DATE CONTROL NUMBER

DESCRIPTION
NAME AND ADDRESS AGENCY
OF REQUESTING
DEPARTMENT OF EDUCATION - ACCT. CODE
101
______________________ ELEMENTARY SCHOOL
AGENCY AGENCY CONTROL No.
AGENCY PROCUREMENT REQUEST PS APR No.
To: THE PROCUREMENT SERVICE
DBM - Region III
Gov't Center, Maimpis (Date Prepared)
Angeles, Pampanga

PLEASE CHECK ( / ) APPROPRIATE BOX ON ACTION REQUESTED ON THE ITEM LISTED BELOW

[ ] Please issue common-use supplies/materials per Price List No. _____________________ dated _______________________
Mode of Delivery : [ ] Pick-up (Fast Lane) [ ] Pick-up schedule [ ] Delivery (door-to-door)

In case fund is not sufficient :[ ] Reduce Quantity [ ] Bill Us [ ] Charged to Unutilized Deposit, APR No. __________ Dated: ______________

[ ] Please purchase for our agency non-common items. Attached herewith:

[ ] Complete Specifications [ ] Obligation Request (ObR) [ ] Others, pls. specify ________________
[ ] Certificate of Budget Allocation (CBA) [ ] Payment ________________________________

IMPORTANT!! PLEASE SEE THE INSTRUCTIONS/CONDITIONS AT THE BACK OF ORIGINAL COPY

ITEM
ITEM AND DESCRIPTION/SPECIFICATIONS/STOCK NO. QUANTITY UNIT Unit Price AMOUNT
NO.
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0.00
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0.00
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0.00
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0.00
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0.00
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0.00
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0.00
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0.00
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0.00
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0.00
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0.00
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0.00
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0.00
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0.00
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0.00
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0.00
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0.00
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0.00
Total AMOUNT 0.00
NOTE : ALL SIGNATURES MUST BE OVER PRINTED NAME
STOCKS REQUESTED ARE CERTIFIED TO BE FUNDS CERTIFIED AVAILABLE/ APPROVED:
WITHIN APPROVED PROGRAM: Verified from SOB & APP:

ROMINA D. VELASCO
School Property Custodian Senior Bookkeeper School Principal/Head
[ ] FUNDS DEPOSITED WITH PS [ ] _________________ CHECK No. ______________
IN THE AMOUNT OF ___________________________________________ (P _______________) ENCLOSED
 ANNUAL PRO
For Common-

INSTRUCTIONS IN FILLING OUT THE ANNUAL PROCUREMENT PLAN (APP) FORM:

1. Select the appropriate worksheet depending on the nearest Regional/Provincial Depot in
2. For Sub - Depots please refer to the following (Arranged/ Classified according to commm
a. Bukidnon, Puerto Princesa Palawan, Biliran, Borongan, Misamis Occ
b. Misamis Oriental, Bacolod, Calbayog, Bontoc and Northern Samar
c. Surigao Del Norte - Surigao Del Norte
d. Zamboanga Sibugay- Zamboanga Sibugay
e. Camiguin - Camiguin
3. Indicate the agency’s monthly requirement per item in the APP form. The form will aut
4. APPs are considered incorrect if: a) form used is other than the prescribed format d
in Portion A of the APP. The agency will be informed through e-mail if the submissi
5. For Other Items not available from the Procurement Service but regularly purchased from oth
purchase of the item/s. These items will be evaluated by the Procurement Service and m
virtual store as soon as it is procured and made available by the Procurement Service.
6. The accomplished HARD COPY of the APP-CSE shall be submitted in the following mann
a. DBM Central Office- for entities in the Central Office
b. DBM Regional Office (RO)- for regional offices, operating units of D
The accomplished SOFT COPY of the APP-CSE shall be submitted to the following emai
a. [email protected] For central and regional offices of all natio
b. [email protected] For main and other campuses of all state
c. [email protected] For all central and regional offices of go
d. [email protected] For primary and secondary schools
e. [email protected] - For Local government units
7. Consistent with National Budget Circular No. 555, the APP for FY 2017 must be submitte
8. Rename your APP file in the following format: APP2017- Name of Agency- Region (e.g. AP
9. For further assistance/clarification, agencies may call the Planning Division of the Procur

Department/Bureau/Office:____________________________________________ Agency Account Code: ___

Region: ___________________________________________________________
Address:___________________________________________________________
___________________________________________________________

Unit of
Item & Specifications Measur
e Jan Feb March

A. AVAILABLE AT PROCUREMENT SERVICE STORES

COMMON ELECTRICAL SUPPLIES
1 BATTERY, size AA, alkaline, 2 pieces per blister pack pack
2 BATTERY, size AAA, alkaline, 2 pieces per blister pack pack
 3 BATTERY, size D, alkaline, 2 pieces per blister pack pack
4 FLUORESCENT LAMP, tubular, 28 watts tube
5 FLUORESCENT LAMP, tubular, 36 watts tube
COMPACT FLUORESCENT LAMP, 18 watts, 1 piece in
6 piece
individual box
7 TAPE, electrical roll

