Canvas, Inspection, P.O & P.R.-form, Itenerary

PURCHASE ORDER
Mangatarem, Pangasinan
LGU
Supplier P.O. No. ________________

Address Date: ________________
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:___________
Item No. Unit Quantity Description Unit Cost Amount

1. LOAD 1 FIREWOOD PhP 3,500.00
(Total Amount in Words) THREE THOUSAND FIVE HUNDRED PESOS ONLY 3,500.00
In case of Failure to make the full delivery within the time speciifed above, a penalty of one-tenty (1-10)
of one percent for every day of delay shall be imposed.
Very Truly yours,
Conforme: _________________________ HON. RAMIL P. VENTENILLA

(Authorized Official)
_________________________
(Date)
(In case of Negotiated Purchase pursuant Requisitioning Office/Dept. Funds Available:
to Section 396(a) of RA 7160, this portion
must be accomplished). Amount:
Approved to be purchase thru negotiated
purchase per Sangguniang Res. No.____ R.O. No.
Certified Correct:________________ HON. RAMIL P. VENTENILLA KENAZ W. BAUTISTA

Secretary to the Sanggunian Authorized Official Municipal Accountant
PURCHASE ORDER
LGU
Supplier GNS TIRE & SERVICE CENTER, INC. P.O. No. ________________
Address DAGUPAN CITY Date: ________________
Mode of Procurement
Gentlemen:

1. PCS 2 WHEEL BEARING OUTER 615.00 1,230.00

2. PCS 2 WHEEL BEARING INNER 550.00 1,100.00
3. PC. 1 WHIZ GREASE 320.00 320.00
4. PCS 2 RACK & 555SR 3680 1,300.00 2,600.00
2 WHEEL ALIGNMENT 1,200.00 1,200.00
5. PC. 1 STEERING BOOT TGS KO1 350.00 350.00
LABOR FOR REPLACE RACK
& LH &RH STEERING BOOT
LH WHEEL BEARING FRONT 1,400.00 1,400.00
LH & RH INCLUDING REPACK
WHEEL BEARING INNER
(Total Amount in Words) EIGHT THOUSAND TWO HUNDRED PESOS ONLY 8,200.00
Very Truly yours,

_________________________
(Date)
Certified Correct:________________ HON. RAMIL P. VENTENILLA KENAZ W. BAUTISTA

Secretary to the Sanggunian Authorized Official Municipal Accountant
ANNEX G-5
PURCHASE ORDER
LGU
Supplier P.O. No. ________________

Address Date: ________________
Mode of Procurement
Gentlemen:
1. set 1 Acer Veritom M46306

Intel Core 0.3 3.46HZ
46B DDR3 / 500 6B HDD
16xSMD Optical Drive
Acer 18.5" Wide Screen LED
Keyboard/Mouse/PWR
Built in Speaker
set 1 EPSON L220 3in1 printer
set 1 JG-288206 Comp. Chair
set 1 JIT 767 Comp. Table
(Total Amount in Words) FIFTY-FIVE THOUSAND PESOS ONLY. 55,000.00

Very Truly yours,

_________________________
(Date)
Certified Correct:________________ ALEXANDER B. CARPIO KENAZ W. BAUTISTA

Secretary to the Sanggunian OIC-Municipal Treasurer Municipal Accountant
ANNEX G-5
PURCHASE REQUEST
LGU
Department: TREASURER'S OFFICE PR No: __________________Date: _____________

Section SAI No.: _________________Date: ______________
ALOB No.: _______________ Date: ______________
Item No. Unit Description Quantity Unit Cost Amount
1. set Acer Veritom M46306 1

46B DDR3 / 500 6B HDD
Keyboard/Mouse/PWR
Built in Speaker
set EPSON L220 3in1 printer 1
set JG-288206 Comp. Chair 1
set JIT 767 Comp. Table 1
TOTAL: 55,000.00
PURPOSE : TO BE USED AT TREASURER'S OFFICE.
CASH AVAILIBILITY: REQUESTED BY APPROVED BY:
Signature:
Printed NameALEXANDER B. CARPIO ALEXANDER B. CARPIO HON. RAMIL P. VENTENILLA
Designation: OIC-Municipal Treasurer OIC-Municipal Treasurer Municipal Mayor
INSPECTION & ACCEPTANCE REPORT
LGU
Supplier : A. H. ARELLANO GEN. MDSE. AR No:

P/O/ No.___________________ Date ________ Invoice No.___________________ Date _____________
Requisitioning Office/Dept. ________________________________________________________________
QUANTITY DESCRIPTION UNIT

