COMMISSION ON ELECTIONS

PROJECT COMPLIANCE CHECKLIST 1

09 May 2022 National & Local Elections

LOCAL GOVERNMENT UNIT-INOPACAN, LEYTE

REQUESTING PARTY:
STO. NIÑ0 STREET, BRGY. POBLACION, INOPACAN, LEYTE
Please put a check ( ü) on the box/es of supporting documents submitted for each public works project. Please add more rows and
pages if necessary.
CATEGORY 1. MAINTENANCE OF EXISTING AND/OR COMPLETED PUBLIC WORKS PROJECT

NAME OF PROJECT Certified True

CTC of Certification, in
(e.g. Rehabilitation of Local Roads, Renovation or Copy (CTC) of Notarized
CTC of contract Certificate of lieu of absent
Improvement of Warehouse, Improvement of School letter of Undertaking
Building) Completion documents
acceptance
R & M, Government Buildings/Facilities
Pension House
Baywalk
Multi-Purpose Building
RHU Building
PNP Building
Ecopark
Closed Dumpsite
(Please arrange the supporting documents of each project in the order that they are listed above for easier validation.)

CERTIFICATION
This is to certify that all information provided is true and correct to the best of my knowledge and belief; and that the certified true
copy/authenticated/original documents submitted in support of the application for exemption are complete and in accordance with the
provided checklist.

AZUCENA P. MIRAMBEL, MD.,FPOGS

SIGNATURE OVER PRINTED NAME DATE
Municipal Mayor
DESIGNATION/POSITION

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 COMMISSION ON ELECTIONS PROJECT COMPLIANCE
09 May 2022 National & Local Elections CHECKLIST 2

LOCAL GOVERNMENT UNIT-INOPACAN, LEYTE

REQUESTING PARTY: STO. NIÑ0 STREET, BRGY. POBLACION,
INOPACAN, LEYTE
Please put a check ( ü) on the box/es of supporting documents submitted for each public works project. Please add
more rows and pages if necessary.

CATEGORY 2 - PUBLIC WORKS UNDERTAKEN BY CONTRACT THROUGH PUBLIC BIDDING OR NEGOTIATED

CONTRACT

NAME OF PROJECT Certified True CTC of Certification, in

CTC of Notice
(e.g. Road concreting, Concreting of Road X at Copy (CTC) of Contract/ lieu of absent
Barangay ABC, Construction of Quarantine Facility) Notice of Award
to Proceed
Agreement documents

Construction of Bagsakan Center / / /

Construction of Public Market Phase 4 / / /
Construction of Isolation Center / / /
Construction of 3 Storey Niche/Tombs /
Construction of Perimeter Fence (Tawid Reservoir) /
Construction of Water Supply System By Pass Line /
Rehab/Expansion of Water System (Maloy-a) /
Construction/Concreting of Pathway (Hugpa, Marao) /
Rehab/Concreting of Bliss Road /
Construction of Comfort Room of Evacuation Building /
Construction/Rehabilitation of Municipal Port /
(Please arrange the supporting documents of each project in the order that they are listed above for easier validation.)

CERTIFICATION
This is to certify that all information provided is true and correct to the best of my knowledge and belief; and that the
certified true copy/authenticated/original documents submitted in support of the application for exemption are complete
and in accordance with the provided checklist.

AZUCENA P. MIRAMBEL, MD.,FPOGS

SIGNATURE OVER PRINTED NAME

Municipal Mayor
DESIGNATION/POSITION

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COMMISSION ON ELECTIONS
PROJECT
COMPLIANCE
09 May 2022 National & Local Elections
CHECKLIST 3

REQUESTING PARTY: COMPLETE NAME OF NATIONAL AGENCY, DEPARTMENT,

GOCC, STATE UNIVERSITY, OR GOVERNMENT UNIT

ADDRESS

Please put a check ( ü ) on the box/es of supporting documents submitted for each public works project. Please add
more rows and pages if necessary.

CATEGORY 3. PAYMENT FOR USUAL COST OF PREPARATION OF PUBLIC WORKS PROJECT FOR WORKING
DRAWINGS, SPECIFICATIONS, BILLS OF MATERIALS, AND ESTIMATES, PURCHASE OF MATERIALS AND
EQUIPMENT, AND OTHER PROCEDURES PREPARATORY TO ACTUAL CONSTRUCTION, AND ALL INCIDENTAL
EXPENSES FOR WAGES OF WATCHMEN AND OTHER LABORERS EMPLOYED FOR SUCH WORK IN THE
CENTRAL OFFICE AND FIELD STOREHOUSES

NAME OF PROJECT Notarized Undertaking

(e.g. Supply and Delivery of Base Course (Cogon Statement of Account, not to hire more
Certification, in lieu
Livestock Road Concreting), Design & Build Project in Billing or Collection labores than those at
connection with Construction of Satellite Market
of absent documents
Invoice the commencement of
Buildings) project

(Please arrange the supporting documents of each project in the order that they are listed above for easier validation.)

