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GAAM Vol. II Appendex 18 GAAM Vol. II Appendex 18Revised January 1992 Revised January 1992
REIMBURSEMENT EXPENSES RECEIPT REIMBURSEMENT EXPENSES RECEIPT
Date __________________ No. _____________________ Date __________________ No. _____________________
Received from ______________________________________________ Received from ______________________________________________ (Name) (Name)
_____________________________________________________ the amount _____________________________________________________ the amount
of _____________________________________________ (Php____________) of _____________________________________________ (Php____________)
in payment for ___________________________________________________ in payment for ___________________________________________________
rental or transportation should show inclusive dates, rental or transportation should show inclusive dates,
purpose, distance, inclusive points or travel, etc.) purpose, distance, inclusive points or travel, etc.)
PAYEE PAYEE
Name/Signature: _________________________________________________ Name/Signature: _________________________________________________
Address: ________________________________________________________ Address: ________________________________________________________
Residence Cert. No.: ______________________________________________ Residence Cert. No.: ______________________________________________
Date of Issue: ____________________________________________________ Date of Issue: ____________________________________________________
Place of Issue: ________________ Place of Issue: ___________________________________________________
WITNESS WITNESS
Name/Signature: _________________________________________________ Name/Signature: _________________________________________________
Address: ________________________________________________________ Address: ________________________________________________________
Residence Cert. No.: ______________________________________________ Residence Cert. No.: ______________________________________________
Date of Issue: ____________________________________________________ Date of Issue: ____________________________________________________
Place of Issue: ___________________________________________________ Place of Issue: ___________________________________________________
(Payment for subsistence, services, (Payment for subsistence, services,
of _____________________________________________ (Php____________)
135
Summary of Expenses
Program / Activity Description Payee Date Amount
ROD MYPA Meals (Snacks) Greenwich 10225 07/03/15 1,001.00
Meals (Lunch) Penongs Lanang 01010343 07/03/15 1,326.00
Taxi Fare Davtransco Taxi 011390 07/03/15 50.50
Fare & Softdrinks RER 07/03/15 62.00
Taxi Fare Voiture Taxi 17689 06/25/15 82.00
Taxi Fare Arlyn Mea Taxi 2318 06/25/15 92.50
Taxi Fare Lago Grande 164 06/25/15 103.00
Taxi Fare RGSM Taxi 25405 06/26/15 92.50
Taxi Fare Mabuhay Taxi 2201 06/08/15 61.00
Taxi Fare Maro Taxi 14107 06/26/15 131.00
Taxi Fare Datts Taxi 6658 06/22/15 274.50
Taxi Fare Visa Cab 11135 06/22/15 274.50
GRAND TOTAL 3,550.50
Prepared by:
WENA C.TINIO
TESDS II
Receipt No./Docketed
No.
Conduct of Compliance Audit (Assessment)
Summary of Expenses
Program / Activity Description Payee Receipt No. Date Amount
Meals Uloy's Ihaw-ihaw 31444 08/28/15 600.00
Pinakbet Edong's Lechon Manok 017193 08/28/15 280.00
Meals 11003 08/28/15 360.00
Meals 11006 08/28/15 643.00
Softdrinks & Rice RER 08/28/15 99.00
Jeepney Fare RER 08/28/15 32.00
GRAND TOTAL 2,014.00
Prepared by:
JEAN C. GONZALES
SR. TESDS
RE-ECHO ON ENHANCE CURRICULUM
Freemont Foods Corporation
Freemont Foods Corporation
TESDA
Standard Form Number: SF-GOODE-59 Project Reference Number: N/ARevised On: May 24, 2004 Name of Project: N/A
Location of the Project: N/A
PURCHASE REQUESTTechnical Education and Skills Development Authority, Davao City
616 Interior 2, Rimas St., Aquino Subd., JP Laurel Avenue, Davao CityRegional Office XI
(Agency)
Department: ROD PR No : Date : 06-Aug-15Section SAI N o : Date :
Stock No. Unit Item Description Quantity Unit Cost Total Cost
unit Computer Monitor 19" 2 6,000.00 12,000.00
12,000.00 Purpose: For MoNet and Scholarship use
REQUESTED BY : APPROVED BY :
SignaturePrinted Name ARLYN S. BANDONG GASPAR S. GAYONA, Ph.D., CESO IIIDesignation Chief, ROD Regional Director
Standard Form Title: Purchase Request
TECHNICAL EDUCATION AND SKILLS DEVELOPMENT AUTHORITY Project Reference Number: N/A 616 Interior 2, Rimas St., Aquino Subd., JP Laurel Avenue, Davao City Name of the Project: N/ATelephone Nos. 221-8778/222-2294 Location of the Project: N/A
Standard Form Number: SF-GOOD-60 Date: Aug. 6, 2015Revise on: May 24, 2004 Quotation No.:
Company Name: ______________________________________________________________________________Address: ____________________________________________________________________________________
Please quote your lowest price on the item/s listed below,subject to the General Conditions on the last page, stating the shortest time of delivery and submit your quotation duly signed by your representative not later than _________________ in the return envelop attached herewith.
