Republic of the Philippines PR-003-1

Department of Health
CAGAYAN VALLEY MEDICAL CENTER
Dalan Na Pagayaya, Regional Government Center
Carig Sur, Tuguegarao City, Cagayan

PURCHASE REQUEST
Fund Cluster: __________________

Office/Section : PR No.: 2017-11-117-DM Date: November 24, 2017

PHARMACY
SECTION
Responsibility Center Code : ___________

Stock/
Property Unit Item Description Quantity Unit Cost Total Cost
No.
pc Printer 1 8000.00 8,000.00
Features: Color Print, Inkjet printer, USB & Wireless connect
Printer Type: Color
Printing Technology: Inkjet
Scanner Type: Flatbed
Print Resolution: 5760x1440 DPI
Print Speed Black 33PPM
Print Speed Color: 15PPM
Paper Size: 10x15cm(4x6in), 13x18cm(5x7in)
9x13cm(3.5x5in), A4, A5, A6, B5, Letter(8 1/2x11)
Scanning Method: CIS
Network: USB, WiFi
Color: Black
Paper Tray: 100 sheerts
Warranty: 1 year(s)

pc Flatbed scanner with ADF 1 180,000.00 180,000.00

Scanner type: Flatbed ADF
Scan Resolution, optical: Up to 600 dpi
Bit depth: 24-bit
Levels of grayscale: 256
Scan Size, Maximum: 216 x 356 mm
Automatic document feeder capacity: Standard, 100 sheets
Automatic document feeder speed: Up to 50 ppm/100 ipm
(b&w, color, grayscale, 200dpi)
Scanning options (ADF): Single-pass duplex
Duty cycle (daily): Recommended daily duty cycle: 3000 pages
Scan file format: PDF (image-only, searchable, MRC, PDF/A
encrypted), TIFF (single page, multipage,
compressed: G3, G4, LZW, JPEG), DOC, RTF
XLS, TXT, XML, XPS, HTML, OPF, JPG, BMP, PNG
***************************************************

BASED ON APP CY 2017 188,000.00

Purpose: FOR USE IN CVMC - OMCC

_______________________________________________________________

Requested by: Approved by:

Signature :

Printed Name : GEMALYN A. MABBORANG GLENN MATHEW G. BAGGAO,MD,MHA,MSN,FPSMS

Designation : ADMIN OFFICER IV MEDICAL CENTER CHIEF II
 Republic of the Philippines PR-003-1
Department of Health
CAGAYAN VALLEY MEDICAL CENTER
Dalan Na Pagayaya, Regional Government Center
Carig Sur, Tuguegarao City, Cagayan

PURCHASE REQUEST
Fund Cluster: __________________

Office/Section : PR No.: 2017-11-118-DM Date: November 24, 2017

OMCC Responsibility Center Code : ___________

Stock/
Property Unit Item Description Quantity Unit Cost Total Cost
No.
pc Contemporary Office Desks With 6 Drawers 1 8000.00 8,000.00

pc High Back Swivel Office Chairs 2 5000.00 10,000.00

***************************************************

BASED ON APP CY 2017 18,000.00

Purpose: FOR USE IN CVMC - For PETO use

_______________________________________________________________

Requested by: Approved by:

Signature :

Printed Name : LEON C. BATUGAL RN, MSN GLENN MATHEW G. BAGGAO,MD,MHA,MSN,FPSMS

Designation : TRAINING SPECIALIST IV MEDICAL CENTER CHIEF II
 Republic of the Philippines PR-003-1
Department of Health
CAGAYAN VALLEY MEDICAL CENTER
Dalan Na Pagayaya, Regional Government Center
Carig Sur, Tuguegarao City, Cagayan

PURCHASE REQUEST
Fund Cluster: __________________

Office/Section : PR No.: 2017-11-119-DM Date: November 24, 2017

OMCC Responsibility Center Code : ___________

Stock/
Property Unit Item Description Quantity Unit Cost Total Cost
No.
pc High Chair with Arm Rest (high back) 2 5000.00 10,000.00
Seat Size: 21.5" W x 20" D
Back Size: 20.5"W x 22.5" H
Seat Height Adjustment: 28" - 33"
Height: weight: 51 lbs
Overall: 54.5" H x 21.5 W x 25.5 D
With Flexible Foam
Materials: Metal
***************************************************

BASED ON APP CY 2017 10,000.00

Purpose: FOR USE IN CVMC - For ALAGANG PINOY KIOSK USE

_______________________________________________________________

Requested by: Approved by:

Signature :

Printed Name : LEON C. BATUGAL RN, MSN GLENN MATHEW G. BAGGAO,MD,MHA,MSN,FPSMS

Designation : TRAINING SPECIALIST IV MEDICAL CENTER CHIEF II
 Republic of the Philippines PR-003-1
Department of Health
CAGAYAN VALLEY MEDICAL CENTER
Dalan Na Pagayaya, Regional Government Center
Carig Sur, Tuguegarao City, Cagayan

PURCHASE REQUEST
Fund Cluster: __________________

Office/Section : PR No.: 2017-011-121-DM Date: November 27, 2017

ACCOUNTING Responsibility Center Code : ___________

Stock/
Property Unit Item Description Quantity Unit Cost Total Cost
No.
pc Uninterruptable Power Supply 2 4000.00 8,000.00
***************************************************

BASED ON APP CY 2017 8,000.00

Purpose: FOR USE IN CVMC - For Accounting use
_______________________________________________________________

Requested by: Approved by:

Signature :

Printed Name : JASSEL S. TAMAYAO, CPA GLENN MATHEW G. BAGGAO,MD,MHA,MSN,FPSMS

Designation : ACCOUNTANT IV MEDICAL CENTER CHIEF II
 Republic of the Philippines PR-003-1
Department of Health
CAGAYAN VALLEY MEDICAL CENTER
Dalan Na Pagayaya, Regional Government Center
Carig Sur, Tuguegarao City, Cagayan

PURCHASE REQUEST
Fund Cluster: __________________

Office/Section : PR No.: Date: November 23, 2017

OMCC Responsibility Center Code : ___________

Stock/
Property Unit Item Description Quantity Unit Cost Total Cost
No.
Purpose: FOR USE IN CVMC - For PETO use
_______________________________________________________________

Requested by: Approved by:

Signature :

Printed Name : EDUARDO M. BADUA III, MD GLENN MATHEW G. BAGGAO,MD,MHA,MSN,FPSMS

Designation : CHIEF MEDICAL PROFESSIONAL STAFF II MEDICAL CENTER CHIEF II