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Note: Pls.

use CAPITAL LETTERS

Name of School: ROMERO ELEMENTARY SCHOOL


School Head: MELBA C. BARBOSA
Senior Bookkeeper: JONALYN H. VILLADAREZ
ROMERO ELEMENTARY SCHOOL
(Name of School)

CHECKLIST OF SUPPORTING DOCUMENTS


PROCUREMENT OF GOODS FROM PS-DBM

Supplier:
Items/Goods Purchased:
Program/Activity/Purpose: for school operation
Duration:
Amount:
Check No.:

NO. REQUIRED DOCUMENTS DATE REMARKS


Disbursement Voucher
1 Picture of signed check
2 Certification that the items/goods are included in the
approved APP-certified by the Supply Officer
and verified by the BAC Sec.
3 Agency Procurement Request -
4 Approved Purchase Order
-duly stamped received by COA
- date, number, delivery terms, etc. indicated
-duly atamped received by the DBM-PS
-duly conformed/signed by the DBM-PS
5 Delivery Receipt
-dated
-with itemized listings of the goods
- with printed name and signature of the DepED
official who received the items
6 Inspection and Acceptance Report
-duly stamped received by COA
-date, number, etc. -indicated
-with itemized listing of the goods
7 Official receipt No:__________
8 Requisition & Issue Slip (RIS)
9 Inventory Custodian Slip (ICS) for non-consumable
supplies or small equipment
10 Picture of supplies/materials purchased located in the
school stockroom

Submitted by: Verified by:

MELBA C. BARBOSA JONALYN H. VILLADAREZ


(School Head) (Bookkeeper)
ROMERO ELEMENTARY SCHOOL
(Name of School)

CHECKLIST OF SUPPORTING DOCUMENTS


PROCUREMENT OF COMMON-USE SUPPLIES & SMALL EQUIPMENT
NOT AVAILABLE AT DBM-PS

Supplier:
Items/Goods Purchased:
Program/Activity/Purpose:
Duration:
Amount:
Check No.:

NO. REQUIRED DOCUMENTS DATE REMARKS


Disbursement Voucher
1 Picture of signed check
2 Certification that the items/goods are included in the
approved APP-certified by the Supply Officer
and verified by the BAC Sec.
3 Approved Purchase Request
-date, number, other required data indicated
- duly stamped received by the BAC Secretariat
4 Activity/Project Proposal-if applicable
-date of preparation indicated
-duly certified by the end-user/coordinator
-approved by SDS if the amount is 50K and above or ASDS
if the amount is below 50K
-duly stamped received by the BAC Secretariat
5 Certificate of Non-Availability of Stocks (CNAS), if applicable
6 Cost-benefit analysis with computation and justification
7 BAC Resolution No.:____________
-recommending the approval of the adoption of the
alternative mode of procurement
8 Three Requests for Quotations (RfQ)-
1. RfQ of :_______________________
2. RfQ of:_______________________
3. RfQ of:_______________________
9 Abstract of Quotations and Award
- duly dated
-duly certified by the BAC
- declaration of the supplier with the lowest
quotation, indicated
10 BAC Resolution to Award (if amount exceeds P50K)
11 Notice of Award (if amount exceeds P50K)
12 Approved Purchase Order
-duly stamped received by COA
- date, number, delivery terms, etc. indicated
-duly stamped received by the supplier
-conformed/signed by Supplier, over printed name

Page 3 of 38
13 Notice to Proceed ( if amount per lot exceeds P50K)
14 Proof of PhilGEPS Posting (if amount exceeds P50K)
1. RFQ
2. Resolution to Award (RTA)
3. Notice of Award (NOA)
4. Purchase Order or Contract
5. Notice to Proceed (NTP)
15 Delivery Receipt
-dated
-with itemized listings of the goods
- with printed name and signature of the Dep ED
official who received the items
16 Inspection and Acceptance Report
-stamped received by COA
-date, number, etc. -indicated
-with itemized listing of the goods
17 Requisition & Issue Slip (RIS)
18 Picture of items purchased located in the school stockroom
for purchase of office supplies
19 Official receipt/Sales invoice No:__________
20 BIR Withholding Tax Form- from sources (2306 and 2307)

ADDITIONAL REQUIREMENTS
FOR SEMI-EXPENDABLE ITEMS
(costing below P15,000)
21 Approved Project Proposal
22 Inventory Custodian Slip
23 Picture of semi-expendable items purchased

24 SUPPLIER'S LEGAL DOCUMENTS (shopping):


Mayor’s/Business Permit
BIR Certificate of Registration
Philgeps number

Submitted by: Verified by:

MELBA C. BARBOSA JONALYN H. VILLADAREZ


(School Head) (Bookkeeper)

Page 4 of 38
ROMERO ELEMENTARY SCHOOL
(Name of School)

CHECKLIST OF SUPPORTING DOCUMENTS


PROCUREMENT OF GOODS-ALTERNATIVE MODE ADOPTED

Supplier: LUCKY EDUCATIONAL SUPPLY, INC.


