Republic of the Philippines

Province of Eastern Samar

MUNICIPALITY OF GIPORLOS

PURCHASE REQUEST

LGU OF GIPORLOS, EASTERN SAMAR

Department: PR NO. Date
Section: SAI NO. Date
ALOBS NO. Date
ESTIMATED ESTIMATED
QTY UNIT DESCRIPTION UNIT COST COST

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-
-
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TOTAL -
Purpose:

Requested by: Approved By:

Signature: Signature:
Printed Name: Printed Name: HON. GILBERT I. GO
Designation: Designation: Municipal Mayor
Name of Procuring Entity: LGU Giporlos, Eastern Samar Project Reference Number:____________
Name of Project: Location of the Project:_______________

Standard Form Number: SF - GOOD-60

Revised on: May 24, 2004
Standard Form Title: REQUEST FOR QOUTATION

_______________________________ Date : ______________________________

___________________________ Quotation No:_______________________

Please quote your lowest price on the item/s listed below, subject to the General Conditions on the
last page, stating the shortest time of delivery and submit your qoutation duly signed by your representative
not later than__________________________________ in the return envelope attached herewith.

Procurement Officer
Note: 1. All deliveries must be typewritten
2. Dellivery period within _________________________ calendar days
3. Warranty shall be for a period of six (6) months foe supplies & materials, one (1) year for equipment,
from date of acceptance by the procuring entity.
4. Price validity shall be for a period of _______________calendar days.
5. Bidders shall submit original brouchures showing certifications of the product being offered.
6. ABC = P ___________

ITEM NO. ITEM AND DESCRIPTION QTY UNIT UNIT PRICE TOTAL PRICE

TOTAL -
After having carefully read and accepted your General Conditions, I/We quote you on the item and prices noted
above.
_________________________
Printed name/Signature
_____________________________
Telephone No./Cellphone No./Email Address
 Republic of the Philippines
Province of Eastern Samar
MUNICIPALITY OF GIPORLOS

INSPECTION AND ACCEPTANCE REPORT

LGU- GIPORLOS, EASTERN SAMAR

Supplier: IAR No. __________________

P.O. No. ______________ Date: ____________ Invoice No. _____ Date: _________

Requisitioning Office: Date:

Dealer:
Quantity Unit DESCRIPTION UNIT COST AMOUNT

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INSPECTION ACCEPTANCE

Date Inspected : ______________ Date Received______________________

Inspected, verified and found Complete

in order as to quantity and specifications. Partial (pls. specify quantity)

ROSEBETH A. COTIN FELIX B. LABUTAP

Inspection Office/Inspection Committee Property Officer/GSO OFFICER
 DISBURSEMENT VOUCHER
MUNICIPALITY OF GIPORLOS, EASTERN SAMAR
PROVINCE OF EASTERN SAMAR

Disbursement Voucher No.

Mode of
Payment X Check Cash Others

Obligation Request No.

Payee
Responsibility Center:
Address Office/Unit/Project

Explanation Amount

A. Certified B Certified
̷̷̷þ Allotment obligated for the purpose as indicated above Funds Available
þ Supporting documents complete

Date Signature Date

Signature

Printed Printed
LEOBEN F. GARADO LUZ A. CABLING
Name Name
Position Municipal Accountant Position Municipal Treasurer
C. Approved Payment D. Received Payment
Date Check No. Bank Name Date
Signature

Printed Signature
HON. GILBERT I. GO
Name Printed Name
Position Municipal Mayor OR/Other DocumentsJEV No. Date:
 ALLOTMENT AND OBLIGATION SLIP No.
(ALOBS) Date:

Payee/Office: Responsibility Center:

Address:

Particulars Allotment P.P.A. Account Amount

Class Code

Certified as to Availabilty Certified as to Obligation Posted to RAO By:

