LOGOLOG FARMERS MULTI-PURPOSE COOPERATIVE

Pangascasan, Sual, Pangasinan

Tin. No. 005-577-002-000 Non Vat

CONTRACTOR’S ACCOMPLISHMENT REPORT (CAR)

CONTRACTOR’S NAME: LOGOLOG FARMERS MULTI-PURPOSE COOPERATIVE DATE: 08/16/21

TO: TEAM SUAL END-USER/DEPARTMENT:
CAR CONTROL NO: CAR-60732
CORPORATION MARCELINO LIONGSON
PO/CONTRACT No: 60732 START DATE: 07/28/2021
PROJECT DESCRIPTION: RE-SEALING OF PILOT TARGET COMPLETION DATE : 08/15/2021
CONTROL VALVE(JOYSTICK ) AND TRAVEL CONTROL ACTUAL COMPLETION DATE: 08/15/2021
VALVE(FOOT PEDAL) FOR CS-01 HITACHI CLAMSHELL
MODEL FH 330LC.3 ETS-3 FIAT-HITACHI EXCAVATOR
CHASSIS 334 L 0208MODEL-FH330 LC.0 /ETS-03/
MADE IN ITALY / MODEL YR 1997 ENGINE IZUZU
-6SD1TQA

PROJECT STATUS
ONE-TIME BILLING PROGRESS BILLING
Previous Current Period to Date
Current Period Coverage Remarks
Accomplishment Accomplishment Accomplishment
0% 100% 100% 07/28/21-08/15/21 For the Month of
August 2021

REQUIRED DOCUMENT/S (for submission as applicable) :

Copy of PO Copy of Contract Timesheet Summary
3 hard copies of reports Soft copies of reports in CD format
Other documents required in the PO/Contract, please specify: Billing Invoice
Note: For submission to Finance: proof of mandated Government remittances (SSS, Philhealth, Pag-ibig & BIR), proof of payment to
subcontractors or any third party and other related documents as stated in the Contract and/or Purchase Order .

NAME OF CONTRACTOR

JERRY CABRITO CHAIRMAN OF THE BOARD

Signature Over Printed Name Position Title
Authorized Representative

TEAM'S ACKNOWLEDGMENT & APPROVAL:

The undersigned hereby certifies that the above-named Contractor has satisfactorily completed the Services as
specified in this document and in accordance with the terms and conditions of the PO and/or Contract.

No. of days delay:       SRN1 No.      

Chargeable to Yes LD Amount:      Concurred by:
Contractor? No Justification:            

Offense (attached copy of SCMCOP-001 FORM 9: SUPPLIER OFFENSE REPORT (SOR))

Remarks:     

Reviewed by: Recommended/Endorsed by: Approved by:

MARCELINO LIONGSON RUSTY PERALTA NICANOR RAMOS

End-user Section Head HOD/Authorized Approver
This document will be considered incomplete without the SRN reference number and signed by the authorized approver.
1

Original: End-user Copy 1: Supplier Copy 2: SCM

This document is being approved without prejudice to subsequent adjustments necessary to arrive at the true and valid cost of the completed
Services. Such adjustments shall be made in accordance with the terms and conditions of the PO and/or Contract.
 LOGOLOG FARMERS MULTI-PURPOSE COOPERATIVE
Pangascasan, Sual, Pangasinan
Tin. No. 005-577-002-000 Non Vat

Approval of the document shall not be construed as an acceptance or waiver of defective work/goods or Contractor's other obligations in the PO
and/or Contract. The Company shall not be considered to have waived, nor shall it be considered in estoppel, in respect of any claims it may
have against the Contractor by the approval of this document .