LGU - TAMPILISAN Purchase Request No.
Bids And Awards Committee Office of the: COA
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 Morocco Folder (blue, short) 48 pcs
2 US Bondpaper short 5 reams
3 Folder Long White (Thick) 100 pcs
4 Paper Fastener Plastic 3 boxes
5 Ink 704 Black 5 pcs
6 Expanded Folder Long (thick) 48 pcs
7 Paste (redstone) 2 pcs
8 Paper Clips (small) plastic 2 boxes
9 Paper clips (big) plastic 2 boxes
10 Ballpen (pilot-red, blue & black) 12 pcs
11 Sign Pen (red & black) my gel 6 pcs
12 Logbook (500 leaves) 5 pcs
13 Scotch Tape 1" BC 3 rolls
14 Stabilo Boss (Orange & Yellow) 6 pcs
15 Correction Pen 2 pcs
16 Rubber Bands (Big) 1 box
17 Alcohol (big) 70% 6 pcs
18 Albatross (big) 6 pcs
19 Zonrox 1 gal
20 Powder Soap (big) 1 pack
21 Freshener (Car) 2 cans
22 Toilet paper 18 pcs
23 Gasul (content) 1 tank
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
PURCHASE REQUEST
Tampilisan, Zamboanga del Norte
LGU
PR No.: Date:
Department: COA SAI No.: Date:
Section: OR No. Date:
Item Unit of Estimated Estimated
Quantity Item Description
No. Issue Unit Cost Cost
1 48 pcs Morocco Folder (blue, short) 15.00 720.00
2 5 reams US Bondpaper short 200.00 1,000.00
3 100 pcs Folder Long White (Thick) 7.00 700.00
4 3 boxes Paper Fastener Plastic 45.00 135.00
5 5 pcs Ink 704 Black 600.00 3,000.00
6 48 pcs Expanded Folder Long (thick) 24.00 1,152.00
7 2 pcs Paste (redstone) 50.00 100.00
8 2 boxes Paper Clips (small) plastic 15.00 30.00
9 2 boxes Paper clips (big) plastic 25.00 50.00
10 12 pcs Ballpen (pilot-red, blue & black) 30.00 360.00
11 6 pcs Sign Pen (red & black) my gel 30.00 180.00
12 5 pcs Logbook (500 leaves) 95.00 475.00
13 3 rolls Scotch Tape 1" BC 25.00 75.00
14 6 pcs Stabilo Boss (Orange & Yellow) 30.00 180.00
15 2 pcs Correction Pen 85.00 170.00
16 1 box Rubber Bands (Big) 230.00 230.00
17 6 pcs Alcohol (big) 70% 92.00 552.00
18 6 pcs Albatross (big) 45.00 270.00
19 1 gal Zonrox 170.00 170.00
20 1 pack Powder Soap (big) 120.00 120.00
21 2 cans Freshener (Car) 145.00 290.00
22 18 pcs Toilet paper 15.00 270.00
23 1 tank Gasul (content) 1,500.00 1,500.00
11,729.00
Purpose: For the use in the Office of the COA.
Requested by: Cash Availability: Approved by:
Signature:
Printed Name: MERIAM B. IBA-OC OLIVIA G. EBORDE ANGELES R. CARLOTO II
Designation: State Auditor III Municipal Treasurer Municipal Mayor
11,729.00
PURCHASE ORDER
Tampilisan, Zamboanga del Norte
LGU
Supplier CLICK HAUS COMPUTER SALES & SERVICES P.O. No.
Address Baybay, Liloy Zamboanga del Norte Date
Mode of Procurement:
Gentlemen:
Please furnish this office the following articles subject to the terms and conditions contained herein:
Place of Delivery: COA Delivery Term:
Date of Delivery: Immediately Payment Term:
Item No. Unit Quantity Item Description Unit Cost Amount
1 pcs 48 Morocco Folder (blue, short) 15.00 720.00
2 reams 5 US Bondpaper short 178.00 890.00
3 pcs 100 Folder Long White (Thick) 7.00 700.00
4 boxes 3 Paper Fastener Plastic 42.00 126.00
5 pcs 5 Ink 704 Black 524.00 2,620.00
6 pcs 48 Expanded Folder Long (thick) 22.00 1,056.00
7 pcs 2 Paste (redstone) 45.00 90.00
8 boxes 2 Paper Clips (small) plastic 12.00 24.00
9 boxes 2 Paper clips (big) plastic 25.00 50.00
10 pcs 12 Ballpen (pilot-red, blue & black) 29.00 348.00
11 pcs 6 Sign Pen (red & black) my gel 26.00 156.00
12 pcs 5 Logbook (500 leaves) 89.00 445.00
13 rolls 3 Scotch Tape 1" BC 20.00 60.00
14 pcs 6 Stabilo Boss (Orange & Yellow) 26.00 156.00
15 pcs 2 Correction Pen 81.00 162.00
16 box 1 Rubber Bands (Big) 205.00 205.00
17 pcs 6 Alcohol (big) 70% 86.00 516.00
18 pcs 6 Albatross (big) 44.00 264.00
19 gal 1 Zonrox (4 LTRS) 170.00 170.00
20 pack 1 Powder Soap (big) 110.00 110.00
21 cans 2 Freshener (Car) 133.00 266.00
22 pcs 18 Toilet paper 14.00 252.00
23 tank 1 Gasul (content) 1,469.00 1,469.00
(Total Amount in Words) 10,855.00
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
CLICK HAUS COMPUTER SALES & SERVICES 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:
10,855.00
Republic of the Philippines
PROVINCE OF ZAMBOANGA DEL NORTE
MUNICIPALITY OF TAMPILISAN
No.:
OBLIGATION REQUEST
PAYEE CLICK HAUS COMPUTER SALES & SERVICES
OFFICE
ADDRESS Baybay, Liloy Zamboanga del Norte
Responsibilit ACCOUNT
PARTICULARS F.P.P AMOUNT
y Center CODE
Office Supplies Php 10,855.00
TOTAL Php 10,855.00
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 MERIAM B. IBA-OC Printed Name GRACE A. GUMANSING
Position State Auditor III Position Municipal Budget Officer
Date Date
Republic of the Philippines
PROVINCE OF ZAMBOANGA DEL NORTE
MUNICIPALITY OF TAMPILISAN
No.:
OBLIGATION REQUEST
PAYEE CLICK HAUS COMPUTER SALES & SERVICES
OFFICE
ADDRESS Baybay, Liloy Zamboanga del Norte
Responsibilit ACCOUNT
PARTICULARS F.P.P AMOUNT
y Center CODE
Office Supplies Php 10,855.00
TOTAL Php 10,855.00
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 Over Signature Over
Printed Name MERIAM B. IBA-OC Printed Name GRACE A. GUMANSING
Position State Auditor III Position Municipal Budget Officer
Date Date
Republic of the Philippines
PROVINCE OF ZAMBOANGA DEL NORTE
MUNICIPALITY OF TAMPILISAN
DISBURSEMENT VOUCHER No.
MODE OF Check Cash Other
PAYMENT
CLICK HAUS COMPUTER SALES & TIN/Employee No.: Obligation Request No.
PAYEE
SERVICES
RESPONSIBILITY CENTER
ADDRESSBaybay, Liloy Zamboanga del Norte
Office/Unit/Project: Code:
EXPLANATION AMOUNT
To payment of Office Supplies for the use in the Office of the COA,
this municipality of Tampilisan Zamboanga del Norte per supporting papers,
hereto attached in the total amount . . . . . . . . . . . . . . . Php 10,855.00
Less: 10,855.00 x 4% 434.20
Total Amount due this Voucher . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Php 10,420.80
A CERTIFIED: B CERTIFIED:
Allotment obligated for the purpose as indicated ab
Funds Available
Supporting documents complete and paper
Signature Signature
Printed Date: Printed Date:
SHERRY LOU P. DAPROSA OLIVIA G. EBORDE
Name Name
Municipal Accountant 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 Date:
NamHAUS COMPUTER SALES & SERVICES
CLICK
Municipal Mayor OR. No./Other Documents JEV No. 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 negotiate
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
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
NATIVE MODE OF PROCUREMENT
rder/Letter Order/Contract,duly received
of emergency purchase-in the absence of
of Authority to negotiate/enter into negotiated
of failure of bidding for the second time from BAC
Contract: (in addition to the above)
***Computation***
Php #REF!
ABSTRACT OF PERSONAL CANVASS/ BIDS FOR THE SUPPLY AND DELIVERY
PR No.
ABSTRACT OF BIDS OPENED ON: ,2013. TIME: AM/PM
IN THE BAC OFFICE, TAMPILISAN, ZAMBOANGA DEL NORTE.
Article/ Services Requisitioned DEALERS FURNISHED
CLICK HAUS TECHNO CLICK RRCC
Q U AN T I T Y
ITEM NO. DESCRIPTION Baybay, Liloy ZN Ipil ZSP Baybay, Liloy ZN
No. Unit of Issue Unit Price Total Amount Unit Price Total Amount Unit Price Total Amount
1 48 pcs Morocco Folder (blue, short) 15.00 720.00 15.00 720.00 15.00 720.00
2 5 reams US Bondpaper short 178.00 890.00 190.00 950.00 200.00 1,000.00
3 100 pcs Folder Long White (Thick) 7.00 700.00 7.00 700.00 7.00 700.00
4 3 boxes Paper Fastener Plastic 42.00 126.00 45.00 135.00 46.00 138.00
5 5 pcs Ink 704 Black 524.00 2,620.00 550.00 2,750.00 600.00 3,000.00
6 48 pcs Expanded Folder Long (thick) 22.00 1,056.00 23.00 1,104.00 25.00 1,200.00
7 2 pcs Paste (redstone) 45.00 90.00 48.00 96.00 52.00 104.00
8 2 boxes Paper Clips (small) plastic 12.00 24.00 14.00 28.00 15.00 30.00
9 2 boxes Paper clips (big) plastic 25.00 50.00 28.00 56.00 26.00 52.00
10 12 pcs Ballpen (pilot-red, blue & black) 29.00 348.00 30.00 360.00 32.00 384.00
11 6 pcs Sign Pen (red & black) my gel 26.00 156.00 28.00 168.00 32.00 192.00
12 5 pcs Logbook (500 leaves) 89.00 445.00 90.00 450.00 95.00 475.00
13 3 rolls Scotch Tape 1" BC 20.00 60.00 22.00 66.00 25.00 75.00
14 6 pcs Stabilo Boss (Orange & Yellow) 26.00 156.00 28.00 168.00 30.00 180.00
15 2 pcs Correction Pen 81.00 162.00 80.00 160.00 85.00 170.00
16 1 box Rubber Bands (Big) 205.00 205.00 210.00 210.00 230.00 230.00
17 6 pcs Alcohol (big) 70% 86.00 516.00 90.00 540.00 92.00 552.00
18 6 pcs Albatross (big) 44.00 264.00 45.00 270.00 46.00 276.00
19 1 gal Zonrox 170.00 170.00 170.00 170.00 172.00 172.00
20 1 pack Powder Soap (big) 110.00 110.00 115.00 115.00 120.00 120.00
21 2 cans Freshener (Car) 133.00 266.00 150.00 300.00 145.00 290.00
22 18 pcs Toilet paper 14.00 252.00 15.00 270.00 15.00 270.00
23 1 tank Gasul (content) 1,469.00 1,469.00 1,470.00 1,470.00 1,500.00 1,500.00
THIS IS TO CERTIFY that the requirements of R.A. No. 9184 otherwise known Total 10,855.00 Total 11,256.00 Total 11,830.00
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.
MERIAM B. IBA-OC GRACE A. GUMANSING
BIDS AND AWARDS COMMITTEE: State Auditor III Municipal Budget Officer
(Requesting Officer) ( Member )
VIGILUS D. CREDO VIVIAN N. UBAGAN OLIVIA G. EBORDE RENE R. MANAIT
Municipal Engineer MSWDO Municipal Treasurer MPDC
(Chairman) ( Vice Chairman ) ( Member ) ( Member )
10,855.00 11,256.00 11,830.00
INSPECTION & ACCEPTANCE REPORT
Tampilisan,Zamboanga del Norte
LGU
Supplier CLICK HAUS COMPUTER SALES & SERVICES O.R. No.
PO No. Date Invoice No. Date
Requesitioning Office/Dept. COA
Item No. Unit Description of Supplies Quantity Unit Cost Total
1 pcs Morocco Folder (blue, short) 48 15.00 720.00
2 reams US Bondpaper short 5 178.00 890.00
3 pcs Folder Long White (Thick) 100 7.00 700.00
4 boxes Paper Fastener Plastic 3 42.00 126.00
5 pcs Ink 704 Black 5 524.00 2,620.00
6 pcs Expanded Folder Long (thick) 48 22.00 1,056.00
7 pcs Paste (redstone) 2 45.00 90.00
8 boxes Paper Clips (small) plastic 2 12.00 24.00
9 boxes Paper clips (big) plastic 2 25.00 50.00
10 pcs Ballpen (pilot-red, blue & black) 12 29.00 348.00
11 pcs Sign Pen (red & black) my gel 6 26.00 156.00
12 pcs Logbook (500 leaves) 5 89.00 445.00
13 rolls Scotch Tape 1" BC 3 20.00 60.00
14 pcs Stabilo Boss (Orange & Yellow) 6 26.00 156.00
15 pcs Correction Pen 2 81.00 162.00
16 box Rubber Bands (Big) 1 205.00 205.00
17 pcs Alcohol (big) 70% 6 86.00 516.00
18 pcs Albatross (big) 6 44.00 264.00
19 gal Zonrox 1 170.00 170.00
20 pack Powder Soap (big) 1 110.00 110.00
21 cans Freshener (Car) 2 133.00 266.00
22 pcs Toilet paper 18 14.00 252.00
23 tank Gasul (content) 1 1,469.00 1,469.00
10,855.00
INSPECTION ACCEPTANCE
Date Received:
Inspected, verified and found OK X Complete
as to quantity and specifications. Partial
LUCITO P. CERNA
Municipal Agriculturist
X
MARY JANE K. CALUMBA
CYNTHIA D. ABIL Property Custodian/ GSO Designate
RCO II
LOLITA B. DELLABA MERIAM B. IBA-OC
Bookeeper II State Auditor III
REQUISITION AND ISSUE SLIP
TAMPILISAN, ZAMBOANGA DEL NORTE
LGU
Division: Resposibility Center RIS No. Date:
Office: Code: SAI No. Date:
R e q ui s i t i o n Issuance
Stock No. Unit Description Quantity Quantity Remarks
pcs Morocco Folder (blue, short) 48 48
reams US Bondpaper short 5 5
pcs Folder Long White (Thick) 100 100
boxes Paper Fastener Plastic 3 3
pcs Ink 704 Black 5 5
pcs Expanded Folder Long (thick) 48 48
pcs Paste (redstone) 2 2
boxes Paper Clips (small) plastic 2 2
boxes Paper clips (big) plastic 2 2
pcs Ballpen (pilot-red, blue & black) 12 12
pcs Sign Pen (red & black) my gel 6 6
pcs Logbook (500 leaves) 5 5
rolls Scotch Tape 1" BC 3 3
pcs Stabilo Boss (Orange & Yellow) 6 6
pcs Correction Pen 2 2
box Rubber Bands (Big) 1 1
pcs Alcohol (big) 70% 6 6
pcs Albatross (big) 6 6
gal Zonrox 1 1
pack Powder Soap (big) 1 1
cans Freshener (Car) 2 2
pcs Toilet paper 18 18
tank Gasul (content) 1 1
Purpose: For the use in the Office of the COA.
Requested by: Approved by: Issued by: Received by:
Signature:
Printed Name: MERIAM B. IBA-OC ANGELES R. CARLOTO II MARY JANE K. CALUMBA MERIAM B. IBA-OC
Designation: State Auditor III Municipal Mayor RCC-II State Auditor III
Date:
