Name of Procurring Entity Project Reference Number

Name of the Project

Location of the Project
Standard Form Number: SF-GOOD-59
Revised on: May 24, 2004
Standard Form Title: Purchase Request

PURCHASE REQUEST

PROVINCIAL GOVERNMENT OF CAGAYAN

Agency / Procuring Entity

Department PROVINCIAL INFORMATION OFFICE PR No. Date:

Section SAI No. Date:

STOCK
UNIT ITEM DESCRIPTION QTY UNIT COST TOTAL COST
NO
1 reams Bond paper, A-1 short (bookpaper) 10 P200.00 P2,000.00
2 reams Bond paper, A-1 long (bookpaper) 10 P230.00 P2,300.00
3 pcs. Ballpen, Panda (Assorted Colors) 10 P7.00 P70.00
4 pcs. Recheargeable batteries (AA,2100 Mah) 10 P150.00 P1,500.00
5 pcs. DVD+RW w/ case 50 P50.00 P2,500.00
6 boxes Diskette 1 P50.00 P50.00
7 pcs. CD-RW 30 P30.00 P900.00
8 pcs. Cannon Ink 830 2 P1,000.00 P2,000.00
9 pcs. Cannon Ink 831 2 P950.00 P1,900.00
10 pcs. PH Tricolor #93 3 P800.00 P2,400.00
11 pcs. HP Black #92 3 P750.00 P2,250.00
12 pcs. Masking tape 2" 2 P75.00 P150.00

TOTAL P18,020.00

Purpose / Remarks: For P.I.O. Use

Requested by: Approved by:

Signature:
Printed Name: JENIFER J. BAQUIRAN ALVARO T. ANTONIO
Designation: OIC-Provincial Information Office Governor
Date:
Name of Procuring Entity Project Reference Number
Name of the Project
Location of the Project
Stadard Form Number: SF-GOOD-58
Revised on: May 24, 2004
Standard Form Title: Purchase Order
PURCHASE ORDER

Agency / Procuring Entity

Supplier : Globestar Technologies Inc. P.O No. :
Address : Tuguegarao City Date
E-mail Address : Mode of
Telephone No. : Payment :
TIN :

Gentlemen:

Please furnish this office the following articles subject to the terms and conditions
contained herein:
Place of Delivery : Delivery Term :
Date of Delivery : Payment Term :
STOCK
UNIT DESCRIPTION QTY UNIT COST AMOUNT
NO
1 unit HP Pavilion a152d Desktop P C 1 P42,542.00 P42,542.00
Intel® Pentium ® D Processor 805 (2.66GHz)
Genuine Windows ® XP Home Edition
512MB DDR2
80.0 GB Ultra DMA Hard Drive
SuperMulti Drive with Lightscribe Technology, Double Layer
Integrated High Definition Audio, 7.1 Surround Sound Ready
9-in-1 digital Media Reader *ITU V.90 K56 flex modem, data/fax only
High power speakers subcoofer with satellite
Integrated 10/100 Base T network interface (Broadband ready)
Integrated ATI Radeon Xpress 200 Hypermemory Graphics
HyperMemory supporting up to 256MB Memory
HP Deluxe multimedia keyboard
HP Optical, 2-button PS2 scroller mouse
17" CRT monitor
Uninterrupted Power Supply
USB 256MB
Card Reader 2 in 1 Imation Brand
Computer Table 1 P1,276.00 P1,276.00
Printer 3 in 1 EPSON CSX-3500 1 P7,340.00 P7,340.00
Printer HP 3920 1 P2,542.00 P2,542.00

(Total Amount in Words) Fifty three Thousand Seven Hundred Six P53,706.00
In case of failure to make the full delivery within the time specified above, a penalty of one-
tenth (1/10) of one (1) percent of every day of delay shall be imposed.
Very truly yours,

ATTY. CHARLIE L. YAP

Authorized Official
Conforme:

Signature over printed name of Supplier

10-Mar-05
Date
Funds Available: ALOBS No.
Amount:
JEANNA C. GARMA
Provincial Accountant
Name of Procuring Entity Project Reference Number
Name of the Project
Location of the Project
Standard Form Number: SF-GOOD-60
Revised on: May 24, 2004
Standard Form Title: Request For Quotation
Date
Quotation No.
Company Name
Address

Please qoute your lowest price on the item/s listed below, subject to the General
Condition on the last page, stating the shortest time of delivery and submit your quotation
duly signed by your representative
in the return enveloped assign herewith.

Procurement Officer
Note: 1. ALL ENTRIES MUST BE TYPEWRITTEN
2. DELIVERY PERIOD WITHIN CALENDAR DAYS
3. WARRANTY SHALL BE FOR A PERIOD OF SIX (6) MONTHS FOR SUPPLIES &
MATERIALS, ONE (1) YEAR FOR EQUIPMENT, FROM DATE OFACCEPTANCE BY
PROCURING ENTITY
4. PRICE VALIDITY SHALL BE A PERIOD OF CALENDAR DAYS
5. G-EPS REGISTRATION CERTIFICATE SHALL BE ATTACHED UPON SUBMISSION OF
OF THE QUOTATION
6. BIDDERS SHALL SUBMIT ORIGINAL BROCHURES SHOWING CERTIFICATIONS OF
THE PRODUCT BEING OFFERED

ITEM
ITEM & DESCRIPTION QTY UNIT PRICE
NO

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

Tel. No. / Cellphone No.

email address
Date
Name of Procuring Entity Project Reference Number
Name of the Project
Location of the Project
Standard Form Number: SF-GOOD-61
Revised on: May 24, 2004
Standard Form Title: Requisition and Issue Slip

REQUISITION AND ISSUE SLIP

OFFICE OF THE PROVINCIAL ADMINISTRATOR

Agency / Procuring Entiry

Division/Branch/ Uni Responsibility Center: _____________ RIS No.___________

Office: _____________________________ Code: __________________________SAI No.___________

REQUISITION ISSUANCE
STOCK
UNIT DESCRIPTION QTY REMARKS
NO
1 pcs Energizer battery AA 15
2 pcs Energizer battery AAA 15
3 rms. Bond paper longs-24 40
4 rms. Bond paper short s-24 40
5 pcs Correction tape joy 8 meters 20
6 pcs Uni pen correction fluid 10
7 blts. elmers glue 130 grms 10
8 pcs signing pen pilot (green, black, violet) v-5 20
9 pcs signing pen parker .07 original 10
10 box parker refill 15
12 jar hbw2000 ballpen (matrix) black and blue 2
13 pcs Hp678 black 15
14 pcs Hp678 colored 15
15 boxes signing pen mygel black 3
16 pcs pilot signing pen mygel blue refill 20
17 pcs brown envelope long 50
18 pcs brown envelope short 50
19 pcs eraser steadler (medium) 10
20 pcs flash drive 32GB 5
21 pads post it (note pad size) 10
22 rolls scotch tape 1" lead us 10
23 pcs folder short ginza 50
24 pcs log book 500 pages 15
25 pcs log book 150 pages 5
26 pads post it 3 x 5 10
27 bxs pentel pen pilot black, blue and red 3
28 box mailing envelope 1
30 blts. baygon insect apray 600ml 15
31 btls. glade air freshener 280ml 20
32 btls. axion paste 350 grms 15
33 blts. ethyl alcohol 500ml casino 30
34 btls. mr. mucle glass cleaner 10
36 rolls tisssue paper vinda 2 ply 100
39 pcs albatross 50g 20
40 pcs tide powder 475g 15
41 pcs lysol disinfectant 500ml spray 10
42 bars tide powder 475g 6

Purpose:

Requested By: Approved By: Issued By: Received By:

Signature
Printed Name VINIA ARAO JOSEPH M. LLOPIS
Designation Administrative Aide IV Provincial Administrator
Date
NAME AND ADDRESS AGENCY
OF PROCURING ACCT. CODE
AGENCY AGENCY CONTROL No.
AGENCY AND PROCUREMENT REQUEST PS APR No.

To: THE PROCUREMENT SERVICE

DBM Compound, PR Road
Cristobal st., Paco Manila July 31, 2014
(Date Prepared)

ACTION REQUESTED ON THE ITEM LISTED BELOW

[ ] Please furnish us with the Price Estimate (for office equipment/furmiture & supplementary items)
[ ] Please purchase for our agency the equipment/furniture/supplementary items per your Price Estimate
(PS RAD No. Attached) dated ,
[ ] Please issue commn-use supplies/materials per pric list as of ,
[ ] Please issue certificate or Price Reasonableness
[ ] Please furnish us with your latest/updated Price List
[ ] Others (Specify)

IMPORTANT!! PLEASE SEE THE INSTRUCTION AT THE BACK OF THE ORIGINAL COPY
ITEM
ITEM AND DESCRIPTION SPECIFICATIONS/STOCK No. QUANTITY UNIT UNIT PRICE AMOUNT
NO.
JANITORIAL SUPPLIES
1 RUBBER MAT(BIG) 4 PC P170.00 P680.00
2 HEAD MOP(CLOATH) 12 PC P100.00 P1,200.00
3 TIDE POWDER 950 GRAMS 2 GRAMS P130.00 P260.00
4 MURIATIC ACID 1000ML 2 LTR P80.00 P160.00
5 LYSOL DISINFECTANT 2 GAL P500.00 P1,000.00
6 SOFTBROOM 6 PC P150.00 P900.00
7 HARDBROOM 6 PC P20.00 P120.00
8 FRESHENER IN CAN (SHALDAN) 10 CAN P150.00 P1,500.00
9 WHITE BOARD (SIZE:2X3FT) 1 PC P900.00 P900.00

Total Office Supplies P6,720.00

NOTE ALL SIGNATURES MUST BE OVER PRINTED NAME
STOCK REQUESTED ARE CERTIFIED TO BEFUNDS CERTIFIED AVAILABLE: APPROVED:
WITHIN APPROVED PROGRAM:

ELIZABETH C. PALMEA EMILIA L. IRINGAN EDNA T. JUNIO,RSW,MSSW

AGENCY PROPERTY SUPPLY OFFICER PROVINCIAL TREASURER AGENCY HEAD/AUTHORIZED
SIGNATURE

[ ] FUND DEPOSITE WITHIN PS [ ] CHECK No.

IN THE AMOUNT OF: (P ) ENCLOSED
Standard Form Number: SF-GOOD-63
Standard Form Title: Agency Procurement Request
NAME AND ADDRESS AGENCY
OF PROCURING ACCT. CODE
AGENCY AGENCY CONTROL No.
AGENCY AND PROCUREMENT REQUEST PS APR No.

To: THE PROCUREMENT SERVICE

DBM Compound, PR Road
Cristobal st., Paco Manila May 3, 2011
(Date Prepared)
ACTION REQUESTED ON THE ITEM LISTED BELOW
[ ] Please furnish us with the Price Estimate (for office equipment/furmiture & supplementary items)
[ ] Please purchase for our agency the equipment/furniture/supplementary items per your Price Estimate
(PS RAD No. Attached) dated ,
[ ] Please issue commn-use supplies/materials per pric list as of ,
[ ] Please issue certificate or Price Reasonableness
[ ] Please furnish us with your latest/updated Price List
[ ] Others (Specify)

IMPORTANT!! PLEASE SEE THE INSTRUCTION AT THE BACK OF THE ORIGINAL COPY
ITEM
ITEM AND DESCRIPTION SPECIFICATIONS/STOCK No. QUANTITY UNIT UNIT PRICE AMOUNT
NO.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
TOTAL AMOUNT P17,354.00
NOTE ALL SIGNATURES MUST BE OVER PRINTED NAME
STOCK REQUESTED ARE CERTIFIED TO BE FUNDS CERTIFIED AVAILABLE: APPROVED:
WITHIN APPROVED PROGRAM:

LEOPOLDO B. CARONAN JEANNA C. GARMA ATTY. CHARLIE L. YAP

AGENCY PROPERTY SUPPLY OFFICER AGENCY CHIEF ACCOUNTANT AGENCY HEAD/AUTHORIZED
SIGNATURE

[ ] FUND DEPOSITE WITHIN PS [ ] CHECK No.

IN THE AMOUNT OF: (P ) ENCLOSED
Name of the Procuring Entity Project Reference Number
Name of the Project
Location of the Project
Standard Form Number: SF-GOOD-62
Revised on: May 24, 2004
Standard Form Title: Supplies Availability Inquiry

SUPPLIES AVAILABILITY INQUIRY

Agency / Procuring Entity

Division/Branch Unit Responsibility Center

Office Code:MOOE 1101 No. 1234

STOCK
ITEM DESCRIPTION UNIT QTY STATUS OF STOCK
NO.
1 Black Ink

Purpose / Remarks:

Inquired by: Status Provided by (Acctg. Div.):

Signature Signature
Name Name
Designation Designation
Date Date
Name of the Procuring Entity Project Reference Number
Name of the Project
Location of the Project
Standard Form Number: SF-GOOD-58
Revised on May 24, 2004
Standard form Title: PURCHASE ORDER
PURCHASE ORDER

Agency/Procuring Entity

Supplier: DONA ALEJANDRA INC.

Address: Tuguegarao City P.O No.:
E-mail Address : ____________________________ Date:
Telephone No._______________________________ Mode of Procurement:
TIN:_______________________________________
Gentlemen
Please furnish this ofice the following articles subject to the terms and conditions contained herein:

Place of Delivery Delivery Term:

Date of Delivery: Payment Term:

Lot No. Unit Description Quantity Unit Cost Amount

1 unit Lateral steel cabinet (4 drawers) 1 P12,995.00 P12,995.00

P12,995.00
TOTAL:
In case of failure to make the full delivery within the time specified above, a penalty of one-tenth (1/10) on one
percent for every day of delay shall be imposed.

Very Truly Yours

ATTY. ALVARO T. ANTONIO

CONFORME: Governor
Signature over printed name os Suplier

(Date)
Cash Available:
ALOBS No. : _____________________________

EMILIA L. IRINGAN
ICO-Provincial Treasurer Amount: _________________________________
 Republic of the Philippines
PROVINCE OF CAGAYAN
Tuguegarao City
REQUEST FOR QUOTATION
Company Name:
Quotation No.: _______
Address:
Please quote your lowest price on the item/s listed below, subject to the General Conditions on the back
page and submit your qoutation duly signed by you or your representative not later than the _________ day of
________2013 in the return envelop to

EDNA T. JUNIO,RSW,MSSW
Provincial Administrator
ITEM NO. ITEMS & DESCRIPTION QTY. UNIT PRICE
1 ELASTIC GASKET 1
2 RADIATOR HOSE 1

Provincial Government of Cagayan

Capitol Hills, Tuguegarao City

After having carefully read and accepted (conformed) the General Conditions and Instructions, reflected at
the back of this form especially the period of the validity of the price, I/We quote you on the item at prices
noted
price, above.
I/We quote you on the item at prices noted above.

_______________________________
Offeror's Signature/Printed Name

___________________________
Tel. No./Cellphone no.
e-mail address
_______________________________________________________________________________________________________
CANVASSED BY:

Canvasser's Signature over Printed Name

 GENERAL CONDITIONS TO OFFERORS

1. The sealed price quotation is for:

Goods/Items under P.R. #

2. Only bona-fide and responsible suppliers/dealers, who hold a valid and

updatedCertification of Registration of Business Name, with license to operate as
suppliers/dealers, are qualified to participate.

3. SEALED PRICE QUOTATIONS - All price quotations must be placed in their

respective officeia envelope provided for, sealed and must be signed by the supplier
concerned crossing the flap at the back of the official envelope.

4. Erasures or inter-delineations in the proposal must be duly signed or initialed.

5. C.O.D. Condition shall not be allowed.

6. The price quoted must be final, without any conditions and inclusive of all taxes.

7. All entries must be legibly written.

8. Delivery period shall be within _______________ calendar days.

9. Warranty shall be for a period of six (6) months for supplies & materials one (1)
year for equiptment, from date of acceptance by the procuring entity.

10. Price validity shall be for a period of thirty (30) calendar days to be reckoned from
the date to offer.

11. This General Condition and Instructions to Offerors must be read and conformed
with by the concerned supplier/dealer, and the same be sealed, together with the
accomplished canvass forms, in a official envelope provided for.

12. The Provincial Government reserves the right to reject any or all bids that maybe
deemed disadvantageous to the government.

0------------------- 0------------------- 0
- -
 PBAC Form 1C Date: P.R.
Date:
Office:
ABSTRACT OF PRICE QUOTATION

Item No. Unit Qty. PARTICULAR

ADILYNNE'S GENERAL MERCHANDISE TUGUEGARAO ALPHA STATIONARY TUGUEGARAO LB MART
1 pcs 24 eveready battery AA
2 pads 10 yellow ruled pad
3 pcs 20 record book
4 reams 30 bond paper long
5 reams 30 bond paper short
6 pcs 10 correction tape
7 pcs 20 unipen corrction fluid
8 box 5 plastic fastener
9 pcs 10 signing pen
10 pcs 20 signing pen parker
11 pcs 12 parker refill
12 pcs 2 glue gun
13 pcs 30 glue stick
14 pcs 10 ballpen pilot

Approved :

EDNA T. JUNIO
Provincial Administrator

IAL BIDS AND AWARDS COMMITTEE

ELIZABETH C. PALMEA ATTY. ROMEO GUILLERMO EMILIA L. IRINGAN ENGR. EDWIN ROSALES
General Services Officer Provincial Legal Officer Provincial Treasurer Provincial Engineer
Member Member Member Member

EDNA LINGAN ATTY. JOSEPH P. PAUIG EDNA T. JUNIO

Provincial Budget Officer Chief of Staff Prov'l Social Welfare & Development Officer
Vice-Chairman Chairman
 PBAC Form 1C Date: P.R.
Date:
Office:
ABSTRACT OF PRICE QUOTATION

Item No. Unit Qty. PARTICULAR

ADILYNNE'S GENERAL MERCHANDISE TUGUEGARAO ALPHA STATIONARY TUGUEGARAO LB MART
15 pcs 10 ballpen HBW2000
16 pcs 5 max stapler
17 pcs 5 paper cutter
18 pcs 20 bay gon insect spray
19 pcs 20 glade air freshner
20 pcs 10 crystal dishwashing liquid
21 pcs 30 casino alcohol
22 pcs 10 glass cleaner
23 pcs 10 toilet bowl cleaner
33 pcs 20 good morning towel
34 pcs 6 duster
35 pcs 10 safeguard regular
36 pcs 60 tissue
37 pcs 20 Downy
The above item is awarded to Fannah Ads
Approved :

EDNA T. JUNIO
Provincial Administrator

IAL BIDS AND AWARDS COMMITTEE

ELIZABETH C. PALMEA ATTY. ROMEO GUILLERMO EMILIA L. IRINGAN ENGR. EDWIN ROSALES
General Services Officer Provincial Legal Officer Provincial Treasurer Provincial Engineer
Member Member Member Member

EDNA LINGAN ATTY. JOSEPH P. PAUIG EDNA T. JUNIO

Provincial Budget Officer Chief of Staff Prov'l Social Welfare & Development Officer
 Chairman Vice-Chairman Chairman

PBAC Form 1C Date: P.R.

Date:
Office:
ABSTRACT OF PRICE QUOTATION

Item No. Unit Qty. PARTICULAR

ADILYNNE'S GENERAL MERCHANDISE TUGUEGARAO ALPHA STATIONARY TUGUEGARAO LB MART
38 pcs 20 door mat cotton
39 pcs 15 scotch brite
40 pcs 20 albatross
41 pcs 6 zoom ultra
42 pcs 3 lysol disinfectant
43 pcs 3 tide
44 pcs 6 zonrox
45 pcs 2 twistling mop

The above item is awarded to Fannah Ads

Approved :

EDNA T. JUNIO
Provincial Administrator

IAL BIDS AND AWARDS COMMITTEE

ELIZABETH C. PALMEA ATTY. ROMEO GUILLERMO EMILIA L. IRINGAN ENGR. EDWIN ROSALES
General Services Officer Provincial Legal Officer Provincial Treasurer Provincial Engineer
Member Member Member Member
 EDNA LINGAN ATTY. JOSEPH P. PAUIG EDNA T. JUNIO
Provincial Budget Officer Chief of Staff Prov'l Social Welfare & Development Officer
Chairman Vice-Chairman Chairman
 ACCEPTANCE AND INSPECTION REPORT
Province of Cagayan
Local Government Unit (LGU)

S & J Caleon Marketing, Inc.

P.O. No.: Date: Invoice No.: Date:
Requisitioning Office/Department:

ITEM NO. UNIT DESCRIPTION QUANTITY

1 unit Everest Window type aircon 1
Model ETM10WD
SN No. C187005

ACCEPTANCE INSPECTION

Date Received:___________ Date Inspected: _________________

Inspected, verified and found OK

Complete
as to quantity and specifications.
Partial

Property Officer Inspection Officer

 ANNEX 54

REPORT OF WASTE MATERIALS

Province of Cagayan
Local Government Unit

Place of Storage: G.S.O. Date:

ITEMS FOR DISPOSSAL

RECORD OF SALES
ITEM QTY. UNIT DESCRIPTION
O.R. No. AMOUNT
37 20 pcs Downy 900ml
43 6 pcs Zonrox big 1000ml

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 to _____________________

Property Inspector (Name & Signature) Witness to disposition:

 Republic of the Philippines
Province of Cagayan
Tuguegarao City

PROVINCIAL INFORMATION OFFICE

Summary of Gasoline Consumption for the month of January 23-25, 2008

Issued to Mr. Eugenio L. Pauig, bearing the Plate No. SFA391.

PRE-CONSUMPTION REPORT

DATE LITERS Place to be visited Amount

1/23/2008 full tank Tuguegarao City to Penablanca, P2,350.00

Iguig, Solana & Enrile
1/24/2008 full tank Enrile to Tuao & Rizal P2,350.00
1/25/2008 full tank Rizal to Sto. Nino to P2,350.00
Tuguegarao City

P7,050.00
Prepared by:

JESUSA S. AVENA
Administrative Aide VI

Certified Correct:

EUGENIO L. PAUIG
Provincial Information Officer