Items/Goods Purchased: Office Supplies
Program/Activity/Purpose:
Duration:
Amount: 9,040.00
Check No.:
NO. REQUIRED DOCUMENTS DATE REMARKS
Disbursement Voucher
1 Picture of signed check
2 Certification that the items/goods are included in the
approved APP-certified by the Supply Officer
and verified by the BAC Sec.
3 Approved Purchase Request
-date, number, other required data indicated
- duly stamped received by the BAC Secretariat
4 Activity/Project Proposal-if applicable
-date of preparation indicated
-duly certified by the end-user/coordinator
-approved by SDS if the amount is 50K and above or ASDS
if the amount is below 50K
-duly stamped received by the BAC Secretariat
5 BAC Resolution No.:____________
-recommending the approval of the adoption of the
alternative mode of procurement
6 Three Requests for Quotations (RfQ)-
1. RfQ of :
2. RfQ of:
3. RfQ of:
7 Abstract of Quotations and Award
- duly dated
-duly certified by the BAC
- declaration of the supplier with the lowest
quotation, indicated
8 BAC Resolution to Award (if amount exceeds P50K)
9 Notice of Award (if amount exceeds P50K)
10 Approved Purchase Order
-duly stamped received by COA
- date, number, delivery terms, etc. indicated
-duly stamped received by the supplier
-conformed/signed by Supplier, over printed name
11 Notice to Proceed ( if amount per lot exceeds P50K)
12 Proof of PhilGEPS Posting (if amount exceeds P50K)
1. RFQ
2. Resolution to Award (RTA)
3. Notice of Award (NOA)
4. Purchase Order or Contract
5. Notice to Proceed (NTP)
13 Delivery Receipt
-dated
-with itemized listings of the goods
- with printed name and signature of the Dep ED
official who received the items
14 Inspection and Acceptance Report
-stamped received by COA
-date, number, etc. -indicated
-with itemized listing of the goods
15 Requisition & Issue Slip (RIS), if applicable

Page 5 of 38
NO. REQUIRED DOCUMENTS DATE REMARKS
16 Picture of items purchased located in the school storage room
for purchase of office supplies
17 Official receipt/Sales invoice No:__________
18 BIR Withholding Tax Form- from sources (2306 and 2307)

ADDITIONAL REQUIREMENTS
FOR SEMI-EXPENDABLE ITEMS
(costing below P15,000)
19 Approved Project Proposal
20 Inventory Custodian Slip
21 Picture of semi-expendable items purchased

FOR SHIRTS/SPORTS UNIFORMS -


22 Specifications of the shirts/uniforms showing the color,
design, kind of letterings and other specifications
(this should be indicated in the PR)
23 Colored drawings or colored print-outs of the shirt/uniform
24 Certified distribution list of the t shirts/uniforms with the
following columnar headings: a) name, b) designation/
sports event, c) description/kind of uniform received,
d) quantity of item received, e) date received, f) signature

FOR CATERING SERVICE


25 Menu plan to be served for the entire duration of the
26 activity on a daily basis (this should be indicated in the PR and RFQ)
27 Daily inspection report indicating the actual set of menu served
28 Picture of actual set of menu served
29 Certified daily attendance sheet indicating the time in and
time out of attendees

FOR MEDICINES
30 License to Operate of the Drug Distributor
31 Certificates of Product Registrations of the medicines

FOR IDs
32 Certification from the Registrar/Admin Officer/Advisers as
to the number of enrollees

FOR INSURANCE OF ATHLETES OR STUDENTS DURING IMMERSION


33 Insurance Policy
34 Names and designations of the persons to be insured

35 SUPPLIER'S LEGAL DOCUMENTS:


For Small Value Procurement:
Mayors Permit
BIR Certificate of Registration
Philgeps Registration Number
Income and Business Tax Returns (if amount exceeds P500K)
Omnibus Sworn Statement (if amount exceeds P50K)

For Shopping:
Mayors Permit
BIR Certificate of Registration
Philgeps number

Submitted by: Verified by:

MELBA C. BARBOSA JONALYN H. VILLADAREZ


(School Head) (Bookkeeper)

Page 6 of 38
ROMERO ELEMENTARY SCHOOL
ROMERO ELEMENTARY SCHOOL

CHECKLIST OF SUPPORTING DOCUMENTS


REPAIRS AND MAINTENANCE OF BUILDINGS
(Materials Only)

Supplier: AL-FATIHAH TRADING


Items/Goods Purchased: HARDWARE MATERIALS

Type of Building Repaired/Maintained:


Check No.:
Amount:

NO. REQUIRED DOCUMENTS DATE REMARKS


Disbursement Voucher
1 Picture of signed check
2 Certification that the items/goods are included in the
approved APP- certified by the Supply Officer
and verified by the BAC Secretariat
3 Approved Project Proposal
-date of preparation indicated
-duly certified by the end-user/coordinator
-approved by SDS if the amount is 50K and above or ASDS
if the amount is below 50K
-duly stamped received by the BAC Secretariat
4 Approved Program of Work
5 Approved Purchase Request
-date, number, other required data indicated
- duly stamped received by the BAC Secretariat
6 BAC Resolution No.:____________
-recommending the approval of the adoption of the
alternative mode of procurement
Three Requests for Quotations (RfQ)-
7 1. RfQ of :
2. RfQ of:
3. RfQ of:
8 Abstract of Quotations and Award
-duly dated
-duly certified by the BAC
-declaration of the supplier with the lowest quotation
specifically indicated
9 BAC Resolution to Award (if amount exceeds P50K)
10 Notice of Award (if amount exceeds P50K)
11 Approved Purchase Order
-duly stamped received by COA

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- date, number, delivery terms, etc. indicated
-duly atamped received by the supplier
-conformed/signed by Supplier, over printed name
12 Notice to Proceed ( if amount per lot exceeds P50K)
13 Proof of PhilGEPS Posting if amount exceeds P50K
1. RFQ
2. Notice of Award (NOA)
3. Notice to Proceed (NTP)
4. Purchase Order or Contract
14 Delivery Receipts DR NO:
-dated
-printed name and signature of the official who
received the items indicated
-with itemized listing of the procured goods
15 Inspection and Acceptance Report
-stamped received by COA
-date, number, etc. -indicated
-with the itemized listing of the goods
16 Requisition & Issue Slip (RIS)
17 Official receipt/sales invoices of supplier
18 BIR Withholding Tax Form-from Sources (2306 and 2307)
19 Report of Waste Materials
-specific action as to disposal of the waste materials
duly indicated (If waste/scrap materials reported in RWM
are re-used such as fence, extension etc. attach pictures

ADDITIONAL REQUIREMENTS IF LABOR WILL BE SOURCED


FROM OTHER FUNDS (other than MOOE):
20 Pre and Post Inspection Report-Division PFU Coordinator
21 Certificate of Acceptance of the School Head
22 Pictures taken before, during and after repair
(taken in the same position/angle)

23 SUPPLIER'S LEGAL DOCUMENTS:


For Small Value Procurement:
Mayors Permit
BIR Certificate of Registration
Philgeps Registration Number
Income and Business Tax Returns (if amount exceeds P500K)
Omnibus Sworn Statement (if amount exceeds P50K)

Submitted by: Verified by:

MELBA C. BARBOSA JONALYN H. VILLADAREZ

Page 8 of 38
(School Head) (Bookkeeper)

Page 9 of 38
ROMERO ELEMENTARY SCHOOL
(Name of School)

CHECKLIST OF SUPPORTING DOCUMENTS


SURVEY OF SCHOOL SITE

Supplier:
Program/Activity/Purpose:
Amount:
Check No.:

NO. REQUIRED DOCUMENTS DATE REMARKS


Disbursement Voucher
1 Picture of signed check
2 Certification that the items/goods are included in the
approved APP-certified by the Supply Officer
and verified by the BAC Sec.
3 Approved Purchase Request
-date, number, other required data indicated
- duly stamped received by the BAC Secretariat
4 Project Proposal
-date of preparation indicated
-duly certified by the end-user/coordinator
-duly stamped received by the BAC Secretariat
5 BAC Resolution No.:____________
-recommending the approval of the adoption of the
alternative mode of procurement
6 Three Requests for Quotations (RfQ)-
1. RfQ of :_______________________
2. RfQ of:_______________________
3. RfQ of:_______________________
7 Abstract of Quotations and Award
- duly dated
-duly certified by the BAC
- declaration of the supplier with the lowest
quotation, indicated
8 Approved Purchase Order/ Contract
-duly stamped received by COA
- date, number, delivery terms, etc. indicated
-duly stamped received by the supplier
9 License of geodetic engineer
10 Copy of output/lot plan/site development plan
11 Inspection and Acceptance Report
-stamped received by COA
-date, number, etc. -indicated
-with itemized listing of the goods
12 Official receipt No:__________
13 BIR Withholding Tax Form-from Sources (2306/2307)

14 LEGAL DOCUMENTS:
For Small Value Procurement:
Mayors Permit
BIR Certificate of Registration
Philgeps Registration Number
Omnibus Sworn Statement (if amount exceeds P50K)

Submitted by: Verified by:

MELBA C. BARBOSA JONALYN H. VILLADAREZ


(School Head) (Bookkeeper)
ROMERO ELEMENTARY SCHOOL
(Name of School)

CHECKLIST OF SUPPORTING DOCUMENTS


REPAIRS AND MAINTENANCE OF SCHOOL BUILDINGS & FACILITIES
(LABOR)

Payee: ANACITO O. PENTECOSTES


Duration of Labor Worked:
Type of Building/Facility Repaired/Maintained: REPAIR OF ROFFING SHEETS IN 1 CLASSROOM
Check No.: 1001368
Amount: Php 11, 538.00

NO. REQUIRED DOCUMENTS DATE REMARKS


IF THE AMOUNT IS ABOVE 3K
Disbursement Voucher 5/26/2022
1 Picture of signed check 5/26/2022
2 Certification - as to inclusion in the approved APP 5/23/2022
3 Approved Project Proposal
4 Copy of the approved Program of Work (POW)
5 Approved Purchase Request
-date, number, other required data indicated
- duly stamped received by the BAC Secretariat
6 BAC Resolution -recommending the adoption of
alternative mode of procurement
7 Three Requests for Quotations (RfQ)
RfQ 1 ______________________
RfQ 2 ______________________
RfQ 3_______________________
8 Abstract of Quotations and Award
-duly dated
-duly certified by the BAC
-with the declaration of the laborer with the
lowest quotation
9 Pakyaw Contract
-specific name of project indicated
-specific dates of the number of labor works duly indicated
-amount of labor cost indicated
-notarized on or before the 1st day of labor work
-stamped received by COA
10 RER, if single payee (amount in words & in figures written by payee)
11 Labor Payroll (for 2 or more laborers)
12 Pre and Post Inspection Report-Division PFU Coordinator
13 Certificate of Acceptance of the School Head
14 Pictures taken before, during and after repair
(taken in the same position/angle)
15 ID or CTC of the laborer

IF THE AMOUNT OF REPAIR IS BELOW 3K (petty repairs)


Same requirement as above except:
- Proposal and POW no longer required
- Pre and post inspection report to be done by School Facilities in-charge

Submitted by: Verified by:

MELBA C. BARBOSA JONALYN H. VILLADAREZ


(School Head) (Bookkeeper)
ROMERO ELEMENTARY SCHOOL
(Name of School)

CHECKLIST OF SUPPORTING DOCUMENTS


REPAIR/MAINTENANCE-EQUIPMENT

Supplier: 3GX SOLUTIONS


Equipment Repaired/Maintained:
Check No.:
Amount:

NO. REQUIRED DOCUMENTS DATE REMARKS


Disbursement Voucher
1 Picture of signed check
2 Approved Purchase Request
-date, number, other required data indicated
- duly stamped received by the BAC Secretariat
3 Copy of the Inventory Custodian Slip/ARE
4 Certification from the Property Custodian/Supply
Officer of the cause/s of the damages that will
warrant repair/maintenance
5 BAC Resolution No.:____________
-recommending the approval of the adoption of the
alternative mode of procurement
Three Requests for Quotations (RfQ)-
6.a 1. RfQ of :_______________________
6.b 2. RfQ of:_______________________
6.c 3. RfQ of:_______________________
7 Abstract of Quotations and Award
-duly dated
-duly certified by the BAC
-declaration of the supplier with the lowest quotation
specifically indicated
8 Approved Purchase Order
-duly stamped received by COA
- date, number, delivery terms, etc. indicated
-duly atamped received by the supplier
9 Official receipt
10 BIR Withholding Tax Form-from Sources (2306 and 2307)
11 Report of Waste Materials
-specific action as to disposal of the waste materials
duly indicated
12 Accomplishment Report
13 Pre and Post Inspection Inspection Report
-signed by the School Physical facilities Coordinator
14 Inspection and Acceptance Report, for replacement of part
-stamped received by COA
-date, number, etc. -indicated
-with the itemized listing of the goods
15 Warranty
16 LEGAL DOCUMENTS:
For Small Value Procurement
Mayors Permit
BIR Certificate of Registration
Philgeps Registration Number
Income and Business Tax Returns (if amount exceeds P500K)
Omnibus Sworn Statement (if amount exceeds P50K)

Submitted by: Verified by:

MELBA C. BARBOSA JONALYN H. VILLADAREZ


(School Head) (Bookkeeper)
ROMERO ELEMENTARY SCHOOL
(Name of School)

CHECKLIST OF SUPPORTING DOCUMENTS


PHOTOCOPYING OF DOCUMENTS

Payee:
Photocopied Documents:
Amount:
Check No.:

NO. REQUIRED DOCUMENTS DATE REMARKS


IF THE AMOUNT IS 1,000 AND BELOW
Disbursement Voucher
1 Picture of signed check
2 Certification that the items/goods are included in the
approved APP-certified by the Supply Officer
and verified by the BAC Sec.
3 Approved Purchase Request
-date, number, other required data indicated
- duly stamped received by the BAC Secretariat
- description, no. of pages & copies duly indicated
4 Inspection and Acceptance Report
- stamped received by COA
- duly dated
-quantities of test papers per subject-indicated
5 Official receipts OR No:_________
6 BIR Withholding Tax Form-from Sources (2306/ 2307)
7 Distribution list duly received by subject teachers/advisers

IF THE AMOUNT IS MORE THAN P1,000.00

8 BAC Resolution No.:____________


-recommending the approval of the adoption of the
alternative mode of procurement
9 Three Requests for Quotations (RfQ)-
9.a 1. RfQ of :_______________________
9.b 2. RfQ of:_______________________
9.c 3. RfQ of:_______________________
10 Abstract of Quotations and Award
-duly dated
-duly certified by the BAC
-declaration of the supplier with the lowest quotation
specifically indicated
11 Approved Purchase Order
-duly stamped received by COA
- date, number, delivery terms, etc. indicated
-duly atamped received by the supplier
-conformed/signed by Supplier, over printed name

12 LEGAL DOCUMENTS:
For Small Value Procurement
Mayors Permit
BIR Certificate of Registration
Philgeps Registration Number
Omnibus Sworn Statement (if amount exceeds P50K)

Submtted by: Verified by:

MELBA C. BARBOSA JONALYN H. VILLADAREZ


(School Head) (Bookkeeper)
ROMERO ELEMENTARY SCHOOL
(Name of School)

CHECKLIST OF SUPPORTING DOCUMENTS


TARPAULIN PRINTING

Payee: MR. BIM'S ADVERTISING


School Acvitity: TARPAULIN PRINTING

Amount: Php 864.00


Check No.:

NO. REQUIRED DOCUMENTS DATE REMARKS


If the amount is below 1K
Disbursement Voucher
1 Picture of signed check
2 Approved Purchase Request indicating 5/18/2022
the school activity where the tarpaulin
will be used.
3 Official Receipt 5/19/2022
4 Picture of the tarpaulin 5/19/2022

If the amount is 1K or above:


Will follow the same procedure on regular
procurement process

Submitted by: Verified by:

MELBA C. BARBOSA JONALYN H. VILLADAREZ


(School Head) (Bookkeeper)
ROMERO ELEMENTARY SCHOOL
(Name of School)

CHECKLIST OF SUPPORTING DOCUMENTS


FIDELITY BOND

Payee: BUREAU OF THE REASURY


Amount: Php 1,500.00
Check No.:
Effectivity Date of the Bond:
Risk No.
Amount of the bond:

NO. REQUIRED DOCUMENTS DATE REMARKS


Disbursement Voucher
1 Picture of signed check
2 Confirmation letter (if available)
3 Authority to Accept Payment (ATAP)
4 Validated bank deposit

Submtted by: Verified by:

MELBA C. BARBOSA JONALYN H. VILLADAREZ


(School Head) (Bookkeeper)
ROMERO ELEMENTARY SCHOOL
(Name of School)

CHECKLIST OF SUPPORTING DOCUMENTS


PAYMENT OF ELECTRIC BILL

Payee: CASURECO II
Consumption Period/Billed Period: NOVEMBER 2022 2022

Amount: 6,969.26
Check No.: 1001391

NO. REQUIRED DOCUMENTS DATE REMARKS


Disbursement Voucher
1 Picture of signed check
2 Statement of Account
3 Official Receipt
4 BIR Withholding Tax Form-from Sources (2306/ 2307)

Submitted by: Verified by:

MELBA C. BARBOSA JONALYN H. VILLADAREZ


(School Head) (Bookkeeper)
ROMERO ELEMENTARY SCHOOL
(Name of School)

CHECKLIST OF SUPPORTING DOCUMENTS


PAYMENT OF WATER CONSUMPTION BILL

Payee: BAAO WATER DISTRICT


Consumption Period/Billed Period: Nov-22
Amount: 2,290.98
Check No.:

NO. REQUIRED DOCUMENTS DATE REMARKS


Disbursement Voucher
1 Picture of signed check
2 Statement of Account
3 Official Receipt
4 BIR Withholding Tax Form-from Sources (2306/ 2307)

Submitted by: Verified by:

MELBA C. BARBOSA JONALYN H. VILLADAREZ


(School Head) (Bookkeeper)
ROMERO ELEMENTARY SCHOOL
(Name of School)

CHECKLIST OF SUPPORTING DOCUMENTS


PAYMENT OF POSTPAID INTERNET/ MOBILE PHONE

Payee: PLDT, INC.


Consumption Period/Billed Period: Dec-22
Amount: 1,968
Check No.: 1061226

NO. REQUIRED DOCUMENTS DATE REMARKS


Disbursement Voucher
1 Picture of signed check
2 Statement of Account
3 Official Receipt
4 BIR Withholding Tax Form-from Sources (2306/ 2307)

Submitted by: Verified by:

MELBA C. BARBOSA JONALYN H. VILLADAREZ


(School Head) (Bookkeeper)
ROMERO ELEMENTARY SCHOOL
(Name of School)

CHECKLIST OF SUPPORTING DOCUMENTS


INITIAL PAYMENT OF INTERNET CONNECTION

Payee:
Name of Activity/Project:
Amount:
Check No.:

NO. REQUIRED DOCUMENTS DATE REMARKS


Disbursement Voucher
1 Picture of signed check
2 Approved Purchase Request
3 Letter request by the end-user approved by the
School Head indicating the following:
- the initial and monthly rate of internet service
(amount should not exceed the allocated budget in the WFP)
- number of computers and speed of internet service
- justification for choosing the internet provider
4 Initial Statement of Account/Billing Statement
5 Copy of provider's Terms and Conditions
6 Official Receipt
7 BIR Withholding Tax Form- from sources (2306 and 2307)

Submitted by: Verified by:

MELBA C. BARBOSA JONALYN H. VILLADAREZ


(School Head) (Bookkeeper)
ROMERO ELEMENTARY SCHOOL
(Name of School)

CHECKLIST OF SUPPORTING DOCUMENTS


PAYMENT OF PREPAID INTERNET/ MOBILE PHONE

Payee: D.M. BRIONES GENERAL MERCHANDISE


Consumption Period/Billed Period: Sep-22
Amount: 1000
Check No.:

NO. REQUIRED DOCUMENTS DATE REMARKS


Disbursement Voucher
1 Picture of signed check
2 Official Receipt
3 Actual used card, if applicable

Submitted by: Verified by:

MELBA C. BARBOSA JONALYN H. VILLADAREZ


(School Head) (Bookkeeper)
ROMERO ELEMENTARY SCHOOL
(Name of School)

CHECKLIST OF SUPPORTING DOCUMENTS


PAYMENT OF TELEPHONE BILLS

Payee:
Billed period;
Amount:
Check No.:

