PURCHASE REQUEST

Entity Name: SB Fund Cluster: General Fund

Office/Section :_________ PR NO.:__________________ Date:_______________
Resoponsibilty Center Code:____________
Stock/Property No. Unit Item Description Quantity Unit Cost Total Cost
1 1 Refrigerator 1 15,000.00 15,000.00

-
-
-
-

15,000.00

Purpose : RHU use.

Requested by : Approved by:

Signature: __________________________ ____________________________
Printed Name: GENERICO R. JAUCULAN GENERICO R. JAUCULAN
Designation: Municipal Vice Mayor Municipal Vice Mayor
 PURCHASE REQUEST

Entity Name: RHU Fund Cluster: Trust Fund Capitation

Office/Section :_________ PR NO.:__________________ Date:_______________
Resoponsibilty Center Code:____________
Stock/Property No. Unit Item Description Quantity Unit Cost Total Cost
1 pack Construction 20's 2 20.00 40.00
2 roll plastic tape 1 45.00 45.00
3 pc. double sided 1 30.00 30.00
4 ream construction 2 280.00 560.00
5 pcs. frame 5 65.00 325.00
6 pcs. frame 8 70.00 560.00
7 doz. filler mini ofron rose 2 43.00 86.00
8 mtrs. plastic charol 50 18.00 900.00
9 kls. stawless 2 80.00 160.00
10 pc. kabo 1 35.00 35.00
11 roll tie wire 1 300.00 300.00
12 kl. c.w.n. #1 1 53.00 53.00
13 kl. c.w.n. #3 1 47.00 47.00
14 kl. c.w.n. #4 1 46.00 46.00
15 pads pins 20 15.00 300.00
16 meters lei cloth assorted 20 66.90 1,338.00
17 pc. tarpaulin 1 1,000.00 1,000.00
18 pack glue stick 1 90.00 90.00
19 pcs. Gift Bag 20 9.00 180.00
20 pcs. metallic balloon 12 51.00 612.00
21 box thumbtacks 24 6.00 144.00
22 pcs. file folder 10 5.00 50.00
23 pcs. brown envelop 41 4.00 164.00
24 pcs. syrtone rose scented 4 38.00 152.00
25 pack asstd. Sunburst col paper 1 175.00 175.00
26 pack asstd. Dayglow col papers 1 205.00 205.00
27 pc. hairclamp 1 35.00 35.00
28 pcs. mirror 1 78.00 78.00
29 pcs. white glue 2 28.00 56.00
30 pcs. eagle glue 120g 3 22.00 66.00
31 pcs. scissor 3 38.00 114.00
32 pc. headband 1 15.00 15.00
33 pcs. packing tape 2 28.00 56.00
34 pc. office scissor 2 30.00 60.00
35 pcs. trans balloon 16 85.00 1,360.00

9,437.00

Purpose : Supplies for TSEKAP CARAVAN on June 27, 2017.

Requested by : Approved by:

Signature: __________________________ ____________________________
Printed Name: CARMEL MATHILDA B. LADEZA ANGELES R. CARLOTO II
Designation: Municipal Health Officer Municipal Mayor
 PURCHASE REQUEST

Entity Name: RHU Fund Cluster: MCP

Office/Section :_________ PR NO.:__________________ Date:_______________
Resoponsibilty Center Code:____________
Stock/Property No. Unit Item Description Quantity Unit Cost Total Cost
1 set Typing sera 1 2,770.00 2,770.00

2,770.00

Purpose : Med. Supplies during Blood Letting Activity May 18,2017.

Requested by : Approved by:

Signature: __________________________ ____________________________
Printed Name: CARMEL MATHILDA B. LADEZA ANGELES R. CARLOTO II
Designation: Municipal Health Officer Municipal Mayor
 PURCHASE REQUEST

Entity Name: RHU Fund Cluster: Trust Fund Capitation

Office/Section :_________ PR NO.:__________________ Date:_______________
Resoponsibilty Center Code:____________
Stock/Property No. Unit Item Description Quantity Unit Cost Total Cost
1 pcs. Focus 18w 2 135.00 270.00
2 pcs. male adaptor 1/2 3 12.00 36.00
3 pc. gate valve 1/2 1 285.00 285.00
4 pc. male plug 1 20.00 20.00
5 meters trapal 4 65.00 260.00
6 meters Flatcord #16 3 28.00 84.00
7 pc. outlet 3 gang 1 70.00 70.00
8 pc. cylinder med. Aviator 1 280.00 280.00
-
-
-
-
-
-
-

1,305.00

Purpose : RHU use.

Requested by : Approved by:

Signature: __________________________ ____________________________
Printed Name: CARMEL MATHILDA B. LADEZA ANGELES R. CARLOTO II
Designation: Municipal Health Officer Municipal Mayor
 PURCHASE REQUEST

Entity Name: Mayor's Office Fund Cluster: 20%

Office/Section :_________ PR NO.:__________________ Date:_______________
Resoponsibilty Center Code:____________
Stock/Property No. Unit Item Description Quantity Unit Cost Total Cost
1 pcs. Plywood ordinary 13 385.00 5,005.00
2 pcs. Paint Latex 800 5 678.00 3,390.00
3 liters Flat White 1 675.00 675.00

9,070.00

Purpose : Counterpart to various project

Requested by : Approved by:

Signature: __________________________ ____________________________
Printed Name: ANGELES R. CARLOTO II ANGELES R. CARLOTO II
Designation: Municipal Mayor Municipal Mayor
 PURCHASE REQUEST

Entity Name: Mayor's Office Fund Cluster: 20%

Office/Section :_________ PR NO.:__________________ Date:_______________
Resoponsibilty Center Code:____________
Stock/Property No. Unit Item Description Quantity Unit Cost Total Cost
1 bags Cement 15 320.00 4,800.00
2 pcs. 10 mm Steel bar 15 145.00 2,175.00
3 cu Mixed sand 2 1,150.00 2,300.00
4 pcs. Paint Flat Latex White 4 678.00 2,712.00
5 pcs. Plywood ordinary 7 385.00 2,695.00
-
-
-

14,682.00

Purpose : Counterpart to various project

Requested by : Approved by:

Signature: __________________________ ____________________________
Printed Name: ANGELES R. CARLOTO II ANGELES R. CARLOTO II
Designation: Municipal Mayor Municipal Mayor
 PURCHASE REQUEST

Entity Name: Mayor's Office Fund Cluster: 20%

Office/Section :_________ PR NO.:__________________ Date:_______________
Resoponsibilty Center Code:____________
Stock/Property No. Unit Item Description Quantity Unit Cost Total Cost
1 bags Cement 50 280.00 14,000.00

14,000.00

Purpose : Counterpart to various project

Requested by : Approved by:

Signature: __________________________ ____________________________
Printed Name: ANGELES R. CARLOTO II ANGELES R. CARLOTO II
Designation: Municipal Mayor Municipal Mayor
 PURCHASE REQUEST

Entity Name: DEP ED Fund Cluster: SEF

Office/Section :_________ PR NO.:__________________ Date:_______________
Resoponsibilty Center Code:____________
Stock/Property No. Unit Item Description Quantity Unit Cost Total Cost
15 Portland cement 15 290.00 4,350.00
500 4" CHB 500 15.00 7,500.00
20 1/4 Marine Plywood 20 550.00 11,000.00
10 DSB 10 mm 10 180.00 1,800.00
15 DSB 8 mm 15 170.00 2,550.00
4 cw nails #1 4 90.00 360.00
2 cw nails #2 2 90.00 180.00
3 cw nails #3 3 90.00 270.00
3 cw nails #4 3 90.00 270.00
2 #16 Tie wire 2 100.00 200.00
5 mixed sand 5 900.00 4,500.00
3 fine aggregates 3 850.00 2,550.00
2 latex paint 2 650.00 1,300.00
2 gloss latex paint 2 700.00 1,400.00
2 enamel paint 2 700.00 1,400.00

39,630.00

Purpose : Repair of School Classrooms of Central Ementary School.

Requested by : Approved by:

Signature: __________________________ ____________________________
Printed Name: ANGELES R. CARLOTO II ANGELES R. CARLOTO II
Designation: Municipal Mayor Municipal Mayor
 PURCHASE REQUEST

Entity Name: Mayor's Office Fund Cluster: 20%

Office/Section :_________ PR NO.:__________________ Date:_______________
Resoponsibilty Center Code:____________
Stock/Property No. Unit Item Description Quantity Unit Cost Total Cost
1 bags Cement 30 280.00 8,400.00
2 cu Mixed sand 12 950.00 11,400.00
3 gal. Latex Flat white 1 545.00 545.00
4 lit Hanza Yellow 1 75.00 75.00
-
-
-
-
-
-
-
-
-
-
-

20,420.00

Purpose : Counterpart to various project

Requested by : Approved by:

Signature: __________________________ ____________________________
Printed Name: CARMEL MATHILDA B. LADEZA ANGELES R. CARLOTO II
Designation: Municipal Health Officer Municipal Mayor