COMMON OFFICE SUPPLIES

1 ACETATE, gauge #3, 50m per roll roll
2 AIR FRESHENER, 280mL/can can
3 ALCOHOL, 70%, ethyl, 500ml bottle
4 CARBON FILM, A4 size, 100 sheets per box box
CARBON FILM, PE, black, 216mm x 30mm, 100 sheets
5 box
per box
6 CARTOLINA, assorted color, 20 pieces per pack pack
7 CHALK, white, dustless, 100 pieces per box box
8 CLEARBOOK, A4 size piece
9 CLEARBOOK, Legal size piece
10 CLIP, backfold, 19mm, 12 pieces per box box
11 CLIP, backfold, 25mm, 12 pieces per box box
12 CLIP, backfold, 32mm, 12 pieces per box box
13 CLIP, backfold, 50mm, 12 pieces per box box
CORRECTION TAPE, 6 meters(min), 1 piece in
14 piece
individual plastic
15 DATA FILE BOX, made with chipboard, with closed ends box
16 DATA FOLDER, made with chipboard, taglia lock piece
ENVELOPE, DOCUMENTARY, for A4 size document, 500
17 box
pieces per box
ENVELOPE, DOCUMENTARY, for Legal size document,
18 box
500 pieces per box
ENVELOPE, EXPANDING, KRAFTBOARD, for legal size
19 box
documents, 100 pieces per box
20 ENVELOPE, EXPANDING, plastic piece
21 ENVELOPE, MAILING, 500 pieces per box, 80 gsm box
ENVELOPE, MAILING, with window, 500 pieces per box,
22 box
80 gsm
23 ERASER, felt, for blackboard/whiteboard piece
24 ERASER, plastic or rubber piece
25 FASTENER, for paper, metal, 50 sets per box box
FILE ORGANIZER, expanding, legal, plastic, assorted
26 piece
colors
27 FILE TAB DIVIDER, A4, five (5) colors per set set
28 FILE TAB DIVIDER, Legal Size, five(5) colors per set set
29 FOLDER, Fancy, A4, 50s/ bundle bundle
30 FOLDER, Fancy, Legal, 50 pieces per bundle bundle
31 FOLDER, L-type, A4, 50 pieces pack pack
32 FOLDER, L-type, Legal size, 50 pieces per pack pack
33 FOLDER, Pressboard, size 210mm x 370mm, 100s/box box
34 FOLDER, Tagboard, A4, 100 pieces per pack pack
35 FOLDER, Tagboard, Legal size, 100 pieces per pack pack
36 GLUE, all purpose, 300 grams min. jar
37 INDEX TAB, self-adhesive, 5 set/box, assorted colors box
38 LOOSELEAF COVER, 50sets per bundle bundle
39 MAGAZINE FILE BOX, LARGE piece
40 MARKER, fluorescent, 3 colors per set set
41 MARKER, whiteboard, bullet type, black piece
42 MARKER, whiteboard, bullet type, blue piece
43 MARKER, whiteboard, bullet type, red piece
44 MARKER, permanent, bullet type, black piece
45 MARKER, permanent, bullet type, blue piece
46 MARKER, permanent, bullet type, red piece
47 NOTE BOOK, stenographer's, 40 leaves, spiral piece
48 NOTE PAD, stick-on, (2"x3"), 100 sheets per pad pad
49 NOTE PAD, stick-on, (3"x3"), 100 sheets per pad pad
50 NOTE PAD, stick-on, (3"x4"), 100 sheets per pad pad
51 PAD PAPER, Ruled pad
52 PAPER CLIP, gem type, 48mm, 100 pieces per box box
53 PAPER CLIP, gem type, 32mm, 100 pieces per box box
54 PAPER, MULTICOPY, 80gsm, size: 210mm x 297mm ream
55 PAPER, MULTICOPY, 80gsm, size: 216mm x 330mm ream
56 PAPER, Multi-Purpose (COPY) A4, 70gsm ream
57 PAPER, Multi-Purpose (COPY), Legal size, 70gsm ream
PARCHMENT PAPER, A4 size, 80 gsm, 100 sheets per
58 ream
pack]
59 PAPER, Thermal, 216mm x 30m roll
60 PENCIL, lead, w/eraser, 0ne(1) dozen per box box
61 PHILIPPINE NATIONAL FLAG piece
62 RECORD BOOK, 300 pages, size: 214mm x 278mm min book
63 RECORD BOOK, 500 pages, size: 214mm x 278mm min book
64 RING BINDER, Plastic 32mm, 10 pieces per bundle bundle
65 RUBBER BAND, 70mm min lay flat length (#18) box
66 RULER, plastic, 450mm, 1 piece in individual plastic piece
67 SIGN PEN, black piece
68 SIGN PEN, blue piece
69 SIGN PEN, red piece
70 STAMP PAD INK, violet, 50mL bottle
71 STAMP PAD, felt pad, min 60mm x 100mm piece
72 STAPLE WIRE, Heavy duty, 23/13 box
73 STAPLE WIRE, Standard box
74 TAPE, masking, 24mm, 50 meters length roll
75 TAPE, masking, 48mm, 50 meters length roll
76 TAPE, transparent, 24mm, 50 meters roll
77 TAPE, transparent, 48mm, 50 meters roll
78 TAPE, packaging, 48mm, 50 meters length roll
79 TOILET TISSUE, 12 rolls per pack pack
80 TWINE, plastic, one kilo per roll roll
81 WRAPPING PAPER, kraft, 50 sheets per pack pack

COMMON OFFICE DEVICES

1 CUTTER BLADE, heavy duty cutter, 10 pieces per tube tube
2 CUTTER KNIFE, heavy duty piece
3 DATING AND STAMPING MACHINE piece
4 PENCIL SHARPENER, 1 piece in indiviual plastic case piece
PUNCHER, paper, heavy duty, with two hole guide, 1
5 piece
piece in individual box
6 SCISSORS, (6") pair
7 STAPLER, standard piece
STAPLER, binder type, heavy duty for high volume
8 stapling,
25-135sheets of 70gsm bond paper stapling piece
capacity, min 100 staples, with adjustable paper guide
9 STAPLE REMOVER, plier type piece
10 TAPE DISPENSER, table top piece
11 WASTE BASKET, non-rigid plastic piece

COMMON JANITORIAL SUPPLIES

1 BROOM, soft (tambo) piece
2 BROOM, stick (tingting) piece
3 CLEANER, TOILET BOWL AND URINAL, 900-1000ml cap bottle
4 CLEANSER, scouring powder, 350grams/can can
5 DETERGENT POWDER, all purpose, 1kilo/pouch pouch
6 DISINFECTANT SPRAY, 400-550 grams can
7 DUST PAN, non-rigid plastic piece
8 FLOOR WAX, Paste, red can
9 FURNITURE CLEANER, aerosol, 300mL/can can
10 INSECTICIDE, aerosol type, 600mL/can can
11 MOPBUCKET piece
12 MOPHANDLE, screw type, aluminum handle piece
13 MOPHEAD, made of rayon piece
14 RAG, all cotton, 32 pieces per kilo per bundle bundle
15 SCOURING PAD, 5 pieces per pack pack
16 TRASHBAG, plastic, transparent, 10pcs/roll roll
17 DISINFECTANT, bleaching solution cont
 COMMON OFFICE EQUIPMENT
BINDING AND PUNCHING MACHINE, two(2) hand lever
system, 34cm or 13" (24 holes) punching, width
1 unit
adjustable to any format, binds 425 sheets, or up to 2"
thick, all metal construction
CALCULATOR, COMPACT, electronic, 12 digits cap, 1
2 unit
unit in individual box
3 CALCULATOR, SCIENTIFIC, 1 unit per box unit
4 CHAIR, monobloc, without armrest, beige piece
5 CHAIR, monobloc, without armrest, white piece
DIGITAL VOICE RECORDER, 4GB (expandable), 1 unit in
6 unit
individual box
DOCUMENT CAMERA, four(4) reference points
7 demarcate viewing area, 16x(1600%) consecutive unit
zoom, PC and Doc Cam video switcher, plug and play
8 ELECTRIC FAN, industrial unit
9 ELECTRIC FAN, orbit type unit
10 ELECTRIC FAN, stand type unit
11 ELECTRIC FAN, wall type unit
FACSIMILE MACHINE, uses thermal paper, 50m/roll, for
documents 216mm x 600mm, 15 sec, transmission
12 speed, running width 2018mm, document feeder holds unit
10 pages, with automatic paper cutter, redial, and
fax/tel switchove
FIRE EXTINGUISHER, dry chemical, for ABC class of fire,
13 stored pressure type,non-electrical conductor,non- unit
toxic, non-corrosive, 4.5kg (10lbs.), brand new
FIRE EXTINGUISHER, pure HCFC 123, with fire rating of
1A, 1BC, for ABC class of fire, stored pressure type,
14 unit
non-electrical conductor, non-corrosive, 4.5kg (10 lbs),
brand new PROJECTOR, 4000 ansi Lumens, 3600
MULTIMEDIA
15 hours lamp life, supports SVGA to SXGA, (compressed) unit
resolution
PAPER TRIMMER/CUTTING MACHINE, max paper size:
16 B4, 30 sheets cutting cap., automatic clamping, unit
stationery blade guard, A4-A6 format indications
PAPER SHREDDER, 0.06m/sec shred speed, cuts 6-8
17 unit
sheets of 70gsm paper
PRINTER, IMPACT DOT MATRIX, 24 pins, 136 column,
18 unit
480 cps print speed
PRINTER, IMPACT DOT MATRIX, 9 pins, 80 column, 337
19 unit
cps print speed
PRINTER, INKJET, wireless capable, 55ppm speed,
20 unit
512MB memory, duplex printing capable
PRINTER, LASER, monochrome, 24ppm speed, 1200 x
21 unit
1200 dpi
TABLE, monobloc, square, 36" X 36", white, four(4)
22 unit
seater, for indoor and outdoor use
TABLE, monobloc, square, 36" X 36", beige, four(4)
23 unit
seater, for indoor and outdoor use

COMMON COMPUTER SUPPLIES

 COMPUTER CONTINUOUS FORMS, 1 ply, 11" x 9-1/2",
1 box
2000 sheets/box
COMPUTER CONTINUOUS FORMS, 1 ply, 11" x 14-7/8",
2 box
2000 sheets/box
COMPUTER CONTINUOUS FORMS, 2 ply, 11" x 9-1/2",
3 box
1000 sets/box
COMPUTER CONTINUOUS FORMS, 2 ply, 11" x 14-7/8",
4 box
1000 sets/box
COMPUTER CONTINUOUS FORMS, 3 ply, 11 x 9-1/2",
5 box
500 sets/box
COMPUTER CONTINUOUS FORMS, 3 ply, 11" x 14-7/8",
6 box
500 sets/box
7 DVD REWRITABLE, 4x speed, 4.7GB capacity piece
EXTERNAL HARD DRIVE, 1TB, 2.5" HDD, USB 3.0,
backward compatible with USB 2.0, 5400 rpm, with
dual color LED light to indicate USB 3.0/USB 2.0
8 piece
transmission, USB powered, System Requirements:
USB 3.0: Windows XP/Vista/7/MacOSx 10.4 or above,
with USB 3.0 cable and product guide
9 FLASH DRIVE, 16GB, USB 2.0, plug and play piece
10 MOUSE, optical, USB connection type unit

HANDBOOK ON PROCUREMENT
HANDBOOK ON PHILIPPINE GOVERNMENT
1 PROCUREMENT-RA 9184(6th Edition), 6" x 9", 296 piece
pages,

