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signed by your representative not later than ________________________.
VIGILUS D. CREDO
NOTE: BAC Chairman
1. ALL ENTRIES MUST BE TYPEWRITTEN
2. DELIVERY PERIOD WITHIN SEVEN (7) CALENDAR DAYS
3. WARRANTY SHALL BE FOR A PERIOD OF THREE (3) MONTHS FOR SUPPLIES & MATERIALS, ONE (1) YEAR FOR
EQUIPMENT, FROM DATE OF ACCEPTANCE BY THE PROCURING ENTITY
4. PRICE VALIDITY SHALL BE FOR A PERIOD OF THIRTY (30) CALENDAR DAYS
5. G-EPS REGISTRATION CERTIFICATE SHALL BE ATTACHED UPON SUBMISSION OF THE QUOTATION, IF AVAILABLE.
6. BIDDERS SHALL SUBMIT ORIGINAL BROCHURES SHOWING CERTIFICATIONS OF THE PRODUCT BEING OFFERED.
ITEM
ITEM & DESCRIPTION QTY. Unit Unit Price TOTAL
NO.
1 Mouse A4tech USB 2 pcs
Printed Name/Signature
Date
PURCHASE REQUEST
Tampilisan, Zamboanga del Norte
LGU
PR No.: Date:
Department: Mun. Budget SAI No.: Date:
Section: OR No. Date:
1,500.00
Date
(In case of Negotiated Purchase pursuant toSection 369 (a) of RA 7160, this portion must
be accomplished).
Certified Correct:
No.:
OBLIGATION REQUEST
PAYEE CLICK HAUS COMPUTER SALES & SERVICES
OFFICE
ADDRESS Baybay, Liloy Zamboanga del Norte
Responsibilit ACCOUNT
PARTICULARS F.P.P AMOUNT
y Center CODE
Mouse A4tech Php 1,398.00
No.:
OBLIGATION REQUEST
PAYEE CLICK HAUS COMPUTER SALES & SERVICES
OFFICE
ADDRESS Baybay, Liloy Zamboanga del Norte
Responsibilit ACCOUNT
PARTICULARS F.P.P AMOUNT
y Center CODE
Mouse A4tech Php 1,398.00
Signature Signature
Printed Date: Printed Date:
SHERRY LOU P. DAPROSA OLIVIA G. EBORDE
Name Name
Municipal Accountant Municipal Treasurer
Position Position
(Head,Accounting Unit/Authorized Representative) (Head,Treasury Unit/Authorized Representative)
APPROVED FOR PAYMENT: RECEIVED PAYMENT:
C D
Signature Check No.: Bank Name: Date:
Printed Date: Signature
ANGELES R. CARLOTO II
Name Printed Date:
NamHAUS COMPUTER SALES & SERVICES
CLICK
Municipal Mayor OR. No./Other Documents JEV No. Date:
Position
(Local Chief Executive/Authorized Representative)
THIS IS TO CERTIFY that the requirements of R.A. No. 9184 otherwise known Total 1,398.00 Total 1,400.00 Total 1,440.00
as the Government Procurement Reform Act ( Rule XVI - Sec.52 ) had been complied with. WE HEREBY CERTIFY to the correctness and authenticity of the above Abstract
of Bids to the best of our knowledge.
699.00
INSPECTION ACCEPTANCE
Date Received:
Inspected, verified and found OK X Complete
as to quantity and specifications. Partial
LUCITO P. CERNA
Municipal Agriculturist
X
MARY JANE K. CALUMBA
CYNTHIA D. ABIL Property Custodian/ GSO Designate
RCO II
R e q ui s i t i o n Issuance
Stock No. Unit Description Quantity Quantity Remarks
pcs Mouse A4tech USB 2 2
Signature:
Printed Name: GRACE A. GUMANSING ANGELES R. CARLOTO II PRAXIDES C. ARCINO GRACE A. GUMANSING
Designation: Municipal Budget Officer Municipal Mayor Asst. Mun. Treasurer Municipal Budget Officer
Date: