Republic of the Philippines

PROVINCE OF NORTHERN SAMAR

Catarman, Northern Samar

OBLIGATION REQUEST
Payee Cabacang, Irylle Von., et Al. 1-5

Office Provincial Engineering Office

Address Catarman, N. Samar

Responsibility Account
Particulars F.P.P. Amount
Center Code

P 15,548.56
To obligate Payment of Other Services for the period
January 26-31, 2024 87515-02-99-990

P 15,548.56
A Certified B Certified
Charges to appropriation/allotment necessary,
lawful and under my direct supervision Existence of available appropriation

Signature Signature

Printed Printed
Name GILLENNY H. MORENO Name ADELWISA L. ACEBUCHE

OIC-Chief, Planning, Designing & Provincial Budget Officer

Position Programming Division/ OIC-Assistant Position
Provincial Engineer Head Budget Unit/Authorized Representative

Date Date
PGNS-PBO-005-FM Rev. 00 Effectivity Date : July 17, 2023
GENERAL FORM No. 5 Sheet 1 of 1 Sheet
Revised January 1992
PAYROLL
OTHER SERVICES

AGENCY: PROVINCE OF NORTHERN SAMAR Period Covered: January 26-31, 2024

NAME OCCUPATION No. of Hours Rate/Hour AMOUNT EARNED W/ TAX NET AMOUNT SIGNATURE
1 Galit, Gemino C. Civil Engineer 26.00 171.46 4,457.96 4,457.96 1
2 Mamaki, Mark Anthony C. Civil Engineer 13.85 171.46 2,374.72 2,374.72 2
3 Osias, Jinky B. Electrical Engineer 27.83 171.46 4,772.30 4,772.30 3
4 Pino, Bernardito Y. Mechanical Engineer 9.00 171.46 1,543.14 1,543.14 4
5 Porteza, Florence Paul Z. Jr. Architect 14.00 171.46 2,400.44 2,400.44 5
TOTAL 15,548.56 15,548.56
CERTIFICATION: The Item 1-5 rendered services in the P.E.O. as a contractual employee.

Certified: Certified:
Each person whose name appears on this roll Each person whose name appears above has
had rendered services for the period stated. been paid the amount indicate his/her name.

Approved for Payment: Signature of disbursing officer:

GILLENNY H. MORENO, A.ASEP EDWIN MARINO C. ONGCHUAN

OIC-Chief, Planning, Designing & Programming Division/ Provincial Governor
OIC-Assistant Provincial Engineer
 ACCOMPLISHMENT REPORT

OFFICE/DIVISION:PROVINCIAL ENGINEERING OFFICE Period Covered: January 26-31, 2024

NO. OF
NAME DATE HOURS ACTIVITY OUTPUT REMARKS
RENDERED

PLAN & POW of the Construction of Liga Hall Building at Brgy. H. Jolejole FINISHED. (For
1 Galit, Gemino C. January 26-31, 2024 26.00
District Poblacion, Las Navas, Northern Samar.
1 PROJECT
Checking)

PLAN & POW of the Construction of Mckinley- Aguinaldo-Tinowaran farm to

2 Mamaki, Mark Anthony C. January 26-31, 2024 13.85
Market Road, Catarman Northern Samar.
1 PROJECT On Going

PLAN & POW of the Construction of Liga Hall Building at Brgy. H. Jolejole FINISHED. (For
3 Osias, Jinky B. January 26-31, 2024 27.83
District Poblacion, Las Navas, Northern Samar.
1 PROJECT
Checking)

FINISHED. (For
Checking
4 Pino, Bernardito Y. January 26-31, 2024 9.00 Construction of 2- Storey Dep Ed Office Building, Catarman, Northern Samar. 1 PROJECT Mechanical &
Plumbing Works
Only)

FINISHED. (For
Checking
5 Porteza, Florence Paul Z. January 26-31, 2024 14.00 Construction of 2- Storey Dep Ed Office Building, Catarman, Northern Samar. 2 PROJECT
Architectural
Works Only)

PREPARED AND SUBMITTED BY:

Galit, Gemino C. Mamaki, Mark Anthony C. Osias, Jinky B..

Civil Engineer Civil Engineer Electrical Engineer

Pino, Bernardito Y.
Mechanical Engineer Porteza, Florence Paul Z.
Architect

APPROVED:
GILLENNY H. MORENO, A.ASEP
OIC-Chief, Planning, Designing & Programming Division/
OIC-Assistant Provincial Engineer

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