CONSUMABLES
1 INK CART, BROTHER LC39BK, Black cart
2 INK CART, BROTHER LC39C, Cyan cart
3 INK CART, BROTHER LC39M, Magenta cart
4 INK CART, BROTHER LC39Y, Yellow cart
5 INK CART, BROTHER LC67B, Black cart
6 INK CART, BROTHER LC67C, Cyan cart
7 INK CART, BROTHER LC67M, Magenta cart
8 INK CART, BROTHER LC67Y, Yellow cart
9 INK CART, BROTHER LC67HYBK, Black cart
10 INK CART, BROTHER LC67HYC, Cyan cart
11 INK CART, BROTHER LC67HYM, Magenta cart
12 INK CART, BROTHER LC67HYY, Yellow cart
13 INK CART, CANON PG-810, Black cart
14 INK CART, CANON PG-740, Black cart
15 INK CART, CANON PGI-725, Black cart
16 INK CART, CANON CLI-726, Black cart
17 INK CART, CANON CL-811, Colored cart
18 INK CART, CANON CL-741, Colored cart
19 INK CART, CANON CLI-726, Cyan cart
20 INK CART, CANON CLI-726, Magenta cart
21 INK CART, CANON CLI-726, Yellow cart
22 INK CART, EPSON C13T038190 (T0 38), Black cart
23 INK CART, EPSON C13T039090 (T0 39), Colored cart
24 INK CART, EPSON C13T105190(73N)/(91N),Black cart
25 INK CART, EPSON C13T105290(73N)/(91N),Cyan cart
26 INK CART, EPSON C13T105390(73N)/(91N),Magenta cart
27 INK CART, EPSON C13T105490(73N)/(91N),Yellow cart
28 INK CART, EPSON C13T6664100 (T6641), Black cart
29 INK CART, EPSON C13T664200 (T6642), Cyan cart
30 INK CART, EPSON C13T664300 (T6643), Magenta cart
31 INK CART, EPSON C13T664400 (T6644), Yellow cart
32 INK CART, HP 51645A, (HP45), Black cart
33 INK CART, HP C1823A, (HP23), Tri-color cart
34 INK CART, HP C4844A, (HP10), Black cart
35 INK CART, HP C4906AA, (HP940XL), Black cart
36 INK CART, HP C4907AA, (HP940XL), Cyan cart
37 INK CART, HP C4908AA, (HP940XL), Magenta cart
38 INK CART, HP C4909AA, (HP940XL), Yellow cart
39 INK CART, HP C4936A, (HP18), Black cart
40 INK CART, HP C4937A, (HP18), Cyan cart
41 INK CART, HP C4938A, (HP18), Magenta cart
42 INK CART, HP C4939A, (HP18), Yellow cart
43 INK CART, HP C6578DA, (HP78), Tri-color cart
44 INK CART, HP C6615DA, (HP15), Black cart
45 INK CART, HP C6625AA, (HP17), Tri-color cart
46 INK CART, HP C6656AA, (HP56), Black cart
47 INK CART, HP C6657AA, (HP57), Tri-color cart
48 INK CART, HP C8727AA, (HP27), Black cart
49 INK CART, HP C8765WA, (HP94), Black cart
50 INK CART, HP C8766WA, (HP95), Tri-color cart
51 INK CART, HP C8767WA, (HP96), Black cart
52 INK CART, HP C9351AA, (HP21), Black cart
53 INK CART, HP C9352AA, (HP22), Tri-color cart
54 INK CART, HP C9361WA, (HP93), Tri-color cart
55 INK CART, HP C9362WA, (HP92), Black cart
56 INK CART, HP C9363WA, (HP97), Tri-color cart
57 INK CART, HP C9364WA, (HP98), Black cart
58 INK CART, HP CB314A, (HP900), Black cart
59 INK CART, HP CB315A, (HP900), Tri-color cart
60 INK CART, HP CB335WA, (HP74), Black cart
61 INK CART, HP CB336WA, (HP74XL), Black cart
62 INK CART, HP CB337WA, (HP75), Tri-color cart
63 INK CART, HP CB338WA, (HP75XL), Tri-color cart
 64 INK CART, HP CC640WA, (HP60), Black cart
65 INK CART, HP CC641WA, (HP60XL), Black cart
66 INK CART, HP CC643WA, (HP60), Tri-color cart
67 INK CART, HP CC644WA, (HP60XL), Tri-color cart
68 INK CART, HP CC653AA, (HP901), Black cart
69 INK CART, HP CC656AA, (HP901), Tri-color cart
70 INK CART, HP CC660AA, (HP702), Black cart
71 INK CART, HP CD887AA, (HP703), Black cart
72 INK CART, HP CD888AA, (HP703), Tri-color cart
73 INK CART, HP CD971AA, (HP 920), Black cart
74 INK CART, HP CD972AA, (HP 920XL), Cyan cart
75 INK CART, HP CD973AA, (HP 920XL), Magenta cart
76 INK CART, HP CD974AA, (HP 920XL), Yellow cart
77 INK CART, HP CD975AA, (HP 920XL), Black cart
78 INK CART, HP CH561WA, (HP61), Black cart
79 INK CART, HP CH562WA, (HP61), Tricolor cart
80 INK CART, HP CN045AA, (HP950XL), Black cart
81 INK CART, HP CN046AA, (HP951XL), Cyan cart
82 INK CART, HP CN047AA, (HP951XL), Magenta cart
83 INK CART, HP CN048AA, (HP951XL). Yellow cart
84 INK CART, HP CN692AA, (HP704), Black cart
85 INK CART, HP CN693AA, (HP704), Tri-color cart
86 INK CART, HP CZ107AA, (HP678), Black cart
87 INK CART, HP CZ108AA, (HP678), Tricolor cart
88 INK CART, HP CZ121A (HP685A), Black cart
89 INK CART, HP CZ122A (HP685A), Cyan cart
90 INK CART, HP CZ123A (HP685A), Magenta cart
91 INK CART, HP CZ124A (HP685A), Yellow cart
92 INK CART, HP Q8893AA (C8728AA), (HP28), Colored cart
93 INK CART, LEXMARK 10NO217 (#17), Black cart
94 INK CART, LEXMARK 10NO227 (#27), Colored cart
95 TONER CART, BROTHER TN-2025, Black cart
96 TONER CART, BROTHER TN-2130, Black cart
97 TONER CART, BROTHER TN-2150, Black cart
98 TONER CART, BROTHER TN-3320, Black cart
TONER CART, BROTHER TN-3350, Black, for
99 cart
HL5450DN (CU Printer)
### TONER CART, HP C4092A, Black cart
### TONER CART, HP C4096A, Black cart
### TONER CART, HP C7115A, Black cart
### TONER CART, HP CB435A, Black cart
### TONER CART, HP CB436A, Black cart
### TONER CART, HP CB540A, Black cart
### TONER CART, HP CB541A, Cyan cart
### TONER CART, HP CB542A, Yellow cart
### TONER CART, HP CB543A, Magenta cart
### TONER CART, HP CC364A, Black cart
### TONER CART, HP CC530A, Black cart
### q22 cart
### TONER CART, HP CC532A, Yellow cart
### TONER CART, HP CC533A, Magenta cart
### TONER CART, HP CE255A, Black cart
### TONER CART, HP CE278A, Black cart
### TONER CART, HP CE285A (HP85A), Black cart
### TONER CART, HP CE310A, Black cart
### TONER CART, HP CE311A, Cyan cart
### TONER CART, HP CE312A, Yellow cart
### TONER CART, HP CE313A, Magenta cart
### TONER CART, HP CE320A, Black cart
### TONER CART, HP CE321A, Cyan cart
### TONER CART, HP CE322A, Yellow cart
### TONER CART, HP CE323A, Magenta cart
### TONER CART, HP CE390A, Black cart
### TONER CART, HP CE400A, Black cart
### TONER CART, HP CE401A, Cyan cart
### TONER CART, HP CE402A, Yellow cart
### TONER CART, HP CE403A, Magenta cart
### TONER CART, HP CE410A, (HP305), Black cart
### TONER CART, HP CE411A, (HP305), Cyan cart
### TONER CART, HP CE412A, (HP305), Yellow cart
### TONER CART, HP CE413A, (HP305), Magenta cart
### TONER CART, HP CE505A, Black cart
### TONER CART, HP CE505X, Black, high cap cart
### TONER CART, HP Q2612A, Black cart
### TONER CART, HP Q2613A, Black cart
### TONER CART, HP Q5942A, Black cart
### TONER CART, HP Q5949A, Black cart
### TONER CART, HP Q5950A, Black cart
### TONER CART, HP Q5951A, Cyan cart
### TONER CART, HP Q5952A, Yellow cart
### TONER CART, HP Q5953A, Magenta cart
### TONER CART, HP Q6000A, Black cart
### TONER CART, HP Q6001A, Cyan cart
### TONER CART, HP Q6002A, Yellow cart
### TONER CART, HP Q6003A, Magenta cart
### TONER CART, HP Q6470A, Black cart
### TONER CART, HP Q6471A, Cyan cart
### TONER CART, HP Q6472A, Yellow cart
### TONER CART, HP Q6473A, Magenta cart
### TONER CART, HP Q7553A, Black cart
### TONER CART, LEXMARK E360H11P, Black cart
### TONER CART, LEXMARK T650A11P, Black cart
### TONER CART, SAMSUNG ML-D2850B, Black cart
### TONER CART, SAMSUNG MLT-D101S, Black cart
### TONER CART, SAMSUNG MLT-D103L, Black cart
### TONER CART, SAMSUNG MLT-D103S, Black cart
### TONER CART, SAMSUNG MLT-D104S, Black cart
### TONER CART, SAMSUNG MLT-D105L, Black cart
### TONER CART, SAMSUNG MLT-D108S, Black cart
TONER CART, SAMSUNG MLT-D119S(ML-2010D3),
### cart
Black
### TONER CART, SAMSUNG MLT-D203E, Black cart
### TONER CART, SAMSUNG MLT-D203L, Black cart
### TONER CART, SAMSUNG MLT-D203U, black cart
### TONER CART, SAMSUNG MLT-D205E, Black cart
### TONER CART, SAMSUNG MLT-D205L, Black cart
### TONER CART, SAMSUNG SCX-D6555A, Black cart
RIBBON CART, EPSON C13S015516 (#8750), Black, for
### cart
LX-300
### RIBBON CART, EPSON C13S015531 (S015086), Black cart
### RIBBON CART, EPSON C13S015584 (S015327), Black cart
RIBBON CART, EPSON C13S015632, Black, for LX-
### cart
310

B. OTHER ITEMS NOT AVALABLE AT PS BUT REGULARLY PURCHASED FROM OTHER S

COMMON ELECTRICAL SUPPLIES
1
2
3

COMMON OFFICE EQUIPMENT

1
2
3
4
5

COMMON OFFICE SUPPLIES

1
2
3
4
 5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21

COMMON JANITORIAL SUPPLIES

1
2
3

CONSUMABLES
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

Office Equipment and Accessories

1
2
3
4
5
6
7
8
9

10

Office Supplies
1
2
3
4
5
6
7
8
9

10
Audio and visual presentation and composing
equipment
1
2
3
4
5
 6
7
8
9

10

Photographic or filming or video equipment

1
2
3
4
5
6
7
8
9

10

Cleaning Equipment and Supplies

1
2
3
4
5
6
7
8
9

10

Paper Materials and Products

1
2
3
4
5
6
7
8
9

10

Lighting and fixtures and accessories

1
2
3
4
 5
6
7
8
9

10

Electrical equipment and components and supplies

1
2
3
4
5
6
7
8
9

10

Computer Supplies
1
2
3
4
5
6
7
8
9

10

Computer Equipment and Accessories

1
2
3
4
5
6
7
8
9

10

*Other Categories
1
2
3
 4
5
6
7
8
9

10

C. TOTAL (A + B):
D. ADDITIONAL PROVISION FOR INFLATION
(10% of TOTAL)
E.
F. GRAND
APPROVEDTOTAL (C + D)
BUDGET BY THE AGENCY
HEAD
In
G. Figures
MONTHLY and Words:
CASH REQUIREMENTS
G.1 Available at Procurement Service Stores
G.2 Other Items not available at PS but regulary
purchased from other sources
TOTAL MONTHLY CASH REQUIREMENTS
*Other categories that are not indicated herein
**Prices are FOB Manila/Applicable for items under A.

We hereby warrant that the total amount reflected in this Annual Supplies/ Equipment Procurem
approved budget for the year.

Prepared by: Certified Funds Available /

Certified Appropriate Funds Available:

Property/Supply Officer Accountant /

Local Budget Officer

Date Prepared:
 ANNUAL PROCUREMENT PLAN FOR 2018
For Common-Use Supplies and Equipment

ENT PLAN (APP) FORM:

Regional/Provincial Depot in your area.
assified according to commmonality of freight cost):
liran, Borongan, Misamis Occidental (Oroquieta) and Southern Leyte (Maasin)- Region XIII
Bontoc and Northern Samar (Catarman)- Regions VI, VII, VIII, X, & XI

APP form. The form will automatically compute for the Total Quarterly requirement, Total Amount per item and the Grand
an the prescribed format downloaded at philgeps.gov.ph and; b) correct format is used but fields were delet
ugh e-mail if the submission is incorrect.
regularly purchased from other sources, agency must specify/indicate the item name under each category and unit price b
e Procurement Service and may be considered Common Supplies or Equipment (CSE). Items will be added to the electronic
the Procurement Service.
mitted in the following manner:
Central Office
offices, operating units of DepEd, DOH, DPWH, CHED, TESDA and SUCs
mitted to the following email addressess:
nd regional offices of all national government agencies
other campuses of all state universities and colleges
ral and regional offices of government owned and controlled corporations
y and secondary schools
overnment units
or FY 2017 must be submitted on or before November 30, 2016.
me of Agency- Region (e.g. APP2017-PS- Central Office).
anning Division of the Procurement Service at telephone nos. (02)561-6116 or (02)689-7750 loc. 4021.

Agency Account Code: ______________________ Contact Person: ___________

Position: __________________
E-mail : ___________________
Telephone/Mobile Nos: ____

Quantity Requirement

Q1 April May June Q2 July Aug Sept Q3 Oct Nov

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0 0 0

HASED FROM OTHER SOURCES (Note: Please indicate price of items)

0 0 0
0 0 0
0 0 0

0 0 0
0 0 0
0 0 0
0 0 0
0 0 0

0 0 0
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0 0 0
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ies/ Equipment Procurement Plan to procure the listed common-use supplies, materials and equipment has b

Available / Approved by:

priate Funds Available:

Accountant / Head of Office/Agency

ocal Budget Officer
ount per item and the Grand Total.
used but fields were deleted and/or inserted

ach category and unit price based on their last

ill be added to the electronic catalogue /

Contact Person: _______________________________________

Position: _____________________________________________
E-mail : ______________________________________________
Telephone/Mobile Nos: _________________________________

Price
Total Catalogue as TOTAL
Dec Q4 Quanti of Aug 15, AMOUNT
ty 2016

0 0 17.42 -
0 0 15.03 -
0 0 77.56 -
0 0 114.40 -
0 0 36.30 -

0 0 93.29 -

0 0 18.20 -

0 0 624.00 -
0 0 83.20 -
0 0 47.82 -
0 0 197.58 -
0 0 202.80 -
0 0 64.48 -
0 0 25.86 -
0 0 39.52 -
0 0 43.68 -
0 0 7.28 -
0 0 13.50 -
0 0 19.12 -
0 0 43.68 -

0 0 31.20 -

0 0 69.78 -
0 0 68.64 -

0 0 381.54 -

0 0 507.40 -

0 0 621.71 -

0 0 27.61 -
0 0 499.20 -

0 0 561.60 -

0 0 11.11 -
0 0 2.29 -
0 0 57.09 -
0 0 70.67 -
0 0 12.48 -
0 0 16.64 -
0 0 234.00 -
0 0 291.20 -
0 0 166.40 -
0 0 203.84 -
0 0 746.72 -
0 0 179.28 -
0 0 200.37 -
0 0 44.18 -
0 0 50.84 -
0 0 539.76 -
0 0 41.60 -
0 0 35.55 -
0 0 10.28 -
0 0 10.28 -
0 0 10.28 -
0 0 9.65 -
0 0 9.65 -
0 0 9.65 -
0 0 10.40 -
0 0 31.20 -
0 0 40.54 -
0 0 54.06 -
0 0 18.26 -
0 0 12.85 -
0 0 6.43 -
0 0 115.95 -
0 0 135.65 -
0 0 91.94 -
0 0 114.35 -
0 0 88.40 -
0 0 31.15 -
0 0 19.62 -
0 0 278.72 -
0 0 60.32 -
0 0 86.85 -
0 0 256.87 -
0 0 93.31 -
0 0 15.48 -
0 0 38.10 -
0 0 38.10 -
0 0 38.10 -
0 0 24.63 -
0 0 27.66 -
0 0 30.42 -
0 0 18.92 -
0 0 55.12 -
0 0 105.04 -
0 0 17.37 -
0 0 26.52 -
0 0 30.63 -
0 0 67.60 -
0 0 49.92 -
0 0 124.80 -

0 0 9.19 -
0 0 19.76 -
0 0 478.38 -
0 0 187.20 -

0 0 114.28 -

0 0 13.73 -
0 0 82.16 -

0 0 878.80 -

0 0 18.18 -
0 0 47.72 -
0 0 23.90 -

0 0 88.40 -
0 0 23.92 -
0 0 41.60 -
0 0 21.27 -
0 0 37.43 -
0 0 119.60 -
0 0 27.96 -
0 0 202.80 -
0 0 84.76 -
0 0 124.80 -
0 0 1,820.00 -
0 0 142.48 -
0 0 98.80 -
0 0 49.69 -
0 0 102.96 -
0 0 139.88 -
0 0 101.82 -
0 0 10,400.00 -

0 0 142.36 -

0 0 328.64 -
0 0 254.68 -
0 0 254.80 -

0 0 6,229.60 -

0 0 25,272.00 -

0 0 956.80 -
0 0 1,248.00 -
0 0 967.10 -
0 0 790.40 -

0 0 3,502.72 -

0 0 1,080.56 -

0 0 4,992.00 -

0 0 26,483.60 -

0 0 7,488.00 -

0 0 5,699.20 -

0 0 18,709.60 -

0 0 5,831.52 -

0 0 10,000.00 -

0 0 1,237.60 -

0 0 1,289.60 -

0 0 1,242.80 -
0 0 630.76 -

0 0 950.30 -

0 0 716.04 -

0 0 1,220.96 -

0 0 571.80 -

0 0 958.15 -

0 0 21.79 -

0 0 2,818.40 -

0 0 194.48 -
0 0 127.80 -

0 0 61.83 -

0 0 681.20 -
0 0 447.20 -
0 0 447.20 -
0 0 447.20 -
0 0 910.00 -
0 0 546.00 -
0 0 546.00 -
0 0 546.00 -
0 0 1,538.16 -
0 0 868.40 -
0 0 868.40 -
0 0 868.40 -
0 0 737.36 -
0 0 -
0 0 574.08 -
0 0 534.56 -
0 0 970.32 -
0 0 945.36 -
0 0 535.60 -
0 0 535.60 -
0 0 535.60 -
0 0 491.92 -
0 0 770.64 -
0 0 426.40 -
0 0 426.40 -
0 0 426.40 -
0 0 426.40 -
0 0 254.80 -
0 0 254.80 -
0 0 254.80 -
0 0 254.80 -
0 0 1,346.80 -
0 0 1,612.00 -
0 0 1,554.80 -
0 0 1,554.80 -
0 0 1,034.80 -
0 0 1,034.80 -
0 0 1,034.80 -
0 0 982.80 -
0 0 717.60 -
0 0 717.60 -
0 0 717.60 -
0 0 1,606.80 -
0 0 1,237.60 -
0 0 1,346.80 -
0 0 921.44 -
0 0 1,466.40 -
0 0 826.80 -
0 0 930.80 -
0 0 1,133.60 -
0 0 1,430.00 -
0 0 650.00 -
0 0 751.92 -
0 0 1,346.80 -
0 0 600.08 -
0 0 1,492.40 -
0 0 826.80 -
0 0 296.40 -
0 0 379.60 -
0 0 696.80 -
0 0 1,508.00 -
0 0 803.92 -
0 0 1,606.80 -
0 0 639.60 -
0 0 1,445.60 -
0 0 754.00 -
0 0 1,658.80 -
0 0 639.60 -
0 0 1,019.20 -
0 0 1,086.80 -
0 0 358.80 -
0 0 358.80 -
0 0 792.48 -
0 0 629.20 -
0 0 629.20 -
0 0 629.20 -
0 0 1,242.80 -
0 0 644.80 -
0 0 826.80 -
0 0 1,554.80 -
0 0 1,175.20 -
0 0 1,180.40 -
0 0 1,180.40 -
0 0 358.80 -
0 0 358.80 -
0 0 358.80 -
0 0 360.88 -
0 0 366.08 -
0 0 249.60 -
0 0 249.60 -
0 0 249.60 -
0 0 930.80 -
0 0 1,003.60 -
0 0 1,196.00 -
0 0 2,556.32 -
0 0 1,820.00 -
0 0 2,860.00 -
0 0 3,354.00 -

0 0 4,992.00 -

0 0 2,741.44 -
0 0 5,352.88 -
0 0 2,971.28 -
0 0 2,802.80 -
0 0 3,218.80 -
0 0 3,312.40 -
0 0 2,984.80 -
0 0 2,984.80 -
0 0 2,984.80 -
0 0 7,378.80 -
0 0 5,402.80 -
0 0 5,298.80 -
0 0 5,298.80 -
0 0 5,298.80 -
0 0 6,754.80 -
0 0 3,114.80 -
0 0 2,756.00 -
0 0 2,386.80 -
0 0 2,490.80 -
0 0 2,490.80 -
0 0 2,490.80 -
0 0 3,166.80 -
0 0 3,010.80 -
0 0 3,010.80 -
0 0 3,010.80 -
0 0 7,690.80 -
0 0 6,754.80 -
0 0 9,978.80 -
0 0 9,978.80 -
0 0 9,978.80 -
0 0 3,790.80 -
0 0 5,402.80 -
0 0 5,402.80 -
0 0 5,402.80 -
0 0 3,998.80 -
0 0 7,066.80 -
0 0 3,104.40 -
0 0 3,328.00 -
0 0 7,482.80 -
0 0 3,530.80 -
0 0 7,644.00 -
0 0 10,845.12 -
0 0 10,845.12 -
0 0 10,845.12 -
0 0 3,317.60 -
0 0 3,614.00 -
0 0 3,614.00 -
0 0 3,614.00 -
0 0 5,526.56 -
0 0 5,495.36 -
0 0 5,844.80 -
0 0 5,844.80 -
0 0 3,894.80 -
0 0 8,874.32 -
0 0 9,630.40 -
0 0 4,992.00 -
0 0 2,600.00 -
0 0 2,912.00 -
0 0 2,912.00 -
0 0 2,392.00 -
0 0 2,704.00 -
0 0 2,631.20 -
0 0 3,120.00 -
0 0 7,280.00 -
0 0 4,368.00 -
0 0 9,464.00 -
0 0 8,736.00 -
0 0 4,888.00 -
0 0 4,212.00 -
0 0 76.75 -
0 0 724.88 -
0 0 334.88 -
0 0 75.92 -

0 0 -
0 0 -
0 0 -

0 0 -
0 0 -
0 0 -
0 0 -
0 0 -

0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -

0 0 -
0 0 -
0 0 -

0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -

0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0

0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -

0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -

0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -

0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -

0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -

0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -

0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -

0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
-
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
-
0 0 -
0 0 -
0 0 -
 0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -

-
-
-

0 0
0 0
0 0

rials and equipment has been included in or is within our

Head of Office/Agency

`
e. [email protected] - Fo
[email protected] - For Local government units
 Document Code: SDO-QF-OSDS-PRO-
002-B
Quality Form Revision: 00
Ref. No. __________________
Effectivity date: 10-16-2017
Request for Quotation (RFQ) Goods
Name of Office: Procurement Unit

Date
RFQ No.

To all Eligible Suppliers:

1
I.
Please quote your lowest price inclusive of VAT on the item(s) listed below, subject to the Terms and Conditions of this RFQ. Submit or
send your quotation(s), duly signed by you or your representative, inside a sealed envelope to the Bids and Awards Committee or its
Secretariat not later than __________ at _________________ Elementary School, Mariveles, Bataan care of _________________, BAC
Secretariat Chairman. Please write the Quotation No. __________________, your business name and contact no. in front of your
envelope. Quotation that exceeds the approved budget for the contract (ABC) [per item/per lot] shall be rejected. Evaluation and award
shall be on a [per item/per lot] basis. For more information please call us at Telephone Nos.: __________________ care of
_________________________, BAC Secretariat. Prospective supplier shall be responsible to verify herein items from
_____________________, BAC Secretariat

_____________________________
BAC Chairperson

II. Particulars
Approved
Item / Lot QUANTITY & Unit of Total Price in
Budget for the measure Brand / Model
No. Contract in PHP Pesos

1 Tornado Mop 1 pc.

2 0 0 0
3 0 0 0
4 0 0 0
5 0 0 0
6 0 0 0
7 0 0 0
8 0 0 0
9 0 0 0
10 0 0 0
11 0 0 0
12 0 0 0
13 0 0 0
14 0 0 0
15 0 0 0
16 0 0 0
17 0 0 0
18 0 0 0
19 0 0 0
20 0 0 0
21 0 0 0
22 0 0 0

Delivery Period: 7 calendar days from Supplier’s receipt of Purchase Order (PO).
Delivered to: ______________________, Elementary School, Mariveles, Bataan
This is to submit our price quotations as indicated above subject to the terms and conditions of this RFQ.

Supplier’s Business Name: TIN:

Address:
Supplier’s Phone No.
Authorized
Telephone No.
Representati
ve’s
Signature Date
over Printed
Name:
 Document Code: SDO-QF-OSDS-PRO-
002-B
Quality Form Revision: 00
Ref. No. __________________
Effectivity date: 10-16-2017
Request for Quotation (RFQ) Goods
Name of Office: Procurement Unit

Date
RFQ No.

To all Eligible Suppliers:

1
I.
Please quote your lowest price inclusive of VAT on the item(s) listed below, subject to the Terms and Conditions of this RFQ. Submit or
send your quotation(s), duly signed by you or your representative, inside a sealed envelope to the Bids and Awards Committee or its
Secretariat not later than __________ at _________________ Elementary School, Mariveles, Bataan care of _________________, BAC
Secretariat Chairman. Please write the Quotation No. __________________, your business name and contact no. in front of your
envelope. Quotation that exceeds the approved budget for the contract (ABC) [per item/per lot] shall be rejected. Evaluation and award
shall be on a [per item/per lot] basis. For more information please call us at Telephone Nos.: __________________ care of
_________________________, BAC Secretariat. Prospective supplier shall be responsible to verify herein items from
_____________________, BAC Secretariat

_____________________________
BAC Chairperson

II. Particulars
Approved
Item / Lot QUANTITY & Unit of Total Price in
Budget for the measure Brand / Model
No. Contract in PHP Pesos

1 Tornado Mop 1 pc.

2 0 0 0
3 0 0 0
4 0 0 0
5 0 0 0
6 0 0 0
7 0 0 0
8 0 0 0
9 0 0 0
10 0 0 0
11 0 0 0
12 0 0 0
13 0 0 0
14 0 0 0
15 0 0 0
16 0 0 0
17 0 0 0
18 0 0 0
19 0 0 0
20 0 0 0
21 0 0 0
22 0 0 0

Delivery Period: 7 calendar days from Supplier’s receipt of Purchase Order (PO).
Delivered to: ______________________, Elementary School, Mariveles, Bataan
This is to submit our price quotations as indicated above subject to the terms and conditions of this RFQ.

Supplier’s Business Name: TIN:

Address:
Supplier’s Phone No.
Authorized
Telephone No.
Representati
ve’s
Signature Date
over Printed
Name:
 Document Code: SDO-QF-OSDS-PRO-
002-B
Quality Form Revision: 00
Ref. No. __________________
Effectivity date: 10-16-2017
Request for Quotation (RFQ) Goods
Name of Office: Procurement Unit

Date
RFQ No.

To all Eligible Suppliers:

1
I.
Please quote your lowest price inclusive of VAT on the item(s) listed below, subject to the Terms and Conditions of this RFQ. Submit or
send your quotation(s), duly signed by you or your representative, inside a sealed envelope to the Bids and Awards Committee or its
Secretariat not later than __________ at _________________ Elementary School, Mariveles, Bataan care of _________________, BAC
Secretariat Chairman. Please write the Quotation No. __________________, your business name and contact no. in front of your
envelope. Quotation that exceeds the approved budget for the contract (ABC) [per item/per lot] shall be rejected. Evaluation and award
shall be on a [per item/per lot] basis. For more information please call us at Telephone Nos.: __________________ care of
_________________________, BAC Secretariat. Prospective supplier shall be responsible to verify herein items from
_____________________, BAC Secretariat

_____________________________
BAC Chairperson

II. Particulars
Approved
Item / Lot QUANTITY & Unit of Total Price in
Budget for the measure Brand / Model
No. Contract in PHP Pesos

1 Tornado Mop 1 pc.

2 0 0 0
3 0 0 0
4 0 0 0
5 0 0 0
6 0 0 0
7 0 0 0
8 0 0 0
9 0 0 0
10 0 0 0
11 0 0 0
12 0 0 0
13 0 0 0
14 0 0 0
15 0 0 0
16 0 0 0
17 0 0 0
18 0 0 0
19 0 0 0
20 0 0 0
21 0 0 0
22 0 0 0

Delivery Period: 7 calendar days from Supplier’s receipt of Purchase Order (PO).
Delivered to: ______________________, Elementary School, Mariveles, Bataan
This is to submit our price quotations as indicated above subject to the terms and conditions of this RFQ.

Supplier’s Business Name: TIN:

Address:
Supplier’s Phone No.
Authorized
Telephone No.
Representati
ve’s
Signature Date
over Printed
Name:
 Document Code: SDO-QF-SGOD-
PRO-003
Quality Form
Revision: 00
Ref. No. ___________
Effectivity date: 10-16-2017
Summary of Canvass
Name of Office: Procurement Unit

Bidders
Quantity Unit Article
Unit Price Unit Price Unit Price
1 pc. Tornado Mop 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

We hereby recommend to award the purchase to _______________________ who has the lowest quotation.

__________________________ ____________________________
School Property Custodian BAC Chairman

_____________________________
School Principal/Head
 Document Code: SDO-QF-
OSDS-PRO-001

Quality Form Revision: 00

Ref. No. ___________

Effectivity date: 10-16-2017

Purchase Request Name of Office:
Procurement Unit

Entity Name: _________________ Elementary School Fund Cluster: 101

PR No.: ______________________________ Date: ________________________
Office/Section : OSDS
Responsibility Center Code : ___________

Stock/
Property No.
Unit Item Description Quantity Unit Cost Total Cost

pc. Tornado Mop 1 - -

-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Purpose:

Requested by: Approved by:

Signature :

Printed Name :
 Document Code: SDO-QF-
OSDS-PRO-001

Quality Form Revision: 00

Ref. No. ___________

Effectivity date: 10-16-2017

Purchase Request Name of Office:
Procurement Unit

Entity Name: _________________ Elementary School Fund Cluster: 101

PR No.: ______________________________ Date: ________________________
Office/Section : OSDS
Responsibility Center Code : ___________

Stock/
Property No.
Unit Item Description Quantity Unit Cost Total Cost

School Property Custodian School Principal/Head

Designation :
 Document Code: SDO-QF-PRO-006
Quality Form
Revision: 00
Effectivity date: 10-18-2017
PURCHASE ORDER
SUPPLY OFFICE

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 : Delivery Term : ________________________

Date of Delivery : Payment Term : ________________________

Stock/ Property
Unit Description Quantity Unit Cost Amount
No.
pc. Tornado Mop 1 - -
0 0 0 - -
0 0 0 - -
0 0 0 - -
0 0 0 - -
0 0 0 - -
0 0 0 - -
0 0 0 - -
0 0 0 - -
0 0 0 - -
0 0 0 - -
0 0 0 - -
0 0 0 - -
0 0 0 - -
0 0 0 - -
0 0 0 - -
0 0 0 - -
0 0 0 - -
0 0 0 - -
0 0 0 - -
0 0 0 - -
0 0 0 - -
0 0 0 - -
0 0 0 - -
0 0 0 - -
0 0 0 - -
0 0 0 - -
(Total Amount in Words) -

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,

_________________________________________ ___________________________________
Signature over Printed Name of Supplier Signature over Printed Name of Authorized Official
___________________________ Principal
Date Designation

Fund Cluster : ___________________________________ ORS/BURS No. : _______________

Funds Available : _________________________________ Date of the ORS/BURS: ________
Amount : __________
 ROMINA D. VELASCO
Signature over Printed Name of Senior Bookkeeper
Accounting Division/Unit
 Document Code: SDO-QF-PRO-007

Quality Form
Revision: 00

Effectivity date: 10-18-2017

INSPECTION AND ACCEPTANCE REPORT (IAR)
SUPPLY OFFICE
Supplier:
PO No. Invoice Number:
Date of PO: Date of Invoice:
Requisitioning Dept. IAR No.

Stock No. Unit Description Quantity

1 pc. Tornado Mop 1
2 0 0 0
3 0 0 0
4 0 0 0
5 0 0 0
6 0 0 0
7 0 0 0
8 0 0 0
9 0 0 0
10 0 0 0
11 0 0 0
12 0 0 0
13 0 0 0
14 0 0 0
15 0 0 0
16 0 0 0
17 0 0 0
18 0 0 0
19 0 0 0
20 0 0 0

Date Inspected: Date Received:

[Please check box if appropriate] [Please check box if appropriate]

Inspected, verified and found in order Complete

as to quantity and specifications
Partial (Please specify quantity)

__________________________ _________________________________
Inspection Officer Property Custodian
Signature over printed name Signature over printed name
A7/AA6
 Document Code: SDO-QF-SO-005
Quality Form Revision: 00
Effectivity date: 10-16-2017

INVENTORY CUSTODIAN SLIP SUPPLY OFFICE

Appendix 59
Entity Name: ____________________ Elementary School
Fund Cluster: __________________________________ ICS No: ________________________

Amount Inventory Estimated

Quantity Unit Description
Unit Cost Total Cost
Item No: Useful Life

1 pc. 0.00 0.00 Tornado Mop

0 0 0.00 0.00 0

0 0 0.00 0.00 0

0 0 0.00 0.00 0

0 0 0.00 0.00 0

0 0 0.00 0.00 0

0 0 0.00 0.00 0

0 0 0.00 0.00 0

0 0 0.00 0.00 0

0 0 0.00 0.00 0

0 0 0.00 0.00 0

0 0 0.00 0.00 0

0 0 0.00 0.00 0

0 0 0.00 0.00 0

0 0 0.00 0.00 0

0 0 0.00 0.00 0

0 0 0.00 0.00 0

0 0 0.00 0.00 0

0 0 0.00 0.00 0

0 0 0.00 0.00 0

0 0 0.00 0.00 0
0 0 0.00 0.00 0
0 0 0.00 0.00 0
0 0 0.00 0.00 0

Received from: Received by:

______________________________ ______________________________
Signature Over Printed Name Signature Over Printed Name

School Property Custodian ___________________________

Position/Office Position/Office
____________________ ____________________
Date Date
 Document Code: SDO-QF-REC-004
Quality Form Revision: 00
Effectivity date: 10-18-2017

REQUISITION AND ISSUE SLIP SUPPLY OFFICE

Appendix 63
Entity Name: _____________________________________________________ Fund Cluster: _______________________

DIVISION:

Office

Requisition Stock Available? Issue

Stock No. Unit Description Quantity Yes No Quantity Remarks

Purpose: ________________________________________________________________________________
________________________________________________________________________________

Requested by: Approved by: Issued by: Received by:

Signature:
Printed Name:
Designation:
Date:
 Appendix 46

REIMBURSEMENT EXPENSE RECEIPT

Entity Name: _________________ Fund Cluster : ________________

Date : _______________________ RER No. : ___________________

RECEIVED from ______________________________________

(Name)
_________________________________________________ the amount
(Official Designation)
of __________________________________________ (P__________)
(In Words) (in Figures)
in payment for _______________________________________________
(Payments for subsistence, services,
_________________________________________________________
rental or transportation should show inclusive dates,
_________________________________________________________
purpose, distance, inclusive points of travel, etc.)
PAYEE
Name/Signature __________________________________________
Address ________________________________________________

WITNESS
Name/Signature __________________________________________
Address ________________________________________________
 Document Code: SDO-QF-SGOD-EFS-025

Revision: 00
Quality Form Ref. No.____________________________

Effectivity date: 10-16-2017

PROGRAM OF WORK Name of Office: SGOD-EFS

PROGRAM OF WORKS
PROJECT TITLE: Installation of Concrete Benches
SCOPE OF WORKS: Putting-up concrete benches/table for Science and Math park
SCHOOL : Mt. View Elementary School
LOCATION : Mt. View E/S Polaris Mt. View,Mariveles
SOURCE OF FUND: MOOE
DATE :April 3,2018

I.D. NO DESCRIPTION UNIT QTY UNIT COST GRAND TOTAL

I TOTAL MATERIALS COST

II TOTAL LABOR COST
III EQUIPMENT COST
IV TOTAL PROJECT COST 25,000.00

Prepared by: Verified from SOB & APP

JOSEPHINE F. SIBAYAN ROMINA D. VELASCO

Property Costudian/ Physical Facilities Coordinator Senior Bookkeeper

Checked & Reviewed

MERCK BRYAN A. GRAGASIN

Division Engineer-III

Noted Approved:

ELMA P. DIZON CIRILO C. CABORALES

Distict Supervisor ESHT-III

Concurred By:

RAMON C. PEREZ
SGOD, Chief
 Concrete
F-1 6.00 0.80 0.80 #REF!
F-2 2.00 1.00 1.00 #REF!
#REF!

WF-1 1.00 0.25 0.40 #REF!

#REF!

C-1 6.00 0.16 0.40 #REF!

C-2 2.00 0.16 0.40 #REF!
#REF!

RG-1 4.00 0.15 0.40 #REF!

RG-2 4.00 0.15 0.40 #REF!
EB-1 4.00 0.15 0.25 #REF!
#REF!

S-1 1.00 8.50 9.00 #REF!

#REF!

Rebars
F-1 1.58 6.00 8.00 #REF!
F-2 1.58 2.00 8.00 #REF!
#REF!

WF-1 0.62 1.00 #REF! #REF!

WF-1 0.62 1.00 #REF! #REF!
#REF!

C-1 1.58 6.00 4.00 #REF!

C-1 0.62 6.00 #REF! #REF!
C-2 1.58 2.00 6.00 #REF!
C-2 0.62 2.00 #REF! #REF!
C-2 0.62 2.00 #REF! #REF!
#REF!

RG-1 1.58 4.00 4.00 #REF!

RG-1 0.62 4.00 #REF! #REF!
RG-2 1.58 4.00 4.00 #REF!
RG-2 0.62 4.00 #REF! #REF!
EB-1 0.62 4.00 4.00 #REF!
EB-1 0.62 4.00 #REF! #REF!
#REF!
Forms
C-1 6.00 0.16 0.40 #REF!
C-2 2.00 0.16 0.40 #REF!
#REF!

RG-1 4.00 0.15 0.40 #REF!

RG-2 4.00 0.15 0.40 #REF!
EB-1 4.00 0.15 0.25 #REF!
#REF!
Masonry
SIDES 2.00 7.00 3.37
FRONT/REAR 2.00 9.00 3.37
PARA 2.00 6.00 0.70
MINUS -2.00 2.10 1.00
MINUS -2.00 2.60 1.60
MINUS -2.00 1.30 1.60
MINUS -4.00 0.60 0.60
 #REF!

2014
106
254.5
212

Per Room

Per Square
 Gravel Bedding
1.20 0.19
1.20 0.10
0.29

0.60 #REF!
#REF!
 Document Code: SDO-QF-OSDS-PRO-002-B
Quality Form Revision: 00
Effectivity date: 10-16-2017

Log Sheet Accounting Unit

Reference Purchase Request Sales Purchase Order

Date Description Amount RFQ # IAR No. ICS No. Signature Date Received
No. No. Invoice No.