Republic of the Philippines
Municipality of Isabel
Isabel, Leyte
DISBURSEMENT VOUCHER NO.
Mode of
Payment Check Cash Others
OBLIGATION REQUEST NO.
PAYEE LORNA P. OBUS-PADES
Responsibility Center
ADRESSS ISABEL, LEYTE Office/ Unit Project Code
PARTICULARS AMOUNT
To payment of additional allowance for the month of July, 2022 3,000.00
in the amount of Three Thousand Pesos (P3, 000.00)
Total Amount 3,000.00
A. Certified B. Certified
Allotment obligated for the purpose as indicated above Funds Available
Supporting documents complete
Signature DATE Signature DATE
Printed Printed
Name MA. LISA P. AMSON, CPA Name MITZI C. AMODIA
MGDH-I (Municipal Accountant) Municipal Treasurer
Position Position
Head, Accounting Unit/ Authorized Representative Treasurer/ Authorized Representative
C. Approved for payment D. Received Payment
Signature DATE Check No. DATE
Printed Signature
LORNA P. OBUS-PADES DATE
Name MR. ARCHILLES A. SILVA , DM
Printed Name
MUN. ADMINISTRATOR OR/ Other Documents JEV NO. DATE
Position
Agency Head/ Authorized Representative
Republic of the Philippines
Municipality of Isabel
Isabel, Leyte
OBLIGATION REQUEST No.
Payee/ Office:
NEED INK SALES/ROY A. MANGUBAT Date:
Office:
Address: Lilia Avenue, Cogon, Ormoc. City
Responsibility Account
Center Particulars F.F.P. Code AMOUNT
Payment for Optimum Toner Cartridge OPT-55A 21,600.00
used at the Office of the Municipal Accountant.
TOTAL 21,600.00
Certified
A. B.
Charges to appropriation/ allotment necessary, lawful and under my Existing of available appropriation
direct supervision
Supporting documents valid, proper and legal
Signature Signature
Printed Name MA. LISA P. AMSON, CPA Printed Name ROBERTO A. SIMBAJON
MGDH-I (Municipal Accountant) OIC- Municipal Budget Officer
Position Position
Head, Requesting Office/ Authorized Representative Head, Budget Office/ Authorized Representative
Republic of the Philippines
Municipality of Isabel
Isabel, Leyte
OBLIGATION REQUEST No.
Payee/ Office: LORNA P. OBUS-PADES Date:
Office: MCTC- ISABEL
Address: ISABEL, LEYTE
Responsibility Particulars F.F.P. Account AMOUNT
Center Code
To payment of additional allowance for the month 3,000.00
of July, 2022 in the amount of Three Thousand Pesos
(P3,000.00)
TOTAL 3,000.00
Certified
A. B.
Charges to appropriation/ allotment necessary, lawful and under my Existing of available appropriation
direct supervision
Supporting documents valid, proper and legal
Signature Signature
Printed Name MR. ARCHILLES A. SILVA , DM Printed Name ROBERTO A. SIMBAJON
MUN. ADMINISTRATOR OIC- Municipal Budget Officer
Position Position
Position Position
Agency Head/ Authorized Representative Head, Budget Office/ Authorized Representative
PURCHASE REQUEST
ISABEL, LEYTE
LGU
Department: LEGAL OFFICE PR No. ________________ Date: _________
SAI No. ________________ Date: _________
Section: _________________________ Alobs No. ________________ Date: _________
Unit of Estimated
Item No. Qnty Item of Description Estimated Cost
Issue Unit Cost
1 10 Reams Long Bond Paper
2 10 Reams Short Bond Paper
3 10 Reams A4 bond paper
4 5 Boxes Ballpen (Flex Stick)
5 5 Rolls Scotch Tape 1 Inch
6 10 Boxes Staple Wire # 35
7 3 Doz. Folder Long
8 12 Bots Epson Ink 664-Black
9 6 Bots Epson Ink 664-Blue
10 6 Bots Epson Ink 664-Yellow
11 6 Bots Epson Ink 664-Magenta
₱ -
Purpose: OFFICE SUPPLIES USED AT ACCOUNTING OFFICE.
Requested by: Controlled By:
Signature
Printed Name MA. LISA P. AMSON, CPA RAMIL C. LARIOSA
Designation Municipal Accountant General Services Officer
Certified as to Availability of Funds: Approved By:
Signature
Printed Name MA. LISA P. AMSON, CPA MR. ARCHILLES A. SILVA, DM
Designation (MGDH-I)Municipal Accountant Municipal Administrator
PURCHASE ORDER
ISABEL, LEYTE
LGU
Supplier: NEED INK SALES & SERVICES/ ROY A. MANGUBAT Date: _________
Adddress: ORMOC CITY Mode of Procurement:
Gentlemen:
Please furnish this office the following articles subject to the terms of conditions contained herein:
Place of Delivery:
Date of Delivery: Payment Term:
Item No. Quantity Unit Unit Cost Amount
4 PCS OPTIMUM TONER CARTRIDGE OPT- 55A 5,400.00 21,600.00
21,600.00
In case of failure to make the full delivery within the time specified above, penalty of one-tenth (1-10)
of one percent for every day shall be imposed.
Conforme: Very truly yours,
NEED INK SALES & SERVICES/ ROY A. MANGUBAT HON. EDGARDO C. CORDEÑO
Signature Over Printed Name (AUTHORIZED SIGNATURE)
(Date) ___________________
(In case of Negotiated Purchase pursuant to Section 369 (a) of RA 7160, this portion must be accomplished.)
Approved per sanggunian Resolution No.: ____________________________
Certified Correct: _________________________
Secretary to the Sanggunian Date: ____________________
Republic of the Philippines 1
Province of Leyte
MUNICIPALITY OF ISABEL
REQUEST FOR PRICE QUOTATION
NEED INK SALES/ROY A. MANGUBAT
A. Please quote your unit price for each of the articles listed below.
B. Submit this request for price quotation, duly accomplished, in sealed envelope plainly marked "CANVASS"
No.:__________________ TO BE OPENED by dropping it inside the CANVASS BOX of the Purchase unit of this
Office hour 10:00 AM of said date.
C. The Purchase of the articles listed hereunder is subject to the terms and condition governing government
purchase.
UNIT OF ESTIMATED
ITEM QUANTITY ITEM OF DESCRIPTION ESTIMATED COST
ISSUE UNIT COST
1 4 PCS TONER MODEL-OPT 55A 5400 21600
TIME OF DELIVER:_______________________
Working days from receipt of the delivery order.
REYNALDO A. PANDAY
Signature of Owner or Representative Canvasser
Republic of the Philippines
PROVINCE OF LEYTE
ISABEL, LEYTE
ABSTRACT OF CANVASS AND AWARDS
DEALERS:
1. NEED INK SALES & SERVICES
2. PCS SPECIALIST
3. ORMOC NET
QUANTITY UNIT ARTICLES
4 PCS TONER MODEL-OPT 55A 23,000.00 22,400.00 21,600.00
23,000.00 22,400.00 21,600.00
REFERENCE : Award is hereby recommended
PURPOSED : to be given to : NEED INK SALES & SERVICES
MITZI C. AMODIA HON. EDGARDO C. CORDEÑO
Municipal Treasurer Office Municipal Mayor
ACCEPTANCE & INSPECTION REPORT
ISABEL, LEYTE
LGU
Supplier: NEED INK SALES & SERVICES/ROY A. MANGUBAT Date: _________
PO No.: ________________ Date: _____________ INVOICE NO. Date: _________
Item No. Unit QUANTITY
1 PCS TONER CARTRIDGE PPT- 55A 4
ACCEPTANCE INSPECTION
Date Received: __________ Date Inspected: ______________
Complete Inspected, verified
as to quantity and specifications
Partial
MA. LISA P. AMSON, CPA RAMIL C. LARIOSA
Property Officer Inspection Officer
