Republic of the Philippines

DEPARTMENT OF HEALTH
CENTER FOR HEALTH DEVELOPMENT - BICOL
Legazpi City
ERNIE V. VERA, MD, MPH, CHA, CESO IV

Trunk line (052) 204-0040, 204-0050 FAX No. (052) 483-5656 local 104

AMENDMENT OF THE CONTRACT

FOR THE PROVISION OF MOBILE X-RAY SERVICES FOR THE
INTEGRATED HEALTH CHECK-UP (CONTRACT NO. 19-03-11)

KNOW ALL MEN BY THESE PRESENTS:

This amendment of contract made and executed by and between:

DEPARTMENT OF HEALTH, CENTER FOR HEALTH

CECILIA B. GAURANO

DEVELOPMENT-BICOL (DOH CHD Bicol), a government agency with

office address at Legazpi City, represented herein by its Director IV, ERNIE V.
VERA, MD, MPH, CHA, CESO IV hereinafter referred to as the
“PROCURING ENTITY”;

-and-

SOUTHEAST OCCUPATIONAL HEALTH AND ENVIRONMENTAL

NORBERTO A. BALANE, JR., CPA, MPA

SAFETY SERVICES, INC., a private entity duly organized and existing under
Philippine laws, with business address at 2nd Floor Tower Mall Building 4,
LandCo Business Park, Legazpi City, herein represented by its Chief Executive
Officer, CESAR O. CHUA, MD, MPH, hereinafter referred to as the
“SERVICE PROVIDER”.

WITNESSETH:

WHEREAS, the PROCURING ENTITY and SERVICE PROVIDER had previously

entered into a contract duly acknowledged and executed on April 17, 2019 for the Project
“Provision of Mobile X-ray Services” Contract no. 19-03-11 (“Original Contact”);

WHEREAS, the PROCURING ENTITY and SERVICE PROVIDER, on its meeting on

OIC-Director IV______________________

July 2, 2019, wants to amend the originalthe Original cContract particularly Item 1 (SCOPE
AND PAYMENT OF CONTRACT) thereof on the basis of Item 11 (AMENDMENT AND
MODIFICATION);

WHEREAS, in consideration of the matters described above, and of the mutual benefits and
obligations set out in this aAmendment of Contract, the PROCURING ENTITY and
SERVICE PROVIDER hereby agrees that Item 1 should be revised and read as follows:

Page 1 of 4
Amendment Contract for Provision of Mobile X-ray for
Integrated Health Check-up (Contract no. 19-03-11)
 “1.The SCOPE AND PAYMENT OF CONTRACT from the Original Contract is hereby
amended and shall hereafter be read as follows:

For and in consideration of the services to be rendered by the SERVICE PROVIDER

ERNIE V. VERA, MD, MPH, CHA, CESO IV

under this Contract, the PROCURING ENTITY shall pay unto the SERVICE PROVIDER
for provision of mobile x-ray services an amount not exceeding the Contract Price per
services as stated below:

LOT
ABC/ UNIT TOTAL COST
NO./PR NO./ ITEMS AND SPECIFICATIONS QTY UNIT
(PhP) (PhP)
END-USER
PROVISION OF MOBILE X-RAY SERVICES FOR THE INTEGRATED HEALTH CHECKUP
FOR SPECIAL POPULATION FOR THE FOLLOWING PROVINCES:
380.00 76,000.00 Masbate 200
Date: March 8, 2019
1 380.00 76,000.00 Catanduanes 200
19-01-490 Date: March 26, 2019 LOT
(IDC) 380.00 76,000.00 Camarines Norte 200
Date: April 11, 2019
380.00 76,000.00 Camarines Sur 200
CECILIA B. GAURANO

Date: March 21 2019

380.00 76,000.00 Albay 200
Date: February 26, 2019
380.00 76,000.00 Sorsogon 200
Date: March 15, 2019

PROVISION OF MOBILE X-RAY SERVICES FOR THE INTEGRATED HEALTH

CHECKUP FOR THE FOLLOWING PROVINCIAL JAILS:
380.00 199,880.00 Naga City District Jail 526 LOT
NORBERTO A. BALANE, JR., CPA, MPA

Date: May 9, 2019

2 380.00 399,760.00 Camarines Sur Provincial Jail 1,052
19-01-495 Date: July 4, 2019
(IDC) 380.00 399,760.00 Sorsogon Provincial Jail 1,052
Date: September 19, 2019

TOTAL 1,455,400.00

The SERVICE PROVIDER shall provide the services for the different schedules enumerated
above. However, the PROCURING ENTITY reserves the right to order or not to order all of
the activities.

All other obligations, terms and conditions contained in the oOriginal Contract shall remain in
full force and effect until termination of the Original Contract unless otherwise specifically
amended herein.
OIC-Director IV______________________

IN WITNESS WHEREOF, the parties, through their duly authorized representative, have
hereunto set their hands on __________, 2019 at the City of ____________, Philippines.

DEPARTMENT OF HEALTH SOUTHEAST OCCUPATIONAL

Center for Health Development-Bicol HEALTH AND ENVIRONMENTAL
SAFETY SERVICES, INC.
Page 2 of 4
Amendment Contract for Provision of Mobile X-ray for
Integrated Health Check-up (Contract no. 19-03-11)
 By: By:

ERNIE V. VERA, MD, MPH, CHA, CESAR O. CHUA, MD, MPH

ERNIE V. VERA, MD, MPH, CHA, CESO IV

CESO IV
Director IV Chief Executive Officer

SIGNED IN THE PRESENCE OF:

JANNISH ALCALA-ARELLANO, MD, ____________________________________

DPCOM
OIC-LHSD Chief Witness
CECILIA B. GAURANO

FUNDS AVAILABLE

DANTE F. ATENTO RESTY D. DAEP, CPA

Administrative Officer V/Budget Officer Accountant III
NORBERTO A. BALANE, JR., CPA, MPA
OIC-Director IV______________________

Page 3 of 4
Amendment Contract for Provision of Mobile X-ray for
Integrated Health Check-up (Contract no. 19-03-11)
ERNIE V. VERA, MD, MPH, CHA, CESO IV

ACKNOWLEDGMENT

REPUBLIC OF THE PHILIPPINES)

______________________________)

Before me, a Notary Public for and in the above jurisdiction on this ______ day
of________, 2019, personally appeared:

Name ID NO. PLACE OF ISSUE

CECILIA B. GAURANO

Dr. Ernie V. Vera TIN ID No. 133-131-067 Manila

Dr. Cesar O. Chua

known to me and to me known to be the same persons who executed the foregoing instrument
and they acknowledged to me that the same is their free and voluntary act and deed, as well as,
of the institutions which they represent and that they are duly authorized to sign the same.
NORBERTO A. BALANE, JR., CPA, MPA

This instrument, referring to AMENDMENT CONTRACT FOR THE PROVISION

OF MOBILE X-RAY SERVICES FOR THE INTEGRATED HEALTH CHECK-UP
(CONTRACT NO. 19-03-11), consists of four (4) pages, including this page where the
acknowledgment is written and has been signed on each and every page by the parties and their
instrumental witness.

WITNESS MY HAND AND OFFICIAL SEAL at the place and on the________ day ,
___________ month and __________ year first above written.

Doc. No._____;
Page No._____;
Book No.____;
Series of 2019
OIC-Director IV______________________

Page 4 of 4
Amendment Contract for Provision of Mobile X-ray for
Integrated Health Check-up (Contract no. 19-03-11)