PURCHASE REQUEST

Fund Cluster: Trust Fund Capitation

Office/Section :_________ PR NO.:__________________ Date:_______________
Resoponsibilty Center Code:____________
Stock/Property No. Unit Item Description Quantity Unit Cost Total Cost
1 pc. white glue 1 110.00 110.00
2 pack pes. Cup 1 248.00 248.00
3 pc. Philip 1 230.00 230.00
4 puzzle mat & flower 210.00
5 plain sheet #26 1 150.00 150.00
6 drill bit 1 190.00 190.00
7 blind rivets 1 105.00 105.00
8

1,243.00

Purpose : Reimbursement of supplies used in RHU.

Requested by : Approved by:

Signature: __________________________ ____________________________
Printed Name: CARMEL MATHILDA B. LADEZA ANGELES R. CARLOTO II
Designation: Municipal Health Officer Municipal Mayor
320
 PURCHASE REQUEST

Entity Name: MTO Fund Cluster: General Fund

Office/Section :_________ PR NO.:__________________ Date:_______________
Resoponsibilty Center Code:_____________
Stock/Property No. Unit Item Description Quantity Unit Cost Total Cost
1 pc. outlet 1 159.00 159.00
2 pcs. T spoon 6 26.75 160.50
3 pcs. spoon 12 14.75 177.00
4 pcs. porcelain mug 10 25.00 250.00
5 pcs. home silvers spoon 1 129.75 129.75
6 pcs. tea fork 3 79.75 239.25
7 pcs. home silvers fork 1 129.75 129.75
8 pcs. dinner plate 6 59.75 358.50
9 pcs. cup & saucer 2 329.75 659.50
10 pcs. ocean tumbler 6 49.75 298.50
less 10% discount (29.88)

2,531.87

Purpose : Mun. Treasurer's Office use.

Requested by : Approved by:

Signature: __________________________ ____________________________
Printed Name: PRAXIDES C. ARCINO ANGELES R. CARLOTO II
Designation: OIC-Municipal Treasurer Municipal Mayor
 PURCHASE REQUEST

Entity Name: MTO Fund Cluster: General Fund

Office/Section :_________ PR NO.:__________________ Date:_______________
Resoponsibilty Center Code:_____________
Stock/Property No. Unit Item Description Quantity Unit Cost Total Cost
1 pc. Outlet 3 gang 1 70.00 70.00
2 pc. male plug 1 32.00 32.00
3 meter Flat Cord #16 5 28.00 140.00
4 pc. Stapler 1 105.00 105.00
5 boxes Stapler Wire 2 52.00 104.00
6 pc. Correction pen 1 58.00 58.00
7 pc. Packing tape 1 24.00 24.00
8 box Scotch tape 1 28.00 28.00
9 pcs. sign pen 1 25.00 25.00
10 pc. Glue 1 40.00 40.00
11 box ballpen 1 54.00 54.00
12 box HBW Scion 1 54.00 54.00
734.00

Purpose : Mun. Treasurer's Office use.

Requested by : Approved by:

Signature: __________________________ ____________________________
Printed Name: PRAXIDES C. ARCINO ANGELES R. CARLOTO II
Designation: Acting Municipal Treasurer Municipal Mayor
Entity Name: Mayor's Office Fund Cluster: General Fund
Office/Section :_________ PR NO.:__________________ Date:_______________
Resoponsibilty Center Code:____________
Stock/Property No. Unit Item Description Quantity Unit Cost Total Cost
1 sack half sack rice 1 1,200.00 1,200.00
2 case mineral water 15 225.00 3,375.00
3 pack monde mamon 10 132.00 1,320.00
4 pcs. mismo softdrinks 10 135.00 1,350.00
5 pcs. styro 2 29.00 58.00
6 pack spoon 2 20.00 40.00
7 pack oil 1 60.00 60.00
8 pack suka 2 6.00 12.00
9 pack toyo 2 8.00 16.00
10 pack magic sarap 1 32.00 32.00
11 meters trapal 15 100.00 1,500.00
12 kls. Fish 10 160.00 1,600.00
13 kls. Pork 6 170.00 1,020.00
14 kls. dress chicken 5 160.00 800.00
15 fire wood & oling 517.00

12,900.00

Purpose : For MDRRM Volunteers on November 1-2, 2017.

Requested by : Approved by:

Signature: __________________________ ____________________________
Printed Name: ANGELES R. CARLOTO II ANGELES R. CARLOTO II
Designation: Municipal Mayor Municipal Mayor
 PURCHASE REQUEST

Entity Name: Market Fund Cluster: General Fund

Office/Section :_________ PR NO.:__________________ Date:_______________
Resoponsibilty Center Code:_____________
Stock/Property No. Unit Item Description Quantity Unit Cost Total Cost
1 kls. chlorine 3.5 90.00 315.00
2 doz. surf powder 1/2 29.50 29.50
3 doz. surf powder 2 59.00 118.00
4 pcs. doormat 3 38.00 114.00

576.50

Purpose : For Public market and Toilet use.

Requested by : Approved by:

Signature: __________________________ ____________________________
Printed Name: ANGELES R. CARLOTO II ANGELES R. CARLOTO II
Designation: Municipal Mayor Municipal Mayor
 PURCHASE REQUEST

Entity Name: DEP ED Fund Cluster: General Fund

Office/Section :_________ PR NO.:__________________ Date:_______________
Resoponsibilty Center Code:____________
Stock/Property No. Unit Item Description Quantity Unit Cost Total Cost
1 pcs. T - shirt Apple green 24 166.66 4,000.00
2 pcs. Square pants 10 75.00 750.00
3 pcs. LDS Shoes 6 130.00 780.00
4 pcs. LDS Sandal 3 60.00 180.00
5 pc. Kids shoes 1 145.00
6 pcs. Off shoulder H.S. F Wear 5 305.00 1,525.00
7 pc. make up kit 149.00
8 pc. sponge 29.00
9 pc. BB Cream 39.00
10 pcs. sleeveless 3 267.63 802.87
11 pc. clothe 1 99.13 99.13
12 pc. pencil case 2 40.00 80.00
13 pc. correction tape 1 17.00 17.00
14 pc. glue 1 20.00 20.00
15 pc. hair pliat 2 10.00 20.00
16 pcs. aspen exce 2 7.00 14.00
17 pck. 978e-20 ALPH Card 1 50.00 50.00
18 pk. Cards 1 30.00 30.00
19 pcs. SS3022- SANRIO 2 20.00 40.00
20 pc. 24815-2 #2 PINS 1 22.00 22.00
21 pcs. M-18 XMAS DÉCOR 10 15.00 150.00
22 pcs. Spiderman Mask 2 27.00 54.00
23 asstd grocery 2,299.50
24 kls. rice 5 50.00 250.00
25 pc. tarpaulin 3x3 2 400.00 800.00
26 pcs. T shirt printing uniform 24 100.00 2,400.00
27 pcs. Printing dancer's uniform 18 100.00 1,800.00
28 lit Diesel 11.82 35.35 418.00
29 lit Diesel 14.37 34.79 500.00
17,463.50

Purpose : Budgetary Expenses for Provincial meet and Special Games 6th Division SPED Festival
for CSNs on October 12-14 and 28-31, 2017.

Requested by : Approved by:

Signature: __________________________ ____________________________
Printed Name: VIVIAN N. UBAGAN ANGELES R. CARLOTO II
Designation: MSWDO Municipal Mayor
5,040.00 ticket van
418.00 gasoline
500.00 gasoline
497.00 meals
575.00 meals
230.00 meals
 7,260.00

24,723.50

24,723.50
(1,276.50)
 PURCHASE REQUEST

Entity Name: RHU Fund Cluster: TF-PFPR

Office/Section :_________ PR NO.:__________________ Date:_______________
Resoponsibilty Center Code:____________
Stock/Property No. Unit Item Description Quantity Unit Cost Total Cost
1 pcs. Toilet Bowl Molder 5 3,500.00 17,500.00

17,500.00

Purpose : For RHU use.

Requested by : Approved by:

Signature: __________________________ ____________________________
Printed Name: CARMEL MATHILDA B. LADEZA ANGELES R. CARLOTO II
Designation: Municipal Health Officer Municipal Mayor
 PURCHASE REQUEST

Entity Name: MTO Fund Cluster: General Fund

Office/Section :_________ PR NO.:__________________ Date:_______________
Resoponsibilty Center Code:_____________
Stock/Property No. Unit Item Description Quantity Unit Cost Total Cost
1 box rubber band # 16 2 100.00 200.00
2 pcs folder long/F4 100 3.00 300.00
3 pcs. folder expanded 100 8.00 800.00
4 reams bond paper long 10 131.50 1,315.00
5 bot. elmers glue 2 30.00 60.00
6 box sign pen 1 200.00 200.00
7 box staple wire#35 6 100.00 600.00
8 pcs. record book 300 leaves 5 80.00 400.00
9 bot. printer ink (L210/220) black 4 350.00 1,400.00
10 pcs. hp cartridge black 704 2 500.00 1,000.00
11 set epson colored 1 750.00 750.00
12 pcs. correction pen 2 45.00 90.00
13 pc. scissor big 1 85.00 85.00
14 bot. stamp pad ink 2 100.00 200.00
15 pc. dust pan 1 200.00 200.00
16 pcs. rubbing alcohol 3 60.00 180.00

7,780.00

Purpose : Mun. Treasurer's Office use.

Requested by : Approved by:

Signature: __________________________ ____________________________
Printed Name: PRAXIDES C. ARCINO ANGELES R. CARLOTO II
Designation: OIC-Municipal Treasurer Municipal Mayor
 PURCHASE REQUEST

Entity Name: RHU Fund Cluster: PFPR

Office/Section :_________ PR NO.:__________________ Date:_______________
Resoponsibilty Center Code:____________
Stock/Property No. Unit Item Description Quantity Unit Cost Total Cost
1 pcs. disposable glass 10 25.00 250.00
2 gal. ultra sound gel 1 1,750.00 1,750.00
3 set urine strips 1 800.00 800.00
4 set typing sera 1 1,000.00 1,000.00
5 cylinder Aviator refill 2 280.00 560.00

4,360.00

Purpose : RHU use.

Requested by : Approved by:

Signature: __________________________ ____________________________
Printed Name: CARMEL MATHILDA B. LADEZA ANGELES R. CARLOTO II
Designation: Municipal Health Officer Municipal Mayor
 PURCHASE REQUEST

Entity Name: DSDWO Fund Cluster: General Fund

Office/Section :_________ PR NO.:__________________ Date:_______________
Resoponsibilty Center Code:____________
Stock/Property No. Unit Item Description Quantity Unit Cost Total Cost
1 pax 4 meals and 8 snacks 30 250.00 30,000.00
2 pcs. plastic rule 24 10.00 240.00
3 pcs. expanded envelop 24 13.00 312.00
4 pcs. pencil 24 7.00 168.00
5 pcs. pentel pen 10 40.00 400.00
6 reams construction paper 2 200.00 400.00
7 pcs. scissors 26 20.00 520.00
8 pcs. lesson plan 24 75.00 1,800.00
9 packs scented paper 4 70.00 280.00
10 pcs. cartolina 48 10.00 480.00
11 pc. tarpaulin 3x4 2 700.00 1,400.00

36,000.00

Purpose : For 4 Day Roll-out Trainig for CDWs on NELC.

Requested by : Approved by:

Signature: __________________________ ____________________________
Printed Name: VIVIAN N. UBAGAN ANGELES R. CARLOTO II
Designation: MSWDO Municipal Mayor
Mayors Office RHU Fund Cluster: Trust Fund -PFPR
Office/Section :_________ PR NO.:__________________ Date:_______________
Resoponsibilty Center Code:____________
Stock/Property No. Unit Item Description Quantity Unit Cost Total Cost
1 pcs. burger 100 32.00 3,200.00
2 pcs. mineral water 120 15.50 1,860.00
3 pcs. C2 juice 120 14.50 1,740.00
4 pack biscuits 24 50.00 1,200.00
5 pax meals 40 175.00 7,000.00

15,000.00

Purpose : For Mass Blood Donation on September 26, 2017.

Requested by : Approved by:

Signature: __________________________ ____________________________
Printed Name: CARMEL MATHILDA B. LADEZA ANGELES R. CARLOTO II
Designation: Municipal Health Officer Municipal Mayor
 PURCHASE REQUEST

Mayors Office: Mayor's Office Fund Cluster: General Fund

Office/Section :_________ PR NO.:__________________ Date:_______________
Resoponsibilty Center Code:____________
Stock/Property No. Unit Item Description Quantity Unit Cost Total Cost
1 mtrs. cloth white 20 65.00 1,300.00
2 pcs. ballpen 60 6.00 360.00
3 pcs. manila paper 5 6.00 30.00
4 pcs. T shirt 65 212.30 13,800.00
5 pcs. ink, black,cyan 8 300.00 2,400.00
6 reams bond paper 14 112.15 1,570.10
7 cart ink cart,epson yellow 2 272.00 544.00
8 cart ink cart,epson cyan 2 272.00 544.00
9 pack paper parchment 1 97.80 97.80
10 pcs. notebook, stenographer, spiral 60 13.00 780.00
11 pcs. marker,permanent 5 10.25 51.25
12 box fastener,metal 70m 1 61.00 61.00
13 room Room rental( 4 night) 4 600.00 2,400.00
14 pcs. cartolina 40 12.00 480.00
15 pcs. manila paper 40 6.00 240.00
16 pcs. pilot pen 12 30.00 360.00
17 pcs. masking tape 6 30.00 180.00
18 pcs. marker pen 6 45.00 270.00
19 pcs. packing tape 3 40.00 120.00
20 meters cellophane cover 40 18.00 720.00
21 box staple wire 2 95.00 190.00
22 pcs. stapler big 3 250.00 750.00
23 pcs. scissors 3 115.00 345.00
24 case coke 8 oz 279 10.00 2,790.00
25 box juice 360 10.00 3,600.00
26 asstd. Bread 3,600.00
27 sack rice 2 1,200.00 2,400.00
28 kls. pork 40 170.00 6,800.00
29 kls. dressed chicken 50 150.00 7,500.00
30 kls. fish 20 250.00 5,000.00
31 fuits 1,500.00
32 spices 2,000.00
33 lechon 2 4,800.00 9,600.00
34 kls. beef 40 280.00 11,200.00
35 labor 2,400.00

Sub-Total 85,983.15

Purpose : Supplies use for 3 Day Basic Incident Command System Training Couse on Sept. 18-20, 2017

Requested by : Approved by:

Signature: __________________________ ____________________________
Printed Name: ANGELES R. CARLOTO II ANGELES R. CARLOTO II
Designation: Municipal Mayor Municipal Mayor
Mayors Office Fund Cluster: General Fund
Office/Section :_________ PR NO.:__________________ Date:_______________
Resoponsibilty Center Code:____________
Stock/Property No. Unit Item Description Quantity Unit Cost Total Cost
85,983.15
-
-
-
-
-
-
-
-
-
-
-

-
-
-
-
-
-

-
-
-
-
-
-
-
-
-
-
-
-
-

85,983.15

Purpose : For Civil Service Family Day September 9, 2017.

 Requested by : Approved by:
Signature: __________________________ ____________________________
Printed Name: ANGELES R. CARLOTO II ANGELES R. CARLOTO II
Designation: Municipal Mayor Municipal Mayor
3,648.15

4,216.85
 PURCHASE REQUEST

Mayors Office Fund Cluster: General Fund

Office/Section :_________ PR NO.:__________________ Date:_______________
Resoponsibilty Center Code:_____________
Stock/Property No. Unit Item Description Quantity Unit Cost Total Cost
1 mtr Geena Cloth 4 30.00 120.00
2 pcs. T shirt 226 90.00 20,340.00
3 pcs. Tub 50L 2 200.00 400.00
4 set Spag w/sauce 5 155.00 775.00
5 box cheese 5 48.00 240.00
6 kl. hotdog 2 100.00 200.00
7 can Liberty 5 41.00 205.00
8 box all purpose 2 48.00 96.00
9 can Corned Beef 5 44.00 220.00
10 pcs. long balloons 12 13.50 162.00
11 pcs. p balloons 15 17.00 255.00
12 pcs. Tulco paint 23 196.78 4,526.00
13 can fruit cocktail 3 181.95 545.85
14 jar eden magic 3.5L 1 502.40 502.40
15 box eden cheese 450g 4 120.00 480.00
16 pack Jolly claro palm olein 2 liters 1 176.50 176.50
17 pack macaroni 1kg. 4 122.00 488.00
18 pack macaroni elbow 1kg 1 122.00 122.00
19 kl. central 1 33.00 33.00
20 kl. mascobado 1/2 45.00 22.50
21 can liberty condense 300ml 10 40.50 405.00
22 can ram green peas 10 26.45 264.50
23 can alaska condensa 3 40.00 120.00
24 can champion black beans 3 17.75 53.25
25 bot. papa catsup 4kg. 1 144.75 144.75
26 bot. ufc catsup 2kg. 1 86.20 86.20
27 bag ajinomoto 50g 1 54.00 54.00
28 bag maggi magic sinigang 10 4.20 42.00
29 pack maggi magic sinigang 2 8.00 16.00
30 kls patata 4 70.00 280.00
31 kls. sibolyon 3 70.00 210.00
32 kls carrots 4 60.00 240.00
33 kls. ahos 3 100.00 300.00
34 kls bana blossom 1 190.00 190.00
35 kl asin 1 40.00 40.00
36 pamenta 250.00
37 siboyas dahunan 100.00
38 pcs. T shirt small 13 85.00 1,105.00
39 pcs. T shirt XL 21 85.00 1,785.00
40 pcs. Packing tape 1 25.00 25.00
41 ml Mayonaise 2 235.00 470.00
42 bot. sandwich spread 3 201.00 603.00
43 pc. DM Slices 1 77.00 77.00
44 bot. kaong 4 143.00 572.00
Sub-Total 37,341.95

Purpose : For Civil Service Family Day September 9, 2017.

Requested by : Approved by:

Signature: __________________________ ____________________________
Printed Name: ANGELES R. CARLOTO II ANGELES R. CARLOTO II
Designation: Municipal Mayor Municipal Mayor
 PURCHASE REQUEST
Mayors Office Fund Cluster: General Fund
Office/Section :_________ PR NO.:__________________ Date:_______________
Resoponsibilty Center Code:_____________
Stock/Property No. Unit Item Description Quantity Unit Cost Total Cost
sub-total 37,341.95
45 bot nata de coco 3 39.00 117.00
46 kl. macaroni 1 70.00 70.00
47 can DM Slices 4 77.00 308.00
48 pack raisins 100g 1 79.50 79.50
49 pc. cheeze 470g 1 115.00 115.00
50 can liberty 300ml 18 41.00 738.00
51 can can goods 4 180.00 720.00
52 pack nestle cream 300g 2 65.00 130.00
53 pack mag apd 250ml 25 47.50 1,187.50
54 can daisy condense 390g 6 29.50 177.00
55 case drinking water 3 350.00 1,050.00
56 cake and cup cakes 1,350.00
57 pc. frame 1 110.00 110.00
58 pc. stick caserole 1 663.00 663.00
59 pc. pioneer screen printing 1 585.00 585.00
60 bot werlook 1 195.00 195.00
61 pc. tulco 1 175.00 175.00
62 pc. durco 1 280.00 280.00
63 mtr cloth 4 32.00 128.00
64 sack rice 4 1,100.00 4,400.00
65 case 8 oz coke 18 175.00 3,150.00
66 kl. Oil 1 65.00 65.00
67 pack asin 2 8.00 16.00
68 pack ajinomoto 2 57.00 114.00
69 gal. soy sauce 2 118.00 236.00
70 gal. vinegar 1 115.00 115.00
71 pcs. black beans 12 20.00 240.00
72 pcs. drypeas 12 11.25 135.00
73 pcs. pork and beans 12 32.00 384.00
74 pcs. tomatoe sauce 12 21.66 260.00
75 pcs. pine apple slice 8 26.00 208.00
76 gal. catsup 1 172.00 172.00
77 kl. flour 1 35.00 35.00
78 kl. ahos 1 90.00 90.00
79 kl. sibolyon 1 80.00 80.00
80 kls. pig 130 100.00 13,000.00
81 kls. fish 20 180.00 3,600.00
82 kls. pig 125 100.00 12,500.00
83 kls. chicken 30 175.00 5,250.00
84 kls. pig 60 100.00 6,000.00
Sub total 95,569.95

Purpose : For Civil Service Family Day September 9, 2017.

Requested by : Approved by:

Signature: __________________________ ____________________________
Printed Name: ANGELES R. CARLOTO II ANGELES R. CARLOTO II
Designation: Municipal Mayor Municipal Mayor

PURCHASE REQUEST

Mayors Office Fund Cluster: General Fund

Office/Section :_________ PR NO.:__________________ Date:_______________
Resoponsibilty Center Code:_____________
Stock/Property No. Unit Item Description Quantity Unit Cost Total Cost
sub-total 95,569.95
85 pc. tarpaulin 4x5 1 1,400.00 1,400.00
86 pcs. Puto 800 2.50 2,000.00
87 pc. cake 1 650.00 650.00
88 pc. lechon 1 4,700.00 4,700.00
89 rental sound system 1,500.00
90 kl fish 2 101.50 203.00
91 boat hired to bayangan island 1,000.00
92 meters trapal 10 98.00 980.00
93 ball strawless 1 120.00 120.00
94 meals 1,580.00
95 pack styro 30 38.00 1,140.00
96 meters Pepsi 25 15.00 375.00
97 assorted items 1,239.00
98 Firewood & uling 1,500.00
99 case softdrinks 8 175.00 1,400.00
100 bot wine 6 250.00 1,500.00
100 liter Diesel 15.38 32.50 500.00

Sub-Total 117,356.95

Purpose : For Civil Service Family Day September 9, 2017.

Requested by : Approved by:

Signature: __________________________ ____________________________
Printed Name: ANGELES R. CARLOTO II ANGELES R. CARLOTO II
Designation: Municipal Mayor Municipal Mayor
 7,950.00 contract
5,000.00 hon.
12,200.00 prizes
 25,150.00

50,430.05

117,402.95
46.00
28,643.05

7,950.00
5,000.00
12,200.00
25,150.00
 PURCHASE REQUEST

Entity Name: RHU Fund Cluster: PFPR

Office/Section :_________ PR NO.:__________________ Date:_______________
Resoponsibilty Center Code:____________
Stock/Property No. Unit Item Description Quantity Unit Cost Total Cost
1 pcs. Ordinary Plywood 1/4 15 350.00 5,250.00
2 sheets Marine Plywood 1/2 6 845.00 5,070.00
3 kl. cwn #4 1 70.00 70.00
4 kl. cwn #3 1 70.00 70.00
5 kl. cwn #2 1 80.00 80.00
6 kl. cwn # 1 1/2 1 80.00 80.00
7 kl. tie wire 1 85.00 85.00
8 gal. Davies Flatwall enamel white 1 800.00 800.00
9 pcs. Baby roller # 4 2 90.00 180.00
10 pc. Paint Brush #3 1 80.00 80.00
11 pc. Measuring tape 5m 1 150.00 150.00
12 bot. G.I. Paint Thinner 5 70.00 350.00
13 bot. Mayon Lac. Thinner 1 80.00 80.00
14 gal. Triton Flatwall enamel 1 680.00 680.00

13,025.00

Purpose : For RHU Tsekap Caravan.

Requested by : Approved by:

Signature: __________________________ ____________________________
Printed Name: CARMEL MATHILDA B. LADEZA ANGELES R. CARLOTO II
Designation: Municipal Health Officer Municipal Mayor
 PURCHASE REQUEST

MCTC Fund Cluster: General Fund

Office/Section :_________ PR NO.:__________________ Date:_______________
Responsibilty Center Code:_____________
Stock/Property No. Unit Item Description Quantity Unit Cost Total Cost
1 box Blank Tape (sony 90) 6 500.00 3,000.00
2 doz. Double batteries 5 220.00 1,100.00
3 reams colored bond paper yellow 10 250.00 2,500.00
4 reams colored bond paper yellow 10 250.00 2,500.00
5 pads yellow 30 30.00 900.00

10,000.00

Purpose : For RTC use.

Requested by : Approved by:

Signature: __________________________ ____________________________
Printed Name: OSCAR D. TOMARONG ANGELES R. CARLOTO II
Designation: RTC-JUDGE Municipal Mayor
 PURCHASE REQUEST

Entity Name: MTO Fund Cluster: General Fund

Office/Section :_________ PR NO.:__________________ Date:_______________
Resoponsibilty Center Code:_____________
Stock/Property No. Unit Item Description Quantity Unit Cost Total Cost
1 unit Laptop, Processor Core 2 Duo or 1 28,000.00
dual core
RAM: 4GB,HDD 320GB
Operating System Windows 7 or newer (64bit)
Browser: Google Chrome v30 or higher, or
Mozilla Firefox v21.0 or higher

28,000.00

Purpose : Mun. Treasurer's Office use.

Requested by : Approved by:

Signature: __________________________ ____________________________
Printed Name: PRAXIDES C. ARCINO ANGELES R. CARLOTO II
Designation: OIC-Municipal Treasurer Municipal Mayor
 PURCHASE REQUEST

Entity Name: MPS Fund Cluster: General Fund

Office/Section :_________ PR NO.:__________________ Date:_______________
Resoponsibilty Center Code:____________
Stock/Property No. Unit Item Description Quantity Unit Cost Total Cost
1 pack Folder, Tagboard, for A4 size documents 2 191.50 383.00
2 reams Bond Paper A4 25 112.15 2,803.75
3 reams Bond Paper Long 5 131.50 657.50

3,844.25

Purpose : Mun. Police Station use.

Requested by : Approved by:

Signature: __________________________ ____________________________
Printed Name: PI RENE B. SAGAN ANGELES R. CARLOTO II
Designation: Officer In-Charge Municipal Mayor
 PURCHASE REQUEST

Entity Name: RHU Fund Cluster: PFPR

Office/Section :_________ PR NO.:__________________ Date:_______________
Resoponsibilty Center Code:____________
Stock/Property No. Unit Item Description Quantity Unit Cost Total Cost
1 amp rubber 20 9.00 180.00
2 pc. pvc faucet 1 35.00 35.00
3 pc. teplon 1 20.25 20.25
4 pack Salad cup 3 45.00 135.00
5 pack Ivory Long 2 60.00 120.00
6 ream Folder Long 2 475.00 950.00
7 pc. Water Jug 1 218.00 218.00
8 pack photo paper 1 95.00 95.00
9 box paper fastener 5 45.00 225.00
10 box glue 1 420.00 420.00
11 box pencil 1 72.00 72.00
12 pcs. correction 1 110.00 110.00
13 pcs. correction tape refill 2 65.00 130.00
14 pc. Flexible Hose 1 132.00 132.00
15 pcs. Cylinder Medical Aviator 3 280.00 840.00

3,682.25

Purpose : For RHU use.

Requested by : Approved by:

Signature: __________________________ ____________________________
Printed Name: CARMEL MATHILDA B. LADEZA ANGELES R. CARLOTO II
Designation: Municipal Health Officer Municipal Mayor
 PURCHASE REQUEST

Entity Name: MTO Fund Cluster: General Fund

Office/Section :_________ PR NO.:__________________ Date:_______________
Resoponsibilty Center Code:____________
Stock/Property No. Unit Item Description Quantity Unit Cost Total Cost
1 pack Folder, Tagboard, for A4 size documents 2 191.50 383.00

383.00

Purpose : Mun. Treasurer's Office use.

Requested by : Approved by:

Signature: __________________________ ____________________________
Printed Name: PRAXIDES C. ARCINO ANGELES R. CARLOTO II
Designation: OIC-Municipal Treasurer Municipal Mayor
 PURCHASE REQUEST

Entity Name: MTO Fund Cluster: General Fund

Office/Section :_________ PR NO.:__________________ Date:_______________
Resoponsibilty Center Code:____________
Stock/Property No. Unit Item Description Quantity Unit Cost Total Cost
1 pcs Adding Machine 3 1,500.00 4,500.00

4,500.00

Purpose : Mun. Treasurer's Office use.

Requested by : Approved by:

Signature: __________________________ ____________________________
Printed Name: PRAXIDES C. ARCINO ANGELES R. CARLOTO II
Designation: OIC-Municipal Treasurer Municipal Mayor
 PURCHASE REQUEST

Entity Name: Mayor's Office Fund Cluster: 20%

Office/Section :_________ PR NO.:__________________ Date:_______________
Resoponsibilty Center Code:____________
Stock/Property No. Unit Item Description Quantity Unit Cost Total Cost
1 gal Roofgard spanish red 1 700.00 700.00

700.00

Purpose : Counterpart to Multi Purpose Center Barangay Balacbaan,Tamp. Z.N.

Requested by : Approved by:

Signature: __________________________ ____________________________
Printed Name: ANGELES R. CARLOTO II ANGELES R. CARLOTO II
Designation: Municipal Mayor Municipal Mayor
 PURCHASE REQUEST

Entity Name: Mayor's Office Fund Cluster: Gen. Fund

Office/Section :_________ PR NO.:__________________ Date:_______________
Resoponsibilty Center Code:____________
Stock/Property No. Unit Item Description Quantity Unit Cost Total Cost
1 kls. Chlorine 4 85.00 340.00
2 pcs. surf powder 12 5.00 60.00
3 kilo chlorine 2 65.00 130.00
4 pcs. bukag 7 150.00 1,050.00

1,580.00

Purpose : Market Public Toilet.

Requested by : Approved by:

Signature: __________________________ ____________________________
Printed Name: ANGELES R. CARLOTO II ANGELES R. CARLOTO II
Designation: Municipal Mayor Municipal Mayor
 PURCHASE REQUEST

Entity Name: Mayor's Office Fund Cluster: 20%

Office/Section :_________ PR NO.:__________________ Date:_______________
Resoponsibilty Center Code:____________
Stock/Property No. Unit Item Description Quantity Unit Cost Total Cost
1 sheets Ordinary Plywood 1/2 5 750.00 3,750.00
2 sheet Marine 1/4 1 550.00 550.00
3 liter black boar Glatin 1 375.00 375.00
4 gal. Flat white Latex 1 530.00 530.00

5,205.00

Purpose : Counterpart to Multi Purpose Center Barangay Lawaan, Tamp. Z.N.

Requested by : Approved by:

Signature: __________________________ ____________________________
Printed Name: ANGELES R. CARLOTO II ANGELES R. CARLOTO II
Designation: Municipal Mayor Municipal Mayor
 PURCHASE REQUEST

Entity Name: Mayor Fund Cluster: 20%

Office/Section :_________ PR NO.:__________________ Date:_______________
Resoponsibilty Center Code:_____________
Stock/Property No. Unit Item Description Quantity Unit Cost Total Cost
1 pcs. 1/4 marine plywood 15 370.00 5,550.00
2 kls. #4 Com. Nails 6 75.00 450.00
3 kls. #2.5 com. Nails 4 75.00 300.00
4 kl. #1 com. Nail 1 80.00 80.00
5 pcs. 4x8x/1/4 clear glass 3 3,140.00 9,420.00
6 gal. flatwall enamel 5 750.00 3,750.00
7 gal. quick dry enamel 6 800.00 4,800.00
8 gal. Paint thinner 1 500.00 500.00
9 pc. Paint brush 1 80.00 80.00
10 pcs. #1.5 paint brush 2 35.00 70.00

Source of Fund: 20% Development Fund

25,000.00

Purpose : For Improvement of Situbo National High School Building.

Requested by : Approved by:

Signature: __________________________ ____________________________
Printed Name: ANGELES R. CARLOTO II ANGELES R. CARLOTO II
Designation: Municipal Mayor Municipal Mayor
 PURCHASE REQUEST

Entity Name: Mayor Fund Cluster: General Fund

Office/Section :_________ PR NO.:__________________ Date:_______________
Resoponsibilty Center Code:____________
Stock/Property No. Unit Item Description Quantity Unit Cost Total Cost
1 pcs. Styro 50 38.00 1,900.00
2 pack milo 600g 1 140.00 140.00
3 pack bear brand 900g 1 275.00 275.00
4 pcs. milk 10 27.00 270.00
5 pack butterkist 3 27.00 81.00
6 pack XO 5 30.00 150.00
7 pack MAXX 1 90.00 90.00
8 pack bear brand 1200g 1 360.00 360.00
9 pcs. Nescafe 100g 2 78.50 157.00
10 kl Milo 2 220.00 440.00
11 kl bear brand Adult 1 375.00 375.00
12 pcs. Fresh grape 6 26.00 156.00
13 pcs. Mr. Buko 10 18.00 180.00
14 kl. Sugar 1 48.00 48.00
15 box Zest O 29 61.00 1,769.00
16 box Zest O Plus mango 31 57.00 1,767.00
17 box Zest O Orange 200ml 140 56.00 7,840.00
18 case Fudgee bar bites 10 570.00 5,700.00
19 ream bufalo mini white 1 105.00 105.00
20 pack doowee donut 6 76.50 459.00
21 pc. panda barquillos stick 1 13.00 13.00
22 pc. Clover chips BBQ 2 36.50 73.00
23 pcs. dutch maid choco milk drink 2 23.75 47.50
24 case Fit n right 1 545.00 545.00
25 pcs. Rinbee 2 4.60 9.20
26 box thumbtacks 3 8.00 24.00
27 meters alfagina cloth 10 45.00 450.00
28 box pins 1 11.00 11.00
23,434.70

Purpose : Budgetary Expenses for Nutrition month celebration, July 24, 2017.

Requested by : Approved by:

Signature: __________________________ ____________________________
Printed Name: ANGELES R. CARLOTO II ANGELES R. CARLOTO II
Designation: Municipal Mayor Municipal Mayor
 PURCHASE REQUEST

Entity Name: Mun. Agriculture Fund Cluster: General Fund

Office/Section :_________ PR NO.:__________________ Date:_______________
Resoponsibilty Center Code:____________
Stock/Property No. Unit Item Description Quantity Unit Cost Total Cost
1 pcs Ink black 6 600.00 3,600.00
2 pc. Epson Ink blue 3 490.00 1,470.00
3 pc. Epson yellow 3 490.00 1,470.00

6,540.00

Purpose : Mun. Agriculture office use.

Requested by : Approved by:

Signature: __________________________ ____________________________
Printed Name: LUCITO P. CERNA ANGELES R. CARLOTO II
Designation: Municipal Agriculturist Municipal Mayor
 PURCHASE REQUEST

Entity Name: Mun. Agriculture Fund Cluster: General Fund

Office/Section :_________ PR NO.:__________________ Date:_______________
Resoponsibilty Center Code:____________
Stock/Property No. Unit Item Description Quantity Unit Cost Total Cost
1 reams bond paper long 4 125.00 500.00
2 reams short bond paper 4 108.85 435.40
3 pcs. correction tape 8mm 12 40.00 480.00
4 dozen ballpen blue/ block 2 150.00 300.00
5 dozen pencil mongol 1 80.00 80.00
6 pcs. folder long 50 8.00 400.00
7 pcs. folder short 50 7.00 350.00
8 box paper fastener 1 65.00 65.00
9 dozen staple wire 1 50.00 50.00

2,660.40

Purpose : Mun. Agriculture office use.

