LGU - TAMPILISAN Purchase Request No.

Bids And Awards Committee Office of the: MSWD

Tampilisan, Zambo. Norte
REQUEST FOR QUOTATION
Date: ____________________
Quotation No.______________

Please quote your lowest price on the item/s listed below, subject to the General Condition on the
Philippine Bidding Documents on Goods, stating the shortest time of delivery and submit your quotation duly
signed by your representative not later than ________________________.

VIGILUS D. CREDO
NOTE: BAC Chairman
1. ALL ENTRIES MUST BE TYPEWRITTEN
2. DELIVERY PERIOD WITHIN SEVEN (7) CALENDAR DAYS
3. WARRANTY SHALL BE FOR A PERIOD OF THREE (3) MONTHS FOR SUPPLIES & MATERIALS, ONE (1) YEAR FOR
EQUIPMENT, FROM DATE OF ACCEPTANCE BY THE PROCURING ENTITY
4. PRICE VALIDITY SHALL BE FOR A PERIOD OF THIRTY (30) CALENDAR DAYS
5. G-EPS REGISTRATION CERTIFICATE SHALL BE ATTACHED UPON SUBMISSION OF THE QUOTATION, IF AVAILABLE.
6. BIDDERS SHALL SUBMIT ORIGINAL BROCHURES SHOWING CERTIFICATIONS OF THE PRODUCT BEING OFFERED.
ITEM
ITEM & DESCRIPTION QTY. Unit Unit Price TOTAL
NO.
1 Cart Canon PG-810 black 1 pc

Brand and Model :

Delivery Period :
Warranty :
Price Validity :
After having carefully read and accepted your General Conditions, I / We quote you on
the item at prices noted above.

Printed Name/Signature

Tel. No/Cellphone No.

Date
 PURCHASE REQUEST
Tampilisan, Zamboanga del Norte
LGU
PR No.: Date:
Department: OFFICE OF THE MUNICIPAL ACCOUNTING SAI No.: Date:
Section: OR No. Date:

Item Unit of Estimated Estimated

Quantity Item Description
No. Issue Unit Cost Cost
1 1 unit Cart. Epson Ink C13T664200 CYAN 500.00 500.00
2 1 bots. Cart. Epson Ink C13T664200 MAGENTA 500.00 500.00
3 1 bots. Cart. Epson Ink C13T664200 YELLOW 500.00 500.00
4 4 bots. Cart. Epson Ink C13T664200 BLACK 750.00 3,000.00
5 1 pc Flash USB 2.0 16gb Kingston DT-101 G2 1,500.00 1,500.00
6 2 pcs Mouse Pad Genius Color Blue 45.00 90.00
7 1 pc Puncher Heavy Duty Joy 280.00 280.00
8 1 pc Ribbon Cartridge Epson FX2175 890.00 890.00

7,260.00

Purpose: For the use in the Office of the Municipal Accountant.

Requested by: Cash Availability: Approved by:

Signature:
Printed Name: SHERRY LOU P. DAPROSA OLIVIA G. EBORDE ANGELES R. CARLOTO II
Designation: Municipal Accountant Municipal Treasurer Municipal Mayor
7,260.00
 Republic of the Philippines
PROVINCE OF ZAMBOANGA DEL NORTE
MUNICIPALITY OF TAMPILISAN

No.:
OBLIGATION REQUEST
PAYEE CLICK HAUS COMPUTER SALES & SERVICES
OFFICE
ADDRESS Baybay, Liloy Zamboanga del Norte

Responsibilit ACCOUNT
PARTICULARS F.P.P AMOUNT
y Center CODE
Office Supplies Php 7,060.00

TOTAL Php 7,060.00

A. CERTIFIED: B. CERTIFIED:
X Charges to appropriation/allotment necessary,
lawful and under my direct supervision Existence of available appropriation
Supporting documents valid, proper and legal

Signature Over Signature Over

Printed Name SHERRY LOU P. DAPROSA Printed Name GRACE A. GUMANSING
Position Municipal Accountant Position Municipal Budget Officer
Date Date

Republic of the Philippines

PROVINCE OF ZAMBOANGA DEL NORTE
MUNICIPALITY OF TAMPILISAN

No.:
OBLIGATION REQUEST
PAYEE CLICK HAUS COMPUTER SALES & SERVICES
OFFICE
ADDRESS Baybay, Liloy Zamboanga del Norte

Responsibilit ACCOUNT
PARTICULARS F.P.P AMOUNT
y Center CODE
Office Supplies Php 7,060.00
 TOTAL Php 7,060.00
A. CERTIFIED: B. CERTIFIED:
Charges to appropriation/allotment necessary,
lawful and under my direct supervision Existence of available appropriation
Supporting documents valid, proper and legal

Signature Over Signature Over

Printed Name SHERRY LOU P. DAPROSA Printed Name GRACE A. GUMANSING
Position Municipal Accountant Position Municipal Budget Officer
Date Date
 Republic of the Philippines
PROVINCE OF ZAMBOANGA DEL NORTE
MUNICIPALITY OF TAMPILISAN

DISBURSEMENT VOUCHER No.

MODE OF Check Cash Other

PAYMENT
CLICK HAUS COMPUTER SALES & TIN/Employee No.: Obligation Request No.
PAYEE
SERVICES
RESPONSIBILITY CENTER
ADDRESSBaybay, Liloy Zamboanga del Norte
Office/Unit/Project: Code:
EXPLANATION AMOUNT
To payment of Office Supplies for the use in the Office of the Mun. Engineer,
this municipality of Tampilisan Zamboanga del Norte per supporting papers,
hereto attached in the total amount . . . . . . . . . . . . . . . Php 7,060.00

Less: 7,060.00 x 4% 282.40

Total Amount due this Voucher . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Php 6,777.60

A CERTIFIED: B CERTIFIED:
Allotment obligated for the purpose as indicated ab
Funds Available
Supporting documents complete and paper

Signature Signature
Printed Date: Printed Date:
SHERRY LOU P. DAPROSA OLIVIA G. EBORDE
Name Name
Municipal Accountant Municipal Treasurer
Position Position
(Head,Accounting Unit/Authorized Representative) (Head,Treasury Unit/Authorized Representative)
APPROVED FOR PAYMENT: RECEIVED PAYMENT:
C D
Signature Check No.: Bank Name: Date:
Printed Date: Signature
ANGELES R. CARLOTO II
Name Printed Date:
NamHAUS COMPUTER SALES & SERVICES
CLICK
Municipal Mayor OR. No./Other Documents JEV No. Date:
Position
(Local Chief Executive/Authorized Representative)

FOR ACCOUNTING/PRE-AUDIT PERSONNEL USE ONLY:

CHECKLIST: MANDATORY MINIMUM SUPPORTING DOCUMENTS FOR COMMON TRANSACTIONS
(Maintenance & Other Operating Expenses/Capital Outlay)
I. TRAVELS 2 ALTERNATIVE MODE OF PROCUREMENT
Travel Order or Memorandum by the LCE authorizing the travel 2.a
Approved Itinerary (Appendix A) Purchase Request
Tickets (Original) for Plane, Bus, Ships Fare or equivalent Purchase Order/Letter Order/Contract,duly received
Certificate of Travel Completed (Appendix B) by bidder/supplier
Certificate of Appearance (Appendix C), or its equivalent Certificate of Acceptance
Liquidation Report-in case of cash advance Inspection Report/Waiver of Inspection
Receipts, in case of actual travel claims Result of Test Analysis (if subject to test)
Original Invoice:
Accomplishment Report -Charge Invoice/Sales Invoice
RER (optional)-For reimb. Of expenses above P 75.00 (COA Cir. 96-005) -Delivery Receipt
II. PURCHASES Canvass sheet/price quotation
1 COMPETITIVE BIDDING: Abstract/summary of canvass
Purchase Request (PR)/RIS-Original Certificate of emergency purchase-in the absence of
Purchase Order (PO)/Letter Order (LO)/Contract, duly received by canvass if amount is below 1,000.00
bidder .b NEGOTIATED PROCUREMENT/NEGOTIATED CONTRACT
Inspection and Acceptance Report/Waiver of Inspection Negotiated Procurement:
Original Invoice: Purchase Request
Delivery Receipt Purchase Order/Letter Order/Contract(contract)
Sales Invoice/Charge Invoice duly received by bidder/supplier
Stock Position Sheet Certificate of Authority to negotiate/enter into negotiate
Result of test analysis by proper government, if subject to test contract.
Copy of Advertisement/Invitation to bid Delivery Receipt
Bidder's Bond Sales Invoice/Original Invoice
Notice/Letter of Award Certificate of Acceptance & Inspection Report
Performance Bond Result of Test Analysis (if subject to test)
Abstract of Bids supported by: Certificate of failure of bidding for the second time from
Bid tenders of other participants Canvass sheet/price quotation
Acceptance of bid/proposal Abstract/summary of canvass
BAC recommendation-Award of the LCRB/HRRB to the LCE Negotiated Contract: (in addition to the above)
TWG recommendation Notice to commence to work
NATIVE MODE OF PROCUREMENT

rder/Letter Order/Contract,duly received

of emergency purchase-in the absence of

of Authority to negotiate/enter into negotiated

of failure of bidding for the second time from BAC

Contract: (in addition to the above)

***Computation***
Php #REF!
 JOURNAL ENTRY VOUCHER No.
Date:
TAMPILISAN, ZAMBO. NORTE
LGU

Collection Check Disbursement Cash Disbursement Others

ACCOUNTING ENTRIES
Responsibility Accounts and Explanation Account PR Amount
Center Debit Credit

T O T A L
Prepared by: Approved by:
JULITO P. LADEZA
Municipal Accountant

JOURNAL ENTRY VOUCHER No.

Date:
TAMPILISAN, ZAMBO. NORTE
LGU

Collection Check Disbursement Cash Disbursement Others

ACCOUNTING ENTRIES

Responsibility Accounts and Explanation Account PR Amount

Center Code Debit Credit

T O T A L
Prepared by: Approved by:
JULITO P. LADEZA
Municipal Accountant
 PURCHASE ORDER
Tampilisan, Zamboanga del Norte
LGU
Supplier CLICK HAUS COMPUTER SALES & SERVICES P.O. No.
Address Baybay, Liloy Zamboanga del Norte Date
Mode of Procurement:
Gentlemen:
Please furnish this office the following articles subject to the terms and conditions contained herein:

Place of Delivery: OFFICE OF THE MUNICIPAL ACCOUNTING Delivery Term:

Date of Delivery: Immediately Payment Term:

Item No. Unit Quantity Item Description Unit Cost Amount

1 unit 1 Cart. Epson Ink C13T664200 CYAN 500.00 500.00
2 bots. 1 Cart. Epson Ink C13T664200 MAGENTA 500.00 500.00
3 bots. 1 Cart. Epson Ink C13T664200 YELLOW 500.00 500.00
4 bots. 4 Cart. Epson Ink C13T664200 BLACK 700.00 2,800.00
5 pc 1 Flash USB 2.0 16gb Kingston DT-101 G2 1,500.00 1,500.00
6 pcs 2 Mouse Pad Genius Color Blue 45.00 90.00
7 pc 1 Puncher Heavy Duty Joy 280.00 280.00
8 pc 1 Ribbon Cartridge Epson FX2175 890.00 890.00

(Total Amount in Words) 7,060.00

In case of failure to make the full delivery within the time specified above, a penalty of one-tenth (1/10)
of one percent for every day of delay shall be imposed.
Very truly yours,
Conforme:
ANGELES R. CARLOTO II
CLICK HAUS COMPUTER SALES & SERVICES Municipal Mayor
(Signature Over Printed Name) (Authorized Official)

Date
(In case of Negotiated Purchase pursuant toSection 369 (a) of RA 7160, this portion must
be accomplished).

Approved to be purchased thru negotiated

purchase per Sanggunian Res. No. ______.

Certified Correct:

Secretary to the Sanggunian Date:

7,060.00
 ABSTRACT OF PERSONAL CANVASS/ BIDS FOR THE SUPPLY AND DELIVERY
PR No.
ABSTRACT OF BIDS OPENED ON: ,2013. TIME: AM/PM
IN THE BAC OFFICE, TAMPILISAN, ZAMBOANGA DEL NORTE.

Article/ Services Requisitioned DEALERS FURNISHED

CLICK HAUS TECHNO CLICK RRCC
Q U AN T I T Y
ITEM NO. DESCRIPTION Baybay, Liloy ZN Ipil ZSP Baybay, Liloy ZN
No. Unit of Issue Unit Price Total Amount Unit Price Total Amount Unit Price Total Amount
1 1 unit Cart. Epson Ink C13T664200 CYAN 500.00 500.00 500.00 500.00 550.00 550.00
2 1 bots. Cart. Epson Ink C13T664200 MAGENTA 500.00 500.00 500.00 500.00 550.00 550.00
3 1 bots. Cart. Epson Ink C13T664200 YELLOW 500.00 500.00 500.00 500.00 550.00 550.00
4 4 bots. Cart. Epson Ink C13T664200 BLACK 700.00 2,800.00 720.00 2,880.00 700.00 2,800.00
5 1 pc Flash USB 2.0 16gb Kingston DT-101 G2 1,500.00 1,500.00 1,550.00 1,550.00 1,500.00 1,500.00
6 2 pcs Mouse Pad Genius Color Blue 45.00 90.00 47.00 94.00 45.00 90.00
7 1 pc Puncher Heavy Duty Joy 280.00 280.00 300.00 300.00 320.00 320.00
8 1 pc Ribbon Cartridge Epson FX2175 890.00 890.00 900.00 900.00 920.00 920.00

THIS IS TO CERTIFY that the requirements of R.A. No. 9184 otherwise known Total 7,060.00 Total 7,224.00 Total 7,280.00
as the Government Procurement Reform Act ( Rule XVI - Sec.52 ) had been complied with. WE HEREBY CERTIFY to the correctness and authenticity of the above Abstract
of Bids to the best of our knowledge.

SHERRY LOU P. DAPROSA GRACE A. GUMANSING

BIDS AND AWARDS COMMITTEE: Municipal Accountant Municipal Budget Officer
(Requesting Officer) ( Member )

VIGILUS D. CREDO VIVIAN N. UBAGAN OLIVIA G. EBORDE RENE R. MANAIT

Municipal Engineer MSWDO Municipal Treasurer MPDC
(Chairman) ( Vice Chairman ) ( Member ) ( Member )
7,060.00 7,224.00 7,280.00
 INSPECTION & ACCEPTANCE REPORT
Tampilisan,Zamboanga del Norte
LGU
Supplier CLICK HAUS COMPUTER SALES & SERVICES O.R. No.
PO No. Date Invoice No. Date
Requesitioning Office/Dept. OFFICE OF THE MUNICIPAL ACCOUNTING

Item No. Unit Description of Supplies Quantity Unit Cost Total

1 unit Cart. Epson Ink C13T664200 CYAN 1
2 bots. Cart. Epson Ink C13T664200 MAGENTA 1
3 bots. Cart. Epson Ink C13T664200 YELLOW 1
4 bots. Cart. Epson Ink C13T664200 BLACK 4
5 pc Flash USB 2.0 16gb Kingston DT-101 G2 1
6 pcs Mouse Pad Genius Color Blue 2
7 pc Puncher Heavy Duty Joy 1
8 pc Ribbon Cartridge Epson FX2175 1

-
INSPECTION ACCEPTANCE
Date Received:
Inspected, verified and found OK X Complete
as to quantity and specifications. Partial

LUCITO P. CERNA
Municipal Agriculturist
X
MARY JANE K. CALUMBA
CYNTHIA D. ABIL Property Custodian/ GSO Designate
RCO II

LOLITA B. DELLABA SHERRY LOU P. DAPROSA

Bookeeper II Municipal Accountant
 Republic of the Philippines
PROVINCE OF ZAMBOANGA DEL NORTE
Municipality of Tampilisan

INVENTORY CUSTODIAN SLIP

ICS No.

Inventory Estimated
Quantity Unit Description
Item No. Useful Life
1 pc. CASIO MX-12B

Received from: Received by:

MILLER B. MAGHANOY ROGELIO S. VILLACURA

Signature Over Printed Name Signature Over Printed Name

Admin. Aid IV/ GSO Designate Casual

Position/Office Position/Office

Date Date

For Use of Property Unit

 REQUISITION AND ISSUE SLIP

TAMPILISAN, ZAMBOANGA DEL NORTE

LGU

Division: Resposibility Center RIS No. Date:

Office: Code: SAI No. Date:

R e q ui s i t i o n Issuance
Stock No. Unit Description Quantity Quantity Remarks
unit Cart. Epson Ink C13T664200 CYAN 1 1
bots. Cart. Epson Ink C13T664200 MAGENTA 1 1
bots. Cart. Epson Ink C13T664200 YELLOW 1 1
bots. Cart. Epson Ink C13T664200 BLACK 4 4
pcs Mouse Pad Genius Color Blue 2 2
pc Ribbon Cartridge Epson FX2175 1 1

Purpose: For the use in the Office of the Municipal Accountant.

Requested by: Approved by: Issued by: Received by:

Signature:

Printed Name: SHERRY LOU P. DAPROSA ANGELES R. CARLOTO II MARY JANE K. CALUMBA SHERRY LOU P. DAPROSA

Designation: Municipal Accountant Municipal Mayor RCC II Municipal Accountant

Date: