PURCHASE REQUEST

Godod, Zamboanga del Norte

Department: MDRRMC PR. No. Date:

SAI No. Date:
Section: OBR No. Date:

Quantity Unit of Stock No. Estimated Estimated

Item Description
Issue Unit Cost Cost
2 reams US Bond paper ( long ) 300.00 600.00
1 ream US Bond paper ( short ) 265.00 265.00
2 reams US Bond paper ( A4 ) 200.00 400.00
1 box Ballpen Ordinary ( black ) 250.00 250.00
2 bots Epson Printer Ink L360 (Light Magenta ) 600.00 1,200.00
2 bots Epson Printer Ink L360 (Light Cyan ) 600.00 1,200.00
3 bots Epson Printer Ink L360 ( Black) 600.00 1,800.00
2 bots Epson Printer Ink L360 ( yellow ) 600.00 1,200.00
1 box Staple wire ( standard ) # 35 60.00 60.00
1 box Paper clip # 50 ( jumbo ) 50.00 50.00
2 rolls Plastic tape ( 2 inches ) 50.00 100.00
3 pcs Glue 50.00 150.00
4 bots Ethyl Alcohol ( 500 ml ) 68.88 272.00
6 pcs Correction Tape 50.00 300.00
3 pcs Dishwashing soap ( smart) 30.00 100.00
2 doz Detergent 96.00 192.00
2 bots Toilet Cleaner (Domex) 200.00 400.00
1 box Paper Fastener (plastic coated ) 60.00 60.00
1 doz US Folder (long) 144.00 144.00
1 doz US Folder (short)) 84.00 84.00
1 doz US Folder (A4) 84.00 84.00

Total 8,911.00
Purpose: For MDRRMO use of office supplies.
Requested by: Cash Availability Approved by:
Signature:
Printed Name: SAMUEL D. SERONAY JR. ROMULO B. LOMOCSO ABEL M. MATILDO
Designation: MDRRMO-designate Municipal Treasurer Municipal Mayor

OK as to Appropriation

GLENDA C. GALLOPIN
Municipal Budget Officer
Name of the Procuring Entry
Project Reference Number
Name of the Project
Location of the Project
Standard Form Number: SF-GOOD-60
Revised on: May 24, 2004
Standard Form Title: Request for Quotation
Approved Budget for the Contract: ______________

Date:_______________
Quotation No.: _______
Company Name: _______________________
Address: _____________________________

Please quote your lowest price on the item/s listed below, subject to the General Conditions
on the last page, stating the shortest time of the delivey and submit your quotaion duly signed by your
representative not later than ___________________________________________________ in the return
envelope attached herewith.

ROMULO B. LOMOCSO
Municipal Treasurer
Procurement Officer

NOTE: 1. ALL ENTRIES MUST BE TYPEWRITTEN

2. DELIVERY PERIOD WITHIN ______________ CALENDAR DAYS
3. WARRANTY SHALL BE FOR A PERIOD OF SIX (6) 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 ____________CALENDAR DAYS
5. G-EPS REGISTRATION CERTIFICATE SHALL BE ATTACHED UPON
SUBMISSION OF THE QUOTATION.
6. BIDDERS SHALL SUBMIT ORIGINAL BROCHURES SHOWING CERTIFICATIONS
OF THE PRODUCT BEING OFFERED.

ITEM NO. ITEM & DESCRIPTION QTY. UNIT PRICE TOTAL PRICE
1 US Bond Paper (Long) 3 rms
2 US Bond Paper (Sort) 3 rms
3 Ballpen Ordinary (Black) 3 boxes
4 US Folder (Long) 2 doz
5 US Folder (Short) 2 doz
6 Printer Ink Refill L220 (Light Magenta) 6 bots
7 Printer Ink Refill L220 (Light Cyan) 6 bots
8 Printer Ink Refill L220 (Yellow) 6 bots
9 Cell Cards (load and internet) 8 pcs
10 Globe Tattoo Pocket Wifi 2 pcs
11 Calculator (manual 12 digits) 2 pcs
12 Paper Fastener (Plastic Coated) 4 boxes
13 Pencil (monggol 2) 4 boxes
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.

e-mail address
____________________________
Date

Purpose: For LDRRMO Use

Name of the Procuring Entry
Project Reference Number
Name of the Project
Location of the Project
Standard Form Number: SF-GOOD-60
Revised on: May 24, 2004
Standard Form Title: Request for Quotation
Approved Budget for the Contract: ______________

Date:_______________
Quotation No.: _______
Company Name: _______________________
Address: _____________________________

Please quote your lowest price on the item/s listed below, subject to the General Conditions
on the last page, stating the shortest time of the delivey and submit your quotaion duly signed by your
representative not later than ___________________________________________________ in the return
envelope attached herewith.

ROMULO B. LOMOCSO
Municipal Treasurer
Procurement Officer

NOTE: 1. ALL ENTRIES MUST BE TYPEWRITTEN

2. DELIVERY PERIOD WITHIN ______________ CALENDAR DAYS
3. WARRANTY SHALL BE FOR A PERIOD OF SIX (6) 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 ____________CALENDAR DAYS
5. G-EPS REGISTRATION CERTIFICATE SHALL BE ATTACHED UPON
SUBMISSION OF THE QUOTATION.
6. BIDDERS SHALL SUBMIT ORIGINAL BROCHURES SHOWING CERTIFICATIONS
OF THE PRODUCT BEING OFFERED.

ITEM NO. ITEM & DESCRIPTION QTY. UNIT PRICE TOTAL PRICE
14 Eraser (steadler 4 pcs
15 Plastic Tape (2 inches) 4 rolls
16 Pentel Pen Refill (black) 2 bots
17 Cartolina (assorted) 5 pcs
18 Scissors (big) 4 pcs
19 Flash Drive (32 GB) 4 pcs
20 Toilet Tissue 10 rolls
21 Energizer Battery (AAA) 8 pcs
22 Eveready 9V (Heavy Duty) 1 doz
23 Extension Wire 6 pcs
24 Glue 6 pcs
25 Correction Fluid (touch&go) 4 pcs
26 Photopaper 2 doz
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.

e-mail address
____________________________
Date

Purpose: For LDRRMO Use

Name of the Procuring Entry
Project Reference Number
Name of the Project
Location of the Project
Standard Form Number: SF-GOOD-60
Revised on: May 24, 2004
Standard Form Title: Request for Quotation
Approved Budget for the Contract: ______________

Date:_______________
Quotation No.: _______
Company Name: _______________________
Address: _____________________________

Please quote your lowest price on the item/s listed below, subject to the General Conditions
on the last page, stating the shortest time of the delivey and submit your quotaion duly signed by your
representative not later than ___________________________________________________ in the return
envelope attached herewith.

ROMULO B. LOMOCSO
Municipal Treasurer
Procurement Officer

NOTE: 1. ALL ENTRIES MUST BE TYPEWRITTEN

2. DELIVERY PERIOD WITHIN ______________ CALENDAR DAYS
3. WARRANTY SHALL BE FOR A PERIOD OF SIX (6) 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 ____________CALENDAR DAYS
5. G-EPS REGISTRATION CERTIFICATE SHALL BE ATTACHED UPON
SUBMISSION OF THE QUOTATION.
6. BIDDERS SHALL SUBMIT ORIGINAL BROCHURES SHOWING CERTIFICATIONS
OF THE PRODUCT BEING OFFERED.

ITEM NO. ITEM & DESCRIPTION QTY. UNIT PRICE TOTAL PRICE
27 Linen Paper 2 doz
28 Broom (lanot) 2 pcs
29 Door Mat 4 pcs
30 Dishwashing Liquid 4 bots
31 Small Basin 3 pcs
32 Dinner Plate 2 doz
33 Table Spoon 2 doz
34 Fork 2 doz
35 Glass Mug 1 doz
36 Detergent Soap 4 doz
37 Door Knob 2 pcs
38 Toilet Cleaner 4 bots
39 Curtains 1 doz
40 Curtain Holder 4 pcs
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.

e-mail address
____________________________
 Date
Purpose: For LDRRMO Use
NDAR DAYS

FICATIONS
NDAR DAYS

FICATIONS
NDAR DAYS

FICATIONS
ABSTRACT OF BIDS OPENED ON___________________________________ O'CLOCK AM/PM PR. NO. ______________________
IN THE OFFICE OF THE MUNICIPAL TREASURER, GODOD, ZAMOBANGA DEL NORTE DATE: ________
DEALERS FURNISHED
BENLES GARMENTS, ARTS AND SERVICES DALTREY JEANS ABETDRESSHOP
Dipolog, Zamboanga del Norte Dipolog, Zamboanga del Norte Dipolog, Zamboanga del Norte
Item PRICES PRICES PRICES PRICES PRICES PRICES
No. Qty. Unit DESCRIPTION Unit Total Unit Total Unit Total
1 50 PCS POLO SHIRTS WITH PRINT 550.00 27,500.00 600.00 30,000.00 650.00 32,500.00

###

Total 27,500.00 30,000.00 32,500.00

THIS IS TO CERTIFY that requirements of R.A. # 9184, WE HEREBY CERTIFY that the above Abstract of Bids is correct and authenticated to the best of our knowledge
as of Government Procurement Reform Act. Have been complied 55,000.00 60,000.00
with Article V.
ABEL M. MATILDO GLENDA C. GALLOPIN
BIDS and AWARDS COMMITTEE: Department Head Municipal Budget Officer

