Appendix 63

REPORT ON THE PHYSICAL COUNT OF LOCAL ROAD NETWORK

As at ______________________

For which ___(Name of Accountable Officer) , (Official Designation) , (LGU name) , is accountable, having assumed such accountability on
_______(Date of Assumption) .

Road Network ID
Road Name Components Description Date Constructed Cost Condition Remarks
No.
A. Road Lot
B. Pavement
C. Drainage and Slope
Protection Structures
D. Other Miscellaneous
Structures (specify)

CERTIFIED CORRECT BY: VERIFIED BY:

Signature over Printed Name Signature over Printed Name Signature over Printed Name
Inventory Committee Chair and Members Local Chief Executive/Authorized Representative COA Representative