Ors Burs & DV Forms For Ati-Co Use

Annex B
Republic of the Philippines

Department of Agriculture
AGRICULTURAL TRAINING INSTITUTE
Elliptical Road, Diliman, Quezon City
Trunk Line : 929-8541 to 49
No.
DISBURSEMENT VOUCHER
Mode of MDS Check Commercial Check ADA Others
Payment
TIN/Employee No. OR/BUR No.
Payee Aries Janitorial Services
Responsibility Center
7-B 12th Avenue, Murphy, Cubao, Quezon City
Office/Unit Project Code
Address
EXPLANATION AMOUNT
To payment of Janitorial services rendered for the period of July 01-15, 2016 as per attached
supporting papers amounting to . . . . . . P 65,595.82
A Certified B Approved for Payment

Cash Available
Subject to Authority to Debit Account (when applicable)
Supporting documents complete
Signature Signature
Printed GAUDIOSO P. CABAGUE, JR.

Printed ASTERIO P. SALIOT, CESO III
Name Name
Accountant Director IV
Position Position
Head, Accounting Unit/Authorized Representative Agency Head/Authorized Representative
Date Date
C Received Payment
Check/ Date Bank Name JEV No.
ADA No.
Date Printed Name Date:
Signature
Official Receipt/Other Documents

Annex B
No.
Payment
Payee MERALCO
CP Central Govt.
Address
MERALCO, Pasig City
EXPLANATION AMOUNT
To payment of Electric Bills for DA-IVB, 3rd floor for the period February 06 - March 05, 2016 as per
attached supporting papers amounting to . . . . . P 46, 607.83
(R-IV B 3rd floor with ID Service No. 100055570101)
Note: Charge to Trust Fund

Cash Available
Signature Signature

Name Name
Position Position
Date Date
C Received Payment
ADA No.
Signature

Annex B
No.
Payment
Payee MERALCO
CP Central Govt.
Address
MERALCO, Pasig City
EXPLANATION AMOUNT
To payment of Electric Bills for SMART for the period May 24 - June 23, 2016 as per attached
supporting papers amounting to . . . . . P 51,589.71

Cash Available
Signature Signature

Name Name
Position Position
Date Date
C Received Payment
ADA No.
Signature

Annex B
No.
Payment
Payee MANILA WATER COMPANY, INC.
489, Katipunan Company Inc.
Address
Quezon City
EXPLANATION AMOUNT
To payment of Water Consumption of ATI GUEST HOUSE for the period of June 06 - July 05, 2016 as per
supporting papers amounting to . . . . . . . P 25, 315.77

Cash Available
Signature Signature

Name Name
Position Position
Date Date
C Received Payment
ADA No.
Signature

Annex B
No.
Payment
Payee Land Transportation Office
East Avenue, Quezon City
Address
EXPLANATION AMOUNT
To payment of Emission fee for UV with Plate No. SHY-446 as per attached supporting papers
amounting to . . . . . . . P 90.00

Cash Available
Signature Signature

Name Name
Position Position
Date Date
C Received Payment
ADA No.
Signature

Trunk Line: (02) 929-8541 to 49 COA Circular 2015 -002: Annex F
No.
OBLIGATION REQUEST AND STATUS (ORS) Date: 2-May-16
Fund
Payee ARIES JANITORIAL SERVICES
Quezon City
Office Quezon City
Address No. 7-B, 12th Avenue, Murphy, Cubao, Quezon City
Responsibility UACS Code/

Particulars MFO / PAP Amount
Center Expenditure
To payment of Janitorial services rendered for the

period of May 01-31, 2016 as per attached supporting P 550,000.00
papers amounting to . . . . . . .
TOTAL P 550,000.00
A. Certified: Charges to appropriation / allotment B. Certified: Allotment available and obligated
necessary, lawful, and under my direct supervision, and for the purpose / adjustment necessary as
supporting documents valid, proper, and legal indicated above
Signature: Signature:
Printed Name: JOSE D. TANHUECO Printed Name: LEONILA D. CAIZ
Position: Administrative Officer V Position: OIC-Budget Officer
Date: Date:
C. STATUS OF OBLIGATION
Reference Amount
ORS / JEV / RCI /
Date Particulars Obligation Payment Not Yet Due Due and Demandable
RADAI No.
Totals
No.
OBLIGATION REQUEST AND STATUS (ORS) Date: 01-04-2016
Fund
Payee MARCELO R. NANGIT, JR.
Office Antipolo City
Address 26 Kaimito Road, Nayong Silangan Subd., Antipolo City

Center Expenditure
Payment of Services rendered as Sr. Civil/Structural Engr.

for the period January - June 2016 as per attached
supporting papers amounting to . . . . . . . . . P210,000.00
TOTAL P210,000.00
Position: Administrative Officer V, Admin. & Finance Unit -OD Position: OIC-Budget Officer
Date: Date:
Reference Amount
ORS / JEV / RCI /
RADAI No.
Totals
No.
Fund
Payee NOEL T. FLORENCONDIA
Office Nueva Ecija
Address San Jose City, Nueva Ecija

Center Expenditure
Payment of services rendered as Prof. Electrical Engr.

for the period of July - September 2016 as per
attached supporting papers amounting to . . . . . . P 60,000.00
TOTAL P 60,000.00
Position: Administrative Officer V, Admin. & Finance Unit -OD Position: OIC-Budget Officer
Date: Date:
Reference Amount
ORS / JEV / RCI /
RADAI No.
Totals
No.
Fund
Payee MANILA WATER
Office Quezon City
Address H. Ventura St., Balara Filters, Brgy. Pansol, Quezon City

Center Expenditure
To payment of Water consumption o ATI for the

period of June 06 - July 05, 2016 as per
attached supporting papers amounting to . . . . . . . . P 63,048.32
TOTAL P 63,048.32
Position: Administrative Officer V, Admin. & Finance Unit-OD Position: OIC-Budget Officer
Date: Date:
Reference Amount
ORS / JEV / RCI /
RADAI No.
Totals
No.
Fund
Payee LAND TRANSPORTATION OFFICE
Office Quezon City
Address East Avenue, Quezon City

Center Expenditure
To payment of Emission Fee for UV with Plate

No. SHY-446 as per attached supporting papers P 90.00
amounting to . . . . .
TOTAL P 90.00
Position: Admin. Office V, Admin. & Finance Unit -OD Position: OIC-Budget Officer
Date: Date:
Reference Amount
ORS / JEV / RCI /
RADAI No.
Totals
No.
Fund
Payee MERALCO
Office Pasig City
Address CP Central Govt, MERALCO, Pasig City

Center Expenditure
To payment of Electric consumption for ATI for the

period of April 24 - May 23, 2016 as per attached
TOTAL P 249,455.79
Position: Administrative Officer V Position: OIC-Budget Officer
Date: Date:
Reference Amount
ORS / JEV / RCI /
RADAI No.
Totals
Annex B
No.
Payment
Payee URDUJA SECURITY SERVICES, INC.
#59 Mayor Gil Fernando Ave., San Roque
Address
Marikina City
EXPLANATION AMOUNT
To payment of Security services rendered for the period of June 01-30, 2016 as per attached
supporting papers amounting to . . . . . . P177,440.52
No. of SG Hrs. Amount

1 12 P34,221.91
3 8 65,398.02
1 12 32,522.68
1 8 23,498.57
1 8 21,799.34

Cash Available
Signature Signature

Name Name
Position Position
Date Date
C Received Payment
ADA No.
Signature

Annex B
No.
Payment
TIN/Employee No. 137 - 755512000 OR/BUR No.
Payee MARCELO R. NANGIT, JR.
26 Kaimito Road, Nayong Silangan Subdivision,
Address
Antipolo City
EXPLANATION AMOUNT
To payment of services rendered as Sr. Civil Engr./Structural Engr. for the month of June 01-30,
2016 as per attached supporting papers amounting to . . . . . P 35,000.00
Less: Tax 10% P 3,500.00

3% P 1,050.00
__________
Total P4,550.00
P 30,450.00
Cash Available
Signature Signature

Name Name
Position Position
Date Date
C Received Payment
ADA No.
Signature

Annex B
No.
Payment
Payee MERALCO
CP Central Govt.
Address
MERALCO, Pasig City
EXPLANATION AMOUNT
To payment of Electric Bills of ATI for the period of April 24 - May 23, 2016 as per
attached supporting papers amounting to . . . . . . . . . . P 249,455.79

Cash Available
Signature Signature

Name Name
Position Position
Date Date
C Received Payment
ADA No.
Signature

Annex B
No.
Payment
Payee MANILA WATER COMPANY, INC.
H. Ventura St., Balara Filters, Brgy. Pansol,
Address
Quezon City
EXPLANATION AMOUNT
To payment of Water Bills of ATI Clients for the Yr. 2016 as per attached supporting papers
amounting to . . . . . P 43,180.07
Summary of Payments ATI Clients

1. DA-IV B Mimaropa - May 06 - June 05, 2016 P 40,662.83
2. PhilRice - May 06 - June 05, 2016 P 387.27
3. PhilMech - May 06 - June 05, 2016 P 968.17
4. PhilFida - May 06 - June 05, 2016 P 1,161.80
Total P43,180.07

Cash Available
Signature Signature

Name Name
Position Position
Date Date
C Received Payment
ADA No.
Signature

Annex B
No.
Payment
TIN/Employee No. 124817400 OR/BUR No.
Payee NOEL T. FLORENCONDIA
San Jose City
Address
Nueva Ecija
EXPLANATION AMOUNT
To payment of services rendered as Electrical Engr. for the period of March 01-31, 2016 as per
Less: Tax 10% P 2,000.00

3% P 600.00
__________
Total P2,600.00
P 17,400.00
Cash Available
Signature Signature

Name Name
Position Position
Date Date
C Received Payment
ADA No.
Signature

Annex B
No.
Payment
TIN/Employee No. 237 -721925000 OR/BUR No.
Payee DHEANNE V. MARTINEZ
007 Elizabeth St., D.M. 5, Brgy. San Andres, Cainta Rizal
Address
EXPLANATION AMOUNT
To payment of services rendered as Civil Engr. for the period of July 01-15, 2016 as per
Less: Tax 10% P 1,232.35

3% P 369.70
__________
Total P 1,602.05
P 10,721.45
Cash Available
Signature Signature

Name Name
Position Position
Date Date
C Received Payment
ADA No.
Signature

No.
Fund
Payee ARIES JANITORIAL
Office Quezon City
Address 7-B, 12th Avenue, Murphy, Cubao, Quezon City

Center Expenditure
To payment of Janitorial services rendered for the

period from July 01-31, 2016 as per attached
TOTAL P 131,191.64
Position: AO V, Admin. & Finance Unit - OD Position: OIC-Budget Officer
Date: Date:
Reference Amount
ORS / JEV / RCI /
RADAI No.
Totals
Trunk Line: (02) 929-8541 to 49 COA Circular 2015 -002: Annex G
No. :
BUDGET UTILIZATION REQUEST AND STATUS (BURS) Date :
Fund :
Payee
Office
Address
Responsibility UACS Code /

Center Expenditure
TOTAL
A. Certified: Charges to budget necessary, lawful B. Certified: Budget available and utilized
and under my direct supervision, and supporting for the purpose/adjustment necessary as
documents valid, proper, and legal indicated above
Printed Name: Printed Name:
Position: Head, Requesting Office/Authorized Representative Position: OIC-Budget Officer
Date: Date:
C. STATUS OF UTILIZATION
Reference Amount
BURS / JEV / RCI
Date Particulars etc. Utilization Payment Not Yet Due Due and Demandable
Totals
Annex B
No.
Payment
Payee FIRST R+J BUILDERS PHILS. CORP.
Blk. 21 lot 35 19st. MRC Mabalacat Pampanga
Address
EXPLANATION AMOUNT
To payment of 92.1647% Accomplishment billing for Repair /

Retrofitting Works at 2nd Floor Left Wing (from ATI-Director's Office
to Planning) Project amounting to . . . . .
Php. 8,716,918.12 x 62.1647% = Php. 5,418,846.87

Cash Available
Signature Signature

Name Name
Position Position
Date Date
C Received Payment
ADA No.
Signature

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Annex B

Republic of the Philippines

A Certified B Approved for Payment

Printed GAUDIOSO P. CABAGUE, JR.

Official Receipt/Other Documents

(R-IV B 3rd floor with ID Service No. 100055570101)

Note: Charge to Trust Fund

A Certified B Approved for Payment

Printed GAUDIOSO P. CABAGUE, JR.

Official Receipt/Other Documents

Note: Charge to Trust Fund

A Certified B Approved for Payment

Printed GAUDIOSO P. CABAGUE, JR.

Official Receipt/Other Documents

A Certified B Approved for Payment

Printed GAUDIOSO P. CABAGUE, JR.

Official Receipt/Other Documents

A Certified B Approved for Payment

Printed GAUDIOSO P. CABAGUE, JR.

Official Receipt/Other Documents

Responsibility UACS Code/

To payment of Janitorial services rendered for the

Responsibility UACS Code/

Payment of Services rendered as Sr. Civil/Structural Engr.

Responsibility UACS Code/

Payment of services rendered as Prof. Electrical Engr.

Responsibility UACS Code/

To payment of Water consumption o ATI for the

Responsibility UACS Code/

To payment of Emission Fee for UV with Plate

Responsibility UACS Code/

To payment of Electric consumption for ATI for the

No. of SG Hrs. Amount

A Certified B Approved for Payment

Printed GAUDIOSO P. CABAGUE, JR.

Official Receipt/Other Documents

Less: Tax 10% P 3,500.00

Printed GAUDIOSO P. CABAGUE, JR.

Official Receipt/Other Documents

A Certified B Approved for Payment

Printed GAUDIOSO P. CABAGUE, JR.

Official Receipt/Other Documents

Summary of Payments ATI Clients

2. PhilRice - May 06 - June 05, 2016 P 387.27

3. PhilMech - May 06 - June 05, 2016 P 968.17

4. PhilFida - May 06 - June 05, 2016 P 1,161.80

A Certified B Approved for Payment

Printed GAUDIOSO P. CABAGUE, JR.

Official Receipt/Other Documents

Less: Tax 10% P 2,000.00

Printed GAUDIOSO P. CABAGUE, JR.

Official Receipt/Other Documents

Less: Tax 10% P 1,232.35

Printed GAUDIOSO P. CABAGUE, JR.

Official Receipt/Other Documents

Responsibility UACS Code/

To payment of Janitorial services rendered for the