Abstract Form (Bl-01)

Annex A

Republic of the PhilippinesProvince of Quezon

Lucena City

OBLIGATION REQUESTNo.

Payee GODWIN LADLAD, ET AL.

Office PROVINCIAL ENGINEER'S OFFICE

Address Brgy. Talipan, Pagbilao, Quezon

Particulars F. P. P. Amount

PER DIEM Php 15,000.00Godwin Ladlad - Php 5,440.00Lysander Ladlad - Php 2,300.00Edwin Matienzo - Php 1,920.00Ricardo Gollena - Php 2,620.00Fernando Llaneta - Php 2,720.00

TOTAL Php 15,000.00

TOTAL Php 15,000.00A. Certified B. Certified

Charges to appropriation/allotment necessary, lawful Existence of available appropriationand under my direct supervision

Supporting documents valid, proper and legal

Signature Signature

Printed Name CESARIO T. PALAYAN Printed Name GODOFREDO E. MATIENZO

PositionProvincial Engineer

PositionProvincial Budget Officer

Head, Requesting Office/Authorized Representative Head, Budget Unit/Autorized Representative

Responsibility Center

Account Code

Date Date

Standard Form No: SF-GOOD-58Revised on: May 24, 2004

PURCHASE ORDERProvince of Quezon

LGU

SUPPLIER : MAVIL PETRON SERVICE CENTER P.O. NO. :Address : Diversion Road, Silangang Mayao, Lucena City DATE :E-Mail Address :Telephone No. : PR No./s :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 :

Unit. Qty. Description Unit Cost Total Cost

PR. NO. March 17-21, 2008

Liters 60 Diesel P 38.69 P 2, 321.40Liter 1 Brake Fluid 277.00 277.00Pail 1 Oil #10 1, 879.00 1, 879.00

March 22-28, 2008

Liters 444 Diesel 39.19 16, 851.70Liters 14 XCS Gasoline 46.96 657.44

March 29-Aapril 7, 2008

Liters 315 Diesel 39.69 12, 281.70April 8, 2008

Liters 430 Diesel 40.19 17, 281.70Pc 1 Brake Fluid (250 ml) 88.00 88.00

XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX

Fifty one thousand eight hundred fifty eight pesos & fifty nine centavos only P P 51, 858.59(Total Amount in Words)

Approved:

RAFAEL P. NANTESConforme: Governor

MONICO VILLANUEVA(Signature over Printed Name)

(Date)

Obligation of Allotment : Funds Available

EVANGELINA M. ONG FELIX L. HABITOProvincial Accountant Provincial Treasurer

Amount : _______________Allotment No.: ___________

Mode of Procurement:

Stock No.

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.


PURCHASE REQUEST

PROVINCIAL GOVERNMENT OF QUEZONAgency / Procuring Entity

Department Provincial General Services Office PR No Date:Section SAI No Date:

Stock No. Unit Item Description QTY. Unit Cost Total Cost

rms Copy Paper Short 100 275.00 27,500.00

rms Copy Paper Long 100 285.00 28,500.00

bxs Ballpen Blue 2 275.00 550.00

pcs Folders Long 300 4.50 1,350.00

ink Cartridge Ink for HP 21 3 1,200.00 3,600.00






ink Cartridge Ink for HP 15A 1 3,950.00 3,950.00

packs Laid Board Short 30 38.00 1,140.00

box Pentel Pen 1 540.00 540.00

pcs Record Book 5 65.00 325.00

bxs Sign Pen / High Tech Pen 1.5 3 260.00 780.00

tube Toner - Xerox Machine 2 4,500.00 9,000.00

xxxxxxxxxxxxxx 108,185.00

P 108,185.00

Purpose / Remarks: For use in the office of the Provincial General Services

Requested by: Approved by:

Signature:

Printed Name: MERCEDES O. PORNELA RAFAEL P. NANTES

Designation Executive Assistant III / Acting APGDH - PGSO Provincial Governor

Date:

Standard Form Title: Purchase Request


PURCHASE REQUEST


Department Janitorial Services - PGSO PR No Date:Section SAI No Date:


bot Air fresherner 12 245.00 2,940.00

bot Alcohol 12 68.00 816.00

bot Cleanser, big 15 45.00 675.00

bot Dish Washing Liquid, Joy 15 68.00 1,020.00

cans Disinfectant Spray, Baygon 15 275.00 4,125.00

cans Insecticide 12 285.00 3,420.00

kilo Powder Soap 6 165.00 990.00

gal Muriatic Acid 10 145.00 1,450.00

pcs Toilet Deodorant 15 43.00 645.00

packs Tissue Paper , 2 ply Joy 12 180.00 2,160.00

pcs Trash Bag 200 7.00 1,400.00

pcs Brown Tambo 12 95.00 1,140.00

pcs Brown Tingting 50 18.00 900.00

pcs Dust Pan 12 65.00 780.00

pcs Mop Handle - Screw Type 10 275.00 2,750.00

pcs Mop Head - all cotton 20 55.00 1,100.00

pcs Plastic Pail 10 85.00 850.00

pcs Rag 15 45.00 675.00

pcs Scouring Pad 12 65.00 780.00

doz Soap 2 420.00 840.00

pcs Tabo 10 20.00 200.00

pcs Toilet Bowl Brush 14 35.00 490.00

pcs Door Knob 3 385.00 1,155.00

packet Battery - Size AA 5 37.10 185.50

pcs Padlock 10 120.00 1,200.00


TOTAL P 32,686.50

Purpose / Remarks: FOR USE IN THE OFFICE OF THE PROVINCIAL GENERAL SERVICES

Requested by: Approved by:

Signature:Printed Name: MERCEDES O. PORNELA RAFAEL P. NANTESDesignation Executive Assistant III / Acting APGDH - PGSO Provincial GovernorDate:



PURCHASE REQUEST


Department PROVINCIAL GENERAL SERVICES OFFICE PR No Date:Section SAI No Date:


bot Air freshener 12 245.00 2,940.00

bot Alcohol 12 68.00 816.00

bot Cleanser, big 15 45.00 675.00

bot Dish Washing Liquid, Joy 15 68.00 1,020.00

cans Disinfectant Spray, Baygon 15 275.00 4,125.00

cans Insecticide 12 285.00 3,420.00

kilo Powder Soap 6 165.00 990.00

gal Muriatic Acid 10 145.00 1,450.00

pcs Toilet Deodorant 15 43.00 645.00

packs Tissue Paper , 2 ply Joy 12 180.00 2,160.00

pcs Trash Bag 200 7.00 1,400.00

pcs Broom Tambo 12 95.00 1,140.00

pcs Broom Tingting 50 18.00 900.00

pcs Dust Pan 12 65.00 780.00

pcs Mop Handle - Screw Type 10 275.00 2,750.00

pcs Mop Head - all cotton 20 55.00 1,100.00

pcs Plastic Pail 10 85.00 850.00

pcs Rag 15 45.00 675.00

pcs Scouring Pad 12 65.00 780.00

doz Soap 2 420.00 840.00

pcs Dipper 10 20.00 200.00

pcs Toilet Bowl Brush 14 35.00 490.00

pcs Door Knob 3 385.00 1,155.00

packs Battery - Size AA 5 37.10 185.50

pcs Padlock - Heavy Duty 10 120.00 1,200.00


TOTAL P 32,686.50

Purpose / Remarks: FOR USE IN THE OFFICE OF THE PROVINCIAL GENERAL SERVICES

Requested by: Approved by:Signature:Printed Name: MERCEDES O. PORNELA RAFAEL P. NANTES

Designation Executive Assistant III / Acting APGDH - PGSO Provincial GovernorDate:



PURCHASE REQUEST

Agency / Procuring Entity

Department Provincial Engineer's Office PR No Date:Section SAI No Date:


March 17-21, 2008

Liters Diesel 60 P 38.69 P 2, 321.40

Liter Brake Fluid 1 277.00 277.00

Pail Oil #10 1 1,879.00 1,879.00

March 22-28, 2008Liters Diesel 444 39.19 16,851.70

Liters XCS Gasoline 14 46.96 657.44

March 29-Aapril 7, 2008Liters Diesel 315 39.69 12,502.35

April 8, 2008Liters Diesel 430 40.19 17,281.70

Pc Brake Fluid (250 ml) 1 88.00 88.00

XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX

TOTAL P 51, 858.59

Purpose / Remarks: For use in Equipment Pool Operations & Management Services

Requested by: Approved by:Signature:

Printed Name: RAFAEL P. NANTES RAFAEL P. NANTES

Designation Provincial Governor Provincial Governor

Date:



PURCHASE REQUEST

Provincial Government of QuezonAgency / Procuring Entity



pcs. Philippine Flag 7' x 13' 8 3,800.00 30,400.00x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-

TOTAL P 30,400.00

Purpose / Remarks: FOR USE AT PEREZ PARK

Requested by: Approved by:Signature:Printed Name: RAFAEL P. NANTES

Designation Provincial Governor

Date:


