Republic of the Philippines

PROVINCE OF NEGROS ORIENTAL

Municipality of Tayasan
No.
DISBURSEMENT VOUCHER
Mode of O Check O Cash O Others
Payment
TIN/Employee No. Obligation Request No.
MMC Hardware and Construction Supply
Payee
Responsibility Center
Address Office/Unit/Project Code

EXPLANATION AMOUNT

Payment of construction materials used for

Rural Health Building with supporting papers
attached in the amount of………..
25,539.37

Gross : 26,985.00
Less :
5% 1,204.69 1,445.63
1% 240.94
1,445.63 25,539.37

A. Certified B. Certified
Allotment obligated for the purpose as indicated above Funds Available
Supporting documents complete

Signature Signature
Printed Date Printed Date
Name DIEJO B. QUILLANO Name NOLI B. GABOTERO
Position Municipal Accountant Position Municipal Treasurer

Head Accounting Unit/Authorized Representative Treasurer/Authorized Representative

C. Approved Payment 25,539.37 D. Received Payment

Check No. Bank Name Date
Signature
Printed Signature
Name HON. SUSANO ANTONIO D. RUPERTO, III Printed
Position Municipal Mayor Date Name MMC Hardware and Construction Supply

Agency Head/Authorized Representative O.R./Other Documents JEV No. Date

 Republic of the Philippines
PROVINCE OF NEGROS ORIENTAL
Municipality of Tayasan
No.
OBLIGATION REQUEST

Payee MMC Hardware and Construction Supply

Office

Address Poblacion, Tayasan, Negros Oriental

Account
RESPONSIBILITY CENTER Particulars F.P.P Amount
Code

Payment of construction materials used for 1011-5-02-13-040

Rural Health Building with supporting papers Maintenance/
attached in the amount of……….. Repair of Mun.
Government 26,985.00
Buildings & Grounds

Total 26,985.00
A. Certified B. Certified
Charges to appropriation/allotment necessary, Existence of available appropriation.
Lawful and under my direct supervision
Supporting documents valid, proper and legal.

Signature: Signature:

Printed Name: Printed Name:

HON. SUSANO ANTONIO D. RUPERTO, III ROVELEN G. VISOR

Position: Position:
Municipal Mayor Municipal Budget Officer
Head requesting Office/Authorized Representative Head budget Unit/Authorized Representative
Date: Date:
 Republic of the Philippines
Province of Negros Oriental
MUNICIPALITY OF TAYASAN
Office of the Municipal Engineer

PRE REPAIR INSPECTION REPORT

Date

This is to certify that upon inspection of the Municipal Vehicle New Nissan Ambulance (NV-350) and
Mitsubishi Forward Mini Dumptruck with Plate No. 090108 the unit needs maintenance and replacement of Tires.

Qty. Unit Item Description/Findings Recommendation

4 pcs. 10.00 X 20 tire Replace
2 pcs. 235/75 R15 Replace

This is to certify further that the above - mentioned are necessary in order for the vehicle
to operate/function properly.

Certified by: Noted by:

JOEY A. VILLAMOR ENGR. STEVE NICHOLS S. DIONALDO

Mechanic II Municipal Engineer

Approved by:

HON. SUSANO ANTONIO D. RUPERTO, III

Municipal Mayor
Procuring Entity: Municipality of Tayasan Project Reference Number:
Province of Negros Oriental Name of Project
Office of the: Rural Health Unit Location of the Project