ROMULO B. LOMOCSO EVELYN A. EVARDO

GSO Municipal Treasurer Nurse II
APPROVED: (Chairman) (Member)

ABEL M. MATILDO
Municipal Mayor PASTOR A. LAPURA, JR. ZENAIDA E. ADLAWAN
Municipal Engineer Administrative Officer IV
(Member) (Member)
 PURCHASE ORDER
Godod, Zamboanga del Norte
LGU

P.O.No.:
Supplier: BENLES GARMENTS, ARTS AND SERVICES Date:
Address: Dipolog, Zamboanga del Norte Mode of Procurement:
PR No./s:______________
Gentlemen:
Please furnish this office the following articles subject to the terms and conditions contained herein:

Place of Delivery: Delivery Term:

Date of Delivery: Payment Term:_________
Unit
Item Unit
No. Unit Quantity Description Cost Amount

1 PCS 50 POLO SHIRTS WITH PRINT 550.00 27,500.00

2 0 0 0 - -
3 0 0 0 - 450.00
4 0 0 0 - 2,800.00
5 0 0 0 - 960.00
6 0 0 0 - 150.00
7 pc 10 0 - 250.00
8 pc 1 0 - 1,580.00
9 pc 4 0 - 140.00
- -
- -
- -
(Total Amount in Words) NINE THOUSAN TWO HUNDRED FIFTY FIVE PESOS ONLY. 33,830.00
In case of failure to make the full delivery within the time specified above, penalty of one-tenth(1/10)
of one percent for every day of delay shall be imposed.

Conforme:
ABEL M. MATILDO
BENLES GARMENTS, ARTS AND SERVICES Municipal Mayor
Dipolog, Zamboanga del Norte

(In case of Negotiated Purchase pursuant to Section 369(a) of RA 7160, this portion must be

accomplished.)

Approved per Sanggunian Resulotion No.:

Certified Correct:____________________________________ Date:________________

Secretary to the Sanggunian
 INSPECTION & ACCEPTANCE REPORT
Godod, Zamboanga Del Norte

Supplier: MUNICIPAL COOPERATIVES

PO No. _____________Date____________Invoice___________Dated:_________
Requisitioning Office/Dept. Office of the LCR.

Item No. Unit Description Quantity

1 SACKS RICE 2

INSPECTION INSPECTION
Date Inspected: ____________ Date Receivied : ____________

Inspected, verified and found ok x Complete

x as to quantity and specifications Partial

ALROE D. CARDINO ROMULO B. LOMOCSO

Inspection Property Officer
 Republic of the Philippines

Province of Zamboanga del Norte

Municipality of Godod

OBLIGATION REQUEST No.

Payee ROMULO B. LOMOCSO
Office
Address POB.GODOD ZAMBOANGA DEL NORTE
Responsibility F.P.P. Account Amount
Particulars
Center Code

Reimbursement of mealsls&&snacks
snacks P 4,972.00

Total P 4,972.00
A. Certified B. Certified
Charges to appropriation/allotment necessary, Existence of available appropriation
lawful and under my direct supervision

Supporting documents valid, proper and legal

Signature Signature

Printed name ABEL M. MATILDO Printed name GLENDA C. GALLOPPIN

Municipal Mayor Municipal Budget Officer

Position Position
Requesting Office/Authorized Representative Budget Unit/Authorized Representative

Date Date
 Republic of the Philippines

Province of Zamboanga del Norte

Municipality of Godod

DISBURSEMENT VOUCHER No.

Mode of Payment x Check Cash Others

TIN/Employee No. Obligation Request No.

Payee Romulo B. Lomocso

Godod, Zamboanga del Norte Responsibility Center

Address
Office/Unit/ Project Code
EXPLANATION AMOUNT

To Reinbursement for the supply for the office of LDRRMC

as per supporting Papers hereto attached in the amount of………………….
……………………………………………………………………………………… P 4,972.00

Total P 4,972.00
Certified Certified
A. B.
Allotment obligation for the purpose as Indicated above Funds Avaible

Supporting documents complete

Signature Signature
Printed name ISAGANI D. NIERVA, CPA Date Printed name ROMULO B. LOMOCSO Date
Municipal Accountant Municipal Treasurer
Position Head, Accounting Unit/ Position Treasurer/Authorized Representative
Authorized Representative
C. Approved for Payment D. Received

Signature Check No. Bank Name Date

Date Signature Date
Printed Name Printed name
Romulo B. Lomocso Date
ABEL M. MATILDO
Position Municipal Mayor O.R/Other Documents JEV. No. Date
Agency Head / Authorized Representative