Article/ Services Requisitioned Dealers: Item No. Quantity Articles/Services Re

I HEREBY CERTIFY that personal canvass was made on the articles/services herein requested and it was found that
offered the lowest price in the locolity which is advantageous in the government.
Article/ Services Requisitioned

DEALERS
Q U AN T I T Y Province of Zamboanga Sibugay Botika Ni Donna RM Convenience Store DEEP SPRING WATER REFILLING NORJUN ENTERPRISES RM Convenience Store
ITEM NO. Articles/Services Re
Qty. Unit Unit Price Total Amount Unit Price Total Amount Unit Price Total Amount Unit Price Total Amount
1 5 bot PLR IL 90.00 450.00

2 5 bot D5LR IL 90.00 450.00
3 60 pcs. Oxytocin Ampules 35.00 2,100.00
4 50 pcs. Phytomenadione amp. 45.00 2,250.00
5 1 pc. ice chest 370.00 370.00
6 1 set barrel bolt 92.50 92.50
7 2 pcs. Ecolum Bulb 9w 205.00 410.00
8 95 gal. mineral water 15.00 1,425.00
TOTAL 900.00 4,350.00 370.00 1,425.00 410.00 92.50
CARMEL MATHILDA B. LADEZA SHERRY LOU P. DAPROSA CYNTHIA D. ABIL

Municipal health Officer Municipal Accountant Acting Municipal Treasurer

DEALERS
Q U AN T I T Y Justine Catering & Food Services VCOOL Bakesp PARK N Go Bakeshop
Qty. Unit Unit Price Total Amount Unit Price Total Amount Unit Price Total Amount
1 pax 21 snacks 45.00 945.00 50.00 1,050.00 55.00 1,155.00
TOTAL 945.00 1,050.00 1,155.00
CYNTHIA D. ABIL SHERRY LOU P. DAPROSA CYNTHIA D. ABIL

Acting Municipal Treasurer Municipal Accountant Acting Municipal Treasurer
offered the lowest price in the locality which is advantageous in the government.

DEALERS
Q U AN T I T Y GJEMPA STORE Bugasan sa Tampi & Gen. Merchansi Tampilisan Construction Supply
ITEM NO. Articles/Services Requested
1 4 kls Chlorine 100.00 400.00

2 3 kilos powder soap 59.00 177.00
3 2 bot Alcohol 52.00 104.00
4 4 bot zonrox 1000ml 35.00 140.00
5 1 pack Fasclean 137.50 137.50
6 1 pc. Bulb 80.00 80.00
* Item1&2 awarded to GJEMPA STORE

* Item 3 to 5 awarded Bugasan sa Tampi & Gen. Merchandise
* Item 6 awarded to Tampilisan Cons. Supply
TOTAL 577.00 381.50 80.00
ANGELES R. CARLOTO II SHERRY LOU P. DAPROSA CYNTHIA D. ABIL

Municipal Mayor Municipal Accountant Acting Municipal Treasurer

DEALERS
Q U AN T I T Y JRJJ STORE CLAIRE STORE
1 1 kilos chlorine 120.00 120.00 -

2 2 kilos powder soap 98.00 196.00
3 1 pc. toilet brush 58.00 58.00
* Item 1 to 2 awarded to CLAIRE STORE

* Item 3 to awarded to JRJJ STORE
TOTAL 58.00 316.00 -


DEALERS
Q U AN T I T Y Justine Catering & Food Service LPC Gyd Juvines Food & Catering Service
1 52 pax snacks 80.00 4,160.00 83.00 4,316.00 85.00 4,420.00
* Item 1 to 5 awarded to Rubina Music Lights & Sporting Goods
TOTAL 4,160.00 4,316.00 4,420.00


DEALERS
Q U AN T I T Y Golden Reigh Enteprises Budget Wise Market SEBIO Educational Supply
Qty. Unit Unit Price Total Amount Unit Price Total Amount Unit Price Total Amount Unit Price Total Amount Unit Price Total Amount
1 pc. 2 sign pen refill 57.00 114.00
2 pc. 1 signpen 90.00 90.00
3 pcs. 6 expanded folder long 18.00 108.00
4 pack 2 index card (4x6 55.00 110.00
5 pcs. 2 mac stock cards 15.25 30.50
6 pcs. 2 AD index card 41.50 83.00
7 pcs. 4 Battery 25.00 100.00
8 box 1 staple wire #35 85.50 85.50
9 pcs. 4 columnar notebook 25.00 100.00
* Item 1 to 4 awarded to Golden Reigh Enterprises

* Item 5 to 6 awarded to Budget Wise Market
* Item 7 to 9 awarded to SEBIO Educational Supply
TOTAL 422.00 113.50 285.50 - -
PRAXIDES C. ARCINO SHERRY LOU P. DAPROSA PRAXIDES C. ARCINO

OIC-Municipal Treasurer Municipal Accountant OIC-Municipal Treasurer
Republic of the Philippines
PROVINCE OF ZAMBOANGA DEL NORTE
MUNICIPALITY OF TAMPILISAN
No.:
OBLIGATION REQUEST
PAYEE ANGELES R. CARLOTO II
OFFICE
ADDRESS Pob. Tampilisan, Z.N.
Responsibilit ACCOUNT
PARTICULARS F.P.P AMOUNT
y Center CODE
Php 374.00
Market Supplies
TOTAL Php 374.00

A. CERTIFIED: B. CERTIFIED:
X Charges to appropriation/allotment necessary,
lawful and under my direct supervision Existence of available appropriation
Supporting documents valid, proper and legal
Signature Over Signature Over

Printed Name ANGELES R. CARLOTO II Printed Name GRACE A. GUMANSING
Position Municipal Mayor Position Municipal Budget Officer
Date Date

No.:
OBLIGATION REQUEST
PAYEE ANGELES R. CARLOTO II
OFFICE
y Center CODE
Php 374.00
Market Supplies
TOTAL Php 374.00

Charges to appropriation/allotment necessary,

Date Date
offered the lowest price in the locality which is advantageous in the government.

DEALERS
Q U AN T I T Y Goulai Trading Henrose Enterprises
1 1 pc. Drainer 200.00 200.00

2 1 pcs. Chopping Board 100.00 100.00
3 2 pcs,. Mugs 52.00 104.00
4 2 pcs. Plastic Laddle 10.00 20.00
5 1 pcs,. Laddle 71.00 71.00
6 2 pcs. Spoon & Fork 69.00 138.00
7 8 pcs,. Transparent Glass 45.00 360.00
8 2 pcs. Dolphin Glass 31.00 62.00
9 1 pcs,. construction paper 201.00 201.00
10 4 pcs. correction tape 43.50 174.00
*Item 1 awarded to JTHREE Ent.
*Item 2 to 4 awarded to Goulai Trading
TOTAL 1,055.00 375.00 -
CARMEL MATHILDA B. LADEZA SHERRY LOU P. DAPROSA CYNTHIA D. ABIL

Municipal Health Officer Municipal Accountant Acting Municipal Treasurer

DEALERS
Q U AN T I T Y Rubina Music Lights & Sporting Goods Tulabong Store
1 2 pcs. volleyball ball 850.00 1,700.00 855.00 1,710.00 860.00 1,720.00

2 1 pc. volleyball net 700.00 700.00 705.00 705.00 710.00 710.00
3 1 pc. basketball ball 950.00 950.00 955.00 955.00 1,000.00 1,000.00
4 1 pc. table tennis net 875.00 875.00 880.00 880.00 885.00 885.00
5 2 tubes table tennis ball 596.50 1,193.00 600.00 1,200.00 605.00 1,210.00
* Item 1 to 5 awarded to Rubina Music Lights & Sporting Goods
TOTAL 5,418.00 5,450.00 5,525.00
ANTONIO S. GUMELA SHERRY LOU P. DAPROSA CYNTHIA D. ABIL

District Supervisor Municipal Accountant Acting Municipal Treasurer
LGU - TAMPILISAN Purchase Request No.
Bids And Awards Committee Office of the: Mayor
Tampilisan, Zambo. Norte
REQUEST FOR QUOTATION
Date: ____________________
Quotation No.______________
Please quote your lowest price on the item/s listed below, subject to the General Condition on the
Philippine Bidding Documents on Goods, stating the shortest time of delivery and submit your quotation duly
signed by your representative not later than ________________________.
VIGILUS D. CREDO
NOTE: BAC Chairman
1. ALL ENTRIES MUST BE TYPEWRITTEN
2. DELIVERY PERIOD WITHIN SEVEN (7) CALENDAR DAYS
3. WARRANTY SHALL BE FOR A PERIOD OF THREE (3) MONTHS FOR SUPPLIES & MATERIALS, ONE (1) YEAR FOR
EQUIPMENT, FROM DATE OF ACCEPTANCE BY THE PROCURING ENTITY
4. PRICE VALIDITY SHALL BE FOR A PERIOD OF THIRTY (30) CALENDAR DAYS
5. G-EPS REGISTRATION CERTIFICATE SHALL BE ATTACHED UPON SUBMISSION OF THE QUOTATION, IF AVAILABLE.
6. BIDDERS SHALL SUBMIT ORIGINAL BROCHURES SHOWING CERTIFICATIONS OF THE PRODUCT BEING OFFERED.
ITEM
ITEM & DESCRIPTION QTY. Unit Unit Price TOTAL
NO.
1 snacks 52 pax
Brand and Model

Delivery Period
Warranty
Price Validity
After having carefully read and accepted your General Conditions, I / We quote you on
the item at prices noted above.
Printed Name/Signature
Tel. No/Cellphone No.
Date
1 CART Epson t6641 black 500 500.00
5 Cactus Long 198 990.00
5 Cactus Short 178 890.00
2,380.00

DEALERS
Q U AN T I T Y JRJJ STORE HP Jumawan EVGEL SARI-SARI STORE
Qty. Unit Unit Price Total Amount Unit Price Total Amount Unit Price Total Amount Unit Price Total Amount
1 1 pack Disposable spoon 25.00 25.00

2 1 pc. paper clip big 35.00 35.00
3 1 pc. paper clip small 15.00 15.00
4 1 pack rebisco 48.00 48.00
5 10 bot wilkins 10.00 100.00
6 1 pack nescafe 178.00 178.00
* Item 1 awarded to JRJJ STORE

* Item 2 to 3 awarded HP Jumawan
* Item 4 to 6 awarded Ev-gel Sari Sari Store
TOTAL 25.00 50.00 326.00 -
CYNTHIA D. ABIL SHERRY LOU P. DAPROSA CYNTHIA D. ABIL

Acting Municipal Treasurer Municipal Accountant Acting Municipal Treasurer

DEALERS
Q U AN T I T Y KJB STORE GARR STORE MARELYN ACAS STORE
1 1 sack half sack rice 1,200.00

2 15 case mineral water 225.00 3,375.00
3 10 pack monde mamon 132.00 1,320.00
4 10 pcs. mismo softdrinks 135.00 1,350.00
5 2 pcs. styro 29.00 58.00
6 2 pack spoon 20.00 40.00
7 1 pack oil 60.00 60.00
8 2 pack suka 6.00 12.00
9 2 pack toyo 8.00 16.00
10 1 pack magic sarap 32.00 32.00
11 15 meters trapal 100.00 1,500.00
* Item 1 awarded to KJB STORE

* Item 2 to 10 awarded GARR STORE
* Item 11 awarded to MARELYN ACAS STORE
TOTAL 1,200.00 6,263.00 1,500.00 - -
ANGELES R. CARLOTO II SHERRY LOU P. DAPROSA PRAXIDES C. ARCINO

Municipal Mayor Municipal Accountant OIC-Municipal Treasurer

DEALERS
Q U AN T I T Y Tampilisan Construction Supply Z.C. Mega Shop O RAMA,INC KCC Mall de Zamboanga
1 1 pc. outlet 159.00 159.00
2 6 pcs. T spoon 26.75 160.50
3 12 pcs. spoon 14.75 177.00
4 10 pcs. porcelain mug 25.00 250.00
5 1 pcs. home silvers spoon 129.75 129.75
6 3 pcs. tea fork 79.75 239.25
7 1 pcs. home silvers fork 129.75 129.75
8 6 pcs. dinner plate 59.75 358.50
9 2 pcs. cup & saucer 329.75 659.50
10 6 pcs. ocean tumbler 49.75 298.50
less 10% discount (29.88)
* Item 1 awarded to Tampilisan Construction Supply & Hauling Services

* Item 2 to 3 awarded to Z.C. Mega Shop O Rama,Inc.
* Item 4 to 10 awarded to KCC Mall de Zamboanga
TOTAL 159.00 337.50 2,035.37 - -


DEALERS
Q U AN T I T Y Golden Reigh Enteprises Budget Wise Market SEBIO Educational Supply
1 pc. 2 sign pen refill 57.00 114.00
2 pc. 1 signpen 90.00 90.00
3 pcs. 6 expanded folder long 18.00 108.00
4 pack 2 index card (4x6 55.00 110.00
5 pcs. 2 mac stock cards 15.25 30.50
6 pcs. 2 AD index card 41.50 83.00
7 pcs. 4 Battery 25.00 100.00
8 box 1 staple wire #35 85.50 85.50
9 pcs. 4 columnar notebook 25.00 100.00
* Item 1 to 4 awarded to Golden Reigh Enterprises

* Item 5 to 6 awarded to Budget Wise Market
* Item 7 to 9 awarded to SEBIO Educational Supply
TOTAL 422.00 113.50 285.50 - -

ABSTRACT OF PERSONAL CANVASS/ BIDS FOR THE SUPPLY AND DELIVERY
PR No.
ABSTRACT OF BIDS OPENED ON: ,2016. TIME: AM/PM
IN THE BAC OFFICE, TAMPILISAN, ZAMBOANGA DEL NORTE.
Article/ Services Requisitioned DEALERS FURNISHED