Requested by : Approved by:

Signature: __________________________ ____________________________
Printed Name: LUCITO P. CERNA ANGELES R. CARLOTO II
Designation: Municipal Agriculturist Municipal Mayor
 PURCHASE REQUEST

Entity Name: RHU Fund Cluster: Trust Fund Capitation

Office/Section :_________ PR NO.:__________________ Date:_______________
Resoponsibilty Center Code:____________
Stock/Property No. Unit Item Description Quantity Unit Cost Total Cost
1 pack Construction 20's 2 20.00 40.00
2 roll plastic tape 1 45.00 45.00
3 pc. double sided 1 30.00 30.00
4 ream construction 2 280.00 560.00
5 pcs. frame 5 65.00 325.00
6 pcs. frame 8 70.00 560.00
7 doz. filler mini ofron rose 2 43.00 86.00
8 mtrs. plastic charol 50 18.00 900.00
9 kls. stawless 2 80.00 160.00
10 pc. kabo 1 35.00 35.00
11 roll tie wire 1 300.00 300.00
12 kl. c.w.n. #1 1 53.00 53.00
13 kl. c.w.n. #3 1 47.00 47.00
14 kl. c.w.n. #4 1 46.00 46.00
15 pads pins 20 15.00 300.00
16 meters lei cloth assorted 20 66.90 1,338.00
17 pc. tarpaulin 1 1,000.00 1,000.00
18 pack glue stick 1 90.00 90.00
19 pcs. Gift Bag 20 9.00 180.00
20 pcs. metallic balloon 12 51.00 612.00
21 box thumbtacks 24 6.00 144.00
22 pcs. file folder 10 5.00 50.00
23 pcs. brown envelop 41 4.00 164.00
24 pcs. syrtone rose scented 4 38.00 152.00
25 pack asstd. Sunburst col paper 1 175.00 175.00
26 pack asstd. Dayglow col papers 1 205.00 205.00
27 pc. hairclamp 1 35.00 35.00
28 pcs. mirror 1 78.00 78.00
29 pcs. white glue 2 28.00 56.00
30 pcs. eagle glue 120g 3 22.00 66.00
31 pcs. scissor 3 38.00 114.00
32 pc. headband 1 15.00 15.00
33 pcs. packing tape 2 28.00 56.00
34 pc. office scissor 2 30.00 60.00
35 pcs. trans balloon 16 85.00 1,360.00

9,437.00

Purpose : Supplies for TSEKAP CARAVAN on June 27, 2017.

Requested by : Approved by:

Signature: __________________________ ____________________________
Printed Name: CARMEL MATHILDA B. LADEZA ANGELES R. CARLOTO II
Designation: Municipal Health Officer Municipal Mayor
 PURCHASE REQUEST

Entity Name: RHU Fund Cluster: Trust Fund Capitation

Office/Section :_________ PR NO.:__________________ Date:_______________
Resoponsibilty Center Code:____________
Stock/Property No. Unit Item Description Quantity Unit Cost Total Cost
1 reams Construction paper 2 280.00 560.00
2 pcs. metallic balloon 12 51.00 612.00
3 pcs. cart HP 7404 Colored 2 650.00 1,300.00
4 reams bond paper long 1 170.00 170.00
5 pcs. Epson Ink L110 black 4 580.00 2,320.00

4,962.00

Purpose : Supplies used during Advocacy on national Tuberculosos Program on May 25, 2017.

Requested by : Approved by:

Signature: __________________________ ____________________________
Printed Name: CARMEL MATHILDA B. LADEZA ANGELES R. CARLOTO II
Designation: Municipal Health Officer Municipal Mayor
 PURCHASE REQUEST

Entity Name: Mayor Fund Cluster: General Fund

Office/Section :_________ PR NO.:__________________ Date:_______________
Resoponsibilty Center Code:____________
Stock/Property No. Unit Item Description Quantity Unit Cost Total Cost
1 sack/25 kls. Rice 19 1,400.00 26,600.00

26,600.00

Purpose : For PNP,SCAA Camul, Sto. Niño Compaq on May 16 to June 05, 2018.

Requested by : Approved by:

Signature: __________________________ ____________________________
Printed Name: ANGELES R. CARLOTO II ANGELES R. CARLOTO II
Designation: Municipal Mayor Municipal Mayor
 PURCHASE REQUEST

Entity Name: SB Fund Cluster: General Fund

Office/Section :_________ PR NO.:__________________ Date:_______________
Resoponsibilty Center Code:____________
Stock/Property No. Unit Item Description Quantity Unit Cost Total Cost
1 1 Refrigerator 1 15,000.00 15,000.00

-
-
-
-

15,000.00

Purpose : RHU use.

Requested by : Approved by:

Signature: __________________________ ____________________________
Printed Name: GENERICO R. JAUCULAN GENERICO R. JAUCULAN
Designation: Municipal Vice Mayor Municipal Vice Mayor
 PURCHASE REQUEST

Entity Name: RHU Fund Cluster: Trust Fund Capitation

Office/Section :_________ PR NO.:__________________ Date:_______________
Resoponsibilty Center Code:____________
Stock/Property No. Unit Item Description Quantity Unit Cost Total Cost
1 pack Construction 20's 2 20.00 40.00
2 roll plastic tape 1 45.00 45.00
3 pc. double sided 1 30.00 30.00
4 ream construction 2 280.00 560.00
5 pcs. frame 5 65.00 325.00
6 pcs. frame 8 70.00 560.00
7 doz. filler mini ofron rose 2 43.00 86.00
8 mtrs. plastic charol 50 18.00 900.00
9 kls. stawless 2 80.00 160.00
10 pc. kabo 1 35.00 35.00
11 roll tie wire 1 300.00 300.00
12 kl. c.w.n. #1 1 53.00 53.00
13 kl. c.w.n. #3 1 47.00 47.00
14 kl. c.w.n. #4 1 46.00 46.00
15 pads pins 20 15.00 300.00
16 meters lei cloth assorted 20 66.90 1,338.00
17 pc. tarpaulin 1 1,000.00 1,000.00
18 pack glue stick 1 90.00 90.00
19 pcs. Gift Bag 20 9.00 180.00
20 pcs. metallic balloon 12 51.00 612.00
21 box thumbtacks 24 6.00 144.00
22 pcs. file folder 10 5.00 50.00
23 pcs. brown envelop 41 4.00 164.00
24 pcs. syrtone rose scented 4 38.00 152.00
25 pack asstd. Sunburst col paper 1 175.00 175.00
26 pack asstd. Dayglow col papers 1 205.00 205.00
27 pc. hairclamp 1 35.00 35.00
28 pcs. mirror 1 78.00 78.00
29 pcs. white glue 2 28.00 56.00
30 pcs. eagle glue 120g 3 22.00 66.00
31 pcs. scissor 3 38.00 114.00
32 pc. headband 1 15.00 15.00
33 pcs. packing tape 2 28.00 56.00
34 pc. office scissor 2 30.00 60.00
35 pcs. trans balloon 16 85.00 1,360.00

9,437.00

Purpose : Supplies for TSEKAP CARAVAN on June 27, 2017.

