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Republic of the PhilippinesDepartment of Public Works & Highways

Cordillera Administrative RegionKalinga District Engineering Office

Bulanao, Tabuk City, Kalinga

PURCHASE REQUESTDPWH, KALINGA DISTRICT ENGINEERING OFFICE

AGENCYDepartment: PR No. 2013-01-048 Date: January 28, 2013DPWH-Kalinga District Engineering OSAE No. Date:Section: ALOBS No. Date:

QTY ITEM DESCRIPTION UNIT COST TOTAL COST

3 units Measuring tape w/ handle 50m 1 700.00 2,100.00 7 units Steel tape 3m 2 180.00 1,260.00 1 unit HP deskjet ink advantage 2060 all-n-one K110 3 7,000.00 7,000.00 20 pcs. Ink 704 black 4 500.00 10,000.00 40 pcs. Ink 704 colored 5 600.00 24,000.00 30 rms. Bondpaper short sub. 20 6 230.00 6,900.00 30 rms. Bondpaper long sub. 20 7 250.00 7,500.00 10 rms. Bondpaper A4 sub. 20 8 220.00 2,200.00 20 pcs. Correctional tape 9 35.00 700.00 100 pcs. White folder long 10 6.00 600.00 100 pcs. White folder short 11 5.00 500.00 25 pcs. Ink #60 black 12 900.00 22,500.00 25 pcs. Ink #60 colored 13 950.00 23,750.00

109,010.00 Purpose:FOR USE OF RBIA

Requested By: Approved By:

Signature:Printed Name: ERNESTO O. VECALDO ALEXANDER C. CASTAÑEDADesignation: Chief, Maintenance Section District Engineer/fmw

UNIT OF ISSUE

STOCK NO.

Republic of the PhilippinesDepartment of Public Works & Highways



Name of Procuring Entity: DPWH-KDEO Request for Quotation(P.R. No): 2013-01-048Revised on: Date: 28-Jan-13Standard Form/Title: REQUEST FOR QUOTATION Office/End user:

COMPANY NAME:

ADDRESS :TEL. NO./FAX NO.: TIN No.Please quote your lowest price on the item(s) listed below, subject to the Terms and conditions stated below and submit your

attached herewith, to the BAC Secretariat for Goods, DPWH-KDEO Bulanao, Tabuk City, Kalinga.TERMS and CONDITIONS:

1.All entries must be typewritten or legibly written.2.Delivery period within __ days upon receipt of the approved funded Purchase Order (P.O.). Administrative penalties pursuant to Sec. 69 of the Revised IRR-RA 9184 shall be imposed for non-delivery w/o valid reason3. Warranty shall be for a minimum of three months for supplies & materials; one year warranty for equipment from date of acceptance by the end-user.4.Price validity shall be for a period of sixty (60) calendar days. __________________________5. G-EPS Registration Certificate?Mayor's Permit/DTI shall be attached upon submission of the quotation. MANUEL P. MADIO6. Bidders shall submit original brochures showing certifications of the product if applicable. BAC Chairman7.Please indicate the brand for each items being offered8. The approved budget ceiling for this procurement is Php 109,010.00 Item no: ITEMS & DESCRIPTION QTY UNIT UNIT PRICE TOTAL PRICE

For use in the Rehabilitation of Lubuagan Batong Buhay Road (KO459+290-KO459+335)Dangoy, Lubuagan, Kalinga.

1 RSB 12mm 63 pcs.2 RSB 10mm 75 pcs.3 Tie Wire #16 10.18 kgs.4 Cement 394 bags5 Coarse Aggragate 6 cu.m.6 Fine Aggregate 3 cu.m.7 ½" x 4" x 8" Plywood 2 pcs.8 2" x 3" x 10' Lumber 87.67 bd.ft.9 CWN .94 5 kgs.

10 PVC Pipe 4"dia x 3m 12 pcs.11 Sand 28 cu.m.12 Boulders 118 cu.m.

xxxxxxxxxxxxxxxxxxxxxx

Total Amount in Words:

Brand and Model: Warranty:Delivery Period : Price Validity:

After having carefully read and accepted your General Conditions, I/We quote you on the item(s) at prices note above. If thespace for delivery Period, Warranty and Price Validity are left blank, it means we are menable the terms and condition statedabove.

Printed Name/Signature/Date

Tel. No./ Cellphone No. / E-mail Address

quotation duly signed by your representative not later than 10:30 A.M. of February 5, 2013 in the return envelope

Republic of the PhilippinesDepartment of Public Works and Highways

OFFICE OF THE DISTRICT ENGINEERKalinga District Engineering Office


BAC- TWG EVALUATION SHEET( Shopping/Small Value Procurement )

CONTRACT NAME Maintenance to Roadway & Related Features along Nambaran-Isabela Road, Purchase Request No. 2013-01-048LOCATION KO.513+113 - KO513+193 Implementing Office DPWH-KDEODATE OF OPENNING December 27, 2012TIME OF OPENING 10:30 AMApproved Budget for the Contract ( ABC ) Php109,010.00

Item No. P A R T I C U L A R S

N A M E O F B I D D E R S

Quantity UnitJ. PERALTA ENTERPRISES

Unit Cost Total Unit Cost Total Unit Cost Total Unit Cost Total1 Cement 292 bags 260.00 75,920.00 265.00 77,380.00 268.00 78,256.00 2 Fine Aggregate 24.3 cu.m. 930.00 22,599.00 935.00 22,720.50 938.00 22,793.40 3 Boulders 97.2 cu.m. 925.00 89,910.00 930.00 90,396.00 935.00 90,882.00

xxxxxxxxxxxxxxxxxxxxxxxxxxxx

188,429.00 190,496.50 191,931.40 FINDINGS Complying Complying Complying Complying

Non - Complying Non - Complying Non - Complying Non - Complying

TERMS AND CONDITION RECOMMENDATION 1. All entries must be typewritten or legible written Award to the bidder with the Lowest Calculated Responsive Bid ( LCRB ) 2. Delivery period within ______ days upon receipt of the approved funded Purchase Order For Rebidding 3. Warranty shall be for a minumum of three (3) months for supplies and materials For specification/modifications /ABC revision one ( 1 ) year for equipment from date of acceptance by the end-user To be procured thru COD due to minimal cost involved. 4. Price validity shall be for a period of sixty ( 60 ) calendar days Others: ______________________________ 5. G-EPS Registration Certificate shall be attached upon submission of the quotation6. Bidder shall submit original brochures showing certifications of the product (if applicable )

Prepared By : Sumitted By:

JONALYN C. BUCAO JULUIS C. GARCIA FREDERICK O. MALIDOM REMEDIOS M. DAPEG CLYDE G. CAIREL Administrative Assistant II Engineer II Engineer III Engineer II Accountant III

(Member, TWG) (Member, TWG) (Member, TWG) (Head, TWG) (Head, BAC Secretariat)

BLESSING BUILDERS & CONSTRUCTION SUPPLY

RMG BUILDERS AND CONSTRUCTION SUPPLY

Republic of the Philippines

Purchase Request No. 2013-01-048 Department of Public Works and HighwaysImplementing Office DPWH-KDEO OFFICE OF THE DISTRICT ENGINEER

Kalinga District Engineering OfficeCONTRACT NAME Maintenance to Roadway & Related Features along Nambaran-Isabela Road, Bulanao, Tabuk City, KalingaLOCATION KO.513+113 - KO513+193DATE OF OPENNING December 27, 2012 ABSTRACT OF SEALED/OPEN CANVASSTIME OF OPENING 10:30 AM

Approved Budget for the Contract ( ABC ) Php109,010.00 ( SHOPPING/SMALL VALUE PROCUREMENT )

P A R T I C U L A R S

N A M E OF B I D D E R S

Quantity UnitABC J. PERALTA ENTERPRISES

Unit Cost Total Unit Cost Total Unit Cost Total Unit Cost Total Unit Cost Total1 Cement 292 bags 273.83 79,958.36 260.00 75,920.00 265.00 77,380.00 268.00 78,256.00 2 Fine Aggregate 24.3 cu.m. 947.13 23,015.26 930.00 22,599.00 935.00 22,720.50 938.00 22,793.40 3 Boulders 97.2 cu.m. 946.89 92,037.71 925.00 89,910.00 930.00 90,396.00 935.00 90,882.00


Total Amount: 195,011.33 188,429.00 190,496.50 191,931.40 - AWARD (S) RECOMMENDED TO:

J. PERALTA ENTERPRISES RUBY A. UYAM ALEXANDER L. COLANGAN RAFAEL L. FERNANDOProvisional BAC Member BAC Member BAC Member

GERRY. R. BAIS MARIVIC T. PAGALA TEODORO A. OWEK MANUEL P. MADIOProvisional BAC Member Provisional BAC Member BAC Vice Chairman BAC Chairman

Item No.

BLESSING BUILDERS & CONSTRUCTION SUPPLY

RMG BUILDERS AND CONSTRUCTION SUPPLY

Republic of the PhilippinesDEPARTMENT OF PUBLIC WORKS AND HIGHWAYS

OFFICE OF THE DISTRICT ENGINEERKalinga District Engineering Office

Tabuk City, Kalinga

Resolution No. 2012-12-

BAC RESOLUTION DECLARING LOWEST CALCULATED RESPONSIVE BID AND RECOMMENDING APPROVAL

APPROVED BUDGET FOR THE CONTRACT: Php109,010.00

NAME OF SUPPLIER ADDRESS BID AMOUNT (as rea%Variance from ABC 109,010.00 1. Malabong Const'n. Supply & Gen. Mdse. Bulanao, Tabuk City, Kalinga 188,429.00 -0.40% 188,429.00 2. Bongdoen Harware Dagupan, Tabuk City, Kalinga 191,931.40 -0.19% (79,419.00)3. Cordillera Hardware Dagupan, Tabuk City, Kalinga 190,496.50 -0.09% -72.85%

NAME OF SUPPLIER BID AMOUNT (as Calc/Corrected)%Variance from ABCRanking/Remarks

after Bid Evaluation

1. Malabong Const'n. Supply & Gen. Mdse. 188,429.00 -0.40% Lowest Bidder

b) To recommend for approval by the District Engineer, Kalinga District Engineering Office the foregoing findings.

ERNESTO O. VECALDOBAC Chairman

TEODORO A. OWEK RAFAEL L. FERNANDOVice Chairman BAC Member (Regular)

MAUEL P. MADIO RUBY A. UYAMBAC Member (Provisional) BAC Member (Provisional)

APPROVED:

ALEXANDER C. CASTAÑEDADistrict Engineer

WHEREAS, the Department of Public Works and Highways, Kalinga District Engineering Office, advertise/sent Request for Quotations to Three (3) dealers for the furnishing of construction materials for the SPOT GRAVELLING AT BALABAG - KINAMA - SAN FRANCISCO ROAD, RIZAL, KALINGA which was posted at PhilGEPS on November 29 - December 6, 2012; the DPWH Website and in conspicuous places of the office for continuous Seven (7) days;

WHEREAS, in response to the said advertisements, three (3) dealers submitted their quotation and where found responsive to the bidding requirements;

WHEREAS, the bid proposal of said bidders where received on December 11, 2012, the set deadline and opening of bids, resulted in:

WHEREAS, the Detailed Evaluation of Bids conducted on April 27, 2012 resulted in the following:

WHEREAS, upon careful examination, validation and verification of all the requirements submitted by the three (3) bidders with eligibility, their technical and financial requirements submitted by the bidders with the Lowest Calculated Bid, Malabong Const'n. Supply & Gen. Merchandise has been found to be responsive.

NOW, THEREFORE, We the Officers and Members of the Bids and Awards Committee, hereby, RESOLVE as it is hereby RESOLVED:

a) To declare the bid of MALABONG CONST'N. SUPPLY & GEN. MDSE. as Lowest Calculated and Responsive Bid for the furnishing of construction materials under P.R. No. 2012-11-448 at is offered bid price.

RESOLVED at the Office of the BAC Chairman, this 12nd day of December 2012.

109,010.00 109,010.00 191,931.40 190,496.50 (82,921.40) (81,486.50)

-76.07% -74.75%


Cordillera Administrative RegionOFFICE OF THE DISTRICT ENGINEER

Kalinga District Engineering OfficeTabuk City, Kalinga

NOTICE OF AWARD

12-Dec-2012

MALABONG CONST'N. SUPPLY & GEN. MDSE.Bulanao, Tabuk City, Kalinga

Dear Sir/Madam:

Please cknowledge by signing and dating for the issuance of the Purchase Order.

Viery truly yours,

ALEXANDER C. CASTAÑEDADistrict Engineer

CONFORME:

MALABONG CONST'N. SUPPLY & GEN. MDSE.DATE:

/fmw

We are happy to inform you that your Bid for the furnishing of construction materials for the Spot Gravelling at Balabag-Kinaman-San Francisco, Rizal, Kalinga with your total bid price equivalent to THREE HUNDRED EIGHTY THREE THOUSAND THREE HUNDRED FIFTY PESOS ONLY (383,350.00), is hereby accepted.

Name of Project : Maintenance to Roadway & Related Features along Nambaran-Isabela Road,

Location of Project: KO.513+113 - KO513+193

PURCHASE ORDERDPWH, Kalinga District Engineering Office

(Agency)

Supplier: J. PERALTA ENTERPRISES PO. NO.

Address: Bulanao, Tabuk City, Kalinga Date:

Telephone No: Mode of Procurement : SHOPPING

TIN No.: P.R. No. 2013-01-048 1/28/2013Gentlemen:

Please furnish this office articles subject to the terms and conditions contained herein.

Place of Delivery: DPWH-Kalinga District Engineering Ofiice Delivery Term: FOB OFFICEDate of Delivery: Within seven (7) working days upon receipt of approved Payment Term: Completion of Delivery

P.O.

Item No: Quantity Unit Description Unit Cost Amount1 410 cu.m. Manual Patching of Unpaved Road Surface 935.00 383,350.00

Base Course Materialsxxxxxxxxxxxxxxxxxxxxxxxxxxxx

Total amount in words: Three Hundred Eighty Three Thousand Three Hundred Fifty Pesos Only 383,350.00 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 everyday of delay shall be imposed.

Very truly yours,Conforme:

J. PERALTA ENTERPRISES ALEXANDER C. CASTAÑEDASignature over printed name of Supplier District EngineerDate:

Funds Available: ALOBS NO.Amount

CLYDE G. CAIRELAccountant III

Republic of the PhillipinesDepartment of Public Works and Highways



DateMEMORANDUM TO : THE BUDGET OFFICER

Budget Unit, Financial Mgt. Section

SUBJECT : O B L I G A T I O N R E Q U E S T

This is to request for the issuance of an Obligation Request for the following claim:

Fund :

Amount : 383,350.00

Payee : J. PERALTA ENTERPRISES

Payee Office/Address : Bulanao, Tabuk City, Kalinga

Particulars : To obligate payment of Construction Materials for use in theMaintenance to Roadway & Related Features along Nambaran-Isabela Road,KO.513+113 - KO513+193

Saro / Saa # :Date :P.P.A. :Legal Basis :

I certify that charges to appropriation/allotment are necessary, lawful andunder my direct supervision. I also certify that supporting documents are valid, properand legal.

Your attention to this would be appreciated.

ERNESTO O. VECALDOChief, Maintenance Section

SPMU/fmw

CHECK-LIST PROCESSING FOR PURCHASE ORDERFor Shopping/Small Value Procurement

CONTRACTOR/DEALER JJA AUTO MOTORPARTS & REPAIR CENTERPROJECT FOR USE OF BCM - 938 NISSAN FRONTIER PICK-UPLIMITLOCATION

SUPPORTING DOCUMENTS DATE SUBMITTED

1. Copy of Approved Program of Works ( if for project)2. Approved Budget for Contract ( ABC )3. Purchase Request4. Invitation to Bid Small Value Procurement5. Request for Quotation6. Copy of P-GEP'S/DTI/Majors Permit of Certificate BAC Secretariat that said document are on file7. Abstract of Bids8. Bid Evaluation9. BAC Resolution - For Small Value Procurement10. Notice of Award - For Small Value Procurement11. Purchase Order 12. Memo Request13. OTHERS

a. Supplies Ledger Cardb. Request for Inspection & Pre-Repair Inspectionc. History of Repaird. Certification

Check & Received By: NOTED:

MARIVIC T. PAGALA ERNESTO O. VECALDOBAC Secretariat BAC Chairman

NOT SUBMITTED



Tabuk, Kalinga

MEMORANDUM

FOR : ANGELO G. SANCHEZState Auditor III/ATL

FROM : GERRY R. BAISChief, Supply & Property Mgt. Unit

DATE: October 22, 2012

Date Supplier Projects Particulars Amount

2012-10-0221 22 October, 2012 Php54,702.00

2012-10-0226 22 October, 2012 Php126,801.00

2012-09-0205 27 September, 2012 Php28,057.34

2012-09-0195 24 September, 2012 Php47,061.28

/rda

Submitting herewith are duly approved PURCHASE ORDERS for your reference viz

Purchase Order No.

BONGDOEN'S HARDWARE &

GEN. MERCHANDISE

FOR USE OF CONSTRUCTION OF AMMACIAN WATER

WORKS (Brgy Ammacian, Pinukpuk)

CONSTRUCTION MATERIALS

BONGDOEN'S HARDWARE &

GEN. MERCHANDISE

FOR USE OF BANNONG WATER

WORKS (Brgy Bagumbayan, Tabuk City)


CORDILLERA HARDWARE

FOR USE OF COMPLETION OF

DEEPWELL (Purok 6 Bulanao Tabuk City)


CORDILLERA HARDWARE

FOR USE OF CONSTRUCTION OF

ONE UNIT DEEPWELL (Brgy Ipil, Tabuk City)


Republic of the PhillipinesDepartment of Public Works and Highways



INSPECTION & ACCEPTANCE REPORTDPWH - Kalinga District Engineering Office

(Agency)

SUPPLIERARUGAY AUTO PARTS & FARM MACHINERIES AR No.

PO NO. 2012-10-0218 Date: October 16, 2012 OS No. 200-151-2012-10-026

P.R. NO. 2012-09-390 Date: September 26, 2012

Requisitioning Office/PURPOSE: For use in the REPAIR OF Fabricated steel sand screen.

OR # Qty DESCRIPTION U-COST AMOUNT

0538 20 kls. Welding Rod 1/8 74.00 1,480.0060 mtrs. Welding Cable Heavy Duty 158.00 9,480.001 pc. Welding Holder 780.00 780.005 pcs. Welding Lens 95.00 475.001 pair Welding Gloves 295.00 295.00

xxxxxxxxxxxxxxxxxxxxx

12,510.00I N S P E C T E D A C C E P T A N C E

Date Inspected: Date Received:

Inspected, verified and found in order as to Completequantity and specfications Partial ( Pls Specify quantity )

ROGELIO B. ABANILLA GERRY R. BAISAdministrative Assistant II Chief, Property & Supply Unit

Date of Issue

Unit of Issue

10/16/2012


CORDILLERA ADMINISTRATIVE REGIONKalinga District Engineering Office


REQUISITION AND ISSUE SLIPDPWH, Kalinga District Engineering Office

Division Responsibility Center RIS No.: 2012-12-2807 Date: December 10, 2012Office DPWH-KDEO Code SAI No.: Date:

R E Q U I S I T I O N I S S U A N C E

QTY UNIT D E S C R I P T I O N AMOUNT

20 kls. Welding Rod 1/8 1,480.00 60 mtrs. Welding Cable Heavy Duty 9,480.00 1 pc. Welding Holder 780.00 5 pcs. Welding Lens 475.00 1 pair Welding Gloves 295.00

xxxxxxxxxxxxxxxxxxxxx

SUPPLIED BY: ARUGAY AUTO PARTS & FARM MACHINERIESP.O. No. 2012-10-0218Dated: October 16, 2012

12,510.00 PURPOSE:

Requested Approved By: Issued By: Received By:

Signature:Printed Name: MANUEL P. MADIO ALEXANDER C. CASTAÑEDA GERRY R. BAIS FREDERICK O. MALIDOMDesignation: Engineer III District Engineer Administrative Officer III Engineer IIIDate:

BAL. ON HAND


CORDILLERA ADMINISTRATIVE REGION


DISBURSEMENT VOUCHER No.: _________________Date: _________________

MODE OF PAYMENT: MDS Check Commercial Check ADA Others:

Payee/Office: TIN/Employee No.: 931-508-149

ARUGAY AUTO PARTS & FARM MACHINERIES OBR/OS No.:

Address: Responsibility CenterDagupan Centro, Tabuk City, Kalinga Title: Code:

Particulars Amount

Payment of materials for use in the repair of Fabricated Sand Screen Invoice #0538 & other supporting documents hereto attached in the amount of . . . .

Gross Amount: 12,510.00 Less: 1% income tax 125.10

3% business tax 375.30 500.40

Net Amount: 12,009.60

P.O. #: 2012-10-0218 dtd. 10/16/12 P.R. #: 2012-09-390 dtd. 9/26/12

Certified: Supporting documents complete and proper

Cash AvailableTwelve Thousand Nine & 60/100 Only Subject to ADA

For request

Signature: _________________________ Signature: ______________________________Printed Name: CLYDE G. CAIREL Printed Name: ALEXANDER C. CASTAÑEDA

Position: Accountant III Position : District EngineerDate: ____________________ Date: ____________________

Received Payment

Date: Date:

Printed Name: Signature:

ARUGAY AUTO PARTS & FARM MACHINERIESDate:

Official Receipt/Other Documents Date:

SPMU/fmw

Kalinga District Engineering Office

Approved for Payment:

JEV SET-UP:

Check/ADA No.

Bank Name:

JEV Number

C

A B

Claimant: J. PERALTA ENTERPRISES

CHECKLIST OF SUPPORTING DOCUMENTS per D.O. 08 series of 2012for REGULAR PROCUREMENT

Disbursement Voucher (DV)Inspection & Acceptance Report1.a) Charge Invoice(s) #_______________________1.b) Delivery Receipt(s) #______________________

3. Test Results, for items that are subject to Test4. Certified True Copy of Submission of Purchase/Work Order to COA-Resident Auditor5. Certificate as to Availability of Funds (CAF)6. Obligation Request (ObR)7. Memorandum Request (MR)8. Purchase Order9. Performance Bond10. Notice of Award11. Bid Documents11.a) Resolution of award11.b) Abstract of Bids11.c) BAC-TWG Evaluation Sheet11.d) Quotation12. Advertisement12.a) Newspaper (if applicable)12.b) PhilGEPS12.c) Conspicuous Places13. Purchase Request13.a) Approved Annual Procurement Plan(APP)13.b) Project Procurement Management Plan (PPMP)

13.c) Request for repair & Pre-Repair Inspection13.d) Approved Job Order (JO)13.e) Approved Waste Material Report (WMR)13.f) History of Repair13.g) Certification that damage is due for fair wear & tear13.h) Certified True Copy of acknowledgement Receipt of Equipment (ARE)13.i) Certified True Copy of current LTO Registration13.j) Certification that the vehicles is included in the Department Inventory of Vehicle

13.c) Pre - Inspection Report13.d) Certified True Copy of Acknowledgement Receipt of Equipment(ARE)13.e) Aproved Authority to Purchase (from DPWH-MIS for IT)

13.c) Approved Budget Cost (ABC)13.d) Program of Work with detailed estimates

Other:

CERTIFIED CORRECT: as to completeness, propriety, validityand veracity of the document attached

2. Post Inspection & Acceptance Report (BOE-for Spareparts)

Additional Requirements on Spare Parts for Motor Vehicle and other Equipment

Additional Requirements for IT Equipment, Aircon & Other Equipment

Additional Requirements for SUPPLIES & MATERIALS

GERRY R. BAISSupply & Property Mgt. Unit

VERIFIED BY:

____________________

Head, Internal Control Unit______ Supporting documents attached


Office of the Regional DirectorCordillera Administrative Region

Engineer's Hill, Baguio City

ACKNOWLEDGEMENT RECEIPT FOR EQUIPMENT

Date:

Quantity Unit Description Property No.1 set Sala Set w/ Center Table


P.O.#: 02-2012-006 dated 2/14/2012ALOBS #: 101-300-11-12-1154-E

SR2010-03-000731

Received by: Received from:

ATTY. REX B. PADERES LUISITO N. PASCUA,JR.Signature Over Printed Name Signature Over Printed Name

OIC-Chief, Administrative Division Supply Officer IIIPosition/Office

Date

WASTE MATERIALS REPORT

Place of Storage: Date:DPWH-KDEO BODEGA

ITEMS FOR DISPOSAL

Item Qty Unit DescriptionRecord of Sales

O.R. No. Amount (P)1 1 assy. Shifting Lever w/ Cable2 1 pc. Fan Blade3 4 pcs. Brake Shoe w/ Lining4 4 pcs. Disc Pad5 1 assy. Brake Master6 1 pc. Pitman Arm7 2 pcs. Axle Bearing8 1 pc. Cltch Disc9 1 pc. Clutch Bearing10 2 pcs. Side Mirror11 1 pc. Wiper Arm w/ Blade12 2 pcs. Cover, Hub13 2 pcs. Backlight14 1 pc. Hyrauvac

xxxxxxxxxxxxxxxxxxxxxxxxx

Taken from AIP-111 Mitsubishi Strada

TOTAL - Returned By Received By

Certified Correct Disposal Approved:

GERRY R. BAISAdministrative Officer III

Property OfficerCERTIFICATE OF INSPECTOR

I hereby certify that this property was disposed of a follows:

Item 1-14 DestroyedItem Sold at private saleItem Sold at public auctionItem Transferred without cost to

Property Inspector: Witness to disposition:

RAFAEL E. BAKIDAN ANGELO G. SANCHEZMech'l. Engineer II State Auditor III

pr rbia

Documents

cairel accountant

malidom engineer

castaeda district

hundred fifty

eps registration

certified

peralta enterprises

public works