Republic of the Philippines

Department of Education
Caraga Administrative Region

DIVISION OF SURIGAO DEL SUR

Tandag
MANA PRINTING
MANGAGOY, BISLIG CITY ,Surigao del Sur

5/30/2015
Date

Sir/Madam:
Please quote your price of item/articles listed below:
ITEM No. QUANTITY

UNIT

PC

SUPPLIES/MATERIALS/ITEMS

TARPAULIN 2X3 K-12 READY

UNIT PRICE

260.00

Sealed price quotations on the items/articles named above will be received in this Office, Supply Secton until
11:00 A.M. ______________________ at which time and place price quotation sealed envelope will be opened.

Very truly yours,

CHANIELOU J. MARTINEZ
SCHOOL HEAD

Sir/Madam:
Our prices are quoted opposite every items above.
________________________
Signature of Dealer

PURCHASE REQUEST
Department of Education
Agency

Department:
Section:

Department of Education

Stock No.

Unit

PC
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

PR No.:
SAI No.:

Item Description

Quantity

TARPAULIN 2X3 K-12 READY

Unit
Cost

Total Cost

240.00

1
0

Date:
Date:

P
Purpose:

240.00
240.00

FOR SCHOOL TARPAULIN ON K-12 READY

Requested by:

Approved by:

Signature :
Printed Name :
Designation :

CHANIELOU J. MARTINEZ

ELIZABETH N. GARDONES, Ph. D.

School Principal/Head

Public Schools District Supervisor

Annex G-5

PURCHASE ORDER
DepED - Surigao del Sur Division
Balilahan, Mabua, Tandag City, Surigao del Sur
Supplier
Address

PHOTO PLUS LAB & STUDIO

SAN. FRANCISCO, AGUSAN SDS

TIN:

P.O. No.
Date :
Mode of Procurement :

Gentlemen :

Please furnish this office the following articles subject to the terms and
conditions contained herein :

Place of Delivery :

Delivery Term :

Date of Delivery :

Payment Term :

Stock No.
1

Unit

Description

PC
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

TARPAULIN 2X3 ON K-12 READY

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

Quantity

1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

Unit Cost

240.00

AMOUNT

240.00

240.00

(Total Amount in words)

In case of failure to make the 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.
Very truly yours,
Conforme :

CHANIELOU J. MARTINEZ
PHOTO PLUS LAB & STUDIO

Schools Division Superintendent

(Signature over printed name)

(Date)

Funds Available :

Amount :
ALOBS No. :

MELVYN C. RULETE, CPA

Accountant II

Annex G-7

INSPECTION & ACCEPTANCE REPORT

DEPARTMENT OF EDUCATION
(Agency)

Supplier:

IAR No.:
Date:

PO No.

Stock No.

Unit

Date:

Description
TARPAULIN 2X3 ON K-12 READY
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

INSPECTION
Date Inspected :
X

DR No.

Quantity

ACCEPTANCE
Date Received :

Inspected, verified and found OK

as to quantity and specifications

Complete
Partial

_____________

____________
Inspectorate Committee

_______________
Property Custodian

Republic of the Philippines

DEPARTMENT OF EDUCATION
Caraga Administrative Region
Division of Surigao del Sur
Tandag

DEPARTMENT OF EDUCATION - SURIGAO DEL SUR

Agency or Office

ABSTRACT OF SEALED QUOTATIONS

Item
Qty.
No.

1
0
0
0
0
0
0
0
0
0
0
0
0
0

Unit

PC
0
0
0
0
0
0
0
0
0
0
0
0
0

PAR T I C U LAR S

TARPAULIN 2X3 ON K-12 READY

0
0
0
0
0
0
0
0
0
0
0
0
0

PHOTO PLUS
Unit Price
Total

240.00
-

240.00
-

NAMES OF DEALERS OR SUPPLIERS:

AFFORDALE ENT.
MANA PRINTING
Unit Price
Total
Unit Price
Total

250.00

WE HEREBY CERTIFY that the prices appearing hereon are to the best of our
knowledge reasonable being the lowest obtainable in the locality at the time of
purchase.

250.00
-

260.00

260.00
-

CERTIFIED CORRECT:
_________________
Rep. of the Auditor

RUBI ANN E. OLVIDA

MEMBERS PRICE VERIFICATION COMMITTEE:

CHANIELOU J. MARTINEZ

SCHOOL PROPERTY CUSTODIAN

_________________

BAC CHAIRMAN

APPROVED:
SARAH JEAN D. BALABA
Co-CHAIRMAN

ROGITA A. CERVANTES
BAC MEMBER

ZENAIDA S. LINDO
BAC MEMBER

Page 5

COA Auditor

ELIZABETH N. GARDONES, Ph. D.

Public Schools District Supervisor

ACKNOWLEDGEMENT RECEIPT FOR EQUIPMENT

Number : ____________

Republic of the Philippines

Department of Education
Caraga Administrative Region
Division of Surigao del Sur
Tandag

Item
No.
1.

Unit

Quantity

Description

Property
No.

Unit
Cost

Total
Cost

TOTAL
Received by:

Received From:

Signature Over Printed Name

Signature Over Printed Name

Position/Office

Position

Date

Date

Annex G-9

REQUISITION AND ISSUE SLIP

Department of Education
(Agency)

Division
Office

Surigao del Sur

Responsibility Center
Code
___________________________

DEPED

RIS No.
SAI No.

Requisition
Unit of
Stock No.
Issue

Purpose :

PC

Date

Issuance

Item No.

Quantity

TARPAULIN PRINTING FOR " K-12 READY"

2X3

Quantity

Remarks

FOR SCHOOL TARPAULIN ON K-12 READINESS

Requested by:

Signature
Printed Name
Designation

5/30/2015

CHANIELOU J. MARTINEZ
School Principal/Head

Approved by :
ELIZABETH N. GARDONES, Ph. D.
Public Sch. District Supervisor

Issued by :
RUBI ANN E. OLVIDA
Property Custodian

Received by:
CHANIELOU J. MARTINEZ

SCHOOL HEAD

Gen Form N. 61-A

REPORT OF WASTE MATERIALS

Name of Local Government Unit:
Department of Education - SEDIP
Department/Office:
Place of Storage:
DepED Storeroom
Item
No.

Qty.

1.

Unit of
Issue

Unit
Cost

Total
Cost

unit

Date:

October 16, 2009

Record of Sales
O.R. No.
Amount

Description

Car Aircon Compressor

(SEDIP Strada vehicle - CSV-105)

TOTAL

TOTAL
CERTIFIED CORRECT

ANTONIO V. SALAZAR

FE C. VALEROSO, CESO VI

Supply Officer-Designate

Schools Division Superintendent

CERTIFICATE OF INSPECTION
This is to certify that I have this ________ days of ___________________, 2003 inspected the above-listed
supplies/property and found the same to be ( with or without value) ______________________________.

CHERYL C. DIME
State Auditor III

CERTIFICATE OF DISPOSAL
This is to certify that the above listed-supplies/property were disposed of as follows: __________________.

ANTONIO V. SALAZAR

FE C. VALEROSO, CESO VI

Supply Officer-Designate

Schools Division Superintendent

Witnessed by:

CHERYL C. DIME
State Auditor III

Republic of the Philippines

Department of Education
Caraga Administrative Region
DIVISION OF SURIGAO DEL SUR
Tandag

REPORT OF PRE-INSPECTION
DESCRIPTION OF PROPERTY:
Type

Brand/Model

Serial/Engine No.

Property No.

Acquisition Cost

Acquisition Date

Date of Last Repair

Nature of Last Repair

COMPLAINTS/DEFECTS
Nature and scope of work to be done

Requested by:

(Date)
PRE-REPAIR:
Findings:

PRE-INSPECTED BY:

NOTED BY:

(Date)

(Date)

No.______________

JOB ORDER FOR SERVICING

Republic of the Philippines

DEPARTMENT OF EDUCATION

Name of Service Center : ____________________________

Caraga Administrative Region

Address : _________________________________________

Division of Surigao del Sur

Tel. No.: __________________________________________

Tandag

Date received of job order : ___________________________

Quantity : _________________________________________
Items/Accessories : _________________________________

Requesting Officer:_____________________ _________________________________________________

Section Office:_________________________ _________________________________________________
Tel. No.: ______________________________ Serial No. : ________________________________________
Date: ________________________________ Complain : ________________________________________
Service Report : ____________________________________
_________________________________________________
Nature & scope of work to be done:

_________________________________________________

____________________________________ Parts : ___________________________________________

____________________________________ _________________________________________________
__________________________________
Summary: Parts : P
Labor :
Signature of requesting officer:

Tax :
Total : P

______________________________

Released by :

Signature Over Printed Name

Appendix 58

LIQUIDATION REPORT
Department of Education
Agency

No :
Date :
Responsibility Center
Code :

DATE

OR No.

PARTICULARS

Amount

2/21/2015

1457

Liquidation of cash advance for CRAM-Socialization

Butuan City Division at SDSSU Campus dated Feb.
22, 2015 per supporting documents hereto attached
in the amount of . . . . . . .

20,000.00

TOTAL AMOUNT SPENT

20,000.00

AMOUNT OF CASH ADVANCE PER DV NO.

____________

Ch#

20,000.00

DTD.

AMOUNT REFUNDED PER OR NO. __________ DTD. _____________

AMOUNT TO BE REIMBURSED
[A] Certified : Correctness of the
above data

[B] Certified : Purpose of

[C] Cetified : Supporting documents

cash advance accomplished

complete and proper

MARILOU P. AMIGO MARILOU B. DEDUMO, Ph. D., CESO VI

MELVYN C. RULETE _________
Claimant
Accountant II
JEV No.
Schools Division Superintendent

LIQUIDATION REPORT
Department of Education
Agency

No :
0
Date :
Responsibility Center
Code :

DATE

OR No.

PARTICULARS

Amount

2/21/2015

1457

Liquidation of cash advance for CRAM-Socialization

Butuan City Division at SDSSU Campus dated Feb.
22, 2015 per supporting documents hereto attached
in the amount of . . . . . . .

20,000.00

TOTAL AMOUNT SPENT

20,000.00

AMOUNT OF CASH ADVANCE PER DV NO.

____________

Ch#

20,000.00

DTD.

AMOUNT REFUNDED PER OR NO. __________ DTD. _____________

AMOUNT TO BE REIMBURSED
[A] Certified : Correctness of the
above data

MARILOU P. AMIGO
Claimant

[B] Certified : Purpose of travel/

cash advance accomplished

MARILOU B. DEDUMO, CESO VI

Schools Division Superintendent

[C] Cetified : Supporting documents

complete and proper

MELVYN C. RULETE _________

Accountant II
JEV No.

Republic of the Philippines

Department of Education
Caraga Administrative Region
DIVISION OF SURIGAO DEL SUR
Third Elementary Education Project
Tandag

REPORT OF DISBURSEMENTS
Check Nos. ___________ and ____________ dated ____________

DATE

Payee

Prepared by :

OR No.

Particulars

No. of Liters

Certified by :

________________________
Implementing School

________________________
District Supervisor

APPROVED :

FE C. VALEROSO, CESO VI
Schools Division Superintendent

Amount

PURCHASE REQUEST
Department of Education
Agency

Department:
Section:

Stock No. Unit

Department of Education
Medical & Dental

Item Description

PR No.:
SAI No.:

Quantity

caps

Amoxicillin (250mg)

200

caps

Amoxicillin (500mg)

200

Mefenamic Acid (250mg)

caps Mefenamic Acid (500mg)
tabs

Ibuprofen P. (Alaxan)

tabs
tabs

Paracetamol (Biogesic 500m 100

Neozep
200

tabs

Loratidine

50

tabs

Kremil - S

50

caps

Loperamide
Hyoscine HCL (Buscopan)
Bactroban cream 5g
Alcohol 500 ml
gauze 4 x 4
gauze 2 x 2
Aplosyn otic drops
Gentamicin eye ointment
efficascent (small)
Visine red
eye mo
omega pain killer

50
20
2
3
10
10
4
3
10
2
2
5

tube
bottle
pack
pack
pcs
tube
bottle
pcs
pcs
bottle

Unit
Cost

1/18/2011

Total Cost

200
200

caps

tabs

Date:
Date:

50

77.00
28.00
173.00
391.50
25.00

Availability of Funds:

MELVYN C. RULETE, CPA

Accountant II

P
Purpose:

To be use at the Medical Section

Requested by:
Signature :
Printed Name :
Designation :

Approved by:

MANTOVANNI C. DUEAS, MD

GREGORIA T. SU, PhD.

Medical Officer IV

Assistant Schools Division Superintendent

Officer-In-Charge