ACCEPTANCE AND INSPECTION REPORT

Supplier ROYCE MOTOR CENTER,INC. AIR No.

PON Date Invoice No. Date
Requisition Office / Department Bongabon District Hospital

Item No. Description QTY Unit Unit Cost Total Price

LABOR:
REPLACE VALVE COVER ASSY, VALVE COVER GASKET
AND INJECTOR OIL SEAL 2,800.05
CLEANING EGR AND INTAKE MANIFOLD 2,800.05
PERFORM CONSULT READING III PLUS 2,000.05
MISCELLANEOUS 700.05
REPLACE AIR INLET HOSE LEFT AND RIGHT 1,700.05
REPLACE REAR BRAKE WHEEL CYLINDER ASSY LH/RH 1,300.05
REPLACE REAR AXLE OIL SEAL RIGHT SIDE 1,200.05
REPLACE FRONT BRAKE PAD & REMOVE & INSTALL 2,500.05
FRONT ROTOR DISC TO GIVE WAY FOR RESURFACE LH/RH
REPLACE PARK LIGHT AND PLATE LIGHT BULB
650.05
PULLDOWN TRANSMISSION ASSY TO GIVE WAY FOR -
REPAIR AND REPLACE CLUTCH DISC, CLUTCH OVER -
AND RELEASE BEARING 3,500.05
-
SUBLET REPAIR: -
RESURFACE ROTOR DISC 2,340.05
-
PARTS: -
1 VALVE COVER GASKET 1 PC 1,364.05
2 VALVE COVER ASSY 1 PC 8,984.05
3 INJECTOR OIL SEAL 4 PC 983.06 3,932.24
4 AIR INLET HOSE LEFT SIDE 1 PC 4,671.05
5 AIR INLET HOSE RIGHT SIDE 1 PC 4,275.05
6 REAR WHEEL CYLINDER ASSY LEFT 1 PC 5,598.05
7 REAR WHEEL CYLINDER ASSY RIGHT 1 PC 5,598.05
8 BRAKE FLUID 2 PC 317.05 634.10
9 SEAL OIL-AXLE 1 PC 753.05
10 SEAL GREASE 1 PC 752.05
11 LTR DIFFERENTIAL GEAR OIL 1 PC 4,772.05
12 SET FRONT BRAKE PAD 1 PC 6,472.05
13 FRONT PARK LIGHT BULB 2 PC 135.03 270.06
14 PLATE LIGHT BULB 2 PC 135.03 270.06
15 CLUTCH DISC 1 PC 13,089.05
16 CLUTCH COVER 1 PC 13,954.05
17 RELEASE BEARING 1 PC 2,321.05
18 PILOT BUSHING 1 PC 284.05
19 BRAKE CLEANER 1 PC 362.05
20 LTR M/T GEAR OIL 1 PC 830.05
TOTAL 100,676.81
Total amount in words :

ACCEPTANCE INSPECTION

Date Received DateDate Inspected __________________________

X Complete Inspected, verified & found OK

As to quantity & specifications
Partial

Inspector/s

Property Officer
0.05 2,800.00 2,800.05
0.05 2,800.00 2,800.05
0.05 2,000.00 2,000.05
0.05 700.00 700.05
0.05 1,700.00 1,700.05
0.05 1,300.00 1,300.05
0.05 1,200.00 1,200.05
0.05 2,500.00 2,500.05

0.05 650.00 650.05

3,500.05
2,340.05
0.05 3,500.00

0.05 2,340.00

0.05 1,364.00 1,364.05

0.05 8,984.00 8,984.05
3,932.00 3,932.24
0.05 4,671.00 4,671.05
0.05 4,275.00 4,275.05
0.05 5,598.00 317 5,598.05
0.05 5,598.00 5,598.05
634.00 634.10
0.05 753.00 753.05
0.05 752.00 752.05
0.05 4,772.00 4,772.05
0.05 6,472.00 6,472.05
270.00 270.06
270.00 270.06
0.05 13,089.00 13,089.05
0.05 13,954.00 13,954.05
0.05 2,321.00 2,321.05
0.05 284.00 284.05
0.05 362.00 362.05
0.05 830.00 830.05
100,675.00 100,676.81