CERTIFICATION
This is to certify that all information provided is true and correct to the best of my knowledge and belief; and that the
certified true copy/authenticated/original documents submitted in support of the application for exemption are complete
and in accordance with the provided checklist.

SIGNATURE OVER PRINTED NAME DATE

DESIGNATION/POSITION

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 COMMISSION ON ELECTIONS PROJECT COMPLIANCE
09 May 2022 National & Local Elections CHECKLIST 4

LOCAL GOVERNMENT UNIT-INOPACAN, LEYTE

REQUESTING PARTY: STO. NIÑ0 STREET, BRGY. POBLACION,
INOPACAN, LEYTE
Please put a check ( ü) on the box/es of supporting documents submitted for each public works project. Please add
more rows and pages if necessary.

CATEGORY 4 - EMERGENCY WORK NECESSITATED BY THE OCCURRENCE OF A PUBLIC CALAMITY,

LIMITED TO RESTORATION OF DAMAGED FACILITY

Certified True Documentation Copy of

NAME OF PROJECT Copy (CTC) of Showing the LDRRMP or Certification, in
(e.g. Repair of Evacuation Center, Repair of Damaged Order declaring scope of local resolution lieu of absent
Bridges) State of emergency and approved documents
Emergency work needed budget

Emergency Repair of Water System / / /

Emergency Repair of New Municipal Hall / / /
Rehabilitation of Cabulisan FMR with Retaining Wall / / /
(Please arrange the supporting documents of each project in the order that they are listed above for easier validation.)

CERTIFICATION
This is to certify that all information provided is true and correct to the best of my knowledge and belief; and that the
certified true copy/authenticated/original documents submitted in support of the application for exemption are complete
and in accordance with the provided checklist.

AZUCENA P. MIRAMBEL, MD.,FPOGS

SIGNATURE OVER PRINTED NAME

Municipal Mayor
DESIGNATION/POSITION

Page ____ of ____

COMMISSION ON ELECTIONS
PROJECT
COMPLIANCE
09 May 2022 National & Local Elections
CHECKLIST 5

REQUESTING PARTY: COMPLETE NAME OF NATIONAL AGENCY, DEPARTMENT,

GOCC, STATE UNIVERSITY, OR GOVERNMENT UNIT

ADDRESS

Please put a check ( ü ) on the box/es of supporting documents submitted for each public works project. Please add
more rows and pages if necessary.

CATEGORY 5. ONGOING PUBLIC WORKS COMMENCED BEFORE THE CAMPAIGN PERIOD OR OTHER SIMILAR
PROJECTS UNDER FOREIGN AGREEMENTS

Certified True Copy

NAME OF PROJECT List of works covered
(CTC) of the foreign Certification, in lieu
(e.g. Project for Enhancement of Capabilities of Flood by the foreign
Control and Sabo Engineering of DPWH)
agreement/ of absent documents
agreement / contract
contract

(Please arrange the supporting documents of each project in the order that they are listed above for easier validation.)

CERTIFICATION
This is to certify that all information provided is true and correct to the best of my knowledge and belief; and that the
certified true copy/authenticated/original documents submitted in support of the application for exemption are complete
and in accordance with the provided checklist.

SIGNATURE OVER PRINTED NAME DATE

DESIGNATION/POSITION

Page ____ of ____

COMMISSION ON ELECTIONS
PROJECT
COMPLIANCE
09 May 2022 National & Local Elections
CHECKLIST 5

REQUESTING PARTY: COMPLETE NAME OF NATIONAL AGENCY, DEPARTMENT,

GOCC, STATE UNIVERSITY, OR GOVERNMENT UNIT

ADDRESS

Please put a check ( ü ) on the box/es of supporting documents submitted for each public works project. Please add
more rows and pages if necessary.

CATEGORY 6. ONGOING PUBLIC WORKS COMMENCED BEFORE THE CAMPAIGN PERIOD UNDERTAKEN BY
ADMINISTRATION

Document or proof
NAME OF PROJECT Document showing
showing that the
(e.g. Construction of Multipurpose Hall, Repair of that the project was Certification, in lieu
project commenced
basketball court, Rehabilitation of Drainage System undertaken by of absent documents
and Declogging of Canal) before the campaign
administration
period

(Please arrange the supporting documents of each project in the order that they are listed above for easier validation.)

CERTIFICATION
This is to certify that all information provided is true and correct to the best of my knowledge and belief; and that the
certified true copy/authenticated/original documents submitted in support of the application for exemption are complete
and in accordance with the provided checklist.

SIGNATURE OVER PRINTED NAME DATE

DESIGNATION/POSITION

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