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Republic of the PhilippinesDepartment of Education

Caraga Administrative RegionDIVISION OF SURIGAO DEL SUR

T a n d a g

MANA PRINTING 5/30/2015MANGAGOY, BISLIG CITY ,Surigao del Sur Date

Sir/Madam:

Please quote your price of item/articles listed below:

ITEM No.QUANTITY UNIT SUPPLIES/MATERIALS/ITEMS UNIT PRICE

1 1 PC TARPAULIN 2X3 K-12 READY 260.00

Sealed price quotations on the items/articles named above will be received in this Office, Supply Secton until 11:00 A.M. ______________________ at which time and place price quotation sealed envelope will be opened.

Very truly yours,

CHANIELOU J. MARTINEZ SCHOOL HEAD

Sir/Madam:

Our prices are quoted opposite every items above. ________________________ Signature of Dealer

PURCHASE REQUESTDepartment of Education

Agency

Department: Department of Education PR No.: Date:Section: SAI No.: Date:

Stock No. Unit Item Description QuantityUnit

Total CostCost

1 PC TARPAULIN 2X3 K-12 READY 1 240.00 240.00

0 0 0 -

0 0 0 -

0 0 0 -

0 0 0 -

0 0 0 -

0 0 0 -

0 0 0 -

0 0 0 -

0 0 0 -

0 0 0 -

0 0 0 -

0 0 0 -

0 0 0 -

0 0 0 -

0 0 0 -

0 0 0 -

0 0 0 -

0 0 0 -

0 0 0 -

0 0 0 -

0 0 0 -

0 0 0 -

0 0 0 -

0 0 0 -

0 0 0 -

P 240.00

Purpose: FOR SCHOOL TARPAULIN ON K-12 READY

Requested by: Approved by:Signature :

Printed Name : CHANIELOU J. MARTINEZ ELIZABETH N. GARDONES, Ph. D.

Designation : School Principal/Head Public Schools District Supervisor

Annex G-5

PURCHASE ORDERDepED - Surigao del Sur Division

Balilahan, Mabua, Tandag City, Surigao del Sur

Supplier PHOTO PLUS LAB & STUDIO P.O. No.

Address SAN. FRANCISCO, AGUSAN SDS Date :

TIN: Mode of Procurement :

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 Quantity Unit Cost AMOUNT1 PC TARPAULIN 2X3 ON K-12 READY 1 240.00 240.00

0 0 00 0 00 0 00 0 00 0 00 0 00 0 00 0 00 0 00 0 00 0 00 0 00 0 00 0 00 0 00 0 00 0 00 0 00 0 00 0 00 0 00 0 0

(Total Amount in words) 240.00

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 :

CHANIELOU J. MARTINEZPHOTO PLUS LAB & STUDIO Schools Division Superintendent

(Signature over printed name)

(Date)

Funds Available : Amount :

ALOBS No. :

MELVYN C. RULETE, CPAAccountant II

B7

Jay G. Loren: ADR

Annex G-7

INSPECTION & ACCEPTANCE REPORTDEPARTMENT OF EDUCATION

(Agency)

Supplier: IAR No.:

PO No. Date: DR No. Date:

Stock No. Unit Description QuantityTARPAULIN 2X3 ON K-12 READY000000000000000000000

INSPECTION ACCEPTANCE

Date Inspected : Date Received :

Inspected, verified and found OK Completeas to quantity and specifications Partial

_____________

____________ _______________Inspectorate Committee Property Custodian

X

Page 5

Republic of the PhilippinesDEPARTMENT OF EDUCATION

Caraga Administrative RegionDivision of Surigao del Sur

Tandag

Agency or Office

ABSTRACT OF SEALED QUOTATIONSItem

Qty. Unit P A R T I C U L A R SNAMES OF DEALERS OR SUPPLIERS:

No. PHOTO PLUS AFFORDALE ENT. MANA PRINTINGUnit Price Total Unit Price Total Unit Price Total

1 PC TARPAULIN 2X3 ON K-12 READY 240.00 240.00 250.00 250.00 260.00 260.00 0 0 0 - - - - 0 0 0 - - - - 0 0 0 - - - - 0 0 0 - - - - 0 0 0 - - - - 0 0 0 - - - - 0 0 0 - - - - 0 0 0 - - - - 0 0 0 - - - - 0 0 0 - - - - 0 0 0 - - - - 0 0 0 - - - - 0 0 0 - - - -

WE HEREBY CERTIFY that the prices appearing hereon are to the best of our CERTIFIED CORRECT:knowledge reasonable being the lowest obtainable in the locality at the time of _________________purchase. Rep. of the Auditor

RUBI ANN E. OLVIDAMEMBERS PRICE VERIFICATION COMMITTEE: CHANIELOU J. MARTINEZ SCHOOL PROPERTY CUSTODIAN

BAC CHAIRMAN _________________APPROVED: COA Auditor

ELIZABETH N. GARDONES, Ph. D. Co-CHAIRMAN BAC MEMBER BAC MEMBER Public Schools District Supervisor

DEPARTMENT OF EDUCATION - SURIGAO DEL SUR

SARAH JEAN D. BALABA ROGITA A. CERVANTES ZENAIDA S. LINDO

ACKNOWLEDGEMENT RECEIPT FOR EQUIPMENT

Number : ____________


Caraga Administrative RegionDivision of Surigao del Sur

T a n d a g

Item Unit Quantity Description Property Unit TotalNo. No. Cost Cost

1.

TOTAL -

Received by: Received From:

Signature Over Printed Name Signature Over Printed Name

Position/Office Position

Date Date

Annex G-9

REQUISITION AND ISSUE SLIPDepartment of Education

(Agency)

Division Surigao del Sur Responsibility Center RIS No.

Office DEPED Code ___________________________ SAI No. 5/30/2015

R e q u i s i t i o n I s s u a n c e

Stock No.Unit of

Item No. Quantity QuantityRemarks

Issue1 PC TARPAULIN PRINTING FOR " K-12 READY 1

2X3

Purpose : FOR SCHOOL TARPAULIN ON K-12 READINESS

Requested by: Approved by : Issued by : Received by:SignaturePrinted Name CHANIELOU J. MARTINEZ ELIZABETH N. GARDONES, Ph. D. RUBI ANN E. OLVIDA CHANIELOU J. MARTINEZDesignation School Principal/Head Public Sch. District Supervisor Property Custodian SCHOOL HEAD

Date

Gen Form N. 61-A

REPORT OF WASTE MATERIALS

Name of Local Government Unit:

Department/Office: Department of Education - SEDIPPlace of Storage: DepED Storeroom Date: October 16, 2009

ItemQty.

Unit of Unit TotalDescription

Record of SalesNo. Issue Cost Cost O.R. No. Amount

1. 1 unit Car Aircon Compressor(SEDIP Strada vehicle - CSV-105)

TOTAL TOTAL

CERTIFIED CORRECT

ANTONIO V. SALAZAR FE C. VALEROSO, CESO VISupply Officer-Designate Schools Division Superintendent

CERTIFICATE OF INSPECTIONThis is to certify that I have this ________ days of ___________________, 2003 inspected the above-listed

supplies/property and found the same to be ( with or without value) ______________________________.

CHERYL C. DIMEState Auditor III

CERTIFICATE OF DISPOSAL

This is to certify that the above listed-supplies/property were disposed of as follows: __________________.

ANTONIO V. SALAZAR FE C. VALEROSO, CESO VISupply Officer-Designate Schools Division Superintendent

Witnessed by:

CHERYL C. DIMEState Auditor III



Tandag

REPORT OF PRE-INSPECTION

DESCRIPTION OF PROPERTY:

Type Brand/Model

Serial/Engine No. Property No.

Acquisition Cost Acquisition Date

Date of Last Repair Nature of Last Repair

COMPLAINTS/DEFECTS

Nature and scope of work to be done

Requested by:

(Date)

PRE-REPAIR:

Findings:

PRE-INSPECTED BY: NOTED BY:

(Date) (Date)

No.______________

JOB ORDER FOR SERVICING

Republic of the Philippines

DEPARTMENT OF EDUCATION Name of Service Center : ____________________________

Caraga Administrative Region Address : _________________________________________

Division of Surigao del Sur Tel. No.: __________________________________________

Tandag Date received of job order : ___________________________

Quantity : _________________________________________

Items/Accessories : _________________________________

Requesting Officer:_____________________ _________________________________________________

Section Office:_________________________ _________________________________________________

Tel. No.: _____________________________ Serial No. : ________________________________________

Date: ________________________________ Complain : ________________________________________

Service Report : ____________________________________

_________________________________________________

Nature & scope of work to be done: _________________________________________________

____________________________________ Parts : ___________________________________________

____________________________________ _________________________________________________

__________________________________

Parts : P

Labor :

Signature of requesting officer: Tax :

Total : P

______________________________ Released by :

Signature Over Printed Name

Summary:

Appendix 58

LIQUIDATION REPORT No :

Department of Education Date :

Agency Responsibility Center

Code :DATE OR No. PARTICULARS Amount

2/21/2015 1457 Liquidation of cash advance for CRAM-Socialization

Butuan City Division at SDSSU Campus dated Feb.

22, 2015 per supporting documents hereto attached

in the amount of . . . . . . . 20,000.00

TOTAL AMOUNT SPENT 20,000.00

20,000.00

AMOUNT REFUNDED PER OR NO. __________ DTD. _____________ -

AMOUNT TO BE REIMBURSED

[A] Certified : Correctness of the [B] Certified : Purpose of [C] Cetified : Supporting documents

above data cash advance accomplished complete and proper

MARILOU P. AMIGO MARILOU B. DEDUMO, Ph. D., CESO VIMELVYN C. RULETE _________Claimant Schools Division Superintendent Accountant II JEV No.

LIQUIDATION REPORT No :

Department of Education Date : 0Agency Responsibility Center

Code :DATE OR No. PARTICULARS Amount

2/21/2015 1457 Liquidation of cash advance for CRAM-Socialization

Butuan City Division at SDSSU Campus dated Feb.

22, 2015 per supporting documents hereto attached

in the amount of . . . . . . . 20,000.00

TOTAL AMOUNT SPENT 20,000.00

20,000.00

AMOUNT REFUNDED PER OR NO. __________ DTD. _____________ -

AMOUNT TO BE REIMBURSED

[A] Certified : Correctness of the [B] Certified : Purpose of travel/ [C] Cetified : Supporting documents

above data cash advance accomplished complete and proper

MARILOU P. AMIGO MARILOU B. DEDUMO, CESO VI MELVYN C. RULETE _________Claimant Schools Division Superintendent Accountant II JEV No.

AMOUNT OF CASH ADVANCE PER DV NO. ____________ Ch# DTD.

AMOUNT OF CASH ADVANCE PER DV NO. ____________ Ch# DTD.



Third Elementary Education ProjectT a n d a g

REPORT OF DISBURSEMENTSCheck Nos. ___________ and ____________ dated ____________

DATE Payee OR No. Particulars No. of Liters Amount

Prepared by : Certified by :

________________________ ________________________ Implementing School District Supervisor

APPROVED :

Schools Division Superintendent FE C. VALEROSO, CESO VI

PURCHASE REQUESTDepartment of Education

Agency

Department: Department of Education PR No.: Date: 1/18/2011

Section: Medical & Dental SAI No.: Date:

Stock No. Unit Item Description QuantityUnit

Total CostCost

caps Amoxicillin (250mg) 200

caps Amoxicillin (500mg) 200

caps Mefenamic Acid (250mg) 200

caps Mefenamic Acid (500mg) 200

tabs Ibuprofen P. (Alaxan) 50

tabs Paracetamol (Biogesic 500mg) 100

tabs Neozep 200

tabs Loratidine 50

tabs Kremil - S 50

caps Loperamide 50

tabs Hyoscine HCL (Buscopan) 20

tube Bactroban cream 5g 2

bottle Alcohol 500 ml 3

pack gauze 4 x 4 10 77.00

pack gauze 2 x 2 10 28.00

pcs Aplosyn otic drops 4 173.00

tube Gentamicin eye ointment 3 391.50

bottle efficascent (small) 10 25.00

pcs Visine red 2

pcs eye mo 2

bottle omega pain killer 5

Availability of Funds:

MELVYN C. RULETE, CPA

Accountant II

P -

Purpose: To be use at the Medical Section

Requested by: Approved by:Signature :Printed Name : MANTOVANNI C. DUEÑAS, MD GREGORIA T. SU, PhD.Designation : Medical Officer IV Assistant Schools Division Superintendent

Officer-In-Charge

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