PURCHASE REQUEST
LGU TAYASAN

Department: Rural Heath Unit PR NO. : Date: October 02, 2023

Section: SAI NO. : Date:
Item Quantity Unit of Unit Total
Item Description
No. issue Cost Cost
1 3 bags Cement 294 882.00
2 10 pcs 60x60 Tiles 250.00 2,500.00
3 3 shts 3/4" x 4" x 8 MPW 3,510.00 10,530.00
4 12 lngth 2" PVC Pipe S1000 312.00 3,744.00
5 1 kl #2 CWN 86.00 86.00
6 2 gals Gloss Latex Paint (White) 912.00 1,824.00
7 1 gal Putty Master 350.00 350.00
8 3 pcs #4 PVC Elbow 150.00 450.00
9 1 lngth #4 PVC 300.00 300.00
10 1 set All purpose Epoxy 796.00 796.00
11 9 pcs Cabinet/Drawer Handle 45.00 405.00
12 12 pcs # 2 PVC Elbow 39.00 468.00
13 2 pcs 1/2" Ø Angle Valve 138.00 276.00
14 2 pcs Kitchen sink 624.00 1,248.00
15 4 pcs 1/2" Ø PVC Threaded Elbow 25.00 100.00
16 8 pcs 1/2" Ø PVC Plain Elbow 17.00 136.00
17 2 pcs 1/2" Ø Long Neck Faucet 408.00 816.00
18 2 pcs 1/2" Ø P.E Tee (CTS) 123.00 246.00
19 4 pcs 1/2" Ø P.E Male Adaptor (CTS) 54.00 216.00
20 1 can Solvent Cement 1/4 liter 180.00 180.00
21 2 rolls Tapelon Tape (Big) 48.00 96.00
22 2 pcs 1/2"Ø x 3/8 Ø x 18 Flexible Hose 168.00 336.00
23 1 Unit Exhaust fan 1,000.00 1,000.00
Total 26,985.00

TOTAL COST OF THIS PURCHASE REQUEST: Twenty Six Thousand Nine Hundred Eighty Five Pesos Only.
Requested By:

DR. MYRASOL P. ZUNIEGA

Municipal Doctor

Purpose/Remarks: For Rural Health Building.

Signature :
Printed Name : ROVELEN G. VISOR NOLI B. GABOTERO HON. SUSANO ANTONIO D. RUPERTO, III

Designation : Municipal Budget Officer Municipal Treasurer Municipal Mayor

Date :
 Republic of the Philippines
PROVINCE OF NEGROS ORIENTAL
Municipality of Tayasan

REQUEST FOR QUOTATION

Date:
P.R. 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 envelope attached herewith.

NOLI B. GABOTERO
Municipal Engineer
Note:
1) All entries must be typewritten.
2) Delivery Period within _____________ calendar days.
3) Warranty shall be for a period of six (6) months for supplies and materials, one (1) year for Equipment
from date of acceptance by the procuring entity.
4) Price validity shall be a period of 30 calendar days.
5) G-EPS Registration Certificate shall be attached upon submission of the quotation.
6) Bidders shall submit original Brochures showing certification of the product being offered (optional).
7) Mode of delivery: [ ] Pick-up (Schedule) [ ] Door to Door Delivery.

ITEM
NO. UNIT ITEM AND DESCRIPTION QTY. UNIT PRICE TOTAL AMOUNT

1 pc. Ignition Switch 1

2 pcs. Shock Absorber 2
3 pc. Oil Filter 1
4 set Intake Manifold Assy. 1
5 pc. Fuel Tank Cap 1

After having carefully read and accepted your General Condition, I / We quote you on the item at prices noted above.

Printed Name with Signature

Canvassed by: Tel. No. /Cellphone No.

JOEY A. VILLAMOR
Authorized Canvasser Tin No. of Establishment

Date
 Republic of the Philippines
PROVINCE OF NEGROS ORIENTAL
Municipality of Tayasan

REQUEST FOR QUOTATION

Date:
P.R. 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 envelope attached herewith.

NOLI B. GABOTERO
Municipal Treasurer
Note:
1) All entries must be typewritten.
2) Delivery Period within _____________ calendar days.
3) Warranty shall be for a period of six (6) months for supplies and materials, one (1) year for Equipment
from date of acceptance by the procuring entity.
4) Price validity shall be a period of 30 calendar days.
5) G-EPS Registration Certificate shall be attached upon submission of the quotation.
6) Bidders shall submit original Brochures showing certification of the product being offered (optional).
7) Mode of delivery: [ ] Pick-up (Schedule) [ ] Door to Door Delivery.

ITEM
UNIT ITEM AND DESCRIPTION QTY. UNIT PRICE TOTAL AMOUNT
NO.
1 set Brake Shoe Front 1
2 tubes Mighty Gasket 2
3 pc. Fan Belt 1
4 pcs. Transmission Linkage 2
5 pc. Hydraulic Hose 1
6 pcs. Radiator Hose 2

After having carefully read and accepted your General Condition, I / We quote you on the item at prices noted above.

Printed Name with Signature

Canvassed by: Tel. No. /Cellphone No.

