Liquidation Forms 1

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REQUIREMENTS & SEQUENCE FOR CASH ADVANCE REQUIREMENTS & SEQUENCE FOR CASH ADVANCE

Disbursement Voucher w/ ATM # 2 COPIES Disbursement Voucher w/ ATM # 2 COPIES


Obligation Request 2 COPIES Obligation Request 2 COPIES
jdj RCA 2 COPIES RCA 2 COPIES
Budgetary Requirement for the Quarter } c/o ADAS Budgetary Requirement for the Quarter } c/o ADAS
Photocopy of Fidelity Bond 2 COPIES Photocopy of Fidelity Bond 2 COPIES
Annual Improvement Plan (AIP) School Head to maintain file Annual Improvement Plan (AIP) School Head to maintain file
Annual Procurement Plan (APP) copy/ present as Reference Annual Procurement Plan (APP) copy/ present as Reference
Project Procurement Management Plan (PPMP) for PSDS' Project Procurement Management Plan (PPMP) for PSDS'

FOR MATERIALS (REPAIRS) FOR MATERIALS (REPAIRS)


Program Of Works 2 COPIES Program Of Works 2 COPIES
Purchase Request (with PR # and Purpose) 2 COPIES Purchase Request (with PR # and Purpose) 2 COPIES
RFQ (3 suppliers with PR No., Date of optional RFQ (3 suppliers with PR No., Date of optional
Quotation, Amount in Words and Figures and Quotation, Amount in Words and Figures and
should be hand written and DO NOT USE PENCIL) should be hand written and DO NOT USE PENCIL)
BACRESO w/ supporting documents optional BACRESO w/ supporting documents optional
Abstract (with PR No.) optional Abstract (with PR No.) optional
Purchase Order (with PO No., Signature of Principal, optional Purchase Order (with PO No., Signature of Principal, optional
Signature of Supplier and date, Alobs No. And amount) Signature of Supplier and date, Alobs No. And amount)
Pre-Repair Inspection w/ Pictures 2 COPIES Pre-Repair Inspection w/ Pictures 2 COPIES
Notice of Award optional Notice of Award optional
FOR LABOR: FOR LABOR:
Job Request (with JR No., Purpose, Alobs No. and Date) 2 COPIES Job Request (with JR No., Purpose, Alobs No. and Date) 2 COPIES
POW 2 COPIES POW 2 COPIES
RFQ (3 suppliers with JR No., Date of optional RFQ (3 suppliers with JR No., Date of optional
Quotation, Amount in Words and Figures and Quotation, Amount in Words and Figures and
should be hand written and DO NOT USE PENCIL) should be hand written and DO NOT USE PENCIL)
Abstract (with JR No.) optional Abstract (with JR No.) optional
Job Order (with JO No., Approval of Principal) optional Job Order (with JO No., Approval of Principal) optional
Pre-Repair Inspection w/ Pictures 2 Copies Pre-Repair Inspection w/ Pictures 2 Copies nzjhsbznnxnjjdjajajjs
Notice to Proceed optional Notice to Proceed optional
FOR SUPPLIES, MEDICINES & EQUIPMENTS: FOR SUPPLIES, MEDICINES & EQUIPMENTS:
Purchase Request (with PR # and Purpose) / APR 2 COPIES Purchase Request (with PR # and Purpose) / APR 2 COPIES
RFQ (3 suppliers with PR No., Date of optional RFQ (3 suppliers with PR No., Date of optional
Quotation, Amount in Words and Figures and Quotation, Amount in Words and Figures and
should be hand written and DO NOT USE PENCIL) should be hand written and DO NOT USE PENCIL)
Abstract (with PR No.) optional Abstract (with PR No.) optional
Purchase Order (with PO No., Signature of Principal, optional Purchase Order (with PO No., Signature of Principal, optional
Signature of Supplier and date, Alobs No. And amount) Signature of Supplier and date, Alobs No. And amount)
FOR TRAVEL: FOR TRAVEL:
DV per Claimant (with signature of Treasurer, 2 COPIES DV per Claimant (with signature of Treasurer, 2 COPIES
Principal & Claimant) Principal & Claimant)
Authority to Travel (with complete signature) 2 COPIES Authority to Travel (with complete signature) 2 COPIES
Itinerary (with complete signature) 2 COPIES Itinerary (with complete signature) 2 COPIES
Certificate of Travel Completed (with signature) 2 COPIES Certificate of Travel Completed (with signature) 2 COPIES
Certificate to Appearance (with complete signature) 2 COPIES Certificate to Appearance (with complete signature) 2 COPIES
Tickets / Receipts Original Copy Tickets / Receipts Original Copy
Memo 1 COPY Memo 1 COPY
FOR UTILITY BILLS (Electricity, Water): FOR UTILITY BILLS (Electricity, Water):
Original Copy & Photocopy of Statement of Account 1 COPY Original Copy & Photocopy of Statement of Account 1 COPY

* Attachments from "For Materials" until "For Cell card will be released * Attachments from "For Materials" until "For Cell card will be released
after paid from accounting/cashier and will later be use as attachments after paid from accounting/cashier and will later be use as attachments
for liquidation for liquidation

Status of Prior Month's Liquidation (Please check box below) Status of Prior Month's Liquidation (Please check box below)
Liquidated w/ Complete Documents Liquidated w/ Complete Documents

Liquidated w/ Lacking Documents Liquidated w/ Lacking Documents


Lacking Documents: Lacking Documents:
SEQUENCE IN PREPARING LIQUIDATION REPORT SEQUENCE IN PREPARING LIQUIDATION REPORT
Liquidation Report 2 COPIES Liquidation Report 2 COPIES
Cash Disbursement Register 2 COPIES Cash Disbursement Register 2 COPIES
Withdrawal Slip 2 COPIES Withdrawal Slip 2 COPIES
RCA 1 COPY RCA 1 COPY
Photocopy of Fidelity Bond 1 COPY Photocopy of Fidelity Bond 1 COPY
ARRANGE PER TRANSACTION ACCORDING TO YOUR CASH DISBURSEMENT REGISTER ARRANGE PER TRANSACTION ACCORDING TO YOUR CASH DISBURSEMENT REGISTER
FOR MATERIALS: FOR MATERIALS:
Disbursement Voucher (School Based Signatories) 2 COPIES Disbursement Voucher (School Based Signatories) 2 COPIES
Program of Work 2 COPIES Program of Work 2 COPIES
Purchase Request 2 COPIES Purchase Request 2 COPIES
Quotation (3 suppliers) 2 COPIES Quotation (3 suppliers) 2 COPIES
Abstract 2 COPIES Abstract 2 COPIES
Purchase Order 2 COPIES Purchase Order 2 COPIES
Delivery Receipt (with date & receive/signature of buyer) Orig. Copy Delivery Receipt (with date & receive/signature of buyer) Orig. Copy
Official Receipt (with date & receive/signature of buyer) Orig. Copy Official Receipt (with date & receive/signature of buyer) Orig. Copy
IAR ( Inspection & Acceptance Report ) w/ name of supplier, 2 COPIES IAR ( Inspection & Acceptance Report ) w/ name of supplier, 2 COPIES
PO No. & date, Invoice No., Date of Inspection, date of acceptance/received) PO No. & date, Invoice No., Date of Inspection, date of acceptance/received)
Pre-repair Inspection Report 2 COPIES Pre-repair Inspection Report 2 COPIES
(w/ JO No., Invoice No. & amount) (w/ JO No., Invoice No. & amount)
FOR LABOR: FOR LABOR:
DV (w/ signature of Treasurer, Principal & Panday) 2 COPIES DV (w/ signature of Treasurer, Principal & Panday) 2 COPIES
Program of Work 2 COPIES Program of Work 2 COPIES
Job Request 2 COPIES Job Request 2 COPIES
RFQ (3 suppliers) 2 COPIES RFQ (3 suppliers) 2 COPIES
Abstract 2 COPIES Abstract 2 COPIES
Notice of Award 2 COPIES Notice of Award 2 COPIES
Notice to Proceed 2 COPIES Notice to Proceed 2 COPIES
Job Order 2 COPIES Job Order 2 COPIES
RER (Rimbursement Expense Receipt) RER (Rimbursement Expense Receipt)
Post Repair Inspection Report w/ Picture 2 COPIES Post Repair Inspection Report w/ Picture 2 COPIES
Certificate of Completion 2 COPIES Certificate of Completion 2 COPIES
IAR ( Inspection & Acceptance Report ) 2 COPIES IAR ( Inspection & Acceptance Report ) 2 COPIES
FOR SUPPLIES, MEDICINES & EQUIPMENTS: FOR SUPPLIES, MEDICINES & EQUIPMENTS:
Disbursement Voucher (School Based Signatories) 2 COPIES Disbursement Voucher (School Based Signatories) 2 COPIES
Purchase Request / (APR - recopy) 2 COPIES Purchase Request / (APR - recopy) 2 COPIES
RFQ (3 suppliers) 2 COPIES RFQ (3 suppliers) 2 COPIES
Abstract of Quotation 2 COPIES Abstract of Quotation 2 COPIES
BACRESO 2 COPIES BACRESO 2 COPIES
Notice to Award 2 COPIES Notice to Award 2 COPIES
Purchase Order 2 COPIES Purchase Order 2 COPIES
Delivery Receipt (with date & receive/signature of buyer) Orig. Copy Delivery Receipt (with date & receive/signature of buyer) Orig. Copy
Official Receipt (with date & receive/signature of buyer) Orig. Copy Official Receipt (with date & receive/signature of buyer) Orig. Copy
IAR ( Inspection & Acceptance Report ) w/ name of supplier, 2 COPIES IAR ( Inspection & Acceptance Report ) w/ name of supplier, 2 COPIES
PO No. & date, Invoice No., Date of Inspection, date of acceptance/received) PO No. & date, Invoice No., Date of Inspection, date of acceptance/received)
RIS - Requisition Issue Slip (for consumable supplies) 3 COPIES RIS - Requisition Issue Slip (for consumable supplies) 3 COPIES
ICS - Inventory Custodian Slip (for semi-expendable supplies) 3 COPIES ICS - Inventory Custodian Slip (for semi-expendable supplies) 3 COPIES
PAR (Property Acknowledgement Receipt ) 3 COPIES PAR (Property Acknowledgement Receipt ) 3 COPIES
OFFICE SUPPLIES THRU PS-DBM OFFICE SUPPLIES THRU PS-DBM
APR (Agency Procurement Request) 2 COPIES APR (Agency Procurement Request) 2 COPIES
Official Receipt (with date & receive/signature of buyer) Orig. Copy Official Receipt (with date & receive/signature of buyer) Orig. Copy
IAR ( Inspection & Acceptance Report ) 2 COPIES IAR ( Inspection & Acceptance Report ) 2 COPIES
PAR (Property Acknowledgement Receipt ) 3 COPIES PAR (Property Acknowledgement Receipt ) 3 COPIES
WMR ( Waste Material Report) if for replacement of damaged 3 COPIES WMR ( Waste Material Report) if for replacement of damaged 3 COPIES
supplies i.e. Stapler, puncher & others 3 COPIES supplies i.e. Stapler, puncher & others 3 COPIES
RIS/ICS - Inventory Custodian Slip (for semi-expendable supplies) 3 COPIES RIS/ICS - Inventory Custodian Slip (for semi-expendable supplies) 3 COPIES
FOR TRAVEL: FOR TRAVEL:
Disbursement Voucher 2 COPIES Disbursement Voucher 2 COPIES
Authority to Travel (with complete signature) 1 COPY Authority to Travel (with complete signature) 1 COPY
Itinerary of Travel (with complete signature) 2 COPIES Itinerary of Travel (with complete signature) 2 COPIES
Certificate of Travel Completed (with signature) 2 COPIES Certificate of Travel Completed (with signature) 2 COPIES
Certificate to Appearance (with complete signature) 2 COPIES Certificate to Appearance (with complete signature) 2 COPIES
Tickets / Receipts Tickets / Receipts
Memo 1 COPY Memo 1 COPY
GROUP TRAVEL: GROUP TRAVEL:
Attendance Sheet 2 COPIES Attendance Sheet 2 COPIES
Follow above requirements for travel Follow above requirements for travel
FOR UTILITY BILLS (Telephone, Water & Internet): FOR UTILITY BILLS (Telephone, Water & Internet):
Disbursement Voucher (School Based Signatories) 2 COPIES Disbursement Voucher (School Based Signatories) 2 COPIES
Statement of Account Orig. Copy Statement of Account Orig. Copy
Official Receipt Official Receipt
Photocopy of Statement Of Accounts and Official Receipts 1 COPY Photocopy of Statement Of Accounts and Official Receipts 1 COPY
Certification of Usage (for CENECO) 2 COPIES Certification of Usage (for CENECO) 2 COPIES
FOR MOA PERSONNEL FOR MOA PERSONNEL
DV (Disbursement Voucher) 2 COPIES DV (Disbursement Voucher) 2 COPIES
MOA (Memorandum of Agreement) duly notarized 2 COPIES MOA (Memorandum of Agreement) duly notarized 2 COPIES
DTR (Daily Time Record)/F-48 duly filled-up & signed DTR (Daily Time Record)/F-48 duly filled-up & signed
RER (Rimbursement Expense Receipt) RER (Rimbursement Expense Receipt)
Republic of the Philippines
DEPARTMENT OF EDUCATION
Region VI - Western Visayas
Schools Division of Silay
City of Silay

DON FELIX T. LACSON MEMORIAL NATIONAL HIGH SCHOOL 0906618


09 06618
CASH DISBURSEMENT REGISTER
For the Month of JULY - AUGUST 2019

TYPE OF WORKING FUND: MOOE


CASH ADVANCE B R E A K D O W N OF P A Y M E N T S

Fidelity Office Repair and Other Supplies Transportatio Telephone Other


BALANCE Traveling Training Electricity PAYMENT OF OTHER Maintenance & Due to BIR Due to BIR
DATE DV # PAYEE/ PARTICULARS AMOUNT Expense Expenses Insurance Supplies Maintenance and Materials Expense
n & delivery Expense- GENERAL SERVICES
WATCHMAN/UTILITY Operating Remittance CR TOTAL
PAYMENTS Premium Expense -Sch. Bldg. Exp. expenses Internet Expenses
RECEIVED
(6=4-5)
5020101000 50202010-00 50215020-00 50203010-00 50213040-02 50203990-00 50204020-00 5029904000 50205020-01 5021299000 5029999002 2020101000 2020101000

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) (20)

16 9/25/2019 2019-10-77 LEONILA FERNANDEZ 10,500.00 38,562.48 10,500.00 10,500.00


17 10/11/2019 2019-10-78 DENSIL JUNO 2,183.17 36,379.31 2,183.17 2,183.17

18 10/11/2019 2019-10-79 DENSIL JUNO 9,571.60 26,807.71 9,571.60 9,571.60


19 10/11/2019 2019-10-80 ANDRES AGUDON 10,500.00 16,307.71 10,500.00 10,500.00
20 10/11/2019 2019-10-81 CEASAR RYAN ASUNCION 851.15 15,456.56 851.15 851.15

21 10/11/2019 2019-10-82 JASON IBANEZ 4,595.00 10,861.56 4,595.00 4,595.00


22 10/11/2019 2019-10-83 ARSELLA FUENTES 4,595.00 6,266.56 4,595.00 4,595.00
23 10/11/2019 2019-10-84 ROLLEN FELECIANO ,ET. AL 1,000.00 5,266.56 1,000.00 1,000.00
24 10/11/2019 2019-10-85 MARTIN VILLARINE 350.00 4,916.56 350.00 350.00
25 10/11/2019 2019-10-86 NADIA M. NAYRAN 500.00 4,416.56 500.00 500.00
26 10/11/2019 2019-10-87 NADIA M. NAYRAN 500.00 3,916.56 500.00 500.00
27 10/11/2019 2019-10-88 CHINA BANK 4,212.59 !(296.03!) 4,212.59 4,212.59

.
TOTAL 148,296.03 !(296.03!) 10,041.15 1,240.00 1,500.00 14,972.50 57,582.77 14,427.50 22,101.30 850.00 1,200.00 21,000.00 2,840.00 4,212.59 4,171.72 148,296.03

CERTIFIED CORRECT: CERTIFIED SUPPORTING DOCUMENTS COMPLETE: NOTED:

NADIA M. NAYRAN ANA FE C. LEONIDA CYNTHIA G. DIMAVIVAS, CESO V


Principal I Accountant III Schools Division Superintendent
DATE: DATE : DATE:
/acctg/02-18-2019
Appendix 32

Republic of the Philippines


Department of Education
Region VI - Western Visayas
Schools Division of Silay City
District 10
DON FELIX T. LACSON MEMORIAL NATIONAL HIGH SCHOOL
City of Silay
Fund Cluster :
1-01-101-101101
DISBURSEMENT VOUCHER Date :
DV No. :

Mode of MDS Check Commercial Check ADA Others (Please specify)


Payment
_________________

Payee TIN/Employee No.: ORS/BURS No.:

Address

Responsibility
Particulars MFO/PAP Amount
Center

Amount Due
A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.

CATHERINE R. APUSAGA, PH.D.


( Printed Name & Signature of PSDS )
Public Schools Disrict Supervisor

B. Accounting Entry:
Account Title UACS Code Debit Credit

C. Certified: D. Approved for Payment


Cash available
Subject to Authority to Debit Account (when applicable)
Sup
proper

Signature Signature

Printed
Printed Name
Name FLORIDA C. ACUNA NADIA M. NAYRAN

Position Teacher 1 / Disbursing Officer Position Principal I

Date Date

E. Receipt of Payment JEV No.


Check/ Date : Bank Name & Account
ADA No. : Number:
Printed Name: Date
Signature :
Printed Name:
Signature :
Official Receipt No. & Date/Other Documents
/acctg/02-18-2019
Republic of the Philippines
Department of Education
Region VI - Western Visayas
Division of Silay City
City of Silay

PURCHASE REQUEST

Office/Section: DFTLMNHS PR No.: Date :


Responsibility Center Code: __ Source of Fund:

Stock/ Property
Unit Item Description Quantity Unit Cost Total Cost
No.
-

TOTAL P -
Purpose:

Requested by: Approved by:

Signature:
Printed Name: GERRY BOY M. DEMECINO NADIA M. NAYRAN
Designation: PRINCIPAL I

In accordance with the approved Allotment Available:


CY 2019 Annual Procurement Plan
Not included in the approved
CY 2019 Annual Procurement Plan FLORIDA C. ACU
Disbursing Officer

/sup/02-18-2019
Standard Form Number SF - GOOD - 58
Revised on May 24, 2005
Standard Form Title: Purchase Order
Republic of the Philippines
Department of Education
Region VI - Western Visayas
Division of Silay City
City of Silay

PURCHASE ORDER

Supplier: GNP 1 MARKETING CORPORATION P.O. No. 2019-06-014

Address: SILAY CITY Date 6/4/2019


E-mail Address: Mode of
Telephone No. Procurement
TIN:

GENTLEMEN:
Please furnish this office the following articles subject to the terms and conditions contained
herein:

Place of Delivery:
Date of Delivery:

Item
Unit Description Quantity Unit Cost TOTAL
No.
MOBILE LOAD 300.00 900.00

TOTAL P 900.00
In case of failure to make the full delivery within the specified above, a penalty of one - tenth (1/10) of one percent for
everyday of delivery shall be imposed.
Very truly yours,
Conforme:

Name of Supplier NADIA M. NAYRAN


Principal I
Date
Funds Available: OBR No. _____________________
Amount: _____________________

JEAN PAULEEN A. BADIAN


Disbursing officer
/sup/02-18-2019
Republic of the Philippines
Department of Education
Region VI - Western Visayas
Division of Silay City
City of Silay

BIDS AND AWARDS COMMITTEE

Request for Quotation (RFQ)


To all Eligible Suppliers:

I. Please quote your lowest price inclusive of VAT on item/s listed below, subject to the Terms and Conditions of this
RFQ and submit your quotation duly signed by your representative not later than ______________________________
at the Office of the Bids and Awards Committee, Division of Silay City, City of Silay. For more information please
call at telephone no(s). ___________________. Prospective supplier shall be responsible to verify the quoted goods /
items from herein stated office thru said telephone number(s).
Price quotations in excess of the herein-stated budget shall be rejected.

________________________________
BAC Chairperson
II. PARTICULARS
Total
ABC in Php Item No. Quantity Unit AGENCY SPECIFICATION BRAND OFFERED Unit Price
Price
195,300.00 1 217 pax

PR NO.2018 - ____ dtd ____________ABC Php 195,300 for the Division Training-Workshop on
Procurement and Financial Management and Adjustment of CY 2018 APP and PPMP on July 30-31,
2018

For interested bidders, please submit the following documents together with your quotation: 1) Valid and Current Mayor's Permit (2017): 2) Income/ Business Tax Return;
3) Valid and Current PhilGEPS Registration Certificate/Number; 4) Professional License/ Curriculum Vitae (Consulting Services); 5) PCAB for Infra and, 6) Omnibus Sworn
Statement.

Supplier's Company Name:


Address:
Tin NO.: PhilGEPS Registration Number
Telephone No.: Fax No.: E-mail:
Supplier's Authorized Representative Date:
Signature over Printed Name:
/02-18-2019
Appendix 47

Republic of the Philippines


Department of Education
Region VI - Western Visayas
Division of Silay City
City of Silay

CERTIFICATION OF TRAVEL COMPLETED

Entity Name: DepEd, Division of Silay


Name of School:

Printed Name & Signature


School Head Station

I HEREBY CERTIFY THAT I have completed the travel as authorized in the


Travel Order/Itinerary of Travel No. ________ dated ________ under conditions indicated below:

Strictly in accordance with the approved itinerary.


Cut short as explained below. Excess payment in the amount of
P_______ was refunded under O. R. No. ________ dated __________
Extended as explained below, additional itinerary was submitted
Other deviation as explained below.

EXPLANATION OR JUSTIFICATIONS:

EVIDENCE OF TRAVEL:

Used Tickets
Certificate of Appearance / Participation
Others:

Respectfully submitted:

(Printed Name & Signature)


Designation

On evidence and information of which I have the knowledge, the travel was actually undertaken.

Approved:
Printed Name & Signature
School Head

/02-18-2019
Republic of the Philippines Appendix 22
Department of Education
Region VI
DIVISION OF SILAY
City of Silay

ITINERARY OF TRAVEL

NAME POSITION
MONTHLLY SALARY OFFICIAL STATION
RESIDENCE
PURPOSE OF TRAVEL :

Reimbursement
Means of Allowable Traveling
Time TOTAL
Date Place to be visited Transpor - Transpor - Expenses
tation tation (Per Diem)
AMOUNT
Departure Arrival
P - P -
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Sub-total P - P - P -
Add: Registration Fee
TOTAL P - P - P -

CERTIFICATION Prepared by:


I hereby certify that (1) I have reviewed the foregoing itinerary,
(2) the travel is necessary to the service, (3) the period covered is
reasonable, and (4) the expenses claimed are proper. Name of Employee

Approved by:

Superior
THIS FORM SHALL BE ATTACHED TO ALL CLAIMS FOR TRAVELLING EXPENSES
/02-18-2019
Republic of the Philippines
Department of Education
Region VI - Western Visayas
Division of Silay City
City of Silay

ABSTRACT OF SEALED CANVASS

Office / End User : J.R.: _______________


Date / Place: /
Project Name:

Item S U P P L I E R / C O N T R A C T O R / P R O V I D E R
# Qty Unit ITEM / DESCRIPTION Remarks
lemans bacolod china mart

GRAND TOTAL 0.00 0.00 0.00

(Printed Name & Signature) (Printed Name & Signature) (Printed Name & Signature)
School Facilites Coordinator School Property Custodian BAC Member
(Printed Name & Signature)
School Head
/02-18-2019
Indicate the DESIGNATION of SCHOOL
HEAD
Republic of the Philippines
Department of Education
Region VI - Western Visayas
Division of Silay City
City of Silay

PROGRAM OF WORKS
Name of Project:

School / Location:
Fund Source:
Scope of Work

No. QTY. UNIT DESCRIPTION UNIT COST TOTAL COST


1 0.00
2 0.00
3 0.00
4 0.00
5 0.00
6 0.00
7 0.00
8 0.00
9 0.00
10 0.00
11 0.00
12 0.00
13 0.00
14 0.00
15 0.00
TOTAL 0.00

Total Cost of Materials 0.00


Labor Cost (35%) 0.00

Total Cost of Materials 0.00

Prepared By: Verified by: Checked by:

(Printed Name & Signature) (Printed Name & Signature) Julius T. Tinsay
School Physical Facilities Coordinator School Head Division Engineer

Recommending Approval / OK as to APP/PPMP: Approved By:

(Printed Name & Signature) Ma. Roselyn J. Palcat, EdD, CESO VI


Public Schools District Supervisor OIC-Schools Division Superintendent
District No.
Republic of the Philippines
Department of Education
Region VI - Western Visayas
Division of Silay City
City of Silay

JOB REQUEST

Office/Section: Job Request No.: Date :


Responsibility Center Code: _______________ Source of Fund:

Estimated
Stock/
Unit Job Description Quantity Unit Cost Estimated Cost
Property No.

TOTAL P -
Purpose:

Requested by: Approved by:

Signature:
Printed Name:
Designation:
(End user)

(School Head)

In accordance with the approved CY Allotment Available:


2019 Annual Procurement Plan
Not included in the approved CY 2019 ________________________
Annual Procurement Plan Disbursing Officer
/sup/02-18-2019
Republic of the Philippines ent of Edu
rtm c
Department of Education

at
a
D ep

io n
Region VI - Western Visayas
Division of Silay City
iv i
Ci

ty
s io
n o f S i la y

City of Silay

JOB ORDER
Job Order No.: ____ Date:
Job Request No.: ______ Date:

Description of Works:

UNIT PRICE TOTAL

Php

Received By:
Date Received:
Project Fund:
Date Work Begin: Date Work Completed:

Inspected By: Date of Inspection:

School Inspector

Requested By: Approved By:

SPC/TIC School Head

Recommending Approval / OK as APP/PPMP:

Printed Name & Signature


Public Schools District Supervisor
District No.
/sup/02-18-2019
Republic of the Philippines
Department of Education
Region VI - Western Visayas
Division of Silay City
City of Silay f

PRE-REPAIR INSPECTION

Name of Project : Proposed replacement of ultrasonic scale rubber tubing.

Location : Health & Nutrition Section, Grnd. Flr. BSP Bldg., Divison of Silay City compound, Silay City

Findings : Untrasonic scale rubber tubing broken.

Recommendations : Replace untrasonic scale rubber tubing.

Date of inspection : April 17, 2018

Pre-Repair Pictures :

Inspected by:
on official travel
ENG'R. JULIUS T. TINSAY HENDEN L. GUARTE
Division Engineer Division Physical Facilities Coordinator
/02-18-2019
Republic of the Philippines
Department of Education
Region VI - Western Visayas
Division of Silay City
City of Silay f

POST-REPAIR INSPECTION

Name of Project : Proposed replacement of ultrasonic scale rubber tubing.


Location : Health & Nutrition Section, Grnd. Flr. BSP Bldg., Divison of Silay City compound, Silay City
Findings : Untrasonic scale rubber tubing replaced.
Date of inspection : April 24, 2018
Post-Repair Pictures :

Inspected by:
on official travel
ENG'R. JULIUS T. TINSAY HENDEN L. GUARTE
Division Engineer Division Physical Facilities Coordinator
/02-18-2019
Republic of the Philippines
Department of Education
Region VI - Western Visayas
Division of Silay City
City of Silay

INVENTORY CUSTODIAN SLIP


Entity Name:
Fund Cluster:____________________________________________ 2019-03-008
Amount
Inventory Estimated
Quantity Unit Unit Total Description
Item No. Useful Life
Cost Cost
1 PC 1295 1295 POCKET WIFI
6 PC 269.5 1617 CURTAIN
3 PC 390 1170 STAPLER BIG
6 PC 389.5 2337 CURTAIN
6 CAN 395 2370 DISINFEVTANT SPRAY
5 BOT 325 1625 EPSON INK
1 CAN 210 210 AIR FRESHENER
2 BOX 22 44 RUBBER BOND

Received from: Received by:

EDNAN S. JAMANDRE NADIA M. NAYRAN


Signature Over Printed Name Signature Over Printed Name
BAC -CHAIRMAN PRINCIPAL I
Position/Office Position/Office

Date Date
/sup/02-18-2019
Appendix 62
Republic of the Philippines
Department of Education
Region VI - Western Visayas
Division of Silay City
City of Silay

INSPECTION AND ACCEPTANCE REPORT (IAR)

Entity Name: _________________________________________ Fund Cluster: _________________


Supplier: IAR No.:
PO No./Date: Date:
Requisitioning Office/Dept.: Invoice No:
Responsibility Center Code: Date:
Stock/
Property Description Unit Quantity
No.

INSPECTION ACCEPTANCE

Date Inspected: _____________________________ Date Received:

Inspected, verified and found in order as to Complete


quantity and specifications Partial (pls. specify quantity)

(Printed Name and Signature)


Chairman, School Inspectorate Team

(Printed Name and Signature) _________________________


Member School Inspectorate Team Designated Property Custodian

(Printed Name and Signature)


Member School Inspectorate Team
/sup/02-18-2019
Appendix 63

Republic of the Philippines


Department of Education
Region VI - Western Visayas
Division of Silay City
City of Silay

REQUISITION AND ISSUE SLIP


Entity Name : Fund Cluster : ______________________

Division : Silay City


Responsibility Center Code : _____________
Office : RIS No. : _____________________________

Requisition Stock Available? Issue

Stock No. Unit Description Quantity Yes No Quantity Remarks

Purpose:

Requested by: Approved by: Issued by: Received by:

Signature :

Printed Name :

Designation :
Date :

/sup/02-18-2019
Republic of the Philippines
Department of Education
Region VI - Western Visayas
Division of Silay City
City of Silay

PROPERTY ACKNOWLEDGEMENT RECEIPT

Entity Name:
Fund Cluster: PAR No.:

Property
Quantity Unit Description Date Acquired Amount
Number

Received by: Issued by:

EDNAN S. JAMANDRE NADIA M. NAYRAN


Signature over Printed Name of End User Signature over Printed Name of Supply Officer
BAC - CHAIRMAN PRINCIPAL I
Position / Office Position / Office

Date Date
/sup/02-18-2019
Appendix 65
Republic of the Philippines
Department of Education
Region VI - Western Visayas
Division of Silay City
City of Silay

WASTE MATERIALS REPORT

Agency
Place of Storage Date:

ITEMS FOR DISPOSAL

DESCRIPTION RECORD OF SALES


ITEMS QTY UNIT Official Receipt

No. O.R. No. Amount

TOTAL

Certified Correct: Disposal Approved :

CERTIFICATE OF INSPECTION

I hereby certify that the property enumerated above was disposed of as follows :

Item Destroyed
Item Sold at private sale
Item Sold at public auction
Item Transferred without cost
Item For storage

Property Inspector : (Name & Signature) Witness to Disposal :


/sup/02-18-2019
Republic of the Philippines
Department of Education
Region VI - Western Visayas
Division of Silay City
City of Silay
NAME &
ADDRESS OF AGENCY
REQUESTING ACCT. CODE
AGENCY
AGENCY CONTROL NO.
AGENCY PROCUREMENT REQUEST PAS APR NO.
To: THE PROCUREMENT SERVICE
DBM Compound, RR Road
Cristobal St., Paco Manila

ACTION REQUESTED ON THE ITEM LISTED BELOW

Please furnish with us the Price Estimate (for office equipment/furnitures & supplementary items)
Please purchase for our agency/furniture/supplementary items per your Price Estimate
(PS RAD No. _________________________________ attached) dated __________________
Please issue common-use supplies/materials per price list as of ______________________________
Please issued Certificate or Price Reasonableness
Please furnish us with your latest/updated Price List
Other (Specify) ______________________________________________________________________
IMPORTANT !! PLEASE SEE INSTRUCTION/CONDITIONS AT THE BACK OF ORIGINAL COPY
ITEM NO. ITEM and DESCRIPTION/SPECIFICATION/STOCK No. QUANTITY UNIT Unit Price AMOUNT
1 Paper , Multi- purpose ( copy ) A4 20 ream 123.32 2,466.40
2 Record book , 300 pages 2 pcs 76.16 152.32
3 Paper , Multi- purpose ( copy ) legal 20 ream 139.98 2,799.60
4 Correction tape 4 pcs 18.91 189.10
5 Data file box 5 pcs 75.15 601.20
6 Fastener Metal , 70 mm 5 box 11.32 56.62
7 Computer Ink Universal black, cyan , yellow, magenta 11 bot 85.00 935.00
8 Alcohol , Ethyl 60% 7 bot 43.78 306.46
9 Cleaner toilet bowl and urinal 8 bot 44.80 358.40
10 Folder Tag board A4 9 pack 238.00 2,151.00
11 Folder Tag board legal 6 pack 301.15 1,806.90
12
13
14
15
16
17
18
19
Total 11,823.00
NOTE: ALL SIGNATURES MUST BE OVER PRINTED NAME
STOCKS REQUESTED ARE CERTIFIED FUNDS CERTIFIED AVAILABLE APPROVED:
TO BE WITHIN THE APPROVED PROGRAM
ERNESTO BRIONES
FLORIDA C. ACUNA NADIA M. NAYRAN
Designated Propertty Custodian Designated DisbusingOfficer School Head

FUNDS DEPOSITED WITH PS _______________________ CHECK No. ___________________

IN THE AMOUNT OF: ______________________________________________________(P___________________) ENCLOSED


/02-18-2019
Appendix 46

Republic of the Philippines


Department of Education
Region VI - Western Visayas
Division of Silay City
City of Silay

REIMBURSEMENT EXPENSE RECEIPT

Entity Name: DepED, Division of Silay Name of School:


Date : _______________________ RER No. : ___________________

RECEIVED from _________________________________________________________


(Name)

_________________________________________________ the amount of


(Official Designation)

____________________________________________________________ (P__________)
(In Words) (in Figures)

in payment for ________________________________________________________________


(Payments for subsistence, services,

_________________________________________________________
rental or transportation should show inclusive dates,

_________________________________________________________
purpose, distance, inclusive points of travel, etc.)
PAYEE
Name/Signature ________________________________________________________
Address _____________________________________________________________

WITNESS
Name/Signature __________________________________________
Address ________________________________________________

/acctg/02-18-2019
ANNEX A
Republic of the Philippines
Department of Education
Region VI - Western Visayas
Division of Silay City
City of Silay

CERTIFICATION OF EXPENSES NOT REQUIRING RECEIPTS


Pursuant to COA Circular No. 2017-001- dated June 19, 2017

Name of Employee
Employee No.
Office
Division
Particulars Amount ((₱)

TOTAL
Purpose

I hereby certify that the above expenses are incurred as they are necessary for the above cited purpose that above
goods and services were acquired from parties not issuing receipts. And that I am fully aware that wilful falsification of
statements is punishable by law.
Certified Correct: Noted By:
Signature:
Printed Name:

Employee Immediate Supervisor


Date Date
/acctg/02-18-2019
Republic of the Philippines
Department of Education
Region VI - Western Visayas
Division of Silay City
City of Silay

NOTICE OF AWARD
NOA NO.

Date of Issue: _______________

(Name of Supplier)
(Address)

Sir/Madam:

We are happy to notify that your qoutation dated ______________________ for the
execution of the ___________________________ with a price equivalent to ________________
____________________________________ as shown in the Abstract of Bids is hereby accepted.

Very truly yours,

Printed name and signature


School head

Conformed:

Name of Representative of the Bidders

Signature

Name of the Supplier

Date
/02-18-2019
Republic of the Philippines
Department of Education
Region VI - Western Visayas
Division of Silay City
City of Silay

NOTICE TO PROCEED

Date

(Name of Supplier)
(Address)

Dear ______________________ ;

Subject:

We wish to inform you that the Contract Agreement for the ______________
has been approved.

You are hereby notified to commence execution of Works and shall fully
complete all the works within _________________________ from receipt hereof of this
notice.

Very truly yours, Noted:

Printed name and signature


School head

Receipt of NTP is hereby acknowledged:


Contractor

Date
/02-18-2019

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