Appropriation/Allotment of Appropriation/Allotment

JEANETTE B. MONTALLANA LEOBEN F. GARADO

Municipal Budget Officer Municipal Accountant In-Charge Date____
 Republic of the Philippines
Province of Eastern Samar
MUNICIPALITY OF GIPORLOS

PURCHASE ORDER

LGU-GIPORLOS, EASTERN SAMAR

Supplier: P.O. No.
Address: Date:
TIN: Mode of Procurement

Gentlemen:
Please furnish this office the following articles subject to the terms and conditions herein:

Place of Delivery: Delivery Term:

Date of Delivery: Payment Term:
Quantity Unit Description Stock No. Unit Cost Amount

-
-
-
Total -
(Total Amount in Words):
In case failure to make the full delivery within the time specified above, a penalty of one-tenth (1-10)
of one percent (1%) for every day of delay shall be imposed.
Very truly yours,

HON. GILBERT I. GO
Conforme: Municipal Mayor
____________________________________
(Signature Over Printed Name of Supplier)
Date:
Funds Available: OR/BUR No. __________________
LEOBEN F. GARADO Amount :
Chief Accountant
 Republic of the Philippines
Province of Eastern Samar
Municipality of Giporlos
BARANGAY 03

RFQ No.
Date:

REQUEST FOR QUOTATION

Sir/ Madam:

Please quote your lowest price on the item/s listed below, subject to the General Conditions on the last page, stating the
shortest time of delivery and submit your quotation duly signed by your representative not later
than__________________________________ in the return envelope attached herewith.

Very truly yours,

Procurement Officer
Note:
1. All deliveries must be typewritten.
2. Dellivery period within ____________ 7
3. Warranty shall be for a period of six (6) months for supplies & materials, one (1) year for
equipment, from date of acceptance by the procuring entity.
Price validity shall be
4. for a period of _______________calendar
1 days.
Bidders shall submit original brouchures
5. showing certifications of the product being offered.
price validity shall be
6. for a period of _______________calendar days.

Item No. Item and Description Qty UNIT Unit Price Total Price

1. MOTHERBOARD 1 PC

2. POWER SUPPLY 1 PC

3. HDD 1 PC

XXXXXXXX

After
having
carefully
read and
accepted
your
General
Conditions
, I/We
XXXX
quote you
on the
item and SUB- TOTAL
prices
noted
above.

Print Name & Signature of Bidder

Telephone No./Cellphone No./Email Address

 Republic of the Philippines
Province of Eastern Samar
Municipality of Giporlos
Barangay No. 03

ABSTRACT OF QUOTATION
RFQ NO. 2024-02-001 Date: 1/2/2024 Requisition No. 001
Note: Unless otherwise stated, all prices appearing hereof are unit price.
Name of Supplier/ Dealer
Quantity Unit Awarded to
MDE

66.28 ltrs. PREMIUM 195.00 205.00 205.00 AWARDED TO

1 PC KICK STARTER 285.00 320.00 400.00 GK MOTOR PARTS

1 PC MAKOTO CLUTCH LINING 650.00 680.00 680.00

1 PC THREE BOND GASKET MAKER 158.00 162.00 160.00

1 PC USA OIL FULLY SYNTHETIC 420.00 420.00 428.00

1 PC KICK STARTER 345.00 345.00 348.00

1 PC SIGNAL LIGHT 47.00 52.00 52.00

1 BTL SLICK OIL 200.00 220.00 220.00

LABOR 550.00 600.00 600.00

***nothing follows***
WE HERBY CERTIFY that the above listed suppliers and / or materials the abstract of which appear hereof at the time and place indicated. We furhter certify the correctness of the foregoing
abstract and that all bids/above submitted are initiated by us.
Approved for award to the lowest bidder/dealer above recommended and indicated by requisitioning officer, subject to the existing requirements of laws, regulations and specific to this
particular transaction subject to the threshold / ABC of not to exceed the amount o of THREE THOUSAND TWO HUNDRED PESOS ONLY

HON. RODRIGO S. DE GUIA HON. DENNIS V. NALAZON HON. GARRY L. DARANG HON. KENTA A. KOGURE
BAC Chairman BAC VICE Chairman BAC Member BAC Member

HON. ANTHONY C. ELECHO HON. LOUFRANCE D. YLARAN HON. ROSELLE Y. INCISO HON. RODRIGO S. DE GUIA
BAC Member BAC Member BAC Member Requisitioning Officer
 Republic of the Philippines
Province of Eastern Samar
Municipality of Giporlos
Barangay 08

PURCHASE REQUEST
Department: __ PAYA PR No. 2024-
Section: ________________________ Date:

Estimated Estimated
Qty Unit Description
Unit Cost Cost

8 reams A4 BOND PAPER 230.00 1840.00

8 reams LONG BOND PAPER 260.00 1,690.00

4 set ink 400.00 1600.00

XXXXXX

SUB-TOTAL ₱5,520.00
Purpose: BARANGAY USE

Requested by: HON. FAUSTINO E. ODRON Approved by:

Signature: Signature:
Printed Name: HON. GLENN C. ELECHO Printed Name: HON. MARIA P. INCISO
Designation: Comm. on Appro. Designation: Barangay Chairperson
 Republic of the Philippines
Province of Eastern Samar
Municipality of Giporlos
Barangay 08

PURCHASE ORDER
Supplier: ALEXIS GRAPHIX AND COMPUTER SATA SYSTEM P.O. No. Date : ________________
Address: BRGY. PAYA, GIPORLOS, E. SAMAR Mode of Procurement
TIN No.: 416-233-889-000 __X_ Bidding ___ Negotiated ___ Over the Counter

Gentlemen:
Please furnish this office the following articles subject to the terms and conditions herein:
Place of Delivery: Brgy. Multi-purpose Hall, Brgy. 03, Giporlos Delivery Term:
Date of Delivery: Payment Term:
Quantity Unit Description Unit Cost Amount

1 PC MOTHERBOARD 5,800.00 5,800.00

1 PC POWER SUPPLY 2,800.00 2,800.00

1 PC HDD 5,140.00 5,140.00

XXXXXXXX

TOTAL P 13,740.00
AMOUNT IN WORDS: THIRTEEN THOUSAND SEVEN HUNDRED FORTY PESOS ONLY
In case of failure to make the full delivery within the time specified above, a penalty of one-tenth (1/10) of
one percent (1%) for every day of delay shall be imposed.

Very truly yours,

HON. MARIA P. INCISO

Barangay Chairperson
Conforme:

ALEXIS CELL A. CONDE

(Signature Over Printed Name of Supplier)
Date:
Funds Available: PHP 14,950.00 Amount: P 14,950.00

HON. GLENN C. ELECHO Date:

Chairman Committee on Appropriations
 INSPECTION AND ACCEPTANCE REPORT
Barangay No. 08
Giporlos, Eastern Samar

Supplier: __ ALEXIS GRAPHIX AND COMPUTER DATA SYSTEM IAR No. ________________________________
P.O. No. o.: Invoice No. 13483552 DATE:

Requesitioning Office: Brgy. 08, Giporlos, E. Samar Date:

Dealer:
Quantity Unit Description Unit Cost Amount

1 PC MOTHERBOARD 5,800.00 5,800.00

1 PC POWER SUPPLY 2,800.00 2,800.00

1 PC HDD 5,140.00 5,140.00

XXXXXXXX

P 13,740.00
INSPECTION ACCEPTANCE

Date Inspect ed Date Received: _______________________

yes Inspected, verified and found in order as to yes Complete

quantity and specifications.
Partial (pls. specify quantity)

HON. FAUSTINO E. ODRON MA. ARMIE C. ECIJA

Inspection Officer/Inspection Committee Property Officer/Brgy. Treasurer