Department of the Interior and Local Government Google Drive Upload Checklist

File 1 of 2
Assessment for the Seal of Good Local Governance
CY 2019

Seal of Good Local Governance –DOCUMENT UPLOAD CHECKLIST

For Cities and Municipalities
File 1 of 2: All RAT Forms + All LGU Certifications

City/Municipality of : __________________________________ Region : __________

Province : __________________________________

INSTRUCTIONS: PLEASE READ BEFORE PROCEEDING TO THE ITEMS.

For the RFP/PFP: (1) This serves as cover page of all the documents listed below. (2) Please ensure that below-listed documents are
complete and duly-certified, and bear the official release stamp of respective Records Office. (3) Once all Forms are thoroughly
checked, upload to the designated LGPMS-SGLG Google Drive.

Form Form Title No. of Pages

Code
Certified by members of the Regional Assessment Team (RAT):
3.1 Financial Administration 24
3.3 Disaster Preparedness
3.3 Social Protection
3.4 Peace and Order
3.5 Business-friendliness and Competitiveness
3.6 Environmental Management
3.7 Tourism, Culture and the Arts

Certification from Department Heads:

2A Accounting Office 2
2B Business Permit Licensing Office (BPLO) At least 2
2C Budget Office 1
2D DepEd Representative 1
2E DILG Field Office 1
2F Disaster Risk Reduction and Management Office (DRRMO) At least 2
2H Planning and Development Office 1
2I Local PNP Office/Station 2
2J Social Welfare and Development Office 1
2K Treasurer’s Office 1
2L City Health Office** At least 2
2M Environmental and Natural Resources Office 1
*No required Form 2G (formerly from Engineering’s Office) Certification
** For HUCs only

I hereby certify that uploaded RAT Forms and Certifications from Department Heads are:

(1) Complete i.e., no missing pages;

(2) Duly and accordingly certified by all RAT members and LGU Department Heads; and
(3) Officially released by respective offices.

_______________________________________________
Signature over Printed Name of the
RFP or PFP

Date: ______________________________________
 Google Drive Upload Checklist
Department of the Interior and Local Government
File 2 of 2
Assessment for the Seal of Good Local Governance
CY 2019

Seal of Good Local Governance –VERIFYING DOCUMENT UPLOAD

For Cities and Municipalities
File 2 of 2: Selected Document-MOVs

City/Municipality of : __________________________________ Region : __________

Province : __________________________________

INSTRUCTIONS: PLEASE READ BEFORE PROCEEDING TO THE ITEMS.

For the RFP/PFP: (1) This serves as cover page of all the documents listed below. (2)Put a check (√) mark on the available/applicable
documents, based on LGU’s situation, that are to be uploaded. (3) If all Forms are completely filled-out as reviewed, upload to the
designated LGPMS-SGLG Google Drive. EXCEPT FOR ITEM(S) THE LGU WISHES TO APPLY FOR A JUSTIFICATION, YOU ONLY NEED TO
UPLOAD THE BELOW-LISTED MOVs AND IN SOME CASES, PORTION or SELECT PAGES OF INDICATED LGU DOCUMENT. PLEASE REFRAIN FROM
UNNECESSARY VOLUMINOUS SUBMISSIONS.

Criterion Available/Applicable Document for Upload

Financial Administration
1. LDC Functionality
Disaster Preparedness
2. Functionality of LDRRMO:
Plantilla LDRRM Officer (Head
of Office)
3. CLUP and zoning ordinance
(in case CLUP is still under review)
Social Protection
4. Mechanisms for GAD and
VAWC
5. Local Code for Children
6. Accredited residential care
facility (For HUCs only]
7. LSWDO is a registered social
worker
Peace and Order
8. Actions against illegal drugs:
Drug-cleared barangays
Business-friendliness and
Competitiveness
9. Local Investment and
Incentive Code (for cities only)
Environmental Management
10. No operating open and/or
controlled dumpsite (in case a
consideration applies)
☐ Copy of Resolution adopting CDP
☐ Appointment of LDRRM Officer – Head of Office with CSC
attestation
☐ CSC Resolution granting the LGU authority to take final action
on its appointment (in case the LGU is accredited)
☐ Certification from PLUC or Regional HLURB stating that the final draft
is currently under review and results of risk assessment is already incorporated
therein
☐ Copy of draft CLUP (only the portion showing that results of risk assessment
are already incorporate)
☐ Ordinance approving/ amending/ revising LGU’s GAD Code
☐ Resolution localizing Provincial Code (as the case may be)
☐ Ordinance approving/ amending/ revising LGU’s Code for
Children
☐ Resolution localizing Provincial Code (as the case may be)
☐ Accreditation of the facility issued by DSWD-Standards Bureau
☐ Memorandum of Agreement between LGU and partner-
organization managing the facility (in case LGU does not manage its
own RCF; but has a partner-facility)
☐ Appointment of C/MSWDO with CSC attestation
☐ CSC Resolution granting the LGU authority to take final action
on its appointment (in case the LGU is accredited)
☐ PRC license of C/MSWDO – Head of Office
☐ PRC license of registered LSWDO staff (in case the exemption
applies)
☐ Copy(ies) of PDEA certifications on drug cleared barangays
☐ Ordinance approving/ amending/ revising LGU’s Code
☐ Certification from DENR-EMB regional office stating that LGU’s
dumpsite is already closed
☐ Proof of approval of Safe Closure and Rehabilitation Plan
(SCRP)
 Department of the Interior and Local Government
Assessment for the Seal of Good Local Governance
CY 2019

Criterion Available/Applicable Document for Upload

☐ Received copy of LGU’s letter for DENR-EMB requesting for

11. Access to sanitary landfill
12. SWM Plan
Tourism, Culture and the Arts
13. Inventory of cultural property
technical assistance in crafting SCRP (in case LGU is yet to craft an
SCRP)
☐ Memorandum of Agreement between the LGU and partner-
entity managing the landfill (in case of partnership)
☐ Proof of LGU-owned sanitary landfill (in case LGU is not yet listed in
DENR-NSWMC)
☐ Proof of that LGU operates a technology recognized by DENR-
NSWMC as alternative to sanitary landfill (as the case may be)
☐ Proof of approval of SWM Plan
☐ Received copy of LGU’s letter to NSWMC requesting for SWM
Plan review (in case plan is still under review)
☐ Page(s) from an inventory of a sample cultural property in the
LGU that contains its name, location, significance, and type.

Other supporting documents (as listed in the accomplished Form 2), if any
Criteria Document Title

___________________________________ ________________________________________________________
___________________________________ ________________________________________________________
___________________________________ ________________________________________________________
___________________________________ ________________________________________________________

Checked and Uploaded by:

_______________________________________________ _____________________
Signature over Printed Name of the Date
RFP or PFP