Remlits Enterprises Jeroline Canoy Enterprises Mengie Store
Q U AN T I T Y
ITEM NO. DESCRIPTION Pob. Tampilisan, Z.N. Pob. Tampilisan, Z.N. Pob. Tampilisan,Z.N.
No. Unit of Issue Unit Price Total Amount Unit Price Total Amount Unit Price Total Amount
1 3 sacks Potash Fertilizer 1,200.00 3,600.00 1,200.00 3,600.00 1,200.00 3,600.00
2 3 sacks Urea Fertilizer 1,050.00 3,150.00 1,075.00 3,225.00 1,050.00 3,150.00
3 3 sacks 14-14-14 Fertilizer 1,100.00 3,300.00 1,100.00 3,300.00 1,150.00 3,450.00
4 3 sacks Ammunium Fertilizer 800.00 2,400.00 800.00 2,400.00 800.00 2,400.00
5 5 packs Foliar (Grow More) 260.00 1,300.00 250.00 1,250.00 260.00 1,300.00
6 10 packs Kamatis 50.00 500.00 50.00 500.00 50.00 500.00
7 10 packs Choy FI 50.00 500.00 50.00 500.00 50.00 500.00
8 10 packs Mestisa FI 50.00 500.00 50.00 500.00 50.00 500.00
9 10 packs Kangkong (tsina) 50.00 500.00 50.00 500.00 50.00 500.00
10 10 packs Pantastiko 50.00 500.00 50.00 500.00 50.00 500.00
11 10 packs Patola 50.00 500.00 50.00 500.00 50.00 500.00
12 10 packs Yellow Squash 50.00 500.00 50.00 500.00 50.00 500.00
13 10 packs Eggplant 50.00 500.00 50.00 500.00 50.00 500.00
14 10 packs Okra 50.00 500.00 50.00 500.00 50.00 500.00
15 10 packs Sibuyas(green onion) 30.00 300.00 30.00 300.00 30.00 300.00
16 10 packs Luy-a 80.00 800.00 80.00 800.00 80.00 800.00
17 1 Lit. Cymbush 1,200.00 1,200.00 1,200.00 1,200.00 1,200.00 1,200.00
18 1 Lit. Fungicide 800.00 800.00 800.00 800.00 800.00 800.00
19 10 kilos Strawless 70.00 700.00 75.00 750.00 70.00 700.00
20 10 kilos Nylon 200.00 2,000.00 200.00 2,000.00 200.00 2,000.00
21 1 pc. Weighing Scale 800.00 800.00 800.00 800.00 800.00 800.00
THIS IS TO CERTIFY that the requirements of R.A. No. 9184 otherwise known Total 24,850.00 Total 24,925.00 Total 25,000.00
as the Government Procurement Reform Act ( Rule XVI - Sec.52 ) had been complied with. WE HEREBY CERTIFY to the correctness and authenticity of the above Abstract
of Bids to the best of our knowledge.
ANTONIO S. GUMELA,EM.D. GRACE A. GUMANSING

BIDS AND AWARDS COMMITTEE: Public School District Supervisor Municipal Budget Officer
(Requesting Officer) ( Member )
VIGILUS D. CREDO ADELBERTO G. SAMUYA OLIVIA G. EBORDE RENE R. MANAIT

Municipal Engineer Municipal Civil Registrar Municipal Treasurer MPDC
(Chairman) ( Vice Chairman ) ( Member ) ( Member )
24,850.00 24,925.00 25,000.00
LGU - TAMPILISAN Purchase Request No.
Bids And Awards Committee Office of the: Dep Ed
Tampilisan, Zambo. Norte
REQUEST FOR QUOTATION
Date: ____________________
Quotation No.______________
Please quote your lowest price on the item/s listed below, subject to the General Condition on the
Philippine Bidding Documents on Goods, stating the shortest time of delivery and submit your quotation duly
signed by your representative not later than ________________________.
VIGILUS D. CREDO
NOTE: BAC Chairman
1. ALL ENTRIES MUST BE TYPEWRITTEN
2. DELIVERY PERIOD WITHIN SEVEN (7) CALENDAR DAYS
3. WARRANTY SHALL BE FOR A PERIOD OF THREE (3) MONTHS FOR SUPPLIES & MATERIALS, ONE (1) YEAR FOR
EQUIPMENT, FROM DATE OF ACCEPTANCE BY THE PROCURING ENTITY
4. PRICE VALIDITY SHALL BE FOR A PERIOD OF THIRTY (30) CALENDAR DAYS
5. G-EPS REGISTRATION CERTIFICATE SHALL BE ATTACHED UPON SUBMISSION OF THE QUOTATION, IF AVAILABLE.
6. BIDDERS SHALL SUBMIT ORIGINAL BROCHURES SHOWING CERTIFICATIONS OF THE PRODUCT BEING OFFERED.
ITEM
ITEM & DESCRIPTION QTY. Unit Unit Price TOTAL
NO.
1 Paracetamol 23 boxes
2 Dicycloverine 10Hcl mg 1 box
3 Amoxicillin 250mg 1 box
4 Metoprolol 100 m 50 pcs.
5 Salbutamol nebule 10 pcs.
6 Nebulizing Kit 1 pc.
7 Oxygen Kit 1 pc.
8 Digital Blood Pressure Monitoring 1 pc.
9 Portable Nebulizer 1 pc.
10 Medical Oxygen complte set 1 pc.
Brand and Model

Delivery Period
Warranty
Price Validity
After having carefully read and accepted your General Conditions, I / We quote you on
the item at prices noted above.
Printed Name/Signature
Tel. No/Cellphone No.
Date
1 CART Epson t6641 black 500 500.00
5 Cactus Long 198 990.00
5 Cactus Short 178 890.00
2,380.00
PURCHASE REQUEST
Tampilisan, Zamboanga del Norte
LGU
PR No.: Date:
Department: Market SAI No.: Date:
Section: OR No. Date:
Item Unit of Estimated Estimated

Quantity Item Description
No. Issue Unit Cost Cost
1 1 kl. Clorine 100.00 100.00
2 2 liters muriatic acid 78.00 156.00
3 1 pc. Sand paper #120 17.00 17.00
4 1/2 kl. Clorine 65.00 65.00
5 2 pcs. pail 50.00 100.00
6 1 pc. mop 145.00 145.00
7 2 kls. Chorine 85.00 170.00
8 1/2 doz. safeguard 60g 188.00 94.00
9 1/2 doz. soap powder 42.00 21.00
10 1 pc. plastic faucet 38.50 38.50
11 1 pc. tapelon 29.50 29.50
-
936.00
Purpose:
Requested by: Cash Availability: Approved by:

Signature:
Printed Name: ANGELES R. CARLOTO II PRAXIDES C. ARCINO ANGELES R. CARLOTO II
Designation: Municipal Mayor OIC-Municipal Treasurer Municipal Mayor
32.757
19,064.00
982.71
35.10
936.00 35.0967857
1965.42
982.71
PURCHASE ORDER
Tampilisan, Zamboanga del Norte
LGU
Supplier REMLITS ENTERPRISES P.O. No.
Address Pob. Tampilsian, Z.N. Date
Mode of Procurement:
Gentlemen:
Please furnish this office the following articles subject to the terms and conditions contained herein:
Place of Delivery: Market Delivery Term:

Date of Delivery: Immediately Payment Term:
Item No. Unit Quantity Item Description Unit Cost Amount

1 3 sacks Potash Fertilizer 1,200.00 3,600.00
2 3 sacks Urea Fertilizer 1,050.00 3,150.00
3 3 sacks 14-14-14 Fertilizer 1,100.00 3,300.00
4 3 sacks Ammunium Fertilizer 800.00 2,400.00
5 5 packs Foliar (Grow More) 260.00 1,300.00
6 10 packs Kamatis 50.00 500.00
7 10 packs Choy FI 50.00 500.00
8 10 packs Mestisa FI 50.00 500.00
9 10 packs Kangkong (tsina) 50.00 500.00
10 10 packs Pantastiko 50.00 500.00
11 10 packs Patola 50.00 500.00
12 10 packs Yellow Squash 50.00 500.00
13 10 packs Eggplant 50.00 500.00
14 10 packs Okra 50.00 500.00
15 10 packs Sibuyas(green onion) 30.00 300.00
16 10 packs Luy-a 80.00 800.00
17 1 Lit. Cymbush 1,200.00 1,200.00
18 1 Lit. Fungicide 800.00 800.00
19 10 kilos Strawless 70.00 700.00
20 10 kilos Nylon 200.00 2,000.00
21 1 pc. Weighing Scale 800.00 800.00
(Total Amount in Words) 24,850.00

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:
ANGELES R. CARLOTO II
REMLITS ENTERPRISES Municipal Mayor
(Signature Over Printed Name) (Authorized Official)
Date
(In case of Negotiated Purchase pursuant toSection 369 (a) of RA 7160, this portion must
be accomplished).
Approved to be purchased thru negotiated

purchase per Sanggunian Res. No. ______.
Certified Correct:
Secretary to the Sanggunian Date:

24,850.00
No.:
OBLIGATION REQUEST
PAYEE KJB STORE
OFFICE
y Center CODE
Php 21,600.00
Food supplies for PNP, /PA/SCA Camul

and Sto. Niño
TOTAL Php 21,600.00

X Charges to appropriation/allotment necessary,

Date Date

No.:
OBLIGATION REQUEST
PAYEE KJB STORE
OFFICE
y Center CODE
Php 21,600.00
Food supplies for PNP, /PA/SCA Camul
and Sto. Niño
TOTAL Php 21,600.00

Charges to appropriation/allotment necessary,

Date Date
DISBURSEMENT VOUCHER No.
MODE OF Check Cash Other

PAYMENT
PAYEE KJB STORE TIN/Employee No.: Obligation Request No.
RESPONSIBILITY CENTER
ADDRESSPob. Tampilsian, Z.N.
Office/Unit/Project: Code:
EXPLANATION AMOUNT
To payment of food supplies use in PNP/PA/SCAA Camul Compaq and Sto. Niño ,per
supporting
papers,hereto attached
P ###
Less: 21,600.00 x 4% 864.00
Total Amount due this Voucher . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .P ###

A CERTIFIED: B CERTIFIED:
Funds Available
Supporting documents complete and paper
Signature Signature
Printed Date: Printed Date:
SHERRY LOU P. DAPROSA CYNTHIA D. ABIL
Name Name
Municipal Accountant Acting Municipal Treasurer
Position Position
(Head,Accounting Unit/Authorized Representative) (Head,Treasury Unit/Authorized Representative)
APPROVED FOR PAYMENT: RECEIVED PAYMENT:
C D
Signature Check No.: Bank Name: Date:
Printed Date: Signature
ANGELES R. CARLOTO II
Name Printed Nam KJB STORE Date:
Municipal Mayor OR. No./Other Documents JEV Date:
Position
(Local Chief Executive/Authorized Representative)
FOR ACCOUNTING/PRE-AUDIT PERSONNEL USE ONLY:

CHECKLIST: MANDATORY MINIMUM SUPPORTING DOCUMENTS FOR COMMON TRANSACTIONS
(Maintenance & Other Operating Expenses/Capital Outlay)
I. TRAVELS 2 ALTERNATIVE MODE OF PROCUREMENT
Travel Order or Memorandum by the LCE authorizing the travel 2.a
Approved Itinerary (Appendix A) Purchase Request
Tickets (Original) for Plane, Bus, Ships Fare or equivalent Purchase Order/Letter Order/Contract,duly received
Certificate of Travel Completed (Appendix B) by bidder/supplier
Certificate of Appearance (Appendix C), or its equivalent Certificate of Acceptance
Liquidation Report-in case of cash advance Inspection Report/Waiver of Inspection
Receipts, in case of actual travel claims Result of Test Analysis (if subject to test)
Original Invoice:
Accomplishment Report -Charge Invoice/Sales Invoice
RER (optional)-For reimb. Of expenses above P 75.00 (COA Cir. 96-005 -Delivery Receipt
II. PURCHASES Canvass sheet/price quotation
1 COMPETITIVE BIDDING: Abstract/summary of canvass
Purchase Request (PR)/RIS-Original Certificate of emergency purchase-in the absence of
Purchase Order (PO)/Letter Order (LO)/Contract, duly received by canvass if amount is below 1,000.00
bidder b NEGOTIATED PROCUREMENT/NEGOTIATED CONTRACT
Inspection and Acceptance Report/Waiver of Inspection Negotiated Procurement:
Original Invoice: Purchase Request
Delivery Receipt Purchase Order/Letter Order/Contract(contract)
Sales Invoice/Charge Invoice duly received by bidder/supplier
Stock Position Sheet Certificate of Authority to negotiate/enter into negotiated
Result of test analysis by proper government, if subject to test contract.
Copy of Advertisement/Invitation to bid Delivery Receipt
Bidder's Bond Sales Invoice/Original Invoice
Notice/Letter of Award Certificate of Acceptance & Inspection Report
Performance Bond Result of Test Analysis (if subject to test)
Abstract of Bids supported by: Certificate of failure of bidding for the second time from BAC
Bid tenders of other participants Canvass sheet/price quotation
Acceptance of bid/proposal Abstract/summary of canvass
BAC recommendation-Award of the LCRB/HRRB to the LCE Negotiated Contract: (in addition to the above)
TWG recommendation Notice to commence to work
***Computation***
Php #REF!
ABSTRACT OF PERSONAL CANVASS/ BIDS FOR THE SUPPLY AND DELIVERY
PR No.
ABSTRACT OF BIDS OPENED ON: ,2016. TIME: AM/PM
IN THE BAC OFFICE, TAMPILISAN, ZAMBOANGA DEL NORTE.
Article/ Services Requisitioned DEALERS FURNISHED
ELJACK PHARMACY LILOY DOCTOR'S PHARMACY MIDTIME PHARMACY
Q U AN T I T Y
ITEM NO. DESCRIPTION Ipil, Zambo. Sibugay Liloy, Z.N. Pob. Tampilisan
No. Unit of Issue Unit Price Total Amount Unit Price Total Amount Unit Price Total Amount
1 23 boxes Paracetamol 41.00 943.00 43.00 989.00 48.00 1,104.00
2 1 box Dicycloverine 10Hcl mg 36.00 36.00 38.00 38.00 51.00 51.00
3 1 box Amoxicillin 250mg 154.00 154.00 155.00 155.00 125.00 125.00
4 50 pcs. Metoprolol 100 m 5.00 250.00 6.00 300.00 3.00 150.00
5 10 pcs. Salbutamol nebule 17.00 170.00 18.00 180.00 36.00 360.00
6 1 pc. Nebulizing Kit 84.00 84.00 88.00 88.00 100.00 100.00
7 1 pc. Oxygen Kit 180.00 180.00 182.00 182.00 110.00 110.00
8 1 pc. Digital Blood Pressure Monitoring 3,600.00 3,600.00 3,800.00 3,800.00 4,000.00 4,000.00
9 1 pc. Portable Nebulizer 2,160.00 2,160.00 2,500.00 2,500.00 4,000.00 4,000.00
10 1 pc. Medical Oxygen complete set 11,000.00 11,000.00 11,500.00 11,500.00 10,000.00 10,000.00
- -
- -
- -
-
-
THIS IS TO CERTIFY that the requirements of R.A. No. 9184 otherwise known Total 18,577.00 Total 19,732.00 Total 20,000.00
as the Government Procurement Reform Act ( Rule XVI - Sec.52 ) had been complied with. WE HEREBY CERTIFY to the correctness and authenticity of the above Abstract
of Bids to the best of our knowledge.
ANTONIO S. GUMELA,EM.D. ADELBERTO G. SAMUYA

