ABSTRACT OF PERSONAL CANVASS/ BIDS FOR THE SUPPLY AND DELIVERY

PR No.
ABSTRACT OF BIDS OPENED ON: ,2016. TIME: AM/PM
IN THE BAC OFFICE, TAMPILISAN, ZAMBOANGA DEL NORTE.

Article/ Services Requisitioned DEALERS FURNISHED

Remlits Enterprises Jeroline Canoy Enterprises Mengie Store
Q U AN T I T Y
ITEM NO. DESCRIPTION Pob. Tampilisan, Z.N. Pob. Tampilisan, Z.N. Pob. Tampilisan,Z.N.
No. Unit of Issue Unit Price Total Amount Unit Price Total Amount Unit Price Total Amount
1 3 sacks Potash Fertilizer 1,200.00 3,600.00 1,200.00 3,600.00 1,200.00 3,600.00
2 3 sacks Urea Fertilizer 1,050.00 3,150.00 1,075.00 3,225.00 1,050.00 3,150.00
3 3 sacks 14-14-14 Fertilizer 1,100.00 3,300.00 1,100.00 3,300.00 1,150.00 3,450.00
4 3 sacks Ammunium Fertilizer 800.00 2,400.00 800.00 2,400.00 800.00 2,400.00
5 5 packs Foliar (Grow More) 260.00 1,300.00 250.00 1,250.00 260.00 1,300.00
6 10 packs Kamatis 50.00 500.00 50.00 500.00 50.00 500.00
7 10 packs Choy FI 50.00 500.00 50.00 500.00 50.00 500.00
8 10 packs Mestisa FI 50.00 500.00 50.00 500.00 50.00 500.00
9 10 packs Kangkong (tsina) 50.00 500.00 50.00 500.00 50.00 500.00
10 10 packs Pantastiko 50.00 500.00 50.00 500.00 50.00 500.00
11 10 packs Patola 50.00 500.00 50.00 500.00 50.00 500.00
12 10 packs Yellow Squash 50.00 500.00 50.00 500.00 50.00 500.00
13 10 packs Eggplant 50.00 500.00 50.00 500.00 50.00 500.00
14 10 packs Okra 50.00 500.00 50.00 500.00 50.00 500.00
15 10 packs Sibuyas(green onion) 30.00 300.00 30.00 300.00 30.00 300.00
16 10 packs Luy-a 80.00 800.00 80.00 800.00 80.00 800.00
17 1 Lit. Cymbush 1,200.00 1,200.00 1,200.00 1,200.00 1,200.00 1,200.00
18 1 Lit. Fungicide 800.00 800.00 800.00 800.00 800.00 800.00
19 10 kilos Strawless 70.00 700.00 75.00 750.00 70.00 700.00
20 10 kilos Nylon 200.00 2,000.00 200.00 2,000.00 200.00 2,000.00
21 1 pc. Weighing Scale 800.00 800.00 800.00 800.00 800.00 800.00

THIS IS TO CERTIFY that the requirements of R.A. No. 9184 otherwise known Total 24,850.00 Total 24,925.00 Total 25,000.00
as the Government Procurement Reform Act ( Rule XVI - Sec.52 ) had been complied with. WE HEREBY CERTIFY to the correctness and authenticity of the above Abstract
of Bids to the best of our knowledge.

ANTONIO S. GUMELA,EM.D. GRACE A. GUMANSING

BIDS AND AWARDS COMMITTEE: Public School District Supervisor Municipal Budget Officer
(Requesting Officer) ( Member )

VIGILUS D. CREDO ADELBERTO G. SAMUYA OLIVIA G. EBORDE RENE R. MANAIT

Municipal Engineer Municipal Civil Registrar Municipal Treasurer MPDC
(Chairman) ( Vice Chairman ) ( Member ) ( Member )
24,850.00 24,925.00 25,000.00
LGU - TAMPILISAN Purchase Request No.
Bids And Awards Committee Office of the: Dep Ed
Tampilisan, Zambo. Norte
REQUEST FOR QUOTATION
Date: ____________________
Quotation No.______________

Please quote your lowest price on the item/s listed below, subject to the General Condition on the
Philippine Bidding Documents on Goods, stating the shortest time of delivery and submit your quotation duly
signed by your representative not later than ________________________.

VIGILUS D. CREDO
NOTE: BAC Chairman
1. ALL ENTRIES MUST BE TYPEWRITTEN
2. DELIVERY PERIOD WITHIN SEVEN (7) CALENDAR DAYS
3. WARRANTY SHALL BE FOR A PERIOD OF THREE (3) 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 THIRTY (30) CALENDAR DAYS
5. G-EPS REGISTRATION CERTIFICATE SHALL BE ATTACHED UPON SUBMISSION OF THE QUOTATION, IF AVAILABLE.
6. BIDDERS SHALL SUBMIT ORIGINAL BROCHURES SHOWING CERTIFICATIONS OF THE PRODUCT BEING OFFERED.
ITEM
ITEM & DESCRIPTION QTY. Unit Unit Price TOTAL
NO.
1 Paracetamol 23 boxes
2 Dicycloverine 10Hcl mg 1 box
3 Amoxicillin 250mg 1 box
4 Metoprolol 100 m 50 pcs.
5 Salbutamol nebule 10 pcs.
6 Nebulizing Kit 1 pc.
7 Oxygen Kit 1 pc.
8 Digital Blood Pressure Monitoring 1 pc.
9 Portable Nebulizer 1 pc.
10 Medical Oxygen complte set 1 pc.

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.

Date
1 CART Epson t6641 black 500 500.00
5 Cactus Long 198 990.00
5 Cactus Short 178 890.00
2,380.00
 PURCHASE REQUEST
Tampilisan, Zamboanga del Norte
LGU
PR No.: Date:
Department: Mun. Agri. SAI No.: Date:
Section: OR No. Date:

Item Unit of Estimated Estimated

Quantity Item Description
No. Issue Unit Cost Cost
1 3 length Angle Bar 1/8x1 235.00 705.00
2 1 pc. Flat Bar 225.00 225.00

930.00

Purpose:
For the Office of Mun. Agriculture

Requested by: Cash Availability: Approved by:

Signature:
Printed Name: LUCITO P. CERNA PRAXIDES C. ARCINO ANGELES R. CARLOTO II
Designation: Munucipal Agriculturist OIC-Municipal Treasurer Municipal Mayor
 32.757

19,070.00
982.71

35.10

930.00 35.0967857

1965.42

982.71
 PURCHASE ORDER
Tampilisan, Zamboanga del Norte
LGU
Supplier REMLITS ENTERPRISES P.O. No.
Address Pob. Tampilsian, Z.N. Date
Mode of Procurement:
Gentlemen:
Please furnish this office the following articles subject to the terms and conditions contained herein:

Place of Delivery: Mun. Agri. Delivery Term:

Date of Delivery: Immediately Payment Term:

Item No. Unit Quantity Item Description Unit Cost Amount

1 3 sacks Potash Fertilizer 1,200.00 3,600.00
2 3 sacks Urea Fertilizer 1,050.00 3,150.00
3 3 sacks 14-14-14 Fertilizer 1,100.00 3,300.00
4 3 sacks Ammunium Fertilizer 800.00 2,400.00
5 5 packs Foliar (Grow More) 260.00 1,300.00
6 10 packs Kamatis 50.00 500.00
7 10 packs Choy FI 50.00 500.00
8 10 packs Mestisa FI 50.00 500.00
9 10 packs Kangkong (tsina) 50.00 500.00
10 10 packs Pantastiko 50.00 500.00
11 10 packs Patola 50.00 500.00
12 10 packs Yellow Squash 50.00 500.00
13 10 packs Eggplant 50.00 500.00
14 10 packs Okra 50.00 500.00
15 10 packs Sibuyas(green onion) 30.00 300.00
16 10 packs Luy-a 80.00 800.00
17 1 Lit. Cymbush 1,200.00 1,200.00
18 1 Lit. Fungicide 800.00 800.00
19 10 kilos Strawless 70.00 700.00
20 10 kilos Nylon 200.00 2,000.00
21 1 pc. Weighing Scale 800.00 800.00

(Total Amount in Words) 24,850.00

In case of failure to make the full delivery within the time specified above, a penalty of one-tenth (1/10)
of one percent for every day of delay shall be imposed.
Very truly yours,
Conforme:
ANGELES R. CARLOTO II
REMLITS ENTERPRISES Municipal Mayor
(Signature Over Printed Name) (Authorized Official)

Date
(In case of Negotiated Purchase pursuant toSection 369 (a) of RA 7160, this portion must
be accomplished).

Approved to be purchased thru negotiated

purchase per Sanggunian Res. No. ______.

Certified Correct:

Secretary to the Sanggunian Date:

24,850.00
 Republic of the Philippines
PROVINCE OF ZAMBOANGA DEL NORTE
MUNICIPALITY OF TAMPILISAN

No.:
OBLIGATION REQUEST
PAYEE LUCITO P. CERNA
OFFICE
ADDRESS Pob. Tampilisan, Z.N.

Responsibilit ACCOUNT
PARTICULARS F.P.P AMOUNT
y Center CODE
reimbursement supplies Php 687.00

TOTAL Php 687.00

A. CERTIFIED: B. CERTIFIED:
X Charges to appropriation/allotment necessary,
lawful and under my direct supervision Existence of available appropriation
Supporting documents valid, proper and legal

Signature Over Signature Over

Printed Name LUCITO P. CERNA Printed Name GRACE A. GUMANSING
Position Municipal Agriculturist Position Municipal Budget Officer
Date Date

Republic of the Philippines

PROVINCE OF ZAMBOANGA DEL NORTE
MUNICIPALITY OF TAMPILISAN

No.:
OBLIGATION REQUEST
PAYEE LUCITO P. CERNA
OFFICE
ADDRESS Pob. Tampilisan, Z.N.

Responsibilit ACCOUNT
PARTICULARS F.P.P AMOUNT
y Center CODE
reimbursement supplies Php 687.00

TOTAL Php 687.00

A. CERTIFIED: B. CERTIFIED:
Charges to appropriation/allotment necessary,
lawful and under my direct supervision Existence of available appropriation
Supporting documents valid, proper and legal

Signature Over Signature Over

Printed Name LUCITO P. CERNA Printed Name GRACE A. GUMANSING
Position Municipal Agriculturist Position Municipal Budget Officer
Date Date
 Republic of the Philippines
PROVINCE OF ZAMBOANGA DEL NORTE
MUNICIPALITY OF TAMPILISAN

DISBURSEMENT VOUCHER No.

MODE OF Check Cash Other

PAYMENT

PAYEE LUCITO P. CERNA TIN/Employee No.: Obligation Request No.

RESPONSIBILITY CENTER
ADDRESSPob. Tampilsian, Z.N.
Office/Unit/Project: Code:
EXPLANATION AMOUNT
To reimbursement of supplies used in Mun. Agriculture , this Municipalilty of
Tampilisan Zamboanga del Norte per supporting papers,hereto attached in
the total. . . . . . . . . . . . . . .
amount Php 687.00

Total Amount due this Voucher . . . . . . . . . . . . . . . . . . . . . . . . . . .Php

. 687.00
A CERTIFIED: B CERTIFIED:
Allotment obligated for the purpose as indicated
Funds Available
Supporting documents complete and paper

Signature Signature
Printed Date: Printed
SHERRY LOU P. DAPROSA PRAXIDES C. ARCINO Date:
Name Name
Municipal Accountant OIC-Municipal Treasurer
Position Position
(Head,Accounting Unit/Authorized Representative) (Head,Treasury Unit/Authorized Representative)
APPROVED FOR PAYMENT: RECEIVED PAYMENT:
C D
Signature Check No.: Bank Name: Date:
Printed Date: Signature
ANGELES R. CARLOTO II
Name Printed Nam LUCITO P. CERNA Date:
Municipal Mayor OR. No./Other Documents JEV No. Date:
Position
(Local Chief Executive/Authorized Representative)

FOR ACCOUNTING/PRE-AUDIT PERSONNEL USE ONLY:

CHECKLIST: MANDATORY MINIMUM SUPPORTING DOCUMENTS FOR COMMON TRANSACTIONS
(Maintenance & Other Operating Expenses/Capital Outlay)
I. TRAVELS 2 ALTERNATIVE MODE OF PROCUREMENT
Travel Order or Memorandum by the LCE authorizing the travel 2.a
Approved Itinerary (Appendix A) Purchase Request
Tickets (Original) for Plane, Bus, Ships Fare or equivalent Purchase Order/Letter Order/Contract,duly received
Certificate of Travel Completed (Appendix B) by bidder/supplier
Certificate of Appearance (Appendix C), or its equivalent Certificate of Acceptance
Liquidation Report-in case of cash advance Inspection Report/Waiver of Inspection
Receipts, in case of actual travel claims Result of Test Analysis (if subject to test)
Original Invoice:
Accomplishment Report -Charge Invoice/Sales Invoice
RER (optional)-For reimb. Of expenses above P 75.00 (COA Cir. 96-005 -Delivery Receipt
II. PURCHASES Canvass sheet/price quotation
1 COMPETITIVE BIDDING: Abstract/summary of canvass
Purchase Request (PR)/RIS-Original Certificate of emergency purchase-in the absence of
Purchase Order (PO)/Letter Order (LO)/Contract, duly received by canvass if amount is below 1,000.00
bidder .b NEGOTIATED PROCUREMENT/NEGOTIATED CONTRACT
Inspection and Acceptance Report/Waiver of Inspection Negotiated Procurement:
Original Invoice: Purchase Request
Delivery Receipt Purchase Order/Letter Order/Contract(contract)
Sales Invoice/Charge Invoice duly received by bidder/supplier
Stock Position Sheet Certificate of Authority to negotiate/enter into negotiated
Result of test analysis by proper government, if subject to test contract.
Copy of Advertisement/Invitation to bid Delivery Receipt
Bidder's Bond Sales Invoice/Original Invoice
Notice/Letter of Award Certificate of Acceptance & Inspection Report
Performance Bond Result of Test Analysis (if subject to test)
Abstract of Bids supported by: Certificate of failure of bidding for the second time from B
Bid tenders of other participants Canvass sheet/price quotation
Acceptance of bid/proposal Abstract/summary of canvass
BAC recommendation-Award of the LCRB/HRRB to the LCE Negotiated Contract: (in addition to the above)
TWG recommendation Notice to commence to work
NATIVE MODE OF PROCUREMENT

rder/Letter Order/Contract,duly received

of emergency purchase-in the absence of

of Authority to negotiate/enter into negotiated

of failure of bidding for the second time from BAC

Contract: (in addition to the above)

***Computation***
Php #REF!
 ABSTRACT OF PERSONAL CANVASS/ BIDS FOR THE SUPPLY AND DELIVERY
PR No.
ABSTRACT OF BIDS OPENED ON: ,2016. TIME: AM/PM
IN THE BAC OFFICE, TAMPILISAN, ZAMBOANGA DEL NORTE.
Article/ Services Requisitioned DEALERS FURNISHED
ELJACK PHARMACY LILOY DOCTOR'S PHARMACY MIDTIME PHARMACY
Q U AN T I T Y
ITEM NO. DESCRIPTION Ipil, Zambo. Sibugay Liloy, Z.N. Pob. Tampilisan
No. Unit of Issue Unit Price Total Amount Unit Price Total Amount Unit Price Total Amount
1 23 boxes Paracetamol 41.00 943.00 43.00 989.00 48.00 1,104.00
2 1 box Dicycloverine 10Hcl mg 36.00 36.00 38.00 38.00 51.00 51.00
3 1 box Amoxicillin 250mg 154.00 154.00 155.00 155.00 125.00 125.00
4 50 pcs. Metoprolol 100 m 5.00 250.00 6.00 300.00 3.00 150.00
5 10 pcs. Salbutamol nebule 17.00 170.00 18.00 180.00 36.00 360.00
6 1 pc. Nebulizing Kit 84.00 84.00 88.00 88.00 100.00 100.00
7 1 pc. Oxygen Kit 180.00 180.00 182.00 182.00 110.00 110.00
8 1 pc. Digital Blood Pressure Monitoring 3,600.00 3,600.00 3,800.00 3,800.00 4,000.00 4,000.00
9 1 pc. Portable Nebulizer 2,160.00 2,160.00 2,500.00 2,500.00 4,000.00 4,000.00
10 1 pc. Medical Oxygen complete set 11,000.00 11,000.00 11,500.00 11,500.00 10,000.00 10,000.00
- -
- -
- -

-
-

THIS IS TO CERTIFY that the requirements of R.A. No. 9184 otherwise known Total 18,577.00 Total 19,732.00 Total 20,000.00
as the Government Procurement Reform Act ( Rule XVI - Sec.52 ) had been complied with. WE HEREBY CERTIFY to the correctness and authenticity of the above Abstract
of Bids to the best of our knowledge.

ANTONIO S. GUMELA,EM.D. ADELBERTO G. SAMUYA

BIDS AND AWARDS COMMITTEE: Public School District Supervisor Municipal Civil Registrar
(Requesting Officer) ( Member )

VIGILUS D. CREDO GRACE A. GUMANSING OLIVIA G. EBORDE RENE R. MANAIT

Municipal Engineer Municipal Budget Officer Municipal Treasurer MPDC
(Chairman) ( Vice Chairman ) ( Member ) ( Member )
18,577.00 19,732.00 20,000.00
 INSPECTION & ACCEPTANCE REPORT
Tampilisan,Zamboanga del Norte
LGU
Supplier O.R. No.
PO No. Date Invoice No. Date
Requesitioning Office/Dept. Mun. Agri.

Item No. Unit Description of Supplies Quantity Unit Cost Total

1 reams Bond Paper long 2 185.00 370.00
2 reams Bond Paper 1 190.00 190.00
3 pc. Pilot Pen 1 40.00 40.00
4 pcs. Folder 8 8.00 64.00
5 pcs. fastener 4 1.50 6.00
6 pc. correction tape 1 17.00 17.00

687.00
INSPECTION ACCEPTANCE
Date Received:
Inspected, verified and found OK X Complete
as to quantity and specifications. Partial

ALBERTO L. ACAS
Assessment Clerk II
X
MILLER B. MAGHANOY
CYNTHIA D. ABIL Admin. Aide VI/ GSO Designate
RCO II

LOLITA B. DELLABA LUCITO P. CERNA

Bookeeper II Municipal Agriculturist
(Requesting Officer)
 CERTIFICATE OF PERSONAL CANVASS

I HEREBY CERTIFY that personal canvass was made on the articles/services herein requested and it was found that
offered the lowest price in the locolity which is advantageous in the government.

Article/ Services Requisitioned

DEALERS
Q U AN T I T Y GL Educational Supply KIAM ENTERPRISES
ITEM NO. Articles/Services Req
Qty. Unit Unit Price Total Amount Unit Price Total Amount Unit Price Total Amount
1 2 reams Bond Paper long 185.00 370.00
2 1 reams Bond Paper - -
3 1 pc. Pilot Pen
4 8 pcs. Folder
5 4 pcs. fastener
6 1 pc. correction tape
*****Nothing Follows ********

* Item 1 awarded to GL Educational Supply

* Item 2 to 6 awarded to KIAM ENTERPRISES

TOTAL 370.00 - -

LUCITO P. CERNA SHERRY LOU P. DAPROSA PRAXIDES C. ARCINO

Municipal Agriculturist Municipal Accountant OIC-Municipal Treasurer
 PURCHASE REQUEST

Entity Name: Mun. Agriculture Fund Cluster: General Fund

Office/Section :_________ PR NO.:__________________ Date:_______________
Resoponsibilty Center Code:_____
Stock/Property No. Unit Item Description Quantity Unit Cost Total Cost
reams Bond Paper long 2 185.00 370.00
reams Bond Paper 1 190.00 190.00
pc. Pilot Pen 1 40.00 40.00
pcs. Folder 8 8.00 64.00
pcs. fastener 4 1.50 6.00
pc. correction tape 1 17.00 17.00
-

687.00

Purpose : For Mun. Agriculture use.

Requested by : Approved by:

Signature: __________________________ ____________________________
Printed Name: LUCITO P. CERNA ANGELES R. CARLOTO II
Designation: Municipal Agriculturist Municipal Mayor