Tev

PURCHASE REQUEST
Entity Name: Department of Education Fund Cluster: __________

Office/Section : PR No.: 2017- Date: July 21, 2017
GEN. LUNA INTEGRATED Responsibility Center Code : __________________
SCHOOL-SENIOR HS.
Stock/ Property No. Unit Item Description Qty Unit Cost Total Cost
1 TABLET PARACETAMOL 100 0.50 50.00

2 CAPSULE LOPERAMIDE 100 1.00 100.00
3 CAPSULE MEFENAMIC 100 1.20 120.00
4 TABLET SYMDEX 50 3.00 150.00
5 TABLET ANTACID 100 1.50 150.00
6 BOTTLE BETADINE 2 51.50 103.00
7 PCS. GAUZE BANDAGE 3 17.50 52.50
8 BOTTLE CASINO 3 36.25 108.75
9 PCS. HAPPY BALLS COTTON 2 27.875 55.75
10 PCS. HAPPY COTTON 2 55.00 110.00
11 0.00
TOTAL 1,000.00
Purpose: ____________________________________________________________
_______________________________________________________________
_______________________________________________________________
Requested by: Approved by:

________________________
Signature : _________________________
___
RIZALDY T.
Printed Name : ANGELICA L. CALOZA
CARITATIVO
Designation : PROPERTY CUSTODIAN SCHOOL HEAD/ Teacher
in charge
151
Department of Education
Region III
Schools Division of Nueva Ecija
District of Carranglan
General Luna Integrated School-Secondary (Senior High School)
REQUEST FOR QUOTATION
Quotation Reference Number:
Sir/Madam:
Please quote your lowest price on the item/s listed below, stating the shortest time of delivery and submit your quotation thru
__________________ or fax at___________________ not later than ___________________
RODEN V. PINEDA
Canvasser
PROCUREMENT TERMS AND CONDITIONS

1. The Approved Budget for the Contract is PhP 1,000.00
2. Price quoted are subject to deduction of 5% VAT & 1% EWT (for goods) or 5%VAT & 2%EWT (for services)
3. Goods, supplies, equipment or work done are subject to inspection/acceptance, DepED reserves the right to cancel
reject or rebid the items which do not conform with the specifications.
4. Complete technical specifications, brand & model must be indicated in the price quotation for evaluation purposes.
5. Delivery period shall be indicated in the quotation. A liquidated damages equivalent to 1/10 of 1% per day
of delay for the value of undelivered items shall be imposed.
6. All bids in excess of the ABC will be rejected.
7. Supplier warrants that he/she has not given nor promised to give any money or gift to any DepEd employee to
secure this offer and to obtain an award.
Item No. Quantity Unit Item and Description

1 100 TABLET PARACETAMOL
2 100 CAPSULE LOPERAMIDE
3 100 CAPSULE MEFENAMIC
4 50 TABLET SYMDEX
5 100 TABLET ANTACID
6 2 BOTTLE BETADINE
7 3 PCS. GAUZE BANDAGE
8 3 BOTTLE CASINO
9 2 PCS. HAPPY BALLS COTTON
10 2 PCS. HAPPY COTTON
0 0 0
0 0 0
0 0 0
0 0 0
***************
Delivery Period: 7/24/2017

Warranty:
Price Validity:
Delivery Term: Pick up
Payment Term: Check
After having carefully read and accept your Procurement Terms & Conditions, I/We quote you on the item at prices
noted above.
Designation:
Company Name:
Business Address:
Telephone Number/CP number:
Email Address:
High School)
Date: 7/21/2017
otation Reference Number:
livery and submit your quotation thru email at

____
RIZALDY T. CARITATIVO
School Head/HT-1
%EWT (for services)

D reserves the right to cancel
tion for evaluation purposes.

o 1/10 of 1% per day
any DepEd employee to
Unit Price Total Amount

0.50 50.00
1.00 100.00
1.20 120.00
3.00 150.00
1.50 150.00
51.50 103.00
17.50 52.50
36.25 108.75
27.88 55.75
55.00 110.00
0.00 0.00
0.00 0.00
0.00 0.00
0.00 0.00
1,000.00
e you on the item at prices
3M DRUG MART CO.

PRINTED NAME/SIGNATURE
3M DRUG MART CO.

Rizal St., Brgy. F.E Marcos, San Jose City, Nueva Ecija
09323556738
Region III
Sir/Madam:
RODEN V. PINEDA
Canvasser


4 50 TABLET SYMDEX
6 2 BOTTLE BETADINE
8 3 BOTTLE CASINO
0 0 0
0 0 0
***************

Warranty:
Price Validity:
Payment Term: Check
noted above.
Designation:
Company Name:
Business Address:
Email Address:
High School)
Date: 7/21/2017

____
School Head/HT-1
%EWT (for services)



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
TOTAL CARE DRUG

TOTAL CARE DRUG
09338523241
Region III
Sir/Madam:
RODEN V. PINEDA
Canvasser


4 50 TABLET SYMDEX
6 2 BOTTLE BETADINE
8 3 BOTTLE CASINO
0 0 0
0 0 0
***************

Warranty:
Price Validity:
Payment Term: Check
noted above.
Designation:
Company Name:
Business Address:
Email Address:
High School)
Date: 7/21/2017

____
School Head/HT-1
%EWT (for services)



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
FARMACIA MANZANO
FARMACIA MANZANO
09178893690
Region III
General Luna Integrated School - Senior High School
ABSTRACT OF CANVASS BID

FOR THE PURCHASE OF DRUGS/MEDICINES SUPPLIES
Held on July 21, 2017
3M DRUG MART CO. TOTAL CARE DRUG FARMACIA MANZANO

QTY UNIT ARTICLES
UNIT PRICE TOTAL UNIT PRICE TOTAL UNIT PRICE TOTAL
100 TABLET PARACETAMOL 0.50 50.00 0.00 0.00 0.00 0.00

100 CAPSULE LOPERAMIDE 1.00 100.00 0.00 0.00 0.00 0.00
100 CAPSULE MEFENAMIC 1.20 120.00 0.00 0.00 0.00 0.00
50 TABLET SYMDEX 3.00 150.00 0.00 0.00 0.00 0.00
100 TABLET ANTACID 1.50 150.00 0.00 0.00 0.00 0.00
2 BOTTLE BETADINE 51.50 103.00 0.00 0.00 0.00 0.00
3 PCS. GAUZE BANDAGE 17.50 52.50 0.00 0.00 0.00 0.00
3 BOTTLE CASINO 36.25 108.75 0.00 0.00 0.00 0.00
2 PCS. HAPPY BALLS COTTON 27.88 55.75 0.00 0.00 0.00 0.00
2 PCS. HAPPY COTTON 55.00 110.00 0.00 0.00 0.00 0.00
0 0 0 0.00 0.00 0.00 0.00 0.00 0.00
TOTAL TOTAL 1,000.00 0.00 0.00
Recommending award to 3M DRUG MART CO.

Prices considered just and reasonable and does not exceed the prices prevailing in the locality.
ESPERANZA B. VILLA ANGELICA L. CALOZA RIZALDY T. CARITATIVO

School Treasurer School Property Custodian School Head
Region III
District of Nueva Ecija
General Luna Integrated School - Senior High School
PURCHASE ORDER
Supplier : 3M Drugmart Co. P.O. No. : ____________________________

