Annex 30

PURCHASE REQUEST
TANJAY CITY
LGU
Department: Disaster RIsk Reduction and PR No. ____________ DATE: ___________________
Management Office
Section : _________________________ SAI No. ____________ DATE: ___________________
ALOBS No. _________ DATE: ___________________

ITEM UNIT OF ESTIMATED ESTIMATED

NO. QTY. ISSUE ITEM DESCRIPTION UNIT COST COST
1 1 unit Brand New Ambulance 2000000.00 2,000,000.00
Engine Model:
3.0 Diesel M/T

Type:
3.0 Liter Diesel, 4-Cylinder, In-line 16V, Double
Overhead Camshaft (DOHC) (Turbo Charged)
Displacement:2,494
Max Output: 102 / 3,600
Max Torque: 260 / 1,600 ~ 2,400
Fuel Tank Capacity: 70 Liters
Steering System:Power Steering
Overall Length xWidth x Height: 4,695 x 1,695 x
1,980
Wheelbase: 2,570

Transmission: 5-Speed Manual (Dash-Mounted)

Suspension Front / Rear: Double Wishbone with
Stabilizer Bar / Rigid Axle, Leaf Spring

Brakes Front / Rear: Ventilated Discs / Drums

Tires: 195/80 R15

Wheels: 6JJ x 15" Steel, with Full Cap
 Annex 30

Ambulance Kit Features:

Collapsible Stretcher
Vinyl Matting
3 Seater w/ Backrest and Seat belt (original!seat)
Oxygen Tank 20lbs with Oxygen TankHolder

Top Light Led Type

Fire Extinguisher
Flash!Light w/ Battery
IV Holder

Minor Surgical Kit

First Aid Kit
Medical Regulator

Ambu Bag Baumanometer Wall Type Medicine

Cabinet

Florescent Light
Complete with decals

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PURPOSE: For DRRMO use.

Requested by: Cash Availability: Approved by:

Signature:

Printed Name: DON REY T. CALUMPANG NANCY A . FERROLINO REYNALDO S. CONCEPCION

City Treasurer
Designation: DRRMO City Mayor