Liquidation Forms 1
Liquidation Forms 1
Liquidation Forms 1
* 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
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) (20)
.
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
Address
Responsibility
Particulars MFO/PAP Amount
Center
Amount Due
A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.
B. Accounting Entry:
Account Title UACS Code Debit Credit
Signature Signature
Printed
Printed Name
Name FLORIDA C. ACUNA NADIA M. NAYRAN
Date Date
PURCHASE REQUEST
Stock/ Property
Unit Item Description Quantity Unit Cost Total Cost
No.
-
TOTAL P -
Purpose:
Signature:
Printed Name: GERRY BOY M. DEMECINO NADIA M. NAYRAN
Designation: PRINCIPAL I
/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
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:
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.
EXPLANATION OR JUSTIFICATIONS:
EVIDENCE OF TRAVEL:
Used Tickets
Certificate of Appearance / Participation
Others:
Respectfully submitted:
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 -
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
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
(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
(Printed Name & Signature) (Printed Name & Signature) Julius T. Tinsay
School Physical Facilities Coordinator School Head Division Engineer
JOB REQUEST
Estimated
Stock/
Unit Job Description Quantity Unit Cost Estimated Cost
Property No.
TOTAL P -
Purpose:
Signature:
Printed Name:
Designation:
(End user)
(School Head)
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:
Php
Received By:
Date Received:
Project Fund:
Date Work Begin: Date Work Completed:
School Inspector
PRE-REPAIR INSPECTION
Location : Health & Nutrition Section, Grnd. Flr. BSP Bldg., Divison of Silay City compound, Silay City
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
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
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 ACCEPTANCE
Purpose:
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
Entity Name:
Fund Cluster: PAR No.:
Property
Quantity Unit Description Date Acquired Amount
Number
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
Agency
Place of Storage Date:
TOTAL
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
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
____________________________________________________________ (P__________)
(In Words) (in Figures)
_________________________________________________________
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
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:
NOTICE OF AWARD
NOA NO.
(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.
Conformed:
Signature
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.
Date
/02-18-2019