Appendix 60a Page : 1 of 1 PR 2024-03-0754

Republic of the Philippines

Department of Health
SOUTHERN ISABELA MEDICAL CENTER

PURCHASE REQUEST
Date: 3/22/2024 PR No: 2024-03-0754

Department: ENGINEERING Fund Cluster : INCOME

Category : OTHER SUPPLIES AND MATERIALS Responsibility Center Code:

Purpose: FOR FIREALARM USE OR NO. 175132 PETTYCASH

Stock No/
Property No Unit Quantity Description Unit Cost Total Cost

OTHERSUP2 Pieces 2 OTHER SUPPLIES AND MATERIALS 950.00 1,900.00

539 Fire Alarm Battery HP5-12 : General Description:
Fire alarm battery
Warranty: N/a
Applicable Standard/s: N/a
Preventive Maintenance: N/a
Green Procurement Standards:
•-All unnecessary plastics that are not needed during the operation are subjected
for disposal by the supplier except for things that can be reuse/ recycle of the
hospital.
Applicable Training: N/a
Delivery Period must be at least within: COD
Mode of inspection and testing:
1.Sampling and items at least 1 samples;

TOTAL : 1,900.00
This is to certify that the requested Good/s and /or service/s specified herein the Purchase Request undergone strict requirements
under the Standard Operating Procedure of Southern Isabela Medical Center for which bears no preferential basis or tailor-fitted on the
part of the undersigned for a particular supplier/ service provider

Requested and Certified by: ARLON P. SARTAGODA, CE, MPA

ENGINEER IV
Signature over Printed Name

Recommending Approval: RIENA JO C. ERESMAS, MPA

(Department Head)
CHIEF ADMINISTRATIVE OFFICER
Signature over Printed Name

Approved by:

MELCHOR C. DELA CRUZ JR. MD, MHA

MEDICAL CENTER CHIEF II

FM_HOPS-PROC-001 REV.5/07.25.2022
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