Office Forms

Republic of the Philippines
DEPARTMENT OF EDUCATION
Caraga Administrative Region
Division of Surigao del Sur
Tandag City
LIST OF DEALERS
Name of Establishments Received by
_______________________________________
Signature over printed name of canvasser
s
ION
on
r
RS
Date Received
_________________________
printed name of canvasser
INVENTORY CUSTODIAN SLIP
DIVISION OF SURIGAO DEL SUR
ICS
No:______________
Quantity Unit Description Inventory Item No. Unit cost
1 unit UPS 720 VA (Ilogic Blazer) 020 1,995.00
Serial No. 231701505584
School: Purisima NHS
TOTAL 1,995.00
Received by: Receive from:
KRISTINE ANN A. CANO DANTE A. GRUMO

Signature Over Printed Name Signature Over Printed Name
State Auditor III Administrative Officer IV

Position/Office Position/Office
September 26, 2017 September 26, 2017

Date Date
HINATUAN NORTH DISTRICT
BACULIN ELEMENTARY SCHOOL
REPORT OF DISBURSEMENTS
SCHOOL BASED FEEDING PROGRAM
ADA NO.
DATE PAYEE PARTICULARS AMOUNT
OR/RER
RER 12/17/2015 LUDELYN C. DUA Feeding supplies 20,094.20
TOTAL 20,094.20
Prepared by:
METODIO B. DANGO
School Head
CAMBATONG ELEMENTARY SCHOOL
ADA NO.
OR/RER
RER 11/3/2014 SILVESTRA BULADO FOOD EXPENSES 430.00
RER EMMA LUCIP FOOD EXPENSES 845.00
RER 11/8/2014 EMMA LUCIP FOOD EXPENSES 845.00
RER SILVESTRA BULADO FOOD EXPENSES 430.00
RER SILVESTRA BULADO FOOD EXPENSES 430.00
TOTAL 8,160.00
Prepared by:
LUZMINDA P. RENDON
School Head

HINATUAN NORTH CENTRAL ELEMENTARY SCHOOL
ADA NO.
OR/RER
0774 7/6/2013 GLENA FILISOFO REG. FEE 550.00
0776 MAY ROSE CASTAÑAS REG. FEE 550.00
0779 ARLYN SAMILLAN REG. FEE 550.00
0780 EMELY BANDOLA REG. FEE 550.00
2639 JULIET GAVINO REG. FEE 550.00
2348 NIMFA ASIS REG. FEE 550.00
56784 7/8/2013 LA CASA PHARMACY PREPAID LOAD 300.00
RER 7/18/2013 LILIBETH JABAGAT LABOR 500.00
RER 7/30/2013 ORLY HALIP HONORARIUM (GUARD) 3,000.00
11689 8/12/2013 SILVERTON MKTG. PREPAID LOAD 300.00
RER 8/13/2013 LILIBETH JABAGAT TRAVEL 2,750.00
RER 8/16/2013 LILIBETH JABAGAT LABOR 500.00
1249010 8/22/2013 SURSECO I ELECTRICITY 1,219.85
1836 9/8/2013 D'JRC BUSINESS WORLD PHOTOCOPY 2,079.00
1506819 9/9/2013 SURSECO I ELECTRICITY 491.37
2427 CELLULAR ZONE COMM. PREPAID LOAD 300.00
16099 9/10/2013 TRI-STAR ENT. OFFICE SUPPLIES 23,610.00
16098 9/18/2013 TRI-STAR ENT. REPAIR - SBP 10,030.00
152107 9/20/2013 NAZARENO SHEEL GASOLINE (GRASSCUTTER) 494.40
RER LILIBETH JABAGAT LABOR 500.00
4900440 12/18/2013 HINATUAN NCES REG. FEE (PAVES) 16,800.00
TOTAL 73,161.39
Prepared by:
SIXTO H. UYPALA
Principal I

AGSABAN PRIMARY SCHOOL
ADA NO.
OR/RER
RER 11/8/2014 JAY-R OTACAN TRAVEL 200.00
10/16/2014 JEFFREY DOBLES TRAVEL 320.00
BUREAU OF TREASURY FEDILITY BOND 562.50
6254 11/14/2014 D'JRC BUSINESS WORLD PHOTOCOPY 265.00
12/5/2014 SURSECO I ELECTRICITY 84.75
11425 12/15/2014 RC CELLULAR PREPAID LOAD 500.00
28627 12/20/2014 JINS RESTAURANT TRAVEL/REG. FEE 487.00
4485 578 DEAL SHOPPING CENOFFICE SUPPLIES 485.00
17552 TRI-STAR ENT. OFFICE SUPPLIES 3,500.00
17553 TRI-STAR ENT. REPAID - SBP 1,500.00
3806 12/26/2014 COPYLANDIA OFFICE SUPPLIES 2,470.00
0417 12/27/2014 KUNJU BAZAAR OTHER OFFICE SUPPLIES 720.00
6870 COMTEC COMP. SALES OFFICE SUPPLIES 940.00
TOTAL 13,002.92
Prepared by:
JEFFREY S. DOBLES
School Head
Appendix 58
REPORT OF DISBURSEMENT No :
Department of Education Date : March 24, 2017
Agency Responsibility Center
Code :
DATE OR No. PARTICULARS Amount
Liquidation of cash advance for meals/snacks
cottage rental and transportation during the
National CSC Day Celebration on 9/23/17 as
per supporting docs hereto attached in the
amount of . . . 68,000.00
TOTAL AMOUNT SPENT 68,000.00

AMOUNT OF CASH ADVANCE PER DV NO. ____________ Ch# DTD. 87,400.00
AMOUNT REFUNDED PER OR NO. 6511377 DTD. March 27, 2017 19,400.00
AMOUNT TO BE REIMBURSED
[A] Certified : Correctness of the [B] Certified : Purpose of travel/ [C] Certified : Supporting
above data cash advance accomplished docs complete and proper
DANTE A. GRUMO MARILOU B. DEDUMO, Ph.D., CESO V BETHANY I. EVILLA, CPA

Claimant Schools Division Superintendent Accountant III JEV No.
REPORT OF DISBURSEMENT No :
Department of Education Date : March 24, 2017
Code :
Liquidation of cash advance for meals/snacks
cottage rental and transportation during the
National CSC Day Celebration on 9/23/17 as
per supporting docs hereto attached in the
amount of . . . 68,000.00

AMOUNT REFUNDED PER OR NO. 6511377 DTD. March 27, 2017 19,400.00
AMOUNT TO BE REIMBURSED -
[A] Certified : Correctness of the [B] Certified : Purpose of travel/ [C] Certified : Supporting
above data cash advance accomplished docs complete and proper
DANTE A. GRUMO MARILOU B. DEDUMO, Ph.D., CESO V BETHANY I. EVILLA, CPA

Claimant Schools Division Superintendent Accountant III JEV No.
Tandag City
FOR THE MONTH OF AUGUST and SEPTEMBER 2015
CASH DISBURSEMENTS REGISTER
TYPE OF WORKING FUND: MOOE

CASH ADVANCE BREAKDOWN OF PAYMENTS
REFERENCE PAYEE/ OFFICE REPAIR & OTHER ACCOUNTS
DATE (OR/RER/ PARTICULARS AMOUNT TRAVEL TRAINING SUPPLIES MAINTENANCE
Check #) RECEIVED PAYMENTS BALANCE EXPENSES EXPENSES EXPENSES OF SCH. BLDG. ACCOUNT ACCOUNT
(6=4-5) (766) (767) (767) (804) NAME CODE
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12)
10,100.00 10,100.00
8/10/2015 18763 TRI STAR ENTERPRISES 1,500.00 8,600.00 1,500.00
8/11/2015 7084 D'JRC BUSINESS WORLD 120.00 8,480.00 Other Office Supplies
8/17/2015 3049 MARY ANN TURIN 500.00 7,980.00 500.00
8/20/2015 RER MARY ANN TURIN 500.00 7,480.00 500.00
8/25/2015 RER MARY ANN TURIN 500.00 6,820.00 Gen. Services
8/29/2015 734 PRINT AVENUE 80.00 6,740.00 Other Office Supplies
8/30/2015 1987355 SURSECO I 151.02 6,588.98 Electricity Expense
9/5/2015 18755 TRI STAR ENTERPRISES 2,000.00 4,408.98 2,000.00
9/8/2015 36 DEE & DAVE SARI SARI STORE 300.00 4,108.98 Internet Expense
9/10/2015 7079 D'JRC BUSINESS WORLD 674.00 3,434.98 Other Office Supplies
9/15/2015 49 DEE & DAVE SARI SARI STORE 200.00 3,234.98 Mobile Load
9/16/2015 RER FE G. MALINAO 180.00 3,054.98 180.00
9/18/2015 760 PRINT AVENUE 480.00 2,394.98 Other Office Supplies
9/24/2015 18722 TRI STAR ENTERPRISES 2,076.00 318.98 2,076.00
9/29/2015 RER MARY ANN TURIN 500.00 (181.02) Gen. Services
9/30/2015 1987973 SURSECO I 125.21 (306.23) Electricity Expense
TOTAL 10,406.23 1,200.00 500.00 5,576.00 -

CERTIFIED CERTIFIED: NOTED:
CORRECT: SUPPORTING DOCUMENTS COMPLETE
MARY ANN A. TURIN JAZEL L. BALDOMERO JURISSA N. ORQUITA

School Head Bookkeeper P-I/District Incharge
Page 11
DATE DATE DATE
Page 12
KDOWN OF PAYMENTS
OTHER ACCOUNTS
AMOUNT
(13)
120.00
500.00
80.00
151.02
300.00
674.00
200.00
480.00
500.00
125.21
3,130.23
JURISSA N. ORQUITA
P-I/District Incharge
Page 13
DATE
Page 14
PROPERTY ACKNOWLEDGMENT RECEIPT
Entity Name : DEPED - DIVISION OF SURIGAO DEL SUR

Fund Cluster: ______________________________________ PAR No.: _______________
Property Date
Quantity Unit Description
Number Acquired
1 unit LAPTOP COMPUTER (i3) LENOVO 740 7/28/2017
Serial No: MPNXB732908Y
Specs:
Intel Core i3
CPU Speed: 3.30Ghz
Display Size: 14"
Hard Disk: 500GB
RAM 4GB DDR3
with wireless mouse, casing bag
TOTAL
Received by: Issued by:
MARVIN G. MINGUILLAN DANTE A. GRUMO

Signatue over Printed Name of End User Signature over Printed Name of Supply Off
ITO-I Administrative Officer IV/Supply

September 26, 2017 September 26, 2017

Date Date
173
Appendix 71
ACKNOWLEDGMENT RECEIPT
PAR No.: _________________
Amount
22,500.00
22,500.00
DANTE A. GRUMO
Signature over Printed Name of Supply Officer
Administrative Officer IV/Supply

Position/Office
September 26, 2017

Date
173
Tandag City Division
DEPARTMENT OF EDUCATION - DIVISION OF SURIGAO DEL SUR

Agency or Office
May 17,2016
ABSTRACT OF SEALED QUOTATIONS
Item NAMES OF DEALERS OR SUPPLIERS:
Qty. Unit PARTICULARS
No. Jins Rest. SURDOECCO Shacene Rest.
1 50 pax 1 Meals and 2 Snacks 300.00 310.00 350.00
WE HEREBY CERTIFY that the prices appearing hereon are to the best of our CERTIFIED CORRECT:
knowledge reasonable being the lowest obtainable in the locality at the time of
quotation
DANTE A. GRUMO
MEMBERS PRICE VERIFICATION COMMITTEE: ELVIRA S. URBIZTONDO,Ph.D. Admin.Officer IV(Supply Officer)
BAC CHAIRMAN
APPROVED:
EDNA E. TRINIDAD ANALIZA G. DOLORICON ALEXANDER D. DAPAR, JR MARILOU B. DEDUMO, Ph.D., CESO V
Co-Chairman BAC MEMBER BAC MEMBER Schools Division Superintendent
Page 17
Surigao del Sur Division
DEPARTMENT OF EDUCATION - DIVISION OF SURIGAO DEL SUR
October 2, 2017
ABSTRACT OF SEALED QUOTATIONS
Item NAMES OF DEALERS OR SUPPLIERS:
Qty. Unit PARTICULARS
No. CRL Medical Ventures Morilla's Pharmacy Percy's Pharmacy
1 400 cap Amoxicillin (Himox) 500mg 16.08 15.50 14.90
2 200 cap Mefenamic (Himox) 500mg 38.26 36.75 35.50
3 500 cap Mefenamic Acid (Ponstan), 500mg 42.00 7.00 5.82
4 400 tab Lagundi 600mh 5.10 3.50 3.40
5 200 tab Paracetamol (Biogesic) 500mg 9.22 8.50 7.95
6 400 cap Alaxan FR 11.60 9.50 9.05
7 400 tab Neozep Non-Drowsy 7.55 5.85 5.45
8 100 tab Kremil-S 7.99 5.85 5.55
9 50 cap Loperamide (Imodium) 17.45 16.00 16.60
10 50 tab Buscopan 28.55 24.85 24.55
11 50 tab Allerta 35.00 22.75 22.60
12 400 cap Co-Amoxiclav 625mg 22.00 30.00 16.80
13 400 tab Ambroxol (Mucosolvan 30mg) 16.65 16.50 16.00
14 15 pack Guaze Bandage 2 x 2 (unsterile) 190.00 125.25 40.00
15 12 pack Guaze Bandage 4 x 4 (unsterile) 12.00 173.25 104.00
16 10 bot White Flower 1.5ml 39.34 39.65 38.00
17 10 bot Hydrogen Peroxide 120ml 180.00 14.50 14.00
18 10 bot Betadine Antiseptic Cleanser 120ml 180.00 184.00 195.80
19 20 bot Omega Pain Killer (15mg) 42.00 20.25 18.50
20 15 bot Isoprophyl Alcohol 70%, 500ml 78.00 70.65 69.50
21 5 roll Elastic Bandage 3 x 5" 98.00 36.75 24.00
22 5 roll Elastic Bandage 6 x 5" 98.00 91.25 45.00
23 3 pcs Ice Cap 224.00 none 180.00
24 1 box Orocan Ice Box, small 1,895.00 none none
25 1500 caps Cecon 7.46 8.25 8.00
THE BAC recommend to award item 1,2-8,10-17,19-23 & 25 to Percy's Pharmacy while item no. 9 to Morill'as Pharmacy and item no. 18
& 24 to CRL Medical Ventures.
Page 18
WE HEREBY CERTIFY that the prices appearing hereon are to the best of our CERTIFIED CORRECT:
knowledge reasonable being the lowest obtainable in the locality at the time of
quotation
DANTE A. GRUMO
MEMBERS PRICE VERIFICATION COMMITTEE: EL VIRA S. URBIZTONDO, Ph.D. Admin. Officer IV(Supply Officer)
BAC CHAIRMAN
APPROVED:
SHIRLENE E. CRABAJALES EDNA E. TRINIDAD ANALIZA G. DOLORICON,Ed.D, ALEXANDER D. DAPAR,

MARILOUJR B. DEDUMO, Ph.D., CESO V
Co-Chairman BAC MEMBER BAC MEMBER BAC MEMBER Schools Division Superintendent
Page 19
Appendix 42
Department of Education
Agency
No: 17-09-
Date: September 25, 2017
ORDER OF PAYMENT
The Collecting Officer
Cash Unit
Please issue Official Receipt in favor of CJEP BUILDERS & ENGINEERING SERVICES
(address/office)
in the amount Twenty Five Thousand pesos only (P 25,000.00
for payment of
Bidding documents for the Repair/Rehab of School Buildings - CLUSTER 10, 11,12,15 AND 16
per Bill No. cash
Please deposit the collections under Bank Account/s:
No. Name of Bank Amount

BTR - Trust Fund 25,000.00
Total P 25,000.00
BETHANY I. EVILLA, CPA

Accountant III
Appendix 42
Agency
No: 17-09-
Date: September 25, 2017
ORDER OF PAYMENT
The Collecting Officer
Cash Unit
Please issue Official Receipt in favor of CJEP BUILDERS & ENGINEERING SERVICES
(name)
0
(address/office)
in the amount Twenty Five Thousand pesos only (P 25,000.00
for payment of
Bidding documents for the Repair/Rehab of School Buildings - CLUSTER 10, 11,12,15 AND 16
per Bill No. cash
Please deposit the collections under Bank Account/s:
No. Name of Bank Amount

BTR - Trust Fund 25,000.00
Total P 25,000.00
BETHANY I. EVILLA, CPA

Accountant III
Tandag, Surigao del Sur
Thru: Division Procurement Office / Supply Office
INVENTORY CUSTODIAN SLIP

District/School: DepED Division Office
ICS Description: ICS No.: _______
Inventory Estimated
Quantity Unit Description
Item No. Useful Life
1 unit EPSON L360 PRINTER 715 3 years
Serial No.: VGFK133741
Received by: Received from:
DANTE A. GRUMO
Administrative Officer - IV
7/11/2017 7/11/2017
Date Date
PURCHASE REQUEST
Agency
Department: Department of Education PR No.: Date:9/29/17

Section: SAI No.: Date:
Unit
Stock No. Unit Item Description Quantity Total Cost
Cost
pax 3 Meals and 2 Snacks 138 700.00 96,600.00
heads Transportation 138 200.00 27,600.00
pc Tarpaulin 1 450.00 450.00
Supplies 20,000.00
AVAILABILITY OF FUNDS:
MYRNA D. CALLOTE
Budget Officer
144,650.00
Purpose: for Reorientation on Civil Servants' Duties and Responsibilities
Requested by: Approved by:
Signature :
Printed Name : SHIRLENE E. CRABAJALES MARILOU B. DEDUMO, Ph.D., CESO V
Designation : AO-V Schools Division Superintendent
REQUISITION AND ISSUE SLIP
Entity Name : DEPED DIVISION OF SURIGAO DEL SUR Fund Cluster :
Division : SURIGAO DEL SUR Responsibility Center Code : _______________

Office : DEPARTMENT OF EDUCATION RIS No. : 17-09-
Requisition Stock Available? Issue
Stock No. Unit Description Yes No Quantity
pcs Polo Shirt with Print / 10
pcs T-shirt with Print / 80
XXXXXXXXNOTHING FOLLOWSxxxxxxxxx
Purpose: for Training-Workshop of MG Teach
Requested by: Approved by: Issued by:

Signature :
Printed Name : ANALIZA G. DOLORICON, Ed.D. DANTE A. GRUMO JOEL B. DEDICATORIA
Designation : EPS-I AO-IV/Supply Officer ADA-VI
Date :
Appendix 63
ITION AND ISSUE SLIP
101101
Responsibility Center Code : ______________________
Issue
Remarks
Received by:
ANALIZA G. DOLORICON, Ed.D.

EPS-I
Annex G-9
REQUISITION AND ISSUE SLIP

(Agency)
Division Surigao del Sur Responsibility Center RIS No. 16-10-

Office Code ______________________ SAI No.
RequIsItIon Issuance
Unit of Remarks
Stock No. Item No. Quantity Quantity
Issue
box Expanded Envelope, 46 46
pcs Ballpen, Black (HB 46 46
unit Notebook, 40 leave 46 46
Purpose : for 3-Day Division Training Workshop on Capability Building Guidelines Counselors/Advocates
Requested by: Approved by : Issued by : Received by:

Signature
Printed Name MARIETO CLEBEN V. LOZADA DANTE A. GRUMO JOEL B. DEDICATORIA MARIETO CLEBEN V. LOZADA
Designation PDO-II Administrative Officer-IV AA-IV PDO-II
Date May 27,2017 May 27,2017
PETTY CASH VOUCHER : PETTY CASH VOUCHER
:
:
Date : Date
:
To: : To:
:
:
PARTICULARS Amount : PARTICULARS Amount
:
:
:
:
:
:
:
:
:
:
:
:
:
:
:
Approved for payment: Received Payment: : Approved for payment: Received Payment:
:
:
Annex G-5
PURCHASE ORDER
DepED - Surigao del Sur Division
Supplier TT & COMPANY P.O. No.

Address Bongtud, Tandag City Date : September 26, 2017
Mode of
TIN: Procurement : Small Value Procurement
Gentlemen :
Please furnish this office the following articles subject to the terms and
conditions contained herein :
Place of Delivery : DepED Division Office-Tandag Delivery Term :

Date of Delivery : Payment Term : 30 days
Stock No. Unit Description Quantity Unit Cost Total Amount
cap Amoxicillin (Himox) 500mg 400 14.90 5,960.00
cap Mefenamic Acid (Ponstan), 500mg 500 5.82 2,910.00
tab Lagundi 600mh 400 3.40 1,360.00
tab Paracetamol (Biogesic) 500mg 200 7.95 1,590.00
cap Alaxan FR 400 9.05 3,620.00
tab Neozep Non-Drowsy 400 5.45 2,180.00
tab Kremil-S 100 5.55 555.00
tab Buscopan 50 24.55 1,227.50
tab Allerta 50 22.60 1,130.00
cap Co-Amoxiclav 625mg 400 16.80 6,720.00
tab Ambroxol (Mucosolvan 30mg) 400 16.00 6,400.00
pack Guaze Bandage 2 x 2 (unsterile) 15 40.00 600.00
pack Guaze Bandage 4 x 4 (unsterile) 12 104.00 1,248.00
bot White Flower 1.5ml 10 38.00 380.00
bot Hydrogen Peroxide 120ml 10 14.00 140.00
bot Omega Pain Killer (15mg) 20 18.50 370.00
bot Isoprophyl Alcohol 70%, 500ml 15 69.50 1,042.50
roll Elastic Bandage 3 x 5" 5 24.00 120.00
roll Elastic Bandage 6 x 5" 5 45.00 225.00
pcs Ice Cap 3 180.00 540.00
caps Cecon 1500 8.00 12,000.00
(Total Amount in words) Twenty Nine Thousand Three Hundred Ten pesos only 50,318.00
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 :
MARILOU B. DEDUMO, Ph.D., CESO V
TT & COMPANY Schools Division Superintendent
(Signature over printed name)
(Date)
Availability of Funds : Amount :

ALOBS No. :
BETHANY I. EVILLA, CPA MYRNA D. CALLOTE
Accountant III Budget Officer
Annex G-5
PURCHASE ORDER
DepED - Surigao del Sur Division
Supplier SURDOECCO P.O. No.

Address Balilahan, Mabua, Tandag City Date : August 21, 2017
Mode of
TIN: Procurement : Small Value procurement
Gentlemen :
Please furnish this office the following articles subject to the terms and
conditions contained herein :
Place of Delivery : Barobo NHS Delivery Term :

Date of Delivery : August 23-26, 2017 Payment Term : 30 days
Stock No. Unit Description Quantity Unit Cost Total Amount
pax 118 2,000.00 236,000.00

Breakfast, AM Snack, Lunch, PM Snack and Dinner for 4 days
whole duration
Aug. 23, 2017 Aug. 24, 2017 Aug. 25, 2017 Aug. 26, 2017
Breakfast Breakfast Breakfast Breakfast
Fish Paksiw Corned Beef w/ potatoe Hotdog Boiled Egg
Ampalaya w/ Egg Fish Paksiw Scrambled Egg Chorizo
Coffee/Milo Coffee/Milo Coffee/Milo Coffee/Milo
AM Snack AM Snack AM Snack AM Snack

Chocolate Cake Puto (2 pcs) Biko Siopao
Juice Juice Hot Choco Water
Lunch Lunch Lunch Lunch

Fried Chicken Fish Tinola Nilagang Baka Pork Afritada
Fish Kinilaw Beef Mechado Fried Bangus Lumpia Shanghai
Veggies Veggies Veggies Veggies
Softdrinks Softdrinks Softdrinks Softdrinks
Fruit Fruit Fruit Fruit
PM Snack PM Snack PM Snack PM Snack

Budbud (2 pcs) Sandwich Torta Doughnut
Hot Choco Juice Water Juice
Dinner Dinner Dinner Dinner

Fried Fish Pork Adobo Fish w/ beans Beefsteak
Veggies Veggies Bam-i Fish Fillet
Kinilaw Fruits Fruits Veggies
Fruits Softdrinks Veggies Soup Fruits
Softdrinks Softdrinks Softdrinks
(Total Amount in words) Two Hundred Thirty Six Thousand pesos only 236,000.00
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 :
MARILOU B. DEDUMO, Ph.D., CESO V
SURDOECCO Schools Division Superintendent
(Signature over printed name)
(Date)
Availability of Funds : Amount :

ALOBS No. :
BETHANY I. EVILLA, CPA MYRNA D. CALLOTE
Accountant III Budget Officer
X X Annex G-7
INSPECTION & ACCEPTANCE REPORT

x DEPARTMENT OF EDUCATION
(Agency)
Supplier: SELADES APARTELLE & CONVENTION CENTER IAR No.:

PO No. 261 Date: September 18, 2017 DR No. Date: Sept. 28-29, 2017
Stock No. Unit Description Quantity

Day 0 - September 28, 2017 - Batch 2
AM Snacks, Lunch, PM Snacks, Dinner and Accommodation for
pax 171
2 days
Day 3 - September 29, 2017 (JHS)

pax Breakfast, AM Snacks, Lunch, PM Snacks 171
INSPECTION ACCEPTANCE
Date Inspected : Sept. 28-29, 2017 Date Received : Sept. 28-29, 2017
X Inspected, verified and found OK X Complete

as to quantity and specifications Partial
JULITA D. MANGATA
NENETTE A. SALAS DANTE A. GRUMO

Inspectorate Committee Administrative Officer IV
X X Annex G-7
INSPECTION & ACCEPTANCE REPORT

x DEPARTMENT OF EDUCATION
(Agency)
Supplier: AP&S PRINTSHOPPE IAR No.:

PO No. Date: DR No. 475-482 Date: June 30, 2017
Stock No. Unit Description Quantity

copies Animal Band/The Birds Flies 480
copies Mr. Particular 480
copies Town of Makinang 480
copies Mrs. Post's Science Class 480
copies Problems at the Restaurant 480
copies The Five Sisters - Easy 480
copies The Five Sisters - Difficult 480
copies Loro Gets Stuck - Easy 480
copies Loro Gets Stuck - Difficult 480
copies Neighbors - Easy 480
copies Neighbors - Difficult 480
copies Lets Learn About Ecosystem - Easy 480
copies Lets Learn About Ecosystem - Difficult 480
copies The Scavenger Hunt - Easy 480
copies The Scavenger Hunt - Difficult 480
copies The Magic Show - Easy 480
copies The Magic Show - Difficult 480
copies Para, The Brave and Beautiful - Easy 480
copies Para, The Brave and Beautiful - Difficult 480
copies Great Inventors Inspiring Inventions - Easy 480
copies Great Inventors Inspiring Inventions - Difficult 480
copies Benjie's Long Trip - Easy 480
copies Benjie's Long Trip - Difficult 480
copies Bounty in Our Hand - Easy 480
copies Bounty in Our Hand - Difficult 480
copies The Biggest Storm - Easy 480
copies The Biggest Storm - Difficult 480
copies Wonders in the Sky - Easy 480
copies Wonders in the Sky - Difficult 480
copies Nagsimula sa Parisukat and Koko 480
copies Bagyo at Ang Bagong Kapitbahay 480
copies Pista ng Pahiyas at Sorpresa Kay Lola 480
copies Ang Meryenda at ang Hangin at sa Saranggola 480
copies Ang Paging at Kuneho at Bangui Wind Farm (base 1) 480
copies Ang Paging at Kuneho at Bangui Wind Farm (base 2) 480
copies Isang Kakaibang Araw at Anyong-tubig sa Pilipinas (base 1) 480
copies Isang Kakaibang Araw at Anyong-tubig sa Pilipinas (base 2) 480
copies Maligayang Pagsating/Punta Tayo sa Argao 480
copies Si Kiko ar Tomas../Magkapatid na Daga 480
copies Si Maya sa Himpapawid/Si Maya sa Davao 480
copies Sina Niña at Nonoy - Difficult 480
copies Mga Bayani sa Kimunidad - Easy 480
copies Mga Bayani sa Kimunidad - Difficult 480
copies Sa Kalye sa Sarado - Easy 480
copies Sa Kalye sa Sarado - Difficult 480
copies Taguan/Ang Alaga Kong si Mong Q1 480
copies Sina Stella at Lisa/Isang Linggo sa Klase Q1 480
copies Ang Pagyanig Q1 480
copies Ang Idolo ni Beatriz - Easy 480
copies Ang Idolo ni Beatriz - Difficult 480
copies Kabang-Asong Bayani - Difficuly 480
copies Misteryo sa Villa Soledad - Difficult 480
copies Si Chico at Hasmin - Difficult 480
copies Ang Dula - Difficult 480
copies Ang Pamamasyal ni Korina - Difficult 480
copies Si Mariang Makiling - Difficult 480
copies Sina bong at Buboy - Difficult 480
copies Ang Mga Pambansang Produckto - Difficult Q4 480
copies Fruit and Tress/Today is Moving Day 480
copies Do You Chores ad Making a Fire Base 1 Q4 480
copies Do You Chores ad Making a Fire Base 2 Q4 480
copies The End of the World/Animal Here, Animals There Base 1 Q4 480
copies The End of the World/Animal Here, Animals There Base 2 Q4 480
copies Sa Bukid 480
copies Tan-awa Kami 480
copies Sustansiyado ba ang haluhalo 480
copies Ang Bongtud ug Ako 480
copies Malong, Aldo ang Superhero 480
copies Magtanom ta og Munggos, Ang Lamok 1 480
copies Magtanom ta og Munggos, Ang Lamok 2 480
copies Pito na ko ka Tuig 480
copies Biko, Paliya 480
copies Si Chico at Hasmin - Easy 480
copies Kabang-Asong Bayani - Easy 480
copies Mistero sa Villa Soledad - Easy 480
copies Si Mariang Makiling - Easy 480
copies Ang Dula - Easy 480
copies Ang Pamamasyal ni Korina - Easy 480
copies Sina bong at Buboy - Easy 480
copies Ang Mga Pambansang Produckto - Easy Q4 480
copies Sina Niña at Nonoy - Easy 480
copies Sa bukid 480
copies Bountry in Our Hands B1 480
copies Bountry in Our Hands B2 480
BUDGET OF WORK
copies Grade 1-3 Araling Panlipunan (37 pages) 175
copies Grade 1-3 ESP (36 pages) 175
copies Grade 1-3 English 175
copies Grade 1-3 Filipino 175
copies Grade 1-3 Arts (25 pages) 175
copies Grade 1-3 Health (19 pages) 175
copies Grade 1-3 Music 175
copies Grade 1-3 Physical Education 175
copies Grade 1-3 Mathematics 175
copies Grade 1-3 Mother Tongue 175
copies Grade 1-3 Araling Panlipunan (31 pages) 166
copies Grade 1-3 ESP (38 pages) 166
copies Grade 1-3 Arts (25 pages) 166
copies Grade 1-3 Health (18 pages 166
copies Grade 4-6 Science 166
copies Grade 4-6 Araling Panlipunan 166
copies Grade 4-6 English 175
copies Grade 4-6 EPP 166
copies Grade 4-6 ESP 166
copies Grade 4-6 Filpino 175
copies Grade 4-6 Arts 166
copies Grade 4-6 Health 175
copies Grade 4-6 Music 166
copies Grade 4-6 Mathematics 175
copies Grade 4-6 Science 166
INSPECTION ACCEPTANCE
Date Inspected : June 30, 2017 Date Received : June 30, 2017
X Inspected, verified and found OK X Complete

as to quantity and specifications Partial
JULITA D. MANGATA
NENETTE A. SALAS DANTE A. GRUMO

Inspectorate Committee Administrative Officer IV
ACKNOWLEDGEMENT RECEIPT FOR EQUIPMENT
Number : ____________

Tandag
Item Property Unit Total

Unit Quantity Description
No. No. Cost Cost
1 unit 1 HP PRINTER (Desk jet ink advantage)2135 -
all in 1 printer(serial nos. CN597394Y7)
2 unit 1 Aspire E-14 (charcoal grey color) Laptop

Serial # NXMXQSP0075250C83E3400
with carry case (black)-acer
3 unit 1 LED -TV-(FLAT SCREEN)-DEVANT

40DL540-102CM
Serial # 400L540AO81500804
Donated by: ONE (1) MERALCO Foundation Inc.
TOTAL -
Received by: Received From:
TRINIDAD G. OTACAN DANTE A. GRUMO

School Head-Calatngan ES-San Miguel II AO-IV/Supply Officer

Position Position
February 1, 2016 February 1, 2016

Date Date
Tandag City
Date
Sir/Madam:
Please quote your price of item/articles listed below:
ITEM No. QUANTITY UNIT SUPPLIES/MATERIALS/ITEMS UNIT PRICE
4 pcs. TUBELESS TIRE 205/65 R15
Sealed price quotations on the items/articles named above will be received in this Office, Supply Secton until
11:00 A.M. ______________________ at which time and place price quotation sealed envelope will be opened.
Very truly yours,
SHERYL B. LARGADO
School Head
Sir/Madam:
Our prices are quoted opposite every items above.

________________________
Signature of Dealer
Gen Form N. 61-A
REPORT OF WASTE MATERIALS
Name of Local Government Unit:
Department/Office: Department of Education - SEDIP
Place of Storage: DepED Storeroom Date: October 16, 2009
Item Unit of Unit Total Record of Sales

Qty. Description
No. Issue Cost Cost O.R. No. Amount
1. 1 unit Car Aircon Compressor
(SEDIP Strada vehicle - CSV-105)
TOTAL TOTAL
CERTIFIED CORRECT
ANTONIO V. SALAZAR FE C. VALEROSO, CESO VI

Supply Officer-Designate Schools Division Superintendent
CERTIFICATE OF INSPECTION
This is to certify that I have this ________ days of ___________________, 2003 inspected the above-listed
supplies/property and found the same to be ( with or without value) ______________________________.
CHERYL C. DIME
State Auditor III
CERTIFICATE OF DISPOSAL
This is to certify that the above listed-supplies/property were disposed of as follows: __________________.
ANTONIO V. SALAZAR FE C. VALEROSO, CESO VI

Supply Officer-Designate Schools Division Superintendent
Witnessed by:
CHERYL C. DIME
State Auditor III
Tandag
REPORT OF PRE-INSPECTION
DESCRIPTION OF PROPERTY:
Type SUV Brand/Model TOYOTA INNOVA

Serial/Engine No. Property No.
Acquisition Cost Acquisition Date
Date of Last Repair Nature of Last Repair
COMPLAINTS/DEFECTS
Nature and scope of work to be done damaged bumper
Requested by:
ERNESTO GUHITING
Driver
May 5, 2017
(Date)
PRE-REPAIR:
Findings: for repainting/repair of front and rear bumper
PRE-INSPECTED BY: NOTED BY:
RUFINO T. REYES MARILOU B. DEDUMO, Ph.D., CESO V

EPS-I/TWG Chairman Schools Division Superintendent
(Date) (Date)
RONNIE L. DIAZ
Member
(Date)
No.______________
JOB ORDER FOR SERVICING
DEPARTMENT OF EDUCATION Name of Service Center : ____________________________

Caraga Administrative Region Address : _________________________________________
Division of Surigao del Sur Tel. No.: __________________________________________
Tandag Date received of job order : ___________________________
Quantity : _________________________________________
Items/Accessories : _________________________________
Requesting Officer:____________________ _________________________________________________
Section Office:________________________ _________________________________________________
Tel. No.: _____________________________ Serial No. : ________________________________________

Date: _______________________________ Complain : ________________________________________
Service Report : ____________________________________
_________________________________________________
Nature & scope of work to be done: _________________________________________________
___________________________________ Parts : ___________________________________________
___________________________________ _________________________________________________
__________________________________
Summary: Parts : P
Labor :
Signature of requesting officer: Tax :
Total : P
______________________________ Released by :
Signature Over Printed Name

SUPPLIES AVAILABILITY INQUIRY
Department of Education - TEEP
(Agency)
Division Surigao del Sur Responsibility Center No. _________________
Office TEEP Code ____________ Date :
Stock No. Item Description Unit Quantity Status of Stock
1 US Bond Paper, A4, Subs. 20 reams 195

2 US Bond Paper, Subs. 20, Long reams 70
3 US Bond Paper, Subs. 20, Short reams 1
4 Staple wire # 35 boxes 2
5 Staple wire # 10 boxes 6
6 Rubber bond arrow (big) pack 1
7 Packing Tape 2" rolls 2
8 Sign Pen Black (Pilot G-Tech) pc. 1
9 Stabilo boss-red pc. 1
10 Computer Ink BC-05 canon pc. 1
11 Computer Ink BC-03 canon pcs. 12
12 Computer Ink BC-03 canon (Refill) pcs. 3
13 Verbatim Diskette boxes 1
14 Expanded Brown Envelope Long pcs. 60
15 Mailing Envelope Long (white) pcs. 50
16 Batteries for Calculator pcs. 8
17 Paste bot. 1
18 Correction Fluid (Touch and Go) pcs. 2
19 Acetate A4 boxes 3
20 Plastic Binder Ring 1/2 size pcs. 50
21 Cartolina thick, blue pcs. 100
22 Sign Pen Pilot (Black G-Tec. C-4) 0.4 dozens 5
23 Sign Pen Pilot (Black G-Tec. C-4) 0.4 Refill dozen 1
24 Sign Pen Pilot (Red G-Tec. C-3) 0.3 dozens 3
25 Sign Pen Pilot (Black G-Tec. 0.5) dozen 1
26 Brown Folder, long pcs. 100
27 Casio Calculator (12 digits JS-20LA) pcs. 3
28 Lysol Earosol pcs. 3
29 Mouse - Logitech - USB Type w/ roller pc. 1
30 HP LaserJet Toner C4127X cartridge 2
31 HP Laser Toner C7115A cartridge 2
32 Kyocera Toner, Series 3750 cartridge 2
33 Toner 15A HP LaserJet, Series (1000-1002-3300) cartridge 2
34 HP Deskjet 840C # 17 (colored) pcs. 21
35 HP Deskjet 840C # 15 (black) pcs. 21
36
Purpose/Remarks : For reproduction of forms for M & E, SBM Manuals, Testing Materials for Teachers Proficiency Test
and for TEEP-SBP use.
Inquired by : Status provided by :
Signature : ___________________________________ Signature : __________________________
Name CARIDAD A. YU Name : MELVYN C. RULETE
Designation : PDO II Designation: Accountant II
Date : Date :
Appendix 58
LIQUIDATION REPORT No :
Department of Education Date :
Code :
Liquidation of cash advance for FUEL during the
delivery of Textbooks & IM's for the different
Districts in the Division of Surigao del Sur on
October 18, 21 & Nov. 11, 2010 as per
supporting documents hereto attached in the
amount of . . . . . . . 5,000.00

AMOUNT REFUNDED PER OR NO. __________ DTD. _____________
[A] Certified : Correctness of the [B] Certified : Purpose of travel/ [C] Cetified : Supporting documents
above data cash advance accomplished complete and proper
DANTE A. GRUMO GREGORIA T. SU, Ph.D. MELVYN C. RULETE _________

Claimant Asst. Schools Division Superintendent-OIC Accountant II JEV No.
LIQUIDATION REPORT No :
Department of Education Date : 0
Code :
Liquidation of cash advance for FUEL during the
delivery of Textbooks & IM's for the different
Districts in the Division of Surigao del Sur on
October 18, 21 & Nov. 11, 2010 as per
supporting documents hereto attached in the
amount of . . . . . . . 5,000.00

AMOUNT OF CASH ADVANCE PER DV NO. ___________ Ch# DTD. 5,000.00
AMOUNT REFUNDED PER OR NO. __________ DTD. _____________
[A] Certified : Correctness of the [B] Certified : Purpose of travel/ [C] Cetified : Supporting documents
above data cash advance accomplished complete and proper
DANTE A. GRUMO GREGORIA T. SU, Ph.D. MELVYN C. RULETE _________

Claimant Asst. Schools Division Superintendent-OIC Accountant II JEV No.
Third Elementary Education Project
Tandag
Check Nos. ___________ and ____________ dated ____________
DATE Payee OR No. Particulars No. of Liters Amount
Prepared by : Certified by :
________________________ ________________________
Implementing School District Supervisor
APPROVED :
FE C. VALEROSO, CESO VI
Schools Division Superintendent
PURCHASE REQUEST
Agency
Department: Department of Education PR No.: Date: 1/18/2011

Section: Medical & Dental SAI No.: Date:
Unit
Stock No. Unit Item Description Quantity Total Cost
Cost
caps Amoxicillin (250mg) 200
caps Amoxicillin (500mg) 200
caps Mefenamic Acid (250mg) 200
caps Mefenamic Acid (500mg) 200
tabs Ibuprofen P. (Alaxan) 50
tabs Paracetamol (Biogesic 500mg) 100
tabs Neozep 200
tabs Loratidine 50
tabs Kremil - S 50
caps Loperamide 50
tabs Hyoscine HCL (Buscopan) 20
tube Bactroban cream 5g 2
bottle Alcohol 500 ml 3
pack gauze 4 x 4 10 77.00
pack gauze 2 x 2 10 28.00
pcs Aplosyn otic drops 4 173.00
tube Gentamicin eye ointment 3 391.50
bottle efficascent (small) 10 25.00
pcs Visine red 2
pcs eye mo 2
bottle omega pain killer 5
Availability of Funds:
MELVYN C. RULETE, CPA

Accountant II
P -
Purpose: To be use at the Medical Section
Requested by: Approved by:

Signature :
Printed Name : MANTOVANNI C. DUEÑAS, MD GREGORIA T. SU, PhD.
Designation : Medical Officer IV Assistant Schools Division Superintendent
Officer-In-Charge
POLO SHIRTS SIZES FOR DIVISION OFFICE PERSONNEL
MENS SIZES
Small Medium Large XL 2XL Total

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Republic of the Philippines

Name of Establishments Received by

School: Purisima NHS

KRISTINE ANN A. CANO DANTE A. GRUMO

State Auditor III Administrative Officer IV

September 26, 2017 September 26, 2017

CAMBATONG ELEMENTARY SCHOOL

Republic of the Philippines

Republic of the Philippines

AGSABAN PRIMARY SCHOOL

TOTAL AMOUNT SPENT 68,000.00

DANTE A. GRUMO MARILOU B. DEDUMO, Ph.D., CESO V BETHANY I. EVILLA, CPA

TOTAL AMOUNT SPENT 68,000.00

DANTE A. GRUMO MARILOU B. DEDUMO, Ph.D., CESO V BETHANY I. EVILLA, CPA

FOR THE MONTH OF AUGUST and SEPTEMBER 2015

CASH DISBURSEMENTS REGISTER

TYPE OF WORKING FUND: MOOE

TOTAL 10,406.23 1,200.00 500.00 5,576.00 -

MARY ANN A. TURIN JAZEL L. BALDOMERO JURISSA N. ORQUITA

Entity Name : DEPED - DIVISION OF SURIGAO DEL SUR

Received by: Issued by:

MARVIN G. MINGUILLAN DANTE A. GRUMO

ITO-I Administrative Officer IV/Supply

September 26, 2017 September 26, 2017

PAR No.: _________________

Administrative Officer IV/Supply

September 26, 2017

DEPARTMENT OF EDUCATION - DIVISION OF SURIGAO DEL SUR

1 50 pax 1 Meals and 2 Snacks 300.00 310.00 350.00

DEPARTMENT OF EDUCATION - DIVISION OF SURIGAO DEL SUR

SHIRLENE E. CRABAJALES EDNA E. TRINIDAD ANALIZA G. DOLORICON,Ed.D, ALEXANDER D. DAPAR,

per Bill No. cash

Please deposit the collections under Bank Account/s:

No. Name of Bank Amount

BETHANY I. EVILLA, CPA

per Bill No. cash

Please deposit the collections under Bank Account/s:

No. Name of Bank Amount

BETHANY I. EVILLA, CPA

Thru: Division Procurement Office / Supply Office

INVENTORY CUSTODIAN SLIP

Received by: Received from:

Department: Department of Education PR No.: Date:9/29/17

Purpose: for Reorientation on Civil Servants' Duties and Responsibilities

Requested by: Approved by:

Entity Name : DEPED DIVISION OF SURIGAO DEL SUR Fund Cluster :

Division : SURIGAO DEL SUR Responsibility Center Code : _______________

Purpose: for Training-Workshop of MG Teach

Requested by: Approved by: Issued by:

Responsibility Center Code : ______________________

ANALIZA G. DOLORICON, Ed.D.

REQUISITION AND ISSUE SLIP

Division Surigao del Sur Responsibility Center RIS No. 16-10-

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

Supplier TT & COMPANY P.O. No.

Place of Delivery : DepED Division Office-Tandag Delivery Term :

Very truly yours,

Availability of Funds : Amount :

Supplier SURDOECCO P.O. No.

Place of Delivery : Barobo NHS Delivery Term :

pax 118 2,000.00 236,000.00

AM Snack AM Snack AM Snack AM Snack

Lunch Lunch Lunch Lunch

Requesting Officer: _____________________________

Section Office: _________________________

Tel. No.: _ Serial No. : ____________

_ Parts : _________