APR FORM revised August 2015 Form No.

003
NAME AND ADDRESS: SB SEC.OFFICE-LGU-LUPON AGENCY ACCT. CODE
OF REQUESTING AGENCY Lupon, Davao Oriental AGENCY CONTROL NO.
TEL. NOS. 808-0344
AGENCY PROCUREMENT REQUEST PS APR No.
To: THE PROCUREMENT SERVICE
DBM Compound, R.R. Road
Cristobal St., Paco Manila 4/2/2018
Date

ACTION REQUESTED ON THE ITEMS LISTED BELOW

( ) Please furnished with us Price Estimate for office equipment/furniture and supplementary items
Mode of Delivery: [ ] Pick-up (Fast Lane) [ ] Pick-up (Schedule) [ ] Delivery (door-to-door)
In case fund is not sufficient: [ ] Reduce Quantity [ ] Bills us [ ] Charge to unutilized Deposit, APR/OR No.: __ Date: __
In case item is not available: [ ] IssueCNAS
( ) Please purchase for our agency non-common items. Attached herewith:
[ ] Complete Specifications [ ] Obligation Request (ObR) [ ] Copy of APP [ ] Others, pls. specify ___________
[ ] Certificate of Budget Allocation (CBA) [ ] Payment ___________________________
( ) Purchase of ITEMS ON SALE (IOS) in PS Main, Depots and Sub-Depots
Item No. Item and Description/Specifications Quantity Unit Unit Price Amount
Stock No.
1 Battery, size AA, alkaline, 2 pieces per blister pack 2 packs 20.44 40.88
2 Battery, size AAA, alkaline, 2 pieces per blister pack 2 packs 19.35 38.70
3 Compact Flourestcent Lamp, 18 watts 1 pc. Individual b 1 piece 106.91 106.91
4 Tape, electrical 1 roll 19.07 19.07
5 Air Freshener, 280 ml./can 1 can 89.38 89.38
6 Alcohol, 70%, ethyl, 500 ml 10 bottle 50.12 501.20
7 Clearbook, Legal size 5 piece 43.68 218.40
8 Clip, Backfold, 19mm, 12 pieces per box 5 boxes 7.94 39.70
9 Clip, Backfold, 25mm, 12 pieces per box 5 boxes 14.04 70.20
10 Clip, Backfold, 32mm, 12 pieces per box 5 boxes 19.00 95.00
11 Clip, Backfold, 50mm, 12 pieces per box 5 boxes 41.42 207.10
12 Correction Tape, 6 meters (min.), 1 piece in individual pla 5 piece 43.13 215.65
13 Data File Box made with chipboard, with closed ends 2 boxes 73.22 146.44
14 Envelope, documentary, for A4 size documents, 500 pcs 1 box 427.76 427.76
15 Envelope, documentary, for legal size documents, 500 p 1 box 542.98 542.98
16 Index Tab, self-adhesive, 5 set/box, assorted colors 10 boxes 65.00 650.00
17 Marker, whiteboard, bullet type, blue 2 pieces 10.77 21.54
18 Marker, permanent, bullet bype, blue 3 pieces 10.12 30.36
19 Pad paper, Ruled 10 pad 18.34 183.40
20 Paper, Multi-purpose (copy) A4, 70gsm 20 reams 120.02 2,400.40
21 Paper, Multi-purpose (copy) legal size, 70gsm 20 reams 136.23 2,724.60
22 Pencil, lead, w/eraser, one (1) dozen per box 1 box 20.57 20.57
23 Philippine National Flag (Extra Large) 3 pieces 314.50 943.50
24 Ring binder, Plastic 32mm, 10 pieces per bundle 8 bundle 269.71 2,157.68
25 Sign pen, black 12 pieces 36.28 435.36
26 Sign pen, red 2 pieces 36.28 72.56
27 Tape, masking, 48mm, 50 meters length 1 roll 110.09 110.09
28 Tape, transparent, 24mm, 50 meters 2 rolls 11.45 22.90
29 Tape, transparent, 48 mm, 50 meters 2 rolls 27.80 55.60
30 Toilet Tissue, 12 rolls per pack 2 packs 70.85 141.70
31 Cutter Blade, heavy duty cutter, 10 pieces per tube 1 tube 8.24 8.24
32 Cutter Knife, heavy duty 1 piece 20.40 20.40
33 Cleaner, Toilet Bowl and Urinal, 900-1000ml cap 2 bottle 43.68 87.36
34 Detergent Powder, all purpose, 1 kilo/pouch 6 pouch 39.23 235.38
35 Disinfectant Spray, 400-550 grams 1 can 126.17 126.17
36 Dust Pan, non-rigid plastic 2 piece 28.34 56.68
37 Furniture Cleaner, aerosol, 300ml/can 3 can 91.56 274.68
38 Insecticide, aerosol type, 600 m./can 1 can 143.88 143.88
39 Mophead, made of rayon 1 piece 111.18 111.18
40 Rag, all cotton, 32 pieces per kilo per bundle 1 bundle 45.86 45.86
 41 Trashbag, plastic, transparent, 10 pcs./roll 1 roll 146.61 146.61
42 Computer Continous Forms, 2 ply, 11"x14-7/8",1000 sets/box 2 box 1,079.00 2,158.00
43 DVD Rewritable, 4x speed, 4.7 GB capacity 5 pieces 22.84 114.20
44 Flash Drive, 16 GB, USB2.0, plug and play 5 pieces 263.78 1,318.90
45 Illustration Board (30"x40") 20 pieces 36.80 736.00
46 Index Card, 5"x8", 500 pieces per pack 2 packs 146.31 292.62
47 Soap, Bathroom, 90grams, 1piece in individual box 6 piece 23.48 140.88
48 Self-inking stamp (name & position) 5 pieces 200.00 1,000.00
49 Metal Bookends 1 pieces 200.00 200.00
50 Top Glass 4 pieces 1,000.00 4,000.00
51 Muriatic Acid 5 gallons 55.00 275.00
52 Card Reader 1 pieces 100.00 100.00
53 Polo Shirt 10 pieces 250.00 2,500.00

Total 26,821.67
NOTE: ALL SIGNATURES MUST BE OVER PRINTED NAME
STOCKS REQUESTED ARE CERTIFIED FUNDS CERTIFIED AVAILABLE APPROVED
WITHIN APPROVED PROGRAM

(SGD)EUGENIO T. ROSETE (SGD)SUBAINA L. ASINAS, CPA, LLB (SGD)ERLINDA D. LIM

General Services Officer Municipal Accountant Municipal Mayor
AGENCY PROPERTY SUPPLY OFFICER AGENCY CHIEF ACCOUNTANT AGENCY HEAD

[ FUNDS DEPOSITED WITH PS [ ] ___________ CHECK NO. __________

IN THE AMOUNT OF: __________________________________ (P ______________) ENCLOSED
APR FORM revised August 2015 Form No. 003
NAME AND ADDRESS: SB OFFICE-LGU-LUPON AGENCY ACCT. CODE
OF REQUESTING AGENCY Lupon, Davao Oriental AGENCY CONTROL NO.
TEL. NOS. 808-0344
AGENCY PROCUREMENT REQUEST PS APR No.
To: THE PROCUREMENT SERVICE
DBM Compound, R.R. Road
Cristobal St., Paco Manila 4/2/2018
Date

ACTION REQUESTED ON THE ITEMS LISTED BELOW

( ) Please furnished with us Price Estimate for office equipment/furniture and supplementary items
Mode of Delivery: [ ] Pick-up (Fast Lane) [ ] Pick-up (Schedule) [ ] Delivery (door-to-door)
In case fund is not sufficient: [ ] Reduce Quantity [ ] Bills us [ ] Charge to unutilized Deposit, APR/OR No.: __ Date: __
In case item is not available: [ ] IssueCNAS
( ) Please purchase for our agency non-common items. Attached herewith:
[ ] Complete Specifications [ ] Obligation Request (ObR) [ ] Copy of APP [ ] Others, pls. specify ___________
[ ] Certificate of Budget Allocation (CBA) [ ] Payment ___________________________
( ) Purchase of ITEMS ON SALE (IOS) in PS Main, Depots and Sub-Depots
Item No. Item and Description/Specifications Quantity Unit Unit Price Amount
Stock No.
1 Battery, size AA, alkaline, 2 pieces per blister pack 10 packs 20.44 204.40
2 Battery, size AAA, alkaline, 2 pieces per blister pack 3 packs 19.35 58.05
3 Tape, electrical 2 roll 19.07 38.14
4 Air Freshener, 280 ml./can 5 can 89.38 446.90
5 Alcohol, 70%, ethyl, 500 ml 8 bottle 50.12 400.96
6 Clip, Backfold, 19mm, 12 pieces per box 10 boxes 7.94 79.40
7 Clip, Backfold, 25mm, 12 pieces per box 10 boxes 14.04 140.40
8 Clip, Backfold, 32mm, 12 pieces per box 10 boxes 19.00 190.00
9 Clip, Backfold, 50mm, 12 pieces per box 10 boxes 41.42 414.20
10 Correction Tape, 6 meters (min.), 1 piece in individual pla 5 piece 43.13 215.65
11 Data File Box made with chipboard, with closed ends 6 boxes 200.00 1,200.00
12 Envelope, documentary, for A4 size documents, 500 pcs 1 box 427.76 427.76
13 Envelope, documentary, for legal size documents, 500 p 1 box 532.77 532.77
14 Envelope, Expanding, Kraftboard, for legal size doc. 100pcs./box 1 box 652.80 652.80
15 Envelope, Expanding, Plastic 1 box 673.02 673.02
16 Envelope, Mailing, 500 pieces per box 1 box 146.33 146.33
17 Folder, Fancy, Legal 50 pieces per bundle 2 bundles 305.76 611.52
18 Folder, L-type, Legal Size, 50 pieces per pack 1 pack 191.10 191.10
19 Glue, all purpose 1 jar 51.32 51.32
20 Index Tab, self-adhesive, 5 set/box, assorted colors 20 boxes 65.00 1,300.00
21 Marker, permanent, bullet type, black 5 pieces 10.77 53.85
22 Marker, permanent, bullet bype, blue 5 pieces 10.12 50.60
23 Notepad, stick-on (2"x3") 100 sheets per pad 1 pad 45.00 45.00
24 Pad paper, Ruled 10 pad 18.34 183.40
25 Paper, Multi-purpose (copy) A4, 70gsm 30 reams 120.02 3,600.60
26 Paper, Multi-purpose (copy) legal size, 70gsm 10 reams 136.23 1,362.30
27 Pencil, lead, w/eraser, one (1) dozen per box 1 box 20.57 20.57
28 Philippine National Flag (Extra Large) 6 pieces 314.50 1,887.00
29 Record Book, 500 pages, size: 214mmx278mm min 5 pieces 98.10 490.50
30 Ring binder, Plastic 32mm, 10 pieces per bundle 10 bundle 269.71 2,697.10
31 Rubber Band, 70mm min. lay flat length (#18) 1 box 111.14 111.14
32 Ruler, plastic, 450mm, 1 piece individual plastic 5 piece 16.38 81.90
33 Sign pen, black 12 pieces 36.28 435.36
34 Sign pen, red 2 pieces 36.28 72.56
35 Stamp Pad ink, violet, 50ml 1 bottle 24.02 24.02
36 Staple wire, Heavy duty, 23/13 1 box 21.02 21.02
37 Staple wire, standard 5 box 21.02 105.10
38 Tape, masking, 24mm, 50 meters length 5 roll 57.77 288.85
39 Tape, masking, 48mm, 50 meters length 5 roll 110.09 550.45
40 Tape, transparent, 24mm, 50 meters 5 rolls 11.45 57.25
 41 Tape, transparent, 48 mm, 50 meters 5 rolls 27.80 139.00
42 Tape, packaging, 48mm, 50 meters 2 rolls 34.94 69.88
43 Toilet Tissue, 12 rolls per pack 1 pack 70.85 70.85
44 Cutter Blade, heavy duty cutter, 10 pieces per tube 1 tube 8.24 8.24
45 Cutter Knife, heavy duty 1 piece 20.40 20.40
46 Puncher, paper, heavy duty, w/ 2 hole guide, 1 pc. In individual box 1 piece 129.60 129.60
47 Scissors, (6") 2 pair 16.31 32.62
48 Stapler, standard 1 piece 86.11 86.11
49 Waste Basket, non-rigid plastic 1 piece 32.21 32.21
50 Broom, soft (tambo) 6 pieces 92.65 555.90
51 Broom, stick (tingting) 2 pieces 25.07 50.14
52 Cleaner, Toilet Bowl and Urinal, 900-1000ml cap 5 bottle 43.68 218.40
53 Cleanser, scouring powder, 350grms/can 2 can 19.11 38.22
54 Detergent Powder, all purpose, 1 kilo/pouch 6 pouch 39.23 235.38
55 Disinfectant Spray, 400-550 grams 1 can 126.17 126.17
56 Dust Pan, non-rigid plastic 2 piece 28.34 56.68
57 Furniture Cleaner, aerosol, 300ml/can 2 can 91.56 183.12
58 Insecticide, aerosol type, 600 m./can 1 can 143.88 143.88
59 Mopbucket 1 piece 1,965.60 1,965.60
60 Mophandle, screw type, aluminum handle 1 piece 136.50 136.50
61 Mophead, made of rayon 1 piece 111.18 111.18
62 Rag, all cotton, 32 pieces per kilo per bundle 1 bundle 45.86 45.86
63 Trashbag, plastic, transparent, 10 pcs./roll 1 roll 146.61 146.61
64 Calculator, scientific, 1 unit per box 1 unit 434.62 434.62
65 DVD Rewritable, 4x speed, 4.7 GB capacity 10 pieces 22.84 228.40
66 Flash Drive, 16 GB, USB2.0, plug and play 5 pieces 263.78 1,318.90
67 Mouse, Optical, usb connection type 1 unit 144.14 144.14
68 Illustration Board (30"x40") 100 pieces 36.80 3,680.00
69 Index Card, 5"x8", 500 pieces per pack 5 packs 146.31 731.55
70 Oil, for general purpose lubricant, 120 ml 1 bottle 38.75 38.75
71 Push pin, flat head type, assorted, 100pcs/case 1 case 26.21 26.21
72 Soap, Bathroom, 90grams, 1piece in individual box 5 piece 23.48 117.40
73 Cover-binding plastic, 200 MIC long 1 pack 427.50 427.50
74 board cover, cann, laid r-long 20 pack 37.50 750.00
75 Ballpen, black, fine point 5 dozen 27.20 136.00
76 Sign Pen, Black 1.0 m (Gel) 20 pieces 75.00 1,500.00
77 Paper Sticker 5 packs 50.00 250.00
78 Adhesive 5 packs 45.00 225.00
79 Metal Bookends 2 pieces 200.00 400.00
80 Sign Pen Refill 12 pieces 45.00 540.00
81 Muriatic Acid 10 gallons 55.00 550.00
82 Photopaper, High Gloss A4 20 sheets 1 pack 100.00 100.00
83 Bookbind cover (Starlin) 15 meters 45.00 675.00
84 Aircon Fuse 5 pieces 1,000.00 5,000.00
85 Aircon Capacitor 2 pieces 1,000.00 2,000.00
86 Toner, Brother TN 2280 1 piece 2,000.00 2,000.00
87 Drum, Brother DR 2255 1 piece 1,000.00 1,000.00
88 Cyan Ink 664 12 bottles 273.30 3,279.60
89 Magenta Ink 664 12 bottles 273.30 3,279.60
90 Yellow Ink 664 12 bottles 273.30 3,279.60
91 Black ink 664 12 bottles 273.30 3,279.60
92 UPS 3 units 2,500.00 7,500.00
93 Polo Shirt 40 piece 250.00 10,000.00

Total 77,607.71
NOTE: ALL SIGNATURES MUST BE OVER PRINTED NAME
STOCKS REQUESTED ARE CERTIFIED FUNDS CERTIFIED AVAILABLE APPROVED
WITHIN APPROVED PROGRAM

EUGENIO T. ROSETE SUBAINA L. ASINAS, CPA, LLB ERLINDA D. LIM

General Services Officer Municipal Accountant Municipal Mayor
AGENCY PROPERTY SUPPLY OFFICER AGENCY CHIEF ACCOUNTANT AGENCY HEAD

[ FUNDS DEPOSITED WITH PS [ ] ___________ CHECK NO. __________

IN THE AMOUNT OF: __________________________________ (P ______________) ENCLOSED