REPUBLIC OF THE PHILIPPINES ‘Office ofthe President PHILPPIND CHARITY & SWEEPSTAKES OFFICE ‘Sun Plaza Building, 119 Floor, 1507 Shaw Blvd, Mandaluyong City ASSETS & SUPPLY MANAGEMENT DEPARTMENT PCSO AMBULANCE DONATION PROGRAM REQUIREMENTS, FOR LOCAL GOVERNMENT UNIT. 1. Request Letter addressed to: HON. JOSE FERDINAND M. ROJAS II Acting Chairman & General Manager Philippine Charity Sweepstakes Office Sun Plaza Building, 1507 Shaw Boulevard, Mandaluyong City 2. Justification for Donation ©) Background of Requesting Party © Official Name/Title of Requesting Party © Name of Contact Person, Official Designation, Office and Mailing address/es, and contact number/s d) Letter from the Head of the Municipal Health Center that the ambulance unit will be attached to the Local Health Center Facility 3, Resolution Requesting Ambulance Unit © LGU ~ Local Sanggunian: Panlalawigan (Province) / Panlungsod (City) / Bayan (Municipality) 4, Requirement for 60-40% Cost Sharing Scheme © Certification of Availability of Funds from the Provincial, City, Municipal ‘Treasurer for the cost sharing of 40% of the total cost of the ambulance unit. For further inquiries and follow-up, please contact Assets & Supply Management Department Sun Plaza Building, 1507 Shaw Boulevard, Mandaluyong City Tel. No. 706-3067REPUBLIC OF THE PHILIPPINES Offic ofthe President, PHILIPPINE CHARITY & SWEEPSTAKES OFFICE ‘Sun Plaza Building, 1507 Shaw Bld, Mandaluyong Cl ASSETS & SUPPLY MANAGEMENT DEPARTMENT. PCSO AMBULANCE DONATION PROGRAM REQUIREMENTS, FOR NON-GOV’T. ORGANIZATION/GOV’T. ORGANIZATION/PRIVATE ORGANIZATION 1. Request Letter addressed to: HON. JOSE FERDINAND M. ROJAS IL Acting Chairman & General Manager Philippine Charity Sweepstakes Office ‘Sun Plaza Building, 1507 Shaw Boulevard, Mandaluyong City fication for Donation Background of Requesting Party © Official Name/Title of Requesting Party Name of Contact Person, Official Designation, Office and Mailing address/es, and contact number/s + Profile of Requesting Party > Organization Profile to include, among others, mandate, statement of vision mission, objectives, nature of organization, financial condition, programs/services, officials, organizational/functional structure and clientele ‘+ SEC Registration with Articles of Incorporation and Constitution & By-Laws, PCNC Accreditation, or License to operate from the appropriate regulating agency (if applicable) * Location Map of Domicile/Place of Operation and its Contiguous Areas 3. Resolution Requesting Ambulance Unit © Non-Governmental Organizations (NGO's) / Govemmment Organizations (GO’s) / i Private Organizations (PO's) - Board of Directors / Trustees / Incorporators. Said resolution must refloct grant of authority to the head of organization to request for such vehicle, as well as the provision for the allocation of the necessary funds for ils uilization/operation and maintenance. ~ 4, Requirement for 60-40% Cost Sharing Scheme © Cottification of Availability of Funds. Payment should be in Cash or Manager's Cheek payable to PCSO Ambulance Donation Program, For further inquiries and follow-up, please contact: Assets & Supply Management Department Sun Plaza Building, 1507 Shaw Boulevard, Mandaluyong ‘Tel. No. 706-3067 |REPUBLIC OF THE PHILIPPINES: Office of the President i PHILIPPINE CHARITY € D SWEEPSTAKES OFFICE ‘un Plaza Buti, 1507 Shaw Bc, Manlyong Cly ASSETS & SUPPLY MANAGEMENT DEPARTMENT PCSO AMBULANCE DONATION PROGRAM REQUIREMENTS ROR HOSPITAL / MEDICAL FACILITY 1. Request Letter addressed to: HON. JOSE FERDINAND M. ROJAS IE ‘Acting Chairman & General Manager Philippine Charity Sweepstakes Office Sun Plaza Building, 1507 Shaw Boulevard, Mandaluyong City 2, Justification for Donation ‘© Background of Requesting Party © Official Name/Title of Requesting Party ® Name of Contact Person, Official Designation, Office and Mailing. address/es, and contact number!s © Profile of Requesting Party > Hospita/Medical Facility Profile, to include, among others, type, classification, category of the facility and organizational/functional ‘structure. © SEC Registration with Articles of Incorporation and Constitution & By- Laws, PCNC Accreditation, or License to operate from the appropriate . regulating agency (if applicable) Location Map of Domicile/Place of Operation and its Contiguous Areas 3. Resolution Requesting Ambulance Unit © Hospitals / Medical Facilities and/or Government Agencies / Institutions Board of Directors / Trustees 4, Requirement for 60-40% Cost Sharing Scheme ‘© Certification of Availability of Funds, Payment should be in Cash or ‘Manager’s Check payable to PCSO Ambulance Donation Program. rT For further inquiries and follow-up, please contact: Assets & Supply Management Department Sun Plaza Building, 1507 Shaw Boulevard, Mandaluyong City ‘Tel. No. 706-3067