NO. REQUIRED DOCUMENTS DATE REMARKS


Disbursement Voucher
1 Picture of signed check
2 Statement of Account
3 Official receipt of telephone company
4 Certification by the Head Agency that all
National Direct Dial (NDD), natural
operator assisted calls and international
assisted calls are offcials calls

Submitted by: Verified by:

MELBA C. BARBOSA JONALYN H. VILLADAREZ


(School Head) (Bookkeeper)
ROMERO ELEMENTARY SCHOOL
(Name of School)

CHECKLIST OF SUPPORTING DOCUMENTS


REIMBURSEMENT OF TRAVELING/TRAINING EXPENSES

Payee:
Position/Designation:
Purpose of Travel:
Duration of Travel:
Amount:
Check No.:

NO. REQUIRED DOCUMENTS DATE REMARKS


Disbursement Voucher
1 Picture of signed check
2 Original copy of the letter of invitation
of host/sponsoring agency/organization
3 DepEd National, Regional or Division Memorandum, if applicable
4 Approved Travel Order
5 Approved Itinerary of Travel
6 Certificate of Travel Completed
7 Original copy of Certificate of Appearance
with original initial of the activity coordinator
8 Official receipt for the registration fee
9 Office receipt for the hotel accomodation
if lodging cost exceeds the allowable rate
10 Certification from the Head as to
the absolute necessity of the cost of the
hotel accommodation if the lodging cost
exceeded the allowable lodging rate per day
11 Passenger copies of the bus/van tickets
12 Paper/electronic plane tickets
13 Boarding pass
14 Terminal fee tickets
15 RER for taxi fare, motorboat, habal-habal or
Certification of Expenses not requiring receipts
pursuant to COA Circular No. 2017-001 dtd 6/19/17
for expenses amounting to P300.00 or less

Note: Affidavit of loss shall not be considered as appropriate replacement.

Submitted by: Verified by:

MELBA C. BARBOSA JONALYN H. VILLADAREZ


(School Head) (Bookkeeper)
ROMERO ELEMENTARY SCHOOL
(Name of School)

CHECKLIST OF SUPPORTING DOCUMENTS


FUEL/GRASS CUTTING

Payee: GAITE SERVICE STATION


Duration of Labor Worked: 2 Days
Amount: Php. 987.00
Check No.:

NO. REQUIRED DOCUMENTS DATE REMARKS


Disbursement Voucher
1 Picture of signed check
2 Approved Pruchase Request
3 Certification that the items/goods are included in the
approved APP- certified by the Supply Officer
and BAC Sec.
4 Inspection and Acceptance Report
-stamped received by COA
5 Accomplishment report of the laborer
- signed by the laborer
-certified by the School Head
-specific date/s and areas where the grass cutting
were made, duly indicated

Dates Areas No. of Liters Used

Note: The allowed fuel consumption is 10-15 liters per hectare

6 Pictures taken before, during and after the grass


cutting were made (taken same position/angle/place)
7 Official receipt of the gasoline
8 Official receipt of 2T oil, if applicable

Submtted by: Verified by:

MELBA C. BARBOSA JONALYN H. VILLADAREZ


(School Head) (Bookkeeper)
ROMERO ELEMENTARY SCHOOL
(Name of School)

CHECKLIST OF SUPPORTING DOCUMENTS


LABOR/GRASS CUTTING

Payee: PEPITO B. DILLA


Duration of Labor Worked: 3 DAYS
Amount: 2,000
Check No.:

NO. REQUIRED DOCUMENTS DATE REMARKS


Disbursement Voucher
1 Picture of signed check
2 Approved Purchase Request
3 Pre and Post Inspection Report by School Physical
Facilities Coordinator
4 Pictures taken before, during and after the grass
cutting were made (taken same position/angle/place)
5 Accomplishment report of the laborer
- signed by the laborer
-certified by the School Head
-specific date/s and areas where the grass cutting
were made, duly indicated

Dates Areas No. of Liters Used

6 RER
-amounts in words and in figures written by payee
7 ID or CTC of the laborer 3/25/2022

Submtted by: Verified by:

MELBA C. BARBOSA JONALYN H. VILLADAREZ


(School Head) (Bookkeeper)
ROMERO ELEMENTARY SCHOOL
(Name of School)

CHECKLIST OF SUPPORTING DOCUMENTS


HAULING EXPENSES

Payee: ERNESTO R. CANAMERO


Goods/Items Hauled: HAULING OF SBFP-MILK
Amount: 750
Check No.:

NO. REQUIRED DOCUMENTS DATE REMARKS


If the amount is 1K or above:
Disbursement Voucher
1 Picture of signed check
2 Approved Purchase Request
-date, number, other required data indicated
- duly stamped received by the BAC Secretariat
3 BAC Resolution No.:____________
-recommending the approval of the adoption of the
alternative mode of procurement
Three Requests for Quotations (RfQ)-
4.a 1. RfQ of :_______________________
4.b 2. RfQ of:_______________________
4.c 3. RfQ of:_______________________
5 Abstract of Quotations and Award
-duly dated
-duly certified by the BAC
-declaration of the supplier with the lowest quotation
specifically indicated
6 Contract of Service (notarized)
-duly stamped received by COA
-name of project/nature of service, amount,
no. of days & specific dates indicated
7 Official receipt, if any or RER (amounts in words
and in figures written by payee)
8 Photo copy of the Driver's License
9 Photo copy of the LTO registration
of the vehicle
10 Certified list of the items/goods hauled, showing their
quantities that warranted the hauling thereof
signed by the hired driver
11 Picture of hauled items situated inside the hired vehicle

If the amount is below 1K (for short-distance hauling,


upland and/or not passable roads)
Disbursement Voucher
1 Photo copy of the check
2 Approved Purchase Request
3 RER
-amounts in words and in figures written by payee
4 Accomplishment Report
5 Picture of hauled items

Submtted by: Verified by:

MELBA C. BARBOSA JONALYN H. VILLADAREZ


(School Head) (Bookkeeper)
ROMERO ELEMENTARY SCHOOL
(Name of School)

CHECKLIST OF SUPPORTING DOCUMENTS


PAYMENT OF JANITORIAL/SECURITY/OFFICE CLERK SERVICES

Payee: GEMMA Z. REFORSADO


AUGUST 2022
Pay Period:
Amount: 4,000

Check No.:

NO. REQUIRED DOCUMENTS DATE REMARKS

For janitorial/security/office clerk services-


Disbursement Voucher
1 Picture of signed check
2 Job Order contract

3 Accomplishment report prepared and


signed by the laborer and verified by
the School Head - specifying the area
and rooms cleaned, and the dates
4 DTR
5 RER (amounts in words and in figures written by payee
6 ID or CTC of janitor/watchman

For General Services -


(procured on some cases only, such as
cutting of tree branches after typhoon,
removal of debris after typhoon, etc.)
Disbursement Voucher
1 Picture of signed check
2 Purchase Request
3 Accomplishment Report
4 Pictures taken before, during and after service
4 RER
-amounts in words and in figures written by payee
5 ID or CTC of payee

Submitted by: Verified by:

MELBA C. BARBOSA JONALYN H. VILLADAREZ


(School Head) (Bookkeeper)
ROMERO ELEMENTARY SCHOOL
(Name of School)

CHECKLIST OF SUPPORTING DOCUMENTS


POSTAGE/COURIER SERVICE

Payee: LBC, PILI


Documents Mailed: Form 137
Amount: 195
Check No.:

NO. REQUIRED DOCUMENTS DATE REMARKS


Disbursement Voucher
1 Picture of signed check
2 Approved Purchase Request
3 Official Receipt

Submtted by: Verified by:

MELBA C. BARBOSA JONALYN H. VILLADAREZ


(School Head) (Bookkeeper)
ROMERO ELEMENTARY SCHOOL
(Name of School)

CHECKLIST OF SUPPORTING DOCUMENTS


NOTARIAL FEES

Payee: LBC PILI


Amount: Php 195.00
Check No.:

NO. REQUIRED DOCUMENTS DATE REMARKS


Disbursement Voucher
1 Picture of signed check
2 Approved Purchase Request
3 Official receipt of the notary official/lawyer
4 Photocopy of the document notarized

Submtted by: Verified by:

MELBA C. BARBOSA JONALYN H. VILLADAREZ


(School Head) (Bookkeeper)
ROMERO ELEMENTARY SCHOOL
(Name of School)

CHECKLIST OF SUPPORTING DOCUMENTS


PAYMENT FOR CHECKBOOK

Payee: LANDBANK OF THE PHILIPPINES


Amount: Php 520.00
Check No.: N/A ( charge our account )

NO. REQUIRED DOCUMENTS DATE REMARKS


Disbursement Voucher N/A
1 Picture of signed check N/A
2 Approved Purchase Request
3 Official Receipt 6/2/2022
4 Copy of accomplished check reorder form
5 Inspection and Acceptance Report
-duly stamped received by COA
-date, number, etc. -indicated
-with itemized listing of the goods

Submitted by: Verified by:

MELBA C. BARBOSA JONALYN H. VILLADAREZ


(School Head) (Bookkeeper)
ROMERO ELEMENTARY SCHOOL
(Name of School)

CHECKLIST OF SUPPORTING DOCUMENTS


PAYMENT OF TRANSPORTATION THRU PAYROLL

Payee:
Program/Activity/Purpose:
Duration:
Amount:
Check No.:

NO. REQUIRED DOCUMENTS DATE REMARKS


Disbursement Voucher
1 Picture of signed check
2 Approved Purchase Request
3 List of passengers - prepared by the activity coordinator
and certified by the School Head
4 Daily Payroll
5 OR and CR of the jeepneys
6 Driver's license of the driver
7 Picture of jeepney/vehicle used with the passengers

Submtted by: Verified by:

MELBA C. BARBOSA JONALYN H. VILLADAREZ


(School Head) (Bookkeeper)
ROMERO ELEMENTARY SCHOOL
(Name of School)

CHECKLIST OF SUPPORTING DOCUMENTS


GSIS INSURANCE

Payee:
Insurance Service Procured:
Amount:
Check No.:

NO. REQUIRED DOCUMENTS DATE REMARKS


Disbursement Voucher
1 Picture of signed check
2 Approved Purchase Request
- stamped received by the BAC Secretariat
3 Certification that the items/goods are included in the
approved APP- certified by the Supply Officer
and BAC Sec.
4 BAC Resolution recommending Negotiated Procurement
- Agency to Agency
5 Insurance Policy
6 Names and designations of the persons to be insured
7 Official Receipt

Submtted by: Verified by:

MELBA C. BARBOSA JONALYN H. VILLADAREZ


(School Head) (Bookkeeper)
ROMERO ELEMENTARY SCHOOL
(Name of School)

CHECKLIST OF SUPPORTING DOCUMENTS


HONORARIUM OF GUEST SPEAKER
(who is not a DepEd employee)

Payee:
Name of Activity:
Date of Activity:
Amount:
Check No.:

NO. REQUIRED DOCUMENTS DATE REMARKS


Disbursement Voucher
1 Picture of signed check
2 Approved Proposal
-date of preparation indicated
-duly certified by the end-user/coordinator
-approved by SDS if the amount is 50K and above or ASDS
if the amount is below 50K
3 Approved Purchase Request
4 Letter of Invitation to the Speaker
5 Training Matrix/Programme
6 Certification of Salary of the Guest Speaker
certified by the employer's HR Officer
7 BIR Withholding Tax Form- from sources (2307)

Note:
Computation: Constant factor of 0.023 x monthly salary rate x no.of actual lecture/training hours

Submitted by: Verified by:

MELBA C. BARBOSA JONALYN H. VILLADAREZ


(School Head) (Bookkeeper)
ROMERO ELEMENTARY SCHOOL
(Name of School)

CHECKLIST OF SUPPORTING DOCUMENTS


PAYMENT for SUPPLIES AND MATERIALS
(with amount of less than 1k)

Payee:
Name of Activity/Project:
Amount:
Check No.:

NO. REQUIRED DOCUMENTS DATE REMARKS


Disbursement Voucher
1 Picture of signed check
2 Approved Purchase Request
3 Sales Invoice
4 Inspection and Acceptance Report
-duly stamped received by COA
-date, number, etc. -indicated
-with itemized listing of the goods
5 Picture of purchased items
6 Inventory Custodian Slip (for non-consumable items)

Submitted by: Verified by:

MELBA C. BARBOSA JONALYN H. VILLADAREZ


(School Head) (Bookkeeper)
ROMERO ELEMENTARY SCHOOL
(Name of School)

CHECKLIST OF SUPPORTING DOCUMENTS


RENTAL OF GENERATOR OR GRASS CUTTER
(with amount of less than 1k)

Payee:
Name of Activity:
Date of Activity:
Amount:
Check No.:

NO. REQUIRED DOCUMENTS DATE REMARKS


Disbursement Voucher
1 Picture of signed check
2 Approved Purchase Request
3 Official Receipt or RER (amounts in words
and in figures written by payee)
4 ID or CTC of payee (if RER is issued)

Submitted by: Verified by:

MELBA C. BARBOSA JONALYN H. VILLADAREZ


(School Head) (Bookkeeper)
ROMERO ELEMENTARY SCHOOL
(Name of School)

CHECKLIST OF SUPPORTING DOCUMENTS


LABOR FOR REPAIR/MAINTENANCE OF BUILDING
(with amount of less than 1k)

Payee:
Name of Activity/Project:
Amount:
Check No.:

NO. REQUIRED DOCUMENTS DATE REMARKS


Disbursement Voucher
1 Picture of signed check
2 Approved Purchase Request
3 Accomplishment Report
4 Pre and Post Inspection Inspection Report by the
School Physical Facilities Coordinator
5 Waste Material Report, if applicable
6 Pictures (before, during and after repair)
7 RER (amounts in words and in figures written by payee)
8 ID or CTC of the payee

Submitted by: Verified by:

MELBA C. BARBOSA JONALYN H. VILLADAREZ


(School Head) (Bookkeeper)
ROMERO ELEMENTARY SCHOOL
(Name of School)

CHECKLIST OF SUPPORTING DOCUMENTS


LABOR FOR REPAIR OF EQUIPMENT
(with amount of less than 1k)

Payee: 3GX SOLUTIONS


Equipment to be Repaired:
Amount: Php 2,120.00
Check No.:

NO. REQUIRED DOCUMENTS DATE REMARKS


Disbursement Voucher
1 Picture of signed check
2 Approved Purchase Request
-date, number, other required data indicated
- duly stamped received by the BAC Secretariat
3 Copy of the Inventory Custodian Slip/ARE
4 Certification from the Property Custodian/Supply
Officer of the cause/s of the damages that will
warrant repair/maintenance
5 Pre and Post Inspection Inspection Report
-signed by the School Physical facilities Coordinator
6 Inspection and Acceptance Report (for replacement of parts)
-duly stamped received by COA
-date, number, etc. -indicated
-with itemized listing of the goods
7 Accomplishment Report
8 Official Receipt
9 Report of Waste Materials
-specific action as to disposal of the waste materials
duly indicated

Submitted by: Verified by:

MELBA C. BARBOSA JONALYN H. VILLADAREZ


(School Head) (Bookkeeper)

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