Liquidation Forms 2021 - Tarpaulin
Liquidation Forms 2021 - Tarpaulin
Liquidation Forms 2021 - Tarpaulin
INSTRUCTIONS Fill in cells in white background with necessary data which will be used in different accounting forms.
Created by:
DISBURSEMENT VOUCHER
DATE PURCHASE October 11, 2021
NAME OF BIDDER No.1 (W) SMILE PRINTING SERVICES OBLIGATION REQUEST
NAME OF BIDDER No.3 (L) MGM PRINTS REPORT OF SUPPLIES AND MATERIALS ISSUED\
PURCHASE REQUEST
INSPECTORATE TEAM
Chairman RISEL C. JO
Appendix 43
Department of Education Fund Cluster:
DIVISION OF MISAMIS ORIENTAL
Del Pilar - Velez Sts., Cagayan de Oro City DV No.:
Tel. Nos. (08822) 724615/ (088) 856-4454 Fax No. 856-4524
Date:
DISBURSEMENT VOUCHER
October 11, 2021
Mode of ____________Others (Please specify)
MDS Check Commercial Check ADA
Payment
TIN/Employee No.: OS/BURS No.:
Payee SMILE PRINTING SERVICES
Responsibility Center:
Address Balingasag, Misamis Oriental Title: Code:
A. Certified:
Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.
ADELINA C. JAPONA
Principal II/HOPE
Date: October 11, 2021
B. Accounting Entries:
Account Title UACS Code Debit Credit
Mobile Load 5020502000 960.00
Advances for Operating Expenses 199010100 960.00
OBLIGATION REQUEST AND STATUS ORS No.:
Department of Education Date:
Division of Misamis Oriental October 11, 2021
Location Code: 104305000 Fund: 02-01101101 MOOE
Payee: SMILE PRINTING SERVICES
Office:
Address: Balingasag, Misamis Orienal
Responsibility
Particulars MFO/PAP UACS Code/ Amount
Center Expenditure
A. Certified B. Certified
P Charges to appropriation/allotment necessary, P Allotment available and obligated for the purpose/
lawful, and under my direct supervision; and adjustment necessary as indicated above
Signature: Signature:
Printed Printed
Name: ADELINA C. JAPONA Name: JILL FAYE I. CARIAGA
Principal II School Treasurer
Position: Position:
Head, Requesting Unit/Authorized Representative Head, Budget Unit/Authorized Representative
P.O. No.: ___________________ Date: ________________ Invoice No. Date: October 11, 2021
TOTAL 700.00
INSPECTION ACCEPTANCE
Date Inspected: October 11, 2021 Date Received: October 11, 2021
Inspected, verified and found OK
as to quantity and specifications
Complete √ Complete √
Partial Partial
TOTAL 700.00
Purpose:
For Printing & Publications
Signature
Printed Name MILDRED A. UYAN ADELINA C. JAPONA JILL FAYE I. CARIAGA GIL MAIDO G. LADERA
Date October 11, 2021 October 11, 2021 October 11, 2021 October 11, 2021
DEPARTMENT OF EDUCATION
Region X
Division of Misamis Oriental
District of Balingasag North
BALINGASAG CENTRAL SCHOOL
Balingasag, Misamis Oriental
- -
- -
TOTAL 700.00
Recapitulation: Recapitulation:
Stock No. Qty. Unit Cost Total Cost Account Code
2 Tarpaulin , (4"x 8") pc 350.00 700.00 5029902000
TOTAL 700.00
I hereby certify to the correctness of the above information. Posted by/date:
Estimated
Inventory
Quantity Unit Description Unit Cost Total Cost Useful Life
Item No.
(In years)
TOTAL 700.00
PURCHASE ORDER
Supplier: P.O. No.
SMILE PRINTING SERVICES
Address: Balingasag, Misamis Orienal Date: October 11, 2021
*/`
NAME OF BIDDERS
UNIT OF DESCRIPTION OF SMILE
ITEM NO. QTY MC YEE COPY
LASERTECH
ISSUE ARTICLE/SERVICES PRINTING CENTER & EDUC.
COPIER SERVICES
SERVICES SUPPLY
We hereby certify to the correctness of this abstract, the price/s of which were taken from the attached Price
Quotations from supplier/s or store/s submitted by the authorized canvasser/s. According to this abstract, the price
quotations of the following supplier/s or store/s represents the most advantageous to the government. We therefore
award the article/s or service/s described above to the following supplier/s or store/s.
APPROVED:
ADELINA C. JAPONA
Principal - I (HOPE)
or
Region X
DIVISION OF MISAMIS ORIENTAL
Cagayan de Oro City
The Proprietor/Manager
_________________________
_________________________
Sir/Madam:
This office requests you to please indicate hereunder opposite each indicated items latest prices which is/are
READILY AVAILABLE in your store/ firm wherein this agency will immediately procure under ALTERNATIVE METHOD
pursuant to paragraph d, Section 48, Article XVI, of Republic Act 9184 (New Government Procurement Reform Act.)
Unit
Item No. Quantity Description of Article/s Service/s Price Quotation
Issued
1 2 pc Tarpaulin , (4"x 8")
0 0 0 -
I/We hereby certify that the price quotation/s indicated above are our prevailing market price/s
and the quantity of goods/equipment are readily available in this store/firm.
_______________________________
(Signature over Printed Name)
Contact No: ___________________
Date: _________________________
TIN # _________________________
DTI/SEC. Reg'n # _____________
VAT or NON-VAT ______________
PHILGEPS Reg'n # _____________
Canvassed by:
WHEREAS, the item/s to be procured as enumerated in the Approved Purchase Request is/are items
which is/are readily available off-the-shelf of the stores in the locality for goods and persons for
services;
WHEREAS, such items are not available in the PS-DBM as confirmed, the amount is less than the
threshold for a competitive public bidding and does not result splitting of contract thereafter;
IT IS RESOLVED AS THIS BODY HEREBY RESOLVES to recommend to the Head of Procuring Entity
(HOPE) of BALINGASAG CENTRAL SCHOOL that the Mode of Procurement to be adapted for the
purchase of the items indicated above shall be SHOPPING one of the ALTERNATIVE METHODS
FOR THE PROCUREMENT OF GOODS AND SERVICES per Section 52, Rule XVI of the Revised
Implementing Rules and Regulations of RA 9184.
REGULAR MEMBERS:
APPROVED:
ADELINA C. JAPONA
Principal – I
PURCHASE REQUEST
Department of Education, Division of Misamis Oriental
. Cagayan de Oro City
Department: DepED Mis. Or. PR. No.: Date: October 11, 2021
Section: BALINGASAG CENTRAL SCHOOL SAI No.: Date:
Item UNIT OF
QTY ITEM DESCRIPTION
NO. ISSUE UNIT COST TOTAL COST
1 2 pc Tarpaulin , (4"x 8") 352.00 704.00
0 0 0 0 12.00 -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
704.00
( ) Please furnish us with Price Estimate (for office equipment/furniture & supplementary items)
( ) Please purchase for our agency the equipment/furniture/supplementary items per your estimate
(PS RAD No. _____________ attached dated:____________, 20________.
( ) Please issue common-use supplies/materials per PS Price List as of January 9, 2009
( ) Please issue certificate of Price Reasonableness
( ) Please furnish us with your latest/updated Price List
( ) Others> (Specify)__________________________
ITEM NO. ITEMS & DESCRIPTION/SPECIFCATIONS/STOCK NO. QUANTITY UNIT UNIT PRICE AMOUNT
C E R T I F I C A T I O N
This is to certify that the following non-common supplies are not available at qualified Stores
in the District. These will be procured from in the next/ nearest District or in Cagayan de Oro City.
T O T A L 377,600.00
Recommending Approval:
ADELINA C. JAPONA
Principal II
APPROVED:
CERTIFICATION
This is to certify that the items procured / disbursements made are found
in the School Annual Procurement Plan (SUPPLEMENTAL - 2ND QUARTER) for
CY 2020 and in accordance with the activities reflected in the School Improvement
Plan.
h. D.
Department of Education
Region X
DIVISION OF MISAMIS ORIENTAL
Cagayan de Oro City
BALINGASAG CENTRAL SCHOOL
ACKNOWLEDGEMENT RECEIPT OF CELLCARD
Prepared by:
EMERE C. JENISAN
Principal - I