CHASE ORDER Supplier : Z~ ~PEB & SIATIONER Address )_1 Tel.lFax : RIVNo. Date Please deliver to this Office within seven(7) working days from receipt hereof the following: -16 Purchase Order No. Date Terms of Payment Mode of Procurement 6-167 esday, April 06, 2016 ..; Local Shopping 0. QTY UNIT ITEM DESCRIPTION UtlllT PRICE TOTAL AMOUNT 1 / .... ~. 'T" ~T P T,,~;~~ -.:,' 'p~' ' Table :.): SG 18 to 23 with mobile V 35,000.0 D 70,000.00 L. ./ J r 1 l\A'~;~ ...100!' T ."~h"oc,J"llsinr· at least 30mm thick table ..I 10M Ull]:;, hr a-d with tic-hter zrav HPL finish, post T v r' 1 Frr.nt ,,;1'1-. dark -rrav pvr /rubber edge sidings and '" with adiustable g!id-· footings and 20mm thick rnodestv oanel, Minimum sill ,:,)Omm Wx700mm Dx750mm r.r 0;...10 t"hlp Attached to "la r: table using 30mm thick table ..I lp,~o Ull]:;, h~n~...1 with lizhter zrav HPL finish with three " ~, ' '..l ' ",j overall dimension of Hx400mmW, post c 1 FY;''1t "n~ back ~~ith dark gray PVC/rubber edge sidings, '" / "r1i, stab.c olider footings and 20mm thick modesty panel. Minimum siz e: 900mmWx,i'i )mmDx750mmH L-TYPE, VE 439-091 XXXXXXXX" XXXXXXXXXXXXXXXNOTHlNG FOLLuw xxx " F: f CE!VEI' ~ .. ~. .. . JiIV If/let IPo - :' PR()'AP.M~i('~::':;'.'~;~ :!nlf ~ . ~ RECEiVED b~~~. ' '"/lA ./v 70,000.00 n_~:"'n' -;:;;:0 " r" ' " TOTAL Conditions. 1. The Agency shall impose penalty in an amount equivalent to 1/10 of one (1) percent of the total value of undelivered order for each day of the delay as liquidated damages; 2. Render your bills in triplicate copies including the original; 3. If~the date ;)f the receipt of the Purchase Order by the supplier is not indicated, it shall be deemed received on the 10th working day from the date of the approval of the Purchase Order,and 4. For imported items. IMPORTATION DOCUMENTS specifically showing the condition. serial numbers of the equipment purchased, and tax recei.Dt.s,should be submitted bythe supplier. SORAYAH Very truly yours,' ~ s;:. ~~ LANODEN A. MACARIMB hief, Management Services Division jro,cPA,cJ Funds available In the amo~.Jntbf: P 10, 000. Q.A) ..••.. .s.. ,:, " resident ~ Name & Signature of Received this P.O. Copy on: _ " by: _ Conform:

Z~ CHASE ORDER - Philippine Health Insurance Corporation · CHASE ORDER Supplier : Z~ ~PEB &SIATIONER Address)_1 Tel.lFax : RIVNo. Date PleasedelivertothisOfficewithin seven(7) working

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CHASE ORDERSupplier :Z~~PEB & SIATIONERAddress )_1Tel.lFax :RIVNo.Date

Please deliver to this Office within seven(7) working days from receipt hereof the following:

-16

Purchase Order No.DateTerms of PaymentMode of Procurement

6-167

esday, April 06, 2016..; Local Shopping

QTY UNIT ITEM DESCRIPTION UtlllT PRICE TOTAL AMOUNT 1

/ ....~. 'T" ~T P T,,~;~~ -.:,' 'p~' ' Table :.): SG 18 to 23 with mobile V 35,000.0 D 70,000.00L.

./J

r1 l\A'~;~ ...100!' T ."~h"oc,J"llsinr· at least 30mm thick table i

..I 10M Ull]:;, hr a-d with tic-hter zrav HPL finish, postI

T v

r '1 Frr.nt ,,;1'1-. dark -rrav pvr /rubber edge sidings and

'"with adiustable g!id-· footings and 20mm thick

rnodestv oanel, Minimum sill ,:,)Omm Wx700mm Dx750mm

r.r 0;...10 t"hlp Attached to "la r: table using 30mm thick table

..I lp,~o Ull]:;, h~n~...1 with lizhter zrav HPL finish with three" ~, ''..l ' ",j overall dimension of Hx400mmW, postc

1 FY;''1t "n~ back ~~ith dark gray PVC/rubber edge sidings,'" / "r1i, stab.c olider footings and 20mm thick modesty panel.Minimum siz e: 900mmWx,i'i )mmDx750mmH

L-TYPE, VE 439-091XXXXXXXX" XXXXXXXXXXXXXXXNOTHlNG FOLLuw xxx

F: f CE!VEI'~..~. .. .JiIV If/let IPo - :' PR()'AP.M~i('~::':;'.'~;~:!nlf ~.

~ RECEiVED b~~~. ' '"/lA ./v 70,000.00n_~:"'n' -;:;;:0 " r" '"

TOTALConditions.1. The Agency shall impose penalty in an amount equivalent to 1/10 of one (1) percent of the total value of undelivered order

for each day of the delay as liquidated damages;2. Render your bills in triplicate copies including the original;3. If~the date ;)f the receipt of the Purchase Order by the supplier is not indicated, it shall be deemed received on the 10thworking day from the date of the approval of the Purchase Order,and

4. For imported items. IMPORTATION DOCUMENTS specifically showing the condition. serial numbers of the equipmentpurchased, and tax recei.Dt.s,should be submitted by the supplier.

SORAYAH

Very truly yours,'

~ s;:. ~~tLANODEN A. MACARIMBhief, Management Services Division

jro,cPA,cJ

Funds available In the amo~.Jntbf: P 10, 000. Q.A)

..••...s..,:,

"resident ~

Name & Signature of

Received this P.O. Copy on: _" by: _ Conform: