VOUCHER With ATTACHMENTS

Republic of the Philippines
PROVINCE OF SAMAR
Municipality of San Jose de Buan
OBLIGATION REQUEST No.

Payee MHAI Digital Printing Shop
Office Address San Jose de Buan, Samar
Responsibility EXPLANATION F.P.P. Account Code AMOUNT
Center
payment for purchase of 165 P39,920.00

pieces sublimated shirts, 12 Less (.05%)
pieces sublimated mugs and 1 P1,996.00
piece tarpaulin (48 sq.ft.)
Total P37,924.00
A Certified B Certified
Allotment obligated for the
purpose as indicated above Existence of available appropriation
Supporting documents complete
Signature Signature
Printed Name ANA C. GABON Printed Name ERNESTO G. DACUT
Position MSWDO Position Municipal Budget Officer
Date Date

PROVINCE OF SAMAR
OBLIGATION REQUEST No.

Payee MHAI Digital Printing Shop
Office Address San Jose de Buan, Samar
Responsibility EXPLANATION F.P.P. Account Code AMOUNT
Center
payment for purchase of 165 P39,920.00

pieces sublimated shirts, 12 Less (.05%)
pieces sublimated mugs and 1 P1,996.00
piece tarpaulin (48 sq.ft.)
Total P37,924.00
Allotment obligated for the
purpose as indicated above Existence of available appropriation
Signature Signature
Printed Name ANA C. GABON Printed Name ERNESTO G. DACUT
Position MSWDO Position Municipal Budget Officer
Date Date
PROVINCE OF SAMAR
DISBURSEMENT VOUCHER No.

MODE OF PAYMENT
Check Cash Others
TIN/Employee No. Obligation Request No.
Payee/Office MHAI Digital Printing Shop
604-869-958
Responsibility Center
San Roque St. (Arteche Boulevard)
Address Office/Unit/Project Code:
Catbalogan City, Samar
EXPLANATION Amount
payment for purchase of 165 pieces sublimated shirts, 12 pieces sublimated P39,920.00
mugs and 1 piece tarpaulin (48 sq.ft.) Less (.05%) P1,996.00
P37,924.00
Allotment obligated for the purpose
as indicated above Existence of available appropriation
Signature Signature
Date Date
Printed Name FELIX R. MABUBAY Printed Name JULIUS M. UY
Position MUNICIPAL ACCOUNTANT Position MUNICIPAL ACCOUNTANT

Head, Accounting Unit/Authorized Representative Treasurer/Authorized Representative
C Certified Approved for Payment D Certified Received Payment
Check No. Bank Name Date

Signature
Signature
Date MHAI Digital Printing Date
Printed Name JOAQUIN R. ELIZALDE Printed Name
Shop
MUNICIPAL MAYOR OR/Other Documents JEV No. Date:
Position
Agency Head/Authorized Representative
ACCOUNTING ENTRIES
Responsibility Amount
Account and Explanation Account Code Ref
Center Debit Credit
payment for purchase of 165 pieces
sublimated shirts, 12 pieces
sublimated mugs and 1 piece
tarpaulin (48 sq.ft.)
Prepared by:
FELIX R. MABUBAY
Municipal Accountant - Designate
PURCHASE ORDER
LGU – SAN JOSE DE BUAN, SAMAR
Supplier: MHAI Digital Printing Shop P.O. No. ________________

Address: San Roque St., Catbalogan City Mode of Procurement: _____________
Gentlemen:
Please furnish this office articles subject to the terms and conditions contained herein:
Place of Delivery: Delivery Term: __________
Date of Delivery: Payment Term: __________
Item No. Unit Quantity Description Unit Cost Total
1 pc 165 Sublimated Shirts P222.00 P36,620.00
2 pc 12 Sublimated Mugs P150.00 P1,800.00
3 pc 1 Tarpaulin (48 sq.ft.) P1,500.0 P1,500.00
0
P39,920.00
(Total Amount in Words) Thirty Nine Thousand Nine Hundred Twenty Pesos
(Total Amount in Figures) P39,920.00
In case of failure to make the full delivery within the time specified above, a penalty of one
(1/10) of one percent for every day of delay shall be imposed.
Conformed: Very truly yours,
MHAI Digital Printing Shop LOLITA V. REBATO

Date: _______________ (Authorized Official)
Requisitioning Office/Dept. Funds Available: Amount
ANA C. GABON FELIX R. MABUBAY

MSWDO Mun. Accountant-Designate O.B.S. No.: _____________
PROVINCE OF SAMAR
Abstract of Quotation of Open/Sealed Canvass for National Children’s Month Celebration of MSWDO - San Jose de Buan, Samar
MHAI Digital Printing Shop MR. PRINT Graphics & PHOTOART Digital
Item AWARD to the lowest bidder in price
DESCRIPTIONS/SPECIFICATIONS Quantity Unit Digital Printing Printing
No. being the lowest in the locality
Unit Price Total Unit Price Total Unit Price Total
1 Sublimated Shirts 165 pc P222.00 P36,620.00 P250.00 P41,250.00 P280.00 P46,200.00
2 Sublimated Mugs 12 pc P150.00 P1,800.00 P180.00 P2,160.00 P200.00 P2,400.00 MHAI Digital Printing Shop
3 Tarpaulin (48 sq.ft.) 1 pc P1,500.00 P1,500.00 P1,500.00 P1,500.00 P1,500.00 P1,500.00
TOTAL P39,920.00 P44,910.00 P50,100.00 P39,920.00
WE HEREBY CERTIFY that we opened the above listed supplier and/or materials, the abstract on which appears hereon at the time and date
indicated. We further certify to the correctness of the foregoing abstract and that all submitted by us.
Engr. ARNEL G. OTIDA TANNY BABALCON ERNESTO G. DACUT

BAC Chairman BAC Member BAC Member
ANA C. GABON CONCEPCION M. GORDO JENNIFER N. BAYABAY

BAC Member BAC Member BAC Member
NIÑO D. REBATO
BAC Member
PURCHASE REQUEST
Department: MSWDO PR No. _____________ Date: ____

______
Section: ECCD SAI No. ____________ Date: __________
Unit of Stock Estimated Estimated
Quantity Item Description
Issue No Unit Cost Cost
165 pc Sublimated Shirts P222.00 P36,620.00
12 pc Sublimated Mugs P150.00 P1,800.00
1 pc Tarpaulin (48 sq.ft.) P1,500.00 P1,500.00
P39,920.00
Purpose: For Office Use
Approved:
ANA C. GABON JOAQUIN R. ELIZALDE

MSWDO Municipal Mayor
Date: _______________ Date: _______________
INSPECTION & ACCEPTANCE REPORT
Supplie MHAI Digital Printing Shop AR No. ____________________

r
PO No. Date __________ Invoice No. __________ Date __________
Requisition Office/Dept.
Item No Unit Description Quantity
1 pc Sublimated Shirts 165
2 pc Sublimated Mugs 12
3 pc Tarpaulin (48 sq.ft.) 1
INSPECTION ACCEPTANCE
Date Inspected _____________________ Requisitioning Officer: ANA C. GABON

Inspected, verified and found OK as Complete
to quantity and specifications Partial
FELIX R. MABUBAY JULIUS M. UY

Inspection Officer Propriety Officer
PROVINCE OF SAMAR
DISTRIBUTION SHEET
T-Shirt for Children’s Month Celebration
November 21, 2022
No. Name Signature

1.
2.
3.
4.
5.
6.
7.
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37.
PROVINCE OF SAMAR
DISTRIBUTION SHEET
November 21, 2022
No. Name Signature

38.
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PROVINCE OF SAMAR
DISTRIBUTION SHEET
November 21, 2022
No. Name Signature

75.
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PROVINCE OF SAMAR
DISTRIBUTION SHEET
November 21, 2022
No. Name Signature

113.
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PROVINCE OF SAMAR
DISTRIBUTION SHEET
November 21, 2022
No. Name Signature

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188.
PROVINCE OF SAMAR
DISTRIBUTION SHEET
Mug for Children’s Month Celebration
November 21, 2022
No. Name Signature

1.
2.
3.
4.
5.
6.
7.
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38.
PROVINCE OF SAMAR
ATTENDANCE SHEET
Children’s Month Celebration
November 21, 2022
Name Age Sex Position Signature

1.
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7.
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11.
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PROVINCE OF SAMAR
ATTENDANCE SHEET
November 21, 2022

22.
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PROVINCE OF SAMAR
ATTENDANCE SHEET
November 21, 2022

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PROVINCE OF SAMAR
ATTENDANCE SHEET
November 21, 2022

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PROVINCE OF SAMAR
ATTENDANCE SHEET
November 21, 2022

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PROVINCE OF SAMAR
ATTENDANCE SHEET
November 21, 2022

106.
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126.
PROVINCE OF SAMAR
ATTENDANCE SHEET
November 21, 2022

127.
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130.
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133.
134.
135.
136.
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138.
139.
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147.
PROVINCE OF SAMAR
ATTENDANCE SHEET
November 21, 2022

148.
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168.
PROVINCE OF SAMAR
Municipality of SAN JOSE DE BUAN
Standard Form Number: __________ Date: _______________

Revised on: May 4, 2004 Quotation No.: ____________________
Standard Form Title: Request for Quotation
_________________________
_________________________
_________________________
Please quote your lowest NET GOVERNMENT PROCE on the items below, subject to the General
Conditions below, stating the shortest time of delivery/completion and submit your quotation signed by your
representative not later than ________________ at 12:00NN in the return of the envelope attached herewith.
Late submission of quotation shall not be accepted.
The Approved Budge of Contract (ABC) is Php _______________.
ARNEL G. OTIDA
BAC Chairperson
NOTE:
1. ALL ENTRIES MUST BE TYPEWRITTEN
2. THE MANUALS SHOULD BE DELIVERED ON OR BEFORE ____________________
3. WARRANTY SHALL BE FOR A PERIOD OF SIX (6) MONTHS FOR THE SUPPLIES &
MATERIALS. ONE (1) YEAR FOR EQIPMENT, FROM DATE OF ACCEPTANCE BY THE
PROCURING ENTITY
4. PRICE VALIDITY SHALL BE FOR A PERIOD OF __________ CALENDAR DAYS
5. PHILGEPS REGISTRATION CERTIFICATE SHALL BE ATTACHED UPON SUBMISSION OF
THE QUOTATION AND MAYOR’S PERMIT, DTI CERTIFICATION, OMNIBUS SWORN
STATEMENT
6. BIDDERS SHALL SUBMIT ORIGINAL BROCHURES SHOWING CERTIFICATIONS OF THE
PRODUCT BEING OFFERED
Item No. Item & Description Quantity Unit Unit Price Total Amount
1 SUBLIMATED SHIRT (ADULT) 165 PC
2 SUBLIMATED MUGS 12 PC
3 TARPAULIN LAYOUT & PRINT (48sq.ft.) 1 PC
Brand and Model:

Delivery Period:
Warranty:
Price Validity:
After having carefully read and acceptance your General Conditions, we quote you on the item at prices noted above.
Accomplished by:
RFQ Received by:
Company Name _______________________________________
Printed Name & Signature: Tel. No. / Cellphone No.
Company Name: _______________________________________
Printed Name / Signature
Date Received:
_______________________________________
Canvasser:
PROVINCE OF SAMAR

_________________________
_________________________
_________________________
ARNEL G. OTIDA
BAC Chairperson
NOTE:
PROCURING ENTITY
STATEMENT
Brand and Model:

Delivery Period:
Warranty:
Price Validity:
Accomplished by:
RFQ Received by:
Company Name _______________________________________
Company Name: _______________________________________
Date Received:
_______________________________________
Canvasser:

PROVINCE OF SAMAR

_________________________
_________________________
_________________________
ARNEL G. OTIDA
BAC Chairperson
NOTE:
PROCURING ENTITY
STATEMENT
Brand and Model:

Delivery Period:
Warranty:
Price Validity:
Accomplished by:
RFQ Received by:
Company Name _______________________________________
Company Name: _______________________________________
Date Received:
_______________________________________
Canvasser:

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Republic of the Philippines

OBLIGATION REQUEST No.

payment for purchase of 165 P39,920.00

Republic of the Philippines

OBLIGATION REQUEST No.

payment for purchase of 165 P39,920.00

DISBURSEMENT VOUCHER No.

Position MUNICIPAL ACCOUNTANT Position MUNICIPAL ACCOUNTANT

Check No. Bank Name Date

Supplier: MHAI Digital Printing Shop P.O. No. ________________

MHAI Digital Printing Shop LOLITA V. REBATO

ANA C. GABON FELIX R. MABUBAY

Engr. ARNEL G. OTIDA TANNY BABALCON ERNESTO G. DACUT

ANA C. GABON CONCEPCION M. GORDO JENNIFER N. BAYABAY

Department: MSWDO PR No. _____________ Date: ____

ANA C. GABON JOAQUIN R. ELIZALDE

Supplie MHAI Digital Printing Shop AR No. ____________________

Date Inspected _____________________ Requisitioning Officer: ANA C. GABON

FELIX R. MABUBAY JULIUS M. UY

No. Name Signature

No. Name Signature

No. Name Signature

No. Name Signature

No. Name Signature

No. Name Signature

Name Age Sex Position Signature

Name Age Sex Position Signature

Name Age Sex Position Signature

Name Age Sex Position Signature

Name Age Sex Position Signature

Name Age Sex Position Signature

Name Age Sex Position Signature

Name Age Sex Position Signature

Standard Form Number: __________ Date: _______________

The Approved Budge of Contract (ABC) is Php _______________.

1 SUBLIMATED SHIRT (ADULT) 165 PC

3 TARPAULIN LAYOUT & PRINT (48sq.ft.) 1 PC

Brand and Model:

Standard Form Number: __________ Date: _______________

The Approved Budge of Contract (ABC) is Php _______________.

1 SUBLIMATED SHIRT (ADULT) 165 PC

3 TARPAULIN LAYOUT & PRINT (48sq.ft.) 1 PC

Brand and Model:

Republic of the Philippines

Standard Form Number: __________ Date: _______________

The Approved Budge of Contract (ABC) is Php _______________.

1 SUBLIMATED SHIRT (ADULT) 165 PC

3 TARPAULIN LAYOUT & PRINT (48sq.ft.) 1 PC

Brand and Model:

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Department: MSWDO PR No. _________ Date:

Standard Form Number: Date: _____

Standard Form Number: Date: _____

Standard Form Number: Date: _____