Annex B

Republic of the Philippines

Province of Oriental Mindoro
MUNICIPALITY OF PINAMALAYAN
No.
DISBURSEMENT VOUCHER

Mode of
Check Cash Others
Payment

TIN/Employee No. Obligation Request No.

Payee EAGLE - R GAS STATION

Responsibility Center
Office/Unit/Project Code
Address
PINAMALAYAN, ORIENTAL MINDORO

EXPLANATION AMOUNT

TO PAYMENT OF: GASOLINE AND OIL CONSUMED BY MULTICAB 7,852.61

FOR THE 4TH QTR. 2022 - MUNICIPAL COMPOUND, PINAMALAYAN
ORIENTAL MINDORO. AMOUNTING TO SEVEN THOUSAND FOUR
HUNDRED THIRTY ONE PESOS 93 / 100 ONLY

NET SALES - 7,011.26

1%EWT - 70.11
5%VAT - 350.56
420.68

7,431.93
A. Certified B. Certified
ü Allotment obligated for the purpose as indicated above Funds Available

ü Supporting documents complete

Signature Signature

Date Date
Printed Name JUDY DE GUZMAN-MORENTE Printed Name PLARIDEL S. CUPIADO

Position MUNICIPAL ACCOUNTANT Position MUNICIPAL TREASURER

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

Date Signature
Printed Name HON. ARISTEO A. BALDOS, JR. Date
Printed Name EAGLE - R GAS STATION
OR/Other Documents JEV No. Date
Position MUNICIPAL MAYOR
Agency Head/Authorized Representative
 Annex B

Republic of the Philippines

Province of Oriental Mindoro
MUNICIPALITY OF PINAMALAYAN
No.
DISBURSEMENT VOUCHER

Mode of
Check Cash Others
Payment

TIN/Employee No. Obligation Request No.

Payee EAGLE - R GAS STATION

Responsibility Center
Office/Unit/Project Code
Address
PINAMALAYAN, ORIENTAL MINDORO

EXPLANATION AMOUNT

TO PAYMENT OF: GASOLINE AND OIL CONSUMED SUZUKI SMASH FW - 100 926.73
FOR THE 4TH QTR. 2022 - MUNICIPAL COMPOUND, PINAMALAYAN
ORIENTAL MINDORO. AMOUNTING TO EIGHT HUNDRED SEVENTY
SEVEN PESOS 09 /100 ONLY.

NET SALES - 827.44

1%EWT - 8.27
5%VAT - 41.37
49.64

877.09
A. Certified B. Certified
ü Allotment obligated for the purpose as indicated above Funds Available

ü Supporting documents complete

Signature Signature

Date Date
Printed Name JUDY DE GUZMAN-MORENTE Printed Name PLARIDEL S. CUPIADO

Position MUNICIPAL ACCOUNTANT Position MUNICIPAL TREASURER

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

Date Signature
Printed Name HON. ARISTEO A. BALDOS, JR. Date
Printed Name EAGLE - R GAS STATION
OR/Other Documents JEV No. Date
Position MUNICIPAL MAYOR
Agency Head/Authorized Representative
 Annex B

Republic of the Philippines

Province of Oriental Mindoro
MUNICIPALITY OF PINAMALAYAN
No.
DISBURSEMENT VOUCHER

Mode of
Check Cash Others
Payment

TIN/Employee No. Obligation Request No.

Payee EAGLE - R GAS STATION

Responsibility Center
Office/Unit/Project Code
Address
PINAMALAYAN, ORIENTAL MINDORO

EXPLANATION AMOUNT

TO PAYMENT OF: GASOLINE AND OIL CONSUMED HONDA CFT 125 MSJ 1,003.97
FOR THE 4TH QTR. 2022 - MUNICIPAL COMPOUND, PINAMALAYAN 744.86
ORIENTAL MINDORO. AMOUNTING TO EIGHT HUNDRED SIXTY
NINE PESOS 51 /100 ONLY.

NET SALES - 896.40

1%EWT - 89.64
5%VAT - 44.82
134.46

869.51
A. Certified B. Certified
ü Allotment obligated for the purpose as indicated above Funds Available

ü Supporting documents complete

Signature Signature

Date Date
Printed Name JUDY DE GUZMAN-MORENTE Printed Name PLARIDEL S. CUPIADO

Position MUNICIPAL ACCOUNTANT Position MUNICIPAL TREASURER

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

Date Signature
Printed Name HON. ARISTEO A. BALDOS, JR. Date
Printed Name EAGLE - R GAS STATION
OR/Other Documents JEV No. Date
Position MUNICIPAL MAYOR
Agency Head/Authorized Representative
 Annex B

Republic of the Philippines

Province of Oriental Mindoro
MUNICIPALITY OF PINAMALAYAN
No.
DISBURSEMENT VOUCHER

Mode of
Check Cash Others
Payment

TIN/Employee No. Obligation Request No.

Payee EAGLE - R GAS STATION

Responsibility Center
Office/Unit/Project Code
Address
PINAMALAYAN, ORIENTAL MINDORO

EXPLANATION AMOUNT

TO PAYMENT OF: GASOLINE AND OIL CONSUMED HONDA RS - 125i 610.81

FOR THE 4TH QTR. 2022 - MUNICIPAL COMPOUND, PINAMALAYAN
ORIENTAL MINDORO. AMOUNTING TO FIVE HUNDRED SEVENTY
EIGHT PESOS 09 /100 ONLY.

NET SALES - 545.37

1%EWT - 5.45
5%VAT - 27.27
32.72

578.09
A. Certified B. Certified
ü Allotment obligated for the purpose as indicated above Funds Available

ü Supporting documents complete

Signature Signature

Date Date
Printed Name JUDY DE GUZMAN-MORENTE Printed Name PLARIDEL S. CUPIADO

Position MUNICIPAL ACCOUNTANT Position MUNICIPAL TREASURER

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

Date Signature
Printed Name HON. ARISTEO A. BALDOS, JR. Date
Printed Name EAGLE - R GAS STATION

OR/Other Documents JEV No. Date

Position MUNICIPAL MAYOR
Agency Head/Authorized Representative
 Annex B

Republic of the Philippines

Province of Oriental Mindoro
MUNICIPALITY OF PINAMALAYAN
No.
DISBURSEMENT VOUCHER

Mode of
Check Cash Others
Payment

TIN/Employee No. Obligation Request No.

Payee EAGLE - R GAS STATION

Responsibility Center
Office/Unit/Project Code
Address
PINAMALAYAN, ORIENTAL MINDORO

EXPLANATION AMOUNT

TO PAYMENT OF: GASOLINE AND OIL CONSUMED YAMAHA XTZ - 125 (TMX -213) 929.97
FOR THE 4TH QTR. 2022 - MUNICIPAL COMPOUND, PINAMALAYAN
ORIENTAL MINDORO. AMOUNTING TO EIGHT HUNDRED
EIGHTY PESOS 15 /100 ONLY.

NET SALES - 830.33

1%EWT - 8.30
5%VAT - 41.52
49.82

880.15
A. Certified B. Certified
ü Allotment obligated for the purpose as indicated above Funds Available

ü Supporting documents complete

Signature Signature

Date Date
Printed Name JUDY DE GUZMAN-MORENTE Printed Name PLARIDEL S. CUPIADO

Position MUNICIPAL ACCOUNTANT Position MUNICIPAL TREASURER

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

Date Signature
Printed Name HON. ARISTEO A. BALDOS, JR. Date
Printed Name EAGLE - R GAS STATION
OR/Other Documents JEV No. Date
Position MUNICIPAL MAYOR
Agency Head/Authorized Representative
 Annex B

Republic of the Philippines

Province of Oriental Mindoro
MUNICIPALITY OF PINAMALAYAN
No.
DISBURSEMENT VOUCHER

Mode of
Check Cash Others
Payment

TIN/Employee No. Obligation Request No.

Payee EAGLE - R GAS STATION

Responsibility Center
Office/Unit/Project Code
Address
PINAMALAYAN, ORIENTAL MINDORO

EXPLANATION AMOUNT

TO PAYMENT OF: GASOLINE AND OIL CONSUMED AUTOMATIC TRANSMISSION 978.65

(MIO SOUL i125 - ORANGE) FOR THE 4TH QTR 2022 - MUNICIPAL COMPOUND
PINAMALAYAN, ORIENTAL MINDORO. AMOUNTING TO NINE HUNDRED TWENTY
SIX PESOS 22 /100 ONLY.

NET SALES - 873.79

1%EWT - 8.74
5%VAT - 43.69
52.43

926.22
A. Certified B. Certified
ü Allotment obligated for the purpose as indicated above Funds Available

ü Supporting documents complete

Signature Signature

Date Date
Printed Name JUDY DE GUZMAN-MORENTE Printed Name PLARIDEL S. CUPIADO

Position MUNICIPAL ACCOUNTANT Position MUNICIPAL TREASURER

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

Date Signature
Printed Name HON. ARISTEO A. BALDOS, JR. Date
Printed Name EAGLE - R GAS STATION
OR/Other Documents JEV No. Date
Position MUNICIPAL MAYOR
Agency Head/Authorized Representative
 Annex B

Republic of the Philippines

Province of Oriental Mindoro
MUNICIPALITY OF PINAMALAYAN
No.
DISBURSEMENT VOUCHER

Mode of
Check Cash Others
Payment

TIN/Employee No. Obligation Request No.

Payee EAGLE - R GAS STATION

Responsibility Center
Office/Unit/Project Code
Address
PINAMALAYAN, ORIENTAL MINDORO

EXPLANATION AMOUNT

TO PAYMENT OF: GASOLINE AND OIL CONSUMED NEW MOTORCYCLE (MIO SOUL i125 - 299.97
BURGUNDY/BLACK) FOR THE 4TH QTR. 2022 - MUNICIPAL COMPOUND, PINAMALAYAN
ORIENTAL MINDORO. AMOUNTING TO TWO HUNDRED EIGHTY
THREE PESOS 90/ 100 ONLY

NET SALES - 267.83

1%EWT - 2.68
5%VAT - 13.39
16.07

283.90
A. Certified B. Certified
ü Allotment obligated for the purpose as indicated above Funds Available

ü Supporting documents complete

Signature Signature

Date Date
Printed Name JUDY DE GUZMAN-MORENTE Printed Name PLARIDEL S. CUPIADO

Position MUNICIPAL ACCOUNTANT Position MUNICIPAL TREASURER

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

Date Signature
Printed Name HON. ARISTEO A. BALDOS, JR. Date
Printed Name EAGLE - R GAS STATION
OR/Other Documents JEV No. Date
Position MUNICIPAL MAYOR
Agency Head/Authorized Representative
 Annex B

Republic of the Philippines

Province of Oriental Mindoro
MUNICIPALITY OF PINAMALAYAN
No.
DISBURSEMENT VOUCHER

Mode of
Check Cash Others
Payment

TIN/Employee No. Obligation Request No.

Payee EAGLE - R

Responsibility Center
Office/Unit/Project Code
Address
PINAMALAYAN, ORIENTAL MINDORO

EXPLANATION AMOUNT

TO PAYMENT OF: GASOLINE AND OIL CONSUMED ( GENERATOR ) 19,999.96

FOR THE 3RD QTR. 2022 - MUNICIPAL COMPOUND, PINAMALAYAN
ORIENTAL MINDORO. AMOUNTING TO EIGHTEEN THOUSAND NINE HUNDRED
TWENTY EIGHT PESOS 53 /100 ONLY.

NET SALES - 17,857.11

1%EWT - 178.57
5%VAT - 892.86
1,071.43

18,928.53
A. Certified B. Certified
ü Allotment obligated for the purpose as indicated above Funds Available

ü Supporting documents complete

Signature Signature

Date Date
Printed Name JUDY DE GUZMAN-MORENTE Printed Name PLARIDEL S. CUPIADO

Position MUNICIPAL ACCOUNTANT Position MUNICIPAL TREASURER

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

Date Signature
Printed Name HON. ARISTEO A. BALDOS, JR. PINAMALAYAN SBC TRADING Date
Printed Name
CORP.
OR/Other Documents JEV No. Date
Position MUNICIPAL MAYOR
Agency Head/Authorized Representative
 PURCHASE ORDER
MUNICIPAL GOVERNMENT OF PINAMALAYAN
Agency
Supplier: EAGLE R GAS STATION P.O. No. _______________________
Address: Pinamalayan, Or. Mindoro Date: _______________________
Mode of Procurement: small value procurement
P.R. No.:
Gentlemen:
Please furnish this office the following articles subject to the terms and conditions contained herein:

Place of Delivery: ________________________ Delivery Term: various delivery

Date of Delivery: __________________ Payment Term: w/in 15 working days after

complete delivery

Item No. Unit Qty. Description Unit Cost AMOUNT

lot I lts 22 Gasoline 100.00 2,200.00

pcs 1 Motor Oil 265.00 265.00

(October - December)4th quarter

Total Amount in Words: Two Thousand Four Hundred Sixty Five Pesos 2,465.00
In case of failure to make the full delivery within the time specified above, a penalty of
one-tenth (1/10) of one percent for every day of delay shall be imposed.

Very Truly yours,

Conforme: HON. ARISTEO A. BALDOS, JR.

EAGLE R GAS STATION Municipal Mayor
(Signature over printed name) (Date)
Funds Available:
OBRE No: ______________

JUDY DE GUZMAN MORENTE Amount ______________

Municipal Accountant
 Annex 30

PURCHASE REQUEST
MUNICIPALITY OF PINAMALAYAN
LGU

Department : Municipal Engineering Office BAC No.: ____________ Date: _________

PR No.: ____________ Date: _________
Section : SAI No.:_____________ Date: _________
ALOBS No.:__________ Date:_________
Item Unit of Estimated Estimated
Quantity Item Description
No. Issue Unit Cost Cost
65 reams Coupon bond paper (long) S-20 260.00 16,900.00
Lot 1 35 reams Coupon bond paper (short) S-20 250.00 8,750.00
4 boxes Sign pen (0.4) 920.00 3,680.00
3 boxes Sign pen (0.5) 920.00 2,760.00
3 boxes Push pin 350.00 1,050.00
3 boxes Packaging Tape 250.00 750.00
1 pcs Duct Tape 260.00 260.00
4 pcs Metal Filing Rack 680.00 2,720.00
4 pcs Scissors 20.00 80.00
7 boxes Ballpen (BP- S Fine) 320.00 2,240.00
63 pcs Accounting folder (long) 35.00 2,205.00
3 boxes Pencil #2 90.00 270.00
7 boxes Staple wire #35 55.00 385.00
11 pcs Correction tape 40.00 440.00
3 tubes Toner (260g) 6,800.00 20,400.00
11 btls Printer Ink (003 black) 520.00 5,720.00
5 btls Printer Ink (003 yellow) 520.00 2,600.00
5 btls Prin ter Ink (003 cyan) 520.00 2,600.00
5 btls Printer Ink (003 magenta) 520.00 2,600.00
5 btls Printer Ink (T 644 Black) 520.00 2,600.00
3 btls Printer Ink (T 644 Yelow) 520.00 1,560.00
3 btls Printer Ink (T 644 Cyan) 520.00 1,560.00
3 btls Printer Ink (T 644 Magenta) 520.00 1,560.00
2 btls T 673 (black) 970.00 1,940.00
2 btls T 673 (colored) 970.00 1,940.00
7 boxes Paper clip (big) 35.00 245.00
7 boxes Binder clip 1' 60.00 420.00
7 boxes Binder clip 2' 100.00 700.00
7 pcs Scotch tape 1" 30.00 210.00
7 pcs Masking tape 1" 45.00 315.00
2 pcs Double sided tape 1" 45.00 90.00
2 pcs Packing tape 2" 50.00 100.00
Sub- total 89,650.00
Purpose: Purchase of Office Supplies (1st qtr.)
MEO, Municipal Compound, Pina.,Or. Mindoro

Requested by: Cash availability: Approved by:

Signature:
Printed Name: ENGR. MANOLITO E. MASCULINO PLARIDEL S. CUPIADO HON. ARISTEO A. BALDOS,JR.
Designation: Municipal Engineer Municipal Treasurer Municipal Mayor
 Annex 30
PURCHASE REQUEST
MUNICIPALITY OF PINAMALAYAN
LGU

Department : Municipal Engineering Office BAC No.: ____________ Date: _________

PR No.: ____________ Date: _________
Section : SAI No.:_____________ Date: _________
ALOBS No.:__________ Date:_________
Item Unit of Estimated Estimated
Quantity Item Description
No. Issue Unit Cost Cost
5 pcs Log book 500pp 440.00 2,200.00
3 pcs Log Book (small) 100.00 300.00
1 ream A 3 bond 500.00 500.00
50 pcs Folder ordinary (long) 8.00 400.00
15 pcs Folder ordinary (short) 7.00 105.00
9 pcs Brown envelope (long) 5.00 45.00
2 pcks Mailing envelope (white) 45.00 90.00
3 pcks Photopaper A4 size 130.00 390.00
3 pcs Stapler w/ staple remover 420.00 1,260.00
1 pc Scotch tape dispenser 420.00 420.00
4 pcs Battery double A 30.00 120.00
6 pcs Battery triple A 25.00 150.00
3 pcs Cork Board Metal Side (12x18 in) 250.00 750.00
1 box Carbon paper (black) 820.00 820.00
1 pc Marker, white board (black) 80.00 80.00
3 pcks Sticker Paper A4 size 45.00 135.00
1 pc Stamp Pad (violet) ink 45.00 45.00
6 pcs Stabilo highlighter (assorted color) 50.00 300.00
10 pcs Ring binder long (2.5 inch.) arts file 350.00 3,500.00
2 pcs Glue all purpose (big) 80.00 160.00
1 pc Pencil Sharpener (Manual-Table Type) 500.00 500.00
1 pc Metal Ruler 12inch) 80.00 80.00
1 pc Heavy duty cutter 120.00 120.00
2 pcs 3m Post it Flag Signed here 1x1.7 inch 420.00 840.00
8 pcs Sticky note (1.0cm) 30.00 240.00
8 pcs Sticky note (3in.x 3in.) 50.00 400.00

13,950.00
Sub-total 89,650.00
103,600.00

Purpose: Purchase of Office Supplies (1st qtr.)

MEO, Municipal Compound, Pina.,Or. Mindoro

Requested by: Cash availability: Approved by:

Signature:
Printed Name: ENGR. MANOLITO E. MASCULINO PLARIDEL S. CUPIADO HON. ARISTEO A. BALDOS,JR.
Designation: Municipal Engineer Municipal Treasurer Municipal Mayor

Annex 30
PURCHASE REQUEST
MUNICIPALITY OF PINAMALAYAN
LGU

Department : Municipal Engineering Office BAC No.: ____________ Date: _________

PR No.: ____________ Date: _________
Section : SAI No.:_____________ Date: _________
ALOBS No.:__________ Date:_________
Item Unit of Estimated Estimated
Quantity Item Description
No. Issue Unit Cost Cost
50 pcks coffee 3 n 1 (27.5g x 12) 185.00 9,250.00
lot 1 15 pcks juice (25 gx12) 285.00 4,275.00
75 pcks assorted biscuit 70.00 5,250.00
38 pcks candy sweet & menthol 45.00 1,710.00
30 pcs detergent powder (80g) 15.00 450.00
99 pcs alcohol % 500ml 90.00 8,910.00
15 btls. dishwashing liquid (250 ml.) 90.00 1,350.00
16 pcs soap (big) 45.00 720.00
15 btls. air freshner 320 ml. 195.00 2,925.00
6 btls. toilet bowl cleaner 500ml. 105.00 630.00
25 pcks tissue paper (big) 165.00 4,125.00
10 btls. insect repellant/spray 600ml 355.00 3,550.00
14 pcs toilet deodorizer (50 ml.) 90.00 1,260.00
8 pcs diswashing foam 40.00 320.00
8 pcs stain remover (500 ml.) 105.00 840.00
6 pcs glass cleaner/spray (500 ml.) 285.00 1,710.00
5 pcs toilet brush 40.00 200.00
1 pcs toilet brush w/ handle 40.00 40.00
3 pcs hand towel 40.00 120.00
2.25 pcs disposable rugs 30.00 67.50
3 pcs doormat 40.00 120.00
1 pcs tornedo floor mop 1,600.00 1,600.00
1 pcs tamboo 200.00 200.00
1 pcs trash can 40.00 40.00
8 pcs gloves 20.00 160.00
1 pcs duster (feather) 40.00 40.00
1 pcs dustpan 40.00 40.00
1 pcs pail (big) 170.00 170.00

50,072.50

Purpose: Purchase of Miscellaneous expenses (1st qtr.)

MEO, Municipal Compound, Pina.,Or. Mindoro
 Requested by: Cash availability: Approved by:
Signature:
Printed Name: ENGR. MANOLITO E. MASCULINO PLARIDEL [Link] HON. ARISTEO A. BALDOS,JR.
Designation: Municipal Engineer Municipal Treasurer Municipal Mayor

Annex 30
PURCHASE REQUEST
MUNICIPALITY OF PINAMALAYAN
LGU

Department : Municipal Engineering Office BAC No.: ____________ Date: _________

PR No.: ____________ Date: _________
Section : SAI No.:_____________ Date: _________
ALOBS No.:__________ Date:_________
Item Unit of Estimated Estimated
Quantity Item Description
No. Issue Unit Cost Cost
2 units Automatic Hand Sanitizer Dispenser 12,500.00 25,000.00
lot 1 Specs:
Automatic Alcohol Dispenser with Adjustable Stand
Non-Contact Infrared Thermometer

25,000.00
 Purpose: Purchase of 2 units Automatic Hand Sanitizer Dispenser (1st qtr.)
MEO, Municipal Compound, Pina.,Or. Mindoro

Requested by: Cash availability: Approved by:

Signature:
Printed Name: ENGR. MANOLITO E. MASCULINO PLARIDEL S. CUPIADO HON. ARISTEO A. BALDOS,JR.
Designation: Municipal Engineer Municipal Treasurer Municipal Mayor

Annex 30
PURCHASE REQUEST
MUNICIPALITY OF PINAMALAYAN
LGU

Department : Municipal Engineering Office BAC No.: ____________ Date: _________

PR No.: ____________ Date: _________
Section : SAI No.:_____________ Date: _________
ALOBS No.:__________ Date:_________
Item Unit of Estimated Estimated
Quantity Item Description
No. Issue Unit Cost Cost
6 sets External Hard Drive (2terabytes) 6,000.00 36,000.00
lot 1 STHN 2000403 2TB
Back up Plus 25 USB 3.0 Slim

1 unit Memory Card 128GB 2,800.00 2,800.00

Sandisk Ultra Micro SDXC 128-GB
Class 10 UHS-I Memory Card
SDSQ UNR
Speed up to 100 MB/s
 38,800.00

Purpose: Purchase of External Hard Drive and Memory Card 128GB to be used for MEO - (1st qtr.)
MEO, Municipal Compound, Pina.,Or. Mindoro

Requested by: Cash availability: Approved by:

Signature:
Printed Name: ENGR. MANOLITO E. MASCULINO PLARIDEL S. CUPIADO HON. ARISTEO A. BALDOS,JR.
Designation: Municipal Engineer Municipal Treasurer Municipal Mayor

Annex 30
PURCHASE REQUEST
MUNICIPALITY OF PINAMALAYAN
LGU

Department : Municipal Engineering Office BAC No.: ____________ Date: _________

PR No.: ____________ Date: _________
Section : SAI No.:_____________ Date: _________
ALOBS No.:__________ Date:_________
Item Unit of Estimated Estimated
Quantity Item Description
No. Issue Unit Cost Cost
Measuring wheel (10000m) - rolling tape
1 unit
measure 10,000.00 10,000.00
lot 1 2 units Measuring Meter tape (50meter) 1,500.00 3,000.00
 13,000.00

Purpose: Purchase of Measuring equipments to be used for MEO - (1st qtr.)

MEO, Municipal Compound, Pina.,Or. Mindoro

Requested by: Cash availability: Approved by:

Signature:
Printed Name: ENGR. MANOLITO E. MASCULINO PLARIDEL S. CUPIADO HON. ARISTEO A. BALDOS,JR.
Designation: Municipal Engineer Municipal Treasurer Municipal Mayor

Annex 30
PURCHASE REQUEST
MUNICIPALITY OF PINAMALAYAN
LGU

Department : Municipal Engineering Office BAC No.: ____________ Date: _________

PR No.: ____________ Date: _________
Section : SAI No.:_____________ Date: _________
ALOBS No.:__________ Date:_________

Item Unit of Estimated Estimated

Quantity Item Description
No. Issue Unit Cost Cost
6 units Uninterruptible Power Supply (UPS) 5,000.00 30,000.00
lot 1 Output Capacity 625 VA/325 watts -
Output Voltage/Frequency on Utility
230/45-65 Hz
 30,000.00

Purpose: Purchase of UPS to be used for MEO - (1st qtr.)

MEO, Municipal Compound, Pina.,Or. Mindoro

Requested by: Cash availability: Approved by:

Signature:
Printed Name: ENGR. MANOLITO E. MASCULINO PLARIDEL S. CUPIADO HON. ARISTEO A. BALDOS,JR.
Designation: Municipal Engineer Municipal Treasurer Municipal Mayor

Annex 30
PURCHASE REQUEST
MUNICIPALITY OF PINAMALAYAN
LGU

Department : Municipal Engineering Office BAC No.: ____________ Date: _________

PR No.: ____________ Date: _________
Section : SAI No.:_____________ Date: _________
ALOBS No.:__________ Date:_________
Item Unit of Estimated Estimated
Quantity Item Description
No. Issue Unit Cost Cost
40 boxes Surgical Mask
lot 1 35 boxes Face Shield
35 pcs Alcohol
20 boxes Vitamins

2 units Automatic hand sanitizer dispenser

 -

Purpose: Purchase of Medical Supplies and Automatic hand sanitizer dispenser

(1st qtr.) to be used for the MEO.
MEO, Municipal Compound, Pina.,Or. Mindoro
Requested by: Cash availability: Approved by:
Signature:
Printed Name: ENGR. MANOLITO E. MASCULINO PLARIDEL S. CUPIADO HON. ARISTEO A. BALDOS,JR.
Designation: Municipal Engineer Municipal Treasurer Municipal Mayor

Annex 30
PURCHASE REQUEST
MUNICIPALITY OF PINAMALAYAN
LGU

Department : Municipal Engineering Office BAC No.: ____________ Date: _________

PR No.: ____________ Date: _________
Section : SAI No.:_____________ Date: _________
ALOBS No.:__________ Date:_________
Item Unit of Estimated Estimated
Quantity Item Description
No. Issue Unit Cost Cost
25 pcs Jacket with logo
lot 1 25 pcs Hard hat
25 pcs Rubber Boots
25 pcs Gloves (leather)
 -

Purpose: Purchase of 25 sets of Personal Protective Equipments to be used by MEO - (1st qtr.)
MEO, Municipal Compound, Pina.,Or. Mindoro

Requested by: Cash availability: Approved by:

Signature:
Printed Name: ENGR. MANOLITO E. MASCULINO PLARIDEL S. CUPIADO HON. ARISTEO A. BALDOS,JR.
Designation: Municipal Engineer Municipal Treasurer Municipal Mayor

Annex 30
PURCHASE REQUEST
MUNICIPALITY OF PINAMALAYAN
LGU

Department : Municipal Engineering Office BAC No.: ____________ Date: _________

PR No.: ____________ Date: _________
Section : SAI No.:_____________ Date: _________
ALOBS No.:__________ Date:_________
Item Unit of Estimated Estimated
Quantity Item Description
No. Issue Unit Cost Cost

lot 1 4 units Emergency lights 6,000.00 24,000.00

specs:
New Quick Response Twinhead
Rechargeable Emergency Lamp
 24,000.00

Purpose: Purchase of 4 units of Emergency Ligths to be used for MEO - (1st qtr.)
MEO, Municipal Compound, Pina.,Or. Mindoro

Requested by: Cash availability: Approved by:

Signature:
Printed Name: ENGR. MANOLITO E. MASCULINO PLARIDEL S. CUPIADO HON. ARISTEO A. BALDOS,JR.
Designation: Municipal Engineer Municipal Treasurer Municipal Mayor
 Pencil
#2
Staple
Correctio
wire #35
n tape
Toner
(260g)
Printer Ink (003
black)
Printer Ink (003
yellow)
Prin ter Ink (003
Printer Ink (003
cyan)
Printer Ink (T 644
magenta)
65
Black)
Printer Ink (T 644
35
Yelow)
Printer Ink (T 644
4
Cyan)
Printer Ink (T 644
3
Magenta)
3 T 673 (black)
T 673
3
(colored)
Paper clip (big)
1
4 Binder clip 1'
4 Scotch
Binder clip 2'
tape 1"
7 Masking
63 tape 1"
3
7
11
3
11
5
5
5
5
3
3
3
2
2
7
7

7
ENGR. MANOLITO E. MASCULINO
Municipal
Engineer
ream A 3 bond
Folder
pcs ordinary
Folder
pcs (long)
ordinary
Brown
pcs (short)
envelope
Mailing
pcks (long)
envelope
pcks (white)
Photopaper A4 size
Stapler w/ staple
pcs
remover
Scotch tape
pc
dispenser
pcs Battery double A
Battery
pcs
triple A
Cork Board Metal
pcs
Side (12x18
Carbon paperin)
box
(black)
Marker, white
pc
board (black)
Sticker
Stamp Paper A4
pcks
size
Pad
pcs
(violet) highlighter
Stabilo
pcs ink
(assorted
Ring bindercolor)
long
pcs Glue all
(2.5 inch.) arts file
pcs purposeSharpener
Pencil
pc (big)
(Manual-Table
Metal
pc Type)
Ruler
pc 12inch)
Heavy
3m Postduty cutter
it Flag
pcs Signed here 1x1.7
Sticky
inch note
pcs
(1.0cm)
Sticky note (3in.x
pcs
3in.)
 coffee 3 n 1 (27.5g x
pcks 50 185.00 9,250.00
12)
pcks juice (25 gx12) 15 285.00 4,275.00
pcks assorted biscuit 75 70.00 5,250.00
candy sweet &
pcks 38 45.00 1,710.00
menthol
detergent powder
pcs 30 15.00 450.00
(80g)
pcs alcohol % 500ml 99 90.00 8,910.00
dishwashing liquid
btls. 15 90.00 1,350.00
(250 ml.)
pcs soap (big) 16 45.00 720.00
btls. air freshner 320 ml. 15 195.00 2,925.00
toilet bowl cleaner
btls. 6 105.00 630.00
500ml.
pcks tissue paper (big) 25 165.00 4,125.00
insect
btls. 10 355.00 3,550.00
repellant/spray
toilet deodorizer600ml
(50
pcs 14 90.00 1,260.00
ml.)
pcs diswashing foam 8 40.00 320.00
stain remover (500
pcs 8 105.00 840.00
ml.)
glass cleaner/spray
pcs 6 285.00 1,710.00
(500 ml.)
pcs toilet brush 5 40.00 200.00
pcs toilet brush w/ handle 1 40.00 40.00
pcs hand towel 3 40.00 120.00
pcs disposable rugs 2.25 30.00 67.50
pcs doormat 3 40.00 120.00
pcs tornedo floor mop 1 1,600.00 1,600.00
pcs tamboo 1 200.00 200.00
pcs trash can 1 40.00 40.00
pcs gloves 8 20.00 160.00
pcs duster (feather) 1 40.00 40.00
pcs dustpan 1 40.00 40.00
pcs pail (big) 1 170.00 170.00
 Automatic Hand
units Sanitizer 2 12,450.00
Dispenser
Specs:
Automatic Alcohol
Dispenser with
Non-Contact
Adjustable Stand
Infrared
Thermometer
 External Hard
set STHN(2terabytes) 6 6,000.00
Drive
Back up
2000403
Plus
2TB 25
USB 3.0
Slim

