Republic of the Philippines

Department of Public Works & Highways Cordillera Administrative Region Kalinga District Engineering Office
Bulanao, Tabuk City, Kalinga

PURCHASE REQUEST
DPWH, KALINGA DISTRICT ENGINEERING OFFICE
AGENCY Department: DPWH-Kalinga District Engineering Office Section: QTY 3 7 1 20 40 30 30 10 20 100 100 25 25 UNIT OF ISSUE units units unit pcs. pcs. rms. rms. rms. pcs. pcs. pcs. pcs. pcs. PR No. SAE No. ALOBS No. 2013-01-048 Date: Date: Date: UNIT COST 700.00 180.00 7,000.00 500.00 600.00 230.00 250.00 220.00 35.00 6.00 5.00 900.00 950.00 January 28, 2013

ITEM DESCRIPTION Measuring tape w/ handle 50m Steel tape 3m HP deskjet ink advantage 2060 all-n-one K110 Ink 704 black Ink 704 colored Bondpaper short sub. 20 Bondpaper long sub. 20 Bondpaper A4 sub. 20 Correctional tape White folder long White folder short Ink #60 black Ink #60 colored

STOCK NO. 1 2 3 4 5 6 7 8 9 10 11 12 13

TOTAL COST 2,100.00 1,260.00 7,000.00 10,000.00 24,000.00 6,900.00 7,500.00 2,200.00 700.00 600.00 500.00 22,500.00 23,750.00

109,010.00
Purpose: FOR USE OF RBIA

Requested By:

Approved By:

Signature: Printed Name: Designation:

/fmw

ERNESTO O. VECALDO Chief, Maintenance Section

ALEXANDER C. CASTAEDA District Engineer

Republic of the Philippines

Department of Public Works & Highways Cordillera Administrative Region Kalinga District Engineering Office
Bulanao, Tabuk City, Kalinga Name of Procuring Entity: Revised on: Standard Form/Title: COMPANY NAME: ADDRESS : TEL. NO./FAX NO.: TIN No. DPWH-KDEO REQUEST FOR QUOTATION Request for Quotation(P.R. No): Date: Office/End user: 2013-01-048 28-Jan-13

Please quote your lowest price on the item(s) listed below, subject to the Terms and conditions stated below and submit your quotation duly signed by your representative not later than 10:30 A.M. of February 5, 2013 in the return envelope attached herewith, to the BAC Secretariat for Goods, DPWH-KDEO Bulanao, Tabuk City, Kalinga. TERMS and CONDITIONS:
1.All entries must be typewritten or legibly written. 2.Delivery period within __ days upon receipt of the approved funded Purchase Order (P.O.). Administrative penalties pursuant to Sec. 69 of the Revised IRR-RA 9184 shall be imposed for non-delivery w/o valid reason 3. Warranty shall be for a minimum of three months for supplies & materials; one year warranty for equipment from date of acceptance by the end-user. 4.Price validity shall be for a period of sixty (60) calendar days. 5. G-EPS Registration Certificate?Mayor's Permit/DTI shall be attached upon submission of the quotation. 6. Bidders shall submit original brochures showing certifications of the product if applicable. 7.Please indicate the brand for each items being offered 8. The approved budget ceiling for this procurement is Php

__________________________ MANUEL P. MADIO BAC Chairman

Item no:

1 2 3 4 5 6 7 8 9 10 11 12

109,010.00 ITEMS & DESCRIPTION QTY UNIT UNIT PRICE For use in the Rehabilitation of Lubuagan Batong Buhay Road (KO459+290-KO459+335) Dangoy, Lubuagan, Kalinga. RSB 12mm 63 pcs. RSB 10mm 75 pcs. Tie Wire #16 10.18 kgs. Cement 394 bags Coarse Aggragate 6 cu.m. Fine Aggregate 3 cu.m. " x 4" x 8" Plywood 2 pcs. 2" x 3" x 10' Lumber 87.67 bd.ft. CWN .94 5 kgs. PVC Pipe 4"dia x 3m 12 pcs. Sand 28 cu.m. Boulders 118 cu.m. xxxxxxxxxxxxxxxxxxxxxx

TOTAL PRICE

Total Amount in Words:

Brand and Model: Delivery Period :

Warranty: Price Validity:

After having carefully read and accepted your General Conditions, I/We quote you on the item(s) at prices note above. If the space for delivery Period, Warranty and Price Validity are left blank, it means we are menable the terms and condition stated above.

Printed Name/Signature/Date Tel. No./ Cellphone No. / E-mail Address

Republic of the Philippines Department of Public Works and Highways OFFICE OF THE DISTRICT ENGINEER Kalinga District Engineering Office Bulanao, Tabuk City, Kalinga

BAC- TWG EVALUATION SHEET

( Shopping/Small Value Procurement )
Maintenance to Roadway & Related Features along Nambaran-Isabela Road, CONTRACT NAME LOCATION KO.513+113 - KO513+193 DATE OF OPENNING December 27, 2012 TIME OF OPENING 10:30 AM Approved Budget for the Contract ( ABC ) Php109,010.00

Purchase Request No. Implementing Office

2013-01-048
DPWH-KDEO

NAME
Item No. 1 2 3 PARTICULARS Cement Fine Aggregate Boulders xxxxxxxxxxxxxxxxxxxxxxxxxxxx Quantity 292 24.3 97.2 Unit bags cu.m. cu.m. J. PERALTA ENTERPRISES Unit Cost 260.00 930.00 925.00 Total 75,920.00 22,599.00 89,910.00

OF

BIDDERS
RMG BUILDERS AND CONSTRUCTION SUPPLY Unit Cost Total 268.00 78,256.00 938.00 22,793.40 935.00 90,882.00 Unit Cost Total

BLESSING BUILDERS & CONSTRUCTION SUPPLY Unit Cost Total 265.00 77,380.00 935.00 22,720.50 930.00 90,396.00

188,429.00
FINDINGS TERMS AND CONDITION 1. All entries must be typewritten or legible written 2. Delivery period within ______ days upon receipt of the approved funded Purchase Order 3. Warranty shall be for a minumum of three (3) months for supplies and materials one ( 1 ) year for equipment from date of acceptance by the end-user 4. Price validity shall be for a period of sixty ( 60 ) calendar days 5. G-EPS Registration Certificate shall be attached upon submission of the quotation 6. Bidder shall submit original brochures showing certifications of the product (if applicable ) Prepared By : JONALYN C. BUCAO Administrative Assistant II (Member, TWG) JULUIS C. GARCIA Engineer II (Member, TWG) FREDERICK O. MALIDOM Engineer III (Member, TWG) Complying Non - Complying

190,496.50
Complying Non - Complying

191,931.40
Complying Non - Complying Complying Non - Complying

RECOMMENDATION Award to the bidder with the Lowest Calculated Responsive Bid ( LCRB ) For Rebidding For specification/modifications /ABC revision To be procured thru COD due to minimal cost involved. Others: ______________________________

Sumitted By: REMEDIOS M. DAPEG Engineer II (Head, TWG) CLYDE G. CAIREL Accountant III (Head, BAC Secretariat)

Republic of the Philippines

Purchase Request No. 2013-01-048 DPWH-KDEO Implementing Office

CONTRACT NAME LOCATION DATE OF OPENNING TIME OF OPENING Maintenance to Roadway & Related Features along Nambaran-Isabela Road, KO.513+113 - KO513+193 December 27, 2012 10:30 AM

Department of Public Works and Highways OFFICE OF THE DISTRICT ENGINEER

Kalinga District Engineering Office Bulanao, Tabuk City, Kalinga

ABSTRACT OF SEALED/OPEN CANVASS

Php109,010.00 NAME ABC
Unit Cost 273.83 947.13 946.89 Total 79,958.36 23,015.26 92,037.71 ( SHOPPING/SMALL VALUE PROCUREMENT )

Approved Budget for the Contract ( ABC )

Item No. 1 2 3 PARTICULARS Cement Fine Aggregate Boulders xxxxxxxxxxxxxxxxxxxxxxxxxxxx

OF
Total 75,920.00 22,599.00 89,910.00

BIDDERS
BLESSING BUILDERS & CONSTRUCTION SUPPLY Unit Cost Total 265.00 77,380.00 935.00 22,720.50 930.00 90,396.00 RMG BUILDERS AND CONSTRUCTION SUPPLY Unit Cost Total 268.00 78,256.00 938.00 22,793.40 935.00 90,882.00 Unit Cost Total

Quantity 292 24.3 97.2

Unit bags cu.m. cu.m.

J. PERALTA ENTERPRISES Unit Cost 260.00 930.00 925.00

Total Amount:

195,011.33

188,429.00

190,496.50

191,931.40

AWARD (S) RECOMMENDED TO:

J. PERALTA ENTERPRISES RUBY A. UYAM
Provisional BAC Member

ALEXANDER L. COLANGAN
BAC Member

RAFAEL L. FERNANDO
BAC Member

GERRY. R. BAIS
Provisional BAC Member

MARIVIC T. PAGALA
Provisional BAC Member

TEODORO A. OWEK
BAC Vice Chairman

MANUEL P. MADIO
BAC Chairman

Republic of the Philippines

DEPARTMENT OF PUBLIC WORKS AND HIGHWAYS OFFICE OF THE DISTRICT ENGINEER Kalinga District Engineering Office Tabuk City, Kalinga Resolution No. 2012-12-

BAC RESOLUTION DECLARING LOWEST CALCULATED RESPONSIVE BID AND RECOMMENDING APPROVAL WHEREAS, the Department of Public Works and Highways, Kalinga District Engineering Office, advertise/sent Request for Quotations to Three (3) dealers for the furnishing of construction materials for the SPOT GRAVELLING AT BALABAG - KINAMA SAN FRANCISCO ROAD, RIZAL, KALINGA which was posted at PhilGEPS on November 29 - December 6, 2012; the DPWH Website and in conspicuous places of the office for continuous Seven (7) days; WHEREAS, in response to the said advertisements, three (3) dealers submitted their quotation and where found responsive to the bidding requirements; WHEREAS, the bid proposal of said bidders where received on December 11, 2012, the set deadline and opening of bids, resulted in: APPROVED BUDGET FOR THE CONTRACT:
NAME OF SUPPLIER

Php109,010.00
ADDRESS BID AMOUNT (as read) %Variance from ABC

1. Malabong Const'n. Supply & Gen. Mdse. 2. Bongdoen Harware 3. Cordillera Hardware

Bulanao, Tabuk City, Kalinga Dagupan, Tabuk City, Kalinga Dagupan, Tabuk City, Kalinga

188,429.00 191,931.40 190,496.50

-0.40% -0.19% -0.09%

WHEREAS, the Detailed Evaluation of Bids conducted on April 27, 2012 resulted in the following:
NAME OF SUPPLIER BID AMOUNT (as Calc/Corrected) %Variance from ABC
Ranking/Remarks after Bid Evaluation

1. Malabong Const'n. Supply & Gen. Mdse.

188,429.00

-0.40%

Lowest Bidder

WHEREAS, upon careful examination, validation and verification of all the requirements submitted by the three (3) bidders with eligibility, their technical and financial requirements submitted by the bidders with the Lowest Calculated Bid, Malabong Const'n. Supply & Gen. Merchandise has been found to be responsive. NOW, THEREFORE, We the Officers and Members of the Bids and Awards Committee, hereby, RESOLVE as it is hereby RESOLVED: a) To declare the bid of MALABONG CONST'N. SUPPLY & GEN. MDSE. as Lowest Calculated and Responsive Bid for the furnishing of construction materials under P.R. No. 2012-11-448 at is offered bid price. b) To recommend for approval by the District Engineer, Kalinga District Engineering Office the foregoing findings. RESOLVED at the Office of the BAC Chairman, this 12nd day of December 2012.

ERNESTO O. VECALDO BAC Chairman TEODORO A. OWEK Vice Chairman RAFAEL L. FERNANDO BAC Member (Regular)

MAUEL P. MADIO BAC Member (Provisional) APPROVED:

RUBY A. UYAM BAC Member (Provisional)

ALEXANDER C. CASTAEDA District Engineer

109,010.00 188,429.00 (79,419.00) -72.85%

109,010.00 191,931.40 (82,921.40) -76.07%

109,010.00 190,496.50 (81,486.50) -74.75%

Republic of the Philippines Department of Public Works and Highways Cordillera Administrative Region OFFICE OF THE DISTRICT ENGINEER Kalinga District Engineering Office Tabuk City, Kalinga

NOTICE OF AWARD
12-Dec-2012

MALABONG CONST'N. SUPPLY & GEN. MDSE. Bulanao, Tabuk City, Kalinga

Dear Sir/Madam: We are happy to inform you that your Bid for the furnishing of construction materials for the Spot Gravelling at Balabag-Kinaman-San Francisco, Rizal, Kalinga with your total bid price equivalent to THREE HUNDRED EIGHTY THREE THOUSAND THREE HUNDRED FIFTY PESOS ONLY (383,350.00), is hereby accepted.

Please cknowledge by signing and dating for the issuance of the Purchase Order.

Viery truly yours,

ALEXANDER C. CASTAEDA District Engineer

CONFORME:

MALABONG CONST'N. SUPPLY & GEN. MDSE. DATE:

/fmw

Name of Project :

Maintenance to Roadway & Related Features along Nambaran-Isabela Road,

Location of Project: KO.513+113 - KO513+193

PURCHASE ORDER
DPWH, Kalinga District Engineering Office (Agency)
Supplier: Address: Telephone No: TIN No.:

J. PERALTA ENTERPRISES Bulanao, Tabuk City, Kalinga

PO. NO. Date: Mode of Procurement : P.R. No. 2013-01-048 SHOPPING

1/28/2013

Gentlemen: Please furnish this office articles subject to the terms and conditions contained herein. Place of Delivery: Date of Delivery: Item No: Quantity 410 1 DPWH-Kalinga District Engineering Ofiice Delivery Term: Within seven (7) working days upon receipt of approved Payment Term: P.O. Unit cu.m. Description Manual Patching of Unpaved Road Surface Base Course Materials xxxxxxxxxxxxxxxxxxxxxxxxxxxx FOB OFFICE Completion of Delivery Amount 383,350.00

Unit Cost 935.00

Total amount in words:

Three Hundred Eighty Three Thousand Three Hundred Fifty 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 for everyday of delay shall be imposed. Very truly yours, Conforme: J. PERALTA ENTERPRISES
Signature over printed name of Supplier

383,350.00

ALEXANDER C. CASTAEDA District Engineer

Date:

Funds Available:

ALOBS NO. Amount

CLYDE G. CAIREL Accountant III

Completion of Delivery

Republic of the Phillipines

Department of Public Works and Highways Cordillera Administrative Region Kalinga District Engineering Office
Bulanao, Tabuk City, Kalinga

Date MEMORANDUM TO : THE BUDGET OFFICER Budget Unit, Financial Mgt. Section OBLIGATION REQUEST

SUBJECT

This is to request for the issuance of an Obligation Request for the following claim: Fund Amount Payee Payee Office/Address : : : : 383,350.00 J. PERALTA ENTERPRISES Bulanao, Tabuk City, Kalinga

Particulars

To obligate payment of Construction Materials for use in the Maintenance to Roadway & Related Features along Nambaran-Isabela Road, KO.513+113 - KO513+193

Saro / Saa # Date P.P.A. Legal Basis

: : : :

I certify that charges to appropriation/allotment are necessary, lawful and under my direct supervision. I also certify that supporting documents are valid, proper and legal. Your attention to this would be appreciated.

ERNESTO O. VECALDO Chief, Maintenance Section

SPMU/fmw

Maintenance to Roadway & Related Features along Nambaran-Isabela Road,

CHECK-LIST PROCESSING FOR PURCHASE ORDER

For Shopping/Small Value Procurement

CONTRACTOR/DEALER PROJECT LIMIT LOCATION

JJA AUTO MOTORPARTS & REPAIR CENTER

FOR USE OF BCM - 938 NISSAN FRONTIER PICK-UP

SUPPORTING DOCUMENTS 1. Copy of Approved Program of Works ( if for project) 2. Approved Budget for Contract ( ABC ) 3. Purchase Request 4. Invitation to Bid Small Value Procurement 5. Request for Quotation 6. Copy of P-GEP'S/DTI/Majors Permit of Certificate BAC Secretariat that said document are on file 7. Abstract of Bids 8. Bid Evaluation 9. BAC Resolution - For Small Value Procurement 10. Notice of Award - For Small Value Procurement 11. Purchase Order 12. Memo Request 13. OTHERS a. Supplies Ledger Card b. Request for Inspection & Pre-Repair Inspection c. History of Repair d. Certification

DATE

SUBMITTED

NOT SUBMITTED

Check & Received By:

NOTED:

MARIVIC T. PAGALA BAC Secretariat

ERNESTO O. VECALDO BAC Chairman

Republic of the Philippines

Department of Public Works and Highways

Cordillera Administrative Region

Kalinga District Engineering Office

Tabuk, Kalinga

MEMORANDUM

FOR :

ANGELO G. SANCHEZ
State Auditor III/ATL

FROM :

GERRY R. BAIS
Chief, Supply & Property Mgt. Unit

DATE:

October 22, 2012

Submitting herewith are duly approved PURCHASE ORDERS for your reference viz
Purchase Order No. Date Supplier
BONGDOEN'S HARDWARE & GEN. MERCHANDISE BONGDOEN'S HARDWARE & GEN. MERCHANDISE CORDILLERA HARDWARE

Projects
FOR USE OF CONSTRUCTION OF AMMACIAN WATER WORKS (Brgy Ammacian, Pinukpuk) FOR USE OF BANNONG WATER WORKS (Brgy Bagumbayan, Tabuk City) FOR USE OF COMPLETION OF DEEPWELL (Purok 6 Bulanao Tabuk City)

Particulars

Amount

2012-10-0221

22 October, 2012

CONSTRUCTION MATERIALS

Php54,702.00

2012-10-0226

22 October, 2012

CONSTRUCTION MATERIALS

Php126,801.00

2012-09-0205

27 September, 2012

CONSTRUCTION MATERIALS

Php28,057.34

2012-09-0195

24 September, 2012

CORDILLERA HARDWARE

FOR USE OF CONSTRUCTION OF CONSTRUCTION MATERIALS ONE UNIT DEEPWELL (Brgy Ipil, Tabuk City)

Php47,061.28

/rda

Republic of the Phillipines

Department of Public Works and Highways Cordillera Administrative Region Kalinga District Engineering Office
Bulanao, Tabuk City, Kalinga

INSPECTION & ACCEPTANCE REPORT

DPWH - Kalinga District Engineering Office
(Agency) SUPPLIER ARUGAY AUTO PARTS & FARM MACHINERIES PO NO. P.R. NO. 2012-10-0218 2012-09-390 Date: Date: October 16, 2012 September 26, 2012 AR No. OS No. 200-151-2012-10-026

Requisitioning Office/PURPOSE: For use in the REPAIR OF Fabricated steel sand screen. Date of Issue 10/16/201 2 OR # 0538 Qty 20 60 1 5 1
Unit of Issue

DESCRIPTION Welding Rod 1/8 Welding Cable Heavy Duty Welding Holder Welding Lens Welding Gloves xxxxxxxxxxxxxxxxxxxxx

U-COST 74.00 158.00 780.00 95.00 295.00

AMOUNT 1,480.00 9,480.00 780.00 475.00 295.00

kls. mtrs. pc. pcs. pair

12,510.00 INSPECTED Date Inspected: Inspected, verified and found in order as to quantity and specfications Date Received: Complete Partial ( Pls Specify quantity ) ACCEPTANCE

ROGELIO B. ABANILLA Administrative Assistant II

GERRY R. BAIS Chief, Property & Supply Unit

Republic of the Philippines

DEPARTMENT OF PUBLIC WORKS AND HIGHWAYS

CORDILLERA ADMINISTRATIVE REGION Kalinga District Engineering Office
Bulanao, Tabuk City, Kalinga

REQUISITION AND ISSUE SLIP

DPWH, Kalinga District Engineering Office Division Office BAL. ON HAND Responsibility Center DPWH-KDEO Code REQUISITION QTY 20 60 1 5 1 UNIT kls. mtrs. pc. pcs. pair RIS No.: SAI No.: 2012-12-2807 Date: Date: ISSUANCE December 10, 2012

DESCRIPTION Welding Rod 1/8 Welding Cable Heavy Duty Welding Holder Welding Lens Welding Gloves xxxxxxxxxxxxxxxxxxxxx

AMOUNT 1,480.00 9,480.00 780.00 475.00 295.00

SUPPLIED BY: ARUGAY AUTO PARTS & FARM MACHINERIES P.O. No. 2012-10-0218 October 16, 2012 Dated: 12,510.00
PURPOSE:

Requested By:

Approved By:

Issued By:

Received By:

Signature:
Printed Name:

Designation: Date:

MANUEL P. MADIO Engineer III

ALEXANDER C. CASTAEDA GERRY R. BAIS District Engineer Administrative Officer III

FREDERICK O. MALIDOM Engineer III

Republic of the Philippines DEPARTMENT OF PUBLIC WORKS AND HIGHWAYS CORDILLERA ADMINISTRATIVE REGION Kalinga District Engineering Office Bulanao, Tabuk City, Kalinga

DISBURSEMENT VOUCHER
MODE OF PAYMENT:

No.: _________________ Date: _________________

MDS Check
Payee/Office:

Commercial Check

ADA
TIN/Employee No.:

Others: 931-508-149

ARUGAY AUTO PARTS & FARM MACHINERIES Address:

Dagupan Centro, Tabuk City, Kalinga

OBR/OS No.:

Responsibility Center
Title: Code:

Particulars
Payment of materials for use in the repair of Fabricated Sand Screen Invoice #0538 & other supporting documents hereto attached in the amount of . . . . Gross Amount:

Amount

Less:

1% income tax 3% business tax

125.10 375.30

Net Amount: P.O. #: P.R. #: 2012-10-0218 2012-09-390 dtd. dtd. 10/16/12 9/26/12

Certified: Supporting documents complete and proper

Cash Available Subject to ADA For request Signature: Printed Name: Position: Date:

Approved for Payment: Twelve Thousand Nine & 60/100 Only

_________________________
CLYDE G. CAIREL Accountant III

Signature: Printed Name: Position : Date:

______________________________
ALEXANDER C. CASTAEDA District Engineer

____________________

____________________
JEV SETUP:

Received Payment
Bank Name:

Check/ ADA No. Printed Name:

Date: Signature:

ARUGAY AUTO PARTS & FARM MACHINERIES Official Receipt/Other Documents

SPMU/fmw

Date: JEV Number Date:

Date:

Republic of the Philippines NT OF PUBLIC WORKS AND HIGHWAYS LLERA ADMINISTRATIVE REGION alinga District Engineering Office Bulanao, Tabuk City, Kalinga
No.: _________________ Date: _________________

Commercial Check

ADA

Others: 931-508-149

Responsibility Center Amount

12,510.00 500.40 12,009.60

Twelve Thousand Nine & 60/100 Only

______________________________
ALEXANDER C. CASTAEDA District Engineer

____________________

Claimant:

J. PERALTA ENTERPRISES

CHECKLIST OF SUPPORTING DOCUMENTS per D.O. 08 series of 2012

for REGULAR PROCUREMENT
Disbursement Voucher (DV) Inspection & Acceptance Report 1.a) Charge Invoice(s) #_______________________ 1.b) Delivery Receipt(s) #______________________ 2. Post Inspection & Acceptance Report (BOE-for Spareparts) 3. Test Results, for items that are subject to Test 4. Certified True Copy of Submission of Purchase/Work Order to COA-Resident Auditor 5. Certificate as to Availability of Funds (CAF) 6. Obligation Request (ObR) 7. Memorandum Request (MR) 8. Purchase Order 9. Performance Bond 10. Notice of Award 11. Bid Documents 11.a) Resolution of award 11.b) Abstract of Bids 11.c) BAC-TWG Evaluation Sheet 11.d) Quotation 12. Advertisement 12.a) Newspaper (if applicable) 12.b) PhilGEPS 12.c) Conspicuous Places 13. Purchase Request 13.a) Approved Annual Procurement Plan(APP) 13.b) Project Procurement Management Plan (PPMP) Additional Requirements on Spare Parts for Motor Vehicle and other Equipment 13.c) Request for repair & Pre-Repair Inspection 13.d) Approved Job Order (JO) 13.e) Approved Waste Material Report (WMR) 13.f) History of Repair 13.g) Certification that damage is due for fair wear & tear 13.h) Certified True Copy of acknowledgement Receipt of Equipment (ARE) 13.i) Certified True Copy of current LTO Registration 13.j) Certification that the vehicles is included in the Department Inventory of Vehicle Additional Requirements for IT Equipment, Aircon & Other Equipment 13.c) Pre - Inspection Report 13.d) Certified True Copy of Acknowledgement Receipt of Equipment(ARE) 13.e) Aproved Authority to Purchase (from DPWH-MIS for IT) Additional Requirements for SUPPLIES & MATERIALS 13.c) Approved Budget Cost (ABC) 13.d) Program of Work with detailed estimates Other: CERTIFIED CORRECT: as to completeness, propriety, validity and veracity of the document attached

GERRY R. BAIS
Supply & Property Mgt. Unit

VERIFIED BY:

____________________
Head, Internal Control Unit ______ Supporting documents attached

Republic of the Philippines DEPARTMENT OF PUBLIC WORKS AND HIGHWAYS Office of the Regional Director Cordillera Administrative Region Engineer's Hill, Baguio City

ACKNOWLEDGEMENT RECEIPT FOR EQUIPMENT

Date: Quantity 1 Unit set Description Sala Set w/ Center Table xxxxxxxxxxxxxxxxxxxxxxxxxxxx Property No.

P.O.#: 02-2012-006 dated 2/14/2012 ALOBS #: 101-300-11-12-1154-E SR2010-03-000731

Received by:

Received from:

ATTY. REX B. PADERES Signature Over Printed Name OIC-Chief, Administrative Division

LUISITO N. PASCUA,JR. Signature Over Printed Name Supply Officer III Position/Office Date

WASTE MATERIALS REPORT

Place of Storage: DPWH-KDEO BODEGA ITEMS FOR DISPOSAL Item 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Qty 1 1 4 4 1 1 2 1 1 2 1 2 2 1 Unit assy. pc. pcs. pcs. assy. pc. pcs. pc. pc. pcs. pc. pcs. pcs. pc. Description Shifting Lever w/ Cable Fan Blade Brake Shoe w/ Lining Disc Pad Brake Master Pitman Arm Axle Bearing Cltch Disc Clutch Bearing Side Mirror Wiper Arm w/ Blade Cover, Hub Backlight Hyrauvac xxxxxxxxxxxxxxxxxxxxxxxxx Record of Sales O.R. No. Amount (P) Date:

Taken from AIP-111 Mitsubishi Strada TOTAL Returned By Received By -

Certified Correct

Disposal Approved:

GERRY R. BAIS Administrative Officer III Property Officer CERTIFICATE OF INSPECTOR I hereby certify that this property was disposed of a follows: Item Item Item Item 1-14 Destroyed Sold at private sale Sold at public auction Transferred without cost to

Property Inspector:

Witness to disposition:

RAFAEL E. BAKIDAN Mech'l. Engineer II

ANGELO G. SANCHEZ State Auditor III