DV NO:

DISBURSEMENT VOUCHER DATE:

BARANGAY : RAJAH SOLIMAN CITY/MUNICIPALITY : BUTUAN CITY
TEL NO : 300-3002 PROVINCE : AGUSAN DEL NORTE
PAYEE/OFFICE : “ASUNCION C. PALAD” EMPLOYEE NO. FUND:
ADDRESS :BUTUAN CITY TIN NO.

PARTICULAR AMOUNT

To cash advanced for the expenses on Nutrition month

activity 2020 , as per supporting papers hereto attached the amount
of………………………….. P3,440.00

A. Certified: B. Certified: C. Certified:

Existence Of Available Appropriations Funds ( Cash ) Available As To Validity, Propriety, And Legality Of
for the charges/expenses indicated Claim
above. Approved For Payment

ALITA B. ATILLO ASUNCION C. PALAD EDDIE RICHARD R. LAGNADA

Chair, Comm. On Appro. Barangay Treasurer Punong Barangay
Date: Date: Date:
D. Accounting Entries
Account Account code Debit Credit

Received Payment:

“ ASUNCION C. PALAD ” Check No. _________________ Date ;__________________

Signature Over Printed Name Bank Name : LBP
Date:_____________
 PURCHASE ORDER
BARANGAY: RAJAH SOLIMAN CITY/MUNICIPALITY: BUTUAN CITY
PROVINCE : AGUSAN DEL NORTE
SUPPLIER: SKYLAR 528 STORE/KRIZZIA MAY E. YBANES PO NO:____________
ADDRESS: BUTUAN CITY DATE:_____________
MODE OF PROCUREMENT:
____ BIDDING _______ NEGOTIATED
_____OVER THE COUNTER
Gentlemen: Please Furnish This Office The Following Articles Subject To The Terms And Conditions Herein:
Place Of Delivery: Barangay 4- Rajah Soliman
Date Of Delivery:
Quantity Unit Particulars Unit Cost Amount
40 PCS. EGG 8.00 640.00
40 PCS. MILK 9.00 360.00
40 PCS. NOODLES 7.00 280.00
1 PCK CELLOPHANE 30.00 30.00
40 KLS. RICE 40.00 2,000.00
1 PC. TARPAULINE 100.00 100.00

Total Estimated Amount. THREE THOUSAND FIVE HUNDRED FORTY 3,540.00

Purpose; FEEDING FOR NUTRITION MONTH.
IN CASE OF FAILURE TO MAKE THE FULL DELIVERY WITHIN THE TIME SPECIFIED ABOVE, A PENALTY 1730 OF THE TENTH (1/10)
OF ONE PERCENT FOR EVERYDAY OF DELAY SHALL BE IMPOSED
Approved By:

HON. EDDIE RICHARD R. LAGNADA

Punong Barangay
Existence of Appropriations and Funds Available:
Conformed:

HON. ALITA B. ATILLO

Comm. On Appropriations
Date:
 INSPECTION AND ACCEPTANCE REPORT
BARANGAY : BARANGAY 4- RAJAH SOLIMAN CITY/MUNICIPALITY : BUTUAN CITY
TELEPHONE NO. : PROVINCE: AGUSAN DEL NORTE
SUPPLIER:SUNGOLD INVOICE NO. : IAR NO. : DATE :
COMMERCIAL INVOICE DATE : RIS DATE :
PO NO. :
DATE:
UNIT DESCRIPTION QUANTITY
PCS. EGG
PCS. MILK
PCS. NOODLES
1 CELLOPHANE
KLS RICE
1 TARPUALINE
DATE INSPECTED : Date Receive:
Inspected, verified and found ok as to
quantity and specifications -----------Complete
______Partial (Pls. specify
quantity received.
INSPECTION COMMITTEE

ANNIE S. CALO MYRNA A. VILLANUEVA JULIETA P. EDNILAN ASUNCION C. PALAD

Inspector Inspector Inspector Barangay Treasurer
 REPUBLIC OF THE PHILIPPINES
BIDS AND AWARDS COMMITTEE
BARANGAY 4- RAJAH SOLIMAN
CITY OF BUTUAN

CERTIFICATE OF CANVASS

This Is To Certify That I Have Received From The Canvasser Of Brgy________, A Copy Of Shopping
Bidding Under P.R No. _____________Dated:_____________.

NAME OD BIDDER/STORE BIDDERS SIGNATURE DATE RECEIVED

I/We Certify That I/We Delivered Personally a Copy of Shopping/Bidding Date____________

To Above Stated Dealers Per P.R. No.____________Dated:______________.

DATE OF OPENING:_____________
TIME OF OPENING:_____________

ASUNCION C. PALAD
Brgy. Treas.
PRINTED NAME & SIGNATURE OF CANVASSER
 REPUBLIC OF THE PHILIPPINES
BARANGAY 4- RAJAH SOLIMAN
CITY OF BUTUAN

BIDS AND AWARDS COMMITTEE

BILL OF QUANTITIES
PROCUREMENT TITLE: _____________
P.R NO.__________________________ DATED:_______________
PROCURING OFFICE: BARANGAY 4- RAJAH SOLIMAN
PURPOSE:

ITEM NO. PARTICULAR QUANTITY UNIT OF UNIT COST TOTAL

MEASURE AMOUNT

TOTAL………………………..

I HEREBY CERTIFY THAT THE ABOVE QUOTED PRICE OF EACHARTICLE IS TRUE AND CORRECT AND I BIND MYSELF TO
DO THE SAME TO THE BARANGAY 4- RAJAH SOLIMAN UPON REQUEST OF THE NOTICE OF SAID PURCHASE ORDER.

SUBMITTED BY:

__________________________________________
SUPPLIER/CONTRACTOR PRINT NAME &
SIGNATURE

NOTE: THIS PRI-PORMA FORMS PART OF THE PAID TENDER DOCUMENTS AND WILL BE MADE AS ONE OF THE BASIS
FOR CLARIFICATIONS FROM THE ENTERESTED BIDDERS/SUPPLIERS, AND EVENTUALLY THE MODEFICATION OF THE
STATEMENTS/PROVISIONS IN THE INVITATIONS TO BID
 REPUBLIC OF THE PHILIPPINES
OFFICE OF THE PUNONG BARANGAY
BARANGAY 4- RAJAH SOLIMAN
BUTUAN CITY

DATE:
The City Auditor
COMMISSION ON AUDIT
Butuan City

SIR,

May I have the honor to notify your good office that there is a delivery made on
____________at barangay 4- Rajah Soliman relative to p.r.no._____,dated,_________ under p.o._____________
no.______,dated,________,which particularly describe as follows:

ITEM NO. QUANTITY UNIT PARTICULARS UNIT COST AMOUNT

Bdft. 106.67 8 pcs. 4”x4 x 10’-Lawaan/Equi.(additional post) 45.00 4,800.15

(Total Amount In Words) Eleven Thousand Five Pesos and 95/100.

FOR YOUR INFORMATION AND REFERENCE.

Respectfully Yours,

HON. EDDIE RICHARD R. LAGNADA

Punong Barangay
 PURCHASE REQUEST
BARANGAY 4- RAJAH SOLIMAN P.R. NO. :2020
CITY/MUNICIPALITY: BUTUAN CITY DATE: June 17, 2020
REQUISITION
ITEM QUANTITY UNIT OF ESTIMATED ESTIMATED
NO. MEASURE ITEM DESCRIPTION COST AMOUNT
1. Pcs. EGG 8.00 640.00
2. Sachet MILK 360.00
3. Pcs. NOODLES 280.00
4. Pck. CELLOPHANE 30.00
5. Kls. RICE 2,000.00
6. 1 TARPAULINE 100.00
TOTAL ESTIMATED AMOUNT: 3,540.00
PURPOSE: NUTRITION MONTH

REQUESTED BY: APPROVED:

ANNIE S. CALO HON. EDDIE RICHARD R. LAGNADA

Signature Over Printed Name Signature Over Printed Name
Requisitioned Punong Barangay
DATE:
DATE: _______________________
 REQUISITON AND ISSUE SLIP
BARANGAY: CITY/MUNICIPALITY; BUTUAN CITY RIS NO. :__________
4- RAJAH SOLIMAN PROVINCE: AGUSAN DEL NORTE DATE:
REQUISITION ISSUANCE
ITEM NO. PARTICULAR QUANTITY UNIT REMARKS

PURPOSE: used for Brgy. Office.

REQUEST BY: APPROVED FOR ISSUANCE: RECEIVED BY: ISSUED BY:

SIGNATURE ANNIE S. CALO HON. EDDIE RICHARD R. LAGNADA MYRNA A. VILLANUEVA ASUNCION C. PALAD
OVER REQUESTOR PUNONG BARANGAY RECIPIENT TREASURER
PRINTED
NAME