Memory Card
1 2,800.00
128GB
Class 10 UHS-I
Memory Card
SDSQ UNR
Speed up to 100
MB/s
Uninterruptible
Power Supply 6 5,000.00
Output
(UPS) Capacity
Output
625 VA/325 watts
Voltage/Frequency
on Utility Hz
230/45-65
Meter tape (50meter) 2 units 8,900.00
Tape measure
1,700.00
(5meter) 2 units
Measuring wheel 1 unit 5,900.00
(10000m)

0
Uninterruptible
Power Supply 6 5,000.00
Output
(UPS) Capacity
Output
625 VA/325 watts
Voltage/Frequency
on Utility Hz
230/45-65
Surgical Mask 100 boxes 18,000.00
Face Shield 75 boxes 3,750.00
Gloves 10 boxes 2,800.00
Alcohol 55 pcs 10,450.00
Vitamins 30 boxes 14,400.00

15 pcs Rubber Boots 520.00

15 pcs Jacket w/ logo of MGOP and MEO ###
15 pcs Hard hat 990.00
15 pcs Leather Gloves (hand working) 450.00

Automatic hand
units 2
sanitizer dispenser

40 boxes 180.00
35 boxes 75.00
35 pcs 205.00
20 boxes 400.00

2 units 5,000.00
Jacket
with 25 2,016.00
Hard
logo 25 1,000.00
hat
Rubber
25 1,000.00
Boots
Gloves
25 984.00
(leather)
2,016.00
1,000.00
1,000.00
984.00
 Annex 31

ACCEPTANCE & INSPECTION REPORT

MUNICIPALITY OF PINAMALAYAN
LGU

Supplier: AIR No.

PO No: Date: Invoice No.: Date:
Requisitioning Office/Department:

Item No. Unit Description Quantity

ACCEPTANCE INSPECTION

Date Received: _________________ Date Inspected: __________________

Complete Inspected, verified and found OK

as to quantity and specifications
Partial

__________________________ ______________________________
Property Officer Inspection Officer/Committee
 Annex 34

ACKNOWLEDGMENT RECEIPT FOR EQUIPMENT

MUNICIPALITY OF PINAMALAYAN
LGU

No._________

Quantity Unit Description Property No.

Received from: Received by:

Name Name

Position Position

Date Date

For Property Office Use

 Annex A

Republic of the Phillippines

Province of Oriental Mindoro
MUNICIPALITY OF PINAMALAYAN
No.
OBLIGATION REQUEST

Payee
EAGLE - R

Office
MUNICIPAL ENGINEERING OFFICE

Address
PINAMALAYAN, ORIENTAL MINDORO
Responsibility Account
Center
Particulars F.P.P Code
Amount

TO PAYMENT OF: GASOLINE AND OIL CONSUMED BY

HONDA CFT 125 MSJ FOR THE 3rd QTR FOR THE MONTH
OF SEPTEMBER 2022 MUNICIPAL COMPOUND
PINAMALAYAN ORIENTAL MINDORO

Total
A. Certified B. Certified
Charges to appropriation/allotment necessary, lawful Existence of available appropriation
and under my direct supervision

Supporting documents valid, proper and legal

Signature Signature

Printed Printed
Name Name

Position ENGR. MANOLITO E. MASCULINO Position ZAIDA D. MICIANO

Position Position
Head, Requesting Office/Authorized Representative Head, Budget Unit/Authorized Representative

Date Date
 Annex 26
GENERAL PAYROLL Sheet ______of ____Sheets

MUNICIPALITY OF PINAMALAYAN
LGU

NOVEMBER 16 - 30, 2021

PERIOD
No.: _____________________

We acknowledge receipt of the sum shown opposite our names as full compensation for services rendered for the perido stated:

DEDUCTIONS
MAYOR'S OFFICE MONTHLY AMOUNT Signature of
No. ID NO. POSITION SALARY
ALLOWANCE
EARNED
ABSENSES LIFE & W/ HOLDING Pag-ibig Philhealth GSIS GSIS State GSIS PAG-IBIG COCO No. Net Amount
Payee
MEDICARE
RETIREMENT TAX
NAME W/O PAY Cont. P. Share P. Share [Link] Ins. Educ'l Calamity CONSO POLICY GFAL II LLS LMLS LIFE Received
1 1
2 2
3 3
4 4
5 5
6 6
7 7
8 8
9 9
10 10
11 11
12 12
13 13
SUB-TOTAL - - - - - - - - - - - - - - - - - - - - -

CERTIFIED: Services have been duly rendered as stated APPROVED FOR PAYMENT:

HON. ARISTEO A. BALDOS, JR.

Name & Signature of Supervisor Name & Signature of Officer

CERTIFIED: Funds available in the amount of P _____________ CERTIFIED: Each employee whose name appears above has been

paid the amount indicated opposite his/her name.

PLARIDEL S. CUPIADO
Name & Signature of Treasurer Disbursing Officer Date