7 TRI WIRE #16
3 NAILS
30 CAP HOOK 1 1/2
1 TOX #6
20 CONCRETE NAIL 3
1 FLIER COMBINATION
1 SIDE COTTON
1 STANLEY CROSSCUTSAW
1 RUBBERGRIP HACK SAW
2 PLASTIC HOSE 1/2
50 W-SAW 10X1
5 PVC ELBOW 1/2
20 PVC CLAMP 1/2
1 TOX #8
1 HAMMER STANLEY
75 FLAT CORD #18
300 CABLE TIE 6"
4 PIN LIGHT
4 LED BULB 3WTS.
1 STEEL TAPE 8MS
3 DRILL BET 3/16
140 METAL SCREW 6x3/4
100 NETTEL C
100 CABLE TRI 25
1 COX 4
1 COX3
2 M-PLUG H.D.
1 UNIVERSAL ADOPTER
1 M-DRILL 6.5
25 TOX #8 W/SCREW 10x1 1/2
1 SPIRAL 24WTS.
2 PVC ADOPTER 1/2
1 J-BOX
10 FL 3 1/4X11/4
2 FAUCET 5/5
3 CEMENT
8 SAND
4 GRAVEL 3/4
1 PAINT BRUSH 2"
1 W. ROD
4 CHB 4
2 D/B 16MS.
3 CUTTING DISC 4
10 LED BULB 6WTS.
2 A/B 1/4x1 STD.
Date Inspected:__________________________ Date Received:________________________

Inspected, verified and found OK
as to quantity and specifications COMPLETE
PARTIAL
Ronalyn V. Mejia/Norma B. De Guzman/Vilma E. Macapinlac/Meldee G. Galano HON. RAMIL P. VENTENILLA

Inspection Officer Property Officer
LGU
Supplier : AR No:

PARTIAL
Ronalyn V. Mejia/Norma B. De Guzman/Vilma E. Macapinlac/Meldee G. Galano JOHN VENTENILLA

LGU
Supplier : AR No:

PARTIAL
Rosario Pulido/Estela Evangelista/Anita Ventenilla DELIA A. AREOLA

LGU
Supplier : VMV ENTERPRISES AR No:

1 Acer Veritom M46306 set

46B DDR3 / 500 6B HDD
Keyboard/Mouse/PWR
Built in Speaker
1 EPSON L220 3in1 printer set
1 JG-288206 Comp. Chair set
1 JIT 767 Comp. Table set

PARTIAL
ROSE F. PULIDO NORMA DE GUZMAN
VILMA E. MACAPINLAC MELDEE G. GALANO ALEXANDER B. CARPIO

Republic of the Philippines
MUNICIPALITY OF MANGATAREM
Office of the Treasurer
NOTICE OF CANVANSSING
(Bidding)
, 20...
(Dealer)
(Address)
SIR:
PLEASE QUOTE YOUR PRICE ON THE FOLLOWING
QUANTITY DESCRIPTION UNIT T O TAL
TOTAL -
Please put your quotations in a sealed envelope and submit to this Office on .
.,20.. To be opened at ..am./p.m. in the presence of in interested
bidders and to be delivered immediately to the lowest bidders at the
ATTESTED: Very truly yours,
HON. RAMIL P. VENTENILLA ALEXANDER B. CARPIO

Municipal Mayor OIC- Municipal Treasurer
The Municipal Treasurer

.,
Signature of Merchant/Dealer
Sir:
My price for the above mentioned articles are as indicated above.
(Bidding)
, 20...
(Dealer)
(Address)
SIR:
QUANTITY UNIT TOTAL
TOTAL -


., Signature of Merchant/Dealer
Sir:
(Bidding)
, 20...
(Dealer)
(Address)
SIR:
QUANTITY DESCRIPTION UNIT TOTAL
TOTAL -


.,
Signature of Merchant/Dealer
Sir:
Province of Pangasinan
o0o
OFFICE OF THE MUNICIPAL TREASURER
APPENDIX A ITINERARY
OF TRAVEL
Date: FEBRUARY 9, 2017
Name : ALEXANDER B. CARPIO, ET. AL.

Purpose of Travel : SUBMIT REPORTS, PURCHASE ACCOUNTABLE FORMS, DEPOSITS & WITHDRAW.
Place to be visited Time of Means of Allowance Allowable Expenses

Date
FROM TO Departure Arrival Transportation Transportation Per Diems Total Amount
02/03/17Mangatarem Lingayen 9:00 AM 4:00PM 3x200 600.00

02/09/17Mangatarem Lingayen 9:30 AM 12:30 PM 2x200 400.00
02/09/17Mangatarem Lingayen 9:30 AM 12:30 PM 2x200 400.00
###
I hereby certify that (1) reviewed the foregoing
itinerary, (2) the travel is necessary to the service,
(3) the period covered is reasonable, (4) the
expenses claimed are proper.
APPENDIX B
Agency Head: LGU-Mangatarem Station: TREASURY Date: February 9, 2017
I hereby certify that I have completed travel authorized in the itinerary of Travel Order dated
______________________________________________________________________________________________
_______________________ under condition below.
Strictly in accordance with approval itinerary.
Cutshort as explained below. Excess payment in the amount of
P _____________________________________ was refunded under
O.R. No. __________________ dated _________________________.
Extended as explained below. Additional itinerary submitted at
____________________________________________.
Explanation or justification : Mini-Bus and jeepneys do not issue tickets _____________________________.

Evidence of Travel : Travel Orders, Certificate of Appearance and Itinerary of Travel.
The evidence & information of which I have knowledge, the travel was actually undertake
Respectfully yours,
IMELDA A. BUGARIN ALEXANDER B. CARPIO

LRCO I OIC-MUNICIPAL TREASURER
EBENG M. MARI ERNESTO LACUESTA

ADM. AIDE I DRIVER
MELBA GORDOVIN Supervisor:

ADM. AIDE I ______________________
Approved by: ALEXANDER B. CARPIO
OIC-Municipal Treasurer
_____________________________
HON. RAMIL P. VENTENILLA
Municipal Mayor
LOCAL GOVERNMENT OF MANGATAREM
MANGATAREM, PANGASINAN
DISBURSEMENT VOUCHER No.

Mode of
Check Cash Others
Payment
Payee ERNESTO MATA TIN/Employee No. Obligation Request No.
Responsibility Center
Address MANGATAREM, PANGASINAN Office/Unit/Project Code
EXPLANATION Amount
To payment of (1) one truck load of firewood use at slaughterhouse

as per supporting papers hereto attached in the amount of 3,500.00
3,500.00
A. Certified B. Certified
Allotment obligated for the purposes as indicated above Funds Available
Supporting documents complete
Signature Date Signature Date
Printed Printed
Name KENAZ W. BAUTISTA, CPA Name ALEXANDER B. CARPIO
Municipal Accountant OIC-Municipal Treasurer
Position Position
Head, Accounting Unit/Authorized Repesentative Treasurer/Authorized Representative
C. Approved for Payment D. Received Payment
Signature Date Check No. Bank Name Date
Printed Signature Date
Name HON. RAMIL P. VENTENILLA Printed Name ERNESTO MATA
Municipal Mayor OR/Other Documents JEV No. Date
Position
Agency Head/Authorized Repesentative
GENERAL
JOURNAL ENTRY VOUCHER
Local Government of Mangatarem No. 100-
LGU Date
Collections Check Disbursement Cash Disbursement Others
ACCOUNTING ENTRIES
Responsi Amount
Account
bility Accounts and Explanation PR Debit Credit
Code
Center
Prepared By: Approved By:
ANITA B. VENTENILLA KENAZ W. BAUTISTA, CPA

Bookkeeper I Municipal Accountant
Original Copy - COA
Duplicate Copy - Accounting Office
Triplicate Copy - Requisitioning Office (Optional)

Mode of
Payment Check Cash Others
Payee ERNESTO MATA TIN/Employee No. Obligation Request No.

EXPLANATION Amount
TO PAYMENT OF (1) ONE TRUCK LOAD OF FIREWOOD USE AT ALAUGHTERHOUSE, AS PER

Supporting papers hereto attached in the amount of
5,250.00
Printed Printed
Position Position
Name HON. RAMIL P. VENTENILLA Printed Name VILMA E. MACAPINLAC
Position
GENERAL
LGU Date
ACCOUNTING ENTRIES
Responsi Amount
Account
Code
Center

Original Copy - COA

Mode of
Payee VILMA E. MACAPINLAC TIN/Employee No. Obligation Request No.

EXPLANATION Amount
To payment 4 set STAR LED BLUE AND WHITE for additional

Christmas decoration as per supporting papers hereto attached
in the amount of 5,600.00
5,600.00
Printed Printed
Position Position
Position
GENERAL
LGU Date
ACCOUNTING ENTRIES
Responsi Amount
Account
Code
Center

Original Copy - COA
Mode of
Payee A.H. ARELLANO GEN.MDSE. TIN/Employee No. Obligation Request No.

EXPLANATION Amount
To payment in purchasing janitorial materials,as per supporting

papers hereto attached in the amount of. P 4,685.00
P 4,685.00
Printed Printed
Position Position
Name HON. RAMIL P. VENTENILLA Printed Name A.H. ARELLANO GEN.MDSE.
Position
GENERAL
LGU Date
ACCOUNTING ENTRIES
Responsi Amount
Account
Code
Center

Original Copy - COA

Mode of
Payee A.H. ARELLANO GEN.MDSE. TIN/Employee No. Obligation Request No.

EXPLANATION Amount
To payment in purchasing supplies ,as per supporting

papers hereto attached in the amount of. P 700.00
P 700.00
Printed Printed
Position Position
Name HON. RAMIL P. VENTENILLA Printed Name A.H. ARELLANO GEN.MDSE.
Position
GENERAL
LGU Date
ACCOUNTING ENTRIES
Responsi Amount
Account
Code
Center

Original Copy - COA

Mode of
Payee VILMA E. MACAPINLAC TIN/Employee No. Obligation Request No.

EXPLANATION Amount
To reimbursement of expenses in purchasing janitorial materials

as per supporting papers hereto attached in the amount P 1,170.00
P 1,170.00
Printed Printed
Position Position
Position
GENERAL
LGU Date
ACCOUNTING ENTRIES
Responsi Amount
Account
Code
Center

Original Copy - COA

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PURCHASE ORDER

Supplier P.O. No. ________________

Place of Delivery: _________________________________________________ Delivery Term: ___________

Item No. Unit Quantity Description Unit Cost Amount

Conforme: _________________________ HON. RAMIL P. VENTENILLA

Certified Correct:________________ HON. RAMIL P. VENTENILLA KENAZ W. BAUTISTA

Place of Delivery: _________________________________________________ Delivery Term: ___________

Item No. Unit Quantity Description Unit Cost Amount

1. PCS 2 WHEEL BEARING OUTER 615.00 1,230.00

Conforme: _________________________ HON. RAMIL P. VENTENILLA

Certified Correct:________________ HON. RAMIL P. VENTENILLA KENAZ W. BAUTISTA

Supplier P.O. No. ________________

Item No. Unit Quantity Description Unit Cost Amount

1. set 1 Acer Veritom M46306

(Total Amount in Words) FIFTY-FIVE THOUSAND PESOS ONLY. 55,000.00

Conforme: _________________________ HON. RAMIL P. VENTENILLA

Certified Correct:________________ ALEXANDER B. CARPIO KENAZ W. BAUTISTA

Department: TREASURER'S OFFICE PR No: __________________Date: _____________

Item No. Unit Description Quantity Unit Cost Amount

1. set Acer Veritom M46306 1

PURPOSE : TO BE USED AT TREASURER'S OFFICE.

CASH AVAILIBILITY: REQUESTED BY APPROVED BY:

Supplier : A. H. ARELLANO GEN. MDSE. AR No:

QUANTITY DESCRIPTION UNIT

Date Inspected:__________________________ Date Received:________________________

Ronalyn V. Mejia/Norma B. De Guzman/Vilma E. Macapinlac/Meldee G. Galano HON. RAMIL P. VENTENILLA

QUANTITY DESCRIPTION UNIT

Date Inspected:__________________________ Date Received:________________________

Ronalyn V. Mejia/Norma B. De Guzman/Vilma E. Macapinlac/Meldee G. Galano JOHN VENTENILLA

INSPECTION & ACCEPTANCE REPORT

QUANTITY DESCRIPTION UNIT

Rosario Pulido/Estela Evangelista/Anita Ventenilla DELIA A. AREOLA

Supplier : VMV ENTERPRISES AR No:

QUANTITY DESCRIPTION UNIT

1 Acer Veritom M46306 set

Date Inspected:__________________________ Date Received:________________________

ROSE F. PULIDO NORMA DE GUZMAN

VILMA E. MACAPINLAC MELDEE G. GALANO ALEXANDER B. CARPIO

Office of the Treasurer

QUANTITY DESCRIPTION UNIT T O TAL

ATTESTED: Very truly yours,

HON. RAMIL P. VENTENILLA ALEXANDER B. CARPIO

The Municipal Treasurer

Office of the Treasurer

QUANTITY UNIT TOTAL

ATTESTED: Very truly yours,

HON. RAMIL P. VENTENILLA ALEXANDER B. CARPIO

The Municipal Treasurer

Office of the Treasurer

QUANTITY DESCRIPTION UNIT TOTAL

ATTESTED: Very truly yours,

HON. RAMIL P. VENTENILLA ALEXANDER B. CARPIO

The Municipal Treasurer

Date: FEBRUARY 9, 2017

Name : ALEXANDER B. CARPIO, ET. AL.

Place to be visited Time of Means of Allowance Allowable Expenses

02/03/17Mangatarem Lingayen 9:00 AM 4:00PM 3x200 600.00

Explanation or justification : Mini-Bus and jeepneys do not issue tickets _____________________________.

IMELDA A. BUGARIN ALEXANDER B. CARPIO

EBENG M. MARI ERNESTO LACUESTA

MELBA GORDOVIN Supervisor:

LOCAL GOVERNMENT OF MANGATAREM

DISBURSEMENT VOUCHER No.

Place of Delivery: _______________________________________ Delivery Term: _

Place of Delivery: _______________________________________ Delivery Term: _

Department: TREASURER'S OFFICE PR No: ______Date: _

Date Inspected:__ Date Received:

Date Inspected:__ Date Received:

Date Inspected:__ Date Received: