Annex 14

PURCHASE REQUEST
SK of Barangay:.STA. CRUZ PR No.: 2022-012-002
City/Municipality: CARMEN Date: December 27, 2022
Province: SURIGAO DEL SUR
Unit of Estimated Estimated
Item No. Qty. Item description
Measurement Unit Cost Amount
1 4 bots Epson Ink #003 (Black) 400.00 1,600.00
2 2 bots Epson Ink #003 (Magenta) 400.00 800.00
3 2 bots Epson Ink #003 (Cyan) 400.00 800.00
4 1 pc Columnar Book 80.00 80.00
5 1 rm Folder Long (Ordinary 850.00 850.00
6 1 box Ballpen 130.00 130.00
7 10 pcs Manila Paper 10.00 100.00
8 1 box Fastener 100.00 100.00
9 1 pc Reocrd Book 250.00 250.00
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Total Estimated Amount (FOUR THOUSAND SEVEN HUNDRED TEN PESOS ONLY) P 4,710.00
Purpose: For the operational of SK of Barangay Sta. Cruz, Carmen, Surigao del Sur
Requested by: Approved by:
MICCA D. PLAZA JUNIEL E. RULITE
Signature over Printed Name Signature over Printed Name
SK Requesting Official SK Chairperson

19-Dec-22 19-Dec-22
Date Date
 PURCHASE ORDER
SK of Barangay: STA. CRUZ City/Municipality: CARMEN
Tel. No.: Province: SURIGAO DEL SUR
Supplier: 3D'S PRINTING SERVICES PO No.: 2022-012-002
Address: Carmen, Surigao del Sur Date: December 23, 2022
Mode of Procurement: Over the
Tel. No.: ___________ TIN:921-118-550-000001 Counter
Gentlemen: Please deliver to this office the following articles subject to the terms and conditions
contained herein: Barangay Hall, Barangay Sta. Cruz,
Place of Delivery: Delivery Term: Free on Board
Carmen, Surigao del Sur Destination
Date of Delivery: December 22, 2022 Payment Term: n/30
Unit of
Item No. Item Description Qty Unit Cost Amount
Measurement

1 bots Epson Ink #003 (Black) 4 350.00 1,400.00

2 bots Epson Ink #003 (Cyan) 2 350.00 700.00
3 bots Epson ink #003 (Magenta) 2 350.00 700.00
4 pc Columnar 3col. 1 55.00 55.00
5 rm Folder Long (Ordinary) 1 700.00 700.00
6 box Ballpen 1 110.00 110.00
7 pcs Manila Paper 10 7.00 70.00
8 box Fastener 1 50.00 50.00
9 pc Record Book (500p) 1 190.00 190.00

(Total Amount in words)Tree Thousand Nine Hundred Seventy Pesos Only P 3,975.00
In case of failure to make 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 on the undelivered item/s.
Conforme: Very truly yours,

3D'S PRINTING AND SERVICES JUNIEL E. RULITE

Signature over Printed Name of Supplier Signature over Printed Name
SK Chairperson

23-Dec-22 23-Dec-22
Date Date
Availability of the budget or funds received for specific purpose:

ROSE MAE R. MADELO December 23, 2022

Signature over Printed Name of Budget Monitoring Officer Date
 INSPECTION AND ACCEPTANCE REPORT
SK of Barangay: STA. CRUZ IAR No.: 2022-012-002
City/Municipality: CARMEN Date: December 23, 2022
Province: SURIGAO DEL SUR
Supplier: 3D's Printing Services Invoice No.: ________________
PO No.: 2022-012-002 Date:December 23, 2022 Date: December 23, 2022
Requesting SK Official: MICCA D. PLAZA
Unit of
Item No. Item Description Quantity
Measurement

1 Epson Ink #003 (Black) bots 4

2 Epson Ink #003 (Cyan) bots 2
3 Epson ink #003 (Magenta) bots 2
4 Columnar 3col. pc 1
5 Folder Long (Ordinary) rm 1
6 Ballpen box 1
7 Manila Paper pcs 10
8 Fastener box 1
9 Record Book (500p) pc 1

INSPECTION ACCEPTANCE

Date Inspected: December 23, 2022 Date Received: December 23, 2022

Inspected, verified as to Complete

quantity
and specifications

Partial (Pls. specify quantity

Received)

DANILO Y. PIMENTEL JELLY E. TALISIC

Signature over Printed Name Signature over Printed Name
Head, Inspection and Appraisal Committee SK Treasurer
 STOCK CARD

SK of Barangay : SAN FRANCISCO Article:

SK Treasurer : RENE SANTOS Item Description:
City/Municipality: QUEZON CITY Unit of Measurement:
Province: METRO MANILA Stock No.:

Receipts
Date Reference Particulars (a)
Total
Quantity Unit Cost
Cost
Totals/Balance brought forward

Totals/Balance carried forward

D

Sheet No.:

2019-01-001

Issues/Losses/
Balance
Transfers/Disposals
(Balance+a-b)
(b) Remarks
Total Total
Quantity Quantity
Coast Coast
 PROPERTY EQUI
SK of Barangay :
SK Treasurer :
City/Municipality:
Province: Receipts
(a) Property
Date Reference Particulars Total
Qty. Unit Cost No.
Cost
Totals/Balances brought forward

Totals/Balances carried forward

PROPERTY EQUIPMENT CARD
Article:
Item Description:
Unit of Measurement:
Issues Balance Lost/Disposed Balance
Property (b) (Balance+a-b) (c) (Balance+a-c)
Total Total Total Total Remarks
Description Qty. Qty. Qty. Qty.
Cost Cost Cost Cost
Sheet No.:

Repair
Nature of History
Amount
Repair
 REQUISITION AND ISSUE SLIP
SK of Barangay: RIS No.:
City/Municipality: Date:
Province:
Requisition Issue
Unit of
Stock No. Item Description Quantity Quantity
Measurement

Purpose:

Requested by: Approved by: Issued by: Received by:

Signature
Signature
Printed Name
Designation
Date
 Issue
Remarks

Received by:
 PROPERTY ACKNOWLEDGEMENT RECEIPT
SK of Barangay:.SAN FRANCISCO PAR No.: 2019-03-001
City/Municipality: QUEZON CITY Date: March 02, 2019
Province: METRO MANILA
Unit of
Quantity Item Description Property No. Date Acquired
Measurement

Received by: Issued by:

___________________________ ____________________________
Signature over Printed Name Signature over Printed Name
and Designation of Recipient/End-User SK Treasurer

_____________ _____________
Date Date
 No.: 2019-03-001
: March 02, 2019

Amount

_______
Name