Form 2A 2M CM Certifications As of May2024 DM For Merge
Form 2A 2M CM Certifications As of May2024 DM For Merge
Form 2A 2M CM Certifications As of May2024 DM For Merge
CERTIFICATION
This is to certify that the City/Municipality of _______________________________
has the following
(Please supply the required information.):
● Disbursement of fund appropriated for the conservation and preservation of cultural property,
CY 2023 (Cut-off: December 31, 2023)
● Disbursement of fund for LYDO functions and operations, CY 2023 (Cut-off: December 31, 2023)
This Certification is issued for the purpose of the Seal of Good Local Governance assessment.
___________________________________ ___________________________________
Signature over Printed Name Signature over Printed Name
1. Ask the BPLO for the month and day of CY 2023 1st quarter with the highest volume of transactions for business permits for both
new and renewal.
3. Get sample transactions, at least 50% each for new business and renewal. The maximum number of samples for each is 20.
Date (month and day) with Date (month and day) with
highest volume of transaction highest volume of transaction for
for business permits: business permits:
_____________________ _____________________
__ __
Not more than 3 working days Not more than 3 working days
from application to release? from application to release?
Application No. Application No.
Yes No Yes No
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11. Click here to enter text. ☐ ☐ 11. Click here to enter text. ☐ ☐
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14. Click here to enter text. ☐ ☐ 14. Click here to enter text. ☐ ☐
15. Click here to enter text. ☐ ☐ 15. Click here to enter text. ☐ ☐
16. Click here to enter text. ☐ ☐ 16. Click here to enter text. ☐ ☐
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18. Click here to enter text. ☐ ☐ 18. Click here to enter text. ☐ ☐
19. Click here to enter text. ☐ ☐ 19. Click here to enter text. ☐ ☐
20. Click here to enter text. ☐ ☐ 20. Click here to enter text. ☐ ☐
Notes: Application filed on Day 1 should be released not later than Day 3. Weekends not counted. Attach additional pages, if necessary
Department of the Interior and Local Government
CY 2024 Seal of Good Local Governance
Certified Form 2A-2M for Cities and Municipalities
_____% of barangays have integrated the issuance of barangay clearance in the LGU’s Business Permit process.
Attached is the list of barangays which complied with the requirement.
Employees derived from registered new businesses and business renewals __________
____________
__
This Form is issued for the purpose of the Seal of Good Local Governance assessment.
___________________________________ ___________________________________
Signature over Printed Name Signature over Printed Name
Attested by:
Department of the Interior and Local Government
CY 2024 Seal of Good Local Governance
Certified Form 2A-2M for Cities and Municipalities
___________________________________
Signature over Printed Name
City/Municipal Mayor
Barangays with Barangay Clearance integrated to the LGU Business Permit Process
# Name of Barangay Issuance Number Date of Approval
_____________________________ _________________________
1 ______________________________
_____________________________ _________________________
2 ______________________________
_____________________________ _________________________
3 ______________________________
_____________________________ _________________________
4 ______________________________
_____________________________ _________________________
5 ______________________________
_____________________________ _________________________
6 ______________________________
_____________________________ _________________________
7 ______________________________
_____________________________ _________________________
8 ______________________________
_____________________________ _________________________
9 ______________________________
_____________________________ _________________________
10 ______________________________
_____________________________ _________________________
11 ______________________________
_____________________________ _________________________
12 ______________________________
_____________________________ _________________________
13 ______________________________
_____________________________ _________________________
14 ______________________________
_____________________________ _________________________
15 ______________________________
CERTIFICATION
This is to certify that the City/Municipality of _______________________________
has budget
appropriation for its (please tick available item(s)):
Local Disaster Risk Reduction and Management Plan
Approved Local Disaster Risk Reduction and Management (LDRRM) Plan covering CY 2024 as
integrated into the CY 2024 Annual Investment Program and Annual Budget.
