PURCHASE ORDER

SAMBOAN, CEBU
LGU

Supplier: P.O. No.

DATE:
Address: 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: SAMBOAN, CEBU Delivery Term:

Date of Derlivery: Payment Term:

Item No. Unit Qty. Description Unit Cost Amount

Banana-1 pack x 10 wafers Nutri-foods

1 pack/bag 300 fortified wafers x 30 days PhP70.00 PhP21,000.00

Milk Banana & Oats -1 pack Nutri Love Instant

2 packs 3000 dry Cereal x 30 days PhP14.00 PhP42,000.00

Champorado-1pack Nutri foods fortified rice

3 packs 3000 porridge x 30 days PhP19.00 PhP57,000.00

PhP120,000.00
TOTAL PHP 120,000.00
In case of failure to make the full delivery within the time specified above, a penalty of one/tenth (1/10) of one
percent for every day of delay shall be imposed.
(1/10) of one (1) percent for every day of delay shall be imposed
Conforme:

ROSELINDA C. GERZON,RN
(Signature over printed name) Public Health Nurse

Funds Available: (Date)

____________________________________________________________________________________________
GAD
 Annex 30
PURCHASE REQUEST
SAMBOAN, CEBU
LGU

Department: RHU PR No. : MHO 2021- Date: 06/24/2021

Samboan, Cebu SAI No.: Date:
Section: ALOBS No.: Date:

Item Unit of Estimated Estimated

No. Quantity Issue Item Description Unit Cost Cost

Banana-1 pack x 10 wafers Nutri-foods

1 3000 pcs fortified wafers x 30 days PhP6.00 PhP18,000.00

Milk Banana & Oats -1 pack Nutri Love

2 3000 packs Instant dry Cereal x 30 days PhP12.75 PhP38,250.00

Champorado-1pack Nutri foods fortified

3 2250 packs rice porridge x 30 days PhP17.00 PhP38,250.00

Subtotal for this page PhP94,500.00

Purpose: Nutrition Feeding Program for malnourished children.

Requested by: Cash Availability: Approved by:

Signature:
Printed Name: ROSELINDA GERZON, RN JULIUS L. CAVALIDA EMERITO D. CALDERON JR.
Designation: PUBLIC HEALTH NURSE Mun. Treasurer Municipal Mayor
 Annex 30
PURCHASE ORDER
SAMBOAN, CEBU
LGU

Supplier: JOURC CATERING SERVICES P.O. No.

Date: 08/11/16
Address: POBLACION, SAMBOAN, CEBU 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: SAMBOAN, CEBU Delivery T

Date of Derlivery: Payment T

Item No. Unit Qty. Description Unit Cost Amount

AUGUST 18,2016
1 50 AM SNACKS 30.00 1500.00
2 50 LUNCH 200.00 10000.00
3 50 PM SNACKS 30.00 1500.00

TOTAL
In case of failure to make the full delivery within P
the time specified above, a penalty of one/tenth 13,000.00
(1/10) of
one percent for every day of delay shall be imposed.

Conforme:
______________________________ DR.IANNE JIREH RAMOS
___ CAÑIZARES, MD
(Signature over printed name) Municipal Health Officer

_______________
(Date)
Funds Available:
____________________________________________________________________________________________
 Republic of the Philippines
MUNICIPALITY OF SAMBOAN
Samboan, Cebu
DISBURSEMENT VOUCHER No.

Mode of
Payment Check Cash Others Others
MAY ALMA FLAVIANO TIN/Employee No. Obligation Request
Payee No.
POBLACION, SAMBOAN, Responsibility Center
Address CEBU Office/Unit/Project Code
MHO
EXPLANATION AMOUNT

TO:
Payment for NUTRITION MONTH OPENING SALVO per supporting
papers attached in the amount of TEN THOUSAND PESOS ONLY. 9,464.29

Gross Amount 10,000.00

5% Vat 446.43
1% Evat 89.29
This payment 9,464.29

A. Certified
Allotment obligated for the purpose
B. Certified
indicated above. Funds Available
Supporting documents complete.
Signature Signature
Printed Date Printed Date
Name MILAGROS O. GEYROZAGA Name JULIUS L. CAVALIDA
Position Municipal Accountant Position Municipal Treasurer
C. Approved Payment D. Received Payment
Check No./Bank N Bank Name Date
Signature
Signature
Printed Date Printed Date
Name EMERITO D. CALDERON JR. Name MAY ALMA FLAVIANO
Position Municipal Mayor OR/Other Documents JEV No. Date
 MUNICIPALITY OF SAMBOAN
Samboan, Cebu
DISBURSEMENT VOUCHER No.

Mode of
Payment Check Cash Others Others
VAN VAN TIN/Employee No. Obligation Request
Payee No.
MOALBOAL, CEBU Responsibility Center
Address Office/Unit/Project Code
MHO
EXPLANATION AMOUNT

TO:
Payment for NUTRITION MONTH OPENING SALVO per
supporting papers attached in the amount of TWENTY
THOUSAND PESOS ONLY. 18,928.57

Gross Amount 20,000.00

5% Vat 892.86
1% Evat 178.57
This payment 18,928.57

A. Certified
Allotment obligated for the purpose
B. Certified
indicated above. Funds Available
Supporting documents complete.
Signature Signature
Printed Date Printed Date
Name MILAGROS O. GEYROZAGA Name JULIUS L. CAVALIDA
Position Municipal Accountant Position Municipal Treasurer
C. Approved Payment D. Received Payment
Check No./Bank Bank Name Date
Signature
Signature
Printed Date Printed Date
Name EMERITOD. CALDERON JR. Name GEOVANIE C. BALGUE
Position Municipal Mayor OR/Other Documents JEV No. Date