Appendix 59

INVENTORY CUSTODIAN SLIP

Entity Name: Department of Agrarian Reform

Fund Cluster : ________________________________ ICS No : ______________
Amount
Inventory Estimated
Quantity Unit Description
Unit Cost Total Cost Item No. Useful Life
1 pc 700.00 700.00 Yoga Mat
xxnothing followsxxx

Received from: Received by:

CRISTINA H. ROSALES RAYMUNDO T. GRANCO

Signature Over Printed Name Signature Over Printed Name
A.O. IV SURVEY AIDE
Position/Office Position/Office
8/10/2020 8/10/2020
Date Date

149
 Appendix 63

REQUISITION AND ISSUE SLIP

Entity Name : DAR Davao de Oro Fund Cluster : ______________________

Division : Responsibility Center Code : ______________________
Office : DAR RIS No. : _____________________________________
Requisition Stock Available? Issue
Stock No. Unit Description Quantity Yes No Quantity Remarks
bottle Varnish Natural 3 3
pc Brush #3 2 2
pc Liha Original 1000 3 3
pc Brass Cup Hook #1 25 25
bottle Lacquer Thinner 1 1
bottle Varnish 1 1
pc Sand Paper 3 3
pc Eco Bag 1 1
***nothing Follows***

Purpose: Repair and maintenance of motor vehicle bearing plate number FP 2065.

Requested by: Approved by: Issued by: Received by:

Signature :
Printed Name : CRISTINA H. ROSALES
Designation : A.O.IV
Date :
 Appendix 71

PROPERTY ACKNOWLEDGMENT RECEIPT

Entity Name : DEPARTMENT OF AGRARIAN REFORM

Fund Cluster: ______________________________________ PAR No.:

Property Date
Quantity Unit Description Amount
Number Acquired
1 Set #REF! 9/1/2020 41,125.00

#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!

Received by: Issued by:

AILEEN C. BALAGAT CRISTINA H. ROSALES
Signatue over Printed Name of Supply
Signatue over Printed Name of End User
and/or Property Custodian

ARPT/ACTING AO III Admin. Officer IV

Position/Office Position/Office

9/1/2020 9/1/2020
Date Date

173
 Appendix 65
WASTE MATERIALS REPORT

Entity Name :Department of Agrarian Reform Fund Cluster : _____________________

Place of Storage : DAR COMVAL Date : ________________________________
ITEMS FOR DISPOSAL
Record of Sales
Item Quantity Unit Description Official Receipt
No. Date Amount
1 pc Steering Pump
1 pc Aircon Tensioner
1 pc Hydraulic Hose
***nothing follows***

TOTAL
Certified Correct : Disposal Approved :

CRISTINA H. ROSALES ZALDY A. ARENAS, MDMG

Signature over Printed Name of Supply Signature over Printed Name of Head of
and/or Property Custodian Agency/Entity or his/her Authorized Representative

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
Item________Transferred without cost to __(Name of the Agency/Entity)__

Certified Signature
Correct: over Printed Name of Inspection Signature over Printed Name of
Officer Witness
 Appendix 62
INSPECTION AND ACCEPTANCE REPORT

Entity Name : DAR DAVAO DE ORO Fund Cluster :

IAR No. :
Requisitioning Office/Dept. : ADMIN & FINANCE Invoice No. :
Responsibility Center Code : Date :
Stock/
Description Unit Quantity
Property No.
Sprocket 38T w/ chain set 1
Engine Oil 40T qt 1
Brake Fluid pc 1
Hub Dumper pc 4
Headlight Bulb pc 1
***nothing follows***

Purpose: Repair and maintenance of motor vehicle bearing plate number FP 2065.

INSPECTION ACCEPTANCE
Date Inspected : ________________________Date Received : _____________________

Inspected, verified and found in Complete

order as to quantity and
specifications
Partial (pls. specify quantity)
NOEL P. SALUDES
Chairman,Inspection Committee CRISTINA H. ROSALES
Supply and/or Property Custodian
VIC M. ONOD/RONN JAYSER D. MARANAN
Inspection Committee
 ABSTRACT OF INVOICES
DEPARTMENT OF AGRARIAN REFORM
PROVINCIAL OFFICE
Palmera Village, Purok 18 DATE October 20, 2023
Nabunturan, Davao de Oro

DESCRIPTION INVOICE # DATE QTY UNIT PRICE TOTAL

Sprocket 38T w/ chain 012452 18-Apr-23 1 465.00 465.00

Engine Oil 40T 012452 18-Apr-23 1 210.00 210.00
Brake Fluid 012452 18-Apr-23 1 125.00 125.00
Hub Dumper 012452 18-Apr-23 4 13.75 55.00
Headlight Bulb 012452 18-Apr-23 1 55.00 55.00
***nothing follows*** 001135 18-Apr-23 -
001135 18-Apr-23 -
003896 21-Apr-23 -
003896 21-Apr-23 -
003896 21-Apr-23 -
003896 21-Apr-23 -
003896 21-Apr-23 -
-
-
-
-
-
-
-
-
TOTAL ₱ 910.00

Prepared By:

JASPER S. ESCAÑO
Department of Agrarian Reform Requisitioner: ADMIN & FINANCE
Provincial Office PR NO.
Nabunturan, Davao de Oro Dated:
Date:
Quotation #:

REQUEST FOR QUOTATION

*Company Name

*Address
Please quote your lowest price on the item/s below, subject to the general conditions on the last page, stating the shortest time of delivery and submit your (OPEN/
SEALED) quotation duly signed by your representative not later than 5/7 days in the return envelope attached herewith.

NANCY S. RAMOS, MPA

BAC, Chairperson
Item No Item & DESCRIPTION Qty. Unit/s Unit Cost Total Cost
Sprocket 38T w/ chain 1 set
Engine Oil 40T 1 qt
Brake Fluid 1 pc
Hub Dumper 4 pc
Headlight Bulb 1 pc
***nothing follows***

*Delivery Period:
*Warranty:
*Price Validity:
After having carefully read and accepted your General conditions, I/We quote you on the item at
prices noted above.
Note: (To be filled up by the End User) *Printed Name/ Signature
1. All entries must be typewritten or written legibly
2. Delivery of period within _____ calendar days
3. Warranty shall be a period of six (6) months for supplies Materials, one (1) year for equipment,
from date of acceptance by the procuring entity
4. Price validity shall be for the period 120 calendar days *Tel. No./ Cellphone #/ e-mail address
5. G-EPS registration certificate shall be attached upon Submission of the quotation
6. Bidders shall submit original brochures showing certification of the product being offered
7. All in "*" must be filled up by the supplier

*PhilGEPS Registration Number

*Date
__________________
Canvasser
 DEPARTMENT OF AGRARIAN REFORM
Provincial Agrarian Reform Office
Compostela Valley Province

ATTY. ARIANE ROSE L. PALOMARIA

AUDIT TEAM LEADER/STATE AUDITOR III
COMMISSION ON AUDIT

Madam:

As per inspection conducted, motor vehicle bearing plate number FP 2065 needs repair.

Findings:
1 set Sprocket 38T w/ chain
1 qt Engine Oil 40T
1 pc Brake Fluid
4 pc Hub Dumper
1 pc Headlight Bulb
***nothing follows***

Pre inspected by: Approved by:

NOEL P. SALUDES ZALDY A. ARENAS, MDMG

Chairman, Inspection Committee PARPO II

VIC M. ONOD RONN JAYSER MARANAN

Member Member
Transaction ID No.:

Appendix 60
PURCHASE REQUEST
DEPARTMENT OF AGRARIAN REFORM - DAVAO DE ORO PROVINCE Fund Cluster: 101101
Office/Section: PR No.:
ADMIN & Date:
FINANCE
Responsibility Center Code :

Stock/ Property
Unit Item Description Quantity Unit Cost Total Cost
No.
set Sprocket 38T w/ chain 1 465.00 465.00
qt Engine Oil 40T 1 210.00 210.00
pc Brake Fluid 1 125.00 125.00
pc Hub Dumper 4 13.75 55.00
pc Headlight Bulb 1 55.00 55.00
***nothing follows*** -
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Total Approved Budget for the Contract 910.00

Purpose: Repair and maintenance of motor vehicle bearing plate number FP 2065.

Requested by: Approved by:

Signature :

Printed Name:
CRISTINA H. ROSALES ZALDY A. ARENAS, MDMG
Designation AO IV PARPO II
 Appendix 32
Transaction ID No.: DEPARTMENT OF AGRARIAN REFORM Fund Cluster :
PROVINCIAL OFFICE, DAVAO DE ORO PROVINCE

Date :
DISBURSEMENT VOUCHER DV No. :

Mode of
MDS Check Commercial Check ADA Others (Please specify)
Payment

TIN No.: ORS/BURS No.:

Payee GREG L. CLARIN

Office Provincial Agrarian Reform Office, Poblacion, Nabunturan, Davao de Oro

Particulars Res. Center MFO/PAP Amount

To reimburse payment for Catering services for the repair and 910.00
maintenance of motor vehicle bearing plate number FP 2065 last
August 16, 2023 in the total amount of …..

Amount Due 910.00

A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.

BRENDA M. MENDOZA, MExEd

PAPRO I
B. Accounting Entry:
Account Title UACS Code Debit Credit

C. Certified: D. Approved for Payment

Cash available
Subject to Authority to Debit Account (when applicable)
Supporting documents complete and amount claimed proper

Signature Signature

Printed Name NOREEN V. NICOLAS Printed Name ZALDY A. ARENAS, MDMG

Position CAO / Acting Accountant II Position PARPO II

Head, Accounting Unit/Authorized Representative Agency Head/Authorized Representative
Date Date
E. Receipt of Payment JEV No.
Check/ Date: Bank Name & Account Number:
ADA No. :
Date : Printed Name: Date
Signature :
GREG L. CLARIN
Official Receipt No. & Date/Other Documents
 OBLIGATION REQUEST AND STATUS NO.

Payee: GREG L. CLARIN

Office : DARPO DAVAO DE ORO

Address: Purok 18, Palmera Village, Nabunturan, Davao del Norte

Responsibility
Center
Particulars P.P.A. UACS Amount

To obligate reimbursement of payment for repair and

maintenance of motor vehicle bearing plate number FP 910.00
2065 last August 16, 2023 in the total amount of …..

TOTAL 910.00
A. CERTIFIED : B. CERTIFIED:
Charges to appropriation/allotment necessary, lawful
and under my direct supervision Allotment available and obligated for the purpose
Supporting documents valid, proper and legal as indicated above

Signature Signature

Printed Printed
BRENDA M. MENDOZA, MExEd MARIA SIEZAMIE B. AGOILO
Name Name
Position PARPO I Position Budget Officer
Head, Requesting Office/Authorized Representative Head, Budget Unit/Authorized Representative
Date Date
C. STATUS OF OBLIGATION
Reference Amount
Due and
Date Particulars ORS/JEV/RCI/RADAI No. Obligation Payment Not Yet due
Demandable

Totals