PURCHASE REQUEST

Godod, Zamboanga del Norte

Department: LDRRMO PR. No. Date:

SAI No. Date:
Section: OBR No. Date:

Quantity Unit of Stock No. Estimated Estimated

Item Description
Issue Unit Cost Cost
2 sack RICE 2,500.00 5,000.00

Total: 5,000.00
Purpose: For the use of LDRRMO
Requested by: Cash Availability Approved by:

Signature:
Printed Name: JONARD C. PAGASI-AN ROMULO B. LOMOCSO ABEL M. MATILDO
Designation: LDRRMO-designate Municipal Treasurer Municipal Mayor
Name of the Procuring Entry
Project Reference Number
Name of the Project
Location of the Project
Standard Form Number: SF-GOOD-60
Revised on: May 24, 2004
Standard Form Title: Request for Quotation
Approved Budget for the Contract: ______________

Date:_______________
Quotation No.: _______
Company Name: _______________________
Address: _____________________________

Please quote your lowest price on the item/s listed below, subject to the General Conditions
on the last page, stating the shortest time of the delivey and submit your quotaion duly signed by your
representative not later than ___________________________________________________ in the return
envelope attached herewith.

GLENDA C. GALLOPIN
Municipal Treasurer
Procurement Officer

NOTE: 1. ALL ENTRIES MUST BE TYPEWRITTEN

2. DELIVERY PERIOD WITHIN ______________ CALENDAR DAYS
3. WARRANTY SHALL BE FOR A PERIOD OF SIX (6) 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 ____________CALENDAR DAYS
5. G-EPS REGISTRATION CERTIFICATE SHALL BE ATTACHED UPON
SUBMISSION OF THE QUOTATION.
6. BIDDERS SHALL SUBMIT ORIGINAL BROCHURES SHOWING CERTIFICATIONS
OF THE PRODUCT BEING OFFERED.

ITEM NO. ITEM & DESCRIPTION QTY. UNIT PRICE TOTAL PRICE
US Bond Paper (long ) 3 rms
US Bond Paper (short ) 3 rms
Bond Paper A4 3 rms
Correction tape 4 pcs
Ballpen Ordinary (black) 2 boxes
Ethyl Alcohol ( 500 ml) 4 bots
Smart Dishwashing 3 pcs
Epson Ink L360 (Light Magenta) 4 bots
Epson Ink L360 (Light Cyan) 4 bots
Epson Ink L360 (Black) 4 bots
Epson Ink L360 (Yellow) 4 bots
Detergent Soup 2 doz

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.

e-mail address
____________________________
Date

Purpose: For MDRRM Office Supplies

NDAR DAYS

FICATIONS
ABSTRACT OF BIDS OPENED ON___________________________________ O'CLOCK AM/PM PR. NO. __________________
IN THE OFFICE OF THE MUNICIPAL TREASURER, GODOD, ZAMOBANGA DEL NORTE DATE: ________
DEALERS FURNISHED
ISAIAS TOP MARKETING Corp. DIAMOND HARD WARE
Dipolog, Zamboanga del Norte Dipolog, Zamboanga del Norte
Item PRICES PRICES PRICES PRICES
No. Qty. Unit DESCRIPTION Unit Total Unit Total
0 1 sheets nut (as per sample) 21,290.00 21,290.00 1,268.00 1,268.00
2 1 sheets Brake pad (as per sample) - 365.00 365.00
3 1 kg Shock Bushing - 57.00 114.00
4 1 pc Ball joint (as per sample) - 66.00 132.00
5 6 pc Horn Switch (24volts) - 576.00 5,760.00
6 1 pc 8mm x 2 inches Bolt With Nut (Flange) - - - -
7 8 pc 8mm x 1 inches Bolt with Nut (Flange) - - - -
8 2 pc Galvanize #16 - - - -
9 4 pc stabilizer bushing - - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
0 - - - -
Total 21,290.00 7,639.00
THIS IS TO CERTIFY that requirements of R.A. # 9184, WE HEREBY CERTIFY that the above Abstract of Bids is correct and authenticated to the best of our knowledge
as of Government Procurement Reform Act. Have been complied 42,580.00 15,278.00
with Article V.
ABEL M. MATILDO GLENDA C. GALLOPIN
BIDS and AWARDS COMMITTEE: Department Head Municipal Budget Officer

ROMULO B. LOMOCSO EVELYN A. EVARDO

GSO Municipal Treasurer Nurse II
APPROVED: (Chairman) (Member)

ABEL M. MATILDO
Municipal Mayor PASTOR A. LAPURA, JR. NELFA T. ADLAWAN
Municipal Engineer Administrative Officer III
(Member) (Member)
_________________

D
E. D. Sales Center
Dipolog, Zamboanga del Norte
PRICES PRICES
Unit Total
1,290.00 1,290.00
360.00 360.00
55.00 110.00###
64.00 128.00
580.00 5,800.00
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
7,688.00

C. GALLOPIN
Budget Officer

A. EVARDO
urse II
ember)

T. ADLAWAN
ative Officer III
ember)
 PURCHASE ORDER
Godod, Zamboanga del Norte
LGU

P.O.No.:
Supplier: ISAIAS TOP MARKETING Corp. Date:
Address: Dipolog, Zamboanga del Norte Mode of Procurement:
PR No./s:______________
Gentlemen:
Please furnish this office the following articles subject to the terms and conditions contained herein:

Place of Delivery: Delivery Term:

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

25 pcs. HAND HELD-RADIO

(Total Amount in Words)

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

Conforme:
ABEL M. MATILDO
ISAIAS TOP MARKETING Corp. Municipal Mayor
Dipolog, Zamboanga del Norte

(In case of Negotiated Purchase pursuant to Section 369(a) of RA 7160, this portion must be

accomplished.)

Approved per Sanggunian Resulotion No.:

Certified Correct:____________________________________ Date:________________

Secretary to the Sanggunian
 INSPECTION & ACCEPTANCE REPORT
Godod, Zamboanga Del Norte

Supplier: ISAIAS TOP MARKETING Corp.

PO No. _____________Date____________Invoice___________Dated:_________
Requisitioning Office/Dept. Office of the LCR.

Item No. Unit Description Quantity

0 pcs. HAND HELD-RADIO 0
0 0 0 0
3 0 0 0
0 0 0 0
5 0 0 0
0 0 0 0
7 0 0 0
0 0 0 0
9 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0

INSPECTION INSPECTION
Date Inspected: ____________ Date Receivied : ____________

Inspected, verified and found ok x Complete

x as to quantity and specifications Partial

ROMULO B. LOMOCSO
Inspection Property Officer
 Unit Prices Total Prices
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
Total -
 Republic of the Philippines

Province of Zamboanga del Norte

Municipality of Godod

OBLIGATION REQUEST No.

Payee ISAIAS TOP MARKETING Corp.
Office
Address Dipolog, Zamboanga del Norte
Responsibility F.P.P. Account Amount
Particulars
Center Code

IT Equipment P 21,290.00

(For the used of GAD YOUTH)

Total P 21,290.00
A. Certified B. Certified
Charges to appropriation/allotment necessary, Existence of available appropriation
lawful and under my direct supervision

Supporting documents valid, proper and legal

Signature Signature

Printed name ABEL M. MATILDO Printed name GLENDA C. GALLOPPIN

Municipal Mayor Municipal Budget Officer

Position Position
Requesting Office/Authorized Representative Budget Unit/Authorized Representative

Date Date
 Republic of the Philippines

Province of Zamboanga del Norte

Municipality of Godod

DISBURSEMENT VOUCHER No.

Mode of Payment x Check Cash Others

TIN/Employee No. Obligation Request No.

Payee SECC COMPUTER SALES SERVICES&ENTERPRISES

Dipolog,City Responsibility Center

Address
Office/Unit/ Project Code
EXPLANATION AMOUNT

To Payment of Communication Equipment for the use of Mayors's Office

as per supporting Papers hereto attached in the amount of………………….
……………………………………………………………………………………… P 13,570.00

13,570.00 / 1.12 x 5% = 605.80

13,570.00 / 1.12 x 1% = 121.16
726.96 726.96

Total P 12,843.04
Certified Certified
A. B.
Allotment obligation for the purpose as Indicated above Funds Avaible

Supporting documents complete

Signature Signature
Printed name ISAGANI D. NIERVA, CPA Date Printed name ROMULO B. LOMOCSO Date
Municipal Accountant Municipal Treasurer
Position Head, Accounting Unit/ Position Treasurer/Authorized Representative
Authorized Representative
C. Approved for Payment D. Received

Signature Check No. Bank Name Date

Date Signature Date
Printed Name Printed name
SECC COMPUTER SALES Date
ABEL M. MATILDO SERVICES&ENTERPRISES

Position Municipal Mayor O.R/Other Documents JEV. No. Date

Agency Head / Authorized Representative