Address : Rizal St., Brgy. F.E Marcos, San Jose City, Nueva Ecija Date : July 21, 2017
TIN : 009-291-259-001 Mode of Procurement : Check
Gentlemen:
Please furnish this Office the following articles subject to the terms and conditions contained herein:
Place of Delivery : Gen. Luna Integrated School-Senior High Shool Delivery Term : Pick up
Date of Delivery : July 23, 2017 Payment Term : Check
Stock/
Unit Description Quantity Unit Cost Amount
Property No.
TABLET PARACETAMOL 100 0.50 50.00
CAPSULE LOPERAMIDE 100 1.00 100.00
CAPSULE MEFENAMIC 100 1.20 120.00
TABLET SYMDEX 50 3.00 150.00
TABLET ANTACID 100 1.50 150.00
BOTTLE BETADINE 2 51.50 103.00
PCS. GAUZE BANDAGE 3 17.50 52.50
BOTTLE CASINO 3 36.25 108.75
PCS. HAPPY BALLS COTTON 2 27.88 55.75
PCS. HAPPY COTTON 2 55.00 110.00
0 0 0 0.00 0.00
0 0 0 0.00 0.00
(Total Amount in Words) ONE THOUSAND PESOS
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 on the undelivered item/s.
Conforme: Very truly yours,
3M Drug Mart Co. RIZALDY T. CARITATIVO

Signature over Printed Name of Supplier Signature over Printed Name of School
Principal/Teacher in Charge
7/23/2017 School Head/Head Teacher-1
Date Designation
Fund Cluster : ___________________________________ ORS/BURS No. : ______________________

Funds Available : _________________________________ Date of the ORS/BURS: _______________
Amount : ____________________________
ESPERANZA B. VILLA
Signature over Printed Name of Disbursing officer/School
Treasurer
153
Region III
INSPECTION AND ACCEPTANCE REPORT
Fund Cluster :
Supplier : 3M Drugmart Co. IAR No. : _______________

PO No./Date : Date : July 24,2017
Requisitioning Office/Dept. : _______________________________ Invoice No. : 29290
Responsibility Center Code : _______________________________ Date : July 24,2017
Stock/
Description Unit Quantity
Property No.
1 PARACETAMOL TABLET 100
2 LOPERAMIDE CAPSULE 100
3 MEFENAMIC CAPSULE 100
4 SYMDEX TABLET 50
5 ANTACID TABLET 100
6 BETADINE BOTTLE 2
7 GAUZE BANDAGE PCS. 3
8 CASINO BOTTLE 3
9 HAPPY BALLS COTTON PCS. 2
10 HAPPY COTTON PCS. 2
0 0 0
0 0 0
0 0 0
INSPECTION ACCEPTANCE
Date Inspected : _______________________ Date Received : _____________________
Inspected, verified and found in / Complete

/ order as to quantity and
specifications Partial (pls. specify quantity)
QUERY B. VILLA ANGELICA L. CALOZA

Inspection Officer/Inspection Committee Supply and/or Property Custodian
Region III
District of Pantabangan
Conversion Integrated School - Secondary
Fund Cluster : 01101101

Date : August 1, 2017
DISBURSEMENT VOUCHER
DV No. :
Mode of MDS Check / Commercial Check ADA Others (Please specify)

Payment
_________________
TIN/Employee No.: ORS/BURS No.:
Payee EMERLINDA R. VILLA
000-000-000
Address Pantabangan, N.E
Particulars Responsibility Center MFO/PAP Amount
Reimbursement of payment for School Head bonding
GROSS AMOUNT 1,125.00
Amount Due P 1,125.00

A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.
EMERLINDA R. VILLA
School Head/ Teacher in charge
B. Accounting Entry:
Account Title UACS Code Debit Credit
Advances for Operating Expenses 1990104000 1,125.00
Cash MDS - Regular 1010404000 1,125.00
TOTAL 1,125.00 1,125.00
C. Certified: D. Approved for Payment
Cash available
Subject to Authority to Debit Account (when applicable)
ONE THOUSAND ONE HUNDRED TWENTY FIVE PESOS ONLY
Su
proper
Signature Signature
Printed
Printed Name
Name MARITES T. BALDEREZ EMERLINDA R. VILLA
Position Disbursing Officer/Treasurer Position School Head/Teacher in Charge
Date Date
E. Receipt of Payment JEV No.

Check/ Date : Bank Name & Account Number:
ADA No. :
Date : Printed Name: Date
Signature :
Official Receipt No. & Date/Other Documents
92
DEPARTMENT OF EDUCATION
DIVISION OF NUEVA ECIJA
MASUNURIN ELEMENTARY SCHOOL
SAN LEONARDO DISTRICT, NUEVA ECIJA
FOR THE MONTH OF JUNE 2017
CASH DISBURSEMENT REGISTER
WORKING FUND 5020101000 5020201000 5020301000 5020307000 5020399000 5020401000 5020402000 5020503000 5021299000 5021203000 5021202000 5021304002 5021299000 5021307000 5021304099 5021502000 5029999002 2020101000
Date of No. Of Check Gross Tax
Check PAYEE Particulars CASH FUND Internet Rep&Main- Rep&Main- Fidelity
Issued Amount withheld PAYMENT Training Office Drugs, Other Other Security Janitorial Rep&Main- Rep&Main-IT
Issued ADVANCE BALANCE Travelling Ex.
Expenses Supplies Ex. Medicine Ex. Supplies Ex.
Water Ex. Electricity Ex. Subscription
Gen.Services Services Services Schl.Bldg. EQ.
Furniture & Other Bond Other MOOE Due to BIR
Expenses Fixtures Structures Premium
LBP ACCOUNT FORWARDED BALANCE 4,737.01

MOOE DOWNLOADING FOR THE 26,020.00 30,757.01
MONTH OF JUNE 2017
Reimbursement for traveling
6/3/2017 10001 VYA G. REYES expenses for the month of May 1,500.00 1,500.00 29,257.01 1,500.00
2017
Reimbursement for registration
6/6/2017 10002 MICHELLE M. fee on WPAD workshop dtd 2,000.00 2,000.00 27,257.01
SAMANIEGO 05/31/17 2,000.00
Payment for office supplies, OR#
6/6/2017 10003 BELBEL TRADING 333515 dtd 6/5/17 3,000.00 190.45 2,809.55 24,447.46
3,000.00
Payment for monthly medical
6/6/2017 10004 ARLYN MEDICS INC supplies, OR#353586 dtd 06/5/17 2,065.00 82.60 1,982.40 22,465.06
2,065.00
Payment for the purchase of
6/6/2017 10005 DAN IT SHOP printer and scanner, OR#2525 dtd 5,000.00 267.86 4,732.14 17,732.92
06/06/17
5,000.00
Payment for water expense for
6/6/2017 10006 PRIMELULU WATER the period 05/05-06/05/17, 3,565.00 178.25 3,386.75 14,346.17
INC OR#5858 dtd 06/06/17
3,565.00
Payment for electricity expense for
6/6/2017 10007 NEECO II the period 05/05-06/05/2017, 3,500.00 218.75 3,281.25 11,064.92
OR#75906258 dtd 6/6/17 3,500.00
Payment for internet subscription
6/6/2017 10008 GLOBE TELECOM for the period of 05/05- 1,000.00 50.00 950.00 10,114.92
06/05/2017, OR#3535 dtd 6/6/17 1,000.00
Payment for Security Services for
6/6/2017 10009 RENREN ESPANTO the month of June 2017 1,350.00 1,350.00 8,764.92
1,350.00
Payment of purchases of
AILEEN construction materials for ceiling
6/6/2017 10010 repair, OR#2525 dtd 06/05/17 1,250.00 50.00 1,200.00 7,564.92
CONSTRUCTION
1,250.00
Payment of labor for repainting of
LUCILLE fences dtd 05/31/17
6/6/2017 10011 ANAWANGIN 950.00 950.00 6,614.92
950.00
Reimbursement for payment of
6/6/2017 10012 DANG JAVIER Fidelity bond for the period of 562.50 562.50 6,052.42
06/01/17 to 06/02/18
562.50
Payment for printing of tarpaulin
for BRIGADA ESKUWELA 2017,
6/6/2017 10013 JONA TARPO SHOP OR#21825114 dtd 6/6/17 2,500.00 156.25 2,343.75 3,708.67
2,500.00
Payment for photocopy of School
AKUSAKI forms, OR#222 dtd 6/6/17
6/6/2017 10014 photoshop 1,514.51 514.00 1,000.51 2,708.16
Payment of tax withheld (BIR

6/6/2017 10015 BIR FORM 1600) 1,024.89 1,683.27
Payment of tax withheld (BIR

6/6/2017 10016 BIR FORM 1601) 683.27 1,000.00
TOTAL 29,757.01 1,708.16 30,757.01 29,757.01 1,000.00
Certified Correct: Certified Correct: Approved:

MARAH M. PACSON RONALDO A. POZON, Ph.D., CESO V
SCHOOL HEAD DIVISION ACCOUNTANT SCHOOLS DIVISION SUPERINTENDENT
DATE DATE DATE
LIQUIDATION REPORT No:
Date:
Department of Education Responsibility Center
Sama-Sama Region III Code:
sa DepEd
Division of Nueva Ecija
PARTICULAR Amount
TO LIQUIDATE DOWNLOADED MOOE FOR THE MONTH OF JUNE 2017 AMOUNTING TO

TWENTY NINE THOUSAND SEVEN HUNDRED FIFTY SEVEN & 01/100 PESOS ONLY 29,757.01
TOTAL AMOUNT SPENT

29,757.01
BALANCE OF PREVIOUS CASH ADVANCE
4,737.01
AMOUNT OF CASH ADVANCE PER DV NO.
26,020.00
BALANCE OF CASH ADVANCE 1000 DTD. 6/6/2017
1,000.00
A Certified: Correctness of the B Certified: Purpose of travel/cash C Certified: Supporting documents
above data: advance duly accomplished: complete and proper:
Pre-Audited by:
HERMOGENES N. CAMANGEG
Claimant Immediate Supervisor ADAS III
Designation: SP II
School: MARAH M. PACSON
Head, Accounting Unit
MOOE ATTACHMENTS
Please accomplish and arrange in order.
Travel Expenses Purchased supplies and m

1. Picture of Check 1. Picture of Check
2. Disbursement Voucher 2. Disbursement Voucher
3. Travel Order 3. Invoice/OR/DR/RER
4. Duly Approved Itinerary of travel 4. Pictures***
5. Certificate of travel completed 5. IAR
6. Certificate of appearance 6. Purchase Order (P.O.)
7. Attach Memorandum Req.(if) training/Seminar attaended 7. Abstract of Open Canvass
8. For rentals of van, Acknowledgment receipt 8. Request for Quotations (R
9. Purchase Request (P.R.)
Training Expenses 10. Property Acknowledgme
1. Picture of Check
2. Disbursement Voucher General Services/ Securit
3. Memorandum 1. Picture of Check
4. Official receipt 2. Disbursement Voucher
5.Certificate of appearance 3. Contract of service
6. Photocopy of Certificate of Participation 4. Duly approved DTR
5. Accomplishment report
Water/Electricity/Internet Expenses
1. Picture of Check Tax remittances
2. Disbursement Voucher (1 for supplier, 1 for reimbursing personnel) 1. Disbursement Vou
3. Statement of Account/Bill 2.Picture of Check
4. Official Receipt 3.Deposit slip
6. BIR form 2306 4.BIR form 1600
7. BIR form 2307 5.BIR form 1601-E
6.Alphalist of 1601-E
Repairs & Maintenance

1. Picture of Check
2. Disbursement Voucher
3. Invoice/OR/DR
4. Pictures with Caption***
(before, during, after)
5. IAR
6. Purchase Order (P.O.)
7. Abstract of Open Canvass
8. Request for Quotations (RFQs)
9. Program of works
11. Labor Contract
12. Labor Payroll and
Acknowledgment Receipt
*for repairs 10,000 and above
1.Letter request duly approved by the Schools Division Superintendent
*for repairs with donated materials
1. Certificate or copy of the received donated materials/Proof of donation/Resolution
*** Inspectors should be included in the pictures (while cheking goods/evaluating output of services)
For the purpose of actual validation of purchases
Purchased supplies and materials

1. Picture of Check
2. Disbursement Voucher OK
3. Invoice/OR/DR/RER OK
4. Pictures***
6. Purchase Order (P.O.)

7. Abstract of Open Canvass
8. Request for Quotations (RFQs)
10. Property Acknowledgment Receipt (PAR) if equipment; Inventory Custodian Slip if semi-expendable
General Services/ Security/ Janitorial services

