BUDGET UTILIZATION REQUEST AND STATUS Serial No.

:
Republic of the Philippines Date : 5-Jun-17
CAVITE STATE UNIVERSITY
Don Severino de las Alas Campus
Indang, Cavite
(6346) 4150-010 / 4150-011 TF Fund Cluster:
www.cvsu.edu.ph

Payee MAGNO N. MOJICA

Office

Address

UACS Object
Responsibility Center Particulars MFO/PAP Code/ Amount
Expenditures

Obligation for: Reimbursement for the cost of

SUPPLY TEV/DIEM for the month of April 2017 as per
supporting documents amounting 320.00
to…………………

Total 320.00

A. B.
Certified: Charges to appropriation/budget Certified: Budget available and utilized
necessary, lawful and under my direct supervision;and for the purpose/adjustment necessary as
supporting documents valid, proper and legal indicated above

Signature : Signature :
Printed Name: HENRY O. GARCIA Printed Name: CORAZON R. RODRIN
Position : VPASS Position : Administrative Officer V
Head, Requesting Office/Authorized Representative Head, Budget Division/Unit/Authorized Representative
Date : Date :

C. STATUS OF UTILIZATION
Reference Amount
Balance
Payable Payment Due and
BURS/JEV/RCI/ Not Yet
Date Particulars Demandab
RADAI/RTRAI No. Due le
(b) (c) (a-b) (b-c)
 OBLIGATION REQUEST AND STATUS Serial No. :

Republic of the Philippines

CAVITE STATE UNIVERSITY Date :
Don Severino de las Alas Campus
Indang, Cavite
(6346) 4150-010 / 4150-011 TF
www.cvsu.edu.ph Fund Cluster:

Payee

Office

Address

UACS Object
Responsibility Center Particulars MFO/PAP Amount
Code

Obligation for:

Total -
A. Certified: Charges to appropriation/allotment are B. Certified: Allotment available and obligated
necessary, lawful and under my direct supervision;and for the purpose/adjustment necessary as
supporting documents valid, proper and legal indicated above

Signature : Signature

Printed Name: HERNANDO D. ROBLES Printed Name CORAZON R. RODRIN

Position : VP-Administration and Support Services Position : Administrative Officer V

Head, Requesting Office/Authorized Representative Head, Budget Division/Unit/Authorized Representative
Date : Date :

C. STATUS OF OBLIGATION
Reference Amount
Balance
ORS/JEV/Check/ Obligation Payable Payment Due and
Date Particulars Not Yet Due
ADA/TRA No. Demandable
(a) (b) (c) (a-b) (b-c)
 Republic of the Philippines
Fund Cluster :
CAVITE STATE UNIVERSITY
Don Severino de las Alas Campus
Indang, Cavite
(6346) 4150-010 / 4150-011 TF Date : June 05, 2017
www.cvsu.edu.ph DV No. :
DISBURSEMENT VOUCHER
Mode of MDS Check Commercial Check ADA Others (Please specify)
Payment _________________
TIN/Employee No.: ORS/BURS No.:
Payee MAGNO N. MOJICA
Address
Responsibility
Particulars MFO/PAP Amount
Center
Reimbursement of TEV/DIEM for the month of April
2017 as per attached supporting documents amounting
to……………………………………………….. 320.00

Amount Due 320.00

A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.

HENRY O. GARCIA
VPASS
B. Accounting Entry:
Account Title UACS Code Debit Credit

C. Certified: D. Approved for Payment

Cash available
Subject to Authority to Debit Account (when applicable)

Supp

Signature Signature
Printed Name LOLITA G. HERRERA Printed Name HERNANDO D. ROBLES
Position Chief, Administrative Officer Position University President
Date Date
E. Receipt of Payment JEV No.
Check/ Date : Bank Name & Account Number:
ADA No. :
Date : Printed Name: Date
Signature :
 Date :
Signature :

Official Receipt No. & Date/Other Documents

 PURCHASE REQUEST

Entity Name: CAVITE STATE UNIVERSITY Fund Cluster:

