Republic of the Philippines

MUNICIPALITY OF PINAMALAYAN
Province of Oriental Mindoro

PURCHASE REQUEST

BAC No.: Date:

Department : Engineering Department PR No.: Date:
Section: Infrastructure Office SAI No.: Date:
OBRE No. Date:

Item/Lot Qty. Unit Estimated Estimated

Item Description
No. of Issue Unit Cost Cost
1 4 reams Coupon Bond Long S-20 220.00 880.00
2 2 reams Coupon Bond Short S-20 200.00 400.00
3 1 reams Coupon Bond Long S-16 180.00 180.00
4 2 reams Coupon Bond Short S-16 160.00 320.00
5 1 ream A3 Size Bond Paper 550.00 550.00
6 5 pcs Ballpen 25.00 125.00
7 1 box Fastener 38.00 38.00
8 10 pcs Accounting Folder Long 12.00 120.00
9 2 btl Computer Ink Black 450.00 900.00
10 3 btl Computer Ink Colored 450.00 1,350.00
11 1 box Sign Pen 320.00 320.00
12 1 box Pencil 72.00 72.00
13 13 pcs Brown Envelop Long 4.00 52.00
14 25 pcs Brown Envelop Short 3.00 75.00
15 1 boxes Staple Wire No.35 38.00 38.00
16 2 pcs Pentel Pen 70.00 140.00

TOTAL 5,560.00

Purpose: Office Supplies of Infrastructure Enforcement Division

Requested by: Cash Availability Approved by:

Signature:
Printed Name: ROY C. LUCBAN PLARIDEL S. CUPIADO HON. ARISTEO A. BALDOS, JR.
Designation: Administrative Office - IV Acting Municipal Treasurer Municipal Mayor
 Republic of the Philippines
MUNICIPALITY OF PINAMALAYAN
Province of Oriental Mindoro

PURCHASE REQUEST

BAC No.: Date:

Department : Engineering Department PR No.: Date:
Section: Infrastructure Enforcement Division SAI No.: Date:
OBRE No. Date:

Item/Lot Qty. Unit Estimated Estimated

Item Description
No. of Issue Unit Cost Cost
1 5 kls. Sugar White 60.00 290.00
2 4 pcks. Coffee 100g. 75.00 288.00
3 5 pcks. Creamer 500g. 120.00 600.00
4 5 ties Coffee Black 150.00 740.00
5 6 ties Coffee Original 45.00 258.00
6 4 cans Assorted Biscuits 225.00 892.00
7 5 pcs Bar Soap 30.00 135.00
8 3 bar Detergent Bar 25.00 69.00
9 10 pcs. Alcohol 500ml. 75.00 720.00
10 3 btls. Dishwashing Liquid 250ml. 65.00 189.00
11 14 pcs. Tissue Paper 15.00 210.00

TOTAL 4,391.00

Purpose: Miscellaneous Expenses of Infrastructure Enforcement Division

Requested by: Cash Availability Approved by:

Signature:
Printed Name: ROY C. LUCBAN PLARIDEL S. CUPIADO HON. ARISTEO A. BALDOS, JR.
Designation: Admin Officer - IV Acting Municipal Treasurer Municipal Mayor
 Republic of the Philippines
MUNICIPALITY OF PINAMALAYAN
Province of Oriental Mindoro

PURCHASE REQUEST

BAC No.: Date:

Department : Engineering Department PR No.: Date:
Section: Infrastructure Enforcement Division SAI No.: Date:
OBRE No. Date:

Item/Lot Qty. Unit Estimated Estimated

Item Description
No. of Issue Unit Cost Cost
1 17 litrs Gasoline (Unleaded) 52.01 884.17
2 1 litrs Motor Oil 235.00 235.00

TOTAL 1,119.17

Purpose: To be used of Infrastructure Enforcement Division

Requested by: Cash Availability Approved by:

Signature:
Printed Name: ROY C. LUCBAN PLARIDEL S. CUPIADO HON. ARISTEO A. BALDOS, JR.
Designation: Admin Officer - IV Acting Municipal Treasurer Municipal Mayor

Republic of the Philippines

MUNICIPALITY OF PINAMALAYAN
Province of Oriental Mindoro

PURCHASE REQUEST

BAC No.: Date:

Department : Engineering Department PR No.: Date:
Section: Infrastructure Office SAI No.: Date:
OBRE No. Date:

Item/Lot Qty. Unit Estimated Estimated

Item Description
No. of Issue Unit Cost Cost
1 12 Gals Purified Water Refill 40.00 480.00

TOTAL 480.00

Purpose: To be used of Infrastructure Enforcement Division (4th Quarter)

Municipal Compound, Pinamalayan Or. Mindoro
 Requested by: Cash Availability Approved by:
Signature:
Printed Name: ROY C. LUCBAN PLARIDEL S. CUPIADO HON. ARISTEO A. BALDOS, JR.
Designation: Administrative Office - IV Acting Municipal Treasurer Municipal Mayor

Republic of the Philippines

MUNICIPALITY OF PINAMALAYAN
Province of Oriental Mindoro

PURCHASE REQUEST

BAC No.: Date:

Department : Engineering Department PR No.: Date:
Section: Infrastructure Enforcement Division SAI No.: Date:
OBRE No. Date:

Item/Lot Qty. Unit Estimated Estimated

Item Description
No. of Issue Unit Cost Cost

TOTAL
 Purpose: Expenses of Infrastructure Enforcement Division

Requested by: Cash Availability Approved by:

Signature:
Printed Name: ROY C. LUCBAN PLARIDEL S. CUPIADO HON. ARISTEO A. BALDOS, JR.
Designation: Admin Officer - IV Acting Municipal Treasurer Municipal Mayor
 880.00
400.00
180.00
320.00
550.00
125.00
38.00
120.00
900.00
1,350.00
320.00
72.00
52.00
75.00
38.00
140.00

5,560.00

Approved by:

HON. ARISTEO A. BALDOS, JR.

Municipal Mayor
 290.00
288.00
600.00
740.00
258.00
892.00
135.00
69.00
720.00
189.00
210.00

4,391.00

Approved by:

HON. ARISTEO A. BALDOS, JR.

Municipal Mayor
 884.17
235.00

1,119.17

Approved by:
HON. ARISTEO A. BALDOS, JR.
Municipal Mayor

480.00

480.00
 Approved by:

HON. ARISTEO A. BALDOS, JR.

Municipal Mayor
 Approved by:

HON. ARISTEO A. BALDOS, JR.

Municipal Mayor
Note: Font: Times New Roman

Font Size: 11

Title : Times New Roman Bold

Font Size: 13

Size: Legal size

LED STREET LIGHTS

Power : 80Watts
Light Efficiency : 7200lm
Dimension : 625 x 260 x 100mm
Warranty : 5years
Beam Angle : 120 degrees
Voltage Range : AC90-305 VA/50/60Hz
Environmental Protection : IP65
Working Temperature : -30 to 50 degrees
Weight : 6kg CRI : 80
Burning Hours : 40,000
Color : Warm White
 Republic of the Philippines
MUNICIPALITY OF PINAMALAYAN
Province of Oriental Mindoro

ABSTRACT OF QUOTATION
RFQ No.: _______________

Supply/Delivery of ______________________________________________
ABC ______________________________ Date: ___________________

Item/
Lot Article Quantity A B C D E
No.

Toner Cartridge for Brother

HL-5350 DN Laser Printer 10
1 40,200.00 55,900.00 41,500.00 41,000.00 -
- Black; Estimate Cartridge cartridges
yield at least 3,000 pages
Total - Lot 1 40,200.00 55,900.00 41,500.00 41,000.00 -
Toner Cartridge for HP
Laserjet PRO MFP M130NW
10
2 Printer 33,900.00 31,640.00 34,500.00 34,200.00 30,650.00
cartridges
- Black; Estimate Cartridge
yield at least 1,500 pages
Total - Lot 2 33,900.00 31,640.00 34,500.00 34,200.00 30,650.00

Bottled Inks for Epson L-365

Ink Tank System Printer
- 70ml./plastic bottle
• Cyan - 4 bottles
• Magenta - 4 bottles
3 18 bottles 4,680.00 4,516.00 4,860.00 4,770.00 4,284.00
• Yellow - 4 bottles
• Black - 6 bottles
- Yield at least 6,500 pages for
colored, 4,000 pages for black
ink.

Total - Lot 3 4,680.00 4,516.00 4,860.00 4,770.00 4,284.00

Total Amount/Quotation Price 78,780.00 92,056.00 80,860.00 79,970.00 34,934.00

Notes : Details of offered Specifications are shown on the respective firm's submitted quotations/proposals.
- Compliant/Responsive with the minimum specifications/requirements.

A is the Lowest Calculated and Responsive Quotation (LCRQ) for Lot No. 1.
B is the LCRQ for Lot Nos. 2 and 3.

MIRASOL J. SANTOS
BAC Chairperson

PLARIDEL S. CUPIADO ROSENIO A. TORIANO

BAC Vice-Chairperson BAC Member

ZAIDA D. MICIANO DANNY S. VILLACRUSIS

BAC Member BAC Member

TEODORA M. FORTU RONE B. MADRID

BAC Member BAC Member
42,930.00 (2,730.00)

32,489.00 (1,839.00)

33,973.00 (29,689.00)

(34,258.00)
 Republic of the Philippines
MUNICIPALITY OF PINAMALAYAN
Province of Oriental Mindoro

OBLIGATION REQUEST

Payee ROY C. LUCBAN

Office
Address Pinamalayan, Oriental Mindoro
Reponsibility
PAR T I C U LAR S F.P.P ACCOUNT AMOUNT
Center

TO REIMBURSEMENT FOR:
Internet Expenses of the
Infrastructure Enforcement Division
for February 11 - March 10, 2019

TOTAL
A. Certified B. Certified

/ Charges to appropriation/allotment necessary,

lawful and under my direct supervision Existence of available appropriation

/ Supporting documents valid, proper and legal

Signature Signature
Printed Name ROY C. LUCBAN Printed Name ZAIDA D. MICIANO
Position Admin Officer - IV Position Municipal Budget Officer
Date Date
 Republic of the Philippines
MUNICIPALITY OF PINAMALAYAN
Province of Oriental Mindoro

OBLIGATION REQUEST

Payee ROY C. LUCBAN

Office
Address Pinamalayan, Oriental Mindoro
Reponsibility
PAR T I C U LAR S F.P.P ACCOUNT AMOUNT
Center

TO REIMBURSEMENT FOR:
Load Expenses of the
Infrastructure Enforcement Division
for February 11 - March 10, 2019

TOTAL
A. Certified B. Certified

/ Charges to appropriation/allotment necessary,

lawful and under my direct supervision Existence of available appropriation

/ Supporting documents valid, proper and legal

Signature Signature
Printed Name ROY C. LUCBAN Printed Name ZAIDA D. MICIANO
Position Admin Officer - IV Position Municipal Budget Officer
Date Date
 Republic of the Philippines
MUNICIPALITY OF PINAMALAYAN
Province of Oriental Mindoro

OBLIGATION REQUEST

Payee CHAVEZ STORE

Office Infrastracture Enforcement Division
Address Pinamalayan, Oriental Mindoro
Reponsibility
PAR T I C U LAR S F.P.P ACCOUNT AMOUNT
Center

TO PAYMENT OF:
Supplies Expenses of the
Infrastructure Enforcement Division

TOTAL
A. Certified B. Certified

/ Charges to appropriation/allotment necessary,

lawful and under my direct supervision Existence of available appropriation

/ Supporting documents valid, proper and legal

Signature Signature
Printed Name ROY C. LUCBAN Printed Name ZAIDA D. MICIANO
Position Admin Officer IV Position Municipal Budget Officer
Date Date
 Republic of the Philippines
MUNICIPALITY OF PINAMALAYAN
Province of Oriental Mindoro

OBLIGATION REQUEST

Payee CHAVEZ STORE

Office
Address Pinamalayan, Oriental Mindoro
Reponsibility
PAR T I C U LAR S F.P.P ACCOUNT AMOUNT
Center

TO PAYMENT OF: 4,391.00

Miscellaneous Expenses of the
Infrastructure Enforcement Division

TOTAL 4,391.00
A. Certified B. Certified

/ Charges to appropriation/allotment necessary,

lawful and under my direct supervision Existence of available appropriation

/ Supporting documents valid, proper and legal

Signature Signature
Printed Name HON. ARISTEO A. BALDOS, JR. Printed Name ZAIDA D. MICIANO
Position Municipal Mayor Position Municipal Budget Officer
Date Date
 Republic of the Philippines
MUNICIPALITY OF PINAMALAYAN
Province of Oriental Mindoro

OBLIGATION REQUEST

Payee ABRENICA WATER REFILLING

Office
Address Pinamalayan, Oriental Mindoro
Reponsibility
PAR T I C U LAR S F.P.P ACCOUNT AMOUNT
Center

TO PAYMENT OF:
Water Expenses of the
Infrastructure Enforcement Division

TOTAL
A. Certified B. Certified

/ Charges to appropriation/allotment necessary,

lawful and under my direct supervision Existence of available appropriation

/ Supporting documents valid, proper and legal

Signature Signature
Printed Name HON. ARISTEO A. BALDOS, JR. Printed Name ZAIDA D. MICIANO
Position Municipal Mayor Position Municipal Budget Officer
Date Date
 Republic of the Philippines
MUNICIPALITY OF PINAMALAYAN
Province of Oriental Mindoro

OBLIGATION REQUEST

Payee EAGLE R GAS STATION

Office
Address Pinamalayan, Oriental Mindoro
Reponsibility
PAR T I C U LAR S F.P.P ACCOUNT AMOUNT
Center

TO PAYMENT OF:
Gas Expenses of the
Infrastructure Enforcement Division

TOTAL
A. Certified B. Certified

/ Charges to appropriation/allotment necessary,

lawful and under my direct supervision Existence of available appropriation

/ Supporting documents valid, proper and legal

Signature Signature
Printed Name HON. ARISTEO A. BALDOS, JR. Printed Name ZAIDA D. MICIANO
Position Municipal Mayor Position Municipal Budget Officer
Date Date
 PURCHASE ORDER

MUNICIPAL GOVERNMENT OF PINAMALAYAN

Agency
Supplier: Chavez
CHAVEZ Grocery
STORE P.O. No.
Address: Date:
Mode of Procurement:
______________________________________________
Pinamalayan, Oriental Mindoro small value
_______________________________________
P.R. No.:

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

Place of Delivery: IED - LGU Pinamalayan, Oriental Mindoro Delivery Term: within 15 working days

Date of Delivery: Payment Term: within 15 working days

Item No. Unit Qty. Description Unit Cost

1 5 kls. Sugar White 55.00
2 4 pcks. Coffee 100g. 70.00
3 5 pcks. Creamer 500g. 119.00
4 5 ties Coffee Black 148.00
5 6 ties Coffee Original 40.00
6 4 cans Assorted Biscuits 220.00
7 3 pcs Bar Soap 20.00
8 5 bar Detergent Bar 25.00
9 10 pcs. Alcohol 500ml. 70.00
10 3 btls. Dishwashing Liquid 250ml. 60.00
11 14 pcs. Tissue Paper 14.00

Total Amount in Words: FOUR THOUSAND TWO HUNDRED SEVENTY ONE

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.
This document shall also serve as NOTICE OF AWARD for alternative modes of procurement.

Very Truly yours,

Conforme: HON. ARISTEO A. BALDOS, JR.

CHAVEZ STORE
(Signature over printed name) (Date)
Funds Available:

JUDY DE GUZMAN MORENTE

Municipal Accountant
 ORDER

NT OF PINAMALAYAN

_______________________
_______________________
Mode of Procurement: small value
procurement
_______________________

the terms and conditions contained herein:

Delivery Term: within 15 working days

after complete delivery
Payment Term: within 15 working days
after complete delivery

AMOUNT
275.00
280.00
595.00
740.00
240.00
880.00
60.00
125.00
700.00
180.00
196.00

4,271.00
he time specified above, a penalty of

WARD for alternative modes of procurement.

Very Truly yours,

HON. ARISTEO A. BALDOS, JR.

Municipal Mayor

OBRE No: ______________

Amount ______________
 PURCHASE ORDER

MUNICIPAL GOVERNMENT OF PINAMALAYAN

Agency
Supplier: Chavez
ABRENICA
Grocery
WATER REFILL P.O. No.
Address: Date:
Mode of Procurement:
______________________________________________
Pinamalayan, Oriental Mindoro small value
_______________________________________
P.R. No.:

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

Place of Delivery: IED - LGU Pinamalayan, Oriental Mindoro Delivery Term: various delivery

Date of Delivery: Payment Term: within 15 working days

Item No. Unit Qty. Description Unit Cost

1 gals 12 Purified Water Refill 40.00

Total Amount in Words: FIVE HUNDRED TWENTY PESOS

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.
This document shall also serve as NOTICE OF AWARD for alternative modes of procurement.

Very Truly yours,

Conforme: HON. ARISTEO A. BALDOS, JR.

ABRENICA WATER REFILLING
(Signature over printed name) (Date)
Funds Available:

JUDY DE GUZMAN MORENTE

Municipal Accountant
 ORDER

NT OF PINAMALAYAN

_______________________
_______________________
Mode of Procurement: small value
procurement
_______________________

the terms and conditions contained herein:

Delivery Term: various delivery

Payment Term: within 15 working days

after complete delivery

AMOUNT
520.00

520.00
he time specified above, a penalty of

WARD for alternative modes of procurement.

Very Truly yours,

HON. ARISTEO A. BALDOS, JR.

Municipal Mayor

OBRE No: ______________

Amount ______________
 Republic of the Philippines
MUNICIPALITY OF PINAMALAYAN
Province of Oriental Mindoro

DISBURSEMENT VOUCHER No.

Mode of
Check Cash Others
Payment
TIN/Employee No. Obligation
Payee ROY C. LUCBAN Request No.
Responsibility Center
Office/Unit/Project Code
Address Pinamalayan, Oriental Mindoro

AMOUNT

EXPLANATION

Reimbursement for internet expenses for the period covering of February 11, 2019 -
Php 808.00
March 10, 2019 amounting to EIGHT HUNDRED EIGHT PESOS ONLY

Amount due...... Php 808.00

A. Certified B. Certified

/ Allotment obligated for the purpose as indicated ab

Funds Available
/ Supporting documents complete

Signature Signature
Printed Name JUDY DE GUZMAN - MORENTE Date Printed Name PLARIDEL S. CUPIADO
Position Municipal Accountant Position Acting Municipal Treasurer

C. Approved for payment D. Received for Payment

Check No. Bank Name
Signature
Date
Signature
Printed Name HON. ARISTEO A. BALDOS, JR.
 Date

Position Municipal Mayor Printed Name ROY C. LUCBAN

OR/Other Documents JEV No.
ion
Request No.
Center

AMOUNT

Php 808.00

Php 808.00

Date

Date
Date
Date
 Republic of the Philippines
MUNICIPALITY OF PINAMALAYAN
Province of Oriental Mindoro

DISBURSEMENT VOUCHER No.

Mode of
Check Cash Others
Payment
TIN/Employee No. Obligation
Payee ROY C. LUCBAN Request No.
Responsibility Center
Office/Unit/Project Code
Address Pinamalayan, Oriental Mindoro

AMOUNT

EXPLANATION

Reimbursement for telephone expenses for the period covering of February 11, 2019 -
Php 1,525.37
March 10, 2019 amounting to ONE THOUSAND FIVE HUNDRED TWENTY FIVE

AND THIRTY SEVEN CENTAVOS ONLY

Amount due...... Php 1,525.37

A. Certified B. Certified

/ Allotment obligated for the purpose as indicated ab

Funds Available
/ Supporting documents complete

Signature Signature
Printed Name JUDY DE GUZMAN - MORENTE Date Printed Name PLARIDEL S. CUPIADO
Position Municipal Accountant Position Acting Municipal Treasurer

C. Approved for payment D. Received for Payment

Check No. Bank Name
Signature
Date
Signature
Printed Name HON. ARISTEO A. BALDOS, JR.
 Date

Position Municipal Mayor Printed Name ROY C. LUCBAN

OR/Other Documents JEV No.
ion
Request No.
Center

AMOUNT

Php 1,525.37

Php 1,525.37

Date

Date
Date
Date
 Err:509
MUNICIPALITY OF PINAMALAYAN
Province of Oriental Mindoro

DISBURSEMENT VOUCHER No.

