INSPECTION & ACCEPTANCE REPORT Municipality of Aloran LGU Supplier FARMACIA JESSICA PO No.

_____________________________________ Date _______________ Invoice No. __________ Requisitioning Office/Dept. ________________________________________________________________ Item No. 1 Unit cards Description Smart Buddy Prepaid Unit Price 300.00 Total 1,200.00 Qty. 4

INSPECTION Date Inspected: __________________ Inspected, verified and found OK as to quantity and specifications

ACCEPTANCE Date Received: ____________________ Complete Partial

JOSEPH E. CUAJOTOR Inspector Officer

AILEEN M. DIANGO Property Officers

Name of Procuring 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
LGU - ALORAN Agency / Procuring Entity Department HRMO________________ Section __________________________ STOCK NO. 1 UNIT cards PR No. __________________ Date: ____________________ SAI No. __________________ Date: ____________________ QTY 4 UNIT COST 300.00 TOTAL COST 1,200.00

ITEM DESCRIPTION Smart Buddy Prepaid

Purpose / Remarks: Telephone Communication Requested by: Signature: Printed Name: Designation: Date: AILEEN M. DIANGO Administrative Officer IV Approved by: ENGR. JIMMY R. REGALADO Municipal Mayor

Name of 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
LGU - ALORAN Agency / Procuring Entity Supplier : FARMACIA JESSICA P.O. No. : _________________ Address : OROQUIETA CITY Date : _________________ Email Address : __________________________ Mod of : _________________ Telephone No. : __________________________ Procurement : _________________ 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 NO. UNIT DESCRIPTION QTY. UNIT COST AMOUNT 1 cards Smart Buddy Prepaid 4 300.00 1,200.00

(Total Amount in Words) One Thousand Two Hundred Pesos PHP 1,200.00 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 for every day of delay shall be imposed.

Very truly yours, Conforme: ________________________________ Signature over printed name of Supplier _____________________ Date Funds Available: MANOLITA M. ORIO Chief Accountant ALOBS No.: ______________________ Amount: _________________________ ENGR. JIMMY R. REGALADO Authorized Official

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 quote your lowest price on the item/s listed below subject to the General Conditions on the last page, stating the shortest time of delivery and submit your quotation in the return envelope attached herewith.

NICHOLAS M. MADANGUIT 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 OF ACCEPTANCE BY THE PROCURING ENTITY 4. PRICE VALIDITY SHALL BE FOR A PERIOD OF ___________ CALENDAR DAYS 5. G-EPS REGISTRATION CERTIFICATE SHALL BE ATTACHED UPON SUBMISSION OF THE QUOTATION 6. BIDDERS SHALL SUBMIT ORIGINAL BROCHURES SHOWING CERTIFICATIONS OF THE PRODUCT BEING OFFERED.

ITEM NO.

ITEM & DESCRIPTION 1 set of computer Intel CPU Intel CPU 1.8ghz ASROCK 82945G Intel Chipset 2gb memory 150gb hardisk Dvd drive Samsung LCD LG monitor 17 L117WSB 500w power supply ATX casing CIVO HP Deskjet D2560 VIVERA AVR 500w elite With keyboard / mouse optical and mouse pad

QTY. 1

UNIT PRICE

AMOUNT

______________ ______________

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 / Signature __________________________ Tel. No. / Cellphone No. e-mail address __________________________ Date

Name of Procuring Entity

Project Reference Number Name of the Project Location of the Project

Standard Form Number: SF-GOOD-42 Revised on: May 24, 2004 Standard Form Title: Purchase Order Abstract of Bids as Calculated Project Name Project Location : ______________________________________________________ : ______________________________________________________ ______________________________________________________ ______________________________________________________ : ______________________________________________________ : ______________________________________________________ : ______________________________________________________ Sheet Date Time : ____________________ : ____________________ : ____________________

Implementing Office Approved Budget for the Contract Time and Place of Bid Opening NAME OF BIDDERS Total Amount of Bid Form of Bid Security Bank / Company Number Validity Period Bid Security Amount Required Bid Security Sufficient / Insufficient Remarks

NICHOLAS M. MADANGUIT BAC Chairman

BIENVENIDO C. GUANTERO, JR. BAC Vice-Chairman

JOVITO P. APARTE BAC Member

MANOLITA M. ORIO BAC Member

AILEEN M. DIANGO PMO/End-User Unit

___________________________ Head, TWG

__________________________ Representative

After all bids have been received, examined, evaluated and ranked, the BAC shall prepare the corresponding Abstract of Bids as Calculated. All members of the BAC, as well as the Observers present, shall sign the Abstract of Bids as Calculated and attach thereto all the bids with their corresponding Bid Securities and the minutes or proceedings of the bidding.

________________________ BAC Member

________________________ Representative

rs of the BAC, as well as the Observers ngs of the bidding.

Department: Accnt. Title: Approp./Allot. Bal.: Less Expenses: Balance:

Department: Accnt. Title: Approp./Allot. Bal.: Less Expenses: Balance:

Department: Accnt. Title: Approp./Allot. Bal.: Less Expenses: Balance:

_________________________ Head Reviewed by: JOVITO P. APARTE Mun. Budget Officer Department: Accnt. Title: Approp./Allot. Bal.: Less Expenses: Balance:

__________________________ Head Reviewed by: JOVITO P. APARTE Mun. Budget Officer Department: Accnt. Title: Approp./Allot. Bal.: Less Expenses: Balance:

__________________________ Head Reviewed by: JOVITO P. APARTE Mun. Budget Officer Department: Accnt. Title: Approp./Allot. Bal.: Less Expenses: Balance:

___________________________ Head Reviewed by: JOVITO P. APARTE Mun. Budget Officer Department: Accnt. Title: Approp./Allot. Bal.: Less Expenses: Balance:

___________________________ Head Reviewed by: JOVITO P. APARTE Mun. Budget Officer Department: Accnt. Title: Approp./Allot. Bal.: Less Expenses: Balance:

___________________________ Head Reviewed by: JOVITO P. APARTE Mun. Budget Officer Department: Accnt. Title: Approp./Allot. Bal.: Less Expenses: Balance:

___________________________ Head Reviewed by: JOVITO P. APARTE Mun. Budget Officer Department: Accnt. Title: Approp./Allot. Bal.: Less Expenses: Balance:

___________________________ Head Reviewed by: JOVITO P. APARTE Mun. Budget Officer Department: Accnt. Title: Approp./Allot. Bal.: Less Expenses: Balance:

__________________________ Head Reviewed by: JOVITO P. APARTE Mun. Budget Officer Department: Accnt. Title: Approp./Allot. Bal.: Less Expenses: Balance:

___________________________ Head Reviewed by: JOVITO P. APARTE Mun. Budget Officer Department: Accnt. Title: Approp./Allot. Bal.: Less Expenses: Balance:

__________________________ Head Reviewed by: JOVITO P. APARTE Mun. Budget Officer Department: Accnt. Title: Approp./Allot. Bal.: Less Expenses: Balance:

___________________________ Head Reviewed by: JOVITO P. APARTE Mun. Budget Officer Department: Accnt. Title: Approp./Allot. Bal.: Less Expenses: Balance:

___________________________ Head Reviewed by: JOVITO P. APARTE Mun. Budget Officer

__________________________ Head Reviewed by: JOVITO P. APARTE Mun. Budget Officer

___________________________ Head Reviewed by: JOVITO P. APARTE Mun. Budget Officer

___________________ Head

VITO P. APARTE un. Budget Officer

____________________ Head

VITO P. APARTE un. Budget Officer

___________________ Head

VITO P. APARTE un. Budget Officer

____________________ Head

VITO P. APARTE un. Budget Officer

____________________ Head

VITO P. APARTE un. Budget Officer

Republic of the Philippines PROVINCE OF MISAMIS OCCIDENTAL Municipality of Aloran

APPENDIX "A" AMENDED ITINERARY OF TRAVEL Name: Position: Purpose of travel: See attached Travel Order DATE
12/16/09

Monthly Salary: Official Station: Aloran, Mis. Occ.

PLACES TO BE TAKEN
Oroq. City - Ozamiz City Mucas - Iligan City Iligan City - CDO

Time of Means of Transport. Arrival Per Diem Departure Transport. (Fare)

Bus Barge Bus Bus Taxi 60.00 28.00 80.00 100.00 150.00 800.00

TOTAL
860.00 28.00 80.00 100.00 150.00 800.00 800.00 150.00 500.00 80.00 28.00 60.00 3,636.00

12/17/09 12/18/09 12/19/09

Still in CDO Still in CDO CDO - Iligan City Iligan City - Mucas Ozamiz City - Oroq. City Taxi Bus Bus Barge Bus 150.00 100.00 80.00 28.00 60.00

800.00 800.00 400.00

1. I hereby certify (1) that I have received the foregoing itinerary (2) The travel is necessary to the service (3) The period covered is reasonable (4) The expenses are proper. Prepared by:

ENGR. JIMMY R. REGALADO Supervisor

Official Employee

ENGR. JIMMY R. REGALADO Head or Chief of Office Republic of the Philippines PROVINCE OF MISAMIS OCCIDENTAL

Municipality of Aloran

OFFICE OF THE TREASURER CERTIFICATE OF TRAVEL COMPLETED

JIMMY R. REGALADO Agency Head Municipal Mayor Position

Aloran, Mis. Occ. Station

Date

I certify that I have completed the travel authorized in Itinerary of Travel No. __________, dated ______________ made conditions indicated below. Strictly in accordance with the approved itinerary. Cut short as explained below excess payment in the amount of ___________________ was refunded on O.R. _________________ dated __________________. Expended as explained below, additional itinerary was submitted. Other deviation as explained below. Explanations or justifications: See attached Travel Order

Evidence of travel attached hereto:

Travel Order

Respectfully Submitted:

Official Employee

On the evidence and information of which I have acknowledge, the travel was actually undertaken.

ENGR. JIMMY R. REGALADO Head of Office

Republic of the Philippines Province of Misamis Occidental Municipality of Aloran ACKNOWLEDGEMENT RECEIPT FOR EQUIPMENT Qty. 1 Unit set Description 1 set of computer Intel CPU Intel CPU 1.8ghz ASROCK 82945G Intel Chipset 2gb memory 150gb hardisk Dvd drive Samsung LCD LG monitor 17 L117WSB 500w power supply ATX casing CIVO HP Deskjet D2560 VIVERA AVR 500w elite With keyboard / mouse optical and mouse pad Unit Price 32,500.00 Total Value 32,500.00 Property No.

Received from:

Received by:

MANOLITA M. ORIO Municipal Treasurer

AILEEN M. DIANGO Printed Name

Administrative Officer IV Position

Annex B

Republic of the Philippines PROVINCE OF MISAMIS OCCIDENTAL Municipality of Aloran

DISBURSEMENT VOUCHER
Mode of Payment Payee Address Check VER MATEO R. SARIGUMBA ET.AL. ALORAN, MIS. OCC. Cash Others
TIN/Employee No.

No.

Obligation Request No.

Responsibility Center Office/Unit/Project Code

EXPLANATION
To payment of wages for Casual Employees for the period of of September 16-30, 2009 in the amount of --------------------------------------

AMOUNT

PHP

44,470.42

AMOUNT DUE
A. Certified
Allotment obligated for the purpose as indicated above Supporting documents complete

PHP

44,470.42

B. Certified Funds Available Signature

Signature Printed Name Position

HERSON M. OZARAGA Municipal Accountant

Date

Printed Name Position

MANOLITA M. ORIO Municipal Treasurer

Date

Head, Accounting Unit/Authorized Representative C. Approved for Payment Signature Printed Name

Treasurer/Authorized Representative D. Received Payment Check No. Bank Name Date Signature Printed Date VER MATEO R. SARIGUMBA ET.AL. Name OR/Other Documents JEV No. Date

ENGR. JIMMY R. REGALADO Municipal Mayor

Date

Position

Agency Head/Authorized Representative

PETTY CASH VOUCHER

Payee/Office: Address: Municipality of Aloran, Misamis Occidental LGU PEBELIN C. LANGI Aloran, Mis. Occ.

No.: Date: Responsibility Center:

I. To be filled upon request PARTICULARS To payment of travelling expenses as per supporting papers hereto attached in the amount of --------------------------------

II. To be filled up upon liquidation Amount Total Amount Granted Total Amount paid per OR No. _____________ P

PHP

120.00

Amount Refunded/ (Reimbursed)

Requested by

B Received Refund PEBELIN C. LANGI Name of Requestor Reimbursement Paid

Approved by:

AILEEN M. DIANGO Immediate Supervisor C Paid by: D

MANOLITA M. ORIO Disbursing Officer

Liquidation Submitted: MANOLITA M. ORIO Disbursing Officer Reimbursement Received by:

Cash Received by:

PEBELIN C. LANGI Signature over Printed Name of Payee

PEBELIN C. LANGI Signature of Payee Date:

Date: _______________________

CIVIL SERVICE FORM NO. 48 DAILY TIME RECORD

CIVIL SERVICE FORM NO. 48 DAILY TIME RECORD

CIVIL SERVICE FORM NO. 48 DAILY TIME RECORD

NAME
For the month of ________________________________________________ Office hours of arrival Regular days_________________________________ and departure Saturdays___________________________________

NAME
For the month of ________________________________________________ Office hours of arrival Regular days_________________________________ and departure Saturdays___________________________________

NAME
For the month of ________________________________________________ Office hours of arrival Regular days_________________________________ and departure Saturdays___________________________________

D A Y 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

Morning IN OUT

Afternoon IN OUT

UNDERTIME MiHours nutes

D A Y 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

Morning IN OUT

Afternoon IN OUT

UNDERTIME MiHours nutes

D A Y 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

Morning IN OUT

Afternoon IN OUT

UNDERTIME MiHours nutes

TOTAL ____________________________________ I certify on my honor that the above is true and correct report of the hours of work performed, record of which was made daily at the time of arrival and departure from office.

TOTAL ____________________________________ I certify on my honor that the above is true and correct report of the hours of work performed, record of which was made daily at the time of arrival and departure from office.

TOTAL ____________________________________ I certify on my honor that the above is true and correct report of the hours of work performed, record of which was made daily at the time of arrival and departure from office.

Employee's Signature Verified as to the prescribed office hours.

Employee's Signature Verified as to the prescribed office hours.

Employee's Signature Verified as to the prescribed office hours.

In-Charge

In-Charge

In-Charge