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SUPPLIER'S PAYMENT CERTIFICATE

Project : One Prime Building


PO No. :
Supplier : COFFRAL FORMWORKS AND SCAFFOLDS
Item Description : FORMWORKS

COST CENTER : COST CODE : COST TY


Materials Ordered (Based on BOQ)
1 RENTAL OF EQUIPMENT FOR THE period of
December 1-31 2018

A B
VALUE OF MATERIALS DELIVERED : Previous Current
Certificate (01) - (24) Certificate (25)
QTY U/P AMOUNT QTY. U/P
1. Certified Value of Items Delivered
Items :
1 RENTAL OF EQUIPMENT FOR THE period of 1.00 ###
December 1-31 2018
0

2. Total Value of Items Delivered (a) ###

3. Advance Payment
(i) Materials
(ii) VAT (12%) ###
(iii) EWT (1%) -
(iv) Less Recovery of Advance Payment
Balance to be recovered

4. Net Amount Certified (a - b) ###

Prepared by: Verified by:

Cherry Verzosa Eduardo Reroma


Proj.Admin Warehouse Manager
Date : ______________________ Date : ______________________

Validated by: Concurring Approval

Maria Elisa M. Villareal Engr. Ericson Garcia


Procurement Manager AVP Engineering Head
Date : ______________________ Date : ______________________
Date : December 31, 2018
Certificate No. : Coffral - 25
Payment Due Date : January 30, 2019
Ref nos.:
DRR No.:

COST TYPE : MATERIALS


QTY. UOM UNIT COST AMOUNT
1.00 LOT 244,125.00 244,125.00

TOTAL AMOUNT Php 244,125.00

B C=A+B
Current Accumulated
Certificate (25) To-Date
AMOUNT QTY. U/P AMOUNT

244,125.00
-

244,125.00 ###

26,156.25 1,163,135.61
- -

217,968.75 ###

Approved by:

Engr. Dante Milo


Project Manager
Date : ______________________
SUPPLIER'S PAYMENT CERTIFICATE
Project : One Prime Building
PO No. :
Supplier : COFFRAL FORMWORKS AND SCAFFOLDS
Item Description : FORMWORKS

COST CENTER : COST CODE : COST TY


Materials Ordered (Based on BOQ)
1 RENTAL OF EQUIPMENT FOR THE period of
November 1-30 2018

A B
VALUE OF MATERIALS DELIVERED : Previous Current
Certificate (01) - (23) Certificate (24)
QTY U/P AMOUNT QTY. U/P
1. Certified Value of Items Delivered
Items :
1 RENTAL OF EQUIPMENT FOR THE period of 1.00 ###
November 1-30 2018
0

2. Total Value of Items Delivered (a) ###

3. Advance Payment
(i) Materials
(ii) VAT (12%) ###
(iii) EWT (1%) -
(iv) Less Recovery of Advance Payment
Balance to be recovered

4. Net Amount Certified (a - b) ###

Prepared by: Verified by:

Cherry Verzosa Eduardo Reroma


Proj.Admin Warehouse Manager
Date : ______________________ Date : ______________________

Validated by: Concurring Approval

Maria Elisa M. Villareal Engr. Ericson Garcia


Procurement Manager AVP Engineering Head
Date : ______________________ Date : ______________________
Date : November 30, 2018
Certificate No. : Coffral - 24
Payment Due Date : December 30, 2018
Ref nos.:
DRR No.:

COST TYPE : MATERIALS


QTY. UOM UNIT COST AMOUNT
1.00 LOT 236,250.00 236,250.00

TOTAL AMOUNT Php 236,250.00

B C=A+B
Current Accumulated
Certificate (24) To-Date
AMOUNT QTY. U/P AMOUNT

236,250.00
-

236,250.00 ###

25,312.50 1,136,979.36
- -

210,937.50 ###

Approved by:

Engr. Dante Milo


Project Manager
Date : ______________________
SUPPLIER'S PAYMENT CERTIFICATE
Project : One Prime Building
PO No. :
Supplier : COFFRAL FORMWORKS AND SCAFFOLDS
Item Description : FORMWORKS

COST CENTER : COST CODE : COST TY


Materials Ordered (Based on BOQ)
1 RENTAL OF EQUIPMENT FOR THE period of
October 1-31 2018

A B
VALUE OF MATERIALS DELIVERED : Previous Current
Certificate (01) - (22) Certificate (23)
QTY U/P AMOUNT QTY. U/P
1. Certified Value of Items Delivered
Items :
1 RENTAL OF EQUIPMENT FOR THE period of 1.00 11,081.88
October 1-31 2018
0

2. Total Value of Items Delivered (a) ###

3. Advance Payment
(i) Materials
(ii) VAT (12%) ###
(iii) EWT (1%) -
(iv) Less Recovery of Advance Payment
Balance to be recovered

4. Net Amount Certified (a - b) ###

Prepared by: Verified by:

Cherry Verzosa Eduardo Reroma


Proj.Admin Warehouse Manager
Date : ______________________ Date : ______________________

Validated by: Concurring Approval

Maria Elisa M. Villareal Engr. Ericson Garcia


Procurement Manager AVP Engineering Head
Date : ______________________ Date : ______________________
Date : October 31, 2018
Certificate No. : Coffral - 23
Payment Due Date : November 30, 2018
Ref nos.:
DRR No.:

COST TYPE : MATERIALS


QTY. UOM UNIT COST AMOUNT
1.00 LOT 11,081.88 11,081.88

TOTAL AMOUNT Php 11,081.88

B C=A+B
Current Accumulated
Certificate (23) To-Date
AMOUNT QTY. U/P AMOUNT

11,081.88
-

11,081.88 ###

1,187.34 1,111,666.86
- -

9,894.54 ###

Approved by:

Engr. Dante Milo


Project Manager
Date : ______________________
SUPPLIER'S PAYMENT CERTIFICATE
Project : One Prime Building
PO No. :
Supplier : COFFRAL FORMWORKS AND SCAFFOLDS
Item Description : FORMWORKS

COST CENTER : COST CODE : COST TY


Materials Ordered (Based on BOQ)
1 RENTAL OF EQUIPMENT FOR THE

A B
VALUE OF MATERIALS DELIVERED : Previous Current
Certificate (01) - (20) Certificate (21)
QTY U/P AMOUNT QTY. U/P
1. Certified Value of Items Delivered
Items :
1 SHORING SYSTEM 1.00 ###
RENTAL FOR THE MONTH OF
JUNE 01-30

2. Total Value of Items Delivered (a) ###

3. Advance Payment
(i) Materials
(ii) VAT (12%) ###
(iii) EWT (1%) -
(iv) Less Recovery of Advance Payment
Balance to be recovered

4. Net Amount Certified (a - b) ###

Prepared by: Verified by:

Cherry Verzosa Eduardo Reroma


Proj.Admin Warehouse Manager
Date : ______________________ Date : ______________________

Validated by: Concurring Approval

Maria Elisa M. Villareal Engr. Ericson Garcia


Procurement Manager Engineering Head
Date : ______________________ Date : ______________________
Date : October 2, 2018
Certificate No. : Coffral - 21
Payment Due Date : November 1, 2018
Ref nos.:
DRR No.:

COST TYPE : MATERIALS


QTY. UOM UNIT COST AMOUNT
1.00 LOT 236,250.00 236,250.00

TOTAL AMOUNT Php 236,250.00

B C=A+B
Current Accumulated
Certificate (21) To-Date
AMOUNT QTY. U/P AMOUNT

236,250.00
-

236,250.00 ###

25,312.50 1,110,479.52
- -

210,937.50 ###

Approved by:

Engr. Dante Milo


Project Manager
Date : ______________________
SUPPLIER'S PAYMENT CERTIFICATE
Project : One Prime Building
PO No. :
Supplier : COFFRAL FORMWORKS AND SCAFFOLDS
Item Description : FORMWORKS

COST CENTER : COST CODE : COST TY


Materials Ordered (Based on BOQ)
1 RENTAL OF EQUIPMENT FOR THE

A B
VALUE OF MATERIALS DELIVERED : Previous Current
Certificate (01) - (20) Certificate (21)
QTY U/P AMOUNT QTY. U/P
1. Certified Value of Items Delivered
Items :
1 SHORING SYSTEM 1.00 ###
RENTAL FOR THE MONTH OF
JUNE 01-30

2. Total Value of Items Delivered (a) ###

3. Advance Payment
(i) Materials
(ii) VAT (12%) ###
(iii) EWT (1%) -
(iv) Less Recovery of Advance Payment
Balance to be recovered

4. Net Amount Certified (a - b) ###

Prepared by: Verified by:

Cherry Verzosa Eduardo Reroma


Proj.Admin Warehouse Manager
Date : ______________________ Date : ______________________

Validated by: Concurring Approval

Maria Elisa M. Villareal Engr. Ericson Garcia


Procurement Manager Engineering Head
Date : ______________________ Date : ______________________
Date : October 2, 2018
Certificate No. : Coffral - 21
Payment Due Date : November 1, 2018
Ref nos.:
DRR No.:

COST TYPE : MATERIALS


QTY. UOM UNIT COST AMOUNT
1.00 LOT 236,250.00 236,250.00

TOTAL AMOUNT Php 236,250.00

B C=A+B
Current Accumulated
Certificate (21) To-Date
AMOUNT QTY. U/P AMOUNT

236,250.00
-

236,250.00 ###

25,312.50 1,110,479.52
- -

210,937.50 ###

Approved by:

Engr. Dante Milo


Project Manager
Date : ______________________
SUPPLIER'S PAYMENT CERTIFICATE
Project : One Prime Building
PO No. :
Supplier : COFFRAL FORMWORKS AND SCAFFOLDS
Item Description : FORMWORKS

COST CENTER : COST CODE : COST TY


Materials Ordered (Based on BOQ)
1 RENTAL OF EQUIPMENT FOR THE

A B
VALUE OF MATERIALS DELIVERED : Previous Current
Certificate (01) - (19) Certificate (20)
QTY U/P AMOUNT QTY. U/P
1. Certified Value of Items Delivered
Items :
1 SHORING SYSTEM 1.00 12,011.33
RENTAL FOR THE MONTH OF
JUNE 01-30

2. Total Value of Items Delivered (a) ###

3. Advance Payment
(i) Materials
(ii) VAT (12%) ###
(iii) EWT (1%) -
(iv) Less Recovery of Advance Payment
Balance to be recovered

4. Net Amount Certified (a - b) ###

Prepared by: Verified by:

Cherry Verzosa Eduardo Reroma


Proj.Admin Warehouse Manager
Date : ______________________ Date : ______________________

Validated by: Concurring Approval

Maria Elisa M. Villareal Engr. Ericson Garcia


Procurement Manager Engineering Head
Date : ______________________ Date : ______________________
Date : October 2, 2018
Certificate No. : Coffral - 20
Payment Due Date : November 1, 2018
Ref nos.:
DRR No.:

COST TYPE : MATERIALS


QTY. UOM UNIT COST AMOUNT
1.00 LOT 12,011.33 12,011.33

TOTAL AMOUNT Php 12,011.33

B C=A+B
Current Accumulated
Certificate (20) To-Date
AMOUNT QTY. U/P AMOUNT

12,011.33
-

12,011.33 ###

1,286.93 1,085,167.02
- -

10,724.40 ###

Approved by:

Engr. Dante Milo


Project Manager
Date : ______________________
SUPPLIER'S PAYMENT CERTIFICATE
Project : One Prime Building
PO No. : 1852
Supplier : COFFRAL FORMWORKS AND SCAFFOLDS
Item Description : FORMWORKS

COST CENTER : COST CODE : COST TY


Materials Ordered (Based on BOQ)
1 RENTAL OF EQUIPMENT FOR THE
PERIOF OF AUGUST 1-31, 2018

A B
VALUE OF MATERIALS DELIVERED : Previous Current
Certificate (01) - (18) Certificate (19)
QTY U/P AMOUNT QTY. U/P
1. Certified Value of Items Delivered
Items :
1 SHORING SYSTEM 1.00 10,724.40
RENTAL FOR THE MONTH OF
JUNE 01-30

2. Total Value of Items Delivered (a) ###

3. Advance Payment
(i) Materials
(ii) VAT (12%) ###
(iii) EWT (1%) -
(iv) Less Recovery of Advance Payment
Balance to be recovered

4. Net Amount Certified (a - b) ###

Prepared by: Verified by:

Cherry Verzosa Eduardo Reroma


Proj.Admin Warehouse Manager
Date : ______________________ Date : ______________________

Validated by: Concurring Approval

Maria Elisa M. Villareal Engr. Ericson Garcia


Procurement Manager Engineering Head
Date : ______________________ Date : ______________________
Date : August 31, 2018
Certificate No. : Coffral - 18
Payment Due Date : September 30, 2018
Ref nos.: 2018-09-22
DRR No.:

COST TYPE : MATERIALS


QTY. UOM UNIT COST AMOUNT
1.00 LOT 10,724.40 10,724.40

TOTAL AMOUNT Php 10,724.40

B C=A+B
Current Accumulated
Certificate (19) To-Date
AMOUNT QTY. U/P AMOUNT

10,724.40
-

10,724.40 ###

1,149.04 1,083,880.09
- -

9,575.36 ###

Approved by:

Engr. Dante Milo


Project Manager
Date : ______________________
SUPPLIER'S PAYMENT CERTIFICATE
Project : One Prime Building
PO No. : 1598
Supplier : COFFRAL FORMWORKS AND SCAFFOLDS
Item Description : FORMWORKS

COST CENTER : COST CODE : COST TY


Materials Ordered (Based on BOQ)
1 RENTAL OF EQUIPMENT FOR THE

A B
VALUE OF MATERIALS DELIVERED : Previous Current
Certificate (01) - (17) Certificate (18)
QTY U/P AMOUNT QTY. U/P
1. Certified Value of Items Delivered
Items :
1 SHORING SYSTEM 1.00 50,211.00
RENTAL FOR THE MONTH OF
JUNE 01-30

2. Total Value of Items Delivered (a) ###

3. Advance Payment
(i) Materials
(ii) VAT (12%) ###
(iii) EWT (1%) -
(iv) Less Recovery of Advance Payment
Balance to be recovered

4. Net Amount Certified (a - b) ###

Prepared by: Verified by:

Cherry Verzosa Eduardo Reroma


Proj.Admin Warehouse Manager
Date : ______________________ Date : ______________________

Validated by: Concurring Approval

Maria Elisa M. Villareal Engr. Ericson Garcia


Procurement Manager Engineering Head
Date : ______________________ Date : ______________________
Date : May 30, 2018
Certificate No. : Coffral - 19
Payment Due Date : June 29, 2018
Ref nos.: 17-00228
DRR No.: 1623

COST TYPE : MATERIALS


QTY. UOM UNIT COST AMOUNT
1.00 LOT 50,211.00 50,211.00

TOTAL AMOUNT Php 50,211.00

B C=A+B
Current Accumulated
Certificate (18) To-Date
AMOUNT QTY. U/P AMOUNT

50,211.00
-

50,211.00 ###

5,379.75 1,082,731.05
- -

44,831.25 ###

Approved by:

Engr. Dante Milo


Project Manager
Date : ______________________
SUPPLIER'S PAYMENT CERTIFICATE
Project : One Prime Building
PO No. : 1852
Supplier : COFFRAL FORMWORKS AND SCAFFOLDS
Item Description : FORMWORKS

COST CENTER : COST CODE : COST TY


Materials Ordered (Based on BOQ)
1 RENTAL OF EQUIPMENT FOR THE
PERIOF OF AUGUST 1-31, 2018

A B
VALUE OF MATERIALS DELIVERED : Previous Current
Certificate (01) - (16) Certificate (17)
QTY U/P AMOUNT QTY. U/P
1. Certified Value of Items Delivered
Items :
1 SHORING SYSTEM 1.00 ###
RENTAL FOR THE MONTH OF
JUNE 01-30

2. Total Value of Items Delivered (a) ###

3. Advance Payment
(i) Materials
(ii) VAT (12%) ###
(iii) EWT (1%) -
(iv) Less Recovery of Advance Payment
Balance to be recovered

4. Net Amount Certified (a - b) ###

Prepared by: Verified by:

Del Christian Vecinal Eduardo Reroma


Proj.Admin Warehouse Manager
Date : ______________________ Date : ______________________

Validated by: Concurring Approval

Maria Elisa M. Villareal Engr. Ericson Garcia


Procurement Manager Engineering Head
Date : ______________________ Date : ______________________
Date : August 31, 2018
Certificate No. : Coffral - 17
Payment Due Date : September 30, 2018
Ref nos.: 2018-09-22
DRR No.:

COST TYPE : MATERIALS


QTY. UOM UNIT COST AMOUNT
1.00 LOT 292,208.11 292,208.11

TOTAL AMOUNT Php 292,208.11

B C=A+B
Current Accumulated
Certificate (17) To-Date
AMOUNT QTY. U/P AMOUNT

292,208.11
-

292,208.11 ###

31,308.01 1,077,351.30
- -

260,900.10 ###

Approved by:

Engr. Dante Milo


Project Manager
Date : ______________________
SUPPLIER'S PAYMENT CERTIFICATE
Project : One Prime Building
PO No. : 1852
Supplier : COFFRAL FORMWORKS AND SCAFFOLDS
Item Description : FORMWORKS

COST CENTER : COST CODE : COST TY


Materials Ordered (Based on BOQ)
1 RENTAL OF EQUIPMENT FOR THE
PERIOF OF JULY 1-31, 2018

A B
VALUE OF MATERIALS DELIVERED : Previous Current
Certificate (01) - (15) Certificate (16)
QTY U/P AMOUNT QTY. U/P
1. Certified Value of Items Delivered
Items :
1 SHORING SYSTEM 1.00 ###
RENTAL FOR THE MONTH OF
JUNE 01-30

2. Total Value of Items Delivered (a) ###

3. Advance Payment
(i) Materials
(ii) VAT (12%) ###
(iii) EWT (1%) -
(iv) Less Recovery of Advance Payment
Balance to be recovered

4. Net Amount Certified (a - b) ###

Prepared by: Verified by:

Del Christian Vecinal Eduardo Reroma


Proj.Admin Warehouse Manager
Date : ______________________

Validated by: Concurring Approval

Maria Elisa M. Villareal Engr. Ericson Garcia


Procurement Manager Engineering Head
Date : ______________________ Date : ______________________
Date : July 31, 2018
Certificate No. : Coffral - 16
Payment Due Date : August 30, 2018
Ref nos.: 2018-08-10
DRR No.:

COST TYPE : MATERIALS


QTY. UOM UNIT COST AMOUNT
1.00 LOT 316,199.25 316,199.25

TOTAL AMOUNT Php 316,199.25

B C=A+B
Current Accumulated
Certificate (16) To-Date
AMOUNT QTY. U/P AMOUNT

316,199.25
-

316,199.25 9,763,070.66

33,878.49 1,046,043.29
- -

282,320.76 ###

Approved by:

Engr. Dante Milo


Project Manager
SUPPLIER'S PAYMENT CERTIFICATE
Project : One Prime Building
PO No. : 1852
Supplier : COFFRAL FORMWORKS AND SCAFFOLDS
Item Description : FORMWORKS

COST CENTER : COST CODE : COST TY


Materials Ordered (Based on BOQ)
1 SHORING SYSTEM
RENTAL FOR THE MONTH OF
JUNE 01-30

A B
VALUE OF MATERIALS DELIVERED : Previous Current
Certificate (01) - (14) Certificate (15)
QTY U/P AMOUNT QTY. U/P
1. Certified Value of Items Delivered
Items :
1 SHORING SYSTEM 1.00 48,964.20
RENTAL FOR THE MONTH OF
JUNE 01-30

2. Total Value of Items Delivered (a) ###

3. Advance Payment
(i) Materials
(ii) VAT (12%) ###
(iii) EWT (1%) -
(iv) Less Recovery of Advance Payment
Balance to be recovered

4. Net Amount Certified (a - b) ###

Prepared by: Verified by:

Del Christian Vecinal Eduardo Reroma


Proj.Admin Warehouse Manager
Date : ______________________

Validated by: Concurring Approval

Maria Elisa M. Villareal Engr. Ericson Garcia


Procurement Manager Engineering Head
Date : ______________________ Date : ______________________
Date : July 31, 2018
Certificate No. :
Payment Due Date : August 30, 2018
Ref nos.: 2018-07-013
DRR No.: 2260

COST TYPE : MATERIALS


QTY. UOM UNIT COST AMOUNT
1.00 LOT 48,964.20 48,964.20

TOTAL AMOUNT Php 48,964.20

B C=A+B
Current Accumulated
Certificate (15) To-Date
AMOUNT QTY. U/P AMOUNT

48,964.20
-

48,964.20 9,446,871.41

5,246.16 1,012,164.79
- -

43,718.04 ###

Approved by:

Engr. Dante Milo


Project Manager
SUPPLIER'S PAYMENT CERTIFICATE
Project : One Prime Building
PO No. : 1756
Supplier : COFFRAL FORMWORKS AND SCAFFOLDS
Item Description : FORMWORKS

COST CENTER : COST CODE : COST TY


Materials Ordered (Based on BOQ)
1 STAFLEX FRAME 150CM
2 STAFLEX C-BRACE 160M x 150
3 STAFLEX CONNECTOR
4 STAFLEX GRAVITY PIN
5 RENTAL COFFRAL FOR 90 DAYS

A B
VALUE OF MATERIALS DELIVERED : Previous Current
Certificate (01) - (13) Certificate (14)
QTY U/P AMOUNT QTY. U/P
1. Certified Value of Items Delivered
Items :
1 RENTAL FOR COFFRAL 30.00 1,867.90
2 VAT
3
4

2. Total Value of Items Delivered (a) ###

3. Advance Payment
(i) Materials
(ii) VAT (12%) ###
(iii) EWT (1%) -
(iv) Less Recovery of Advance Payment
Balance to be recovered

4. Net Amount Certified (a - b) ###

Prepared by: Approved by:

Del Christian Vecinal Engr. Dante Milo


Proj.Admin Project Manager
Date : ______________________

PRF#
P.O#
Validated by: Concurring Approval DRR#
DR#
Maria Elisa M. Villareal Engr. Ericson Garcia INV#
Procurement Manager Engineering Head Amount
Date : ______________________ Date : ______________________
Date : June 8, 2018
Certificate No. : Coffral - 14
Payment Due Date : July 8, 2018
Ref nos.:
DRR No.: 0349

COST TYPE : MATERIALS


QTY. UOM UNIT COST AMOUNT
440.00 PCS 2.58 1,135.20
470.00 PCS 0.75 352.50
1550.00 PCS 0.06 93.00
3100.00 PCS 0.03 93.00
30.00 DAYS 1,867.90 51,884.70
VAT 6,226.16
TOTAL AMOUNT Php 58,110.86

B C=A+B
Current Accumulated
Certificate (14) To-Date
AMOUNT QTY. U/P AMOUNT

56,037.00
6,226.16

58,110.86 9,397,907.21

6,226.16 1,006,918.63
- -

51,884.70 ###
SUPPLIER'S PAYMENT CERTIFICATE
Project : One Prime Building
PO No. : 0791
Supplier : COFFRAL FORMWORKS AND SCAFFOLDS
Item Description : FORMWORKS

COST CENTER : COST CODE : COST TY


Materials Ordered (Based on BOQ)
1 SHORING JACK 3T 4.5M
RENTAL (JUNE) SHORING 4.5 (P6615.00/DAY)
2 SHORING JACK 3T 3.5M
RENTAL (JUNE) SHORING 3.5 (P1260.00/DAY)

A B
VALUE OF MATERIALS DELIVERED : Previous Current
Certificate (01) - (12) Certificate (13)
QTY U/P AMOUNT QTY. U/P
1. Certified Value of Items Delivered
Items :
1 RENTAL (JUNE) SHORING 4.5 (P6615.00/DAY) 30.00 6,615.00
2 RENTAL (JUNE) SHORING 3.5 (P1260.00/DAY) 30.00 1,260.00
3
4

2. Total Value of Items Delivered (a) ###

3. Advance Payment
(i) Materials
(ii) VAT (12%) 975,379.97
(iii) EWT (1%) -
(iv) Less Recovery of Advance Payment
Balance to be recovered

4. Net Amount Certified (a - b) ###

Prepared by: Approved by:

Del Christian Vecinal Engr. Dante Milo


Proj.Admin Project Manager
Date : ______________________

PRF#
P.O#
Validated by: Concurring Approval DRR#
DR#
Maria Elisa M. Villareal Engr. Ericson Garcia INV#
Procurement Manager Engineering Head Amount
Date : ______________________ Date : ______________________
Date : June 9, 2018
Certificate No. : Coffral - 13
Payment Due Date : July 9, 2018
Ref nos.: 18-00095; 18-00096
DRR No.: 1218

COST TYPE : MATERIALS


QTY. UOM UNIT COST AMOUNT
540.00 SETS 12.25 6,615.00
30.00 DAYS 6,615.00 198,450.00
180.00 SETS 7.00 1,260.00
30.00 DAYS 1,260.00 37,800.00

TOTAL AMOUNT Php 236,250.00

B C=A+B
Current Accumulated
Certificate (13) To-Date
AMOUNT QTY. U/P AMOUNT

198,450.00
37,800.00

236,250.00 9,339,796.35

25,312.50 1,000,692.47
- -

210,937.50 ###
SUPPLIER'S PAYMENT CERTIFICATE
Project : One Prime Building
PO No. : 1598
Supplier : COFFRAL FORMWORKS AND SCAFFOLDS
Item Description : FORMWORKS

COST CENTER : COST CODE : COST TY


Materials Ordered (Based on BOQ)
1 RENTAL OF COFFRAL FORMWORKS

A B
VALUE OF MATERIALS DELIVERED : Previous Current
Certificate (01) - (10) Certificate (11)
QTY U/P AMOUNT QTY. U/P
1. Certified Value of Items Delivered
Items :
1 RENTAL OF COFFRAL FORMWORKS 1.00 50,211.00

2. Total Value of Items Delivered (a) ###

3. Advance Payment
(i) Materials
(ii) VAT (12%) 970,000.22
(iii) EWT (1%) -
(iv) Less Recovery of Advance Payment
Balance to be recovered

4. Net Amount Certified (a - b) ###

Prepared by: Reviewed by:

Louie Leyva
Proj.Admin Cost Engineer
Date : ______________________ Date : ______________________

Concurring Approval Validated by:


Maria Elisa M. Villareal
Sr. Project Manager Procurement Manager
Date : ______________________ Date : ______________________
Date : April 30, 2018
Certificate No. : Coffral - 12
Payment Due Date : May 30, 2018
Ref nos.:
DRR No.: 1280

COST TYPE : MATERIALS


QTY. UOM UNIT COST AMOUNT
1.00 LOT 50,211.00 50,211.00

TOTAL AMOUNT Php 50,211.00

B C=A+B
Current Accumulated
Certificate (11) To-Date
AMOUNT QTY. U/P AMOUNT

50,211.00
-

50,211.00 9,103,546.35

5,379.75 975,379.97
- -

44,831.25 ###

Approved:

Engr. Ron Bristol


Project Manager
Date : ______________________

PRF#
P.O# 458
DRR# 1280
DR# 0

INV#
AMOUNT 50,211.00
SUPPLIER'S PAYMENT CERTIFICATE
Project : One Prime Building
PO No. : 0808
Supplier : COFFRAL FORMWORKS AND SCAFFOLDS
Item Description : FORMWORKS

COST CENTER : COST CODE : COST TY


Materials Ordered (Based on BOQ)
1 RENTAL OF EQUIPMENT
PERIOD COVERED MARCH 1-31,2018

A B
VALUE OF MATERIALS DELIVERED : Previous Current
Certificate (01) - (10) Certificate (11)
QTY U/P AMOUNT QTY. U/P
1. Certified Value of Items Delivered
Items :
1 RENTAL OF EQUIPMENT 1.00 58,110.86
0 PERIOD COVERED MARCH 1-31,2018

2. Total Value of Items Delivered (a) ###

3. Advance Payment
(i) Materials
(ii) VAT (12%) 963,774.05
(iii) EWT (1%) -
(iv) Less Recovery of Advance Payment
Balance to be recovered

4. Net Amount Certified (a - b) ###

Prepared by: Reviewed by:

Louie Leyva
Proj.Admin Cost Engineer
Date : ______________________ Date : ______________________

Concurring Approval Validated by:


Maria Elisa M. Villareal
Sr. Project Manager Procurement Manager
Date : ______________________ Date : ______________________
Date : March 31, 2018
Certificate No. : Coffral - 11
Payment Due Date : April 30, 2018
Ref nos.: 2018-04-012
DRR No.: 1185

COST TYPE : MATERIALS


QTY. UOM UNIT COST AMOUNT
1.00 LOT 58,110.86 58,110.86

TOTAL AMOUNT Php 58,110.86

B C=A+B
Current Accumulated
Certificate (11) To-Date
AMOUNT QTY. U/P AMOUNT

58,110.86
-

58,110.86 9,053,335.35

6,226.16 970,000.22
- -

51,884.70 ###

Approved:

Engr. Ron Bristol


Project Manager
Date : ______________________

PRF#
P.O# 458
DRR# 1185
DR# 2018-04-012

INV#
AMOUNT 58,110.86
SUPPLIER'S PAYMENT CERTIFICATE
Project : One Prime Building
PO No. : 0808
Supplier : COFFRAL FORMWORKS AND SCAFFOLDS
Item Description : FORMWORKS

COST CENTER : COST CODE : COST TY


Materials Ordered (Based on BOQ)
1 Staflex Connector
2 Staflex Frame 1.50
3 Staflex cross brace 160
4 Staflex Gravity
5 Amount Due
6 12%

A B
VALUE OF MATERIALS DELIVERED : Previous Current
Certificate (01) - ( 08) Certificate (09)
QTY U/P AMOUNT QTY. U/P
1. Certified Value of Items Delivered
Items :
1 Staflex Connector 1550.00 0.06
2 Staflex Frame 1.50 440.00 2.58
3 Staflex cross brace 160 470.00 0.75
4 Staflex Gravity 3100.00 0.03
5 Amount Due 0.00 -
6 0.12 0.00 -

2. Total Value of Items Delivered (a) ###

3. Advance Payment
(i) Materials
(ii) VAT (12%) 957,358.21
(iii) EWT (1%) -
(iv) Less Recovery of Advance Payment
Balance to be recovered

4. Net Amount Certified (a - b) ###

Prepared by: Reviewed by:


Louie Leyva
Proj.Admin Cost Engineer
Date : ______________________ Date : ______________________

Concurring Approval Validated by:

Maria Elisa M. Villareal


Sr. Project Manager Procurement Manager
Date : ______________________ Date : ______________________
Date : February 6, 2018
Certificate No. : Coffral - 09
Payment Due Date : March 8, 2018
Ref nos.: 2018-02-011
DRR No.: 1062

COST TYPE : MATERIALS


QTY. UOM UNIT COST AMOUNT
1550.00 pcs 0.06 2,883.00
440.00 pcs 2.58 35,191.20
470.00 pcs 0.75 10,927.50
3100.00 pcs 0.03 2,883.00
1,770.37
6,226.16
TOTAL AMOUNT Php 59,881.23

B C=A+B
Current Accumulated
Certificate (09) To-Date
AMOUNT QTY. U/P AMOUNT

2,883.00
35,191.20
10,927.50
2,883.00
1,770.37
6,226.16

59,881.23 8,995,224.49

6,415.85 963,774.05
- -

53,465.38 ###

Approved:
Engr. Ron Bristol
Project Manager
Date : ______________________

PRF#
P.O# 458
DRR# 1062
DR# 2018-02-011

INV#
AMOUNT 59,881.23
SUPPLIER'S PAYMENT CERTIFICATE
Project : One Prime Building
PO No. : 0808
Supplier : COFFRAL FORMWORKS AND SCAFFOLDS
Item Description : FORMWORKS

COST CENTER : COST CODE : COST TY


Materials Ordered (Based on BOQ)
1 Staflex Frame 150
2 Staflex Frame 150
3 Staflex cross brace 160
4 Staflex connector

A B
VALUE OF MATERIALS DELIVERED : Previous Current
Certificate (01) - ( 07) Certificate (08)
QTY U/P AMOUNT QTY. U/P
1. Certified Value of Items Delivered
Items :
1 Staflex Frame 150 350.00 2.89
2 Staflex Frame 150 90.00 2.89
3 Staflex cross brace 160 470.00 0.84
4 Staflex connector 1550.00 0.07

2. Total Value of Items Delivered (a) ###

3. Advance Payment
(i) Materials
(ii) VAT (12%) 957,168.04
(iii) EWT (1%) -
(iv) Less Recovery of Advance Payment
Balance to be recovered

4. Net Amount Certified (a - b) ###

Prepared by: Reviewed by:

Louie Leyva
Proj.Admin Cost Engineer
Date : ______________________ Date : ______________________
Concurring Approval Validated by:

Engr.Antonio Bernardo Maria Elisa M. Villareal


Sr. Project Manager Procurement Manager
Date : ______________________ Date : ______________________
Date : October 11, 2017
Certificate No. : Coffral - 08
Payment Due Date : November 10, 2017
Ref nos.: 17-00264
DRR No.: 1898

COST TYPE : MATERIALS


QTY. UOM UNIT COST AMOUNT
350.00 pcs 2.89 1,011.50
90.00 pcs 2.89 260.10
470.00 pcs 0.84 394.80
1550.00 pcs 0.07 108.50
-
TOTAL AMOUNT Php 1,774.90

B C=A+B
Current Accumulated
Certificate (08) To-Date
AMOUNT QTY. U/P AMOUNT

1,011.50
260.10
394.80
108.50

1,774.90 8,935,343.26

190.17 957,358.21
- -

1,584.73 ###

Approved:

Engr. Ron Bristol


Project Manager
Date : ______________________
PRF#
P.O# 458
DRR# 1898
DR# 17-00264

INV#
AMOUNT 1,774.90
SUPPLIER'S PAYMENT CERTIFICATE
Project : One Prime Building
PO No. : 0458
Supplier : COFFRAL FORMWORKS AND SCAFFOLDS
Item Description : FORMWORKS

COST CENTER : COST CODE : COST TY


Materials Ordered (Based on BOQ)
1 Staflex spindle
2 Staflex fork head
3 Wooden Beam c20 2.00m
4 Wooden Beam c20 2.45m
5 Wooden Beam c20 3.00m
6 Wooden Beam c20 3.80m
7 Wooden Beam c20 3.90m
8 Staflex cross brace 160
9 rack
10 crafe

A B
VALUE OF MATERIALS DELIVERED : Previous Current
Certificate (01) - ( 05) Certificate (06)
QTY U/P AMOUNT QTY. U/P
1. Certified Value of Items Delivered
Items :
1 Staflex spindle 818.00 874.70
2 Staflex fork head 194.00 295.85
3 Wooden Beam c20 2.00m 47.00 892.86
4 Wooden Beam c20 2.45m 160.00 1,093.75
5 Wooden Beam c20 3.00m 42.00 1,339.29
6 Wooden Beam c20 3.80m 36.00 1,473.22
7 Wooden Beam c20 3.90m 58.00 1,741.08
8 Staflex cross brace 160 302.00 746.07
9 rack 5.00 -
10 crafe 1.00 -

2. Total Value of Items Delivered (a) ###

3. Advance Payment
(i) Materials
(ii) VAT (12%) 804,441.70
(iii) EWT (1%) -
(iv) Less Recovery of Advance Payment
Balance to be recovered
4. Net Amount Certified (a - b) ###

Prepared by: Reviewed by:

Louie Leyva
Proj.Admin Cost Engineer
Date : ______________________ Date : ______________________

Concurring Approval Validated by:

Engr.Antonio Bernardo Maria Elisa M. Villareal


Sr. Project Manager Procurement Manager
Date : ______________________ Date : ______________________
Date : September 13, 2017
Certificate No. : Coffral - 07
Payment Due Date : October 13, 2017
Ref nos.: 17-00236
DRR No.: 1749

COST TYPE : MATERIALS


QTY. UOM UNIT COST AMOUNT
818.00 pcs 874.70 715,504.60
194.00 pcs 295.85 57,394.90
47.00 pcs 892.86 41,964.42
160.00 pcs 1,093.75 175,000.00
42.00 pcs 1,339.29 56,250.18
36.00 pcs 1,473.22 53,035.92
58.00 pcs 1,741.08 100,982.64
302.00 pcs 746.07 225,313.14
5.00 pcs -
1.00 pcs -
-
TOTAL AMOUNT Php ###

B C=A+B
Current Accumulated
Certificate (06) To-Date
AMOUNT QTY. U/P AMOUNT

715,504.60
57,394.90
41,964.42
175,000.00
56,250.18
53,035.92
100,982.64
225,313.14
-
-

### 8,933,568.36

152,726.34 957,168.04
- -
### ###

Approved:

Engr. Ron Bristol


Project Manager
Date : ______________________

PRF#
P.O# 458
DRR# 1749
DR# 17-00236

INV#
AMOUNT 1,425,445.80
SUPPLIER'S PAYMENT CERTIFICATE
Project : One Prime Building
PO No. : 0458
Supplier : COFFRAL FORMWORKS AND SCAFFOLDS
Item Description : FORMWORKS

COST CENTER : COST CODE : COST TY


Materials Ordered (Based on BOQ)
1 Wooden Beam c20 1.50m
2 Staflex spindle
3 Staflex frame 180
4 Staflex fork head
5 Staflex cross brace 160
6 coffral shoring jack 20-3.50

A B
VALUE OF MATERIALS DELIVERED : Previous Current
Certificate (01) - ( 05) Certificate (06)
QTY U/P AMOUNT QTY. U/P
1. Certified Value of Items Delivered
Items :
1 Wooden Beam c20 1.50m 412.00 669.65
2 Staflex spindle 400.00 874.70
3 Staflex frame 180 100.00 3,087.20
4 Staflex fork head 390.00 295.85
5 Staflex cross brace 160 302.00 -
6 coffral shoring jack 20-3.50 150.00 2,688.38

2. Total Value of Items Delivered (a) ###

3. Advance Payment
(i) Materials
(ii) VAT (12%) 648,748.74
(iii) EWT (1%) -
(iv) Less Recovery of Advance Payment
Balance to be recovered

4. Net Amount Certified (a - b) ###

Prepared by: Reviewed by:


Louie Leyva
Proj.Admin Cost Engineer
Date : ______________________ Date : ______________________

Concurring Approval Validated by:

Engr.Antonio Bernardo Maria Elisa M. Villareal


Sr. Project Manager Procurement Manager
Date : ______________________ Date : ______________________
Date : September 6, 2017
Certificate No. : Coffral - 06
Payment Due Date : October 6, 2017
Ref nos.: 17-00232
DRR No.: 1717

COST TYPE : MATERIALS


QTY. UOM UNIT COST AMOUNT
412.00 pcs 669.65 275,895.80
400.00 pcs 874.70 349,880.00
100.00 pcs 3,087.20 308,720.00
390.00 pcs 295.85 115,381.50
302.00 pcs -
150.00 pcs 2,688.38 403,257.00
-
TOTAL AMOUNT Php ###

B C=A+B
Current Accumulated
Certificate (06) To-Date
AMOUNT QTY. U/P AMOUNT

275,895.80
349,880.00
308,720.00
115,381.50
-
403,257.00

### 7,508,122.56

155,692.96 804,441.70
- -

### ###

Approved:
Engr. Ron Bristol
Project Manager
Date : ______________________

PRF#
P.O# 458
DRR# 1717
DR# 17-00232

INV#
AMOUNT 1,453,134.30
SUPPLIER'S PAYMENT CERTIFICATE
Project : One Prime Building
PO No. : 0458
Supplier : COFFRAL FORMWORKS AND SCAFFOLDS
Item Description : FORMWORKS

COST CENTER : COST CODE : COST TY


Materials Ordered (Based on BOQ)
1 Wooden Beam c20 1.50m
2 Wooden Beam c20 1.80m
3 Coffral shoring jack 3.50
4 Racks

A B
VALUE OF MATERIALS DELIVERED : Previous Current
Certificate (01) - ( 04) Certificate (05)
QTY U/P AMOUNT QTY. U/P
1. Certified Value of Items Delivered
Items :
1 Wooden Beam c20 1.50m 280.00 669.65
2 Wooden Beam c20 1.80m 150.00 3,087.20
3 Coffral shoring jack 3.50 301.00 2,688.38
4 Racks 6.00 -

2. Total Value of Items Delivered (a) ###

3. Advance Payment
(i) Materials
(ii) VAT (12%) 492,343.27
(iii) EWT (1%) -
(iv) Less Recovery of Advance Payment
Balance to be recovered

4. Net Amount Certified (a - b) -

Prepared by: Reviewed by:

Louie Leyva
Proj.Admin Cost Engineer
Date : ______________________ Date : ______________________
Concurring Approval Validated by:

Engr.Antonio Bernardo Maria Elisa M. Villareal


Sr. Project Manager Procurement Manager
Date : ______________________ Date : ______________________
Date : September 12, 2017
Certificate No. : Coffral - 05
Payment Due Date : October 12, 2017
Ref nos.: 17-00234
DRR No.: 1739

COST TYPE : MATERIALS


QTY. UOM UNIT COST AMOUNT
280.00 pcs 669.65 187,502.00
150.00 pcs 3,087.20 463,080.00
301.00 pcs 2,688.38 809,202.38
6.00 pcs -
-
TOTAL AMOUNT Php ###

B C=A+B
Current Accumulated
Certificate (05) To-Date
AMOUNT QTY. U/P AMOUNT

187,502.00
463,080.00
809,202.38
-

### 6,054,988.26

156,405.47 648,748.74
- -

### ###

Approved:

Engr. Ron Bristol


Project Manager
Date : ______________________
PRF#
P.O# 458
DRR# 1739
DR# 17-00234

INV#
AMOUNT 1,459,784.38
SUPPLIER'S PAYMENT CERTIFICATE
Project : One Prime Building
PO No. : 0458
Supplier : COFFRAL FORMWORKS AND SCAFFOLDS
Item Description : FORMWORKS

COST CENTER : COST CODE : COST TY


Materials Ordered (Based on BOQ)
1 Wooden Beam c20 1.50m
2 Wooden Beam c20 3.00m
3 Wooden Beam c20 3.30m
4 Wooden beam c20 3.90m

A B
VALUE OF MATERIALS DELIVERED : Previous Current
Certificate (01) - ( 03) Certificate (04)
QTY U/P AMOUNT QTY. U/P
1. Certified Value of Items Delivered
Items :
1 Wooden Beam c20 1.50m 200.00 669.65
2 Wooden Beam c20 3.00m 100.00 1,339.29
3 Wooden Beam c20 3.30m 100.00 1,473.22
4 Wooden beam c20 3.90m 200.00 1,741.08

2. Total Value of Items Delivered (a) ###

3. Advance Payment
(i) Materials
(ii) VAT (12%) 410,550.74
(iii) EWT (1%) -
(iv) Less Recovery of Advance Payment
Balance to be recovered

4. Net Amount Certified (a - b) ###

Prepared by: Reviewed by:

Louie Leyva
Proj.Admin Cost Engineer
Date : ______________________ Date : ______________________
Concurring Approval Validated by:

Engr.Antonio Bernardo Maria Elisa M. Villareal


Sr. Project Manager Procurement Manager
Date : ______________________ Date : ______________________
Date : September 8, 2017
Certificate No. : Coffral - 04
Payment Due Date : October 8, 2017
Ref nos.: 17-00233
DRR No.: 1744

COST TYPE : MATERIALS


QTY. UOM UNIT COST AMOUNT
200.00 pcs 669.65 133,930.00
100.00 pcs 1,339.29 133,929.00
100.00 pcs 1,473.22 147,322.00
200.00 pcs 1,741.08 348,216.00
-
TOTAL AMOUNT Php 763,397.00

B C=A+B
Current Accumulated
Certificate (04) To-Date
AMOUNT QTY. U/P AMOUNT

133,930.00
133,929.00
147,322.00
348,216.00

763,397.00 4,595,203.88

81,792.54 492,343.27
- -

681,604.46 ###

Approved:

Engr. Ron Bristol


Project Manager
Date : ______________________
PRF#
P.O# 458
DRR# 1744
DR# 17-00233

INV#
AMOUNT 763,397.00
SUPPLIER'S PAYMENT CERTIFICATE
Project : One Prime Building
PO No. : 0458
Supplier : COFFRAL FORMWORKS AND SCAFFOLDS
Item Description : FORMWORKS

COST CENTER : COST CODE : COST TY


Materials Ordered (Based on BOQ)
1 Wooden Beam c20 1.50m
2 Wooden Beam c20 2.00m
3 Wooden Beam c20 2.45m
4 Wooden beam c20 3.90m
5 Staflex Spindle
6 Starflex Forkhead
7 Shoring Jack 20-3.50
8 Racks

A B
VALUE OF MATERIALS DELIVERED : Previous Current
Certificate (00) - ( 01) Certificate (02)
QTY U/P AMOUNT QTY. U/P
1. Certified Value of Items Delivered
Items :
1 Wooden Beam c20 1.50m 320.00 669.65
2 Wooden Beam c20 2.00m 117.00 892.86
3 Wooden Beam c20 2.45m 95.00 1,093.75
4 Wooden beam c20 3.90m 160.00 1,741.08
5 Staflex Spindle 480.00 874.70
6 Starflex Forkhead 30.00 295.85
7 Shoring Jack 20-3.50 31.00 2,688.38
8 Racks 2.00 -

2. Total Value of Items Delivered (a) ###

3. Advance Payment
(i) Materials
(ii) VAT (12%) 280,553.99
(iii) EWT (1%) -
(iv) Less Recovery of Advance Payment
Balance to be recovered

4. Net Amount Certified (a - b) ###


Prepared by: Reviewed by:

Louie Leyva
Proj.Admin Cost Engineer
Date : ______________________ Date : ______________________

Concurring Approval Validated by:

Engr.Antonio Bernardo Maria Elisa M. Villareal


Sr. Project Manager Procurement Manager
Date : ______________________ Date : ______________________
Date : August 18, 2017
Certificate No. : Coffral - 03
Payment Due Date : September 17, 2017
Ref nos.: 17-00228
DRR No.: 1623

COST TYPE : MATERIALS


QTY. UOM UNIT COST AMOUNT
320.00 pcs 669.65 214,288.00
117.00 pcs 892.86 104,464.62
95.00 pcs 1,093.75 103,906.25
160.00 pcs 1,741.08 278,572.80
480.00 pcs 874.70 419,856.00
30.00 pcs 295.85 8,875.50
31.00 pcs 2,688.38 83,339.78
2.00 pcs -
-
TOTAL AMOUNT Php ###

B C=A+B
Current Accumulated
Certificate (02) To-Date
AMOUNT QTY. U/P AMOUNT

214,288.00
104,464.62
103,906.25
278,572.80
419,856.00
8,875.50
83,339.78
-

### 3,831,806.88

129,996.74 410,550.74
- -

### ###
Approved:

Engr. Ron Bristol


Project Manager
Date : ______________________

PRF#
P.O# 458
DRR# 1623
DR# 17-00228

INV#
AMOUNT 1,213,302.95
SUPPLIER'S PAYMENT CERTIFICATE
Project : One Prime Building
PO No. : 0458
Supplier : COFFRAL FORMWORKS AND SCAFFOLDS
Item Description : FORMWORKS

COST CENTER : COST CODE : COST TY


Materials Ordered (Based on BOQ)
1 Wooden Beam c20 1.5m
2 Wooden Beam c20 3.3m
3 Wooden Beam c20 3m
4 Wooden beam c20 2m
5 Wooden beam c20 2.45m
6 Starflex Crossbrace 160
7 Starflex Spindle
8 Starflex Forkhead
9 Rack
10 Crate

A B
VALUE OF MATERIALS DELIVERED : Previous Current
Certificate (00) - ( 01) Certificate (02)
QTY U/P AMOUNT QTY. U/P
1. Certified Value of Items Delivered
Items :
1 Wooden Beam c20 1.5m 400.00 669.65
2 Wooden Beam c20 3.3m 90.00 1,473.22
3 Wooden Beam c20 3m 50.00 1,339.29
4 Wooden beam c20 2m 103.00 892.86
5 Wooden beam c20 2.45m 100.00 1,093.75
6 Starflex Crossbrace 160 340.00 746.07
7 Starflex Spindle 200.00 874.70
8 Starflex Forkhead 195.00 295.85
9 Rack 3.00 -
10 Crate 1.00 -

2. Total Value of Items Delivered (a) ###

3. Advance Payment
(i) Materials
(ii) VAT (12%) 156,798.80
(iii) EWT (1%) -
(iv) Less Recovery of Advance Payment
Balance to be recovered
4. Net Amount Certified (a - b) ###

Prepared by: Reviewed by:

Louie Leyva
Proj.Admin Cost Engineer
Date : ______________________ Date : ______________________

Concurring Approval Validated by:

Engr.Antonio Bernardo Maria Elisa M. Villareal


Sr. Project Manager Procurement Manager
Date : ______________________ Date : ______________________
Date : August 12, 2017
Certificate No. : Coffral - 02
Payment Due Date : September 11, 2017
Ref nos.: 227 MNL
DRR No.: 1601

COST TYPE : MATERIALS


QTY. UOM UNIT COST AMOUNT
400.00 pcs 669.65 267,860.00
90.00 pcs 1,473.22 132,589.80
50.00 pcs 1,339.29 66,964.50
103.00 pcs 892.86 91,964.58
100.00 pcs 1,093.75 109,375.00
340.00 pcs 746.07 253,663.80
200.00 pcs 874.70 174,940.00
195.00 pcs 295.85 57,690.75
3.00 pcs -
1.00 pcs -
-
TOTAL AMOUNT Php ###

B C=A+B
Current Accumulated
Certificate (02) To-Date
AMOUNT QTY. U/P AMOUNT

267,860.00
132,589.80
66,964.50
91,964.58
109,375.00
253,663.80
174,940.00
57,690.75
-
-

### 2,618,503.93

123,755.19 280,553.99
- -
### ###

Approved:

Engr. Ron Bristol


Project Manager
Date : ______________________

PRF#
P.O# 458
DRR# 1600
DR# 227 MNL
DR#pipe
INV#
AMOUNT 1,155,048.43
SUPPLIER'S PAYMENT CERTIFICATE
Project : One Prime Building
PO No. : 0458
Supplier : COFFRAL FORMWORKS AND SCAFFOLDS
Item Description : FORMWORKS

COST CENTER : COST CODE : COST TYP


Materials Ordered (Based on BOQ)
1 Starflex Frame 1.80m
2 Starflex Spindle
3 Starflex Fork Head
4 Rack
5 Crate

A B
VALUE OF MATERIALS DELIVERED : Previous Current
Certificate (00) - ( 00) Certificate (01)
QTY U/P AMOUNT QTY. U/P
1. Certified Value of Items Delivered
Items :
1 Starflex Frame 1.80m 295.00 3,087.20
2 Starflex Spindle 500.00 874.70
3 Starflex Fork Head 390.00 295.85
4 Rack 2.00 -
5 Crate 2.00 -

2. Total Value of Items Delivered (a)

3. Advance Payment
(i) Materials
(ii) VAT (12%)
(iii) EWT (1%) -
(iv) Less Recovery of Advance Payment
Balance to be recovered

4. Net Amount Certified (a - b)

Prepared by: Reviewed by:

Louie Leyva
Proj.Admin Cost Engineer
Date : ______________________ Date : ______________________

Concurring Approval Validated by:

Engr.Antonio Bernardo Maria Elisa M. Villareal


Sr. Project Manager Procurement Manager
Date : ______________________ Date : ______________________
Date : August 12, 2017
Certificate No. : Coffral - 01
Payment Due Date : September 11, 2017
Ref nos.: 226 - MNL
DRR No.: 1600

COST TYPE : MATERIALS


QTY. UOM UNIT COST AMOUNT
295.00 pcs 3,087.20 910,724.00
500.00 pcs 874.70 437,350.00
390.00 pcs 295.85 115,381.50
2.00 pcs -
2.00 pcs -
-
TOTAL AMOUNT Php ###

B C=A+B
Current Accumulated
Certificate (01) To-Date
AMOUNT QTY. U/P AMOUNT

910,724.00
437,350.00
115,381.50
-
-

### 1,463,455.50

156,798.80 156,798.80
- -

### ###

Approved:

Engr. Ron Bristol


Project Manager
Date : ______________________

PRF#
P.O# 458
DRR# 1600
DR# 226 MNL
DR#pipe
INV#
AMOUNT 1,463,455.50

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