ANNEX G-7

INSPECTION & ACCEPTANCE REPORT

Mauban, Quezon
LGU

Supplier AR No. Date:

PO NO. Date: Invoice No.
Requisition Office/Dept.

Item No. Unit Description QTY.

INSPECTION ACCEPTANCE
Date Inspected: _______________________ Date Received: ________________

Inspected, verified and found OK Complete

as to quantity and specifications

JAN MIRLO ALMIRA/ SHERYL SANTOALLA ARVIN VILLASENOR/RODMAR SANTOALLA Incomplete

Information Technology Engineering Office

For Vehicles only: TRISHA TALISAYON/RHANDY BURAGA

Municipal Health Office
ROLAND REPIQUE Partial
Mechanic I

GSO
ARVIN PAJULAS
TEAM A TEAM B BRGY. Chairman

SHERYL S. AMBAL ROGELIO T. PANSACOLA

Supply Officer I Storekeeper I

Received by: JASMIN C. PASUMBAL

HONEYLYN E. REGALA ELSA SHYN CONSUELO General Services Officer
Administrative Aide I Administrative Aide I Date:
Name of Procuring Agency
SEF
Project Reference Number
Name of Project
Location on Project

PURCHASE REQUEST
LGU - Mauban, Quezon

PR NO. _____________________ Date

SAI NO. ____________________ Date
ALOBS NO. __________________ Date

Estimated
Item No. Quantity Unit of Issue Item Description Estimated Cost
Unit Cost
1 1 set Fabricated Partition using Glass and Aluminum 40,000.00
Ordinary Bronze Glass and Analok Aluminum Frames
6mm Bronze Glass Dimension 3m x 6m
2 26 pcs. pcs. 1/4 x 4 x 8 Hardiflex 500.00
3 41 pcs. pcs. Metal furring .7mm, 16ft. Every .60m 150.00
botways
pcs. 1/2" x 1 1/2, carrying channel, 16ft. Every .8m,
4 16 pcs. traverse 150.00
5 120 box pcs. Metal Furring Clip 13.00
6 150 pcs. pcs. J-Clip for carrying channel 13.00
7 11 pcs. pcs. Wall angle .4 mm x 10ft. 100.00
8 15 pcs. Round bar, 12mm dia. (Carrying Channel Hanger) 300.00
9 500 unit pcs. Screw 1.50
10 5 tubes tubes Silicon Sealant 180.00
11 4 bags bags portland cement, type I 290.00
12 1 cu.m. cu.m Sand S1 1,900.00
13 25 pcs. pcs 8' x 8" floor tiles 25.00
14 155 pcs. pcs 8" x 12" wall tiles 25.00
15 4 bags bags ABC grout (2kg./bag) 90.00
16 1 abg ABC Tile Adhesive 390.00
17 1 set Water Closet (Royal Tern) 6,500.00
18 1 set Lavatory (Royal Tern) 1,800.00
19 126 pcs. Waterproof Wallpaper 3D Wall Sticker 40.00
20 3 gal. Q.D.E. paint, white (Boysen) 690.00
21 3 gal. gloss latex paint (Boysen) 600.00
22 1 gal. Elastomeric paint, (Ready Mixed) 780.00
23 1 lit. glazzing putty 180.00
24 1 gal. paint thinner 395.00
25 1 lit. tinting color 550.00
PURPOSE/S: Use for Repair and Improvement of Office, Dr. Maria D. Pastrana
National High School, Brgy. Bagong Bayan, Mauban, Quezon

Requested by: Cash Availability: Approved by:

Signature
Printed Name ELENAR B. OPEŇA MAY LL. DARAN MARITA T. LLAMAS
Designation Public Schools District Supervisor Municipal Treasurer Municipal Mayor
Date

Page 3
Name of Procuring Agency
SEF
Project Reference Number
Name of Project
Location on Project

PURCHASE REQUEST
LGU - Mauban, Quezon

PR NO. _____________________ Date

SAI NO. ____________________ Date
ALOBS NO. __________________ Date

Item No. Quantity Unit of Issue Item Description Estimated

Estimated Cost
Unit Cost
26 2 pcs. Paint Brush #3, orig. 70.00
27 2 pcs. Paint Roller #7 95.00
28 2 pcs. Paint Brush #2, orig. 60.00
29 2 pcs. Paint Brush #1, orig. 45.00
30 2 ft. Sanding Paper #120, sia 75.00
31 2 ft. Sanding Paper #100, sia 80.00
32 2 ft. Sanding Paper #80, sia 85.00
33 2 pairs putty knife 45.00
34 2 pcs. Roller Tray 60.00
Square vertical downlight surfaced type (FD411 WH6)
35 4 sets 6" glass & groove design (FD477WH6) white 6" 415.00

36 8 sets T8 straight FL 18 watts (Firely FEWL8118) 450.00

37 1 set Two gang Switch 126.00
38 2 pcs. pcs. Utility box 60.00
39 2 pcs. Junction box w/ cover 60.00
40 2 pcs. roll Electrical Tape (big) 66.00
41 0.5 rolls roll. 3.5 mm2 THHN wire 3,300.00
42 1 l.s. pc. Tarpaulin 8' x 4' w/ print of proj. signage 640.00

PURPOSE/S: Use for Repair and Improvement of Office, Dr. Maria D. Pastrana
National High School, Brgy. Bagong Bayan, Mauban, Quezon

Requested by: Cash Availability: Approved by:

Signature

Page 4
Printed Name ELENAR B. OPEŇA MAY LL. DARAN MARITA T. LLAMAS
Designation Public Schools District Supervisor Municipal Treasurer Municipal Mayor
Date

Page 5
40,000.000 Err:520
-
-
13,000.000
6,150.000
2,400.000
1,560.000
1,950.000
1,100.000
4,500.000
750.000
900.000
1,160.000
1,900.000
625.000
3,875.000
360.000
390.000
6,500.000
1,800.000
5,040.000
2,070.000
1,800.000
780.000
180.000
395.000
550.000

99,735.00

Page 6
 140.000
190.000
120.000
90.000
150.000
160.000
170.000
90.000
120.000

1,660.000

3,600.000
126.000
120.000
120.000
132.000
1,650.000
640.000
-
-
-
-
-
-
-
-
-
-
9,278.00

109,013.00

Page 7
Page 8
Name of Procuring Agency MEO

Project Reference Number

Name of Project SITIO CAMAGONG,
BRGY. CAGSIAY 1
Location on Project Brgy. Cagsiay I
Mauban, Quezon
PURCHASE REQUEST
LGU - Mauban, Quezon

PR NO. _____________________ Date

SAI NO. ____________________ Date
P 308, 690.40 ALOBS NO. __________________ Date

Unit of
Item No. Quantity Item description Estimated Unit Cost Estimated Cost
Issue

1 1 pc 4' x 8' Tarpaulin with print of project signage 640.00 640.00

2 2 pcs Ordinary plywood, 1/4" x 4' x 8' 30.00 60.00
3 72 bd.ft cocolumber, 12 pcs. 2"x3"x12' 30.00 2,160.00
4 1 kg CWN (Asstd.) 100.00 100.00
5 24.64 cu.m Aggregate base Coarse (G-1) 2,130.00 52,483.20
6 400 bd.ft 25pcs. 2" x 8" x 12' cocolumber 30.00 12,000.00
7 120 bd.ft 10pcs. 2" x 3" x 12' cocolumber 30.00 3,600.00
8 10 kg CWN(Asstd.) 110.00 1,100.00
9 1 kg concrete nail 140.00 140.00
10 333 bags portland cement (prefarably fortune) 340.00 113,220.00
11 19 cu.m sand, S1 2,020.00 38,380.00
12 37 cu.m crushed gravel, G1" 2,130.00 78,810.00
13 103.4 kg RSB (11-16mm dia. Deformed bar) 58.00 5,997.20
-
-
-

Total: 308,690.40
Purpose/Remarks: Use for CONCRETING OF ROAD
Sitio Camagong, Brgy. Cagsiay I, Mauban, Quezon

Requested By: Cash Availability: Approved By:

VENANCIO V. SANTAYANA MAY L. DARAN HON. BAUTISTA ERWIN DWIGHT C. PASTRANA

Acting Mun. Engineer/MPDC Municipal Treasurer Municipal Mayor
.
Name of Procuring Agency : MEO

Project Reference Number

Name of Project Fuel, oil & Lubricants (H.E.) used in
the River Banks & Slope Protection
for Suspension Footbridge
Location on Project Remedios - 1
Standard Form Number : SF-GOOD-58
Revised on : May 24, 2004
Standard Form Title: Purchase Order

PURCHASE ORDER
LGU-Mauban, Quezon

Supplier: GIANT PETROLEUM CONCPETS PHILS. INC. D.O. No:

Address: BRGY. POLO, MAUBAN, QUEZON Date:
E- mail Address: Mode of
Telephone Number Procurement SVP
TIN

Gentlemen:
Plese furnish this office the following articles subject to the terms and conditions contained herein:
Place of Delivery: MEO Delivery Term : as per order
Date of Delivery : Payment Term :
STOCK NO. UNIT PARTICULARS QTY. UNIT COST AMOUNT

1
2
3
4

(Total Amount in Words) Nine Thousand Three Hundred Fourtty Seven Pesos Only & 23/100 -
In case of failure to make the full delivery within the time specified above, a penalty of one -tenth (1/10) of one
(1%) percent for every day of delay shall be imposed.
Very truly yours,

FERNANDO Q. LLAMAS
Conforme: # Municipal Mayor

GRAN ADDISON ALMENDRAZ

Signature over printed name of Supplier
_________________
Date
Funds Available: ObR No.
ZARAH T. AMAN Amount:
Municipal Accountant
-
-
-
- Total Amount
 PROJECT PROCUREMENT MANGEMENT PLAN FOR 2021

Dept. / Bureau / Office: MEO

Control No.: 2021 - 11 - 35
Unit of Quantity Requirement
Item No. Description TOTAL
Measure Jan Feb Mar April May June July Aug. Sept. Oct. Nov. Dec.
1 For the use of OBO

Materials:
1 Similar to Yamaha Nmax unit 4 4
Specifications and Features Console:
Navigator-x, speedometer digital
Display screen-check, tripmeter-check
side satand indicator-x,odometer-digital
Fuel gauge-digital
Differentiating features:
Cruise Control-x, height adjustable seats - x
Safety and security
Back rest-x, Legs guard-x, shutter lock check
ABS-x, Traction control-x, anti-theft-x Lunch
control-x, Pass switch check, engine check,
warning check, stability control-x engine
Immobilizer-x, riding modes-street
ELECTRICAL Adjustable headlight-check,
head lamp-LED indicator Light Check, Tall
Lamp-LED

Battery Voltage-12V
Brake: front Braker-disc, Rear brake-disc
Dimension: Width-740mm, gropund
clearance-125mm, Ker weight-129kg.,
Wheeel base-1340mm seating capacity--2, oil
tankcapasity-1.0L, Length-1935mm, Height-
1160mm Category Scooter, seat hewight-
765mm,

WHEELS & TYRES:

Tyre type-Tubeless, rear type-130/70R13,
Front wheel size R13,
FUEL & IGNITION: Start option-electric
ignition System-tcl, Fuel supply system-fuel
injection, fuel type gasoline

TOTAL

Prepared by: Approved by:

MANUEL P. AMBON MARITA T. LLAMAS

Municipal Engineer Municipal Mayor
NT MANGEMENT PLAN FOR 2021

UNIT COST TOTAL AMOUNT

142,800.00 571,200.00

-
-

-
-
-

571,200.00
 REQUISITION AND ISSUE SLIP
LGU - MAUBAN, QUEZON
Agency

Division: MEO RIS No. ___________ Date ______________

Office: LGU - MAUBAN, QUEZON SAI No. ___________ Date _______________

ISSUANCE
Item No. Unit Description Qty. Qty. Remarks
1 pc 4' x 8' Tarpaulin with print of project signage 1 1
2 pcs Ordinary plywood, 1/4" x 4' x 8' 2 2
3 bd.ft cocolumber, 12 pcs. 2"x3"x12' 72 72
4 kg CWN (Asstd.) 1 1
5 cu.m Aggregate base Coarse (G-1) 24.64 24.64
6 bd.ft 25pcs. 2" x 8" x 12' cocolumber 400 400
7 bd.ft 10pcs. 2" x 3" x 12' cocolumber 120 120
8 kg CWN(Asstd.) 10 10
9 kg concrete nail 1 1
10 bags portland cement (prefarably fortune) 333 333
11 cu.m sand, S1 19 19
12 cu.m crushed gravel, G1" 37 37
13 kg RSB (11-16mm dia. Deformed bar) 103.4 103.4

Purpose/Remarks: Use for CONCRETING OF ROAD

Sitio Camagong, Brgy. Cagsiay I, Mauban, Quezon

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

Signature
Printed Name VENANCIO V. SANTAYANA SHERYL S. AMBAL
Designation Acting Mun. Engineer/MPDC Supply Officer
Date
 GIANT PETROLEUM CONCEPTS PHILS INC.
Maharlika Highway, Brgy. Polo, Mauban, Quezon
Statement of Account

To: LGU- Mauban: Engineering Office

Date Invoice No Type of Vehicle & Plate No Qty. Price/Liter

5/27/2020 57665 Blue Diesel (Backhoe, 970-B) 81.265 29.22

6/10/2020 57906 Blue Gas 93+ (Concrete mixer) 20 42.75
7/7/2020 57830 Blue Gas 93+ (Concrete mixer) 20 45.75

TOTAL AMOUNT

Received by:

DELIA C. CALDERERO
Admin Aide I
Total Amount

2,374.56
855.00
915.00

4,144.56
 ANNEX G-7

INSPECTION & ACCEPTANCE REPORT

Mauban, Quezon
LGU

Supplier AR No. Date:

PO NO. Date: Invoice No.
Requisition Office/Dept.

Item No. Unit Description

INSPECTION ACCEPTANCE
Date Inspected: _______________________ Date Received: ________________

Inspected, verified and found OK Complete

as to quantity and specifications

JAN MIRLO ALMIRA/ SHERYL SANTOALLA ARVIN VILLASENOR/RODMAR SANTOALLA Incomplete

Information Technology Engineering Office

For Vehicles only: TRISHA TALISAYON/RHANDY BURAGA

Municipal Health Office
ROLAND REPIQUE Partial
Mechanic I

GSO

TEAM A TEAM B

SHERYL S. AMBAL ROGELIO T. PANSACOLA

Supply Officer I Storekeeper I

Received by: JASMIN C. PASUMBAL

HONEYLYN E. REGALA ELSA SHYN CONSUELO General Services Officer
Administrative Aide I Administrative Aide I Date:
 ANNEX G-7

QTY.

EPTANCE
___________
N C. PASUMBAL
al Services Officer