Office/ PR No. __________________________________ Date

Section Responsibility Center Code: ____________________

Stock/
Unit Item Description Quantity Unit Cost Total Cost
Property No.
1 Fuel and toll 4,912.00

4,912.00

Purpose:

Requested by:

Signature:
Printed Name: RHODORA S. CRIZALDO
Designation: OIC, OUP
 CAVITE STATE UNIVERSITY
Indang, Cavite
Telefax: 046-862-0852
email address: supplyoffice@cvsu.edu.ph

REQUEST FOR QUOTATION

Date:
Ref. No.
Company:
Address:
TIN:

Sir/Madam:

Please quote your lowest price on the item/s listed below, subject to the Terms and Conditions on the last page,
stating the shortest time of delivery and submit your quotation duly signed by your authorized representative not later than
.

ROSALIE A. PELLE
NOTE: Administrative Officer V
1. All entries must be written legibly or typewritten.
2. Delivery Period: ____ calendar days from the receipt of P.O.
3. Warranty shall be for a period of six (6) months for supplies and materials. Warranty for equipment must not be
less than one (1) year from the date of acceptance and shall be accompanied with Warranty Certificate.
4. Price validity shall be for a period of 30 calendar days.
5. Bidders shall indicate the brand and model of the items being offered.
6. Approved Budget for the Contract (ABC): P

ITEM ITEM & DESCRIPTION QTY. UNIT PRICE TOTAL PRICE

1

After having carefully read and accepted your Terms and Conditions, I quote you on the item/s at prices noted above.

Printed Name/Signature

Tel. No./E-mail address

Date

Canvassed by:
Please print at the back

IMPORTANT, PLEASE READ:

TERMS AND CONDITIONS

1. Bidders must possess PhilGEPS Registration Certificate, Valid Business Permit,

BIR Registration and Official Receipt (OR) duly registered with the BIR. Copy of the
first three documents must be submitted to the BAC.

2. Bidders shall provide correct and accurate information required in this form.

3. Bidders may quote for any or all the items.

4. Price quotation/s must be valid for a period of sixty (60) calendar days from
date of submission.

5. Price quotation/s shall include all taxes, duties and/or levies payable.

6. Quotations exceeding the Approved Budget for the Contract (ABC) shall be rejected.

7. Any erasures or overwriting should be duly signed or initialed by you or your

authorized representative.
8. Brochure and/or manual of operation of the product being offered must be attached
with the quotation and the bidder/supplier must be able to demonstrate the operation
of the machine upon request.

9. Terms of payment shall be Charged Account unless specified.

10. The item/s shall be delivered within the specified number of days of delivery.

11. Liquidated damages equivalent to one tenth (1/10) of one percent (1%) of the value
of the goods not delivered within the prescribed delivery period shall be imposed
per day of delay. The University shall rescind the contract once the cumulative
amount of liquidated damages reaches ten percent (10%) of the amount of the
contract, without prejudice to other courses of action and remedies open to it.
 ABSTRACT OF CANVASS

AAE: Project: Date of Bidding:______________________

Time of Bidding:______________________

ITEM NO. QTY. UNIT SPECIFICATIONS/DESCRIPTION

-
1

_____________________________________________
CHAIRMAN

Requisitioner Member Member Member

 PURCHASE ORDER
CAVITE STATE UNIVERSITY
Entity Name

Supplier: VARIOUS SUPPLIER P.O. No.:

Address: Date :
TIN : Mode of
Procurement

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

Place of Delivery : CvSU-GEN.TRIAS CAMPUS Delivery Term: FOB Shopping Point

Date of Delivery : Payment Term: CASH

Stock/
Unit Item Description Quantity Unit Cost Total Cost
Property No.
1 mtr Level Hose 4 12.00 48.00
2 can Solignum colourless 1ltr 1 510.00 510.00
3 pc Elastoseal 1 60.00 60.00
4 mtr Garden Hose 2 30.00 60.00
5 pc Hammer 1 330.00 330.00
6 pc Saw 1 250.00 250.00
7 pc Chrome Faucet 1 175.00 175.00
8 pc Teflon 1 15.00 15.00
9 btl Thinner 1 35.00 35.00
10 pc Empty boxes 4 15.50 62.00
11 pc Cellophane (red) 2 10.00 20.00
12 pc Mirror 1 100.00 100.00
13 pc Stryo Board 5 60.00 300.00
14 pack Colored paper 10's 1 30.00 30.00
15 pc Cutter 1 10.00 10.00
16 pc Roller Tray 2 45.00 90.00
17 sack Portland cement 1 230.00 230.00
18 pc Sand paper 4 15.00 60.00
19 pc Drill bit 1 100.00 100.00
20 pc Double Sided tape 5 20.00 100.00
21 pc Cutter 1 10.00 10.00
22 pc Cartolina neon color 3 7.00 21.00
(Total Amount in Words) TWO THOUSAND SIX HUNDRED SIXTEEN AND 00/100 2,616.00
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.
Very truly yours,

HERNANDO D. ROBLES
Conforme: University President
VARIOUS SUPPLIER
Signature over Printed Name of Supplier
Sep-15
Date

Fund Cluster: ORS/BURS No.:

Funds Available: Date of ORS/BURS:
Amount :
LOLITA G. HERRERA
Chief Administrative Officer
 PURCHASE ORDER
CAVITE STATE UNIVERSITY
Entity Name

Supplier: VARIOUS SUPPLIER P.O. No.:

Address: Date :
TIN : Mode of
Procurement

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

Place of Delivery : CvSU-GEN.TRIAS CAMPUS Delivery Term: FOB Shopping Point

Date of Delivery : Payment Term: CASH
Stock/
Unit Item Description Quantity Unit Cost Total Cost
Property No.
23 pc Scissor 1 15.00 15.00
24 pc Glue 1 30.00 30.00
25 pc Colored Paper 5 1.00 5.00
26 pc Photo paper 10 5.00 50.00
27 pc Cutter 2 10.00 20.00
28 pc Paint brush 2 40.00 80.00
29 pc Baby roller 1 60.00 60.00
30 pc Paint brush 2 80.00 160.00
31 btl Thinner 2 35.00 70.00
32 pc Sink strainer 1 80.00 80.00
33 pc Coupling 2 1 25.00 25.00
34 kilo Pako 0.5 80.00 40.00
35 can Nation Maple (paint) 1 160.00 160.00
36 pc 7/7 60ml 1 60.00 60.00
37 pc Bulb 11w 2 99.75 199.50
38 pc Bulb 15w 2 104.75 209.50
39 pc Tissue holder 2 49.75 99.50
40 ltr Fresh milk 1ltr 3 110.00 330.00
41 pack Pastillas 9 55.00 495.00
42 btl Atsara 3 80.00 240.00
43 bx Malagkit (bibingka) 4 85.00 340.00
44 bx Malagkit (bibingka) 2 85.00 170.00
(Total Amount in Words) TWO THOUSAND NINE HUNDRED THIRTY EIGHT AND 50/100 2,938.50
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.

Very truly yours,

HERNANDO D. ROBLES
Conforme: University President
VARIOUS SUPPLIER
Signature over Printed Name of Supplier
Sep-15
Date

Fund Cluster: ORS/BURS No.:

Funds Available: Date of ORS/BURS:

Amount :
 LOLITA G. HERRERA
Chief Administrative Officer
 PURCHASE ORDER
CAVITE STATE UNIVERSITY
Entity Name

Supplier: VARIOUS SUPPLIER P.O. No.:

Address: Date :
TIN : Mode of
Procurement
Gentlemen:
Please furnish this office the following articles subject to the terms and conditions contained herein:
Place of Delivery : CvSU-GEN.TRIAS CAMPUS Delivery Term: FOB Shopping Point
Date of Delivery : Payment Term CASH
Stock/
Unit Item Description Quantity Unit Cost Total Cost
Property No.
45 bx Malagkit (sapin-sapin) 1 120.00 120.00
46 pack Grapes 1 50.00 50.00
47 pack Orange 1 75.00 75.00
48 pack Grapes 1 50.00 50.00
49 btl Del monte 4 seasons 2 31.00 62.00
50 btl Del monte pineapple juice 1 34.00 34.00
51 btl Smart C-juice 1 34.00 34.00
52 btl Del monte pineapple juice 2 31.00 62.00
53 pack Fox Candy 3 20.00 60.00
54 pack Nachos chips 1 145.00 145.00
55 pack Chips ahoy 1 150.00 150.00
56 pc Hershey kisses 2 56.00 112.00
57 pack Ginataang Bilo-bilo 1 600.00 600.00
58 bilao Puto 1 400.00 400.00
59 bilao Pancit malabon 1 800.00 800.00
60 pc Colored paper 30 1.00 30.00
61 pack Elastoseal small 1 60.00 60.00
-
-
-
-
-
(Total Amount in Words) TWO THOUSAND EIGTH HUNDRED FORTY FOUR AND 00/100 2,844.00
(Grand total) EIGHT THOUSAND THREE HUNDRED NINETY EIGTH AND 50/100 8,398.50

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.
Very truly yours,

HERNANDO D. ROBLES
Conforme: University President
VARIOUS SUPPLIER
Signature over Printed Name of Supplier
Sep-15
Date

Fund Cluster: ORS/BURS No.:

Funds Available: Date of ORS/BURS:
 Amount :
LOLITA G. HERRERA
Chief Administrative Officer
 REPUBLIC OF THE PHILIPPINES
CAVITE STATE UNIVERSITY WORK ORDER NO. ____________20 ____
Indang, Cavite

DATE ISSUED:

TO:

ITEM NO: WORK TO BE DONE AMOUNT

Contract Period:
(No. of days)
Date of Effectivity:

Date of completio
REQUISITIONER: FUNDS AVAILABLE:

LOLITA G. HERRERA
Signature Chief Administrative Officer

RECOMMENDING APPROVAL:
PURPOSE:
HERNANDO D. ROBLES
Performance Bond: VPASS

Received Work Order and bind myself to the conditions

stipulated in the canvass/proposal dated APPROVED:

Printed Name & Signature

Date received _________________________________________ RHODORA S. CRIZALDO
Contractor's License No. ________________________________ OIC, OUP
Bond No. _____________________________________________
Amount of Bond _______________________________________

(To be accomplished in three copies: (1) for the Supply & Property Office (1) for the Administrative Office, (1) to
be attached to the Voucher)
 INSPECTION & ACCEPTANCE REPORT

Entity Name: CAVITE STATE UNIVERSITY Fund Cluster:

Supplier: VARIOUS SUPPLIER IAR No.:

PO No./Date Date:

Requisitioning Office/Dept. GEN. TRIAS CAMPUS Invoice No.

Responsibility Center Code: Date:

Stock / Description
Property No. Unit Quantity

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
INSPECTION ACCEPTANCE

Date Inspected: ____________________________ Date Received: ____________________________

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

specifications. Partial (pls. specify quantity)

___________________________________ ROSALIE A. PELLE

Inspection Officer/Inspection Committee Administrative Officer V
 PROPERTY ACKNOWLEDGEMENT RECEIPT

Entity Name: CAVITE STATE UNIVERSITY

Fund Cluster: PAR No.

Qty. Unit Description Property Date Unit Total

Number Acquired Cost Amount

Received by: Issued by:

______________________________________ ROSALIE A. PELLE

Signature Over Printed Name
______________________________________
Position/Office
_____________________________________
Date
Signature over Printer Name
Administrative Officer V
Position/Office
____________________________
Date
 INVENTORY CUSTODIAN SLIP

Entity Name: CAVITE STATE UNIVERSITY

Fund Cluster: ICS No.

Amount Date Inventory Estimated

Qty Unit Unit Cost Total Cost Description Acquired Item No. Useful Life

Received from: Received by

ROSALIE A. PELLE
Signature Over Printed Name Signature Over Printed Name
Administrative Officer V
Position/Office Position/Office
______________________________
Date Date
 Serial No. :
LIQUIDATION REPORT Date:
Period Covered:______________________ Responsibility Center Code:

Name of Entity: CAVITE STATE UNIVERSITY

Fund Cluster:

PARTICULARS AMOUNT

Liquidation of Cash Advance Re: Travelling Expenses

22,502.00

TOTAL AMOUNT SPENT 22,502.00

### AMOUNT OF CASH ADVANCE PER DV NO. MOOE-16- DTD. 24,200.00

AMOUNT TO BE REFUNDED PER OR NO. DTD. 1,698.00

AMOUNT TO BE REIMBURSED
A. Certified: Correctness of B. Certified: Purpose of travel/cash C. Certified: Supporting documents
the above data advance duly accomplished complete and proper

RHODORA S. CRIZALDO LOLITA G. HERRERA JEV No.

Claimant Immediate Supervisor Chief Admin Officer
 REQUEST FOR PRE-REPAIR INSPECTION
No.
Date:
DESCRIPTION OF PROPERTY

Item & Description: Brand/Model:

Serial/Engine No.: Property Number:
Acquisition Date: Acquisition Cost:
Date of last repair: Nature of last repair:

DEFECTS/COMPLAINTS:

WORK TO BE DONE:

PARTS TO BE REPLACED/SUPPLIED:

Requested by:

Name & Signature of Requisitioner

PRE-REPAIR INSPECTION REPORT

FINDINGS/RECOMMENDATIONS:

Inspected by: Noted by:

ROSALIE A. PELLE
Name & Signature of Inspector Administrative Officer V

Date Date

POST-REPAIR INSPECTION REPORT

COMMENTS ON WORK DONE:

Inspected by: Noted by:

ROSALIE A. PELLE
Name & Signature of Inspector Administrative Officer V

Date Date
 ITINERARY OF TRAVEL

Entity Name: CAVITE STATE UNIVERSITY

Fund Cluster: No.: _______________

Name : MAGNO N. MOJICA Date of Travel: March 7 and 10, 2017

Position: DRIVER Purpose of Travel:
Official Station :
Places to be visited TIME Means of Transpor- Per Total
Date Others
(Destination) Departure Arrival Transportation station Diem Amount
4/20/2017 CvSU to Batangas 6:45 AM 9:00 AM RP 320.00 320.00
Batangas to CvSU 3:30 PM 6:30 PM

320.00

TOTAL
Prepared by :

I certify that : (1) I have reviewed the foregoing MAGNO N. MOJICA

itinerary, (2) the travel is necessary to the Signature over Printed Name
service, (3) the period covered is reasonable
and (4) the expenses claimed are proper. Approved by:

DAVID L. CERO HERNANDO D. ROBLES

Signature over Printed Name Signature over Printed Name
Immediate Supervisor Agency Head/Authorized Representative
 CERTIFICATION OF TRAVEL COMPLETED

Entity Name: CAVITE STATE UNIVERSITY Fund Cluster : ___________________

DR. HERNANDO D. ROBLES SUPPLY

President Station

I HEREBY CERTIFY THAT I have completed the travel authorization in the Travel Order/
Itinerary of Travel No. __________ dated April 20, 2017 under conditions indicated below:

Strictly in accordance with the approved itinerary.

Cut short as explained below. Excess payment in the amount of

P________ was refunded under O.R. No. ______________ dated __________.

Extended as explained below. Additional itenerary was submitted.

Other deviations as explained below.

Explanation or justifications:

Evidence of Travel:

Used tickets
Certificate of Apperance
Others

Respectfully submitted:

MAGNO N. MOJICA
Name of Employee

On evidence and information of which I have knowledge, the travel was actually undertaken.

Approved:

HERNANDO D. ROBLES, Ed.D

President