Purchase Request: Cagayan Valley Medical Center Cagayan Valley Medical Center

Republic of the Philippines PR-003-1
Department of Health
CAGAYAN VALLEY MEDICAL CENTER
Dalan Na Pagayaya, Regional Government Center
Carig Sur, Tuguegarao City, Cagayan
PURCHASE REQUEST
Fund Cluster: __________________
Office/Section : PR No.: F-2018-01-001 Date: January 11, 2018
FINANCE Responsibility Center Code : ___________
Stock/
Property Unit Item Description Quantity Unit Cost Total Cost
No.
pc INDEX CARD, as per attched sample 2000 4.25 8,500.00
*************************
BASED ON PPMP 2018 8,500.00
Purpose: FOR CVMC USE - ACCOUNTING SECTION

_______________________________________________________________
Requested by: Approved by:

Signature :
Printed Name : NOEL B. ARNEDO, CPA GLENN MATHEW G. BAGGAO,MD,MHA,MSN,FPSMS

Designation : FINANCIAL AND MANAGEMENT OFFICER II MEDICAL CENTER CHIEF II
PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
pcs SUBSIDIARY LEDGER CARD, as per attched sample 1000 4.25 4,250.00
*************************

_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
pc Photocopier Toner MX235FT 3 8,500.00 25,500.00
*************************
BASED ON PPMP 2018 25,500.00

_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
Unit LAPTOP 2 25,000.00 50,000.00
Specifications:
Processor Type - Core i3 or higher
Processor Speed - 2.0 GHz or faster
Memory - minimum of 4GB
Storage Type & Capacity - minimum of 500GB Hard Disk Drive
(HDD)
Optical Drive - atleast 8x DVD-RW
Display - atleast 14" HD LED LCD Display with at least 1366 x
768 Resolution
Graphics - minimum of 16.7 colours with 16:9 aspect ratio
Audio - at least 5.1-channel surround-sound output
-High Definition audio support
-S/PDIF support for digital speakers
-MS-Sound compatible
Network Interface - Wired-Gigabit Ethernet with minimum of 1
Gbps NIC (built-in)
-Wireless - 802.11 b/g/n (built in)
(optional prefer with 802.11 ac)
IO PORTS - atleast 3 x sub-ports (usb 2.0 and 3.0 ), 1 x HDMI
port, 1 x vga port Headphones/speaker/line-out jack with S/PDIF
support
-Microphone-in jack
-Line-in Jack
-Gigabit Ethernet (RJ-45) port
-DC-in jack for AC adapter
Card Reader - 5-in-1 car reader (SD, MMC, MS, MS PRO, XD)
Built-in Webcam - min of 640 x 480 @ 30 fps or 1280 x 800
@300 fps resolution image capture
Power Supply & Battery - 48.8 W 4400 mAh 6-cell battery pack
-min. of 4 hours battery life 3-pin 65 W AC adapter ENERGY
STAR compliant
Warranty - at least 1 year (parts and services)
Operating System - Windows 10
************************* 50,000.00
BASED ON PPMP 2018
Purpose: FOR CVMC USE

_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
pax Accomodation for Friendship Meet 2018 150 1,000.00 150,000.00
*From february 12-16, 2018
*************************
BASED ON PPMP 2018 150,000.00
Purpose: FOR CVMC USE - FRIENDSHIP MEET 2018

_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
Unit LaserJet Monochrome Printer 2 7,000.00 14,000.00
Specifications:
Printer type - Laser/Monochrome
Print Speed - Up to 18 ppm
Connectivity Technology - Wired
Interface - USB
Connector Type - 4 pin USB Type B
Max Resolution (B&W) - 1200 dpi
Total Media Capacity - at least 150 sheets
Max Media Size (Custom) - 8.5 x 14 in
Output Trays Capacity - 100 sheets
Monthly Duty Cycle - 5000 pages
*************************
BASED ON PPMP 2018 14,000.00
Purpose: FOR CVMC USE - BUDGET Section

