Canvass Forms

7/24/2019 Canvass Forms

1/19

Office of the Barangay Sub-Project Management CommitteeBarangay Bagacay

Muncipality of DauinProvince Negros Oriental

Construction of Barangay Health Station

To : C.F. Ref . # BA ! "" A$$ress : DateTel. No. :

Pac%age 1: Hardware&te' No. Description (uantity )nit )nit Price A'ount

Materials:

Nylon String 2.00 kg

* Anti-Termite (e.g. solignum, ) 5.00 gal

+ 1/4" 1/4" ! #lasti$ S$reen 2.00 meter

, 1/4 t%k. 4 & 'r inary #ly oo 15.00 s%ts

- 1/4" 4 & *arine #ly oo 2+.00 S%ts.

5 N 4.00 gs.

/ 4 Nails 1+.00 kgs

0 ! N 1+.00 gs.

1 2 N 10.00 kgs.

" 1 Nails 5.00 kgs

1 inis%ing Nails 2.00 gs.

* 1/2 " Nails &.00 kg

+ #ortlan ement Ty e !!1.00 3ags

, e ement ( S 6ans$o or u7i8alent) 19.00 kilos

- Soil #oisoning *aterials 51.00 $u.m.

12mm ia. : ;" *a$%ine 3olt / not an as%er 14.00 #$s.

/ 12mm ia. : 9m, lain roun


2/19


+" 4" 4" # loor @rain 1.00 set

+ 4" !.0m ia. # #i e serries 1000 !.00 lengt%

+* 4" ia. : 45D # 3en El


3/19


/ 10 atts $om a$t =loures$ent 6am !.00 set

// 2 >ang S it$% it% #late 2.00 $

/0 1 >ang S it$t% / #late 4.00 $

/1 @u le on8enien$e 'utlet 5.00 $

0" 6ig%ting 'utlet ( 4" #or$elain e$e ta$le) ;.00 $

0 emale A a tor 5.00 $0* ? meter / 3ase 1.00 unit

0+ Entran$e a 1" ia. 5.00 $

0, 1.00 set

Total P4p

, $MS O# P .M !,

* /0" $. P $0O*

Canvasseres an$ ot4er inci$ental e>penses. +. Price 3uote$ 'ust 5e fi>e$ for - calen$ar $ays.

,. Cost of $elivery: 888?88 to inclu$e 8888888 not to inclu$e-. A2ar$ s4all 5e 'a$e: 888888 on per ite' 5asis 88?88 on per pac%age 5asis

B=PMC C4airperson

Canvass =u5'itte$ 5y:

=ignature over Printe$ Na'eO2ner?Manager Date :

#anel 3oar (4-


4/19

BS,$ C, O# C !" SSConstruction of Barangay Health Station

%age 1: Hardware

m !o2 *escri3tion 'ty 4nit

=upplier =upplier * =upplier + =upplier , =upp

)nit Price Total )nit Price Total )nit Price Total )nit Price Total )nit Price

Materials:

Nylon =tring *."" %g

* Anti!Ter'ite 9e.g. solignu'; -."" gal

+ ?,@ > ?,@ > +< Plastic =creen *."" 'eter

, ?, t4%. ,0< Or$inary Ply2oo$ -."" s4ts

- ?,@ > ,< > 0< Marine Ply2oo$ *1."" =4ts.

# - C N ,."" gs.

/ # , C Nails 1."" %gs

0 # + C N 1."" gs.

1 # * C N "."" %gs.

" # C Nails - ."" %gs

# Finis4ing Nails *."" gs.

* ?* @ C Nails 0 ."" %g

+ Portlan$ Ce'ent Type & ++ ."" Bags

, ."" %ilos

- =oil Poisoning Materials - ."" cu.'.

Re$ Ce'ent 9)= ansco oru3ivalent


5/19


=upplier =upplier * =upplier + =upplier , =u


,."" Pcs.

/ *+."" lengt4s

0 "' ' $ia. > ."' R=B +*"."" engt4

1 *'' $ia. > ."' R=B *"."" engt4

*" ' ' $ia. > ."' R=B -."" engt4

* # .&. Tie ire .-" rolls

** # .&. Tie ire -."" gs.

*+ ac%sa2 Bla$e "."" Pcs.

*, ."" set

*- ."" set

* oc%set 94ig4 3uality $oor%no5 ,."" set

*/ 9 +! ?*@ > +! ?*@ loose pin 4inges *."" pcs

*0 *"."" engt4

&E. P )MB&N OR = ! !

*1 Flus4 Type Toilet Bo2l ."" unit

+" ,@ > ,@ P C Floor Drain ."" set

+ ,@ > +."' $ia. P Pipe serries """ +."" lengt4

+* ,@ $ia. E ,-G P C Ben$ Hl5o2 *."" pc

++ *@ $ia. E 1"G P C Ben$ Hl5o2 ."" pc

+, ,@ $ia. E 1"G P C Ben$ Hl5o2 *."" pc

*'' $ia. E /@ Mac4ine Bolt 2? notan$ 2as4er

*'' $ia. E '; plain roun$5ar forgrills

D ! *; 9".0"' > *. "' Plastic9P CDoor 2? plastic 7a'5

avatory!closet!cover 2it4 4an$le Iinges attac4e$

@> *@>0< ar$i!=anipa 9 ar$ifle>!Boar$


6/19




+- *@ E +."' P Pipe ."" lengt4

+ ,@ $ia.> ,@ $ia. P C ye *."" pc

+/ ,@ $ia.P C Clean Out Plug ."" pc

+0 *@ > ,@ Tee ."" pc

+1 +@ > +."' $ia. P Pipe serries """ *."" lengt4

," *@ E +."' P Pipe serries """ *."" lengt4

, *@ $ia. E 1"G P C Ben$ Hl5o2 *."" pc

,* *@ $ia. P C P!Trap ."" pc

,+ +@ $ia. E ,-$eg. P C el5o2 +."" pc

,, =olvent Ce'ent ."" pint

,- ."" pc

, ?*@ > +."' pipe pvc "."" lengt4

,/ ?*@ $ia. ate valve ."" pc

,0 ?*@ Coupling P C "."" pc

,1 ?*@ 1" $eg. Ben$ el5o2 pvc /."" pc

-" ?*@ P C Tee ."" pc

- ?*@ fe'ale t4rea$e$ a$aptor *."" pc

-* ?*@ Faucet; 4ose5i5; 5rass *."" pc

-+ Teflon Tape +."" roll

-, =olvent Ce'ent ."" pint

-- ,@ > ,@ P C Tee +."" pc

itc4en =in%;9".,' > ". '; =ingleTa5; =tainless


7/19




- +@ $ia. > +."' P C Pipe 1."" lengt4

-/ +@ $ia. E 1" $eg. 5en$ P C Hl5o2 0."" pc

-0 =olvent Ce'ent ."" pint

E. T& H OR = ! !

-1 *+"."" pc

" *"."" pc

4ite ce'ent ? Tile rout "."" 5ags

* Tile Tri' > +' *"."" pc

At avatory: ! !

+ 0."" pc

, 4ite ce'ent ? Tile rout *."" %ls.

- Tile Tri' > +' +."" pc

E&. H HCTR&CA OR = ! !

*@ > ,@ )tility Bo>es Pvc *."" pcs.

/ ,@ > ,@ Juncton Bo>es P C /."" pcs.

0 +?,@ $ia. R=C Pipe ."" lengt4

1 =cre2 &nsulator ."" pc.

/" +.-' '* T =tran$e$ *."" 5o>

/ =ervice Drop ire "."" '

/* P C Cla'p "."" pc

0@ > 0@ laKe$ all Tiles 9 reen ore3uivalent colors

0@ > 0@ )nglaKe$ Floor Tiles 9 reenor e3uivalent colors

0@ > 0@ laKe$ all Tiles 9 reen ore3uivalent colors


8/19




/+ Fle>i5le tu5e +?,@ $ia 0"."" '

/, Hlectrical Tape 9Big +."" pc

/- Flourescent a'p; ," 2atts -."" assy

/ " 2atts co'pact flourescent a'p +."" set

// * ang =2itc4 2it4 Plate *."" pc

/0 ang =2itct4 2? Plate ,."" pc

/1 Duple> Convenience Outlet -."" pc

0" /."" pc

0 Fe'ale A$aptor - ."" pc

0* R 'eter 2? Base ."" unit

0+ Hntrance Cap # @ $ia. -."" pc

0, ."" set

,O, /

circle$ is?are t4e price?s evaluate$ to 5e t4e lo2est an$ co'plying 3uotation?s.*S !* 5 $*S COMM0,, Approve$ 5y:

