ABSTRACT OF PERSONAL CANVASS/ BIDS FOR THE SUPPLY AND DELIVERY

PR No.
ABSTRACT OF BIDS OPENED ON: ,2019. TIME: AM/PM
IN THE BAC OFFICE, TAMPILISAN, ZAMBOANGA DEL NORTE.

Article/ Services Requisitioned DEALERS FURNISHED

BOTIKA NI DONNA Southern Drugstore Jusades Pharma
Q U AN T I T Y
ITEM NO. DESCRIPTION Poblacion,Tampilisan, Z.N. Baybay, Liloy, Z.N. Ipil, Zambo. Sibugay
No. Unit of Issue Unit Price Total Amount Unit Price Total Amount Unit Price Total Amount
1 450 amp. Phytomenadione amp. 65.00 29,250.00 66.00 29,700.00 68.00 30,600.00
2 450 amp. Oxytocin Amp. 60.00 27,000.00 62.00 27,900.00 63.00 28,350.00

THIS IS TO CERTIFY that the requirements of R.A. No. 9184 otherwise known Total 56,250.00 Total 57,600.00 Total 58,950.00
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.

CARMEL MATHILDA B. LADEZA GRACE A. GUMANSING

BIDS AND AWARDS COMMITTEE: Municipal Health Officer Municipal Budget Officer
(Requesting Officer) Member

VIGILUS D. CREDO CYNTHIA D. ABIL GODFREY B. GIMON RENE R. MANAIT

Municipal Engineer Acting Mun. Treasurer Municipal Assessor MPDC
(Chairman) ( Vice Chairman ) ( Member ) ( Member )
56,250.00 57,600.00 58,950.00
LGU - TAMPILISAN Purchase Request No.
Bids And Awards Committee Office of the: MTO
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 Top Glass 3 pcs.

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
 ABSTRACT OF PERSONAL CANVASS/ BIDS FOR THE SUPPLY AND DELIVERY
PR No.
ABSTRACT OF BIDS OPENED ON: ,2018. TIME: AM/PM
IN THE BAC OFFICE, TAMPILISAN, ZAMBOANGA DEL NORTE.

Article/ Services Requisitioned DEALERS FURNISHED

KJB STORE G.R. Jauculan D. Geraldez
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 11 sack Rice 1,600.00 17,600.00 1,605.00 17,655.00 1,610.00 17,710.00
2 5 sack Corn 800.00 4,000.00 805.00 4,025.00 810.00 4,050.00

THIS IS TO CERTIFY that the requirements of R.A. No. 9184 otherwise known Total 21,600.00 Total 21,680.00 Total 21,760.00
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.

ANGELES R. CARLOTO II ADELBERTO G. SAMUYA

BIDS AND AWARDS COMMITTEE: Municipal Mayor Municipal Civil Registrar
(Requesting Officer)

VIGILUS D. CREDO GRACE A. GUMANSING GODFREY B. GIMON RENE R. MANAIT

Municipal Engineer Municipal Budget Officer Municipal Assessor MPDC
(Chairman) ( Vice Chairman ) ( Member ) ( Member )
21,600.00 21,680.00 21,760.00
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 Liter 2T 200.00 200.00

200.00

Purpose: For Brush Cutter used.

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
 1963.42

32.757

19,800.00
982.71

35.10

200.00 35.0967857

1965.42

982.71
 PURCHASE ORDER
Tampilisan, Zamboanga del Norte
LGU
Supplier KJB STORE 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 sack 11 Rice 1,600.00 17,600.00
2 sack 5 Corn 800.00 4,000.00

(Total Amount in Words) 21,600.00

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
KJB STORE 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:

21,600.00
 Republic of the Philippines
PROVINCE OF ZAMBOANGA DEL NORTE
MUNICIPALITY OF TAMPILISAN

OBLIGATION REQUEST No.:

PAYEE PROCUREMENT SERVICE

OFFICE Sub-Depot
ADDRESS Zamboanga Sibugay

Responsibilit ACCOUNT
y Center
PARTICULARS F.P.P AMOUNT
CODE
Php 2,821.00

office supplies

TOTAL Php 2,821.00

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 PRAXIDES C. ARCINO Printed Name GRACE A. GUMANSING
Position OIC-Municipal Treasurer Position Municipal Budget Officer
Date Date

Republic of the Philippines

PROVINCE OF ZAMBOANGA DEL NORTE
MUNICIPALITY OF TAMPILISAN

OBLIGATION REQUEST No.:

PAYEE PROCUREMENT SERVICE

OFFICE
ADDRESS Zamboanga Sibugay

Responsibilit ACCOUNT
y Center
PARTICULARS F.P.P AMOUNT
CODE
Php 2,821.00

TOTAL Php 2,821.00

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 PRAXIDES C. ARCINO Printed Name GRACE A. GUMANSING
Position OIC-Municipal Treasurer 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
PATHFINDER PHARMACY & TIN/Employee No.: Obligation Request No.
PAYEE
DISTRIBUTOR
RESPONSIBILITY CENTER
ADDRESSDipolog City
Office/Unit/Project: Code:
EXPLANATION AMOUNT
To payment of Medical supplies used in RHU,Municipality of Tampilisan
Zamboanga del Norte , per
Tampilisan Zamboanga del supporting papers hereto
Norte per supporting attached inattached
papers,hereto the amount
in
of…….
the total
amount . . . . . . . . . . . . . . . Php 98,470.00

Less: 98,470.00 x 6% 3,938.80

Total Amount due this Voucher . . . . . . . . . . . . . . . . . . . . . . . . . . .Php

. 94,531.20
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 PrintedPATHFINDER
Nam Date:
PHARMACY & DISTRIBUTOR
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 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 B
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: ,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 Justine Foo & Catering Services O.R. No.
PO No. Date Invoic Date
Requesitioning Office/Dept. Mayor

Item No. Unit Description of Supplies Quantity Unit Cost Total

1 pax meals w/ lechon 70 300.00 21,000.00

21,000.00
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 ANGELES R. CARLOTO II

Bookeeper II Municipal Mayor
((Requesting Officer)