Republic of the Philippines

Department of Education
Schools Division of _______________

CERTIFICATION
This serves to certify that the DepEd Recipient School, namely:
NAME OF RECIPIENT SCHOOL: _________________________________________________
LOCATION / ADDRESS: ________________________________________________________
SCHOOL IDENTIFICATION NUMBER: ___________________________________________
for the project entitled,
“Supply, Delivery, Installation, Configuration, Testing, Commissioning, Training and
Maintenance for Various IT Equipment and e-Classroom for Public Elementary and
Junior and Senior High Schools Nationwide Under FY2016 and FY2017 DepEd
Computerization Program (DCP) Batches 35, 36 and 40 to 44”

is officially requesting for the deferment of the installation of the e-Classroom that is being supplied
and delivered to us, since our said institution is NOT READY, due to one or several of the following
reason(s), such as:
 no proper tables or structure(s) for the e-Classroom package is available
 no electrical outlets available or ready for the e-Classroom package
 room not secured from possible loss of equipment
 room or building is not ready for the installation of the e-Classroom package
Pending the installation of the above item(s), the undersigned undertakes the responsibility to safely
store and keep the e-Classroom Package from loss and damage.

has received the six (6) hour Training Requirements for the same with the complete topics on the
Training Checklist taken up, properly discussed and understood, for the following personnel:
NAME OF SCHOOL PERSONNEL OFFICIAL DESIGNATION / POSITION

is officially requesting for the deferment of the installation or non-mounting of the Projector that
is being supplied and delivered to us, since our said institution is NOT READY, due to one or
several of the following reason(s), such as:
 surface for Projector to be mounted is not stable or safe enough
 no electrical outlet available for the Projector, if mounted
 room not secured from possible loss of equipment
 building is not ready for Projector mounting
 Projector will be used on other locations, or for other purposes
Pending the installation of the above item(s), the undersigned undertakes the responsibility to safely
store and keep the same from loss and damage.

FOR DEPED DCP RECIPIENT SCHOOLS WITH PROJECTORS INSTALLED

The undersigned guarantee and assure that the surface and/or structure for the installation or
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mounting of the Projector, that is being supplied and delivered to us, is sufficiently stable and/or
SIGNATORY’S INITIAL HERE

strong enough to keep the said item(s) / equipment secure from falling, and that we hold the
supplier, thereof, free from any liability(ies) of any kind, form, or type, should the aforementioned
installation fail, or result to the failure of the same, which may result to possible damage or
destruction of, and/or which may render the unit inoperable.
The undersigned also understands that such installation / mounting failure is not covered by the
Warranty provided with the abovementioned Projector, or any of its parts, and/or accessories,
supplied, therewith.
 is officially requesting for the deferment of the installation or non-mounting of the Television (TV)
that is being supplied and delivered to us, since our said institution is NOT READY, due to one or
several of the following reason(s), such as:
 surface for the Television to be mounted is not stable or safe enough
 no electrical outlet available for the Television, if mounted
 room not secured from possible loss of equipment
 building is not ready for Television mounting
 Television will be used on other locations, or for other purposes
Pending the installation of the above item(s), the undersigned undertakes the responsibility to safely
store and keep the same from loss and damage.

FOR DEPED DCP RECIPIENT SCHOOLS WITH TELEVISIONS INSTALLED

The undersigned guarantee and assure that the surface and/or structure for the installation or
mounting of the Television, that is being supplied and delivered to us, is sufficiently stable and/or
strong enough to keep the said item(s) / equipment secure from falling, and that we hold the
supplier, thereof, free from any liability(ies) of any kind, form, or type, should the aforementioned
installation fail, or result to the failure of the same, which may result to possible damage or
destruction of, and/or which may render the unit inoperable.

The undersigned also understands that such installation / mounting failure is not covered by the
Warranty provided with the abovementioned Television, or any of its parts, and/or accessories,
supplied, therewith.

Only for DCP Batches 35 and 36:

is, hereto, certifying that the Rubber Molding and Cable Ties, in lieu of the Plastic Molding,
delivered by the Supplier, thereof, is complete and is properly installed to our satisfaction and
approval.

is officially requesting for the non-installation of the Rubber Molding and Cable Ties, in lieu of
the Plastic Molding, that is being supplied and delivered to us, since our said particular institution
/ facilities deems it desirable / preferred, due to one or several of the following reason(s), such as:
 Surface for DCP Package to be installed on does not have enough space for the installation
of Rubber Moldings and Cable Ties, in lieu of the Plastic Molding
 DCP Package is installed on a temporary and/or makeshift stand and would have to be
transferred to another location and/or to another more suitable table / surface
 Due to our current facilities set-up and configuration of the computer tables, the DCP
Package cannot be installed if the cables are covered with Rubber Moldings and Cable
Ties, in lieu of the Plastic Moldings
Due to the non-installation of the above item(s), the undersigned undertakes the responsibility to
safely store and keep the supplied Rubber Molding and Cable Ties, in lieu of the Plastic Molding,
from loss and damage.

_______________________
SIGNATURE OVER PRINTED NAME

________________________________
OFFICIAL DESIGNATION/POSITION

________________________________
DATE ISSUED

aaol/combinedcertifications/dcp/07182018/2P-LB2B