Purchase Request: Fund Cluster

Republic of the Philippines PR-003-1
Department of Health
CAGAYAN VALLEY MEDICAL CENTER
Dalan Na Pagayaya, Regional Government Center
Carig Sur, Tuguegarao City, Cagayan
PURCHASE REQUEST
Fund Cluster: __________________
Office/Section : PR No.: MCC-2018-01-001 Date: January 04, 2018
OMCC Responsibility Center Code : ___________
Stock/
Property Unit Item Description Quantity Unit Cost Total Cost
No.
set Sofa set with center table and corner tables 2 25,000.00 50,000.00
Specs: 6 seaters, 4 pieces (1 big and 2 small) with corner and
center table
pcs Wooden cabinet rack 2 5,000.00 10,000.00
Specs: 4 layers, Open
pcs Flower vase for center tables 2 1,000.00 2,000.00
Specs: Big, with plastic flowers (mixed colors)
pcs Room Curtains 189 600.00 113,400.00
Specs: Thick cloth, printed (Choice of Pastel Green, Pastel yellow
and Mixed of Black and White), Length: 60 inches
pcs Curtain Rods 63 400.00 25,200.00
Specs: Adjustable, 5 feet 60 inches length
********************************
BASED ON WORK AND FINANCIAL PLAN 200,600.00
Purpose: FOR THE BLESSING/INAUGURATION OF THE FIVE STOREY PAYWARD BLDG. 2ND AND 3RD FLOOR
_______________________________________________________________
Requested by: Approved by:

Signature :
Printed Name : JOCELYN I. SORITA, RN, MSN GLENN MATHEW G. BAGGAO,MD,MHA,MSN,FPSMS

Designation : CHAIR, WORKING COMMITTEE MEDICAL CENTER CHIEF II
PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
set Venetian Blind 2 10,000.00 20,000.00
Specs: Color: Dark Green, Width: 22.5", Length: 80"
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_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
pcs Decorative Big Ceramic jars 2 4,000.00 8,000.00
********************************
_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
pcs Personalized key 1 1,500.00 1,500.00
Specs: 36" x 24", Material: Plywood, Color: Bronze
********************************
_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
pcs Big Ribbon 1 1,500.00 1,500.00
pcs Small candles 100 2.00 200.00
pcs Good luck Balloons (Mixed green and white) 100 25.00 2,500.00
pcs Flower/Ribbon Tree 2 2,000.00 4,000.00
********************************
_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
pcs Token for Guests, visitors, Press (wall clock) 50 100.00 5,000.00
********************************
_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
head Lunch 100 200.00 20,000.00
Menu: 2 Big Lechon, Pinakbet, Chicken Caldereta, Fried Hito,
Beef Steak, Tapioca
pcs Mineral Water 25 15.00 375.00
********************************
_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
pc Server Computer UPS (Uninterruptible Power Supply) 1 110,000.00 110,000.00
Specifications:
Power Rating: atleast 2.7 kW
Output Voltage: 220-230V
VA Rating: atleast 3000VA
Mounting Type: Rack Mountable
Communications: Serial Port, Smart Lot, USB
No. of Outlets: atleast 11 outlets
Type: Line Interactive
Max. Operating Frequency: 60 Hz
Plug Type: C20, CEE 7/EU1-16P, Type G
Features: Hot Swappable
Socket Type: C13, C19, IEC
Run Time: atleast 15 mins at full load
Battery Life: atleast 5 years
***************************
BASED ON PPMP 2018 110,000.00
Purpose: FOR CVMC USE - IHOMP Unit

_______________________________________________________________

Signature :
Printed Name : JUNE S. PRODIGO GLENN MATHEW G. BAGGAO,MD,MHA,MSN,FPSMS

Designation : CMT III MEDICAL CENTER CHIEF II
PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
1 Photocopier Machine 1 65,000.00 65,000.00
Specifications:
20 Copies per Machine
Color Scanning
A5-A3 Copy Size
Toner Recycle System
Built-in PC Connectivity (USB and Ethernet)
Feature Rich Printing
***************************
BASED ON PPMP 2018 65,000.00

_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
pc Manageable Network Switch 3 70,000.00 210,000.00
Specifications:
Device Type: Switch-28 ports-L3-Managed-stackable
Ports: 2x10/100/1000/10000 + 2x10 Gigabit
SFP + +24x10/100/1000 (PoE+)
Power Over Ethernet (PoE)
PoE+
PoE Budget
Performance: Switching capacity - 128Gbps
Routing Protocol: OSPF,RIP, IGMPv2, IGMP, VRRP, PIM-SM
PIM-DM, IGMPv3, MLDv2, Remote Management
Protocol, Telnet, HTTPS, SSH, CLI, Authentication
Method, RADIUS, TACACS+
Features: ARP support, DiffServ support, IPv6 support,
Spanning Tree Protocol (STP) Support,
Rapid Spanning Tree Protocol (RSTP) Support, Virtual
Route Redundancy Protocol (VRRP) Support, DHCP
snooping, Access Contol List (ACL) Support, Quality
of Service (QoS), MLD Snooping, front to back airflow,
STP Root Guard, IPv4 support, LACP support, DHCP
relay, Remote Switch Port Analyzer (RSPAN), Per-VLAN
Rapid Spanning Tree (PVRST), dynamic ARP protection
IP source guard, Bridge Protocol data unit (BPDU), LISP
Across Subnet Mode (ASM), Source-specific Multicast
(SSM)
*************************** 210,000.00
BASED ON PPMP 2018
Purpose: Network Installation for the 5 storey building

_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
pc Network Switch 3 5,000.00 15,000.00
Specifications:
Standards and Protocols:
IEEE 802.3i/802.3u/802.3ab/802.3x
Interface:
8 10/100/1000Mbps RJ45 Ports
AUTO Negotiation/AUTO MDI/MDIX
Jumbo Frame: 15KB
Switching Capacity: 16Gbps
Transfer Method: Store and Forward
*************************** 15,000.00
BASED ON PPMP 2018

_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
pc Filing Cabinet 1 10,000.00 10,000.00
Specifications:
Size: 916(W)x460(D)x915(H)
Material:Metal, Cold Rolled Steel
Finishing: Powder Coating
*Half height cupboard with glass sliding door
*1 adjustable shelves
*Keylocks with 2 keys
*************************** 10,000.00
BASED ON PPMP 2018

_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
Unit Laser Jet Printer 2 25,000.00 50,000.00
Specifications:
Printer Category- High Speed Laser Monochrome
Type- Printer Onle
Connection Type- Ethernet, Wireless
Maximum Standard Paper Size- Legal
Rated Speed at Default Settings(MONO)- 40PPM or faster
Duty cycle- 50000 pages per month
Printer Duplexing: Automatic
Input Capacity (Printer Only)- 250+100 sheets
***************************
BASED ON PPMP 2018 50,000.00

_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
Unit Inkjet Printer 2 11,000.00 22,000.00
Specifications:
Inkjet Color- 4 individual ink tanks:
1 x tank (black) - up to 4000 pages
1 x tank (cyan) - up to 6500 pages
1 x tank (magenta) - up to 6500 pages
1 x tank (yellow) - up to 6500 pages
180 nozzles (black), 3 x 59 nozzles (cyan, magenta,

yellow)
Up to 5760 x 1440 dpi (mono)/ up to 5760 x 1440 dpi

(color)
Up to 33 ppm (mono)/ up to 15 ppm (color)
Max resolution B/W 5760 x 1440 dpi

Max resolution Color 5760 x 1440 dpi
***************************
BASED ON PPMP 2018 22,000.00

_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
Printer Toner for HP LaserJet CP1025(CMYK)
cartridge Black (CE 310A) 3 2,300.00 6,900.00
cartridge Cyan (CE 311A) 3 2,600.00 7,800.00
cartridge Yellow (CE 312A) 3 2,600.00 7,800.00
cartridge Magenta (CE 312A) 3 2,600.00 7,800.00
***************************
BASED ON PPMP 2018 30,300.00

_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
pc Uninterruptible Power Supply 2 15,000.00 30,000.00
Specifications:
Output power capacity- atleast 550watts/1.1 kVa
Output Frequency (sync to mains)- 50/60 Hz +/-1 Hz
Input Frequency- 50/60 Hz +/- 3 Hz (auto sensing)
Topology - Line Interactive
Battery Type- Maintenance-free sealed Lead-Acid
battery with suspended electrolyte: leakproof
Typical recharge type- 6hours
*************************** 30,000.00
BASED ON PPMP 2018

_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
Unit Airconditioner 1 50,000.00 50,000.00
Specifications:
Aircon Type- Window
EER Rating- minimun of 9.8
Cooling capacity (HP)- up to 2.5 HP
Coolong capacity- minimum of 22000Kj/Hr
Power comsumption- minimum of 2250 W
Features: Icool Green
R410A Refrigerant (Eco-friendly Refrigerant)
Side Discharge
Remote
*************************** 50,000.00
BASED ON PPMP 2018

_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
pc Router 3 20,000.00 60,000.00
Specifications:
Interface- 4 10/100/1000Mbps LAN Ports
1 10/100/1000Mbps WAN Port
2 USB 3.0 Ports
Button- Wireless On/Off Button
Power On/Off Button
LED On/off Button
WPS Button
Reset Button
Antenna- 8 external antennas, 1 internal antenna
Wireless Standards- IEEE 802.11ad 60GHz
IEEE 802.11ac/n/a 5GHz
IEEE 802.11b/g/n 2.4GHz
Frequency- 60GHz, 2.4GHz and 5GHz Band1/Band4
Signal Rate- 60GHz: Up to 4600Mbps
5GHz: Up to 1733Mbps
2.4GHz: Up to 800Mbps
Wireless Security- 64/128-bit WEP, WPA/WPA2, WPA-PSK/
WPA2-PSK encryption
Management Access Control- Local Management, Remote
Management
DHCP server, client, DHCP Client List
***************************
BASED ON PPMP 2018 60,000.00

_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
unit Sofa Bed 63 15,000.00 945,000.00
Specifications:
Multi functional, can easily switch into a couch
lounge and a bed (foldable)
High Back rest for extra support
P Fabric Cover Removable and Washable
Preferably Plain In Color
Size: 7.5x36x75or Standard Size
***************************
BASED ON PPMP 2018 945,000.00
Purpose: FOR THE USE AT THE FIVE STOREY PAYWARD BLDG. 2ND AND 3RD FLOOR
_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
set TV Set 18 25,000.00 450,000.00
*Wall Mounter, Swivel, Flat Screen
*With Remote Control
pc Hot and Cold Water Probe 70 2,000.00 140,000.00
set Laptop with Printer/Scanner 4 35,000.00 140,000.00
pc Cellular Phone (ANDROID) 4 5,000.00 20,000.00
pc Convex Mirror 4 5,000.00 20,000.00
*36 inches (round)
Water Dispenser 6 6,000.00 36,000.00
***************************
BASED ON PPMP 2018 806,000.00
_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
set Conference Table 4 39,900.00 159,600.00
*Wood, 8 seaters
set Venetian Blind
*Color: Dark, Green, Width: 22.5 ft., Length: 80 ft. 1 10,000.00 10,000.00
***************************
BASED ON PPMP 2018 169,600.00
_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
Room Signages with CVMC logo, with Room Number, with

pc Slide Slots for Physician's Name 63 960.00 60,480.00
pc Doctor's Directory 4 920.00 3,680.00

pc Organizational Chart 4 2,970.00 11,880.00
***************************
BASED ON PPMP 2018 76,040.00
_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
pc Portable Nebulizer 70 8,000.00 560,000.00
*Single Phase
*210-230V / 50-60hz
*easy to clean and disinfect
*parts and accessories available for replacement
pc Suction Machine 16 110,000.00 1,760,000.00
*Portable
*Opening Voltage: 220-240V / 50-60hz
*Maximum Suction: 0.90 Bar (675 mmHg) or up to 1.5L/min
*Operating Cycle: Continuous
*Flow: 90L/min
*Power: 300VA
*Norms:CEI 62-5 (IEC 601-1)
*93/42 EEC
*2 bottles, 2-3L
*Polysulfone Autoclavable jars
*with trolley, accesory to hold bottle during the suctioning
pc IV Hook 100 1,000.00 100,000.00
*wall-mount ready, swivel
*with 2-4 hooks
*durable, can carry up to 4 (1000ml) IV bottles
pc Steel Chart Holder 6 25,000.00 150,000.00
*transport trolley for steel chart/medical records
*with ABS top board
*with ABS slide board
*20-50 ABS cases-history folders, with or without lock
*with stainless steel handrails
*ABS drawer with lock
*with PE Chasis
*portable, with 4 castors
pc Steel Chart 80 2,500.00 200,000.00
*spring hold, can strongly hold up to 100 pages of patient's
medical record (sizes A4, Letter and Legal sized papers)
*durable, stainless steel
*with slider slots for labelling
*(optional) color choices
***************************
BASED ON PPMP 2018 2,770,000.00
_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Office/Section : PR No.: MCC-2018-01-0024 Date: January , 2018
Stock/
No.
pc Hand Sanitizer Dispenser 70 2,000.00 140,000.00
*Wall Mounted
*touch-free, infrared sensor
*1000ml capacity
*white or elegant color area matching
*AC/DC operated
pc Anti Slip Rubber Mat 100 200.00 20,000.00
pc Pail with Dipper 100 150.00 15,000.00
pc Supplies Organizer 600 500.00 300,000.00
*Stackable
*Plastic
***************************
BASED ON PPMP 2018 475,000.00
_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
pc Internet Wifi Connection 4 6,763.00 27,052.00
Specifications:
Interface - 4 10/100/1000 Mbps LAN Ports
- 1 1/100/1000Mbps WAN Port
Antenna Type - at least 3 external antennas
Wireless Standards - IEEE 802.11ac/n/a 5GHz
- IEEE 802.11n/g/b 2.4 GHz
Frequency - 5GHz and 2.4GHz
Wireless Function - Enable/Disable Wireless Radio, WMM,
Wireless Statistic
Wireless Security - 64/128-bit WEP, WPA/WPA2, WPA-
PSK/WPA-PSK encryption
Firewall Security - DoS, SPI Firewall
- MAC Address Filter
- IP and MAC Address Binding
*************************** 27,052.00
BASED ON APP 2018
_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
pc BP Apparatus 70 5,000.00 350,000.00
* 100% mercury free
*interchangeable cuff from adult, pedia, neonate with
connector
*Aneroid, Floor Type with mobile stand assembly
*Adjustable, Luminous, or Glow in the Dark Clock gauge
*Black Nylon cuff, with 2-tube bladder
*With air release valve
*late inflation bulb
*8feet coiled tubing with connector
*with Large circular Basket
*wall-mounted ready
*lifetime calibration and 1 year warranty
***************************
BASED ON PPMP 2018 350,000.00
_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
pc Contemporary Office Desk with 6 Drawers 1 13,000.00 13,000.00
Specifications:
160Wx70Dx74H in cm
Main table - beechwood
Top and 2 legs dixed
Pedestal
Beige, Charcoal, Black
Off - white (flush handle)
CSL drawer - Beige 4 9,500.00 38,000.00
pc Contemporary Office Desk with 3 Drawers
Specifications:
100Wx70Dx74H in cm
Main table - beechwood
Top and 1 legs dixed
Pedestal
Beige, Charcoal, Black
Off - white (flush handle)
CSL drawer - Beige
pc High Back Office Chair 5 5,000.00 25,000.00
Specifications:
Leatherette
PVC Base Padded
Polyurethane Armrest
Black
***************************
BASED ON PPMP 2018 76,000.00
Purpose: FOR CVMC USE - For Professional Education and Training Office use
_______________________________________________________________

Signature :
Printed Name : FREDERICK B. PUA, MD, FPCS GLENN MATHEW G. BAGGAO,MD,MHA,MSN,FPSMS

Designation : Chief Training Officer MEDICAL CENTER CHIEF II
PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
pc Campaign Awareness T-Shirt 80 150.00 12,000.00
pc Certificate of Recognition 23 100.00 2,300.00
***************************
*please see attached
Purpose: FOR CVMC USE - For HTCP (RED ORCHID) USE

_______________________________________________________________

Signature :
Printed Name : ENCARNACION MALANA, RN GLENN MATHEW G. BAGGAO,MD,MHA,MSN,FPSMS

Designation : HEPO III MEDICAL CENTER CHIEF II
PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
Meals for early dinner on February 28, 2018, CVMC function

pax room 150 200.00 30,000.00
Menu:
Steamed rice
Creamy Alpine Chicken
Beef Lengua with Mushroom
Buttered mix Vegetable
Peanut Pancit Guisado
Crème Brulee
Iced tea
group Dance Instructors 1 2,000.00 2,000.00
group Vocalist/Pianist 1 1,500.00 1,500.00
group Choir/Music Ministry 1 2,000.00 2,000.00
(note: Originally Scheduled Dec 12, 2017 but moved to Feb 28,
2018 due to overlapping of activities)
***************************
Purpose: FOR CVMC USE - For Anti-Awareness Campaign/Red Orchid

_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
Meals and Snacks for CVMC Newsletter Team Unit Meeting

pc (presentation and critiquing of outputs) on Jan. 31, 2018) 36 300.00 10,800.00
Meal:
AM snacks - Ham and Cheese Roll, Juice (four seasons
Lunch - Eggplant Omelet with Ground Pork, Fish Sinigang,
Crispy Fried Chicken, Rice, Banana
****With FREE flowing coffee
***************************
Purpose: FOR CVMC USE - For CVMC Newsletter Team

_______________________________________________________________

Signature :
Printed Name : LEON C. BATUGAL, RN, MSN GLENN MATHEW G. BAGGAO,MD,MHA,MSN,FPSMS

Designation : Editor-In-Chief, CVMC Newsletter MEDICAL CENTER CHIEF II
PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
pc Snacks for participants 100 75.00 7,500.00
Menu - Pancit Guisado, Crème Brulee, House Hold Iced Tea
*************************** 7,500.00
BASED ON WORK AND FINANCIAL PLAN
Purpose: FOR CVMC USE - For HTCP (RED ORCHID) USE, (April 27, 2018(
_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
Venetian Blind for the 2 lobbies (Combi Blinds Crescendo
set Green color) total sq feet: 456 sq feet 3 75,000.00 225,000.00
***************************
Purpose: FOR CVMC USE - FOR THE USE AT THE FIVE STOREY PAYWARD BUILDING 2ND AND 3RD FLOOR
_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
Lunch 100 420.00 42,000.00
Menu: 2 Big Lechon, Pinakbet, Chicken Caldereta, Fried Hito,
Beef Steak, Tapioca, Soft Drinks in can)
Mineral Water for Press Conference 50 25.00 1,250.00
***Note: For February 20,2018, (Blessing, Inauguration and
Turn Over Ceremony)
***************************
_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
pc Gift Bags 50 50.00 2,500.00
***************************
2,500.00
**please see attached
_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
Unit Laptop 2 47,000.00 94,000.00
Specifications:
Processor - Intel Core i7 6th Generation HQ Processor
Processor Speed - 2.5-3.5GHz
Operating System - Licensed Windows 10
Memory - at least 8Gb DDR3L 1600 MHz SDRAM
Display - 15.6" 16:9 HD (1366x768)/Full HD (1920x1080)
Graphic - NVIDIA GeForce with at least 2G GDDR5 VRAM
Storage - 1TB HDD 7200 RPM or better
Optical Drive - DL DVD±RX/CD-RW
Card Reader - 3-in-1 card reader (SD/SDHC/SDXC/MMC)
Networking - Integrated 802.11ac
- Built-in Bluetooth V4.0
Interface - 1 x Microphone-in/headphone-out jack
- 1 x USB 3.1 Type C port(s)
- 2 x USB 3.0 ports or more
- 2 x USB 2.0 ports or more
- 1 x RJ45 LAN Jack for LAN Insert
- 1 x HDMI port
- 1 x VGA port
Audio - Built-in Speakers and Microphone
- ICE Sound Support
Battery - at least 4-cell 3200 mAh
pc External Drive (3 TB or higher) 1 8,000.00 8,000.00
***************************
Purpose: FOR CVMC USE - CVMC NEWSLETTER TEAM USE

_______________________________________________________________

Signature :

Designation : EDITOR-IN-CHIEF, CVMC NEWSLETTER TEAM MEDICAL CENTER CHIEF II
PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
set Computer Ink, Epson L220 1 1,200.00 1,200.00
pads Pad Paper 2 50.00 100.00
box Pencil 10 140.00 1,400.00
pcs Brown Envelop, Long 100 10.00 1,000.00
set Parchment Paper 10 100.00 1,000.00
***************************
Purpose: FOR CVMC USE - FOR LEADERSHIP TRAINING COURSE USE

_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
pc Expanded Folder (long) 100 100.00
pc Folder (short) 100 100.00
pc Puncher 1 300.00 300.00
pc Staple Wire 2 50.00 100.00
pc Staple Wire Remover 2 2.00
pc Record Book 300 Pages 15 50.00 750.00
ream A4 Colored Bond Paper (Orange) 2 2.00
***************************
BASED ON APP 2018 1,354.00
Purpose: FOR CVMC USE - ANTI-MICROBIAL STEWARDSHIP COMMITTEE

_______________________________________________________________

Signature :
Printed Name : SHAREEZ B. NADAL, MD, FPOGS GLENN MATHEW G. BAGGAO,MD,MHA,MSN,FPSMS

Designation : AMS CHAIRMAN MEDICAL CENTER CHIEF II
PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
Unit Computer Laptop with complete accessories 1 25,000.00 25,000.00
Specifications:
Processor - Intel Core i3 or higher
Procesor Speed - 2.0 GHz or faster
Operating System - Windows 10
Memory - minimum of 4 GB
Display - at least 14" with at least 1366x768 display
Graphics - Integrated Intel HD Graphics
Storage Type & Capacity - minimum of 1000 GB HDD
Optical Drive - Super-Multi DVD
Card Reader - 3-in-1 card reader (SD/SDHC/SDXC)
Camera - VGA Web Camera
Network Interface - Integrated 802.11 b/g/n or 802.11 ac
Built-in Bluetooth V4.0 (optional)
Atleast 10/100/1000 Base T
Interface - 1 x Microphone-in/Headphone-out jack
1 x VGA port/Mini D-sub 15-pin for external
monitor
1 x USB 3.0 port(s)
1 x USB 2.0 port(s)
1 x USB-C Gen 1 (upto 5 Gbps)
1 x RJ45 LAN Jack for LAN insert
1 x HDMI
Audio - Built-in Speakers and microphone
Battery - Atleast 3 cells 33 whrs 1 7,000.00 7,000.00
Unit Printer with complete accessories
Specifications:
Printer Type - laser monochrome
Printer Speed - Up to 18 ppm
Connectivity Technology - wired
Interface - USB
Connector Type - 4 pin USB Type B
Max Resolution - (B&W) - 1200 dpi
Total Media Capacity - at least 150 sheets
Max Media Size (Custom) - 8.5 x 14 in
*************************** 32,000.00
BASED ON PPMP 2018
Purpose: FOR CVMC USE - ANTI-MICROBIAL STEWARDSHIP COMMITTEE
_______________________________________________________________

Signature :
Printed Name : SHAREEZ B. NADAL, MD, FPOGS GLENN MATHEW G. BAGGAO,MD,MHA,MSN,FPSMS

Designation : AMS CHAIRMAN MEDICAL CENTER CHIEF II
PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
pc Clear Book Long 5 50.00 250.00
pc Clear Book Refill Long 5 20.00 100.00
***************************
BASED ON WORK AND FINANCIAL PLAN 350.00

_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Office/Section : PR No.: MCC-2018-01-0040 Date: January , 2018
Stock/
No.
Unit Printer 3-in-1 (Laser-jet) 1 15,000.00 15,000.00
Specifications:
Interface - USB
Output Trays Capacity - 100 sheets
Monthly Duty Cycle (max) - 5000 pages
pc Printer Ink (Black and Colored) 2 1,350.00 2,700.00
***************************

_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
pcs Personalized Leadership T-shirts 100 180.00 18,000.00
***************************
*Please see attached design

_______________________________________________________________

Signature :
Printed Name : CLARA ENCARNACION MALANA, RN GLENN MATHEW G. BAGGAO,MD,MHA,MSN,FPSMS

PURCHASE REQUEST
Fund Cluster: __________________
Office/Section : PR No.: MCC-2018-02-0042 Date: February 1 , 2018
Stock/
No.
pc T-shirt (tri-colored, free size) 50 500.00 25,000.00
***************************
_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Office/Section : PR No.: MCC-2018-0-0043 Date: February 05, 2018
Stock/
No.
pax Meals and Snacks (March 31, 2018) 100 250.00 25,000.00
Meals:
AM Snack - Mac and Cheese
- Mixed Drinks
Lunch - Pinakbet
- Chicken and Pork Caldereta
- Kamatis con Bagoong
- Leche Flan
- Bottled Drinks (Soda)
PM Snacks - Arrozcaldo
- Mixed Drinks
*************************** 25,000.00

_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
Unit Drawing Pad/Tablet 1 20,000.00 20,000.00
Specifications:
GENERAL:
Buttons Qty - 4
Orientation - Right and left-handed
Manufacturer - Wacom Technology Corp.
INPUT DEVICE:
Connectivity Technology - Wired
Interface - USB
Movement Detection Technology - Electromagnetic
Movement Resolution - 2540 lpi
Accuracy - ± 0.02 in
Performance - 133 points per second
Pressure levels - 1024
Activity Area - 6 in x 3.7in
Buttons Qty - 4
MISCELLANEOUS:
Included Pointing Device Accessories - Color identification
rings, stylus holder, stylus pen
Color - Black
Color Category - Black
SYSTEM REQUIREMENTS:
OS Required - Apple MacOS x 10.6.8 or later, Microsoft

Windows 7 SP1, Microsoft Windows Vista SP2, Windows 8
HEADER:
Model - Small
Packaged Quantity - 1
Compatibility - Mac, PC
INTERFACED REQUIREMENT :
Connector Type - 4pin USB type A
CABLE DETAILS:
Type - USB
Form Factor - Detachable
Included Qty - 1
DIMENTIONS & WEIGHT :
Width - 8.3 inches
Depth - 7 inches
Height - 0.4 inches
Weight - 10.93 oz
*************************** 20,000.00

PAR - Accountable Person (LEON C. BATUGAL)

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
pc Tape Recorder 5 5,000.00 25,000.00
Specifications:
HD voice Reorder - 1536Kbps high quality PCM Recording
(.wav format), with sensitive microphones and big power
loudspeaker for clearest playback
You could widely use EVIDA digital recorer for taking notes at
lectures, meetings, interviews and more.
Long-lasting time - 8Gb Original Flash Memory stores up to

580hours of recordings at 32Kbps. Not just a recorder as well
as your USB Flash Drive. Built in high capacity Rechargeable
lithium battery, works up to 11 hours continuously at high
quality flawless 1536Kbps PCM recording.
Ultra-thin Metal Casting voice recorder - Handy and durable -

Only 0.39 in thickness, lightweight (2.03oz)
Easily fit in any palmm, pocket or wallet for easy access and
portability
[2 in 1] Audio Recorder + MP3 Player - More than just a
recorder, it could be used as MP3 player
Just Press M button for 3 seconds switch to music mode, start
to enjoy your music freely
More advanced features with VOR (voice activated recorder),
A-B repeat, button lock ect.
***************************


Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
pc Steel Filing Cabinet (4 drawers) 1 12,700.00 12,700.00
Specifications:
Type - Office Furniture
Specific Use - Filing Cabinet
General Use - Commercial Furniture
Material - Metal, High quality cold rolled steel
Size - H1331*W454*D620mm
Item - Customize specific used 4 drawer metal steel filing
cabinet
Structure - Knock-down construction
Handle - Plastic/Aluminum/Steel
Lock & Key - Cyber lock, Central locking
Color - Grey, white, beige, red, yellow, pink, blue, black, etc.
Customized RAL color
Design - 3 section slider, anti-tilt mechanis
*************************** 12,700.00


Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
pc White Board 1 500.00 500.00
Specifications:
Wall Type, Magnetic, Dry-erase
Aluminum Frame
3" x 4" size
pc Big Bulletin/Advisory Board 1 2,000.00 2,000.00
Specifications:
Wall Type, Magnetic, Dry-erase
Aluminum Frame
4" x 8"
***************************


Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
Unit DSLR Cameras: 2 40,000.00 80,000.00
Specifications:
Type - 22.3mm x 14.9 mm CMOS

Effective Pixels - Approx. 24.20 megapixels
Total Pixels - Approx. 25.80 megapixels
Aspect Ratio - 3:2
Low-Pass Filter - Built-in/Fixed
Sensor Cleaning - EOS integrated cleaning system
Colour Filter Type - Primary Colour
Type - DIGIC 7
Lens Mount - EF/EF-S
Focal Length - Equivalent to 1.6x the focal length of the lens
Type - TTL-CT-SIR with a CMOS sensor
AF System/ Points - 45 cross-type AF points
(45 f/5.6 cross-type AF points, 27 f/8 points [9 cross-type],
centre point is f/2.8 and f/5.6 dual cross-type)
AF working range - EV -3 - 18 (at 23°C & ISO100)
AF Modes - AI Focus
One Shot
AI Servo
AF Point Selection - Automatic selection: 45 point AF
Manual selection: Single point AF
Manual selection: Zone AF
Manual selection: Large Zone AF

AF points can be selected separately for vertical and
horizontal shooting
Selected AF point display - Indicated by a transmissive LCD in
viewfinder and Quick Control screen
Predictive AF - Yes, up to 8m
****page 1/11


Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
Unit High Chair w/ Arm Rest (High Black) 2 3,500.00 7,000.00
Specifications:
Seat Size - 21.5" W x 20" D
Back Size - 20.5" W x 22.5" H
Weight - 51 Lbs.
Overall - 54.5"H x 21.5" W x 25.5" D
With Flexible Foam
Materials - Metal 7,000.00
***************************
BASED ON APP 2018
Purpose: FOR CVMC USE - ALAGANG PINOY KIOSK

PAR - Accountable Person (Czarina D. Canicula)

Signature :

Designation : Chair, HOSC MEDICAL CENTER CHIEF II
PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
Unit LCD PROJECTOR 1 25,000.00 25,000.00
Specifications:
LCD:
Size - at least 0.55" (D7)
Native Resolution - SVGA
Projection Lens:
Type - No Optical Zoom / Focus (Manual)
F-Number - at least 1.44
Focal Length - at least 16.7mm
Zoom Ratio - 1.0 - 1.2 (Digital Zoom)
Throw Ratio - 1.45 - 1.96 (Wide - Tele)
Type - at least 200W UHE
Life (Normal/Eco)*¹ - 5,000 hours / 10,000 hours
Colour Light Output - 3,200lm
White Light Output (Normal)- 3,200lm/2,240lm
Keystone
Vertical / Horizontal - ±30° / ±30°
Auto Keystone Correction - Yes (Vertical only)
Horizontal Slide Keystone Correction - Yes
Quick Corner - Yes
Analog Input -
D-Sub 15 pin - 1 (Blue molding)
Composite - RCA x 1 (Yellow)
S-Video - 1
Digital Input HDM - 1 (MHL not supported)
2 RCA (White/Red) - 1
USB Interface:
USB Type A - 1 (for USB Memory, Document Camera, Wireless
LAN, Firmware Update)
USB Type B - 1 (for USB Display, Mouse, K/B, Control, Firmware
Update)
Network:
Wireless LAN - Optional (ELPAP10)
Supported Speed For Each Mode*3 - IEEE 802.11b: 11 Mbps,
IEEE 802.11g: 54 Mbps, EEE 802.11n: 130 Mbps
Maintenance Cycle - 5,000 hours / 10,000 hours (Power

consumption: Normal / Eco) *4
*************************** 25,000.00
BASED ON PPMP 2018
Purpose: FOR CVMC USE - FOR BIDS AND AWARDS COMMITTEE
_______________________________________________________________

Signature :
Printed Name : MARIALISA S. DAUIGOY, MD, FPAFP GLENN MATHEW G. BAGGAO,MD,MHA,MSN,FPSMS

Designation : BAC CHAIRMAN MEDICAL CENTER CHIEF II
PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
Unit Multi-function Printer 1 9,000.00 9,000.00
Specifications:
Print Method - On-demand ink jet
Nozzle Configuration - at least 180 nozzles Black, 59 nozzles
per colour (Cyan, Magenta, Yellow)
Resolution - at least 5760 x 1440 dpi (with Variable-Sized Dropl
Ink Droplet Volume - at least 3 pl
Black Draft Text - Memo (A4) - Approx. 33 ppm / 15 ppm
(Black/Colour)
Photo Draft - 10x15cm/4x6"*2 - at least 27 sec per photo
(W/Border)
Photo Default - 10x15cm/4x6"*2 - at least 69 sec per photo
(W/Border)
Max Draft Text - Memo (A4) - Approx. 5.0sec/10sec
(Black/Colour)
Copies from Standalone - at least 20 copies
Copy Size - at least A4, Letter
Scanner Type - Flatbed colour image scanner
Sensor Type - CIS
Optical Resolution - at least 600 x 1200 dpi
Maximum Scan Area - 216 x 297mm (8.5 x 11.7”)
Interface High Speed USB 2.0
***************************
BASED ON PPMP 2018 9,000.00
Purpose: FOR CVMC USE - FOR BIDS AND AWARDS COMMITTEE

_______________________________________________________________

Signature :
Printed Name : MARIALISA S. DAUIGOY, MD, FPAFP GLENN MATHEW G. BAGGAO,MD,MHA,MSN,FPSMS

Designation : BAC CHAIRMAN MEDICAL CENTER CHIEF II
PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
set Sofa Set with foot rest, corner table, center table, 8 seaters 2 30,000.00 60,000.00
***************************
BASED ON PPMP 2018 60,000.00
_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
Unit Video Coverage with Photo Album and with CD and soft copy 1 15,000.00 15,000.00
***************************
BASED ON PPMP 2018 15,000.00
_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
pc Portable Nebulizer 70 8,000.00 560,000.00
*Single Phase
*210-230V / 50-60hz
*easy to clean and disinfect
***************************
BASED ON PPMP 2018 560,000.00
****Re-PR ( MCC-2018-02-0023)
_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Office/Section : PR No.: OMCC-2018-02-0056 Date: February 8, 2018
Stock/
No.
pc Suction Machine 16 110,000.00 1,760,000.00
*Portable
*Opening Voltage: 220-240V / 50-60hz
*Maximum Suction: 0.90 Bar (675 mmHg) or up to 1.5L/min
*Operating Cycle: Continuous
*Flow: 90L/min
*Power: 300VA
*Norms:CEI 62-5 (IEC 601-1)
*93/42 EEC
*2 bottles, 2-3L
*Polysulfone Autoclavable jars
*with trolley, accesory to hold bottle during the suctioning
***************************
BASED ON PPMP 2018 1,760,000.00
****Re-PR ( MCC-2018-02-0023)
_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
pc IV Hook 100 1,000.00 100,000.00
*wall-mount ready, swivel
*with 2-4 hooks
*durable, can carry up to 4 (1000ml) IV bottles
***************************
BASED ON PPMP 2018 100,000.00
****Re-PR ( MCC-2018-02-0023)
_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
pc Steel Chart Holder 6 25,000.00 150,000.00
*transport trolley for steel chart/medical records
*with ABS top board
*with ABS slide board
*20-50 ABS cases-history folders, with or without lock
*with stainless steel handrails
*ABS drawer with lock
*with PE Chasis
*portable, with 4 castors
***************************
BASED ON PPMP 2018 150,000.00
****Re-PR ( MCC-2018-02-0023)
_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
pc Steel Chart 80 2,500.00 200,000.00
*spring hold, can strongly hold up to 100 pages of patient's
medical record (sizes A4, Letter and Legal sized papers)
*durable, stainless steel
*with slider slots for labelling
*(optional) color choices
***************************
BASED ON PPMP 2018 200,000.00
****Re-PR ( MCC-2018-02-0023)
_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/
Unit Item Description Quantity Unit Cost Total Cost
Property No.
Meals and Snacks (lunch, AM & PM Snacks) for Newsletter

pc Team Meeting on February 26, 2018) 32 300.00 9,600.00
Snacks: (AM) Special Empanada and Juice (4 seasons)

(PM) Turon with Langka and Softdrink
Lunch: Rice, Pinakbet, Fried Tilapia, Chicken Adobo, Banana
*with free flowing coffee

***************************
Purpose: FOR CVMC USE - CVMC NEWSLETTER TEAM

_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
Unit Printer 1 15,000.00 15,000.00
Specifications:
Features: Color Print,Inkjet printer,USB & Wireless
connectivity
Printing type: Color
Printing Technology: inkjet
Scanner Type: Flatbed
Print Resolution: 5760x1440 DPI
Print Speed Black 33PPM
Print Speed colour: 15PPM
Paper Size: 10x15cm(4x6in),13x18cm(5x7in)
9x13cm(3.5x5in),A4,A5,A6,B5,Letter(81/2x11in)
Scanning Method: CIS
Network:USB,WIFI
Color: Black
Paper tray: 100 sheerts.
Warranty: 1 year(s)
Unit Flatbed Scanner with ADF 1 75,000.00 75,000.00
Specifications:
Scanner type Flatbed, ADF
Scan resolution, optical:Up to 600 dpi
Bit depth: 24-bit
Levels of grayscale 256
Scan size, maximum: 216 x 356 mm
Automatic document feeder capacity:Standard, 100
sheets
Automatic document feeder speed: Up to 50 ppm/100
ipm (b&w, color, grayscale, 200dpi)
Scanning options (ADF):Single-pass duplex
Duty cycle (daily): Recommended daily duty cycle: 3000
pages
Scan file format: PDF (image-only, searchable, MRC,
PDF/A,
encrypted), TIFF (single page, multi-page,
compressed: G3, G4, LZW, JPEG), DOC, RTF
WPD, XLS, TXT, XML, XPS, HTML, OPF, JPG,
BMP, PNG
*************************** 90,000.00
BASED ON PPMP 2018
Purpose: FOR CVMC USE - OMCC

_______________________________________________________________

Signature :
Printed Name : GEMALYN A. MABBORANG GLENN MATHEW G. BAGGAO,MD,MHA,MSN,FPSMS

Designation : Admin. Officer IV MEDICAL CENTER CHIEF II
PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
pax Food and Hotel Accomodation 18 11,200.00 201,600.00
(For BEmONC Skills Training Course for Midwives on March 12-

18, 2018)
Food includes meal for breakfast, lunch, dinner and AM, and
PM snacks
Room Capacity: 2-3 pax
HOTEL AMENITIES:
Serves breakfast and supper for 15-18 participants at the hotel
on March 12-18, 2018.
Shall cater AM and PM snacks, lunch for 15-18 participants
and 8 additional facilitators at CVMC function Hall on March
12-18 2018
Serves unlimited coffee and water for participants and

facilitators at CVMC on March 12-18,2018 during didactics and
practicum
With free transport from hotel to CVMC and vice-versa 8AM to
5PM
Shall provide table cloth at CVMC function hall
***************************
Purpose: FOR CVMC USE - For BASIC EMERGENCY OBSTETRICS AND NEWBORN CARE, Skills Training Course for Midwives
_______________________________________________________________

Signature :
Printed Name : CRISELINE D. TOLENTINO, MD, FPOGS GLENN MATHEW G. BAGGAO,MD,MHA,MSN,FPSMS

Designation : BEmONC Training Coordinator MEDICAL CENTER CHIEF II
PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
Unit Colored Printer with Scanner 1 9,000.00 9,000.00
Specifications: Print
Method - On-demand ink jet
Nozzle Configuration - at least 180 nozzles Black, 59 nozzles
per colour (Cyan, Magenta, Yellow)
Resolution - at least 5760 x 1440 dpi (with Variable-Sized
Droplet Technology)
Ink Droplet Volume - at least 3 pl
Black Draft Text - Memo (A4) - Approx. 33 ppm / 15 ppm

(Black/Colour)
Photo Draft - 10x15cm/4x6"*2 - at least 27 sec per photo
(W/Border)
Photo Default - 10x15cm/4x6"*2 - at least 69 sec per photo
(W/Border)
Max Draft Text - Memo (A4) - Approx. 5.0sec/10sec
(Black/Colour)
Copies from Standalone - at least 20 copies
Copy Size - at least A4, Letter
Scanner Type - Flatbed colour image scanner
Sensor Type - CIS
Optical Resolution - at least 600 x 1200 dpi
Maximum Scan Area - 216 x 297mm (8.5 x 11.7”)
Interface High Speed USB 2.0
***************************
Purpose: FOR CVMC USE - FOR SPECIAL BIDS AND AWARDS COMMITTEE
_______________________________________________________________

Signature :
Printed Name : PAULINE SOLIS, MD GLENN MATHEW G. BAGGAO,MD,MHA,MSN,FPSMS

Designation : SBAC CHAIRMAN MEDICAL CENTER CHIEF II
PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
Unit Computer Laptop 1 25,000.00 25,000.00
Specifications:
monitor
1 x USB 3.0 port(s)
1 x USB 2.0 port(s)
1 x HDMI
Battery - Atleast 3 cells 33 whrs
pc Computer Keyboard 1 600.00 600.00
pc Computer Mouse 1 300.00 300.00
*************************** 25,900.00
BASED ON PPMP 2018
_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
Unit LCD PROJECTOR 1 25,000.00 25,000.00
Specifications:
LCD:
Size - at least 0.55" (D7)
Native Resolution - SVGA
Projection Lens:
Type - No Optical Zoom / Focus (Manual)
F-Number - at least 1.44
Focal Length - at least 16.7mm
Zoom Ratio - 1.0 - 1.2 (Digital Zoom)
Throw Ratio - 1.45 - 1.96 (Wide - Tele)
Type - at least 200W UHE
Life (Normal/Eco)*¹ - 5,000 hours / 10,000 hours
Colour Light Output - 3,200lm
White Light Output (Normal)- 3,200lm/2,240lm
Keystone
Vertical / Horizontal - ±30° / ±30°
Auto Keystone Correction - Yes (Vertical only)
Horizontal Slide Keystone Correction - Yes
Quick Corner - Yes
Analog Input -
D-Sub 15 pin - 1 (Blue molding)
Composite - RCA x 1 (Yellow)
S-Video - 1
Digital Input HDM - 1 (MHL not supported)
2 RCA (White/Red) - 1
USB Interface:
USB Type A - 1 (for USB Memory, Document Camera, Wireless
LAN, Firmware Update)
USB Type B - 1 (for USB Display, Mouse, K/B, Control, Firmware
Update)
Network:
Wireless LAN - Optional (ELPAP10)
Supported Speed For Each Mode*3 - IEEE 802.11b: 11 Mbps,
IEEE 802.11g: 54 Mbps, EEE 802.11n: 130 Mbps
Maintenance Cycle - 5,000 hours / 10,000 hours (Power

consumption: Normal / Eco) *4
*************************** 25,000.00
BASED ON PPMP 2018
_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
set Table with chairs (for 8 persons) 1 10,000.00 10,000.00

Specifications:
Table top: L1455xW840xT18mm
Chair Size: H935xW400xD495mm (8 pieces)
Solid Wood Table Leg 65x65
***************************
BASED ON PPMP 2018 10,000.00
_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
pc Heavy Duty Monoblock Chairs 10 350.00 3,500.00

***************************
_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
pc Supplies Organizer 10 100.00 1,000.00

***************************
_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
pc Slotted Angle Rack 10 6,000.00 60,000.00

Specifications: Dimension - W36" D18" H72"
***************************
BASED ON PPMP 2018 60,000.00
*Please see attached
_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
pax Meals 220 140.00 30,800.00

Menu: ChickenJoy (thigh part), Spaghetti, 3 pcs. Shanghai
(meat), Rice, Regular Drinks
***************************
Purpose: FOR CVMC USE - Day Care Centers Dental Health Outreach Program (March 2, 2018) to be held at Tuguegarao city People's
Gymnasium
_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
pcs Meals: 135 350.00 47,250.00

Menu - Snacks (AM): Sandwich and Juice
- Lunch: Combination of Pork, Vegetable, and Chicken
- Snacks (PM): Clubhouse/Bihon with Juice
*************************** 47,250.00
Purpose: FOR CVMC USE - FOR HEMS USE (Basic Life Support training course and Moving and Lifting of Patients to Hospital Employees on
FEBRUARY 26-28, 2018)
_______________________________________________________________

Signature :
Printed Name : CHERRY LOU M. ANTONIO, MD GLENN MATHEW G. BAGGAO,MD,MHA,MSN,FPSMS

Designation : DRRM-H MANAGER MEDICAL CENTER CHIEF II
PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
Unit Bedside Devan 63 6,000.00 378,000.00

Specifications: Plain Only
Standard Size
*************************** 378,000.00
BASED ON PPMP 2018
Purpose: FOR CVMC USE- For the use of the Five Storey Payward Building 2nd and 3rd Floor
_______________________________________________________________

Signature :
Printed Name : JOCELYN I. SORITA, MSN GLENN MATHEW G. BAGGAO,MD,MHA,MSN,FPSMS

PURCHASE REQUEST
Fund Cluster: __________________
Office/Section : PR No.: OMCC-2018-02-0073 Date: February 21 ,2018
Stock/ Property
No.
pcs Canvass Oil Painting 4 7,000.00 28,000.00

***************************
BASED ON PPMP 2018 28,000.00
_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
Unit Automatic Hand Hygiene Dispenser 165 6,000.00 990,000.00

with 1 liter hand rubbing gel
75% ethyl alcohol
*************************** 990,000.00
BASED ON PPMP 2018
_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
Unit Convex Mirror 8 15,000.00 120,000.00

wide angled security mirror
round, with 35-40 inches diameter
wall-mount ready
clear, superior optical quality mirror
back made with ABS material
*************************** 120,000.00
BASED ON PPMP 2018
_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
pc ACLS Provider Manual 48 3,600.00 172,800.00

pc BLS Provider Manual 24 1,300.00 31,200.00
***************************
Purpose: FOR CVMC USE - FOR BLS/ACLS use

_______________________________________________________________

Signature :

Designation : CHIEF TRAINING OFFICER MEDICAL CENTER CHIEF II
PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
Unit Computer Laptop 1 24,000.00 24,000.00
Specifications:
monitor
1 x USB 3.0 port(s)
1 x USB 2.0 port(s)
1 x HDMI
*************************** 24,000.00
BASED ON APP 2018
Purpose: FOR CVMC USE - FOR INFECTION CONTROL USE
ACCOUNTABLE PERSON: ANGELINA C. CADAG, RN,

Signature :
Printed Name : KARINA DOMINGO, MD GLENN MATHEW G. BAGGAO,MD,MHA,MSN,FPSMS

Designation : ICC CHAIRMAN MEDICAL CENTER CHIEF II
PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
Unit Desktop Computer 1 27,000.00 27,000.00
Specifications:
Memory - minimum of 4 GB DDR3
Storage Type & Capacity - minimum of 500 GB Hard Disk Serial
ATA
IO Ports: 1x PCI-ex1
1x PCI-ex16
1x mini PCI-e
2xSATA 3Gb/s
2xSATA 6Gb/s
1xHeadphone
1xMicrophone
1x6 in Card Reader
1x RJ45 LAN Ethernet, Fast Ethernet, Gigabit Ethernet
1x 7.1 - Channel Audio I/O
1 x HDMI
1 x VGA
3 x USB 2.0
2 x USB 3.0
Optical Drive - atleast 8x DVD RW
Display - at least 21" HD LED LCD monitor w/ atleast 1366x768
Resolution
Graphics - Intel HD Graphics
Mouse - Optical Interface - USB
Keyboard - QWERTY, Interface - USB
*************************** 27,000.00
BASED ON APP 2018
Purpose: FOR CVMC USE - FOR INFECTION CONTROL USE
ACCOUNTABLE PERSON: ANGELINA C. CADAG, RN,

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
Unit Additional Meals (LUNCH, Feb 28, 2018) 100 300.00 30,000.00
Menu: Pinakbet, Chicken Caldereta, Fried Hito, Beef Steak,
Tapioca, Soft drinks in can
*************************** 30,000.00
BASED ON PPMP 2018
_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
Unit Laptop 1 25,000.00 25,000.00

Specifications:
1 x VGA port/Mini D-sub 15-pin for external monitor
1 x USB 3.0 port(s)

1 x USB 2.0 port(s)
1 x HDMI
Unit Printer 1 5,000.00 5,000.00
Specifications:
Interface - USB
Output tray Capacity: 100 sheets, Monthly Duty Cycle(max):
500pages
***************************
BASED ON APP 2018 30,000.00
Purpose: FOR CVMC USE - FOR PATIENT SAFETY COMMITTEE USE
_______________________________________________________________

Signature :
Printed Name : PAUL M. BALISI, MD, FPSGP GLENN MATHEW G. BAGGAO,MD,MHA,MSN,FPSMS

Designation : CHAIR, PATIENT SAFETY COMMITTEE MEDICAL CENTER CHIEF II
PURCHASE REQUEST
Fund Cluster: __________________
Office/Section : PR No.: MCC-2018-03-0081 Date: March 2, 2018
Stock/
No.
Unit Laptop 2 25,000.00 50,000.00

Specifications:
1 x VGA port/Mini D-sub 15-pin for external monitor
1 x USB 3.0 port(s)

1 x USB 2.0 port(s)
1 x HDMI
Unit Printer (Color Print, Inkjet Printer) 1 8,000.00 8,000.00
Specifications:
Printer Type - colour
Printer Technology - inkjet
Scanner Type - flatbed
Print Resolution - 5760 x 1440 DPI
Print Speed Black - 33 PPM
Print Speed Colour - 15 PPM
Paper Sizes - 10x15cm(4x6in), 13x18cm(5x7in), 9x13cm(3.5x5in),
A4, A5, A6, B5, Letter(8 1/2x11in)
Scanning Method - CIS
Network - USB
Color - Black
Paper Tray - 100 sheets
Warranty - 1 year
Printer Type - Multifunction
***************************
BASED ON APP 2018 58,000.00
****RE-PR (#MCC-01-0081, 02/26/18)
Purpose: FOR CVMC USE - HEMS USE

_______________________________________________________________

Signature :
Printed Name : CHERRY LOU M. ANTONIO, MD GLENN MATHEW G. BAGGAO,MD,MHA,MSN,FPSMS

Designation : DRRM-H MANAGER MEDICAL CENTER CHIEF II
PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
Catering Services (March 8-9,2018)

pax Snacks (AM&PM): 80 400.00 32,000.00
Menu:
March 8, 2018: Am Snacks - Pancit Canton with puto and Juice .
Pm Snacks - Ube ensaymada and turon with softdrinks
March 9, 2018: Am Snacks - Sopas with whole Egg and cheese

sandwich with Juice . . . Pm
Snacks - Pancit Guisado and sandwich with softdrinks
pax Lunch 25 300.00 7,500.00

March 8, 2018: Caldereta, Fried Chicken, Sinigang Fish, Vegetable salad
and dessert
March 9, 2018: Sinigang na Pork, Inihaw na fish, pakbet and dessert
*************************** 39,500.00
Purpose: FOR CVMC USE - For Gender and Development Medical Activity for Womens Month on March 8-9,2018
_______________________________________________________________

Signature :
Printed Name : ALIZZA LOVE F. VELASCO, MD, FPAFP, FPSHPM GLENN MATHEW G. BAGGAO,MD,MHA,MSN,FPSMS
Designation : GAD-TWG Chairperson MEDICAL CENTER CHIEF II
PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
package Film Viewing 1 70,000.00 70,000.00

***************************
_______________________________________________________________

Signature :
PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
Tarpaulin 4 1,000.00 4,000.00

pc size: 11'x 4'
pc size: 5'x6'
pc size: 4'x6'
pc Size: 2'x3'
*************************** 0.00
_______________________________________________________________

Signature :
PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
pax Two-way (Back and forth) Travel Expenses 2 3,000.00 6,000.00

***************************
_______________________________________________________________

Signature :
PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
pax Hotel Accomodation (3-days) 1 6,000.00 6,000.00

March 7, 2018 - ARRIVAL
March 8-9, 2018 - ACTUAL ACTIVITY
******inclusive of meals
***************************
_______________________________________________________________

Signature :
PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
pax Food Expenses for the Film Representative 8 250.00 2,000.00

***************************
_______________________________________________________________

Signature :
PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
pc Certificate Linen Paper 20 40.00 800.00

***************************
BASED ON WORK AND FINANCIAL PLAN 800.00
_______________________________________________________________

Signature :
PURCHASE REQUEST
Fund Cluster: __________________
HEPO Responsibility Center Code : ___________
Stock/ Property
No.
pax Snacks for Audience: 100 100.00 10,000.00

Menu - Chickenjoy, Pancit Palabok with Drinks
pax Meals and Snacks for Lecturers 12 450.00 5,400.00
Meal Menu - Steamed Rice, Buttered Shrimps, Lechon Kawali,
Mixed Veggies, Leche Flan
Snacks Menu (AM) - Chicken Sandwich, Four Seasons in Can
Snacks Menu (PM) - Pancit Palabok, Mango Juice in Can
*************************** 15,400.00
Purpose: FOR CVMC USE - For World Hearing Awareness Day (Theme: HEAR THE FUTURE) March 2, 2018
_______________________________________________________________

Signature :
Printed Name : CLARA ENCARNACION A. MALANA GLENN MATHEW G. BAGGAO,MD,MHA,MSN,FPSMS

PURCHASE REQUEST
Fund Cluster: __________________
HEPO Responsibility Center Code : ___________
Stock/ Property
No.
pc Tarpaulin 3 600.00 1,800.00
*************************** 1,800.00
Purpose: FOR CVMC USE - For World Hearing Awareness Day (Theme: HEAR THE FUTURE) March 2, 2018
_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
pc CVMC Newsletter Maiden Issue 1000 100.00 100,000.00

*Glossy
*20 pages/5 signatures
*Size: A4; Substance 20 gsm
***************************
Purpose: FOR CVMC USE - For the launching of Newsletter Maiden Issue
_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
pc Polo Shirt with Printing for Newsletter Team and MANCOM 60 500.00 30,000.00
*Color:Red, White, Black
*Fabric: Lacoste
*Embroidered CVMC Logo (front)
*Vinyl Printing of Newsletter Logo (back)
***************************
*please see attached design
_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
4" by 3" Tarpaulin with stand - Portrait (Blow-up Newsletter

pc Cover Page) 1 500.00 500.00
***************************
*please see attached design 500.00
_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
Snacks and Lunch for Special Guests, MANCOM and

pc Newsletter Team (March 26, 2018) 50 350.00 17,500.00
* Snack: Clubhouse Sandwich with Juice; Ham and Cheese

Sandwich with Juice
* Lunch: Gorgonzola and Orange Chicken Tenders, Grilled
PorkChop, Chopseuy, Mushroom Soup, Dessert, Juice (4
seasons)
***************************
_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
pc AM Snack for guests and other attendees (March 26, 2018 ) 200 100.00 20,000.00
*Menu: Clubhouse Sandwich with Juice
***************************
_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
pc Stage Decorations (Curtains and Flower Arrangements) 1 5,000.00 5,000.00

*extra curtain to cover 4" by 3" Tarpaulin for the blow-up
cover page
*************************** 5,000.00
_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Office/Section : PR No.: OMCC-2018-03-0097 Date: March 6, 2018
Stock/ Property
No.
pax Meals and Snacks (4 days, April 3-6,2018) 60 450.00 108,000.00

Menu:
Day 1: AM Snacks- Fresh Lumpia and softdrinks,

Lunch - Chicken Cordon Blue, Bikol Express, Beef
Ampalaya, Dessert, Soup
PM Snacks - Eggpie, juice in can
Day 2: AM Snacks- Empanada, Fit & Right

Lunch - Lechon Manok, Sinigang na pink Salmon,
Pinakbet, Dessert, Soup
PM Snacks - Cheeseburger, juice in can
Day 3: AM Snacks- Sinanta w/ puto, softdrinks

Lunch - Beefsteak, Fish Fillet, Vegetable, Dessert, Soup
PM Snacks -
Tuna Sandwich, juice in can
Day 4: AM Snacks- Clubhouse, C2

Lunch - Pork Caldereta, Fried Sliced Fish, Vegetable,
Dessert, Soup
PM Snacks - Sotanghon Guisado, Soft Drinks
***************************
Purpose: FOR CVMC USE - PETO - For Research Workshop Use, April 3-6, 2018
_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
pax Meals and Snacks (2 days, March 16-17, 2018)

Day 1: PM Snacks - Tuna Sandwich Softdrinks 35 80.00 2,800.00

Lunch - Lechon Manok, Fried Fish with
tomato/onion sauce, Pinakbet, Dessert, Soup 35 450.00 15,750.00
PM Snacks -
Cheeseburger, juice in can
***************************
Purpose: FOR CVMC USE - PETO - For Basic Evidence Based Medicine Workshop Use (March 16-17, 2018)
_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
Meals and Snacks (5 days, April 13-17, 2018)

Menu:
Day 1: AM Snacks- Fresh Lumpia and softdrinks,

Lunch - Chicken Cordon Blue, Bikol Express, Beef
pax Ampalaya, Dessert, Soup 50 350.00 17,500.00
PM Snacks - Eggpie, juice in can

Lunch - Lechon Manok, Sinigang na pink Salmon,
pax Pinakbet, Dessert, Soup 25 350.00 8,750.00
PM Snacks - Cheeseburger, juice in can
Day 3: AM Snacks- Sinanta w/ puto, softdrinks

Lunch - Beefsteak, Fish Fillet, Vegetable, Dessert, Soup
pax PM Snacks - Tuna 50 350.00 17,500.00
Sandwich, juice in can
Day 4: AM Snacks- Clubhouse, C2

Lunch - Pork Caldereta, Fried Sliced Fish, Vegetable,
pax Dessert, Soup 50 350.00 17,500.00
Day 5: AM Snacks- Puto Bibingka, Pineapple Juice in can

Lunch - Igado, Adobong Squid,
pax Chopseuy, Dessert Soup 50 350.00 17,500.00
***************************
Purpose: FOR CVMC USE - BLS/ACLS use (April 13-17, 2018)

_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
set 1 Set Table, 6-seater with Wooden Chair 2 39,900.00 79,800.00

Specifications:
D/T 6's Marmol top
Malaysian Wood Chair
*************************** 79,800.00
**RE-PR (MCC-18-01-0021, 1/17/2018)
_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
Unit Television, 32 inches 18 25,000.00 450,000.00

Specifications:
PICTURE QUALITY - Hexa Chroma Drive, IPS Led Super Bright
Panel, Adaptive Backlight Panel, 800 Hz BMR, V Audio
SMART FEATURES - My Home Screen, Dual Core, Easy

Mirroring, Swipe and Share, TV Remote App, Internet Apps,
Web Browser
MEDIA PLAYER - USB HDD Recording, Wireless LAN Built-in,

DLNA, 3 HDMI Terminals, 2 USB Terminals, Hbb TV
*************************** 450,000.00
**RE-PR (MCC-18-01-0020, 1/17/2018)
_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
pc Frame for Certificate 30 80.00 2,400.00

***************************
Purpose: FOR CVMC USE - HEPO - Healthy Heart: "Mahalin ang pusong nagmamahal. Mag healthy lifestyle na! March 23, 2018
_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
cartridge Ink, black (Compatible with CANON PIXMA PRINTER) 1 400.00 400.00
cartridge Ink, colored (Compatible with CANON PIXMA PRINTER) 1 800.00 800.00
***************************
_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
pax Meals and Snacks 100 400.00 40,000.00

Menu:
Snacks (AM) - Chicken Sandwich, Mango Juice in can
Lunch - Steamed white rice, Steamed brown rice, Tinolang
Manok with Veggies, Pork Adobo, Fruit in Season
Snacks (PM) - Tuna Sandwich, Four Seasons in Can
***************************
_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
Hotel Accomodation
pax 3 Single Bedrooms (4 days, April 2-5, 2018) 3 6,000.00 18,000.00
pax 1 Twin Bedroom (6 days, April 2-7, 2018) 2 7,500.00 15,000.00
***************************
Purpose: FOR CVMC USE - PETO - For Research Workshop Use, April 3-6, 2018
_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
Hotel Accomodation, with breakfast and dinner for

pax 3 days (March 16-18, 2018) 3 2,000.00 18,000.00
***************************
*****Person x Unit Cost x 3 days
Purpose: FOR CVMC USE - PETO - For Basic Evidence Based Medicine Workshop Use (March 16-17, 2018)
_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
Hotel Accomodation, with breakfast and dinner for 5

pax days (April 13-17, 2018) 6 1,350.00 40,500.00
***************************
*****Person x Unit Cost x 5 days
Purpose: FOR CVMC USE - BLS/ACLS use (April 13-17, 2018)

_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
pc Snacks for participants 100 75.00 7,500.00
Menu - Pancit Guisado, Crème Brulee, House Hold Iced Tea
*************************** 7,500.00
Purpose: FOR CVMC USE - For HTCP (RED ORCHID) USE, (April 27, 2018)
_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/
No.
pc Token for Judges 5 500.00 2,500.00
*************************** 2,500.00
Purpose: FOR CVMC USE - For HTCP (RED ORCHID) USE, (April 27, 2018)
_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/
Property No.
Meals and Snack (Lunch, AM Snack) for Newsletter Team

pc Meeting on April 2, 2018 35 300.00 10,500.00
Snacks: (AM) Clubhouse Sandwich and Juice
Lunch: Rice, Pinakbet, Fried fish, Chicken Adobo, Fresh Fruits

***************************

_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
pc Aerial Photoshoot of CVMC (12 shots) 1 8,000.00 8,000.00

***************************

_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Office/Section : PR No.: OMCC-2018-04-00112 Date: April 3, 2018
Stock/ Property
No.
Unit Television Set 18 10,000.00 180,000.00

Specifications:
Type: 32 inch LED TV
Slim, Flat Screen
Resolution: 1366 x768
Refresh rate: 60Hz
Clear motion rate:200
Response time: 5ms
Power consumption: 60watts
Connectivity: HDMI x 2, USB x2
One(1) YearWarranty
Wall Mounted, Swivel
With Remote Control
*************************** 180,000.00
**RE-PR (MCC-18-01-0020, 1/17/2018)

**RE-PR (MCC-18-02-00101, 03/06/2018)
_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
Catering Services:
pax Snacks: Day 1 140 100.00 14,000.00
AM - Palabok, Puto, and Juice 140 100.00 14,000.00
PM - Ube cheese ensaymada, Special Turon with Langka and
Juice
pax Snacks: Day 2
AM - Pancit Canton Guisado, Sandwich, and Juice 140 100.00 14,000.00
PM - Bibingkinitan, Lumpiang Shanghai and Juice 140 100.00 14,000.00
pax Lunch: Day 1
Inihaw na Fish, Tinola, Caldereta, Vegetable salad with dessert 25 150.00 3,750.00
pax Lunch: Day 2

Pinakbet, Breaded Porkchop, Sinigang na Salmon and Dessert 25 150.00 3,750.00
**with overflowing coffee and table setting
***************************
Purpose: FOR CVMC USE - Gender and Development Activity for Women's Month Celebration on May 10-11, 2018
_______________________________________________________________

Signature :
Designation : GADFPS MEMBER MEDICAL CENTER CHIEF II
PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
Hotel Accomodation (1 person) with Complimentary

days Breakfast ; With Dinner 3 2,000.00 6,000.00
Check in Time: May 9, 2018
Check out Time: May 11, 2018
*************************** 6,000.00
_______________________________________________________________

Signature :
PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
days Film Viewing Rental 2 35,000.00 70,000.00

***************************
_______________________________________________________________

Signature :
PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
set Personal Hygiene Kit 500 130.00 65,000.00

Small towel, soap, toothbrush and toothpaste with bag
*************************** 65,000.00
Purpose: FOR CVMC USE - Gender and Development Activity for on April 26-27, 2018
_______________________________________________________________

Signature :
Designation : GAD-TWG CHAIRPERSON MEDICAL CENTER CHIEF II
PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
tube Copier Toner for Gestetner MP 2001 12 2,700.00 32,400.00

********************************
BASED ON APP 2018 32,400.00
***Please see attached certificate of exclusivity

_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
pc Glass Topped Computer Table 4 7,000.00 28,000.00

Specifications:
Dimentions: 30.75"Hx55"Wx23.5"L
Features: Pull-out keyboard shelf, Glass top table, two storage
drawers
Material: Metal Computer Desk
Style: Transitional Computer Desks
******************************** 28,000.00
BASED ON APP 2018

_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
pc Cable Moulding 30 1,500.00 45,000.00

Specifications:
Size: 5.6ft
Style: 2in x 2in
Open Slot Wiring Cable Raceway Duct with Cover
Parallel openings on both sidewalls facilitates customization
********************************
BASED ON APP 2018

_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
pax BATCH 1
Day 1: May 15, 2018 40 300.00 12,000.00

SNACKS (AM + PM)
AM SNACKS: Tuna Sandwich and canned Juice
PM SNACKS; Spaghetti and Softdrinks
LUNCH: Rice, Fish Fillet, Chicken Curry, Ginataang Kalabasa,
and Sitaw, with Macaroni Salad and Juice
Day 2: May 16, 2018 40 300.00 12,000.00

SNACKS (AM + PM)
AM SNACKS: Bihon Guisado and Fit N' Right Juice
PM SNACKS: Chicken Sandwich and Canned Mango Juice
LUNCH: Rice, Lechon Kawali, Pinakbet, Cream of Mushroom
Soup, Fruit Dessert, Juice
BATCH 2
Day 1: May 17, 2018 40 300.00 12,000.00
SNACKS (AM + PM)
AM SNACK: Spaghetti, and Pineapple Juice
PM SNACKS: Siopao with Softdrinks
LUNCH: Rice,Fried Chicken, Chopseuy and Crab and Corn Soup,
with Leche Flan and Water
Day 2: May 18, 2018 40 300.00 12,000.00

SNACKS (AM + PM)
AM SNACKS: Pancit Guisado and Fit N' Right Juice
PM SNACKS: Spaghetti and Softdrinks
LUNCH: Rice, Fish Fillet, Chicken Curry, Ginataang Kalabasa
and Sitaw, Macaroni Salad and Juice
***With Overflowing Coffee on ALL BATCHES
***With Water Dispenser
***************************
Purpose: FOR CVMC USE - FOR INFECTION CONTROL SEMINAR
_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
pax BATCH 1
Day 1: May 03, 2018 35 300.00 10,500.00

SNACKS (AM + PM)
AM SNACKS: Bihon Guisado and Fit N' Right Juice
PM SNACKS: Chicken Sandwich and Softdrinks
LUNCH: Rice, Adobo, Fried Fish, Mongo, Buko Pandan, Juice
Day 2: May 04, 2018 35 300.00 10,500.00

SNACKS (AM + PM)
AM SNACK: Spaghetti, and Pineapple Juice
PM SNACKS: Siopao with Softdrinks
LUNCH: Rice,Fried Chicken, Chopseuy and Crab and Corn Soup,
with Leche Flan and Water
***With Overflowing Coffee on ALL BATCHES
***With Water Dispenser
*************************** 21,000.00
Purpose: FOR CVMC USE - FOR BASIC INFECTION CONTROL SEMINAR

_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
pax 3-day AM Snacks 70 100.00 ***21,000.000

May 8, 2018: Spaghetti with Garlic Bread and Canned Juice
May 9, 2018: Bihon Guisado with 3 pcs Puto, and Canned Juice
May 15, 2018: Spaghetti with Garlic Bread and Canned Juice
***************************
***70 pax x 3 batches x 100.00php
Purpose - ANTI MICROBIAL STEWARDSHIP PROGRAM ORIENTATION

_______________________________________________________________

Signature :
Printed Name : SHAHREZA B. NADAL, MD, FPOGS, FPIDSOG GLENN MATHEW G. BAGGAO,MD,MHA,MSN,FPSMS
Designation : CHAIR, ANTIMICROBIAL STEWARDSHIP COMMITTEE MEDICAL CENTER CHIEF II
PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
pcs Dataman Filer Box 20 250.00 5,000.00

pcs Dataman Filer 50 200.00 10,000.00
pcs Binder 50 300.00 15,000.00
***************************
BASED ON APP 2018 30,000.00
_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Office/Section : PR No.: OMCC-2018-05-00124 Date: May 2, 2018
Stock/ Property
No.
pc Laptop For System Programming 1 75,000.00 75,000.00

Specifications:
Memory: at least 16 GB DDR4
Processor: at least Intel Core i7 7700HQ 2.80GHz
Display: at least 15.6" (16:9) LED backlit FHD (1920x1080)
60Hz Anti-Glare Panel
Graphics: 2Gb/4Gb GDDR5
Hard Drive: at least 1TB
Solid State Drive: at least 128Gb, Multi-format card reader
(SD/SDHC/SDXC, Illuminated Chiclet Keyboard
Wifi Integrated 802.11 AC (2x2)
10/100/1000 Base T
Interface: atleast
1 x COMBO audio jack
1 x Type C USB3.0 (USB 3.1 GEN1)
2 x USB3.0 port(s) Type A
1 x HDMI
1 x mini Display Port
Operating System: Windows 10
*************************** 75,000.00
BASED ON APP 2018
PURPOSE: FOR CMVC USE - IHOMP UNIT

_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
pc Heavy Duty Stand Fan 1 5,000.00 5,000.00

Specifications:
3 speed rotary switch
Tilting head adjustment with oscillation
Easy Height Adjustment
Round and Stable Plastic Base
High-Performance motor
With Thermal fuse protector
*************************** 5,000.00
BASED ON APP 2018

_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Office/Section : PR No.: MCC-2018-05-00126 Date: May 2, 2018
Stock/
No.
Unit Laptop with Windows 10 6 25,000.00 150,000.00
Specifications:
Atleast 10/100/1000 Base T ethernet
monitor
1 x USB 3.0 port(s)
1 x USB 2.0 port(s)
1 x HDMI
***************************
BASED ON APP 2018 150,000.00

_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
pc Venetian Blinds (F023 -4; gray tri color) (thickness: 0.20mm)

W - 69" x H - 87" (41.69 sq. ft.) 4 12,507.00 50,028.00
W - 56" x H - 87" (33.83 sq. ft.) 1 10,149.00 10,149.00
W - 60" x H -87" (36.25 sq. ft.) 1 10,875.00 10,875.00
***************************
BASED ON APP 2018 71,052.00
PURPOSE - FOR BOARD ROOM USE

_______________________________________________________________

Signature :
Printed Name : LEON C. BATUGAL,RN,MSN GLENN MATHEW G. BAGGAO,MD,MHA,MSN,FPSMS

Designation : TRAINING SPECIALIST IV MEDICAL CENTER CHIEF II
PURCHASE REQUEST
Fund Cluster: __________________
OMCC/ISO-IQA Responsibility Center Code : ___________
Stock/ Property
No.
MEALS AND SNACKS (MAY 17, 2018, 9:00 AM TO 12:00 PM)

PAX SNACKS: SANDWICH AND BOTTLED DRINKS 45 80.00 3,600.00
PAX LUNCH: RICE, BEEF CALDERETA, CHOPSEUY, BANANA 45 200.00 9,000.00
***************************
****WITH FREE-FLOWING COFFEE
PURPOSE: FOR THE RE-ECHOING OF THE RISK BASED LEAD AUDITORS TRAINING ON MAY 17, 2018
_______________________________________________________________

Signature :
Printed Name : JANE G. PAGADDU, MD, FPSP, MBA-H GLENN MATHEW G. BAGGAO,MD,MHA,MSN,FPSMS
Designation : QUALITY MANAGEMENT REPRESENTATIVE MEDICAL CENTER CHIEF II
PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
pax MEALS AND SNACKS: 100 400.00 40,000.00

AM SNACK: BOTTLED FRUIT JUICE, PANCIT CANTON
LUNCH: RICE, FRIED CHICKEN WITH GRAVY SAUCE, CHOPSEUY,

SWEET AND SOUR PORK MEATBALLS, FRUIT SALAD, BOTTLED
WATER
PM SNACK: BOTTLED FRUIT JUICE, CHEESEBURGER

***************************
PURPOSE: FOR CVMC USE ON HOSPITAL AS CENTER OF WELLNESS CELEBRATION , HYPERTENSION AND WORLD NO
TOBACCO AWARENESS ON MAY 31, 2018
_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
set BASIC SOUND SET-UP WITH LIGHT RENTALS 1 5,000.00 5,000.00

PROVISIONS:
2 UNITS FBT PROMAXX ACTIVE SPEAKER
1 UNIT PRX712 ACTIVE MONITOR
3 UNITS DVON WIRELESS MICROPHONE
4 UNITS FULL COLOR PARLIGHTS
***************************
_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
pc TARPAULIN, Size: 8x8" 1 1,200.00 1,200.00

***************************
PLEASE SEE ATTACHED DESIGN
_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
pax 1 Meal and 2 Snacks x 2 days 50 400.00 ***40000.00

Follow menu
Day 1 :
AM Snack:
Canned Four Seasons Juice
Pancit Guisado
Lunch:
Rice
Chicken Tinola
Sweet and Sour Pork Adobo
Ginataang Sitaw and Kalabasa
Fruit Salad
Bottled Water
Pm Snack:
Bottled Fruit Juice
Clubhouse
Day 2:
AM Snack:
Bottled Fruit Juice
Baked Carbonara
Lunch:
Rice
Grilled Tuna
Kare Kare
Chicken and Pork Kaldereta
Molo Soup
Bottled Water
Buko Pandan
***************************
50 pax x 400.00 x 2 days****
PURPOSE - HTCP MPOWER TRAINING ON MAY 24-25, 2018 AT CVMC FUNCTION HALL 1 & 2
_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
pc GAD Tshirts 250 300.00 75,000.00

*for Men's Health Motorcade and Zumba for Kalalakihan
***************************
PURPOSE - For GADFPS TWG Men's Health Activity on June 27-28, 2018
_______________________________________________________________

Signature :
PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
pc Mugs 400 110.00 44,000.00

*for Men's Health Motorcade, Zumba for Kalalakihan and
Men's Health Seminar (Disaster Preparedness and Physical
Enhancement)
***************************
_______________________________________________________________

Signature :
PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
pc Tarpauline 3 900.00 2,700.00

5'x7,6'x8',8'x10'
***************************
_______________________________________________________________

Signature :
PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
pc AM Snacks: For Men's Health Motorcade (June 27,2018) 100 120.00 12,000.00
Menu: pancit canton, ensaymada and bottled water
pc AM Snacks: For Zumba para sa Kalalakihan (June 27,2018) 100 100.00

Menu: pancit canton, ensaymada and bottled water
PM Snacks: For Men's Health Seminar (Disaster

pc Preparedness) (June 27,2018) 100 100.00 10,000.00
Menu: fresh lumpia, puto, bottled water
AM Snacks: For Men's Health Seminar (Physical

pc Enhancement) (June 28,2018) 100 100.00 10,000.00
Menu: pancit guisado, puto, bottled water

***************************
_______________________________________________________________

Signature :
PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
pc Certificate Holder 20 60.00 900.00

pc Certificate Linen Paper 60 70.00 900.00
***************************
_______________________________________________________________

Signature :
PURCHASE REQUEST
Fund Cluster: __________________
Office/Section : PR No.: OMCC-2018-06-00138 Date: June 06, 2018
Stock/ Property
No.
room Hotel Accomodation for 2 nights 1 9,000.00 9,000.00

*including breakfast and dinner
***************************
PURPOSE - Orientation/Re-orientation Seminar on Internal Quality Audit for QMS 9001:2015

_______________________________________________________________

Signature :
PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
pax Meals and Snacks (AM and PM) for 2 days 65 280.00 *** 36400.00
Menu: Rice, Meat and Vegetable
***************************
***65pax X 280.00 X 2 days
PURPOSE - Orientation/Re-orientation Seminar on Internal Quality Audit for QMS 9001:2015

_______________________________________________________________

Signature :
PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
Unit 37 25,000.00 925,000.00
LAPTOP
LAPTOP
Specifications:
Processor: at least 2 cores or more

Processor Speed: 2.9 GHz or faster
Operating System: Windows 10
Memory: minimum of 4 GB
Display: at least 14” inches with at least 1366x768 display
Graphics: Integrated Intel HD Graphics
Storage Type & Capacity: minimum of 1000 GB Hard Disk Drive
(HDD)
Optical Drive: Super-Multi DVD
Card Reader: 3 -in-1 card reader ( SD/ SDHC/ SDXC)
Camera : VGA Web Camera
Network Interface:
-Integrated 802.11 b/g/n or 802.11 ac
-Built-in Bluetooth™ V4.0 (Optional)
-At least 10/100/1000 Base T
Interface
-1 x Microphone-in/Headphone-out jack
-1 x VGA port/Mini D-sub 15-pin for external monitor
-1 x USB 3.0 port(s)
-1 x USB 2.0 port(s)
-1 x USB-C Gen 1 (up to 5 Gbps)
-1 x RJ45 LAN Jack for LAN insert
-1 x HDMI
Audio: Built-in Speakers and Microphone
Battery: at least 3Cells 33 Whrs
Warranty: at least 1 year for service and parts
PAGE 1 OF 4
PURPOSE - FOR CVMC USE

_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
pax Meals and Snacks (AM and PM) for 2 days 200 400.00 80,000.00
Menu: Rice, Meat and Vegetable
***************************
PURPOSE - IQA Management Review (June 19-20, 2018)

_______________________________________________________________

Signature :
PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
pax AM Snacks: 2 barbeque and spaghetti, and bottled water (500cc) 85 110.00 9,350.00
PM Snacks: Special Okoy (2pcs/pax), turon with langka (2pcs/pax),
pax bottled juice 85 110.00 9,350.00
Lunch: Adobo, Pinakbet, Pritong Fish, Chicken Teriyaki, Crab and Corn
pax Soup, Dessert 85 150.00 12,750.00
***************************
PURPOSE - For PETO and HRMO activity on June 13, 2018

_______________________________________________________________

Signature :

Designation : Training Specialist IV MEDICAL CENTER CHIEF II
PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
pc Mugs 150 110.00 16,500.00

***************************
_______________________________________________________________

Signature :
PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
pc AM Snacks: 150 110.00 16,500.00

Menu: Chicken Macaroni Soup, Ensaymada, and bottled juice
pc PM Snacks: 150 110.00 16,500.00
Menu: fresh lumpia, puto, bottled water
pc Lunch: 150 150.00 22,500.00
Menu: Tinolang Manok, Pritong Fish, Adobong baboy,
Vegetable Salad with Bagoong, Dessert
***************************
PURPOSE - For GADFPS TWG Men's Health Activity on June 26, 2018
_______________________________________________________________

Signature :
PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
pc Tarpaulin (6' x 7') 2 800.00 1,600.00

***************************
PURPOSE - National Kidney Month Celebration; "Kalusugan ng Bato'y Makakamtan sa Pag-alaga ng Kalikasan" and World Blood Donor
Awareness on June 26, 2018 in CVMC Main Lobby
_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
pc Tarpaulin (6' x 7') 2 800.00 1,600.00

***************************
PURPOSE - For Community Outreach: Lecture/ Campaign Against Drugs/ Substance Abuse, Illicit Trafficking and Anti-Smoking on June 27,
28, 29 2018 in Tuguegarao City
_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
pax Meals and Snacks for Lecturers 4 400.00 *4,800.00

Menu:
Day 1: Snack (AM): Bottled Fruit Juice, Palabok
Snack (PM): Canned Juice, Chicken Sandwich
Lunch: Rice, Buttered Mixed Vegetables, Creamy Alpine
Chikcen, Pork Adobo, Panna Cotta
Day 2: Snack (AM): Bottled Fruit Juice, Spaghetti
Snack (PM): Canned Fruit Juiice, Tuna Sandwich
Lunch: Rice, Lechon Kawali, Chopseuy, Chicken Caldereta,
Buko Pandan
Day 3: Snack (AM): Bottled Fruit Juice, Pancit Guisado
Snack (PM): Bottled Fruit Juice, Ilocos Empanada
Lunch: Rice, Sweet and Sour Fish Fillet, Beef Tenderloin in
Mushroom Sauce, Fruit Salad
***************************
*****(4 x 400.00 x 3 days)
PURPOSE - For Community Outreach: Lecture/ Campaign Against Drugs/ Substance Abuse, Illicit Trafficking and Anti-Smoking on June 27,
28, 29 2018 in Tuguegarao City
_______________________________________________________________

Signature :

PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
Training - Refresher Course for ISO 9001:2015 Internal

Unit Quality Auditors 1 150,000.00 150,000.00
***************************
PURPOSE - Orientation/Re-Orientation Seminar On Internal Quality Audit for QMS 9001:2015

_______________________________________________________________

Signature :
PURCHASE REQUEST
Fund Cluster: __________________
Stock/ Property
No.
PURPOSE
_______________________________________________________________

Signature :
Printed Name : GLENN MATHEW G. BAGGAO,MD,MHA,MSN,FPSMS

Designation : MEDICAL CENTER CHIEF II

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Republic of the Philippines PR-003-1

Office/Section : PR No.: MCC-2018-01-001 Date: January 04, 2018

OMCC Responsibility Center Code : ___________

Requested by: Approved by:

Printed Name : JOCELYN I. SORITA, RN, MSN GLENN MATHEW G. BAGGAO,MD,MHA,MSN,FPSMS

Office/Section : PR No.: MCC-2018-01-002 Date: January 04, 2018

OMCC Responsibility Center Code : ___________

Requested by: Approved by:

Printed Name : JOCELYN I. SORITA, RN, MSN GLENN MATHEW G. BAGGAO,MD,MHA,MSN,FPSMS

Office/Section : PR No.: MCC-2018-01-003 Date: January 04, 2018

OMCC Responsibility Center Code : ___________

Requested by: Approved by:

Printed Name : JOCELYN I. SORITA, RN, MSN GLENN MATHEW G. BAGGAO,MD,MHA,MSN,FPSMS

Office/Section : PR No.: MCC-2018-01-004 Date: January 04, 2018

OMCC Responsibility Center Code : ___________

Requested by: Approved by:

Printed Name : JOCELYN I. SORITA, RN, MSN GLENN MATHEW G. BAGGAO,MD,MHA,MSN,FPSMS

Office/Section : PR No.: MCC-2018-01-005 Date: January 04, 2018

OMCC Responsibility Center Code : ___________

Requested by: Approved by:

Printed Name : JOCELYN I. SORITA, RN, MSN GLENN MATHEW G. BAGGAO,MD,MHA,MSN,FPSMS

Office/Section : PR No.: MCC-2018-01-006 Date: January 04, 2018

OMCC Responsibility Center Code : ___________

Requested by: Approved by:

Printed Name : JOCELYN I. SORITA, RN, MSN GLENN MATHEW G. BAGGAO,MD,MHA,MSN,FPSMS

Office/Section : PR No.: MCC-2018-01-007 Date: January 04, 2018

OMCC Responsibility Center Code : ___________

Requested by: Approved by:

Printed Name : JOCELYN I. SORITA, RN, MSN GLENN MATHEW G. BAGGAO,MD,MHA,MSN,FPSMS

Office/Section : PR No.: MCC-2018-01-008 Date: January 11, 2018

OMCC Responsibility Center Code : ___________

Purpose: FOR CVMC USE - IHOMP Unit

Requested by: Approved by:

Printed Name : JUNE S. PRODIGO GLENN MATHEW G. BAGGAO,MD,MHA,MSN,FPSMS

Office/Section : PR No.: MCC-2018-01-009 Date: January 11, 2018

OMCC Responsibility Center Code : ___________

Purpose: FOR CVMC USE - IHOMP Unit

Requested by: Approved by:

Printed Name : JUNE S. PRODIGO GLENN MATHEW G. BAGGAO,MD,MHA,MSN,FPSMS

Office/Section : PR No.: MCC-2018-01-010 Date: January 15, 2018

OMCC Responsibility Center Code : ___________

Purpose: Network Installation for the 5 storey building

Requested by: Approved by:

Printed Name : JUNE S. PRODIGO GLENN MATHEW G. BAGGAO,MD,MHA,MSN,FPSMS

Office/Section : PR No.: MCC-2018-01-011 Date: January 15, 2018

OMCC Responsibility Center Code : ___________

Purpose: FOR CVMC USE - IHOMP Unit

Requested by: Approved by:

Printed Name : JUNE S. PRODIGO GLENN MATHEW G. BAGGAO,MD,MHA,MSN,FPSMS

Office/Section : PR No.: MCC-2018-01-012 Date: January 15, 2018

OMCC Responsibility Center Code : ___________

Purpose: FOR CVMC USE - IHOMP Unit

Requested by: Approved by:

Printed Name : JUNE S. PRODIGO GLENN MATHEW G. BAGGAO,MD,MHA,MSN,FPSMS

Office/Section : PR No.: MCC-2018-01-013 Date: January 11, 2018

OMCC Responsibility Center Code : ___________

Purpose: FOR CVMC USE - IHOMP Unit

Requested by: Approved by:

Printed Name : JUNE S. PRODIGO GLENN MATHEW G. BAGGAO,MD,MHA,MSN,FPSMS