1. Picture of Check
2. Disbursement Voucher
3. Contract of service
4. Duly approved DTR
5. Accomplishment report
Tax remittances
1. Disbursement Voucher (1 for supplier, 1 for reimbursing personnel)
2.Picture of Check
3.Deposit slip
4.BIR form 1600
5.BIR form 1601-E
6.Alphalist of 1601-E
Account Codes for Disbursement Vouchers
5020101000 Travel Expenses
5020201000 Training Expenses
5020301000 Office Supplies Expenses
5020307000 Drugs, Medicine Expenses
5020399000 Other Supplies Expenses
5020401000 Water Expenses
5020402000 Electricity Expenses
5020503000 Internet Subscription Expenses
5021299000 Other Gen.Services
5021203000 Security Services
5021202000 Janitorial Services
5021304002 Rep&Maintenance-School Building
5021299000 Rep&Maintenance-IT Equipment
5021307000 Rep&Main-Furniture & Fixtures
5021304099 Rep&Main-Other Structures
5021502000 Fidelity Bond Premium
5029999002 Other MOOE
1990104000 Advances for Operating Expenses

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PURCHASE REQUEST

Entity Name: Department of Education Fund Cluster: __________

1 TABLET PARACETAMOL 100 0.50 50.00

Requested by: Approved by:

General Luna Integrated School-Secondary (Senior High School)

REQUEST FOR QUOTATION

Quotation Reference Number:

PROCUREMENT TERMS AND CONDITIONS

Item No. Quantity Unit Item and Description

Delivery Period: 7/24/2017

livery and submit your quotation thru email at

%EWT (for services)

tion for evaluation purposes.

any DepEd employee to

Unit Price Total Amount

e you on the item at prices

3M DRUG MART CO.

3M DRUG MART CO.

General Luna Integrated School-Secondary (Senior High School)

REQUEST FOR QUOTATION

Quotation Reference Number:

PROCUREMENT TERMS AND CONDITIONS

Item No. Quantity Unit Item and Description

Delivery Period: 7/24/2017

livery and submit your quotation thru email at

%EWT (for services)

tion for evaluation purposes.

any DepEd employee to

Unit Price Total Amount

e you on the item at prices

TOTAL CARE DRUG

TOTAL CARE DRUG

General Luna Integrated School-Secondary (Senior High School)

REQUEST FOR QUOTATION

Quotation Reference Number:

PROCUREMENT TERMS AND CONDITIONS

Item No. Quantity Unit Item and Description

Delivery Period: 7/24/2017

livery and submit your quotation thru email at

%EWT (for services)

tion for evaluation purposes.

any DepEd employee to

Unit Price Total Amount

e you on the item at prices

ABSTRACT OF CANVASS BID

3M DRUG MART CO. TOTAL CARE DRUG FARMACIA MANZANO

100 TABLET PARACETAMOL 0.50 50.00 0.00 0.00 0.00 0.00

TOTAL TOTAL 1,000.00 0.00 0.00

Recommending award to 3M DRUG MART CO.

ESPERANZA B. VILLA ANGELICA L. CALOZA RIZALDY T. CARITATIVO

Supplier : 3M Drugmart Co. P.O. No. : ____________________________

(Total Amount in Words) ONE THOUSAND PESOS

Conforme: Very truly yours,

3M Drug Mart Co. RIZALDY T. CARITATIVO

Fund Cluster : ___________________________________ ORS/BURS No. : ______________________

INSPECTION AND ACCEPTANCE REPORT

Supplier : 3M Drugmart Co. IAR No. : _______________

Inspected, verified and found in / Complete

QUERY B. VILLA ANGELICA L. CALOZA

Fund Cluster : 01101101

Mode of MDS Check / Commercial Check ADA Others (Please specify)

Particulars Responsibility Center MFO/PAP Amount

Reimbursement of payment for School Head bonding

GROSS AMOUNT 1,125.00

Fund Cluster : _____________ ORS/BURS No. :