Republic of the Philippines

Province of Albay
MUNICIPALITY OF OAS
BARANGAY NAGAS ( ) - Replacement
( / ) - Repair /Maintenance
( ) - Installation
STATEMENT OF WORK ACCOMPLISHED ( ) – Construction
As of ____NOVEMBER 10,2021________

Name of Project : Clean and Green Program 2021

Location : Nagas, Oas, Albay
Project Cost : Php. 50,000.00
Source of Fund : 10% SK Fund

Item Unit of Work Percentage of Cost of Project Cost of Project Cost for Cost for Total % T0
No. DESCRIPTION work Accomplished as Completion Previous This Payment (Peso) Total Cost
Measurement of this date Accomplis (Percentage)
Accomplished hed

CLEAN AND
GREEN Php. 49,800
11 days 100% Php 49,800 Php. 49,800
PROGRAM
2021

BY ADMINISTRATION:
Work Actually Started : _____NOV.10,2021_______ Project Cost : Php. 50,000.00
Work Actually Finished : ______NOV.20,2021______ Less: Labor Only :
Number of Workers : 16 Laborers Cost for Previous Payment :
Number of Men days : 11 Days Present Payment :
Balance : 0
This is to certify that the works has been accomplished in accordance with the plans, specification and requirements thereof and that it has been duly inspected, verified and provisionally
accepted for purpose of payment.

Prepared by:

JOSHUA P. TEVES APRIL JAY REY ENGR. DOMINGO Z. RENALES JR. MELVIN PLANTA
SK Treasurer SK Kagawad Municipal Engineer SK Chairman Committee on Infrastructure