Mode of
Check Cash Others
Payment
TIN/Employee No. Obligation
Payee CHAVEZ STORE Request No.
Responsibility Center
Office/Unit/Project Code
Address Pinamalayan, Oriental Mindoro

AMOUNT

EXPLANATION

To payment of Miscellaneous Expenses in the amount of FOUR THOUSAND THREE

Php 4,391.00
HUDNRED NINETY ONE PESOS only.

Amount due...... Php 4,391.00

A. Certified B. Certified

/ Allotment obligated for the purpose as indicated ab

Funds Available
/ Supporting documents complete

Signature Signature
Printed Name JUDY DE GUZMAN - MORENTE Date Printed Name PLARIDEL S. CUPIADO
Position Municipal Accountant Position Acting Municipal Treasurer

C. Approved for payment D. Received for Payment

Check No. Bank Name
Signature
Date
Signature
Printed Name HON. ARISTEO A. BALDOS, JR.
Position Municipal Mayor Printed Name CHAVEZ STORE
OR/Other Documents JEV No.
ion
Request No.
Center

AMOUNT

Php 4,391.00

Php 4,391.00

Date

Date

Date
Date
 Republic of the Philippines
MUNICIPALITY OF PINAMALAYAN
Province of Oriental Mindoro

DISBURSEMENT VOUCHER No.

Mode of
Check Cash Others
Payment
TIN/Employee No. Obligation
Payee ABRENICA WATER REFILL STATION Request No.
Responsibility Center
Office/Unit/Project Code
Address Pinamalayan, Oriental Mindoro

AMOUNT

EXPLANATION

To payment of Miscellaneous Expenses in the amount of FOUR THOUSAND THREE

Php 4,391.00
HUDNRED NINETY ONE PESOS only.

Amount due...... Php 4,391.00

A. Certified B. Certified

/ Allotment obligated for the purpose as indicated ab

Funds Available
/ Supporting documents complete

Signature Signature
Printed Name JUDY DE GUZMAN - MORENTE Date Printed Name PLARIDEL S. CUPIADO
Position Municipal Accountant Position Acting Municipal Treasurer

C. Approved for payment D. Received for Payment

Check No. Bank Name
Signature
Date
Signature
Printed Name HON. ARISTEO A. BALDOS, JR.
Position Municipal Mayor Printed Name CHAVEZ STORE
OR/Other Documents JEV No.
ion
Request No.
Center

AMOUNT

Php 4,391.00

Php 4,391.00

Date

Date

Date
Date
 Republic of the Philippines
MUNICIPALITY OF PINAMALAYAN
Province of Oriental Mindoro

DISBURSEMENT VOUCHER No.

Mode of
Check Cash Others
Payment
TIN/Employee No. Obligation
Payee EAGLE R GAS STATION Request No.
Responsibility Center
Office/Unit/Project Code
Address Pinamalayan, Oriental Mindoro

AMOUNT

EXPLANATION

To payment of Miscellaneous Expenses in the amount of FOUR THOUSAND THREE

Php 4,391.00
HUDNRED NINETY ONE PESOS only.

Amount due...... Php 4,391.00

A. Certified B. Certified

/ Allotment obligated for the purpose as indicated ab

Funds Available
/ Supporting documents complete

Signature Signature
Printed Name JUDY DE GUZMAN - MORENTE Date Printed Name PLARIDEL S. CUPIADO
Position Municipal Accountant Position Acting Municipal Treasurer

C. Approved for payment D. Received for Payment

Check No. Bank Name
Signature
Date
Signature
Printed Name HON. ARISTEO A. BALDOS, JR.
Position Municipal Mayor Printed Name CHAVEZ STORE
OR/Other Documents JEV No.
ion
Request No.
Center

AMOUNT

Php 4,391.00

Php 4,391.00

Date

Date

Date
Date
 Annex G-7
INSPECTION & ACCEPTANCE REPORT

MUNICIPAL GOVERNMENT OF PINAMALAYAN

(Agency)

Supplier: CHAVEZ STORE IAR No. :____________________________

PO No. __________ Date :_______________________________
Invoice No. Date :_______________________________
Requisitioning Office/Dept.
Purpose: For official use of Infrastructure Office

Item No. Unit Description Quantity

1 kls. Sugar White 5
2 pcks. Coffee 100g. 4
3 pcks. Creamer 500g. 5
4 ties Coffee Black 5
5 ties Coffee Original 6
6 cans Assorted Biscuits 4
7 pcs. Bar Soap 5
8 bar Detergent Bar 3
9 pcs. Alcohol 500ml 10
10 btls. Dishwashing Liquid 250ml 3
11 pcs. Tissue Paper 14

INSPECTION ACCEPTANCE

Date Inspected: Date Received:

Inspected, verified and found OK Complete

as to quantity and specifications Partial

Other findings:_____________
__________________________

EnP ROSENIO A. TORIANO ROY C. LUCBAN

MPDC Admin Officer - IV
Head, Inspectorate Team
Inspection Officer
 Annex G-7
INSPECTION & ACCEPTANCE REPORT

MUNICIPAL GOVERNMENT OF PINAMALAYAN

(Agency)

Supplier: ABRENICA WATER REFILLING IAR No. :____________________________

PO No. __________ Date :_______________________________
Invoice No. Date :_______________________________
Requisitioning Office/Dept.Infrastructure Enforcement Division
Purpose: For official use of Infrastructure office _________________________

Item No. Unit Description Quantity

1 gals. Purifies Water Refill 12

INSPECTION ACCEPTANCE

Date Inspected: Date Received:

Inspected, verified and found OK Complete

as to quantity and specifications Partial

Other findings:_____________
__________________________

EnP ROSENIO A. TORIANO ROY C. LUCBAN

MPDC Admin Officer - IV
Head, Inspectorate Team
Inspection Officer
 Annex G-7
INSPECTION & ACCEPTANCE REPORT

MUNICIPAL GOVERNMENT OF PINAMALAYAN

(Agency)

Supplier: IAR No. :____________________________

PO No. __________ Date :_______________________________
Invoice No. Date :_______________________________
Requisitioning Office/Dept. _______________________
Purpose: For official use of __________________________

Item No. Unit Description Quantity

1
2
3
4
5
6
7
8
9
10
11

INSPECTION ACCEPTANCE

Date Inspected: Date Received:

Inspected, verified and found OK Complete

as to quantity and specifications Partial

Other findings:_____________
__________________________

ROSENIO A. TORIANO ROY C. LUCBAN ENRIQUE N. MOCLING

MPDC Admin Officer - IV OIC-GSO
Head, Inspectorate Team
Inspection Officer
 INSPECTION & ACCEPTANCE REPORT

MUNICIPAL GOVERNMENT OF PINAMALAYAN

(Agency)

Supplier: ____________________________________
PO No. __________ Date ________________ Invoice No. _______ Date _____________
Requisitioning Office/Dept. : ______________________________________________________________
Purpose: For official use of ________________________________________________________________

Item No. Unit Description Brand

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33

INSPECTION ACCEPTANCE

Date Inspected: Date Received:

 Inspected, verified and found OK Complete
as to quantity and specifications Partial

Other findings:_________________
_______________________________
_______________________________

Name of Head, Inspectorate Team (Name of Supply Officer)

Position Position
Head, Inspectorate Team Designated Supply Officer
 Annex G-7
ORT

YAN

Date _____________
___________________
_____________________

Quantity
Supply Officer
 Republic of the Philippines
MUNICIPALITY OF PINAMALAYAN
Province of Oriental Mindoro

ACKNOWLEDGEMENT RECEIPT FOR EQUIPMENT

ARE No. ________________

Date: _________________
QTY UNIT ARTICLE/DESCRIPTION UNIT COST TOTAL COST PROP. NO.

TOTAL -

RECEIVED BY: RECEIVED FROM:

_____________________
NAME: _________________________________ RONE B. MADRID
DESIGNATION: _________________________________ AO IV/Property Management Officer
DATE: _________________________________
 Annex 50

Republic of the Philippines

MUNICIPALITY OF PINAMALAYAN
Province of Oriental Mindoro

WASTE MATERIAL REPORT

RECORD OF SALES
ITEM QTY. UNIT DESCRIPTION
O.R. NO. Amount

TOTAL
Certified Correct: Disposal Approval:

RONE B. MADRID ______________________________

AO IV/ Property Management Officer

CERTIFICATE OF INSPECTION

I hereby certify that the property enumerated above was disposed of as follows:

Item ________________ Destroyed

Item ________________ Sold at private sale
Item ________________ Sold at public auction
Item ________________ Transferred without cost to _______________

Property Inspector: Witness to:

________________________________
Name and Signature
 Municipality of Pinamalayan Municipality of Pinamalayan
Pinamalayan Oriental Mindoro Pinamalayan Oriental Mindoro

REQUISITION SLIP REQUISITION SLIP

Date Date

To: EAGLE R GAS STATION To: EAGLE R GAS STATION

Please issue to : Please issue to :

Vehicle : Yamaha DT 125 Vehicle : Yamaha DT 125
Driver : ROY C. LUCBAN Driver : ROY C. LUCBAN

Item Quantity Unit Price Amount Item Quantity Unit Price

Gasoline :____________ :____________ :____________ Gasoline :____________ :____________
Diesel :____________ :____________ :____________ Diesel :____________ :____________
Motor Oil :____________ :____________ :____________ Motor Oil :____________ :____________
Brake Fluid :____________ :____________ :____________ Brake Fluid :____________ :____________
Gear Oil :____________ :____________ :____________ Gear Oil :____________ :____________
ATF :____________ :____________ :____________ ATF :____________ :____________
Oil 10 :____________ :____________ :____________ Oil 10 :____________ :____________
Others :____________ :____________ :____________ Others :____________ :____________

Requested by: Noted By: Requested by: Noted By:

ROY C. LUCBAN ENGR. TEODORA M. FORTU ROY C. LUCBAN ENGR. TEODORA M

Admin Officer IV Municipal Engineer Admin Officer IV Municipal Engi

Approved By: Approved By:

HON. ARISTEO A. BALDOS, JR. HON. ARISTEO A. BALDOS, JR.

Municipal Mayor Municipal Mayor

Municipality of Pinamalayan Municipality of Pinamalayan

Pinamalayan Oriental Mindoro Pinamalayan Oriental Mindoro

REQUISITION SLIP REQUISITION SLIP

Date Date

To: EAGLE R GAS STATION To: EAGLE R GAS STATION

Please issue to : Please issue to :

Vehicle : Yamaha DT 125 Vehicle : Yamaha DT 125
Driver : ROY C. LUCBAN Driver : ROY C. LUCBAN

Item Quantity Unit Price Amount Item Quantity Unit Price

Gasoline :____________ :____________ :____________ Gasoline :____________ :____________
Diesel :____________ :____________ :____________ Diesel :____________ :____________
Motor Oil :____________ :____________ :____________ Motor Oil :____________ :____________
Brake Fluid :____________ :____________ :____________ Brake Fluid :____________ :____________
Gear Oil :____________ :____________ :____________ Gear Oil :____________ :____________
ATF :____________ :____________ :____________ ATF :____________ :____________
Oil 10 :____________ :____________ :____________ Oil 10 :____________ :____________
Others :____________ :____________ :____________ Others :____________ :____________

Requested by: Noted By: Requested by: Noted By:

ROY C. LUCBAN ENGR. TEODORA M. FORTU ROY C. LUCBAN ENGR. TEODORA M

Admin Officer IV Municipal Engineer Admin Officer IV Municipal Engi

Approved By: Approved By:

HON. ARISTEO A. BALDOS, JR. HON. ARISTEO A. BALDOS, JR.

Municipal Mayor Municipal Mayor
Municipality of Pinamalayan
Pinamalayan Oriental Mindoro

REQUISITION SLIP

Date

Yamaha DT 125
ROY C. LUCBAN

Amount
:____________
:____________
:____________
:____________
:____________
:____________
:____________
:____________

Noted By:

ENGR. TEODORA M. FORTU

Municipal Engineer

Municipality of Pinamalayan
Pinamalayan Oriental Mindoro

REQUISITION SLIP

Date

Yamaha DT 125
ROY C. LUCBAN

Amount
:____________
:____________
:____________
:____________
:____________
:____________
:____________
:____________

Noted By:

ENGR. TEODORA M. FORTU

Municipal Engineer