BAC C4airperson Me'5er

Date Me'5er B=PMC

ig4ting Outlet 9 ,@ PorcelainReceptacle

Panel Boar$ 9,!5ranc4es to inclu$e

+"A Main; *"A po2er outlet; -Alig4ting outlet I -A spare


9/19

lier -

Total


10/19

lier -

Total


11/19

lier -

Total


12/19

lier -

Total


13/19

lier -

Total

ir


14/19

Office of t4e Barangay =u5!Pro7ect Manage'ent Co''itteeBarangay Bagacay; DA)&N; NH RO= ORH&NTA

P4$CH S O$* $Construction of Barangay Health Station

To: *umaguete 6enith Commercial P.O. No. : BA ! "" A$$ress Cor. Real?=an Jose =ts. Brgy. /; Du'aguete City Pac%age No. :Tel. No. :

Pac%age 1: Hardware

0tem !o2 *escri3tion 'uantity 4nit 4nit Price ,otal Price

Materials:

Nylon =tring *."" %g +""."" "".""* Anti!Ter'ite 9e.g. solignu'; -."" gal ;" -."" -;+*-.""+ ?,@ > ?,@ > +< Plastic =creen *."" 'eter 0-."" /"."", ?, t4%. ,0< Or$inary Ply2oo$ -."" s4ts +--."" -;+*-.""- ?,@ > ,< > 0< Marine Ply2oo$ *1."" =4ts. ,*-."" *;+*-.""

# - C N ,."" gs. ,0."" 1*.""/ # , C Nails 1."" %gs ,-."" 0--.""0 # + C N 1."" gs. , ."" 0/,.""1 # * C N "."" %gs. ,0."" ,0".""" # C Nails -."" %gs -*."" * ".""

# Finis4ing Nails *."" gs. -0."" .""* ?* @ C Nails 0."" %g -"."" ,"".""+ Portlan$ Ce'ent Type & ++ ."" Bags *-"."" 0*;/-"."", Re$ Ce'ent 9)= ansco or u3ivalent ."" %ilos /-."" ;*"".""- =oil Poisoning Materials - ."" cu.'. /-."" +;0*-.""

*'' $ia. E /@ Mac4ine Bolt 2? not an$ 2as4er ,."" Pcs. +-."" ,1".""/ *'' $ia. E '; plain roun$5ar for grills *+."" lengt4s *-"."" -;/-".""0 "'' $ia. > ."' R=B +*"."" engt4 +"."" , ; "".""1 *'' $ia. > ."' R=B *"."" engt4 0-."" +;/"".""

*" '' $ia. > ."' R=B -."" engt4 ++"."" * ;,-".""* # .&. Tie ire .-" rolls ;--"."" *;+*-.""** # .&. Tie ire -."" gs. -"."" /-".""*+ ac%sa2 Bla$e "."" Pcs. ,*."" ,*".""*, D ! *; 9".0"' > *. "' Plastic9P C Door 2? plastic 7a'5 ."" set ;0-"."" ;0-".""*- avatory!closet!cover 2it4 4an$le I inges attac4e$ ."" set ;-""."" ;-"".""* oc%set 94ig4 3uality $oor%no5 ,."" set 0-"."" +;,"".""*/ 9 +! ?*@ > +! ?*@ loose pin 4inges *."" pcs "."" ;+*".""*0 @> *@>0< ar$i!=anipa 9 ar$ifle>!Boar$ *"."" engt4 +,-."" ;1"".""

&E. P )MB&N OR = ! ! !*1 Flus4 Type Toilet Bo2l ."" unit +;*""."" +;*"".""+" ,@ > ,@ P C Floor Drain ."" set "."" ".""+ ,@ > +."' $ia. P Pipe serries """ +."" lengt4 -+-."" ; "-.""+* ,@ $ia. E ,-G P C Ben$ Hl5o2 *."" pc ,/.-" 1-.""++ *@ $ia. E 1"G P C Ben$ Hl5o2 ."" pc * .-" * .-"+, ,@ $ia. E 1"G P C Ben$ Hl5o2 *."" pc *.-" *-.""+- *@ E +."' P Pipe ."" lengt4 *"-."" *"-.""

&n accor$ance 2it4 your 3uotation $ate$ 88888888888888888888888 t4e =u5!Pro7ect Manage'ent Co''ittee of Barangay 88888888888888888 re3uests you to supply an$ $eliver t4e ite's $etaile$ 5elo2L


15/19


+ ,@ $ia.> ,@ $ia. P C ye *."" pc ""."" *"".""+/ ,@ $ia.P C Clean Out Plug ."" pc ,0.-" ,0.-"+0 *@ > ,@ Tee ."" pc 0/.-" 0/.-"+1 +@ > +."' $ia. P Pipe serries """ *."" lengt4 ,*"."" 0,".""," *@ E +."' P Pipe serries """ *."" lengt4 *"-."" , "."", *@ $ia. E 1"G P C Ben$ Hl5o2 *."" pc * .-" ,+."",* *@ $ia. P C P!Trap ."" pc -."" -."",+ +@ $ia. E ,-$eg. P C el5o2 +."" pc +"."" 1"."",, =olvent Ce'ent ."" pint /-."" /-."",- itc4en =in%;9".,' > ". '; =ingle Ta5; =tainless ."" pc /-"."" /-"."", ?*@ > +."' pipe pvc "."" lengt4 - ."" - "."",/ ?*@ $ia. ate valve ."" pc *""."" *""."",0 ?*@ Coupling P C "."" pc ,."" ,"."",1 ?*@ 1" $eg. Ben$ el5o2 pvc /."" pc ./- ,/.*--" ?*@ P C Tee ."" pc 1.*- 1.*-- ?*@ fe'ale t4rea$e$ a$aptor *."" pc /.0- -./"-* ?*@ Faucet; 4ose5i5; 5rass *."" pc +-."" */".""-+ Teflon Tape +."" roll +.-" ,".-"-, =olvent Ce'ent ."" pint /-."" /-.""-- ,@ > ,@ P C Tee +."" pc "."" ++".""- +@ $ia. > +." ' P C Pipe 1."" lengt4 ,*"."" +;/0".""-/ +@ $ia. E 1" $eg. 5en$ P C Hl5o2 0."" pc +/.-" /-.""-0 =olvent Ce'ent ."" pint /-."" /-.""

E. T& H OR = !-1 0@ > 0@ laKe$ all Tiles 9 reen or e3uivalent colors *+"."" pc -.-" +;- -.""

" 0@ > 0@ )nglaKe$ Floor Tiles 9 reen or e3uivalent colors *"."" pc /.-" *; ""."" 4ite ce'ent ? Tile rout "."" 5ags -."" -".""

* Tile Tri' > +' *"."" pc *0."" - "."" At avatory: !

+ 0@ > 0@ laKe$ all Tiles 9 reen or e3uivalent colors 0."" pc -.-" ;"-,."", 4ite ce'ent ? Tile rout *."" %ls. -."" +".""- Tile Tri' > +' +."" pc *0."" 0,.""

E&. H HCTR&CA OR = ! *@ > ,@ )tility Bo>es Pvc *."" pcs. **.-" */".""

/ ,@ > ,@ Juncton Bo>es P C /."" pcs. */.-" 1*.-"0 +?,@ $ia. R=C Pipe ."" lengt4 * -."" * -.""1 =cre2 &nsulator ."" pc. .-" .-"

/" + .-''* T =tran$e$ *."" 5o> +;*1-."" ;-1".""/ =ervice Drop ire "."" ' 1.-" ; /".""/* P C Cla'p "."" pc .-" -.""/+ Fle>i5le tu5e +?,@ $ia 0"."" ' 0.-" 0".""/, Hlectrical Tape 9Big +."" pc **.-" /.-"/- Flourescent a'p; ," 2atts - ."" assy *0"."" ;,"".""/ " 2atts co'pact flourescent a'p +."" set *-."" +/-.""// * ang =2itc4 2it4 Plate *."" pc 0/.-" /-.""/0 ang =2itct4 2? Plate ,."" pc --."" **".""/1 Duple> Convenience Outlet -."" pc 0/.-" ,+/.-"0" ig4ting Outlet 9 ,@ Porcelain Receptacle /."" pc +"."" * ".""0 Fe'ale A$aptor -."" pc *-."" *-.""0* R 'eter 2? Base ."" unit *; -"."" *; -".""0+ Hntrance Cap # @ $ia. -."" pc ,"."" *"".""

0, ."" set ;-""."" ;-"".""

,O, / MO4!, O# ,H0S P4$CH S O$* $ Ph3 789 ;


16/19


B=PMC reserves t4e rig4t to accept or re7ect any part of t4e ite's DH & HRHD 24ic4 are not in accor$ance 2it4 t4especifications.

ery truly yours;

!,O!0O 2 / MC4airperson; B=PMC Date

Fun$s availa5le:

M $"0! ,4 SO!

Brgy. Treasurer DateConfor'e:

9Na'e an$ =ignature of =upplier Date

&nspecte$?Teste$ 5y:Date

Receive$ 5y:Date

THRM= I COND&T&ON=: Deliver to 88888888888888888888 Barangay all on or 5efore 8888888888888888888. &n caseof $elivery; ? " of of t4e price of eac4 ite' not $elivere$ 2ill 5e $e$ucte$ fro' t4e a'ount $ue for eac4 $ay of $elay92ee%en$s an$ 4oli$ays inclu$e$ .Payment Mode is by: Check upon acceptance of completed delivery.


17/19

Page / of 1

0!SP C,0O! = CC P, !C $ PO$,

Office of the Barangay Sub-Project Management CommitteeBarangay Bagacay

Muncipality of DauinProvince Negros Oriental

=upplier :PO No. : &AR No. BA ! ""PO Date : &nvoice No. :Pac%age 1: Hardware &nvoice Date :

Re3uisitioning Office?Dept.: 8888888 A A &!C&D== MCC888888888888888888888888

T4is is to certify t4at t4e follo2ing ite's 2ere $uly c4ec%e$?inspecte$ in accor$ance 2it4 t4e specificationsL

0tem !o2 *escri3tion 'uantity 4nit 4nit-Cost ,otal 'uality

Materials:

Nylon =tring *."" %g

* Anti!Ter'ite 9e.g. solignu'; -."" gal

+ ?,@ > ?,@ > +< Plastic =creen *."" 'eter

, ?, t4%. ,0< Or$inary Ply2oo$ -."" s4ts

- ?,@ > ,< > 0< Marine Ply2oo$ *1."" =4ts.

# - C N ,."" gs.

/ # , C Nails 1."" %gs

0 # + C N 1."" gs.

1 # * C N "."" %gs.

" # C Nails -."" %gs

# Finis4ing Nails *."" gs.

* ?* @ C Nails 0."" %g

+ Portlan$ Ce'ent Type & ++ ."" Bags

, Re$ Ce'ent 9)= ansco or u3ivalent ."" %ilos

- =oil Poisoning Materials - ."" cu.'.

*'' $ia. E /@ Mac4ine Bolt 2? not an$ 2as4er ,."" Pcs.

/ *'' $ia. E '; plain roun$5ar for grills *+."" lengt4s

0 "'' $ia. > ."' R=B +*"."" engt4

1 *'' $ia. > ."' R=B *"."" engt4

*" '' $ia. > ."' R=B -."" engt4

* # .&. Tie ire .-" rolls

** # .&. Tie ire -."" gs.

*+ ac%sa2 Bla$e "."" Pcs.

*, D ! *; 9".0"' > *. "' Plastic9P C Door 2? plastic 7a'5 ."" set

*- avatory!closet!cover 2it4 4an$le I inges attac4e$ ."" set

* oc%set 94ig4 3uality $oor%no5 ,."" set

*/ 9 +! ?*@ > +! ?*@ loose pin 4inges *."" pcs

*0 @> *@>0< ar$i!=anipa 9 ar$ifle>!Boar$ *"."" engt4

&E. P )MB&N OR = ! !

*1 Flus4 Type Toilet Bo2l ."" unit

+" ,@ > ,@ P C Floor Drain ."" set

+ ,@ > +."' $ia. P Pipe serries """ +."" lengt4

+* ,@ $ia. E ,-G P C Ben$ Hl5o2 *."" pc


18/19

Page 0 of 1


++ *@ $ia. E 1"G P C Ben$ Hl5o2 ."" pc

+, ,@ $ia. E 1"G P C Ben$ Hl5o2 *."" pc

+- *@ E +."' P Pipe ."" lengt4

+ ,@ $ia.> ,@ $ia. P C ye *."" pc

+/ ,@ $ia.P C Clean Out Plug ."" pc

+0 *@ > ,@ Tee ."" pc

+1 +@ > +."' $ia. P Pipe serries """ *."" lengt4

," *@ E +."' P Pipe serries """ *."" lengt4

, *@ $ia. E 1"G P C Ben$ Hl5o2 *."" pc

,* *@ $ia. P C P!Trap ."" pc

,+ +@ $ia. E ,-$eg. P C el5o2 +."" pc

,, =olvent Ce'ent ."" pint

,- itc4en =in%;9".,' > ". '; =ingle Ta5; =tainless ."" pc

, ?*@ > +."' pipe pvc "."" lengt4

,/ ?*@ $ia. ate valve ."" pc

,0 ?*@ Coupling P C "."" pc

,1 ?*@ 1" $eg. Ben$ el5o2 pvc /."" pc

-" ?*@ P C Tee ."" pc

- ?*@ fe'ale t4rea$e$ a$aptor *."" pc

-* ?*@ Faucet; 4ose5i5; 5rass *."" pc

-+ Teflon Tape +."" roll

-, =olvent Ce'ent ."" pint

-- ,@ > ,@ P C Tee +."" pc

- +@ $ia. > +."' P C Pipe 1."" lengt4

-/ +@ $ia. E 1" $eg. 5en$ P C Hl5o2 0."" pc

-0 =olvent Ce'ent ."" pint

E. T& H OR = ! !

-1 0@ > 0@ laKe$ all Tiles 9 reen or e3uivalent colors *+"."" pc

" 0@ > 0@ )nglaKe$ Floor Tiles 9 reen or e3uivalent colors *"."" pc

4ite ce'ent ? Tile rout "."" 5ags

* Tile Tri' > +' *"."" pc

At avatory: ! !

+ 0@ > 0@ laKe$ all Tiles 9 reen or e3uivalent colors 0."" pc

, 4ite ce'ent ? Tile rout *."" %ls.

- Tile Tri' > +' +."" pcE&. H HCTR&CA OR = ! !

*@ > ,@ )tility Bo>es Pvc *."" pcs.

/ ,@ > ,@ Juncton Bo>es P C /."" pcs.

0 +?,@ $ia. R=C Pipe ."" lengt4

1 =cre2 &nsulator ."" pc.

/" +.-''* T =tran$e$ *."" 5o>

/ =ervice Drop ire "."" '

/* P C Cla'p "."" pc

/+ Fle>i5le tu5e +?,@ $ia 0"."" '

/, Hlectrical Tape 9Big +."" pc/- Flourescent a'p; ," 2atts -."" assy

/ " 2atts co'pact flourescent a'p +."" set


19/19


// * ang =2itc4 2it4 Plate *."" pc

/0 ang =2itct4 2? Plate ,."" pc

/1 Duple> Convenience Outlet -."" pc

0" ig4ting Outlet 9 ,@ Porcelain Receptacle /."" pc

0 Fe'ale A$aptor -."" pc

0* R 'eter 2? Base ."" unit

0+ Hntrance Cap # @ $ia. -."" pc

0, ."" set

TOTAINSPECTION ACCEPTANCE

Date &nspecte$:8888888888888 Date Receive$: 88888888888888888

&nspecte$; verifie$ an$ foun$ O Co'pleteas to 3uantity an$ specifications. Partial

!O / ,4 SO! >OC /.! *4S /

Monitoring I &nspection Tea' P&T

erifie$ 5y:

$O*SO! $2 SCO$ !,O!0O 2 / MDeputy Area Coor$intor B=PMC C4airperson

Panel Boar$ 9,!5ranc4es to inclu$e +"A Main; *"A po2eroutlet; -A lig4ting outlet I -A spare

Documents

Canvass Forms