PURCHASE REQUEST

TOLOSA NATIONAL HIGH SCHOOL

BRGY. MALBOG, TOLOSA, LEYTE
SCHOOL ID: 303440

DEPARTMENT TOLOSA NATIONAL HIGH SCHOOL PR NO.

SECTION ALS-EST SAI NO.
DATE ALOBS NO.

UNIT OF ESTIMATED UNIT ESTIMATED

QUANTITY ITEM DESCRIPTION STOCK NO.
ISSUE COST COST
3 pcs Burn/Trymicin Ointment Antibacterial, 10 grams - 256.00 768.00
2 gal Alcohol - 214.56 429.12
3 rolls Elastic Bandage 4x5 yards - 82.00 246.00
1 bttles Eye Wash Solution, 250 ml - 238.50 238.50
1 bttles Hydrogene Peroxide 10V 3% Solution, 120 ml - 25.00 25.00
1 pcs Povidone Iodine 60ml - 93.00 93.00
2 pcs Cotton Balls, 300 pcs - 110.00 220.00
1 pcs Cotton Buds 200s - 101.00 101.00
3 bttles Spirit of Ammonia (Aromatic) (15 ml) - 30.00 90.00
1 pcs Ice Bag Pain Pack Injury First Aid - 165.00 165.00
3 boxes Band Aid - 40.00 120.00
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - -
TOTAL ESTIMATED COST P 2,495.62
Purpose:

Requested by: Noted Approved by:

Signature:
Printed Name: ______________________________ _____________________________ ___________________________
Designation: School Head
 Republic of the Philippines
Department of Education (DepEd)
Region VIII (Eastern Visayas)
DIVISION OF LEYTE
Gov't Center, Candahug, Palo, Leyte

DISTRICT OF TOLOSA
TOLOSA NATIONAL HIGH SCHOOL
Brgy. Malbog, Tolosa, Leyte

REQUEST FOR QUOTATION

RFQ NO.
DATE

SIR / MADAM:

Please quote your lowest price for the following items enumerated below, taking into consideration the following:

TERMS AND CONDITIONS

1. The approved budget for the purchase is P ______________.

2. Price Quotation should be inclusive of the 5% final VAT and expanded withholding tax (EWT) of 1%.
3. Price Quotation shall be valid within thirty 30 (calendar days from deadline of RFQ.
4. Delivery period is within fifteen (15) calendar days from receipt of Purchase Order.
5. If awarded the contract, processing and payment shall be made after the complete delivery of services / supplies
5. and final acceptance.
6. Refusal to accept an award maybe ground for imposition of administrative sanctions under rule XXII of the Revised
6. IRR of RA 9184.
7. FOB
8. The procurring entity may terminate the contract, in whole or in part at any time for unsatisfactory service.

QUANTITY UNIT ARTICLE & DESCRIPTION UNIT PRICE TOTAL

3 pcs Burn/Trymicin Ointment Antibacterial, 10 grams

2 gal Alcohol
3 rolls Elastic Bandage 4x5 yards
1 bttles Eye Wash Solution, 250 ml
1 bttles Hydrogene Peroxide 10V 3% Solution, 120 ml
1 pcs Povidone Iodine 60ml
2 pcs Cotton Balls, 300 pcs
1 pcs Cotton Buds 200s
3 bttles Spirit of Ammonia (Aromatic) (15 ml)
1 pcs Ice Bag Pain Pack Injury First Aid
3 boxes Band Aid
- - -
TOTAL

Date

I have read and understood the terms and conditions stated above. By Admin Head:
signing this quote, I hereby agreed and bind myself to the terms and
conditions. ___________________________
School Head
Signature over Printed Name: __________________________________
Position in Firm: ______________________________________________ Canvassed by:
Business Address: ____________________________________________
Telephone Number: ___________________________________________

Tolosa National High School

Brgy. Malbog, Tolosa, Leyte Three Roads, One Goal.
303440@deped.gov.ph Three Groups, One School.
0926 448 3002
 Republic of the Philippines
Department of Education (DepEd)
Region VIII (Eastern Visayas)
DIVISION OF LEYTE
Gov't Center, Candahug, Palo, Leyte

DISTRICT OF TOLOSA
TOLOSA NATIONAL HIGH SCHOOL
Brgy. Malbog, Tolosa, Leyte

ABSTRACT OF THE PRICES OF CANVASS OPENED ON ________________

Unless otherwise stated all prices appearing below are unit prices
SUPPLIER I SUPPLIER II SUPLLIER III
QUANTITY UNIT ARTICLE & DESCRIPTION ITEM NO.
ADDRESS I ADDRESS II ADDRESS III
Burn/Trymicin Ointment Antibacterial, 10
3 pcs -
grams
2 gal Alcohol -
3 rolls Elastic Bandage 4x5 yards -
1 bttles Eye Wash Solution, 250 ml -
1 bttles Hydrogene Peroxide 10V 3% Solution, 120 ml -
1 pcs Povidone Iodine 60ml -
2 pcs Cotton Balls, 300 pcs -
1 pcs Cotton Buds 200s -
3 bttles Spirit of Ammonia (Aromatic) (15 ml) -
1 pcs Ice Bag Pain Pack Injury First Aid -
3 boxes Band Aid -
- - - -
- - - -

PLACE OF DELIVERY TOLOSA NATIONAL HIGH SCHOOL

DATE OF DELIVERY

WE HEREBY CERTIFY that we actually witness the opening of the attached

REQUEST FOR QUOTATION and that the date shown is true and correct.

RONALYN C. VIÑAS ARNEL B. MALATE MICHAEL L. PERMEJO OLIVER CAYOSA ______________________________

PBAC Chairman BAC Member Member Member End User

APPROVED FOR PURCHASE under the facts here above stated from the 2022 MOOE FUNDS

_________________________________
Property Custodian
________________________________
School Head
 PURCHASE ORDER
TOLOSA NATIONAL HIGH SCHOOL
BRGY. MALBOG, TOLOSA, LEYTE
SCHOOL ID: 303440

Supplier: P.O No.:

Adress: Date: -
Mode of Payment:

Gentlemen:
Please furnish this office the following articles subject to the terms & conditions contained herein.
Place of Delivery: TOLOSA NATIONAL HIGH SCHOOL Delivery Term:
Date of Delivery: Payment Term:

ITEM NO. QUANTITY UNIT DESCRIPTION UNIT COST AMOUNT

TOTAL -
Amount in Words:
In case of failure to make the full delivery within the times specified above, a penalty
of one-tenth (1/10) of one (1) percent for every day of delay shall be imposed.

Conforme: Very Truly Yours,

Supplier School Head

(Signature over printed name)

Date Date
Requisitioning Office/Department: Funds Available:

Amount: -

Property Custodian ALOBS No.:

 Appendix 32
DepEd - TOLOSA NATIONAL HIGH SCHOOL FUND CLUSTER
Entity Name ALS-EST FUND
Date: -
DISBURSEMENT VOUCHER DV No.:
Mode of MDS Check Commercial Check ADA x Others, please specify
Payment
Payee TIN/Employee No.: ORS/BURS No.:

Address
Responsibility MFO/PAP Amount

Payment/Reinbursement for
-
as per supporting documents attached thereto…

Amount Due -

School Head

B. Accounting Entry:
Account Title UACS Code Debit Credit

OTHER SUPPLIES AND MATERIALS EXPENSES 5020399000 - -

C.Certified:
x Cash available
Subject to Authority to Debit Account(when applicable)
Supporting documents complete and amount claimed
proper
Signature Signature
Printed Name Printed Name
Position Position School Head
Date - Date -
E.Receipt of Payment
Check/ADA JEV No.
No.:
Date: Bank Name & Account Number:

Date: Printed Name: Date:

Signature:
- -
Official Receipt No. & Date/Other Documents:
 INSPECTION AND ACCEPTANCE
REPORT
TOLOSA NATIONAL HIGH SCOOL
BRGY. MALBOG, TOLOSA, LEYTE
SCHOOL ID: 303440

Supplier 0 A.R. No.

P.O. No. Invoice No.
Requisitioning Office / ALS-EST Date
Department

ITEM NO. UNIT DESCRIPTION QUANTITY

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 0
0 0 0 0
INSPECTION ACCEPTANCE
Date Inspected: ____________________________________ Date Received: ______________________________________

Inspected, verified and found Complete

OK as to quantity and specifications Partial

Quantity in good order

as to specifications _____________________

Quantity found defective / damaged

Findings:

OLIVER C. CAYOSA
Faculty

MA. RUBY T. LABATA JO-ON RAYMUND L. VILLANUEVA

Faculty Property Custodian
______________________________
Faculty / End User
 PURCHASE ORDER
TOLOSA NATIONAL HIGH SCHOOL
BRGY. MALBOG, TOLOSA, LEYTE
SCHOOL ID: 303440

Supplier: SUPPLIER II P.O No.:

Adress: ADDRESS II Date: -
Mode of Payment:

Gentlemen:
Please furnish this office the following articles subject to the terms & conditions contained herein.
Place of Delivery: TOLOSA NATIONAL HIGH SCHOOL Delivery Term:
Date of Delivery: Payment Term:

ITEM NO. QUANTITY UNIT DESCRIPTION UNIT COST AMOUNT

- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
TOTAL -
Amount in Words:
In case of failure to make the full delivery within the times specified above, a penalty
of one-tenth (1/10) of one (1) percent for every day of delay shall be imposed.

Conforme: Very Truly Yours,

JEANIA MENDOZA-TISTON
Supplier School Head
(Signature over printed name)

Date Date
Requisitioning Office/Department: Funds Available:

Amount: -
JO-ON RAYMUND L. VILLANUEVA MERLE M. HERNANDO
Property Custodian Administrative Assistant II ALOBS No.:
 Appendix 32
DepEd - TOLOSA NATIONAL HIGH SCHOOL FUND CLUSTER
Entity Name MOOE
Date: -
DISBURSEMENT VOUCHER DV No.:
Mode of MDS Check Commercial Check ADA x Others, please specify
Payment
Payee SUPPLIER II TIN/Employee No.: ORS/BURS No.:

Address ADDRESS II
Responsibility MFO/PAP Amount

Payment/Reinbursement for
-
as per supporting documents attached thereto…

Amount Due -

JEANIA MENDOZA-TISTON
School Head

B. Accounting Entry:
Account Title UACS Code Debit Credit

ELECTRICITY EXPENSES 5020102000 - -

C.Certified:
x Cash available
Subject to Authority to Debit Account(when applicable)
Supporting documents complete and amount claimed
proper
Signature Signature
Printed Name MERLE M. HERNANDO Printed Name JEANIA MENDOZA-TISTON
Position Administrative Assistant II Position School Head
Date - Date -
E.Receipt of Payment
Check/ADA JEV No.
No.:
Date: Bank Name & Account Number:

Date: Printed Name: Date:

Signature:
- SUPPLIER II -
Official Receipt No. & Date/Other Documents:
 INSPECTION AND ACCEPTANCE
REPORT
TOLOSA NATIONAL HIGH SCOOL
BRGY. MALBOG, TOLOSA, LEYTE
SCHOOL ID: 303440

Supplier SUPPLIER II A.R. No.

P.O. No. Invoice No.
Requisitioning Office / ALS-EST Date
Department

ITEM NO. UNIT DESCRIPTION QUANTITY

- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
INSPECTION ACCEPTANCE
Date Inspected: ____________________________________ Date Received: ______________________________________

Inspected, verified and found Complete

OK as to quantity and specifications Partial

Quantity in good order

as to specifications _____________________

Quantity found defective / damaged

Findings:

OLIVER C. CAYOSA
Faculty

MA. RUBY T. LABATA JO-ON RAYMUND L. VILLANUEVA

 Faculty Property Custodian

______________________________
Faculty / End User
 PURCHASE ORDER
TOLOSA NATIONAL HIGH SCHOOL
BRGY. MALBOG, TOLOSA, LEYTE
SCHOOL ID: 303440

Supplier: SUPLLIER III P.O No.:

Adress: ADDRESS III Date: -
Mode of Payment:

Gentlemen:
Please furnish this office the following articles subject to the terms & conditions contained herein.
Place of Delivery: TOLOSA NATIONAL HIGH SCHOOL Delivery Term:
Date of Delivery: Payment Term:

ITEM NO. QUANTITY UNIT DESCRIPTION UNIT COST AMOUNT

- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
TOTAL -
Amount in Words:
In case of failure to make the full delivery within the times specified above, a penalty
of one-tenth (1/10) of one (1) percent for every day of delay shall be imposed.

Conforme: Very Truly Yours,

JEANIA MENDOZA-TISTON
Supplier School Head
(Signature over printed name)

Date Date
Requisitioning Office/Department: Funds Available:

Amount: -
JO-ON RAYMUND L. VILLANUEVA MERLE M. HERNANDO
Property Custodian Administrative Assistant II ALOBS No.:
 Appendix 32
DepEd - TOLOSA NATIONAL HIGH SCHOOL FUND CLUSTER
Entity Name MOOE
Date: -
DISBURSEMENT VOUCHER DV No.:
Mode of MDS Check Commercial Check ADA x Others, please specify
Payment
Payee SUPLLIER III TIN/Employee No.: ORS/BURS No.:

Address ADDRESS III

Responsibility MFO/PAP Amount

Payment/Reinbursement for
-
as per supporting documents attached thereto…

Amount Due -

JEANIA MENDOZA-TISTON
School Head

B. Accounting Entry:
Account Title UACS Code Debit Credit

DRUG AND MEDICINE EXPENSES 5020307000 - -

C.Certified:
x Cash available
Subject to Authority to Debit Account(when applicable)
Supporting documents complete and amount claimed
proper
Signature Signature
Printed Name MERLE M. HERNANDO Printed Name JEANIA MENDOZA-TISTON
Position Administrative Assistant II Position School Head
Date - Date -
E.Receipt of Payment
Check/ADA JEV No.
No.:
Date: Bank Name & Account Number:

Date: Printed Name: Date:

Signature:
- SUPLLIER III -
Official Receipt No. & Date/Other Documents:
 INSPECTION AND ACCEPTANCE
REPORT
TOLOSA NATIONAL HIGH SCOOL
BRGY. MALBOG, TOLOSA, LEYTE
SCHOOL ID: 303440

Supplier SUPLLIER III A.R. No.

P.O. No. Invoice No.
Requisitioning Office / ALS-EST Date
Department

ITEM NO. UNIT DESCRIPTION QUANTITY

- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
INSPECTION ACCEPTANCE
Date Inspected: ____________________________________ Date Received: ______________________________________

Inspected, verified and found Complete

OK as to quantity and specifications Partial

Quantity in good order

as to specifications _____________________

Quantity found defective / damaged

Findings:

OLIVER C. CAYOSA
Faculty

MA. RUBY T. LABATA JO-ON RAYMUND L. VILLANUEVA

 Faculty Property Custodian

______________________________
Faculty / End User
DRUG AND MEDICINE EXPENSES 5020307000
ELECTRICITY EXPENSES 5020102000
EXTRAORDINARY AND MISCELLANEOUS EXPENSES 5021003000
FIDELITY BOND PREMIUMS 5021502000
FUEL, OIL, AND LUBRICANT EXPENSES 5020309000
INTERNET SUBSCRIPTION EXPENSES 5020503000
JANITORIAL SERVICES 5021202000
OFFICE SUPPLIES EXPENSES 5020301000
OTHER MAINTENANCE & OPERATING EXPENSES 5029999000
OTHER SUPPLIES AND MATERIALS EXPENSES 5020399000
POSTAGE AND COURIER SERVICES 5020501000
PRINTING AND PUBLICATION EXPENSES 5029902000
REPAIRS & MAINTENANCE - ICT EQUIPMENT 5021305003
REPAIRS & MAINTENANCE - OFFICE EQUIPMENT 5021305002
REPAIRS & MAINTENANCE - OTHER LAND IMPROVEMENT 5021302099
REPAIRS & MAINTENANCE - SCHOOL BUILDING 5021304002
SECURITY SERVICES 5021203000
TELEPHONE EXPENSES - MOBILE 5020502001
TRAINING EXPENSES 5020201000
TRANSPORTATION & DELIVERY EXPENSES 5029904000
TRAVELLING EXPENSES 5020101000
WATER EXPENSES 5020401000