JOEY A. VILLAMOR
Authorized Canvasser Tin No. of Establishment

Date
 Republic of the Philippines
PROVINCE OF NEGROS ORIENTAL
Municipality of Tayasan

REQUEST FOR QUOTATION

Date:
P.R. 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 envelope attached herewith.

NOLI B. GABOTERO
Municipal Treasurer
Note:
1) All entries must be typewritten.
2) Delivery Period within _____________ calendar days.
3) Warranty shall be for a period of six (6) months for supplies and materials, one (1) year for Equipment
from date of acceptance by the procuring entity.
4) Price validity shall be a period of 30 calendar days.
5) G-EPS Registration Certificate shall be attached upon submission of the quotation.
6) Bidders shall submit original Brochures showing certification of the product being offered (optional).
7) Mode of delivery: [ ] Pick-up (Schedule) [ ] Door to Door Delivery.

ITEM
UNIT ITEM AND DESCRIPTION QTY. UNIT PRICE TOTAL AMOUNT
NO.
1 pcs. U-Bolt 2
2 set Brake Pad 1
3 set Wiper Blade 1
4 pc. Clutch Disc 1
5 pc. Clutch Cover 1
6 pc. Release Bearing 1

After having carefully read and accepted your General Condition, I / We quote you on the item at prices noted above.

Printed Name with Signature

Canvassed by: Tel. No. /Cellphone No.

JOEY A. VILLAMOR
Authorized Canvasser Tin No. of Establishment

Date
 Republic of the Philippines
PROVINCE OF NEGROS ORIENTAL
Municipality of Tayasan

REQUEST FOR QUOTATION

Date:
P.R. 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 envelope attached herewith.

NOLI B. GABOTERO
Municipal Treasurer
Note:
1) All entries must be typewritten.
2) Delivery Period within _____________ calendar days.
3) Warranty shall be for a period of six (6) months for supplies and materials, one (1) year for Equipment
from date of acceptance by the procuring entity.
4) Price validity shall be a period of 30 calendar days.
5) G-EPS Registration Certificate shall be attached upon submission of the quotation.
6) Bidders shall submit original Brochures showing certification of the product being offered (optional).
7) Mode of delivery: [ ] Pick-up (Schedule) [ ] Door to Door Delivery.

ITEM
UNIT ITEM AND DESCRIPTION QTY. UNIT PRICE TOTAL AMOUNT
NO.
1 pc. Clutch Disc 1
2 pc. Head Gasket 1
3 pcs. Wheel Cylinder 2
4 pc. Hydrovac Assy. 1
5 pc. Tie Rod End 2
6 pc. Brake Master 1

After having carefully read and accepted your General Condition, I / We quote you on the item at prices noted above.

Printed Name with Signature

Canvassed by: Tel. No. /Cellphone No.

JOEY A. VILLAMOR
Authorized Canvasser Tin No. of Establishment

Date
 Republic of the Philippines
PROVINCE OF NEGROS ORIENTAL
Municipality of Tayasan

REQUEST FOR QUOTATION

Date:
P.R. 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 envelope attached herewith.

NOLI B. GABOTERO
Municipal Treasurer
Note:
1) All entries must be typewritten.
2) Delivery Period within _____________ calendar days.
3) Warranty shall be for a period of six (6) months for supplies and materials, one (1) year for Equipment
from date of acceptance by the procuring entity.
4) Price validity shall be a period of 30 calendar days.
5) G-EPS Registration Certificate shall be attached upon submission of the quotation.
6) Bidders shall submit original Brochures showing certification of the product being offered (optional).
7) Mode of delivery: [ ] Pick-up (Schedule) [ ] Door to Door Delivery.

ITEM
UNIT ITEM AND DESCRIPTION QTY. UNIT PRICE TOTAL AMOUNT
NO.
1 pcs. Shock Absorber 2
2 pc. Air Cleaner Hose 1
3 pcs. Axle Oil Seal 2
4 pc. 3T 24V Relay Circuit 1
5 pcs. GUT-24 Cross Joint 2
6 pcs. Hub Oil Seal 2

After having carefully read and accepted your General Condition, I / We quote you on the item at prices noted above.

Printed Name with Signature

Canvassed by: Tel. No. /Cellphone No.

JOEY A. VILLAMOR
Authorized Canvasser Tin No. of Establishment

Date
 ABSTRACT OF BIDS/ CANVASS FOR FURNISHING AND DELIVERING SUPPLIES
AND/ OR MATERIALS TO THE MUNICIPALITY OF TAYASAN

MMC HARDWARE RAV'S MONICARL Amount to the following bidders recommended

ITEM # QTY. UNIT DESCRIPTION OF ARTICLES AND CONST. SUP. ENT. MKTG. price offered being the most advantageous to
the government.
1 3 bags Cement 294.00 305.00 300.00 Item # 1-23 is awarded to
2 10 pcs 60x60 Tiles 250.00 270.00 265.00 MMC HARDWARE AND CONSTRUCTION SUPPLY
3 3 shts 3/4" x 4" x 8 Tiles 3,510.00 3,560.00 3,550.00 for the prices offered being the most
4 12 lngth 2" PVC Pipe S1000 312.00 330.00 320.00 advantageous to the government.
5 1 kl #2 CWN 86.00 95.00 88.00
6 2 gals Gloss Latex Paint (White) 912.00 940.00 930.00
7 1 gal Putty Master 350.00 380.00 375.00
8 3 pcs #4 PVC Elbow 150.00 155.00 152.00
9 1 lngth #4 PVC 300.00 325.00 325.00
10 1 set All Purpose Epoxy 796.00 810.00 810.00
11 9 pcs Cabinet/Drawer Handle 45.00 50.00 47.00
12 12 pcs #2 PVC Elbow 39.00 40.00 39.50
13 2 pcs 1/2" Ø Angle Valve 138.00 160.00 150.00 Canvassed by:
14 2 pcs Kitchen Sink 624.00 650.00 640.00
15 4 pcs 1/2" Ø PVC Threaded Elbow 25.00 30.00 26.00
16 8 pcs 1/2" Ø PVC Plain Elbow 17.00 20.00 18.00 DANILO C. RUPERTO
17 2 pcs 1/2" Ø Long Neck Faucet 408.00 430.00 420.00 Admin Aide III
18 2 pcs 1/2" Ø P.E Tee (CTS) 123.00 130.00 125.00
19 4 pcs 1/2" Ø P.E Male Adaptor (CTS) 54.00 63.00 60.00
20 1 can Solvent Cement 1/4 Liter 180.00 190.00 185.00
21 2 rolls Tapelon tape (Big) 48.00 55.00 50.00
22 2 pcs 1/2" Ø x 3/8 Ø x 18 Flexible Hose 168.00 180.00 175.00
23 1 Unit Exhaust Fan 1,000.00 1,200.00 1,100.00

WE HEREBY CERTIFY THAT WE open the bids/ canvass for the above listed supplies/ materials: the abstract of which appears above. The items, prices, timeand date are individuals.
We hereby certify the correctness of the foregoing abstract and that all bids/ canvass submitted and initiated by us.

PREPARED BY: APPROVED BY:

ENGR. STEVE NICHOLS S. DIONALDO HON. SUSANO ANTONIO D. RUPERTO, III

Municipal Engineer Municipal Mayor
 Republic of the Philippines
Province of Negros Oriental
MUNICIPALITY OF TAYASAN
Office of the Municipal Engineer

PURCHASE ORDER
LGU - TAYASAN
Agency/ Procuring Entity

Supplier : MMC HARDWARE AND CONSTRUCTION SUPPLY P.O No. :

Address : Poblacion, Tayasan, Negros Oriental Date :
E - mail Add : Mode of :
Telephone No. : Procurement : shopping
TIN NO. : Location :

Please furnish this office the following articles subject to the terms and condition herein :
Place of Delivery : Delivery Term :
Date of Delivery : Payment Term :