Approved Local Disaster Risk Reduction and Management (LDRRM) Plan covering CY 2023 as
integrated into the CY 2023 Annual Investment Program and Annual Budget.
Personal Services
Additionally, the City/Municipality also has the following information based on the approved CY 2024
annual budget:
(1) Total Income from regular sources realized in the next
PhP ________________
preceding fiscal year
This Certification is issued for the purpose of the Seal of Good Local Governance assessment.
______________________________________ ______________________________________
Signature over Printed Name Signature over Printed Name
CERTIFICATION
_____% of programs, project, and activities (PAPs) under the LSB Plan are completed.
Accordingly, the said Plan completed, or its fund utilized for the following items (tick the appropriate
item(s)):
The Local School Board met at least once in these months in CY 2023:
Department of the Interior and Local Government
CY 2024 Seal of Good Local Governance
Certified Form 2A-2M for Cities and Municipalities
January July
February August
March September
April October
May November
June December
This Certification is issued for the purpose of the Seal of Good Local Governance assessment.
Certified By:
_____________________________________________
Signature over Printed Name
Official Release of this Certification (Please affix stamp of Records Section/Officer below)
Department of the Interior and Local Government
CY 2024 Seal of Good Local Governance
Certified Form 2A-2M for Cities and Municipalities
CERTIFICATION
has (Please tick available item(s)):
This is to certify that the City/Municipality of INDANG
No submission
In addition, I confirm the correctness of the information/conditions contained in the attached Documentation
template (Certified Form 2E – Photo Documentation).
This Certification is issued for the purpose of the Seal of Good Local Governance assessment.
Certified by:
CERTIFICATION
This is to certify that the City/Municipality of ______________________________
has the following (Please
supply required data):
_____% of planned PAPs to be charged against the CY 2022 70% component for Disaster Preparedness
and Mitigation (Current Fund) were completed. Attached is the list of PAPs for CY 2023;
_____% of barangays with Evacuation Information Guides; and
_____% of barangays with approved Community-Based Disaster Risk Reduction and Management
(CBDRRM) Plans. Attached is the list of barangays with approved CBDRRM Plans;
Department of the Interior and Local Government
CY 2024 Seal of Good Local Governance
Certified Form 2A-2M for Cities and Municipalities
This Certification is issued for the purpose of the Seal of Good Local Governance assessment.
_______________________________________ ________________________________________
Signature over Printed Name Signature over Printed Name
2 ______________________________ _________
3 ______________________________ _________
4 ______________________________ _________
5 ______________________________ _________
6 ______________________________ _________
7 ______________________________ _________
8 ______________________________ _________
9 ______________________________ _________
10 ______________________________ _________
11 ______________________________ _________
12 ______________________________ _________
13 ______________________________ _________
14 ______________________________ _________
15 ______________________________ _________
16 ______________________________ _________
17 ______________________________ _________
18 ______________________________ _________
19 ______________________________ _________
20 ______________________________ _________
Notes: Kindly include in the accomplishment rate the planned PAPs that were eventually implemented through other funding
sources (e.g., grants/assistance from National Government Agencies) and those completed until December 31, 2023, even if
the funds for them are yet to be disbursed. Attach additional pages if necessary.
2 ______________________________ ☐
3 ______________________________ ☐
4 ______________________________ ☐
5 ______________________________ ☐
6 ______________________________ ☐
7 ______________________________ ☐
8 ______________________________ ☐
9 ______________________________ ☐
10 ______________________________ ☐
% Accomplishment _______
CERTIFICATION
This is to certify that the City/Municipality of ______________________________
has the following (Please
supply required data and photo documentation. You may add remarks for each photo.):
Gradient: _____________
Good
Fair
Poor to Fair
Very Poor to Fair
Slip-Resistance (if wet)
Very Good
Good
Fair
Poor to Fair
Very Poor to Fair
________________________________
________________________________
Fair
Poor to Fair
Very Poor to Fair
Other Remarks (if any):
________________________________
________________________________
Gradient: _____________
________________________________
Fair
Poor to Fair
Very Poor to Fair
Other Remarks (if any):
________________________________
________________________________
Minimum Requirements:
________________________________
Department of the Interior and Local Government
CY 2024 Seal of Good Local Governance
Certified Form 2A-2M for Cities and Municipalities
WALKWAYS
Minimum Requirements:
________________________________
Department of the Interior and Local Government
CY 2024 Seal of Good Local Governance
Certified Form 2A-2M for Cities and Municipalities
CORRIDORS
Minimum Requirements:
________________________________
Minimum Requirements:
All doors have a minimum clear width of 0.80 m.
Clear openings are measured between the surface of
the fully open door at the hinge and the door jamb at
the stop.
Doors are operable by a pressure or force not more
than 4.0kg. The closing device pressure on interior
door does not exceed 1kg.
Department of the Interior and Local Government
CY 2024 Seal of Good Local Governance
Certified Form 2A-2M for Cities and Municipalities
________________________________
Minimum Requirements:
________________________________
RAMPS
Minimum Requirements:
Put “N/A”as a remark if the optional feature is not
applicable.
________________________________
PARKING AREAS
Minimum Requirements:
Met the recommended ratio for parking spaces
provided in the technical notes
Parking spaces allow enough space for a person to
transfer to a wheelchair from a vehicle.
Located as close as possible to building entrances or
to accessible entrances.
Whenever and wherever possible, accessible parking
spaces should be perpendicular or to an angle to the
road or circulation aisles.
Slots have a minimum width of 3.70 m.
A walkway from accessible spaces of 1.20 m. clear
width is provided between the front ends of parked
cars.
Pavement markings, signs or other means are
provided to delineate parking spaces for the
handicapped.
Parking spaces for the disabled are not located at
ramped or sloping areas.
____________________________
HANDRAILS
Minimum Requirements:
Department of the Interior and Local Government
CY 2024 Seal of Good Local Governance
Certified Form 2A-2M for Cities and Municipalities
____________________________
Minimum Requirements:
________________________________
FLOOR FINISHES
Minimum Requirements:
CR and ramp flooring have grooves.
Corrugated floor for the blind.
____________________________
Department of the Interior and Local Government
CY 2024 Seal of Good Local Governance
Certified Form 2A-2M for Cities and Municipalities
DRINKING/WATER FOUNTAINS
Minimum Requirements:
OR
____________________________
PUBLIC TELEPHONE
Minimum Requirements:
OR
__________________________
SEATING ACCOMMODATIONS
____________________________
Department of the Interior and Local Government
CY 2024 Seal of Good Local Governance
Certified Form 2A-2M for Cities and Municipalities
SIGNAGES
Minimum Requirements:
_________________________________
Minimum Requirements:
__________________________________
Certified by:
___________________________________ ___________________________________
Signature over Printed Name Signature over Printed Name
Attested by:
Department of the Interior and Local Government
CY 2024 Seal of Good Local Governance
Certified Form 2A-2M for Cities and Municipalities
___________________________________
Signature over Printed Name
City/Municipal Mayor
CERTIFICATION
CY 2023 PAPs funded out of the 1% of NTA allocation for the Local
____________
Council for the Protection of Children
B. On Presence of Illegal Dwelling Units (Indicator for Cities only, but Municipalities are encouraged to also
fill this out)
_____________________________________________________________________________________
_____________________________________________________________________________________
____________________________________________________________________________
This Certification is issued for the purpose of the Seal of Good Local Governance (SGLG) assessment and
the Local Governance Performance Management System (LGPMS) LGU profiling.
___________________________________ ___________________________________
Signature over Printed Name Signature over Printed Name
CERTIFICATION
✘ The LGU has provided logistical support to the PNP Local Police Office/Station in CY 2023.
Accordingly, the following are the forms of support given (please tick applicable choices only):
✘ Ammunition ✘ Police station
✘ Communication ✘ Supplies
✘ Vehicle Others (please specify): _________________
✘ The LGU has supported the organization of the Barangay Peacekeeping Action Teams, barangay
tanods, and/or any similar unit.
_____________________________________________________________________________________
_____________________________________________________________________________________
____________________________________________________________________________________
Department of the Interior and Local Government
CY 2024 Seal of Good Local Governance
Certified Form 2A-2M for Cities and Municipalities
This Certification is issued for the purpose of the Seal of Good Local Governance assessment.
Certified By:
2 ______________________________ ☐ ☐
3 ______________________________ ☐ ☐
4 ______________________________ ☐ ☐
5 ______________________________ ☐ ☐
6 ______________________________ ☐ ☐
7 ______________________________ ☐ ☐
8 ______________________________ ☐ ☐
9 ______________________________ ☐ ☐
10 ______________________________ ☐ ☐
11 ______________________________ ☐ ☐
12 ______________________________ ☐ ☐
13 ______________________________ ☐ ☐
14 ______________________________ ☐ ☐
15 ______________________________ ☐ ☐
CERTIFICATION
This is to certify that the City/Municipality of ______________________________
has the following
accomplishments and data (please supply the following information):
Component Barangays have their respective violence against women (VAW) desks. Please provide the
percentage of barangays with VAW desks: _____%
Component Barangays have their VAWC reports. Please provide the necessary information below:
Percentage of barangays with VAWC quarterly reports submitted to the LSWDO in CY 2023
Quarter % of Barangays
1st Quarter _______
_____________________________________________________________________________________
_____________________________________________________________________________________
_____ % of barangays with established daycare/child development centers. Attached is the list of
barangays which complied with the requirement; and
2 ______________________________ ☐ ☐
3 ______________________________ ☐ ☐
4 ______________________________ ☐ ☐
5 ______________________________ ☐ ☐
6 ______________________________ ☐ ☐
7 ______________________________ ☐ ☐
8 ______________________________ ☐ ☐
9 ______________________________ ☐ ☐
1 ______________________________ ☐ ☐
0
1 ______________________________ ☐ ☐
1
1 ______________________________ ☐ ☐
2
1 ______________________________ ☐ ☐
3
1 ______________________________ ☐ ☐
4
1 ______________________________ ☐ ☐
5
Number of Barangays _______
This Certification is issued for the purpose of the Seal of Good Local Governance assessment.
___________________________________ ___________________________________
Signature over Printed Name Signature over Printed Name
CERTIFICATION
This is to certify that the City/Municipality of ______________________________
has the following (Please supply
required data):
condition):
Approved; Date of approval: __________________________
With percent-completion of: ______________________
as of ______________________
Currently being drafted with DENR’s technical assistance
Has an LGU-owned and operated Sanitary Landfill (SLF) (completed and operational)
Forged partnership with a government/private entity for the use of an SLF as final waste disposal facility
Department of the Interior and Local Government
CY 2024 Seal of Good Local Governance
Certified Form 2A-2M for Cities and Municipalities
_____% of barangays are covered by segregated collection. A list of barangays covered is attached.
Has separate schedule for the collection of the different types of wastes
This Certification is issued for the purpose of the Seal of Good Local Governance assessment.
__________________________________________ ________________________________________
Signature over Printed Name Signature over Printed Name
2 ______________________________ ☐ ☐
3 ______________________________ ☐ ☐
4 ______________________________ ☐ ☐
5 ______________________________ ☐ ☐
6 ______________________________ ☐ ☐
7 ______________________________ ☐ ☐
8 ______________________________ ☐ ☐
9 ______________________________ ☐ ☐
10 ______________________________ ☐ ☐
11 ______________________________ ☐ ☐
12 ______________________________ ☐ ☐
13 ______________________________ ☐ ☐
14 ______________________________ ☐ ☐
15 ______________________________ ☐ ☐