Requested by : Approved by:

Signature: __________________________ ____________________________
Printed Name: CARMEL MATHILDA B. LADEZA ANGELES R. CARLOTO II
Designation: Municipal Health Officer Municipal Mayor
 PURCHASE REQUEST

Entity Name: RHU Fund Cluster: MCP

Office/Section :_________ PR NO.:__________________ Date:_______________
Resoponsibilty Center Code:____________
Stock/Property No. Unit Item Description Quantity Unit Cost Total Cost
1 pc. storage box 1 325.00 325.00
2 pcs. doormat 4 185.00 740.00
3 pcs. broom 1 85.00 85.00
4 pcs. dust pan 1 146.00 146.00
5 pcs. led bulb 4 108.00 432.00
6 pcs. neonatal cuff 1 1,150.00 1,150.00

2,878.00

Purpose : Med. Supplies during Blood Letting Activity May 18,2017.

Requested by : Approved by:

Signature: __________________________ ____________________________
Printed Name: CARMEL MATHILDA B. LADEZA ANGELES R. CARLOTO II
Designation: Municipal Health Officer Municipal Mayor
 PURCHASE REQUEST

Entity Name: RHU Fund Cluster: Trust Fund MCP

Office/Section :_________ PR NO.:__________________ Date:_______________
Resoponsibilty Center Code:____________
Stock/Property No. Unit Item Description Quantity Unit Cost Total Cost
1 set Glass smoke 1 2,200.00 2,200.00
2 pcs. Clean Towel 65 50.00 3,250.00

5,450.00

Purpose : RHU use.

Requested by : Approved by:

Signature: __________________________ ____________________________
Printed Name: CARMEL MATHILDA B. LADEZA ANGELES R. CARLOTO II
Designation: Municipal Health Officer Municipal Mayor
 PURCHASE REQUEST

Entity Name: Mayor's Office Fund Cluster: 20%

Office/Section :_________ PR NO.:__________________ Date:_______________
Resoponsibilty Center Code:____________
Stock/Property No. Unit Item Description Quantity Unit Cost Total Cost
1 pcs. Plywood ordinary 13 390.00 5,070.00
2 pcs. Paint Latex 800 5 690.00 3,450.00
3 liters Flat White 1 685.00 685.00

9,205.00

Purpose : Counterpart to Multi Purpose Building of Barangay Balacbaan.

Requested by : Approved by:

Signature: __________________________ ____________________________
Printed Name: ANGELES R. CARLOTO II ANGELES R. CARLOTO II
Designation: Municipal Mayor Municipal Mayor
 PURCHASE REQUEST

Entity Name: Mayor's Office Fund Cluster: 20%

Office/Section :_________ PR NO.:__________________ Date:_______________
Resoponsibilty Center Code:____________
Stock/Property No. Unit Item Description Quantity Unit Cost Total Cost
1 bags Cement 10 290.00 2,900.00
2 pcs. mixed sand 4 1,050.00 4,200.00

7,100.00

Purpose : Counterpart to Multi Purpose Building of Barangay Farmington.

Requested by : Approved by:

Signature: __________________________ ____________________________
Printed Name: ANGELES R. CARLOTO II ANGELES R. CARLOTO II
Designation: Municipal Mayor Municipal Mayor
 PURCHASE REQUEST

Entity Name: Mayor's Office Fund Cluster: 20%

Office/Section :_________ PR NO.:__________________ Date:_______________
Resoponsibilty Center Code:____________
Stock/Property No. Unit Item Description Quantity Unit Cost Total Cost
1 bags Cement 50 285.00 14,250.00

14,250.00

Purpose : Counterpart to Multi Purpose Building of Barangay Sto. Niño

Requested by : Approved by:

Signature: __________________________ ____________________________
Printed Name: ANGELES R. CARLOTO II ANGELES R. CARLOTO II
Designation: Municipal Mayor Municipal Mayor
 PURCHASE REQUEST

Entity Name: DEP ED Fund Cluster: SEF

Office/Section :_________ PR NO.:__________________ Date:_______________
Resoponsibilty Center Code:____________
Stock/Property No. Unit Item Description Quantity Unit Cost Total Cost
15 Portland cement 15 290.00 4,350.00
500 4" CHB 500 15.00 7,500.00
20 1/4 Marine Plywood 20 550.00 11,000.00
10 DSB 10 mm 10 180.00 1,800.00
15 DSB 8 mm 15 170.00 2,550.00
4 cw nails #1 4 90.00 360.00
2 cw nails #2 2 90.00 180.00
3 cw nails #3 3 90.00 270.00
3 cw nails #4 3 90.00 270.00
2 #16 Tie wire 2 100.00 200.00
5 mixed sand 5 900.00 4,500.00
3 fine aggregates 3 850.00 2,550.00
2 latex paint 2 650.00 1,300.00
2 gloss latex paint 2 700.00 1,400.00
2 enamel paint 2 700.00 1,400.00

39,630.00

Purpose : Repair of School Classrooms of Central Ementary School.

Requested by : Approved by:

Signature: __________________________ ____________________________
Printed Name: ANGELES R. CARLOTO II ANGELES R. CARLOTO II
Designation: Municipal Mayor Municipal Mayor
 PURCHASE REQUEST

Entity Name: Mayor's Office Fund Cluster: 20%

Office/Section :_________ PR NO.:__________________ Date:_______________
Resoponsibilty Center Code:____________
Stock/Property No. Unit Item Description Quantity Unit Cost Total Cost
1 bags Cement 10 290.00 2,900.00
2 cu Mixed sand 4 1,050.00 4,200.00
3 gal Latex Flat white 1 560.00 560.00
4 lit Hanza Yellow 1 100.00 100.00

7,760.00

Purpose : Counterpart to Multi Purpose Center Barangay Galingon, Tamp. Z.N.

Requested by : Approved by:

Signature: __________________________ ____________________________
Printed Name: ANGELES R. CARLOTO II ANGELES R. CARLOTO II
Designation: Municipal Mayor Municipal Mayor