ITEM UNIT AMOUNT

NO. UNIT DESCRIPTION QNTY. COST in ( PhP )
1 bags Cement 3 294.00 882.00
2 pcs 60x60 Tiles 10 250.00 2,500.00
3 shts 3/4" x 4" x 8 Tiles 3 3,510.00 10,530.00
4 lngth 2" PVC Pipe S1000 12 312.00 3,744.00
5 kl #2 CWN 1 86.00 86.00
6 gals Gloss Latex Paint (White) 2 912.00 1,824.00
7 gal Putty Master 1 350.00 350.00
8 pcs #4 PVC Elbow 3 150.00 450.00
9 lngth #4 PVC 1 300.00 300.00
10 set All Purpose Epoxy 1 760.00 796.00
11 pcs Cabinet/Drawer Handle 9 45.00 405.00
12 pcs #2 PVC Elbow 12 39.00 468.00
13 pcs 1/2" Ø Angle Valve 2 138.00 276.00
14 pcs Kitchen Sink 2 624.00 1,248.00
15 pcs 1/2" Ø PVC Threaded Elbow 4 25.00 100.00
16 pcs 1/2" Ø PVC Plain Elbow 8 17.00 136.00
17 pcs 1/2" Ø Long Neck Faucet 2 408.00 816.00
18 pcs 1/2" Ø P.E Tee (CTS) 2 123.00 246.00
19 pcs 1/2" Ø P.E Male Adaptor (CTS) 4 54.00 216.00
20 can Solvent Cement 1/4 Liter 1 180.00 180.00
21 rolls Tapelon tape (Big) 2 48.00 96.00
22 pcs 1/2" Ø x 3/8 Ø x 18 Flexible Hose 2 168.00 336.00
23 Unit Exhaust Fan 1 1,000.00 1,000.00
Total 26,985.00
( Total Amount in Words ) Twenty Six Thousand Nine Hundred eighty Five Pesos Only

In case of failure to make the full delivery within the time specified above, a penalty of one tenth
( 1/10 ) of one ( 1 ) percent for every day of delay shall be imposed.

Conformned :

MMC HARDWARE AND CONSTRUCTION SUPPLY

Signature Over Printed Name of Supplier

Approved by :
Date
HON. SUSANO ANTONIO D. RUPERTO, III

Municipal Mayor

Funds Available : ALOBS NO. :

AMOUNT :

Chief Accountant
 ACCEPTANCE AND INSPECTION REPORT
MUNICIPALITY OF TAYASAN
LGU

Supplier : MMC Hardware and Construction Supplies AIR No.

P.O. No. : Date : Invoice No.
Requisitioning Office/ Department : Engineering

ITEM
UNIT ITEM DESCRIPTION QTY.
NO.
1 bags Cement 3
2 pcs 60x60 Tiles 10
3 shts 3/4" x 4" x 8 Tiles 3
4 lngth 2" PVC Pipe S1000 12
5 kl #2 CWN 1
6 gals Gloss Latex Paint (White) 2
7 gal Putty Master 1
8 pcs #4 PVC Elbow 3
9 lngth #4 PVC 1
10 set All Purpose Epoxy 1
11 pcs Cabinet/Drawer Handle 9
12 pcs #2 PVC Elbow 12
13 pcs 1/2" Ø Angle Valve 2
14 pcs Kitchen Sink 2
15 pcs 1/2" Ø PVC Threaded Elbow 4
16 pcs 1/2" Ø PVC Plain Elbow 8
17 pcs 1/2" Ø Long Neck Faucet 2
18 pcs 1/2" Ø P.E Tee (CTS) 2
19 pcs 1/2" Ø P.E Male Adaptor (CTS) 4
20 can Solvent Cement 1/4 Liter 1
21 rolls Tapelon tape (Big) 2
22 pcs 1/2" Ø x 3/8 Ø x 18 Flexible Hose 2
23 Unit Exhaust Fan 1
ACCEPTANCE INSPECTION

Date Received : Date Inspected :

Complete Inspected, verefied and found

OK as to quantity and

Partial Specification

ENGR. HARLAN C. ABSIN MANOLITO A. ARBOLY

Supply Officer II Utility Foreman
LGU - Tayasan Project Number
Municipality of Tayasan Name of the Project
Province of Negros Oriental Location of the Project

Standard Form Number : SF - GOOD - 61

Revised on : May 24 2006

REQUISITION AND ISSUE SLIP

LGU - TAYASAN
Agency/ Procuring Entity

Division/ Branch/ Unit : Engineering Responsibility Center : RIS No.

Office : Code : SAI No.

REQUISITION ISSUANCE
STOCK
UNIT DESCRIPTION QTY. QTY. REMARKS
NO.
1 bags Cement 3 3
2 pcs 60x60 Tiles 10 10
3 shts 3/4" x 4" x 8 Tiles 3 3
4 lngth 2" PVC Pipe S1000 12 12
5 kl #2 CWN 1 1
6 gals Gloss Latex Paint (White) 2 2
7 gal Putty Master 1 1
8 pcs #4 PVC Elbow 3 3
9 lngth #4 PVC 1 1
10 set All Purpose Epoxy 1 1
11 pcs Cabinet/Drawer Handle 9 9
12 pcs #2 PVC Elbow 12 12
13 pcs 1/2" Ø Angle Valve 2 2
14 pcs Kitchen Sink 2 2
15 pcs 1/2" Ø PVC Threaded Elbow 4 4
16 pcs 1/2" Ø PVC Plain Elbow 8 8
17 pcs 1/2" Ø Long Neck Faucet 2 2
18 pcs 1/2" Ø P.E Tee (CTS) 2 2
19 pcs 1/2" Ø P.E Male Adaptor (CTS) 4 4
20 can Solvent Cement 1/4 Liter 1 1
21 rolls Tapelon tape (Big) 2 2
22 pcs 1/2" Ø x 3/8 Ø x 18 Flexible Hose 2 2
23 Unit Exhaust Fan 1 1
Requested by : Approved by : Issued by : Received by :
Signature

Printed Name STEVE NICHOLS S. DIONALDO HON. SUSANO L. RUPERTO JR. NOLI B. GABOTERO JOEY A. VILLAMOR
Designation Municipal Engineer Municipal Mayor Mun. Treasurer Mechanic II
Date
 Republic of the Philippines
Province of Negros Oriental
MUNICIPALITY OF TAYASAN
Office of the Municipal Engineer

POST REPAIR INSPECTION REPORT

Date

This is to certify that the Municipal Vehicle Bighorn with plate number SGW-410,
is now functioning properly.

Qty. Unit Item Description/Findings Remarks

2 pcs. Rad. Hose Upper/Lower Replaced
1 pc. Brake Disc Pad VA-8184k Replaced
2 pcs. Front Wheel Oil Seal Replaced
2 pcs. Flexible Brake Hose Replaced
2 pcs. Shock Absorber Replaced
1 pc. Grease Gun Purchased
1 pc. Hydraulic Jack Replaced
20 pcs. Rubber Bushing Replaced
2 sets Tie Rod End Replaced
1 set Ball Joint Upper Replaced
1 set Ball Joint Lower Replaced
2 pcs. Stabilizer Bushing Replaced
1 pc. Steering Pump Assy. Replaced
1 pc. Stabilizer Bushing Link Replaced
4 pcs. Upper Arm Bushing Replaced

This is to certify further that the above - mentioned vehicle is in operational.

Certified by: Noted by:

JOEY VILLAMOR STEVE NICHOLS S. DIONALDO

Mechanic II Municipal Engineer

Approved by:

HON. SUSANO L. RUPERTO, JR.

Municipal Mayor
 REPORT OF WASTE MATERIALS
Office/Agency: MO Place of Source: Date:

RECORD OF SALES
Item Qnty. Unit Name & Description
O.R. No. Amount
1 2 pcs. Rad. Hose Upper/Lower
2 1 pc. Brake Disc Pad VA-8184k
3 2 pcs. Front Wheel Oil Seal
4 2 pcs. Flexible Brake Hose
5 2 pcs. Shock Absorber
6 1 pc. Hydraulic Jack
7 20 pcs. Rubber Bushing
8 2 sets Tie Rod End
9 1 set Ball Joint Upper
10 1 set Ball Joint Lower
11 2 pcs. Stabilizer Bushing
12 1 pc. Steering Pump Assy.
13 1 pc. Stabilizer Bushing Link
14 4 pcs. Upper Arm Bushing

TOTAL
NOLI B. GABOTERO
FIRST INDORSEMENT

Date
Respectfully forwarded to __
______________________________ for appropriate section

Agency Head/ Authorized Representative: Position:

CERTIFICATE OF INSPECTOR
I hereby certify that this property was disposed of as follows:
Item ____________________________Destroyed
Item ____________________________Sold at private sale
Item ____________________________Sold at public suction
Item ____________________________Transferred without cost
Item ____________________________Continued in service

Property Inspector: (Name & Signature) Witness to disposition:

SECOND INDORSEMENT

Date

Respectfully returned to the ___________________________________________________ hereby

approving the action of the property inspector as contained in his foregoing certificate.

Auditor: (Name & Signature Designation: