ANNEX'A"

(Letterhead)

(Date)

NOTICE OF INSPECTION
Contract Management Division

TO

Dear

This notice of inspection is hereby issued to your firm in connection with your
attached request for [pre4elitnry lnspection or lrtslnctlon (uthichever is
applicable)l dated

Attached for your reference are the copies of designations of inspectors dated
and _, for tl:e [prc-deliocry lnspection/tnspectlon (whlche*r
is appltcable)1.

The particulars of t}:e fpre-d.elhEry inspection/inspection] are as follows:

ProjectName :

Contract No. :

Total Contract Price:

Date and Time of Inspection:
Inspection Site:
Items for Inspection:
Item Requested Quantity
Item Description
l{o. for Inspection

Chief Administrative Offi cer/

Supervising Administrative Offi cer
 ANNE'X "B"

PRE-DELTVERY INSPECTION/ INSPECTION REPORT

Supplier:

Project Tltle:
Contract No.: Lot No:
InspectioB Order Date of Inspection:
Ref. No. & Date:
Inspectlotr Technique used:
( ) By Item (100%) ( ) By Sampling Sampling Type:
( ) Simple Random
( ) Interval
( ) Cluster
( )Stratilied Random
Sample Size {7o): RQL (%):
ReEarka
Item
Item Description Unit of (indicate also if
No lllleaaurement Quantlty
passed/failed)

Notes, if aay:

Inspcction Team
(Sig-nature over Printed Name)

Member, Asset Management Division Team [rader, (End-user Unit)

Member, Accounting Division Member, (End-user Unit)

Coaforme: (Signature over Printed Name)

Supplier's Representative
(indicate name of firm)
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 (Letterhead)

(Date)

DESIGNATION OF INSPECTORS
(End-user Unit)

INSPECTION TEAM:

1. Team [,eader:
Plantilla Item:

2. Member:
Plantilla Item:

3. Member:
Plantilla ltem:

The above-named personnel are hereby designated inspection team members,

pursuant to DepEd Order No. _ s. 2O23 to conduct [pre-deltwry inspection
(PDl)/inspect'lon (z.ll.hlcltet er is o,p.pltcablc)l of the goods supplied by the [Supplter].

The particulars of the [pre-deliuery inspection/inspectlon] are as follows:

Project Name :

Contract No. : Lot No.:

Total Contract Price:
Requested Date and Time of Inspection:
Inspection Site:
Items for Inspection:
Requested Quantity for
Item No. Item Description
Inspectioa

The techalcal specilications of the goods/items herein mentioned, lnspection

Protocol, and the Sampliog Plan are attached for reference.

Director/Chief of Division

Encl.: as stated
 (Letterhead)

(Date)

DTSIGNATION OF INSPECTORS
(Accounting Division/AMD)

INSPECTION TEAM:

1. Member:
Plantilla Item:

2. Member:
Plantilla Item:

The above-named personnel are hereby designated inspection team members, pursuant
to DepEd Order No. _ s. 2023 to conduct fpre- dellvery lnspectlon (PDl)finspection
(rohicheur ls appllcable)l of the goods supplied by t}:e [Supplier].

The particulars of the fpre-delloery inspection/inspectlon] are as follows:

ProjectName :

Contract No. : lrt No.:

Total Contract Price:
Requested Date and Time of Inspeclion:
Inspection Site:
Items for Inspection:
Rcquested Quantity for
Item No. Item Description
Inspectlo[

Director/Chief of Division
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