_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
Unit Laptop 2 26,000.00 52,000.00
Specifications:
Processor - Inter Core i3 or higher
Processor Speed - 2.0 GHz or faster
Memory - minimum of 4 GB
Display - at least 15.6" with at least 1366x768 display
Graphics - Integrated Intel HD Graphics
Storage Type & Capacity - minimum of 500 GB Hard Disk Drive
(HDD)
Optical Drive - Super-Multi DVD
Card Reader - 3-in-1 card reader (SD/SDHC/SDXC)
Camera - VGA Web Camera
Network Interface - Integrated 802.zz b/g/n or 802.11 ac
Built-in Bluetooth V4.0 (optional)
Atleast 10/100/1000 Base T
Interface - 1 x Microphone-in/Headphone-out jack
1 x VGA port/Mini D-sub 15-pin for external
monitor
1 x USB 3.0 port(s)
1 x USB 2.0 port(s)
1 x USB-C Gen 1 (upto 5 Gbps)
1 x RJ45 LAN Jack for LAN insert
1 x HDMI
Audio - Built-in Speakers and microphone
Battery - Atleast 3 cells 33 whrs
*************************
BASED ON PPMP 2018 52,000.00

_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
pc Executive Chair 4 4,000.00 16,000.00
Specifications:
All PU Chair, high back
Black plastic, fixed armrest
Tilt tension backrest adjustment
Seat height adjustment
Chrome base
Weight: 11kg
Weight Capacity: 100kg
*************************
BASED ON PPMP 2018 16,000.00

_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
set Uniforms (Officials, Players, Committees) 150 1,500.00 225,000.00
(Jacket, Jogging Pants, Jersey)
(Micro Shine)
set Uniforms (Basketball, Volleyball, Badminton) 55 1,000.00 55,000.00
(Micro cool)
*************************
BASED ON PPMP 2018 280,000.00
*Please see attached design

_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
set Uniforms (Cheer and dance) 25 1,200.00 30,000.00
*************************
BASED ON PPMP 2018 30,000.00
*Please see attached design

_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
pc Laptop 2 22,000.00 44,000.00
Specifications:
Processor - Intel Core i3 or higher
Memory - minimum of 4 GB
Display - at least 14" with at least 1366x768 display
Graphics - Integrated Intel HD Graphics
Storage Type & Capacity - minimum of 500 GB HDD
Optical Drive - Super-Multi DVD
Card Reader - 3-in-1 card reader (SD/SDHC/SDXC)
Camera - VGA Web Camera
Network Interface - Integrated 802.11 b/g/n or 802.11 ac
Built-in Bluetooth V4.0 (optional)
Atleast 10/100/1000 Base T
Interface - 1 x Microphone-in/Headphone-out jack
1 x VGA port/Mini D-sub 15-pin for external monitor
1 x USB 3.0 port(s)
1 x USB 2.0 port(s)
1 x USB-C Gen 1 (upto 5 Gbps)
1 x RJ45 LAN Jack for LAN insert
1 x HDMI
Audio - Built-in Speakers and microphone
Battery - Atleast 3 cells 33 whrs
pc Computer Monitor 17" 2 3,500.00 7,000.00
*************************
BASED ON PPMP 2018 51,000.00
Purpose: FOR CVMC USE - Cashier Section

_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
cart Printer Toner Cartridge (CF217A/17A) 6 3,450.00 20,700.00
*************************
BASED ON PPMP 2018 20,700.00

_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
unit UNINTERRUPABLE POWER SUPPLY (UPS) 1 70,000.00 70,000.00
Specifications:
Power Rating - 2.7kW
Input Voltage - 160-286V
Output Voltage - 230 V
VA Rating - 3000 VA
Mounting Type - Rack mount
Communications - Serial Port, Smart Slot, USB
Number of Outlets - at least 11 outlets
Type - Line Interactive
Maximum Operating Efficiency - 60Hz
Plug Type - C20, CEE 7/EU1-16P, Type G
Special Features - Hot Swappable
Minimum Operating Frequency - 50Hz
Socket Type - C13, C19, IEC
Hot Swappable - YES
Run Time (up to) - at least 15 min. at full load
Battey Life - at least 5 years
Service Support - at least 3 years warranty
*************************
BASED ON PPMP 2018 70,000.00
Purpose: FOR CVMC USE - ACCOUNTING SECTION (For Purchase)

_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
pc Laser Jet Printer 3 30,000.00 90,000.00
Specifications:
Technology - Laser
Print Speed - up to 18ppm - B/W-A4 (8.25"x11.7")
Connectivity - Wired
Interface - USB
Image Enhancement Technology - FastRes 1200
First Print-out time B/W - 8.5 sec
Max H-Document size - 14 in m
Media Type - Cards, envelopes, labels, photo paper, postal card
paper, recycled paper, tranparencies, vellum paper
Min Media Weight - 60g/m2
Max Media Weight - 163 g/m2
Envelop Sizes - International B5 (6.93"x9.83"), international C5
(6.38"x9"), international DL (4.33"x 8.66")
Total Media Capacity - 150 sheets
************************* 90,000.00
BASED ON PPMP 2018
Purpose: FOR CVMC USE - BILLING AND CLAIMS

_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
PC STAPLER HEAVY DUTY 2 300.00 600.00
PC DATAMAN BOX, RED 30 90.00 2,700.00
PC DATAMAN FILER WITH RING, RED 30 165.00 4,950.00
*************************
Purpose: FOR CVMC USE - Billing and Claims

_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Office/Section : PR No.: F-2018-01-0016 Date: March 13,2018
Stock/
No.
pc By Pass Tray Assembly 1 7,347.00 7,347.00
pc AR-205 DR-Drum 1 2,303.00 2,303.00
pc MX-235 SD-Developer 1 1,324.00 1,324.00
pc AR-160 Cleaner Blade 1 1,078.00 1,078.00
***************************
12,052.00
Purpose: FOR CVMC USE - Billing and Claims (SHARP PHOTOCOPIER AR5618)
_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Office/Section : PR No.: F-2018-02-017 Date: February 6, 2018
Stock/
No.
Specifications:
All PU Chair, high back
Black plastic, fixed armrest
Tilt tension backrest adjustment
Seat height adjustment
Chrome base
Weight: 11kg
Weight Capacity: 100kg
*************************
BASED ON PPMP 2018 16,000.00
*Re-PR (F-2018-01-008)

_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Office/Section : PR No.: F-2018-05-0018 Date: May 2, 2018
Stock/
No.
Specifications:
ALL PU Chair, high back
Black Plastic; fixed armrest
Seat Height Adjustment
Chrome Base
Weight: 11kg
Weight Capacity: 100kgs
************************* 8,000.00
BASED ON APP 2018
*please see attached design
Purpose: FOR CVMC USE - BUDGET SECTION USE

_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Office/Section : PR No.: F-2018-05-0019 Date: May 7,2018
Stock/
No.
PC MX 235 FT TONER 6 8,500.00 51,000.00
*************************** 51,000.00
BASED ON APP 2018
Purpose: FOR CVMC USE - Billing and Claims (SHARP PHOTOCOPIER AR5618)
_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Office/Section : PR No.: F-2018-06-020 Date: June 01, 2018
Stock/
No.
pc Laser Jet Printer 2 6,000.00 12,000.00
Specifications:
Technology - Laser
Print Speed - up to 18ppm - B/W-A4 (8.25"x11.7")
Connectivity - Wired
Interface - USB
Image Enhancement Technology - FastRes 1200
First Print-out time B/W - 8.5 sec
Max H-Document size - 14 in m
Media Type - Cards, envelopes, labels, photo paper, postal card

paper, recycled paper, tranparencies, vellum paper
Min Media Weight - 60g/m2

Max Media Weight - 163 g/m2
Envelop Sizes - International B5 (6.93"x9.83"), international C5
(6.38"x9"), international DL (4.33"x 8.66")
Total Media Capacity - 150 sheets
*************************
BASED ON APP 2018
Purpose: FOR CVMC USE - BILLING AND CLAIMS

_______________________________________________________________

Signature :

PURCHASE REQUEST
NATIONAL PRINTING OFFICE Fund Cluster: __________________
Stock/
No.
box Personalized Official Receipt (500 sets/box) 200 1,900.00 380,000.00
*************************
BASED ON APP 2018
Purpose: FOR CVMC USE - Cashier Section

_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
pc DATAMAN FILER WITH RING (RED) 100 165.00 16,500.00
*************************
BASED ON APP 2018
Purpose: FOR CVMC USE - Acounting Section

_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
Unit UPS 500 watts 3 165.00 495.00
*************************
BASED ON APP 2018
Purpose: FOR CVMC USE - Acounting Section

_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Office/Section : PR No.: F-2018-01-00 Date: January , 2018
Stock/
No.

_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Office/Section : PR No.: Date:
Responsibility Center Code : ___________
Stock/
No.
V-009A# DOORBELL 2 239.00 478.00
V-003Q# DOORBELL 2 239.00 478.00
V-009A# DOORBELL 2 239.00 478.00
V-003Q# DOORBELL 2 239.00 478.00
V-009A# DOORBELL 1 239.00 239.00
V-008B# DOORBELL 1 189.00 189.00
V-003Q# DOORBELL 1 239.00 239.00
FOCUS LED BULB WIDE ANGLE 10W 39 119.00 4,641.00
REDOU - 102# SURFACE TYPR DOUBLE 20 49.00 980.00
FOCUS LED BULB ANGLE 7W 11 99.00 1,089.00
REDPLI06# REGULAR 3A PLUG 19 15.00 285.00
12U DOORBELL BATTERY 23A 10 18.00 180.00
L#CUP HOOK 20 6.00 120.00
1.25# HOOK 2 4.00 8.00
2# HOOK 7 5.00 35.00
1/4# MASONRY DRILL 1 39.00 39.00
1/2LTR# VULCA SEAL 2 349.00 698.00
1/2# VULCA SEAL 1 269.00 269.00
FH017 16/2# FLAT CORD TYPE JPT 150 19.00 2,850.00
13,773.00

_______________________________________________________________

Signature :
Printed Name : GLENN MATHEW G. BAGGAO,MD,MHA,MSN,FPSMS

Designation : MEDICAL CENTER CHIEF II
PURCHASE REQUEST
Fund Cluster: __________________
Office/Section : PR No.: Date:
Responsibility Center Code : ___________
Stock/
No.
ZIPLOC GALLON 20 BAGS 5 190.00 950.00
GLOW CLEAR WRAP 30 METERS 1 50.60 50.60
ZIPLOC QUART 25 BAGS 5 170.00 850.00
HBW RE BALLPEN 51 7.00 357.00
PACKING TAPE 15 99.00 1,485.00
ZONROX BLEACH 48 34.75 1,668.00
SAMCAKE TISSUE JUMBO 10 106.75 1,067.50
TISSUE BT 2 PLY 1'S 36 11.50 414.00
TISSUE 12'S 2 PLY 8 131.00 1,048.00
7,890.10

_______________________________________________________________

Signature :
Printed Name : GLENN MATHEW G. BAGGAO,MD,MHA,MSN,FPSMS

Designation : MEDICAL CENTER CHIEF II

Purchase Request: Cagayan Valley Medical Center Cagayan Valley Medical Center

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Purchase Request: Cagayan Valley Medical Center Cagayan Valley Medical Center

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Republic of the Philippines PR-003-1

Office/Section : PR No.: F-2018-01-001 Date: January 11, 2018

FINANCE Responsibility Center Code : ___________

Purpose: FOR CVMC USE - ACCOUNTING SECTION

Requested by: Approved by:

Printed Name : NOEL B. ARNEDO, CPA GLENN MATHEW G. BAGGAO,MD,MHA,MSN,FPSMS

Office/Section : PR No.: F-2018-01-002 Date: January 11, 2018

FINANCE Responsibility Center Code : ___________

Purpose: FOR CVMC USE - ACCOUNTING SECTION

Requested by: Approved by:

Printed Name : NOEL B. ARNEDO, CPA GLENN MATHEW G. BAGGAO,MD,MHA,MSN,FPSMS

Office/Section : PR No.: F-2018-01-003 Date: January 11, 2018

FINANCE Responsibility Center Code : ___________

Purpose: FOR CVMC USE - ACCOUNTING SECTION

Requested by: Approved by:

Printed Name : NOEL B. ARNEDO, CPA GLENN MATHEW G. BAGGAO,MD,MHA,MSN,FPSMS

Office/Section : PR No.: F-2018-01-004 Date: January 15, 2018

FINANCE Responsibility Center Code : ___________

Purpose: FOR CVMC USE

Requested by: Approved by:

Printed Name : NOEL B. ARNEDO, CPA GLENN MATHEW G. BAGGAO,MD,MHA,MSN,FPSMS

Office/Section : PR No.: F-2018-01-005 Date: January 19, 2018

FINANCE Responsibility Center Code : ___________

Purpose: FOR CVMC USE - FRIENDSHIP MEET 2018

Requested by: Approved by:

Printed Name : NOEL B. ARNEDO, CPA GLENN MATHEW G. BAGGAO,MD,MHA,MSN,FPSMS

Office/Section : PR No.: F-2018-01-006 Date: January 22, 2018

FINANCE Responsibility Center Code : ___________

Purpose: FOR CVMC USE - BUDGET Section

Requested by: Approved by:

Printed Name : NOEL B. ARNEDO, CPA GLENN MATHEW G. BAGGAO,MD,MHA,MSN,FPSMS

Office/Section : PR No.: F-2018-01-007 Date: January 22, 2018

FINANCE Responsibility Center Code : ___________

Purpose: FOR CVMC USE - BUDGET Section

Requested by: Approved by:

Printed Name : NOEL B. ARNEDO, CPA GLENN MATHEW G. BAGGAO,MD,MHA,MSN,FPSMS

Office/Section : PR No.: F-2018-01-008 Date: January 22, 2018

FINANCE Responsibility Center Code : ___________

Purpose: FOR CVMC USE - BUDGET Section

Requested by: Approved by:

Printed Name : NOEL B. ARNEDO, CPA GLENN MATHEW G. BAGGAO,MD,MHA,MSN,FPSMS

Office/Section : PR No.: F-2018-01-009 Date: January 19, 2018

FINANCE Responsibility Center Code : ___________

*Please see attached design

Purpose: FOR CVMC USE - FRIENDSHIP MEET 2018

Requested by: Approved by:

Printed Name : NOEL B. ARNEDO, CPA GLENN MATHEW G. BAGGAO,MD,MHA,MSN,FPSMS

Office/Section : PR No.: F-2018-01-0010 Date: January 19, 2018

FINANCE Responsibility Center Code : ___________

*Please see attached design

Purpose: FOR CVMC USE - FRIENDSHIP MEET 2018

Requested by: Approved by:

Printed Name : NOEL B. ARNEDO, CPA GLENN MATHEW G. BAGGAO,MD,MHA,MSN,FPSMS

Office/Section : PR No.: F-2018-01-0011 Date: January 23, 2018

FINANCE Responsibility Center Code : ___________

Purpose: FOR CVMC USE - Cashier Section

Requested by: Approved by:

Printed Name : NOEL B. ARNEDO, CPA GLENN MATHEW G. BAGGAO,MD,MHA,MSN,FPSMS

Office/Section : PR No.: F-2018-01-0012 Date: January 31, 2018