DISBURSEMENT VOUCHER

SK of Barangay: SANTA CLARA DV No.:2024-10-006

City/Municipality: BOBON Date: 10/03/2024
Province: NORTHERN SAMAR
Payee: K SQUARED ENTERPRISES
Address: MARCOS ST. BRGY. MABOLO,
CATARMAN, NORTHERN
SAMAR
TIN No.:
PARTICULAR AMOUNT
TO PAYMENT THE DESKTOP COMPUTER SET (INTEL CORE I3) 49,745.80
AND 720VA UPS IN THE TOTAL AMOUNT OF FOURTY-SEVEN
THOUSAND EIGHTY AND 80/100 only…

Vat 5% 2,220.8
W/Tax 1% 444.2
2,665.00
2,665.00

Amount Due 47,080.80

A. Certified as to availability B. Certified as to availability C. Certified as to necessity,
of the budget or funds of cash, and completeness validity, propriety, and
received for specific purpose. and propriety of supporting legality of claim; and
documents. Approved for payment:

DWAN E. MOSLARES RONNA MAE R. GORPEDO BRENT AMANS N.

(Signature Over Printed (Signature Over Printed BALLICUD
Name) Name) (Signature Over Printed
Budget Monitoring Officer SK Treasurer Name)
SK Chairperson
Date: ____________ Date: ____________ Date: ____________
D. Received Payment: Check No.: 0002301507
Date: 10/03/2024
Bank Name: LANDBANK OF THE
K SQUARED ENTERPRISES PHILIPPINES
Signature Over Printed Name of Payee/ Bank Branch: LBP-Catarman
Authorized Representative OR No.:
____________________ Date:
Date
NAME OF PROCUREMENT ENTITY _________________ REQUEST FOR
QUOTATION (PR)
__________________________________
REVISED ON: ________________________________DATE:
_________________________________________________
STANDARD FORM/TITLE: REQUEST FOR QUOTATION OFFICE/end-
user:_____________
__________________________________________
COMPANY NAME: _____________________________
ADDRESS: _____________________________
TEL. No.__________________________________

Please quote your lowest price on the item listed below, subject to the term and conditions stated
below and submit your quotation duly signed by your representative not later than 10:00 a.m. of
_____________ in the return envelope attached herewith.

TERMS AND CONDITIONS:

1. All entries must be typewritten or legibly written

2. Delivery period within ____________ upon receipt of the approved funded purchase order (P.0)
3. Warranty shall be for a minimum of three (3) months for supplies & materials from dated of acceptance by
the end-user.
4. Price validity shall be for a period of sixty calendar days.
5. PhilGEPS registration certificate shall be attached upon submission of the quotation.
6. Bidders shall submit original brochures showing certifications of the product, if applicable.

BRENT AMANS N. BALLICUD XANDRIE

S. CASIÑAS
SK CHAIRPERSON BAC
CHAIRPERSON
ITEM ITEMS & DESCRIPTION QTY UNIT UNIT TOTAL PRICE
No. PRICE
1 INTEL CORE I3 DESKTOP 2
SET

2 1
720 VA UPS

TOTAL

ABC: FORTY NINE THOUSAND NINE HUNDRED PESOS & 00/100 PHP 49,900.00
BRAND AND MODEL: _____________________________________WARRANTY:
_________________
DELIVERY PERIOD: ______________________________________________________ PRICE VALIDITY:
___________________

After having carefully read and accepted your general conditions, I /we quote you on the items at prices noted above.

_______________________________
SIGNATURE OVER PRINTED NAME/
 AUTHORIZED REPRESENTATIVE

_____________________
DATE
REPUBLIC OF THE PHILIPPINES
PROVINCE OF NORTHERN SAMAR
MUNICIPALITY OF BOBON
BARANGAY SANTA CLARA
---oooOOOooo---

OFFICE OF THE SANGGUNIANG KABATAAN

ABSTRACT OF CANVASS

QTY. UNIT DESCRIPTION NAME OF DEALER/SUPPLIER

UNIT TOTAL UNIT TOTAL UNIT TOTAL

PRICE PRICE PRICE PRICE PRICE PRICE
INTEL CORE I3 23,839. 23,850.0 23,900.0
2
SET DESKTOP SET 4 0 0
2,067.0 2,080.0 2,100.0
1 720 VA UPS
PCS 0 0 0

4 49,9
TOTAL 49,745.80
9,780.00 00.00

We hereby certify the correctness of the foregoing findings:

MARY JOY B. MIJARES XANDRIE S. CASIÑAS

MARVIN JAY P. DE VERA
Head-BAC Secretariat BAC Chairperson
BAC Member

LIRRA E. PAREDES DWAN E. MOSLARES JOVAN

KIM D. PEÑAFLOR
BAC Secretariat BAC Vice-Chairperson BAC Member

ALTHEA MAE S. ESTORES RYAN E.

MADEJA
BAC Secretariat BAC Member

NOTED BY:

BRENT AMANS N. BALLICUD

SK Chairperson
 REQUISITION AND ISSUE SLIP

SK of Barangay: SANTA CLARA RIS No.:2024-10-005

City/Municipality: BOBON Date:
Province: NORTHERN SAMAR
Requisition Issue
Stock Unit of Item Description Quantity Quantity REMARKS
No. Measuremen
t
1. PCS. INTEL CORE I3 2
DESKTOP SET
2. PCS. 720 VA UPS 1

Purpose: TO BE USED AT MINI INTERNET LIBRARY

Requested by: Approved by: Issued by: Received by:

Signature

Printed XANDRIE S. BRENT AMANS RONNA MAE R. BRENT AMANS

Name CASINAS N. BALLICUD GORPEDO N. BALLICUD
Designatio SK MEMBER SK SK TREASURER SK
n CHAIRPERSON CHAIRPERSON
Date
 PURCHASE REQUEST
SK of Barangay: SANTA CLARA PR No.: 2024-09-004
City/Municipality: BOBON Date: 09/22/2024
Province: NORTHERN SAMAR

Item No. Qty. Unit of Item Estimated Estimated

Measurement description Unit Cost Amount
1. 2 INTEL CORE I3 23,850.00 47,700.00
DESKTOP SET
2. 1 720 VA UPS 2,100.00 2,100.00

Total Estimated Amount 49,800.00

Purpose: TO BE USED AT INTERNET LIBRARY
Requested by: Approved by:

XANDRIE S. CASINAS BRENT AMANS N. BALLICUD

Signature over Printed Name Signature over Printed Name
Requesting SK Official SK Chairperson
_____________ _____________
Date Date
 Republic of the Philippines
Republic of the Philippines
Province of Northern Samar
Municipality of Bobon
Barangay Santa Clara
--oo0oo--

OFFICE OF THE SANGGUNIANG KABATAAN

NOTICE OF AWARD
September 23, 2024

K SQUARED ENTERPRISES
CATARMAN, NORTHERN SAMAR

Dear Maam/Sir,

Please be informed that the purchased of Intel Core I3 Desktop Set at Brgy.
Santa Clara, BOBON N. SAMAR is hereby awarded to you for the contract

price of 49,745.80 / FOURTY-NINE THOUSAND SEVEN HUNDRED FOURTY FIVE

AND 80/100 ONLY.

You are hereby required to provide the services immediately from receipt of
this Notice of Award.

VERY TRULY YOURS,

BRENT AMANS N. BALLICUD

SK Chairperson

CONFORME:

K SQUARED ENTERPRISES
Authorized Representative
CATARMAN, NORTHERN SAMAR
 ACCEPTANCE & INSPECTION REPORT
BARANGAY SANTA CLARA
BOBON N. SAMAR
SUPPLIER: RONVER ENTERPRISES AR No. 2024-10-004
PO No. 2024-07-001 INVOICE No.
REQUISITIONING
OFFICE/ DEPARTMENT
____________________________________________________________

ITEM unit DESCRIPTION QUANTITY

No.
1. PCS.
2
INTEL CORE I3 DESKTOP SET

2. PCS. 1
720VA UPS

DATE INSPECTED: DATE RECEIVED:

( ) COMPLETE
( ) INSPECTED, VERIFIED AND FOUND OK AS TO ( ) PARTIAL
QUANTITY AND SPECIFICATION.

BRENT AMANS N. RONNA MAE R. GORPEDO

BALLICUD
INSPECTION OFFICER PROPERTY OFFICER
 PURCHASE ORDER
SK of Barangay: SANTA CLARA City/Municipality: BOBON
Tel. No.: Province: NORTHERN SAMAR
Supplier: K SQUARED ENTERPRISES PO No.:
Address: CATARMAN, NORTHERN SAMAR ___________________________
Tel. No.:__________________TIN:__________________ Date:______________
Mode of Procurement:
________________
Gentlemen: Please deliver to this office the following articles subject to the terms and
conditions contained herein:
Place of Delivery: ___________________________ Date of Delivery Term:
Delivery: __________________________ _____________________________
Payment Term:
_____________________________
Item No. Unit of Item Description Quantity Unit Cost Amount
Measurement
1 PIECE INTEL CORE I3 DESKTOP SET 2 23,839.4 47,678.8
0 0
2 PIECE 720VA UPS 1 2,067.00 2,067.00

(Total Amount in words) FIFTEEN THOUSAND FOUR HUNDRED PESOS & 00/100
49,745.80
In case of failure to make 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 on the undelivered item/s.

Conforme: Very truly yours,

K SQUARED ENTERPRISES BRENT

AMANS N. BALLICUD
Signature over Printed Name of Supplier Signature over Printed
Name of SK Chairperson
______________
______________
Date
Date

Availability of the budget or funds received for specific purpose:

DWAN E. MOSLARES
Signature over Printed Name of Budget Monitoring Officer
_____________________
Date
 REPUBLIC OF THE PHILIPPINES
PROVINCE OF NORTHERN SAMAR
MUNICIPALITY OF BOBON
BARANGAY SANTA CLARA
OFFICE OF THE SANGGUNIANG KABATAAN

SK CHAIRPERSON’S CERTIFICATION
SKCC NO. 2024-10-
007
Date: OCTOBER 03,
2024
To: The Bank Manager
Land Bank of the Philippines
Catarman, Northern Samar

Sir/Madam:
This is to certify that the following checks were duly issued by SK of Barangay Santa
Clara, complete with respective Disbursement Vouchers and supporting documents.

ACCOUNT CHECK DATE PAYEE AMOUN PURPOSE

NO. NO. T
1192-1549- 2301507 10-03- K SQUARED 47,080.8 Payment for the
75 2024 ENTERPRIS 0 purchase of INTEL
ES CORE I3 DESKTOP
SET AND 720VA
UPS

This certification is issued, pursuant to COA Circular 2020-001, dated January 30,
2019
As a condition for the encashment of said checks.
The undersigned attest to the truthfulness of the foregoing facts, under pain of
Liability for falsification, Pursuant to Article 171 (4) OF THE Revised Penal Code of
the Philippines

Very truly yours,

BRENT AMANS N. BALLICUD

SK Chairperson

Delivered by: Received by:

RONNA MAE. R GORPEDO
____________________________
SK Treasurer/Representative Bank Representative
Date:_________ Date:____________