Appendex 34

PURCHASE REQUEST

Municipality of Mambajao

Department: BAC PR No. Date:

Section : SAI No. Date:
ALOBS No. Date:

Item Estimated Estimated

Quantity Unit of Issue Item Description
No. Unit Cost Cost
1 1 unit Ceiling Type Airconditioner 97,000.00 97,000.00

TOTAL 97,000.00
Purpose For Barangay Office Affairs

Requested by: Cash Availability Approved by:

Signature:
Printed Name:MARIA LUISA D. ROMUALDO CRISTITA V. ABASTAS MARIA LUISA D. ROMUALDO
Designation: Municipal Mayor ICO Municipal Treasurer Municipal Mayor
 PURCHASE REQUEST
MAMBAJAO
LGU
PR No.: Date :
Department : SAI No. Date :
Section : ALOBS No. Date :

Item Quantity Unit of Issue Item Description Estimated Estimated

No. Unit Cost Cost
1 150 bots. Amoxicillin 100mg/1ml 25.30 3,795.00
2 150 bots. Amoxicillin 250mg/5ml 34.50 5,175.00
5 boxes Amoxicilline 250mg capsule 550.00 2,750.00
3 13 boxes Amoxicillin 500mg capsule 575.00 7,475.00
4 150 bots. Cefalexin 100mg/1ml 37.00 5,550.00
5 150 bots. Cefalexin 250mg/5ml 56.50 8,475.00
6 13 boxes Cefalexin 500mg capsule 575.00 7,475.00
7 100 bots. Cloxacillin 250/5mg syrup 65.55 6,555.00
5 boxes Ranitidine 150mg tablet 575.00 2,875.00
5 boxes Aluminum Magnesium tablet 230.00 1,150.00
5 boxes Metronidazole 500mg tablet 350.00 1,750.00
100 bots. Cetirizine Drops 103.50 10,350.00
100 bots. Cetirizine Syrup 103.50 10,350.00
5 boxes Cetirizine 10mg tablet 365.00 1,825.00
100 bots. Salbutamol Syrup 23.00 2,300.00
5 boxes Salbutamol 2mg tablet 115.00 575.00
150 bots. Lagundi Syrup 90.00 13,500.00
18 boxes Lagundi 300mg tablet 560.00 10,080.00
50 bots. Phenylpropanolamine drops 100.00 5,000.00
50 bots. Salinase Drops 80.00 4,000.00
100 bots. Phenylpropanolamine syrup 100.00 10,000.00
5 boxes Phenylpropanolamine tablet 605.00 3,025.00
3 boxes Sambong tablet 1,100.00 3,300.00
3 boxes Colchicine 100mcg tablet 345.00 1,035.00
23 boxes Mefenamic 500mg tablet 230.00 5,290.00
5 boxes Mefenamic 250mg capsule 200.00 1,000.00
200 bots. Multivitamins + iron syrup 98.00 19,600.00
200 bots. Multivitamins + iron drops 88.00 17,600.00
25 boxes Multivitamins capsule 345.00 8,625.00
25 boxes Vitamin B complex 230.00 5,750.00
5 boxes Multivitamin+FeSO4+Folic Acid tablet 575.00 2,875.00
20 boxes Losartan 50mg tablet 575.00 11,500.00
20 boxes Amlodipine 5mg tablet 460.00 9,200.00
8 boxes Metoprolol 50mg tablet 365.00 2,920.00
8 boxes Simvastatin 40mg tablet 1,100.00 8,800.00
8 boxes Glicazide 30mg tablet 1,100.00 8,800.00
8 boxes Aspirin 80ec tablet 430.00 3,440.00
5 boxes Nifedipine 10mg 575.00 2,875.00
5 boxes Captopril 25mg tablet 345.00 1,725.00
150 bots. Paracetamol Drops 34.00 5,100.00
150 bots. Paracetamol Syrup 37.00 5,550.00
2 boxes Paracetamol 500mg tablet (Biogesic) 3,100.00 6,200.00
5 boxes Lidocaine HCI + Epinephrine carpule 1,400.00 7,000.00
4 boxes Dental needle short 100's 800.00 3,200.00
2 boxes Surgical Disposable Gloves 300.00 600.00
1 boxes Face Mask 200.00 200.00
16 packs Cotton 25.00 400.00
5 bots. Alcohol 500ml 50.00 250.00
145 bots. Ascorbic Acid Drops (Ceelin) 90.00 13,050.00
110 bots. Ascorbic Acid Syrup (Ceelin) 95.00 10,450.00
20 bots. Ascorbic Acid 500mg tablet (ritemed) 500.00 10,000.00

x x x x x
Total 300,365.00
Purpose : for MSAK program (medical & dental)

Requested by: Cash Availability Approved by :

Signature :
Printed Name : YÑIGO JESUS D. ROMUALDO CRISTITA V. ABASTAS YÑIGO JESUS D. ROMUALDO
Designation : Municipal Mayor ICO-Mun. Treasurer Municipal Mayor
 Appendex 34

PURCHASE REQUEST
Municipality of Mambajao

Department : TOURISM PR No. Date : 28-Nov-18

Section : SAI No. Date :

ALOBS No. Date :

Item No. Quantity Unit of Item Description Estimated Estimated

Issue Unit Cost Cost

1 1 pc Maniquin Baby Jesus 3,500.00 3,500.00

2 35 pcs Adaptor 30.00 1,050.00
3 10 rolls Hose Lights 4,000.00 40,000.00
4 4 pcs Lantern 4,000.00 16,000.00
5 100 pcs Series Lights 180.00 18,000.00
6 3 gals Latex white Boysen 825.00 2,475.00
7 1 gal Latex red Boysen 825.00 825.00
8 1 gal Latex yellow Boysen 825.00 825.00
9 1 gal Latex black Boysen 620.00 620.00
10 1 gal Latex blue Boysen 765.00 765.00
11 1 gal Latex emerald green Boysen 720.00 720.00
12 9 sheets Marine Plywood 1/2 995.00 8,955.00
13 15 mtrs Floral wire 195.00 2,925.00
14 20 mtrs Cable Tie 95.00 1,900.00
15 2 pcs Ruler Brush Big #9 75.00 150.00
16 1 gal Acrylic thinner 775.00 775.00
17 15 mtrs Tie wire #16 90.00 1,350.00
18 10 bottles Rugby 85.00 850.00
19 10 pcs Electrical Tape 40.00 400.00
20 20 mtrs Flatcord #16 28.00 560.00
21 1 rolls Electrical Wire 16mm 4,000.00 4,000.00
22 20 pcs Bulb 250.00 5,000.00
23 10 pcs Female plug 4ports 120.00 1,200.00
112,845.00
Purpose : FOR CHRISTMAS VILLAGE