WILMA G. UDALVENOTE: Procurement Officer
1. ALL ENTRIES MUST BE TYPEWRITTEN.2. DELIVERY PERIOD WITHIIN __________ CALENDAR DAYS3. WARRANTY SHALL BE FOR A PERIOD OF SIX (6) MONTHS FOR SUPPLIES &MATERIALS, ONE YEAR FOR EQUIPMENT, FROM THE DATE OF ACCEPTANCE OF THE PROCURING ENTITY.4. PRICE VALIDITY SHALL BE FOR A PERIOD OF ___________ CALENDAR DAYS.5. G-EPS REGISTRATION CERTIFICATE SHALL BE ATTACHED UPON SUBMISSION OF THE QUOTATION.6. BIDDERS SHALL SUBMIT ORIGINAL BROCHURES SHOWING CERTIFICATIONSOF THE PRODUCT BEING OFFERED.
ITEM & DESCRIPTION QTY UNIT PRICE
1 Computer Monitor 19" 2 units
For MoNet and Scholarship use
Brand & Model: __________________________Delivery Period: __________________________
Warranty: __________________________Price Validity: __________________________
After having carefully read and accepted your General Conditions, I/ We quote you on the item at prices
noted above.Printed Name & Signature_____________________Tel. No./ Cellphone #e-mail address_______________________Date
Standard Form Title : Request for Quotation
ITEM NO.
Republic of the PhilippinesTECHNICAL EDUCATION AND SKILLS DEVELOPMENT AUTHORITY XI
Regional Office, 616 Interior 2, Rimas St., Aquino Subd., JP Laurel Avenue, Davao CityTelephone Nos. 221-8778, 222-2294,
Date: 6-Aug-15 NOTICE TO BIDDERS:
Sealed bids subject to the conditions consigned herein will be received at the Technical Education
publicly opened for the furnishing POB, TESDA Office XI of the following: TO BE DELIVERED WITHIN_________ WORKING DAYS AFTER RECEIPTS OF AWARD
No. Qty. Unit NAMES AND DESCRIPTION OF ARTICLES Unit Price Total Price
1 1 unit Router P_____________ P____________
TERESITA Y. RODA GASPAR S. GAYONA, Ph.D., CESO IIICanvasser Regional Director
The above are our quoted for items called for and I/We hereby certify that the above articles are our bonafide stock. In case of failure on our part to furnish the above materials and or equipment within____working days from the date of receipt of the order we agree to pay the penalty imposed one tenth (1/10) of the percent per day of delay the diferent in price should there be any other expenses that the government may incure in securing articles from the dealers and therefore authorizing the TESDA Disbursing Officer to deduct the value of the penalty imposed from any money due or which may become due us.
Name of Establishment________________________________________ Business/Trade Name_________________________________________ Principal Place of Business____________________________________ Vat No. or Non Vat Taxpayer Reg. No___________________________ TIN _________________________________________________________
and Skills Development Authority Office XI, Davao City on or before 10:00 Am dated on , ________2014
TESDA
Standard Form Number: SF-GOODE-58 Project Reference Number:Revised On: May 24, 2004 Name of Project:
Location of the Project:
PURCHASE ORDERTechnical Education and Skills Development Authority, Davao City
616 Interior 2, Rimas St., Aquino Subd., JP Laurel Avenue, Davao CityName of Procuring Entity
Supplier JEAN C. GONZALES P. O.
Address Date
Email Address
Telephone No.
TINGentlement
Please furnish this office the following articles subject to the terms and conditions contained herein :
Place of Delivery Delivery Term:Date of Delivery Payment Term:
Stock No. Unit Description Quantity Unit Cost
units Computer Monitor 19" 2 5,590.00 11,180.00
unit Optical Mini Mouse 1 680.00 680.00
(Total Amount in Words) Eleven thousand eight hundred sixty pesos only 2,014.00
In case of failure to make the full delivery the time specified above, a penalty .
of one-tenth (1/10) of one percent for every day of delay shall be imposed.
JEAN C. GONZALES GASPAR S. GAYONA, Ph.D., CESO III
(Signature Over Printed Name) Regional Director
(Authorized Officials)
(Date)
Date
Funds Available: OR No.:
Amount: 2,014.00
Source of Fund:
MIREY LOVE C. CAGUIAT Name of End User:
Accountant IV Check No.:
Standard Form Title: Purchase Order
Mode of Procurement
Appendix 64
INSPECTION & ACCEPTANCE REPORT
Technical Education and Skills Development Authority, Davao City(Agency)
Supplier: JEAN C. GONZALES IAR No :
PO No. Invoice No.0140 Date : 12/31/14Requisitioning Office/Dept.
Stock No. Unit Description Qty. Unit Total
page Publication of 2014 Compendium of 2 10,000.00 20,000.00
Registered Programs and Accredited
Assessment Centers
20,000.00 Inspected, verified and found OK Partial (pls. specify quantity)as to quantity and specifications
JOEL A. ATABLANCO WILMA G. UDALVE Inspection Officer Supply Officer
For Property Officer Use
Republic of the Philippines Technical Education and Skills Development Authority XI
ABSTRACT OF BIDS
Tel. Nos. 221-8778 and 222-2294July 18, 2014
NO. QTY. Unit Description Chippens Yellow Fin Seafood Restaurant
1 5 pax Meals - Dinner 2,111.20 2,200.00 2,325.00
Item no. 1 is Nanay Bebeng Culinary Enterprises, Inc. due to lower costs
MELBA A. RAÑON ADONIS F. CULAS JEAN C. GONZALES DORLITA B. LAUREL ARLYN S. BANDONG
Provisional Member Provisional Member Reg. Member Vice-Chair Chairman
Nanay Bebeng Culinary Enterprises, Inc.
Appendix 50TESDA
Standard Form Number SF-GOOD-61 Revised on: May 24, 2004Standard Form Title: Requisition and Issuance Slip
REQUISITION AND ISSUANCE SLIP
Technical Education and Skills Development Authority, XI616 Interior 2, Rimas Street, Aquino Subdivision, JP Laurel Avenue, Davao City
Regional Office XI, Tel. No. 221-8778
DIVISION: ROD RIS No.OFFICE: TESDA XI - Regional Office SAI No.
R e q u I s I t I o n
Stock No. Unit Description Quantity Unit Remarks
page Publication of 2014 Compendium of 2 10,000.00 20,000.00
Registered Programs and Accredited
Assessment Centers
Purpose: 20,000.00 Requested By : Approved By : Issued By : Received By :
JEAN C. GONZALES WILMA G. UDALVE MALANGKA S. JUMDANA JEAN C. GONZALESSr. TESDS Supply Officer V Adm. Asst. III Sr. TESDS
Annex A1Republic of the Philippines
TECHNICAL EDUCATION AND SKILLS DEVELOPMENT AUTHORITY616 Interior 2, Rimas St., Aquino Subd., JP Laurel Avenue, Davao City
Regional Office XI
No.
OBLIGATION REQUEST
Payee JEAN C. GONZALES
Office
Address Davao City
Responsibility AccountCenter P.P.A Code Amount
To reimbursement of expenses spent during re-echo on 2,014.00 enhanced curriculum as per supporting papers hereto attached in the amount of…
Total 2,014.00
Certified Certified
Charges to appropriation/allotment necessary, lawful Allotment available and obligated for the Purpose and under my direct supervision as indicated above
Supporting documents valid, proper and legal
Signature Signature
PrintedARLYN S. BANDONG
Printed YOLANDA S. VILLAFLORName Name
Position Chief, ROD Position Administrative Officer V
Head, Requesting Officer/Authorized Representative Head, Budget Unit/Authorized Representative
Date Date
A.
B.
A.
B.
A. B.
A.
Annex BRepublic of the Philippines
TECHNICAL EDUCATION AND SKILLS DEVELOPMENT AUTHORITY616 Interior 2, Rimas St., Aquino Subd., JP Laurel Avenue, Davao City
Regional Office XI
DISBURSEMENT VOUCHER No.
MODE OF PAYMENT MDS Check Commercial Check ADA Others
TIN/Employee No. OR/BUR No.Payee JEAN C. GONZALES
Office/Unit/Project Code
Address Davao City
EXPLANATION AMOUNT
To reimbursement of expenses spent during re-echo on 2,014.00 enhanced curriculum as per supporting papers hereto attached in the amount of…
0
0
2,014.00 Certified: Approved for Payment: Cash Available
Supporting documents complete and proper
Subject to ADA (where available)
Signature Signature
Printed MIREY LOVE C. CAGUIAT
Printed GASPAR S. GAYONA, Ph.D., CESO III Name Name
Position Accountant IV Position Regional DirectorHead, Accounting Unit/Authorized Representative Agency Head/Authorized Representative
Date Date Received Payment: JEV NO. Check/ Date Bank Name ADA No.
Date Printed Name Date:Signature
Official Receipt/Other Documents
A B
D
B
D
C
TECHNICAL EDUCATION AND SKILLS DEVELOPMENT AUTHORITYRegion XI, Davao City
TRAVEL ORDERNo. _________
Name : ADONIS F. CULAS
Station : TESDA XI - RO, Davao City
You are hereby directed to travel on official business via Cebu Pacific, land transport,and/or sea transport.
Place : Davao del SurDuration: Dcember 10, 2014Purpose: Attendance to the Local Poverty Reduction Action Team Orientation
It is understood that a report shall be submitted upon completion of this travel.
GASPAR S. GAYONA, Ph.D., CESO III Regional Director
Authorized Representative
TECHNICAL EDUCATION AND SKILLS DEVELOPMENT AUTHORITYRegion XI, Davao City
TRAVEL ORDERNo. _________
Name : ADONIS F. CULAS
Station : TESDA XI - RO, Davao City
You are hereby directed to travel on official business via Cebu Pacific, land transport,and/or sea transport.
Place : Davao del SurDuration: Dcember 10, 2014Purpose: Attendance to the Local Poverty Reduction Action Team Orientation
It is understood that a report shall be submitted upon completion of this travel.
GASPAR S. GAYONA, Ph.D., CESO III Regional Director
Authorized Representative
Appendix 46
ITINERARY OF TRAVEL
TECHNICAL EDUCATION AND SKILLS DEVELOPMENT AUTHORITY 616 Interior 2, Rimas St., Aquino Subd., JP Laurel Avenue, Davao City
Region XI
No.
Name: ADONIS F. CULAS
Purpose of Travel: Attendance to the LPRAT Orientation
TIME Expenses
Date Places to be Visited Means of FARE ALLOW Total
Depart. Arrival Transpo.
10-Dec-14 Davao City - Davao del Sur 6:30 AM 9:00 AM RP Vehicle - 320.00 320.00
10-Dec-14 Davao del Sur - Davao City 6:30 PM 9:00 AM RP Vehicle
TOTAL 0.00 320.00 320.00 Prepared by:
I certify that : (1) I have reviewed theforegoing itinerary , (2) the travel isnecessary to the service, (3) the periodforegoing itinerary , (2) the travel is ADONIS F. CULAScovered is reasonable and (4) the Official/Employeeexpenses claimed are proper. Approved by:
ARLYN S. BANDONGSupervisor GASPAR S. GAYONA, Ph.D., CESO III
Regional Director
TECHNICAL EDUCATION AND SKILLS DEVELOPMENT AUTHORITYAgency
CERTIFICATE OF TRAVEL COMPLETED
GASPAR S. GAYONA, Ph.D., CESO III TESDA Regl. Office XIAgency Head Station
Regional Director 10-Dec-14Position DATE
I CERTIFY THAT I have completed the travel authorized in Itinerary of Travel No. dated December 26, 2012 under conditions indicated below:
x Strictly in accordance in the approved itinerary.Cut short as explained below; payment in the amount of P ________, was refundedunder O. R. No. _________, dated ______________.Extended as explained below; additional itinerary was submitted.Other deviations as explained below:
Explanation or justification:
Evidence of Travel:x Appendix B
Plane Ticket/Busx Certificate of Appearance
Others:
Respectfully Submitted:
ADONIS F. CULASSr. TESDS
On evidence and information of which I have knowledge, the travel was actually undertaken.
ARLYN S. BANDONGSupervisor
Appendix 58
LIQUIDATION REPORT No.Date: 8-Oct-12
TECHNICAL EDUCATION AND SKILLS DEVELOPMENT AUTHORITY Responsibility Center(Agency) Code:
ALBERT N. MANINGO
PARTICULARS AMOUNT
Liquidation of cash advance granted for traveling expenses during the ROD Team ###at Surigao del Sur on October 4-6, 2012
TOTAL AMOUNT SPENT 2,400.00AMOUNT OF CASH ADVANCE PER DV NO. 12-08-900 Dtd. 2,400.00AMOUNT REFUNDED PER OR NO. _____________DTD_________
AMOUNT TO BE REIMBURSE
Certified: Correctness of the Certified: Purpose of travel/cash Certified: Supporting documents
above date advance duly accomplished complete and proper
ALBERT N. MANINGO ARLYN S. BANDONG MIREY LOVE C. CAGUIAT
Immediate Supervisor Accountant IV
Claimant JEV. No.
AA
B C
Republic of the PhilippinesTECHNICAL EDUCATION AND SKILLS DEVELOPMENT AUTHORITY
Rimas St., Aquino Village, J.P. Laurel Avenue, Davao City
PAYMENT OF SALARYDecember 2013
Gross Total
350 4 1400.00 0 43.75 32 1,400.00
Each Official whose name appears above has been paidthe amount indicated opposite his/her name. Certified by:
EVANGELINE C. PEDARIOS MIREY LOVE C. CAGUIATCashier Accountant IV
Noted by:
ARLYN S. BANDONGChief TESD Specialist, ROD
NAME OF PERSONNEL
Rate per Day
No. of Working
days
Minutes Late
Rate per hour
Undertime hours
Total Number of Hours
JESSIELO C. GUBALANI
Republic of the PhilippinesTECHNICAL EDUCATION AND SKILLS DEVELOPMENT AUTHORITY
616 Int. 2, Rimas St., Aquino Village, J.P. Laurel Avenue, Davao City
PAYMENT OF SALARYDecember 16-31, 2014
Gross Total
620 13 8060.00 0 77.50 0 8 8,680.00
Each Official whose name appears above has been paidthe amount indicated opposite his/her name. Certified by:
KRISTI DONNA N. PAREDES MIREY LOVE C. CAGUIATHRMO Accountant IV
Noted by:
ARLYN S. BANDONGChief TESD Specialist, ROD
NAME OF PERSONNEL
Rate per Day
No. of Working
days
Minutes Late
Rate per hour
Undertime
Overtime (in hours)
ALBERT N. MANINGO
Republic of the PhilippinesTECHNICAL EDUCATION AND SKILLS DEVELOPMENT AUTHORITY616 Interior 2, Rimas St., Aquino Subd., JP Laurel Avenue, Davao City
PAYROLL
NAME OF PERSONNEL DESIGNATION AMOUNT SIGNATURE
ARLYN S. BANDONG CHIEF ROD 1,840.00
THELMA M. REQUILLO TESDS II 1,040.00
ARNULFO L. PELAYO DRIVER 1,040.00
ALBERT N. MANINGO JOB ORDER 1,040.00
TOTAL 4,960.00
Each Official whose name appears above has been paidthe amount indicated opposite his/her name.
Prepared by:
EVANGELINE C. PEDARIOSCashier
PANTAWID PAMILYA BENEFICIARIES
AS OF MAY 20, 2014
PANTAWID PAMILYA BENEFICIARIES
AS OF MAY 20, 2014
PANTAWID PAMILYA BENEFICIARIES
AS OF MAY 20, 2014
PANTAWID PAMILYA BENEFICIARIES
AS OF MAY 20, 2014