
Kindly qoute your price of the items listed below. This bid proposal shall be in accordance
with the following requirements, to wit:
1. Submit this form with your price quotation not later than _ 7 days___________.
2. Prices shall be valid until within __30________ days; and
3. Payment shall be within __20___________ days after the completion of repair/delivery
of the unit/item described below.

ITEM
QTY UNIT NOMENCLATURE UNIT PRICE TOTAL PRICE
NO.
2 Pcs Tire Black 1,200.00 2,400.00
1 Pc Oil Filter 1,200.00 1,200.00
1 Pc Gear Oil 4ltrs 1,100.00 1,100.00
2 Pcs Break Fluid 550.00 1,100.00
3 Pcs Battery Solution 450.00 1,350.00
2 Pcs ATF Fluid 450.00 900.00

TOTAL 8,050.00

THIS IS TO CERTIFY that we personally conducted the canvass and the foregoing entries are true
and correct.

FO2 Sally V Vios BFP (Name of Firm/Establishment)

Logistics/SAO
(Address and Telephone No.)
10000
6500
3500
 Republic of the Philippines
Department of the Interior and Local Government
BUREAU OF FIRE PROTECTION
BALABAGAN FIRE STATION
Balabagan, Lanao Del Sur

Date

CANVASS PROPOSAL
Gentlemen:
Kindly qoute your price of the items listed below. This bid proposal shall be in accordance
with the following requirements, to wit:
1. Submit this form with your price quotation not later than _ 7 days___________.
2. Prices shall be valid until within __30________ days; and
3. Payment shall be within __20___________ days after the completion of repair/delivery
of the unit/item described below.

ITEM
QTY UNIT NOMENCLATURE UNIT PRICE TOTAL PRICE
NO.
2 Pcs Tire Black 1,200.00 2,400.00
1 Pc Oil Filter 1,250.00 1,250.00
1 Pc Gear Oil 4ltrs 1,200.00 1,200.00
2 Pcs Break Fluid 550.00 1,100.00
3 Pcs Battery Solution 500.00 1,500.00
2 Pcs ATF Fluid 450.00 900.00

TOTAL 8,350.00

THIS IS TO CERTIFY that we personally conducted the canvass and the foregoing entries are true
and correct.

COTABATO HI-POWER SALES INC.

Jose S. Lim Sr., Street, Cotabato City
Tel. 421-85-46; Telefax (064) 421-71-17
FO2 Sally V Vios BFP (Name of Firm/Establishment)
Municipal Fire Marshal
(Address and Telephone No.)
 Republic of the Philippines
Department of the Interior and Local Government
BUREAU OF FIRE PROTECTION
BALABAGAN FIRE STATION
Balabagan, Lanao Del Sur

Date

CANVASS PROPOSAL
Gentlemen:
ems listed below. This bid proposal shall be in accordance
with the following requirements, to wit:
price quotation
1. not later than _ 7 days___________.
2. within __30________ days; and
alid until
3.
__________ days after the completion of repair/delivery
he unit/item described below.

ITEM
QTY UNIT NOMENCLATURE UNIT PRICE TOTAL PRICE
NO.
2 Pcs Tire Black 1,250.00 2,500.00
1 Pc Oil Filter 1,250.00 1,250.00
1 Pc Gear Oil 4ltrs 1,200.00 1,200.00
2 Pcs Break Fluid 550.00 1,100.00
3 Pcs Battery Solution 550.00 1,650.00
2 Pcs ATF Fluid 450.00 900.00

TOTAL 5,250.00 8,600.00

nally conducted the canvass and the foregoing entries are true
and correct.

FO2 Sally V Vios BFP (Name of Firm/Establishment)

Municipal Fire Marshal
(Address and Telephone No.)
 PURCHASE ORDER

Bureau of Fire Protection

Agency Name

Supplier: P.O No.

Address: DATE:

TIN : Mode of Procurement: Shopping

Gentlemen:
Please furnish this office articles subject to the terms and conditions contained herein:
Place of Delivery: Delivery Terms:
Date of Delivery:

Stock No. Unit DESCRIPTION Quantity Unit Cost Amount

Pcs Tire Black 2 1,200.00 2,400.00
Pc Oil Filter 1 1,200.00 1,200.00
Pc Gear Oil 4ltrs 1 1,100.00 1,100.00
Pcs Break Fluid 2 550.00 1,100.00
Pcs Battery Solution 3 450.00 1,350.00
Pcs ATF Fluid 2 450.00 900.00

(Total Amount in Words) TOTAL >> 8,050.00

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.

Very truly yours,

SFO4 Joselito Oclarino BFP

Municipal Fire Marshal
Authorized Official
Conforme:

Signature over Printed Name of Supplier

(Date)

Funds Available: OBR No.:

Amount:
 INSPECTION AND ACCEPTANCE REPORT
Bureau of Fire Protection-ARMM
Agency

Supplier: IAR No. ________________________

PO No. ___________ Date: __________ Invoice No. ____________ Date _______________
Requisitioning Office/Dept.: Balabagan Fire Station

Stock No. Unit Description Qty

Pcs Tire Black 2
Pc Oil Filter 1
Pc Gear Oil 4ltrs 1
Pcs Break Fluid 2
Pcs Battery Solution 3
Pcs ATF Fluid 2

INSPECTION ACCEPTANCE

Date Inspected: _________________________ Date received: ___________________________

Inspected, verified and found in order as to Complete

quantity and specifications
Partial (pls. specify quantity)

FO2 Sally V Vios BFP SFO4 Joselito Oclarino BFP

Logistics/SAO Municipal Fire Marshal
 WASTE MATERIALS REPORT
Bureau of Fire Protection-ARMM
Agency

A Place of Storage B Date

ITEMS FOR DISPOSAL

RECORD OF SALES
ITEM QTY UNIT DESCRIPTION
O.R. No. Amount
1 2 Pcs Tire Black 2,400.00
2 1 Pc Oil Filter 1,200.00
3 1 Pc Gear Oil 4ltrs 1,100.00
4 2 Pcs Break Fluid 1,100.00
5 3 Pcs Battery Solution 1,350.00
6 2 Pcs ATF Fluid 900.00
-
-

TOTAL 8,050.00
Certified Correct: Disposal Approved:

SFO4 Joselito Oclarino BFP

Municipal Fire Marshal

CERTIFICATE OF INSPECTION
I hereby certify that the property enumerated above was disposed of as follows:

Item - - - - - - Destroyed
Item - - - - - - Sold at private sale
Item - - - - - - Sold at public auction
Transferred without cost to
Item ------
_____________

C Property Inspector: (Name & Signature) D Witness to disposition

E

FO2 Sally V Vios BFP

Logistics/SAO

--gdat2/27/10