Request by : Cash Availability : Approved by :

Signature :

Printed Name JURDIN JESUS M. ROMUALDO CRISTITA V. ABASTAS JURDIN JESUS M. ROMUALDO
Designatin : Municipal Mayor Acting Municipal Treasurer Municipal Mayor
 MUNICIPAL GOVERNMENT OF MAMBAJAO
Mambajao, Camiguin

Standard Form Number: SF-GOOD-60 Project Reference No.:_________________

Revised on: May 24, 2004 Name of Project: Purchase of goods for
Disaster Preparedness(water heaters,plastic chairs & folding tables)
Location of Project: Mambajao, Camiguin
REQUEST FOR QUOTATION

Supplier: Date:
Address: Quotation No.

Please quote your lowest price on the item's listed below, subject to the General Conditions hereunder,
stating the shortest time of delivery and submit your quotation duly signed by your representative not later than
March 25, 2020.

Sgd. YÑIGO JESUS D. ROMUALDO

Procurement Officer

ITEM NO. ITEM & DESCRIPTION UNIT QTY UNIT PRICE

1 Hongkong Botton pcs. 2000

2 Inkjected Paper pads 3
3 Plastic Ware pcs. 250
4 Plastic Whistle packs 50
5 Cosmetic Kit Pouch pcs. 500

After having carefully read and accepted your General Conditions, I/We quote you on the Item at prices
noted above.

Canvasser:
Printed Name/Signature

GABRIEL C. ESPAÑOLA
Buyer III Tel. No./Cellphone No./E-mail address

Date

MUNICIPAL GOVERNMENT OF MAMBAJAO

Mambajao, Camiguin

Standard Form Number: SF-GOOD-60 Project Reference No.:_________________

Revised on: May 24, 2004 Name of Project: Purchase of goods for
Disaster preparedness(Mannequins)
Location of Project: Mambajao, Camiguin
REQUEST FOR QUOTATION

Supplier: Date:
Address: Quotation No.

Please quote your lowest price on the item's listed below, subject to the General Conditions hereunder,
stating the shortest time of delivery and submit your quotation duly signed by your representative not later than
March 25, 2020.

Sgd. YÑIGO JESUS D. ROMUALDO

 Procurement Officer

ITEM NO. ITEM & DESCRIPTION UNIT QTY UNIT PRICE

1 MANNEQUINS (Adult) SET 10

Specifications:
Product: Material
Weight: 2 kg.
Length: 70 cm
Width: 33 cm
Height: 20 cm
Max. insuf. Volume 1.8 liters
Max. compression depth 7.5 cm
Storage Temperature -20° to ₊70°C
* Incorporates the unique and patented hygienic system
that enables
training with a face piece and head bag.
* Closed shape of the torso with its anatomical correct
landmarks
enables students to learn the complete algorithm of
Basic Life Support
including the use of Automatic External
Defibrillators(AED) and the
placement of the AED Pads
* The airway is opened only when the head is tilted-
there are realistic
airway resistance and chest rise
* Unique hygienic solution with disposable head bags
and washable faces pieces
* Head can be placed inside the manikins so everything
is packed in only one small bag

After having carefully read and accepted your General Conditions, I/We quote you on the Item at prices
noted above.

Canvasser:
Printed Name/Signature

GABRIEL C. ESPAÑOLA
Buyer III Tel. No./Cellphone No./E-mail address

Date

MUNICIPAL GOVERNMENT OF MAMBAJAO

Mambajao, Camiguin

Standard Form Number: SF-GOOD-60 Project Reference No.:_________________

Revised on: May 24, 2004 Name of Project: Purchase of goods for
replacement of spareparts of MDRRMC rescue vehicle
Location of Project: Mambajao, Camiguin
REQUEST FOR QUOTATION

Supplier: Date:
Address: Quotation No.

Please quote your lowest price on the item's listed below, subject to the General Conditions hereunder,
stating the shortest time of delivery and submit your quotation duly signed by your representative not later than
March 25, 2020.

Sgd. YÑIGO JESUS D. ROMUALDO

Procurement Officer

ITEM NO. ITEM & DESCRIPTION UNIT QTY UNIT PRICE

1 Clutch Disc pc. 1

2 Release Bearing pc. 1
3 Bearing, small pc. 1
4 Bearing pc. 1
5 Bearing, big pc. 2
6 Oil Seal pc. 1
7 Gear oil liter 8
8 Clutch cover pc. 1
9 Selector cable pc. 1
10 Door stay set 2

After having carefully read and accepted your General Conditions, I/We quote you on the Item at prices
noted above.

Canvasser:
Printed Name/Signature

GABRIEL C. ESPAÑOLA
Buyer III Tel. No./Cellphone No./E-mail address

Date

MUNICIPAL GOVERNMENT OF MAMBAJAO

Mambajao, Camiguin

Standard Form Number: SF-GOOD-60 Project Reference No.:_________________

Revised on: May 24, 2004 Name of Project: Purchase of goods for
Disaster preparedness(laptop)
Location of Project: Mambajao, Camiguin
REQUEST FOR QUOTATION

Supplier: Date:
Address: Quotation No.

Please quote your lowest price on the item's listed below, subject to the General Conditions hereunder,
stating the shortest time of delivery and submit your quotation duly signed by your representative not later than
March 25, 2020.

Sgd. YÑIGO JESUS D. ROMUALDO

Procurement Officer

ITEM NO. ITEM & DESCRIPTION UNIT QTY UNIT PRICE

1 LAPTOP COMPUTER ASUS TUF GAMING LAPTOP unit 1

Specifications:
Graphics Card: GTX1050TI, GTX1050, GTX1060 and above

RAM: Atleast 8G
 Drive: Dual (Solid State Drive and Hard Disk Drive

Processor: At least core i7

After having carefully read and accepted your General Conditions, I/We quote you on the Item at prices
noted above.

Canvasser:
Printed Name/Signature

GABRIEL C. ESPAÑOLA
Buyer III Tel. No./Cellphone No./E-mail address

Date

MUNICIPAL GOVERNMENT OF MAMBAJAO

Mambajao, Camiguin

Standard Form Number: SF-GOOD-60 Project Reference No.:_________________

Revised on: May 24, 2004 Name of Project: Purchase of goods for
Disaster Preparedness(Resograph & ink)
Location of Project: Mambajao, Camiguin
REQUEST FOR QUOTATION

Supplier: Date:
Address: Quotation No.

Please quote your lowest price on the item's listed below, subject to the General Conditions hereunder,
stating the shortest time of delivery and submit your quotation duly signed by your representative not later than
March 25, 2020.

Sgd. YÑIGO JESUS D. ROMUALDO

Procurement Officer

ITEM NO. ITEM & DESCRIPTION UNIT QTY UNIT PRICE

1 COPY PRINTER DX2430 unit 1

Specifications:
Type: Digital Desktop
Printing Process : Fully-automatic one-drum stencil system
Originals: Sheet (1 original sheet only)
Original size: : Minimum: 90 x 140 mm
Maximum: 275 x 395 mm
Print Paper size: Minimum: 90 x 140 mm
Maximum: 275 x 395 mm
Print Paper weight: 35.0-127.9 g/m²
Print Area: DX 2330: Maximum: 210 x 335 mm
DX 2430: Maximum: 250 x 355 mm
Print Speed: 60-90 sheets per minute (2 steps)
 First Print Speed: Less than 45 seconds
Resolution : 300 x 300 dpi
Image Modes: Letter mode, Photo Mode, Photo/Letter Mode
Image position: Vertical: ± 10mm
Horizontal:± 10 mm
Reproduction Ratios: Pre-set enlargement: 11, 122, 141%
Pre-set reduction: 71, 82, 87,
93 %
Zoom: No
Colour Printing: By replacing colour drum
Paper Feed/delivery table capacity: 500 sheets (80 g/m²)
Power Source: 220-240 V, 50-60 Hz

Power Consumption: Maximum: Master Making: less than

175 W Printing: Less than 145 W (at 90 sheets per minute)
Standby: 35 W

Dimensions( W x D x H) : 1,232 x 672 x 519 mm

Weight: 55 kg.
2 Ink Black CPI10/dX2430 pcs. 5
3 Master DX2430 pc. 1

After having carefully read and accepted your General Conditions, I/We quote you on the Item at prices
noted above.

Canvasser:
Printed Name/Signature

GABRIEL C. ESPAÑOLA
Buyer III Tel. No./Cellphone No./E-mail address

Date

MUNICIPAL GOVERNMENT OF MAMBAJAO

Mambajao, Camiguin

Standard Form Number: SF-GOOD-60 Project Reference No.:_________________

Revised on: May 24, 2004 Name of Project: Purchase of goods for
MDRRMC Rescue equipment
Location of Project: Mambajao, Camiguin
REQUEST FOR QUOTATION

Supplier: Date:
Address: Quotation No.

Please quote your lowest price on the item's listed below, subject to the General Conditions hereunder,
stating the shortest time of delivery and submit your quotation duly signed by your representative not later than
March 25, 2020.

Sgd. YÑIGO JESUS D. ROMUALDO

Procurement Officer

ITEM NO. ITEM & DESCRIPTION UNIT QTY UNIT PRICE

1 TENDON KERN MANTLE STATIC ROPE roll 1

Specification: 10 mm x 10 meters
2 OMAGA HARD HAT/CONSTRUCTION HAT pcs. 150
 3 HANDHELD RADIO pcs. 8

After having carefully read and accepted your General Conditions, I/We quote you on the Item at prices
noted above.

Canvasser:
Printed Name/Signature

GABRIEL C. ESPAÑOLA
Buyer III Tel. No./Cellphone No./E-mail address

Date

MUNICIPAL GOVERNMENT OF MAMBAJAO

Mambajao, Camiguin

Standard Form Number: SF-GOOD-60 Project Reference No.:_________________

Revised on: May 24, 2004 Name of Project: Purchase of goods for
Municipal Health Office (Dental Use)
Location of Project: Mambajao, Camiguin
REQUEST FOR QUOTATION

Supplier: Date:
Address: Quotation No.

Please quote your lowest price on the item's listed below, subject to the General Conditions hereunder,
stating the shortest time of delivery and submit your quotation duly signed by your representative not later than
March 16, 2020.

Sgd. YÑIGO JESUS D. ROMUALDO

Procurement Officer

ITEM NO. ITEM & DESCRIPTION UNIT QTY UNIT PRICE

1 Kiddy Toothbrush pcs 1000

2 Isopropyl Alcohol(70%) bots 12
3 Dental Needles (G/S-27) bxs 20
4 Dental Lidocaine 1+C1+ Epinephrine bxs 20
5 Mefenmic Acid(500 mg) bxs 20
After having carefully read and accepted your General Conditions, I/We quote you on the Item at prices
noted above.

Canvasser:
Printed Name/Signature

GABRIEL C. ESPAÑOLA
Buyer III Tel. No./Cellphone No./E-mail address

Date

MUNICIPAL GOVERNMENT OF MAMBAJAO

Mambajao, Camiguin

Standard Form Number: SF-GOOD-60 Project Reference No.:_________________

Revised on: May 24, 2004 Name of Project: Purchase of goods for
MDRRMC
Location of Project: Mambajao, Camiguin
REQUEST FOR QUOTATION

Supplier: Date:
Address: Quotation No.

Please quote your lowest price on the item's listed below, subject to the General Conditions hereunder,
stating the shortest time of delivery and submit your quotation duly signed by your representative not later than
March 9, 2020.

Sgd. YÑIGO JESUS D. ROMUALDO

Procurement Officer

ITEM NO. ITEM & DESCRIPTION UNIT QTY UNIT PRICE

1 Type B Uniform 120 pcs

T-shirt
Colors: Black and White Polo Shirt
After having carefully read and accepted your General Conditions, I/We quote you on the Item at prices
noted above.

Canvasser:
Printed Name/Signature

GABRIEL C. ESPAÑOLA
Buyer III Tel. No./Cellphone No./E-mail address

Date

MUNICIPAL GOVERNMENT OF MAMBAJAO

Mambajao, Camiguin

Standard Form Number: SF-GOOD-60 Project Reference No.:_________________

Revised on: May 24, 2004 Name of Project: Purchase of goods for
Tourism related activities(contingent props)
Location of Project: Mambajao, Camiguin
REQUEST FOR QUOTATION

Supplier: Date:
Address: Quotation No.

Please quote your lowest price on the item's listed below, subject to the General Conditions hereunder,
stating the shortest time of delivery and sublit your quotation duly signed by your representative not later than
October 11, 2019.

Sgd. YÑIGO JESUS D. ROMUALDO

Procurement Officer

ITEM NO. ITEM & DESCRIPTION UNIT QTY UNIT PRICE

1 Flat latex, white pail 4
2 Clear Gloss Emulsion gals 12
3 Rugby gals 20
4 Black Latex gals 2
5 Paint ltrs 26
6 Roller brush #9 pcs 5
7 Brush 2 1/2 pcs 5
8 Nylon kls 3
9 Tie wire kls 10
10 Cutter small pcs 10
11 cutter blade box 1
12 Plywood, 1/4 Marine pcs 8
 13 Good lumber, 1x2x10 pcs 48

After having carefully read and accepted your General Conditions, I/We quote you on the Item at prices
noted above.

Canvasser:
Printed Name/Signature

GABRIEL C. ESPAÑOLA
Buyer III Tel. No./Cellphone No./E-mail address

Date

MUNICIPAL GOVERNMENT OF MAMBAJAO

Mambajao, Camiguin

Standard Form Number: SF-GOOD-60 Project Reference No.:_________________

Revised on: May 24, 2004 Name of Project: Purchase of goods for
Improvement/Rehab. Of NCCD
Location of Project: Mambajao, Camiguin
REQUEST FOR QUOTATION

Supplier: Date:
Address: Quotation No.

Please quote your lowest price on the item's listed below, subject to the General Conditions hereunder,
stating the shortest time of delivery and sublit your quotation duly signed by your representative not later than
October 24, 2019.

Sgd. YÑIGO JESUS D. ROMUALDO

Procurement Officer

ITEM NO. ITEM & DESCRIPTION UNIT QTY UNIT PRICE

1 12mmØx6.0m DSB kgs 533
2 10mmØx6.0m DSB kgs 425.5
3 Tie wire kls. 20
4 Hacksaw blade pcs 5
5 Portland cement bags 120
6 Washed sand cu.m. 16.5
7 Washed gravel cu.m. 8.5
8 4x8x16 CHB pcs. 800
9 1/4 ordinary plywood shts. 10
10 2 x 2 x 8 coco lumber BD.FT. 186.66667
 11 cwn # 1 kl. 1
12 cwn # 3 kls. 5
13 cwn # 4 kls. 9
14 2" G.I. pipe sch. 40 length 15
15 welding rod boxes 2
16 interling 4ft. X 7.0m. rolls 10
17 10mmx6.0dsb kgs 185
18 sander blade 4" pcs 3
19 cutting wheel pcs 5
20 steel plate no. 14 shts 3

After having carefully read and accepted your General Conditions, I/We quote you on the Item at prices
noted above.

Canvasser:
Printed Name/Signature

GABRIEL C. ESPAÑOLA
Buyer III Tel. No./Cellphone No./E-mail address

Date

MUNICIPAL GOVERNMENT OF MAMBAJAO

Mambajao, Camiguin

Standard Form Number: SF-GOOD-60 Project Reference No.:_________________

Revised on: May 24, 2004 Name of Project: Purchase of goods for
Kasalan ng Bayan at handog Regalo 2019
Location of Project: Mambajao, Camiguin
REQUEST FOR QUOTATION

Supplier: Date:
Address: Quotation No.

Please quote your lowest price on the item's listed below, subject to the General Conditions hereunder,
stating the shortest time of delivery and sublit your quotation duly signed by your representative not later than
November 11, 2019.

Sgd. YÑIGO JESUS D. ROMUALDO

Procurement Officer

ITEM NO. ITEM & DESCRIPTION UNIT QTY UNIT PRICE

1 JENA EARTH CLOTH (30 meters) Meters 30
2 FLORAL FOAM boxes 2
3 LAID PAPER packs 15
4 EPSON INK 664 sets 2
5 STAPLE WIRE NO. 35 boxes 2
6 PINS pads 10
7 BOOK PAPER LONG reams 5
8 STREAMERS
9 SNACKS DURING SEMINAR NOVEMBER 30 , 2019 TO pax 100
DECEMBER 1, 2019
Bread
 Softdrinks
10 SNACKS FOR WORKING COMMITTEE - DECEMBER 15, 2019 pax 17
Bread
Softdrinks
11 SNACKS FOR OFFICALS AND WORKING PERSONNEL DURING pax 30
KASALAN NG BAYAN - DECEMBER 14, 2019
Spaghetti / Carbonara
Garlic Bread
Lumpia
Fruits salad / Maroni Salad
Softdrinks
12 UTENSILS (DESPOSABLE PLATE, SPOON, FORK, CUP) pcs 100
13 CAKE lot 1
14 RED WINE bots 20
15 SOFTDRINKS bots 12
16 SAKO BAGS pcs 75
17 SOUVENIR MUGS pcs 110
18 RICE sacks 30

After having carefully read and accepted your General Conditions, I/We quote you on the Item at prices
noted above.

Canvasser:
Printed Name/Signature

GABRIEL C. ESPAÑOLA
Buyer III Tel. No./Cellphone No./E-mail address

Date
________

ding tables)
miguin

79,720.00

________

miguin
 150,000.00

________

rescue vehicle
miguin
________

miguin
 60,000.00

146,510.00
11,200.00
32,000.00
43,200.00 103,310.00

________

miguin
________

miguin
________

miguin
________

miguin
________

miguin
________

miguin
________

o 2019
miguin
 MUNICIPAL GOVERNMENT OF MAMBAJAO
Mambajao, Camiguin

Standard Form Number: SF-GOOD-60 Project Reference No.:_________________

Revised on: May 24, 2004 Name of Project: Purchase of goods for
MUN .Health Office use
Location of Project: Mambajao, Camiguin
REQUEST FOR QUOTATION

Supplier: Date:
Address: Quotation No.

Please quote your lowest price on the item's listed below, subject to the General Conditions hereunder,
stating the shortest time of delivery and submit your quotation duly signed by your representative not later than
March 25, 2020.

Sgd. YÑIGO JESUS D. ROMUALDO

Procurement Officer

ITEM NO. ITEM & DESCRIPTION UNIT QTY UNIT PRICE

1 BLOOD TYPING SERA(ANTI-A,ANTI-B,ANTI-D) PCS. 2

2 YELLOW PIPET TIPS 1000'S PACK 1
3 10ML TEST TUBE 2'S PCS. 30
4 2ML EDTA TUBE 100'S BOXES 3
5 CAPILLARY CLAY SEALER BOXES 3
6 CAPILLARY HEPARINIZED TUBES 100'S X10 PCS. 10
7 MEDICS HEMA-QUICK STAINING SET box 1
8 EASYLIFE HEMOGLOBIN MONITOR UNIT 1
9 EASYLIFE HEMOGLOBIN TEST STRIPS 25'S BOXES 8
10 2OL MINDRAY DILUENT BOX 1
11 MINDRAY M-30 CFL LYSE 500ML
BOTTLE 1
(3 PART DIFFERENTIAL)
12 MINDRAY M-30E E-Z CLEANSER 100ML BOTTLES 2
13 MINDRAY B-30 CONTROLL (LOW, NORMAL,HIGH) SET 1
14 DIFFERENTIAL BLOOD CELL COUNTER 5 KEYS PC. 1

After having carefully read and accepted your General Conditions, I/We quote you on the Item at prices
noted above.

Canvasser:
Printed Name/Signature

GABRIEL C. ESPAÑOLA
Buyer III Tel. No./Cellphone No./E-mail address

Date
MUNICIPAL GOVERNMENT OF MAMBAJAO
Mambajao, Camiguin

Standard Form Number: SF-GOOD-60 Project Reference No.:_________________

Revised on: May 24, 2004 Name of Project: Purchase of goods for
Agoho Cemetery
Location of Project: Mambajao, Camiguin
REQUEST FOR QUOTATION

Supplier: Date:
Address: Quotation No.
Please quote your lowest price on the item's listed below, subject to the General Conditions hereunder,
stating the shortest time of delivery and submit your quotation duly signed by your representative not later than
March 25, 2020.

Sgd. YÑIGO JESUS D. ROMUALDO

Procurement Officer

ITEM NO. ITEM & DESCRIPTION UNIT QTY UNIT PRICE

1 Cement bags 150

2 Steel bar(10mm) pc. 100
3 Steel bar(12mm) pc. 100
4 Sand cu.m. 30
5 Plywood (1/4) pc. 15
6 Coco lumber(2x3x8) pc. 100

After having carefully read and accepted your General Conditions, I/We quote you on the Item at prices
noted above.

Canvasser:
Printed Name/Signature

GABRIEL C. ESPAÑOLA
Buyer III Tel. No./Cellphone No./E-mail address

Date
MUNICIPAL GOVERNMENT OF MAMBAJAO
Mambajao, Camiguin

Standard Form Number: SF-GOOD-60 Project Reference No.:_________________

Revised on: May 24, 2004 Name of Project: Purchase of goods for
replacement of spareparts of MDRRMC rescue vehicle
Location of Project: Mambajao, Camiguin
REQUEST FOR QUOTATION

Supplier: Date:
Address: Quotation No.

Please quote your lowest price on the item's listed below, subject to the General Conditions hereunder,
stating the shortest time of delivery and submit your quotation duly signed by your representative not later than
March 25, 2020.

Sgd. YÑIGO JESUS D. ROMUALDO

Procurement Officer

ITEM NO. ITEM & DESCRIPTION UNIT QTY UNIT PRICE

1 Clutch Disc pc. 1

2 Release Bearing pc. 1
3 Bearing, small pc. 1
4 Bearing pc. 1
 5 Bearing, big pc. 2
6 Oil Seal pc. 1
7 Gear oil liter 8
8 Clutch cover pc. 1
9 Selector cable pc. 1
10 Door stay set 2

After having carefully read and accepted your General Conditions, I/We quote you on the Item at prices
noted above.

Canvasser:
Printed Name/Signature

GABRIEL C. ESPAÑOLA
Buyer III Tel. No./Cellphone No./E-mail address

Date

MUNICIPAL GOVERNMENT OF MAMBAJAO

Mambajao, Camiguin

Standard Form Number: SF-GOOD-60 Project Reference No.:_________________

Revised on: May 24, 2004 Name of Project: Purchase of goods for
Sports tourism Program
Location of Project: Mambajao, Camiguin
REQUEST FOR QUOTATION

Supplier: Date:
Address: Quotation No.

Please quote your lowest price on the item's listed below, subject to the General Conditions hereunder,
stating the shortest time of delivery and submit your quotation duly signed by your representative not later than
March 25, 2020.

Sgd. YÑIGO JESUS D. ROMUALDO

Procurement Officer

ITEM NO. ITEM & DESCRIPTION UNIT QTY UNIT PRICE

1 Bamboo Poles pcs. 150

2 Plastic Drum pcs. 24
3 Nylon kls 3
After having carefully read and accepted your General Conditions, I/We quote you on the Item at prices
noted above.

Canvasser:
Printed Name/Signature

GABRIEL C. ESPAÑOLA
Buyer III Tel. No./Cellphone No./E-mail address

Date

MUNICIPAL GOVERNMENT OF MAMBAJAO

Mambajao, Camiguin

Standard Form Number: SF-GOOD-60 Project Reference No.:_________________

Revised on: May 24, 2004 Name of Project: Purchase of goods for
MTO use
Location of Project: Mambajao, Camiguin
REQUEST FOR QUOTATION

Supplier: Date:
Address: Quotation No.

Please quote your lowest price on the item's listed below, subject to the General Conditions hereunder,
stating the shortest time of delivery and submit your quotation duly signed by your representative not later than
March 25, 2020.

Sgd. YÑIGO JESUS D. ROMUALDO

Procurement Officer

ITEM NO. ITEM & DESCRIPTION UNIT QTY UNIT PRICE

1 Municipal License Card pcs. 2500

After having carefully read and accepted your General Conditions, I/We quote you on the Item at prices
noted above.

Canvasser:
Printed Name/Signature

GABRIEL C. ESPAÑOLA
 Buyer III Tel. No./Cellphone No./E-mail address

Date

MUNICIPAL GOVERNMENT OF MAMBAJAO

Mambajao, Camiguin

Standard Form Number: SF-GOOD-60 Project Reference No.:_________________

Revised on: May 24, 2004 Name of Project: Purchase of goods for
replacement of spareparts of MDRRMC rescue vehicle
Location of Project: Mambajao, Camiguin
REQUEST FOR QUOTATION

Supplier: Date:
Address: Quotation No.

Please quote your lowest price on the item's listed below, subject to the General Conditions hereunder,
stating the shortest time of delivery and submit your quotation duly signed by your representative not later than
March 25, 2020.

Sgd. YÑIGO JESUS D. ROMUALDO

Procurement Officer

ITEM NO. ITEM & DESCRIPTION UNIT QTY UNIT PRICE

1 TENDON KERN MANTLE STATIC ROPE roll 1

Specification: 10 mm x 10 meters
2 OMAGA HARD HAT/CONSTRUCTION HAT pcs. 150
3 HANDHELD RADIO pcs. 8

After having carefully read and accepted your General Conditions, I/We quote you on the Item at prices
noted above.

Canvasser:
Printed Name/Signature

GABRIEL C. ESPAÑOLA
Buyer III Tel. No./Cellphone No./E-mail address

Date
 MUNICIPAL GOVERNMENT OF MAMBAJAO
Mambajao, Camiguin

Standard Form Number: SF-GOOD-60 Project Reference No.:_________________

Revised on: May 24, 2004 Name of Project: Purchase of goods for
Municipal Health Office (Dental Use)
Location of Project: Mambajao, Camiguin
REQUEST FOR QUOTATION

Supplier: Date:
Address: Quotation No.

Please quote your lowest price on the item's listed below, subject to the General Conditions hereunder,
stating the shortest time of delivery and submit your quotation duly signed by your representative not later than
March 16, 2020.

Sgd. YÑIGO JESUS D. ROMUALDO

Procurement Officer

ITEM NO. ITEM & DESCRIPTION UNIT QTY UNIT PRICE

1 Kiddy Toothbrush pcs 1000

2 Isopropyl Alcohol(70%) bots 12
3 Dental Needles (G/S-27) bxs 20
4 Dental Lidocaine 1+C1+ Epinephrine bxs 20
5 Mefenmic Acid(500 mg) bxs 20

After having carefully read and accepted your General Conditions, I/We quote you on the Item at prices
noted above.

Canvasser:
Printed Name/Signature

GABRIEL C. ESPAÑOLA
Buyer III Tel. No./Cellphone No./E-mail address

Date

MUNICIPAL GOVERNMENT OF MAMBAJAO

Mambajao, Camiguin

Standard Form Number: SF-GOOD-60 Project Reference No.:_________________

Revised on: May 24, 2004 Name of Project: Purchase of goods for
MDRRMC
Location of Project: Mambajao, Camiguin
REQUEST FOR QUOTATION

Supplier: Date:
Address: Quotation No.

Please quote your lowest price on the item's listed below, subject to the General Conditions hereunder,
stating the shortest time of delivery and submit your quotation duly signed by your representative not later than
March 9, 2020.

Sgd. YÑIGO JESUS D. ROMUALDO

Procurement Officer

ITEM NO. ITEM & DESCRIPTION UNIT QTY UNIT PRICE

1 Type B Uniform 120 pcs

T-shirt
Colors: Black and White Polo Shirt

After having carefully read and accepted your General Conditions, I/We quote you on the Item at prices
noted above.

Canvasser:
Printed Name/Signature

GABRIEL C. ESPAÑOLA
Buyer III Tel. No./Cellphone No./E-mail address

Date

MUNICIPAL GOVERNMENT OF MAMBAJAO

Mambajao, Camiguin
Standard Form Number: SF-GOOD-60 Project Reference No.:_________________
Revised on: May 24, 2004 Name of Project: Purchase of goods for
Tourism related activities(contingent props)
Location of Project: Mambajao, Camiguin
REQUEST FOR QUOTATION

Supplier: Date:
Address: Quotation No.

Please quote your lowest price on the item's listed below, subject to the General Conditions hereunder,
stating the shortest time of delivery and sublit your quotation duly signed by your representative not later than
October 11, 2019.

Sgd. YÑIGO JESUS D. ROMUALDO

Procurement Officer

ITEM NO. ITEM & DESCRIPTION UNIT QTY UNIT PRICE

1 Flat latex, white pail 4
2 Clear Gloss Emulsion gals 12
3 Rugby gals 20
4 Black Latex gals 2
5 Paint ltrs 26
6 Roller brush #9 pcs 5
7 Brush 2 1/2 pcs 5
8 Nylon kls 3
9 Tie wire kls 10
10 Cutter small pcs 10
11 cutter blade box 1
12 Plywood, 1/4 Marine pcs 8
13 Good lumber, 1x2x10 pcs 48

After having carefully read and accepted your General Conditions, I/We quote you on the Item at prices
noted above.

Canvasser:
Printed Name/Signature

GABRIEL C. ESPAÑOLA
Buyer III Tel. No./Cellphone No./E-mail address

Date
 MUNICIPAL GOVERNMENT OF MAMBAJAO
Mambajao, Camiguin

Standard Form Number: SF-GOOD-60 Project Reference No.:_________________

Revised on: May 24, 2004 Name of Project: Purchase of goods for
Improvement/Rehab. Of NCCD
Location of Project: Mambajao, Camiguin
REQUEST FOR QUOTATION

Supplier: Date:
Address: Quotation No.

Please quote your lowest price on the item's listed below, subject to the General Conditions hereunder,
stating the shortest time of delivery and sublit your quotation duly signed by your representative not later than
October 24, 2019.

Sgd. YÑIGO JESUS D. ROMUALDO

Procurement Officer

ITEM NO. ITEM & DESCRIPTION UNIT QTY UNIT PRICE

1 12mmØx6.0m DSB kgs 533
2 10mmØx6.0m DSB kgs 425.5
3 Tie wire kls. 20
4 Hacksaw blade pcs 5
5 Portland cement bags 120
6 Washed sand cu.m. 16.5
7 Washed gravel cu.m. 8.5
8 4x8x16 CHB pcs. 800
9 1/4 ordinary plywood shts. 10
10 2 x 2 x 8 coco lumber BD.FT. 186.66667
11 cwn # 1 kl. 1
12 cwn # 3 kls. 5
13 cwn # 4 kls. 9
14 2" G.I. pipe sch. 40 length 15
15 welding rod boxes 2
16 interling 4ft. X 7.0m. rolls 10
17 10mmx6.0dsb kgs 185
18 sander blade 4" pcs 3
19 cutting wheel pcs 5
20 steel plate no. 14 shts 3

After having carefully read and accepted your General Conditions, I/We quote you on the Item at prices
noted above.

Canvasser:
Printed Name/Signature

GABRIEL C. ESPAÑOLA
Buyer III Tel. No./Cellphone No./E-mail address

Date

MUNICIPAL GOVERNMENT OF MAMBAJAO

Mambajao, Camiguin
Standard Form Number: SF-GOOD-60 Project Reference No.:_________________
Revised on: May 24, 2004 Name of Project: Purchase of goods for
Kasalan ng Bayan at handog Regalo 2019
Location of Project: Mambajao, Camiguin
REQUEST FOR QUOTATION

Supplier: Date:
Address: Quotation No.

Please quote your lowest price on the item's listed below, subject to the General Conditions hereunder,
stating the shortest time of delivery and sublit your quotation duly signed by your representative not later than
November 11, 2019.

Sgd. YÑIGO JESUS D. ROMUALDO

Procurement Officer

ITEM NO. ITEM & DESCRIPTION UNIT QTY UNIT PRICE

1 JENA EARTH CLOTH (30 meters) Meters 30
2 FLORAL FOAM boxes 2
3 LAID PAPER packs 15
4 EPSON INK 664 sets 2
5 STAPLE WIRE NO. 35 boxes 2
6 PINS pads 10
7 BOOK PAPER LONG reams 5
8 STREAMERS
9 SNACKS DURING SEMINAR NOVEMBER 30 , 2019 TO pax 100
DECEMBER 1, 2019
Bread
Softdrinks
10 SNACKS FOR WORKING COMMITTEE - DECEMBER 15, 2019 pax 17
Bread
Softdrinks
11 SNACKS FOR OFFICALS AND WORKING PERSONNEL DURING pax 30
KASALAN NG BAYAN - DECEMBER 14, 2019
Spaghetti / Carbonara
Garlic Bread
Lumpia
Fruits salad / Maroni Salad
Softdrinks
12 UTENSILS (DESPOSABLE PLATE, SPOON, FORK, CUP) pcs 100
13 CAKE lot 1
14 RED WINE bots 20
15 SOFTDRINKS bots 12
16 SAKO BAGS pcs 75
17 SOUVENIR MUGS pcs 110
18 RICE sacks 30

After having carefully read and accepted your General Conditions, I/We quote you on the Item at prices
noted above.
Canvasser:
Printed Name/Signature

GABRIEL C. ESPAÑOLA
Buyer III Tel. No./Cellphone No./E-mail address

Date
________

miguin

129,850.00

________

miguin
________

rescue vehicle
miguin
________

miguin
 146,510.00
11,200.00
32,000.00
43,200.00 103,310.00

________

miguin
________

rescue vehicle
miguin
________

miguin

________
miguin
________

miguin
________

miguin
________

o 2019
miguin
Standard Form Number: SF GOOD-58
Revised on: May 24, 2004
Standard Form Title: Purchase Order

PURCHASE ORDER

Municipality of Mambajao
Agency/Procuring Entry

Supplier: SUPERIOR MOTOR CORPORATION PO #

Address: RER, Kauswagan, Cagayan de Oro City Date: 04/19/18
E-mail Address: Mode of
Telephone No.: Procurement: Public Bidding
TIN: Project: Purchase of one unit Multicab

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

Place of Delivery: LGU-Mambajao, Camiguin Delivery Term:

Date of Delivery: Payment Term:
Item No. UNIT DESCRIPTION QTY UNIT COST TOTAL
1 unit Purchase of One unit Multicab 1 259,000.00 259,000.00
Van type, 12-Valve, and airconditioned

Total 259,000.00
In case of failure to make the full delivery within the time specified above, a penalty of one-tenth (1/10)
of the (1) percent for every day of delay shall be imposed.

Very truly yours,

JURDIN JESUS M. ROMUALDO

Conformed: Municipal Mayor

SUPERIOR MOTOR CORPORATION

Signature over printed name of Supplier

Date
1,465,046.50
ABSTRACT OF PROPOSALS FOR FURNISHING SUPPLIES AND MATERIALS FOR THE MUNICIPALITY OF MAMBAJAO, CAMIGUIN UNDER OUR ADVERTISEMENT
at BAC Office on April 10, 2018 through Public Bidding under the Revised IRR RA 9184

Purchase of One Unit MulTicab

Superior Motor Corporation
ITEM NO. QTY. UNIT ITEM & DESCRIPTION
Unit Cost Total Cost

1 1.00 unit Purchase of One unit Multicab 259,000.00 259,000.00

Van type, 12-Valve, and airconditioned

WE HEREBY CERTIFY that we have opened the bids for the above listed supplies/materials the abstract of which appear and the date indicated. We further
certify to the correctness of the foregoing abstract of lowest prices indicated by the bid.

LORNA B. LAGO REGALADO B. AGUILAR JR.

BAC Member BAC Member
ENGR. ELVIS V. CIMACIO
BAC Chairman
JANE F. LUSDOC TEDDY V. GALAGAR
BAC Member BAC Vice Chairman
 Republic of the Philippines
MUNICIPAL GOVERNMENT OF MAMBAJAO
Province of Camiguin

DISBURSEMENT VOUCHER No.

Mode of Check Cash Others
Payment
TIN/Employee No. Obligation Request
Payee CRISTITA V. ABASTAS No.
Responsibility Center
Office/Unit/Project Code
Address Pandan, Mambajao, Camiguin
EXPLANATION AMOUNT

To cash advance for payment of honorarium as per supporting papers hereto attached in
the amount of ………… 22,800.00

TOTAL 22,800.00
Certified Certified
Allotment obligated for the purpose as indicated above Funds Available
Supporting documents complete

Signature Signature
Printed Date Printed Date
PETRA C. ALUGAR
Name GILBERT L. GRADO, CPA Name
Position Municipal Accountant Position Municipal Treasurer
Head Accounting Unit/Authorized Representative Treasurer/ Authorized Representative
Approved for Payment Received Payment
Check No. Bank Name Date
Signature
Printed Date Signature
Name MA. LUISA D. ROMUALDO Printed Date
CRISTITA V. ABASTAS
Name
Municipal Mayor
Position OR/Other Documents JEV No. Date
Agency Head/Authorized Representative
No.
JOURNAL ENTRY VOUCHER
Date:

Cash Advance Reimbursement Other Payments

Responsib Amount
ility Accounts and Explanation Account Code
Debit Credit
Center

TOTAL:

Prepared by: Approved by:

GILBERT L. GRADO, CPA

Municipal Accountant
 Annex 31
ACCEPTANCE & INSPECTION REPORT

Mambajao
LGU

Supplier: A & L MARKETING

P.O. No.: Invoice No.
Requisitioning Office/Department:

Item No. Unit Description Quantity

1 unit Cylinder Head Assy. w/ valve & camshaft 1
2 pc. Piston 1
3 pc. Piston ring 1
4 pc. Main bearing 1
5 pc. Connecting rod bearing 1
6 pc. Over hauling gasket w/ camshaft & camshaft oil, 1
Valve cover gasket,haftmoon,steam Valve seal
7 pc. oil filter 1
8 pc. Fuel Filter 1
9 can Oil contents 6 ltrs. 1
10 tubes Silicon Gasket 2
11 tubes Tribond Gasket 3
12 set Cylinder liner sleve 1
13 can Grinder compound 1
14 pc. Plastic gauge 1
15 pcs Valve grinder 2

JAMES A. EDERANGO
Municipal Vice Mayor/OIC

ACCEPTANCE INSPECTION

Date Received: Date inspected:

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

CRISTALINE L. LUSTRE ELVIE JUNIO AZARDO R. FABE

Storekeeper II RCCI Bookkeeper I
Inspection Officer/Committee
 Annex 31
ACCEPTANCE & INSPECTION REPORT

Mambajao
LGU

Supplier: EMCOR
P.O. No.: Invoice No.
Requisitioning Office/Department:

Item No. Unit Description Quantity

1 unit Steel Cabinet 1

ENGR. LEONIDES G. OCLARIT

MPDC/BAC Chairman

ACCEPTANCE INSPECTION

Date Received: Date inspected:

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

CRISTALINE L. LUSTRE ELVIE JUNIO AZARDO R. FABE

Storekeeper II RCCI Bookkeeper I
Inspection Officer/Committee
 PURCHASE REQUEST
MAMBAJAO
LGU
PR No.: Date :
Department : SAI No. Date :
Section : ALOBS No. Date :
Item Quantity Unit of Issue Item Description Estimated Estimated
No. Unit Cost Cost
1 150 bots. Amoxicillin 100mg/1ml 25.30 3,795.00
2 150 bots. Amoxicillin 250mg/5ml 34.50 5,175.00
3 5 boxes Amoxicilline 250mg capsule 550.00 2,750.00
4 13 boxes Amoxicillin 500mg capsule 575.00 7,475.00
5 150 bots. Cefalexin 100mg/1ml 37.00 5,550.00
6 150 bots. Cefalexin 250mg/5ml 56.50 8,475.00
7 13 boxes Cefalexin 500mg capsule 575.00 7,475.00
8 100 bots. Cloxacillin 250/5mg syrup 65.55 6,555.00
9 5 boxes Ranitidine 150mg tablet 575.00 2,875.00
10 5 boxes Aluminum Magnesium tablet 230.00 1,150.00
11 5 boxes Metronidazole 500mg tablet 350.00 1,750.00
12 100 bots. Cetirizine Drops 103.50 10,350.00
13 100 bots. Cetirizine Syrup 103.50 10,350.00
14 5 boxes Cetirizine 10mg tablet 365.00 1,825.00
15 100 bots. Salbutamol Syrup 23.00 2,300.00
16 5 boxes Salbutamol 2mg tablet 115.00 575.00
17 150 bots. Lagundi Syrup 90.00 13,500.00
18 18 boxes Lagundi 300mg tablet 560.00 10,080.00
19 50 bots. Phenylpropanolamine drops 100.00 5,000.00
20 50 bots. Salinase Drops 80.00 4,000.00
21 100 bots. Phenylpropanolamine syrup 100.00 10,000.00
22 5 boxes Phenylpropanolamine tablet 605.00 3,025.00
23 3 boxes Sambong tablet 1,100.00 3,300.00
24 3 boxes Colchicine 100mcg tablet 345.00 1,035.00
25 23 boxes Mefenamic 500mg tablet 230.00 5,290.00
26 5 boxes Mefenamic 250mg capsule 200.00 1,000.00
27 200 bots. Multivitamins + iron syrup 98.00 19,600.00
28 200 bots. Multivitamins + iron drops 88.00 17,600.00
29 25 boxes Multivitamins capsule 345.00 8,625.00
30 25 boxes Vitamin B complex 230.00 5,750.00
31 5 boxes Multivitamin+FeSO4+Folic Acid tablet 575.00 2,875.00
32 20 boxes Losartan 50mg tablet 575.00 11,500.00
33 20 boxes Amlodipine 5mg tablet 460.00 9,200.00
34 8 boxes Metoprolol 50mg tablet 365.00 2,920.00
35 8 boxes Simvastatin 40mg tablet 1,100.00 8,800.00
36 8 boxes Glicazide 30mg tablet 1,100.00 8,800.00
37 8 boxes Aspirin 80ec tablet 430.00 3,440.00
38 5 boxes Nifedipine 10mg 575.00 2,875.00
39 5 boxes Captopril 25mg tablet 346.00 1,730.00
40 150 bots. Paracetamol Drops 34.00 5,100.00
41 150 bots. Paracetamol Syrup 37.00 5,550.00
42 2 boxes Paracetamol 500mg tablet (branded) 3,100.00 6,200.00
43 5 boxes Lidocaine HCI + Epinephrine carpul 1,400.00 7,000.00
44 4 boxes Dental needle short 100's 800.00 3,200.00
45 2 boxes Surgical Disposable Gloves 300.00 600.00
46 1 boxes Face Mask 200.00 200.00
47 16 packs Cotton 25.00 400.00
48 5 bots. Alcohol 500ml 50.00 250.00
49 145 bots. Ascorbic Acid Drops (branded) 90.00 13,050.00
50 110 bots. Ascorbic Acid Syrup (branded) 95.00 10,450.00
51 20 bots. Ascorbic Acid 500mg tablet (branded) 500.00 10,000.00
x x x x x
Total 300,370.00
Purpose : for MSAK program (medical & dental)

Requested by: Cash Availability Approved by :

Signature :
Printed Name : YÑIGO JESUS D. ROMUALDO CRISTITA V. ABASTAS YÑIGO JESUS D. ROMUALDO
Designation : Municipal Mayor ICO-Mun. Treasurer Municipal Mayor