MERCEDES O. PORNELA Executive Assistant III

Acting APGDH-PGSO


PURCHASE REQUEST

Agency / Procuring Entity



11/5/2007 ltrs. Petron Diesel ### 1,000.0011/9/2007 ltrs. Shell Diesel 51.54 1,878.63

11/14/2007 ltrs. Shell Diesoline 40.11 1,492.1011/16/2007 Body Wash, Vacuum 100.0011/19/2007 ltrs. Shell Diesel ### 1,667.0511/21/2007 Body Wash 50.00

Vacuum 50.00Setting 120.00Carpet Shampoo 120.00Wax 100.00

11/23-24/07 ltrs. Petron Diesel ### 1,500.0011/27/2007 ltrs. Shell Diesoline ### 1,322.4611/29/2007 ltrs. Petron Diesel ### 1,869.30

Parking & Toll Fees 772.00x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-

TOTAL P 12,041.54

Purpose / Remarks: FOR USE OF SFN-303 ASSIGNED TO THE PROVINCIAL GENERAL SERVICES OFFICER.

Requested by: Approved by:Signature:Printed Name: EXALTACION Q. ANGELES RAFAEL P. NANTES


Designation Provincial General Services Officer Provincial GovernorDate:

ACCEPTANCE & INSPECTION REPORTProvincial Government of Quezon

LGU

Supplier A / R No.PO No. Date Invoice No. DateRequisitioning Office/Dept.

Item No. Unit Description QuantityMarch 17-21, 2008

Liters Diesel 60Liter Brake Fluid 1Pail Oil #10 1

March 22-28, 2008Liters Diesel 444Liters XCS Gasoline 14

March 29-Aapril 7, 2008Liters Diesel 315

April 8, 2008Liters Diesel 430

Pc Brake Fluid (250 ml) 1XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX

Date Received: Date Inspected:

XXXXXXXX Complete

Partial

Inspection Office/Committee

Asst. Provincial Engineer - EPOMS INSPECTED & VERIFIED BY:OIC

CESARIO T. PALAYAN EVANGELINA M. ONGHead of Office PAO Representative Provincial Accountant

Noted:ICU Representative

MERCEDES O. PORNELAC FELIX L. HABITO

Acting APGDH-PGSO PTO Representative Provincial Treasurer

Inspected, verified and found OK As to quantity and specifications

REO-AMBROSIO MAAÑO III

ANNEX G-7


LGU

Supplier Gino's Marketing A / R No.

PO No. Date Invoice No. Date

Requisitioning Office/Dept. MMDH-LOPEZ

Item No. Unit Description Quantityvials Urine Strips, 10SG 15

boxes Capillary tube heparinized 10 vials/box, chase brand, red top, 8Germany

kit Creatinine, 4 x 50ml., Biochemistry 1vials Blood typing Sera, Anti- A, 1 x 10ml. Diaclon 4vials Blood typing Sera, Anti- B, 1 x 10ml. Diaclon 4

boxes X-ray Film, 11 x 14, 100's Konica 4boxes X-ray Film, 14 x 17, 100's Konica 2box X-ray Fixer, Manual 5 US Gal., Konica 1box X-ray Developer, Manual 5 US Gal. Konica 1

xxxxxxxxxxxxxxxxxxxxxx

A C C E P T A N C E I N S P E C T I O N


Complete

Partial


Property/Supply Officer INSPECTED & VERIFIED BY:

Emma B. Serdon, MD., MPH.,FPCHA EVANGELINA M. ONGHead of Office PAO Representative Provincial Accountant


MERCEDES O. PORNELA

Executive Assistant III FELIX L. HABITO

Acting APGDH-PGSO PTO Representative Provincial Treasurer


ANNEX G-7


LGU

Supplier Gino's Marketing A / R No.PO No. Date Invoice No. DateRequisitioning Office/Dept. IPHO - QMC

Item No. Unit Description Quantitypcs Toner Copier Model KM -2030, 450g 8

xxxxxxxxxxx

A C C E P T A N C E I N S P E C T I O N


Complete

Partial


Property/Supply Officer INSPECTED & VERIFIED BY:

MERCEDES O. PORNELA EVANGELINA M. ONGHead of Office PAO Representative Provincial Accountant


MERCEDES O. PORNELA

Executive Assistant III FELIX L. HABITOActing APGDH-PGSO PTO Representative Provincial Treasurer


Republic of the Philippines

PROVINCIAL GOVERNMENT OF QUEZONLucena city

Request for Quotation

Date:____________

Name of Dealers/Suppliers/Distributor

Business Address

Sir/Madam:

Please quote your lowest government price, taxes included on the following items listed hereunder:

Very truly yours,

ROWELL Q. RADOVANExecutive Assistant/Acting PGSO

End-User of PMO: (PEO/EPOMS)

Approved Budget Contract : P 11,300.00

ITEM NO. QTY. UNIT ITEM DESCRIPTION UNIT COST

1 -1 roll. Roll Steel Tube 3/8 Soft2 -4 pcs. Connector APS3 -1 set Tandem Drive Chain Connector

X-X-X-X-X-X-X-X-X-X-X-X-X-

PROCESSED BY:

Printed Name/Signature

Tel. No./Cellphone No./e-mail address

Date

Quotation No.____________

Name of Program/Project/Activity: Spare Parts for the repair of Motor Grader, MG-09.


PROVINCE OF QUEZONCity of Lucena

PROVINCIAL GENERAL SERVICES OFFICE

Date

Sir/Madam:

Very truly yours,

EXALTACION Q. ANGELES

PRICE QUOTATION / PRO-FORMA INVOICE

ITEM NO. QTY. UNIT ITEM DESCRIPTION UNIT COST150 pcs. Firefly 18 watts5 pcs. Plastic Globe 12 inches30 pcs. Monggol Socket Adoptor8 pcs. Mercury Bulb 160 watts12 pcs. Receptacle Socket 2 x 2 porcelain

x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x

CANVASSED BY:

Dealer

Signature



PROVINCE OF QUEZONCity of Lucena

PROVINCIAL GENERAL SERVICES OFFICE

Date

Sir/Madam:

Very truly yours,

MERCEDES O. PORNELA

PRICE QUOTATION / PRO-FORMA INVOICE

ITEM NO. QTY. UNIT ITEM DESCRIPTION UNIT COST4 pcs. Headlight socket1 pc. Flasher relay 24 V Electronics

10 pcs. Fuse 30A plug in type

10 pcs. Fuse 20A Plug in type10 pcs. Fuse 15A plug in type

10 pcs. Fuse 10A plug in type

2 pcs. Starter Relay 24V (JIDECO)

2 pcs. Headlight relay 24V

3 pcs. Dimmer Relay 24V1 roll Wire #10 Class A

3 roll Wire #18 Class A

2 roll Wire #16 Class A

1 roll Wire #14 Class A15 pcs. Electrical Tape

10 pcs. Eye terminal 5/16

30 pcs. Eye terminal 3/16

30 pcs. Utilux Wiring socket Female

2 pcs. Bosch relay w/socket 24V

15 mtrs. Wire #12

3 mtrs. Insulator hose #1

7 mtrs. Insulator hose # 1/2

1 roll Soldering Lead

x-x-x-x-x-x-x-x-x-x-x-x-x-x-x-x--x-x-x-x--x-x-x-x-x-x-x--x-x-x-x-

CANVASSED BY:

Dealer

Signature


Republic of the PhilippinesPROVINCIAL ATTORNEY'S OFFICE

Lucena City

ABSTRACT OF PRICE CANVASSSHOPPING

PROCUREMENT THRU NEGOTIATED CONTRACT UNDER SECTION 52 (b) of REPUBLIC ACT NO. 9184

Date:(Furnishing and delivery) Time: (a.m./p.m.)(Hauling of materials) Opened:(Furnishing others)

(Public Services, etc.)

JOB ORDER:

1 Replace and fabrication of one (1) pc. HydraulicShaft per instruction as per sample.

2 Hydraulic Cylinder dismantle/cutting of hydrauliccap, to give way for fabrication of new cap,welding build up on cylinder treated portion to giveway for re-treading.

3 Two (2) pcs. Hydraulic Shaft allignment.4 Welding and machining for restoration of

Hydraulic Shaft Packing Seal Head Housing.X-X-X-X-X-X-X-X-X-X-X-X-X-X-X-X-X-X-

For use in the repair of Backhoe Loader BL-01,P.E.O.

XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXXX XXX XXX XXX- - - - - - - - - - - - - - - - - - - - - - - - - - P

(1) that the quotation of the amount

indicated in the above abstract is/are considered as the LOWEST best and the most

advantageous to the government and we therefore recommend that he/they be awarded the corresponding

Purchase Order.

CESARIO T. PALAYAN Romulo M. Edaño, Jr.Requisitioning Officer Provincial Administrator

Chairman BAC

QUOTATION FOR

No. of Item

Description of supplies, materials, equipment, services, etc.

Name of Registered Bidders/Contractors or Dealers

AMOUNT OF BOND (if required)

We hereby certify to the correctness of the above abstract of quotations received and opened in the Provincial Governor's Office.

THE UNDERSIGNED BIDS AND AWARDS COMMITTEE (BAC) FIND:

PROVINCIAL GENERAL SERVICES OFFICELucena City

ABSTRACT OF PRICE CANVASSNEGOTIATED PROCUREMENT

PROCUREMENT THRU NEGOTIATED CONTRACT UNDER SECTION 53 (h) of REPUBLIC ACT NO. 9184

(Furnishing and delivery) Date:(Hauling of materials) Time: (a.m./p.m.)(Furnishing others) Opened:(Public Service, etc.)

1 unit ALENAIRE PACKAGED TYPE S#HO200914059General cleaning using chemicals & check-up of motor

Replacement of bearing, machinery works & repair of shafting

1 unit ALENAIRE PACKAGED TYPE S#HO200914037General cleaning using chemicals & check-up of motor

Recharging of Freon gas & repair of valve

Replacement of capacitor 50 MFD


1 unit ALENAIRE PACKAGED TYPE S#HO200914071Replacement of capacitor 50 MFD

General cleaning using chemicals & check-up of motor

Complete rewinding of fan motor

1 unit ALENAIRE PACKAGED TYPE General cleaning using chemicals & check-up of motor


1 unit CARRIER WINDOW TYPE



3 units WINDOW TYPE


1 unit NATIONAL 1.5 HP



1 unit CARRIER 2 HP



Replacement of capacitor 7.5 MFD

AMOUNT OF BOND (if required - - - - - - - - - - - - - - - - - - - - - - - - - - P

(1) that the quotation of the amount



Purchase Order.

EXALTACION Q. ANGELES ARISTEO R. FLORES Requisitioning Officer Provincial Administrator

Chairman BAC

QUOTATION FOR

No. of Item



We hereby certify to the correctness of the above abstract of quotations received and opened in the Provincial General Services Office.


PROVINCIAL GENERAL SERVICES OFFICELucena City

ABSTRACT OF PRICE CANVASSNEGOTIATED PROCUREMENT

PROCUREMENT THRU NEGOTIATED CONTRACT UNDER SECTION 53 (h) of REPUBLIC ACT NO. 9184

Date:Time: (a.m./p.m.)Opened:

150 FOODS MENU: Cheeseburger Softdrinks in Can (Assorted)

xxxxxxxxxxxxxxxxx

AMOUNT OF BOND (if required - - - - - - - - - - - - - - - - - - - - - - - - - - P

(1) that the quotation of POLARIS INDUSTRIAL TRADING CORP. the amount



Purchase Order.

MERCEDES O. PORNELA ARISTEO R. FLORES Executive Assistant III Provincial Administrator

Acting APGDH-PGSO Chairman BAC

QUOTATION FOR

No. of Item



We hereby certify to the correctness of the above abstract of quotations received and opened in the Provincial General Services Office.


Republic of the PhilippinesProvince of Quezon

Lucena City

DISBURSEMENT VOUCHERNo.

Check Cash Others

Payee JAVIMED Pharmaceutical DistributorTIN/Employee No. Obligation Request No.

189-850-810

Address

Responsibility Center Brgy. Bukal Pagbilao Quezon Office/Unit/Project Code

IPHO - QMC

E X P L A N A T I O N AMOUNT

P 618,426.50

TOTAL P 618,426.50A. B. Certified

Allotment obligated for the purpose as indicated above Funds Available

Supporting documents complete

Signature Signature

EVANGELINA M. ONGDate

FELIX L. HABITODate

PositionProvincial Accountant

PositionProvincial Treasurer

Head, Accounting Unit/Authorized Representative Treasurer/Authorized Representative

C. D. Received Payment

Signature Check No.Bank Name Date

RAFAEL P. NANTESDate Signature

Printed Name JAVIMED PHARMECEUTICAL DISTRIBUTOR Date

PositionProvincial Governor OR/Other Documents JEV No. Date

Agency Head/Authorized Representative

JOURNAL ENTRY VOUCHERNo.:

Provincial Government of Quezon Date:

Collection Check Disnursement Cash Disbursement Others

ACCOUNTING ENTRIES

Accounts and Explanation Account Code Ref

Amount

Debit Credit

Prepared by: Approved by:

EVANGELINA M. ONGProvincial Accountant

Mode of Payment

Payment for the purchase of Medicines for use of IPHO - QMC as per supporting papers hereto attached in the total amount of . .

Printed Name

Printed Name

Printed Name

Responsibility

Center