BIDS AND AWARDS COMMITTEE: Public School District Supervisor Municipal Civil Registrar
(Requesting Officer) ( Member )
VIGILUS D. CREDO GRACE A. GUMANSING OLIVIA G. EBORDE RENE R. MANAIT

Municipal Engineer Municipal Budget Officer Municipal Treasurer MPDC
(Chairman) ( Vice Chairman ) ( Member ) ( Member )
18,577.00 19,732.00 20,000.00
INSPECTION & ACCEPTANCE REPORT
Tampilisan,Zamboanga del Norte
LGU
Supplier O.R. No.
PO No. Date Invoic Date
Requesitioning Office/Dept. RHU
Item No. Unit Description of Supplies Quantity Unit Cost Total

1 bot PLR IL 5 90.00 450.00
2 bot D5LR IL 5 90.00 450.00
3 pcs. Oxytocin Ampules 60 35.00 2,100.00
4 pcs. Phytomenadione amp. 50 45.00 2,250.00
5 pc. ice chest 1 370.00 370.00
6 set barrel bolt 1 92.50 92.50
7 pcs. Ecolum Bulb 9w 2 205.00 410.00
8 gal. mineral water 95 15.00 1,425.00
7,547.50
INSPECTION ACCEPTANCE
Date Received:
Inspected, verified and found OK X Complete
as to quantity and specifications. Partial
ALBERTO L. ACAS
Assessment Clerk II
X
MILLER B. MAGHANOY
CYNTHIA D. ABIL Admin. Aide VI/ GSO Designate
RCO II
LOLITA B. DELLABA CARMEL MATHILDA B. LADEZA, MD

Bookeeper II Municipal Health Officer
(Requesting Officer)
ticle/ Services Requisitioned

DEALERS
Q U AN T I T Y Termar's Textile & T Ipil Saver Mart M &M Amigo MarketinMBM Fashion Center GARR STORE Bugasan sa Tampi M
& obil Gasoline StationRKB Tarpaulin Printing Te Caltex Station
NAM CHA SHOPPING CENTER
GUOLAI TRADINGCAMSUR GEN. MRDSE
TEM NO. Articles/Serv
Qty. Unit Unit Price
Total Amount
Unit Price
Total Amount
Unit Price
Total Amount
Unit Price
Total Amount Unit Price
Total Amount
Unit Price
Total Amount
Unit Price
Total Amount
1 24 pcs. T - shirt Apple gre 166.66 4,000.00
2 10 pcs. Square pants 75.00 750.00
3 6 pcs. LDS Shoes 130.00 780.00
4 3 pcs. LDS Sandal 60.00 180.00
5 1 pc. Kids shoes 145.00
6 5 pcs. Off shoulder H.S. F Wear 305.00 1,525.00
7 pc. make up kit 149.00
8 pc. sponge 29.00
9 pc. BB Cream 39.00
10 3 pcs. sleeveless 267.63 802.87
11 1 pc. clothe 99.13 99.13
12 2 pc. pencil case 40.00 80.00
13 1 pc. correction tape 17.00 17.00
14 1 pc. glue 20.00 20.00
15 2 pc. hair pliat 10.00 20.00
16 2 pcs. aspen exce 7.00 14.00
17 1 pck. 978e-20 ALPH Card 50.00 50.00
18 1 pk. Cards 30.00 30.00
19 2 pcs. SS3022- SANRIO 20.00 40.00
20 1 pc. 24815-2 #2 PINS 22.00 22.00
21 10 pcs. M-18 XMAS DÉCOR 15.00 150.00
22 2 pcs. Spiderman Mask 27.00 54.00
23 asstd grocery 2,299.50
24 5 kls. rice 50.00 250.00
25 2 pc. tarpaulin 3x3 400.00 800.00
26 24 pcs. T shirt printing uniform 100.00 2,400.00
27 18 pcs. Printing dancer's uniform 100.00 1,800.00
28 11.8 lit Diesel 3,535.00 418.00
29 14 lit Diesel 34.79 500.00
TOTAL 4,000.00 750.00 1,451.00 1,525.00 2,299.50 250.00 500.00 5,000.00 418.00 217.00 902.00 151.00
VIVIAN N. UBAGAN
MSWDO SHERRY LOU P. DAPROSA PRAXIDES C. ARCINO
Municipal Accountant OIC-Municipal Treasurer

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I HEREBY CERTIFY that personal canvass was made on the articles/services herein requested and it was found that

Article/ Services Requisitioned

1 5 bot PLR IL 90.00 450.00

TOTAL 900.00 4,350.00 370.00 1,425.00 410.00 92.50

CARMEL MATHILDA B. LADEZA SHERRY LOU P. DAPROSA CYNTHIA D. ABIL

Article/ Services Requisitioned

1 pax 21 snacks 45.00 945.00 50.00 1,050.00 55.00 1,155.00

TOTAL 945.00 1,050.00 1,155.00

CYNTHIA D. ABIL SHERRY LOU P. DAPROSA CYNTHIA D. ABIL

Article/ Services Requisitioned

1 4 kls Chlorine 100.00 400.00

* Item1&2 awarded to GJEMPA STORE

TOTAL 577.00 381.50 80.00

ANGELES R. CARLOTO II SHERRY LOU P. DAPROSA CYNTHIA D. ABIL

Article/ Services Requisitioned

1 1 kilos chlorine 120.00 120.00 -

* Item 1 to 2 awarded to CLAIRE STORE

TOTAL 58.00 316.00 -

ANGELES R. CARLOTO II SHERRY LOU P. DAPROSA CYNTHIA D. ABIL

Article/ Services Requisitioned

1 52 pax snacks 80.00 4,160.00 83.00 4,316.00 85.00 4,420.00

* Item 1 to 5 awarded to Rubina Music Lights & Sporting Goods

TOTAL 4,160.00 4,316.00 4,420.00

ANGELES R. CARLOTO II SHERRY LOU P. DAPROSA CYNTHIA D. ABIL

Article/ Services Requisitioned

* Item 1 to 4 awarded to Golden Reigh Enterprises

TOTAL 422.00 113.50 285.50 - -

PRAXIDES C. ARCINO SHERRY LOU P. DAPROSA PRAXIDES C. ARCINO

TOTAL Php 374.00

Signature Over Signature Over

Republic of the Philippines

TOTAL Php 374.00

Signature Over Signature Over

Article/ Services Requisitioned

1 1 pc. Drainer 200.00 200.00

TOTAL 1,055.00 375.00 -

CARMEL MATHILDA B. LADEZA SHERRY LOU P. DAPROSA CYNTHIA D. ABIL

Article/ Services Requisitioned

1 2 pcs. volleyball ball 850.00 1,700.00 855.00 1,710.00 860.00 1,720.00

* Item 1 to 5 awarded to Rubina Music Lights & Sporting Goods

TOTAL 5,418.00 5,450.00 5,525.00

ANTONIO S. GUMELA SHERRY LOU P. DAPROSA CYNTHIA D. ABIL

Brand and Model

Tel. No/Cellphone No.

Article/ Services Requisitioned

1 1 pack Disposable spoon 25.00 25.00

* Item 1 awarded to JRJJ STORE

TOTAL 25.00 50.00 326.00 -

CYNTHIA D. ABIL SHERRY LOU P. DAPROSA CYNTHIA D. ABIL

Article/ Services Requisitioned

1 1 sack half sack rice 1,200.00

* Item 1 awarded to KJB STORE

TOTAL 1,200.00 6,263.00 1,500.00 - -

ANGELES R. CARLOTO II SHERRY LOU P. DAPROSA PRAXIDES C. ARCINO

Article/ Services Requisitioned

* Item 1 awarded to Tampilisan Construction Supply & Hauling Services

TOTAL 159.00 337.50 2,035.37 - -

PRAXIDES C. ARCINO SHERRY LOU P. DAPROSA PRAXIDES C. ARCINO

Article/ Services Requisitioned

* Item 1 to 4 awarded to Golden Reigh Enterprises

TOTAL 422.00 113.50 285.50 - -

PRAXIDES C. ARCINO SHERRY LOU P. DAPROSA PRAXIDES C. ARCINO