Appendix 58

LIQUIDATION REPORT No.:

Department of Education, Schools Division of Roxas City Date:
BANICA ELEMENTARY SCHOOL Responsibility
Center:

Cluster 3 Code:
Bgy. Banica, Roxas Cty
FOR THE MONTH OF OCTOBER 2019
PARTICULARS DATE OR. NO. AMOUNT

Photocopy of RUNT materials 08/19/2019 8117 727.50

CDS(LBP) - 3342101452
Landbank Service Fee (Registration) 08/28/2019 50.00
(Annex A)
Transportation Expense - LBP 08/28/2019 Annex A 20.00
Purified Water for Ofice Use 09/13/2019 4612 75.00
Materials for Pole of Volleyball Net for Sector Meet/Playday 09/17/2019 12848 160.00
Volleyball Net for Sector Meet/Playday 09/17/2019 0006102 600.00
Ball for Soccer 2pcs 09/17/2019 933689 1,298.00
Transportation Expense -Deliver F137 to CRAAHS/Capiz
09/18/2019 Annex A 30.00
NHS
Padlock for Library Use 09/19/2019 014022 42.00
Office Supply - Long Bond Paper (Office) 09/20/2019 0000493917 181.00
Office Supply - Guidance Office Use 09/20/2019 58526 185.00
Materials for Painting Of Principal's Office 09/23/2019 121844 256.75
Office Supplies - Ink Epson L360 Black 09/25/2019 11440 245.00
Purified Water for Ofice Use 09/25/2019 4824 100.00
Janitorial Expense 09/30/2019 General Payroll 4,000.00
Reimbursement of Various Travel Expense ( Alex B. Borda
3/10/2019 General Payroll 30,866.60
et.al)
Meals during Teahers Day Celebration 4/10/2019 004136 7,350.00
Office Supply - Ink Epson L360 Magenta & Yellow 10/07/2019 11672 550.00
Office Supply - Ink Epson L360 Black & Cyan 10/07/2019 11671 520.00
Transportation Expense - Ink 10/07/2019 Annex A 20.00
Materials for Bestank additional tank installation PVC Male
10/07/2019 661706 233.00
Adaptor 1",PVC Female Adaptor 1",etc.
Materials for Bestank additional tank installation PVC Elbow
10/07/2019 455.50
1" plain,PVC Male adaptor 1",PVC tee 1" plain,etc. 644374
Materials for Bestank additional tank installation PE Pipe
10/07/2019 644373 1,169.13
1/2,GI Coupling 1/2HD,etc.
Materials for Painting of Bracket for New Bestank Paint Brush
10/08/2019 079993 120.00
4"
Materials for concreting of Floor Near the Stage (stagnant
10/08/2019 033 1,800.00
water) Stone
Materials for Bestank additional tank installation 10/08/2019 664965 162.00
Materials for concreting of Floor Near the Stage (stagnant
10/08/2019 034 600.00
water) Sand
Welding rod 10/09/2019 080149 130.00
Registration Fee for Division Mancom DM#228 10/11/2019 4911240 1,000.00
Tarpaulin for DSPC Winners 10/11/2019 1906 420.00
Transportation Expense to photocopy additional testpapers 10/11/2019 Annex A 20.00
Materials for concreting of Floor Near the Stage (stagnant
10/14/2019 122319 1,784.00
water) Grand Cement
Materials for concreting of Floor Near the Stage (stagnant
10/14/2019 037 1,800.00
water) Gravel
Materials for concreting of Floor Near the Stage (stagnant
10/14/2019 038 1,800.00
water) Gravel & Sand

Augmentation to District Meet Expenses 10/14/2019 RER

4 bags Grand cement for concreting of floor near the stage 10/15/2019 122347 892.00
Postage for mailing of form 137 10/15/2019 02029405 72.00
Transportation Expense to photocopy additional testpapers 10/15/2019 Annex A 20.00
Cement and tie wire for installation of septic tank cover
10/16/2019 122404 1,184.00
(Rehabilitation)
Hollow blocks for installation of septic tank cover
10/16/2019 0383 600.00
(Rehabilitation)
Apog for installation of septic tank cover (Rehabilitation) 10/16/2019 Annex A 80.00
Electricity Expense (October) 10/16/2019 2220529 19,718.91
Board paper for certificates of INSET 10/16/2019 060981 69.90
License frame for certificates of INSET 10/16/2019 18554 69.00
Water Expense (October) 10/18/2019 5421911 5,132.00
Internet Subscription Expense 10/18/2019 91493585 2,437.43
Bamboo for installation of septic tank cover (Rehabilitation) 10/18/2019 RER 350.00
Tie wire and cement for installation of septic tank cover
10/18/2019 122460 1,917.00
(Rehabilitation)
Hollow blocks for installation of septic tank cover
10/18/2019 0384 204.00
(Rehabilitation)
Concrete nails for installation of septic tank cover
10/18/2019 122497 28.25
(Rehabilitation)
Fare & Hauling of Hollow blocks,tie rod and cement for
10/18/2019 Annex A 150.00
rehabilitation of Septic Tank Cover
Jeep Rental during DSPC 2019 for 2days 10/20/2019 RER 1,000.00
Labor for Installation of Additional Bestank 8/10/2019 General Payroll 1,800.00
Labor for Installation of CR drainage in the Office 10/10/2019 General Payroll 900.00
Labor for Concreting of Floor Near the Stage (stagnant water) 10/15/2019 General Payroll 2,250.00
2 bags cement fot 10/21/2019 122518 436.00
Meals during INSET for Teachers (2 days) 10/22/2019 1867 29,400.00
A4 bond paper for athletes 10/23/2019 1415 190.00
Meals during last day of INSET for teachers 10/23/2019 5787

TOTAL 127,670.97

Total Amount Spent ---------------------------------Php 127,670.97

Amount of Cash Advance Per DV No. ------------------ 129,000.00
Amount Refunded Per OR No. -------------------------- 1,329.03
Amount to be reimbursed -------------------------------

C. Certified supporting
A. Certified Correctness of the above data: B. Certified Cash Advance duly accomplished : documents complete and
proper :

ALEX B. BORDA DR. NERISSA A. RESENTE ROSANA M. AURELLA

Principal IV Chief Education Supervisor, SGOD Accountant III
 Department of Education Department of Education
Region VI - Western Visayas Region VI - Western Visayas
Schools Division of Roxas City Schools Division of Roxas City
Brgy. Banica Roxas City Brgy. Banica Roxas City
PRESIDENT MANUEL A. ROXAS MEMORIAL INTEGRATED SCHOOL - SPED PRESIDENT MANUEL A. ROXAS MEMORIAL INTEGRATED SCHOOL - SPED

ANNEX A ANNEX A
CERTIFICATION OF EXPENSES NOT REQUIRING RECEIPTS CERTIFICATION OF EXPENSES NOT REQUIRING RECEIPTS
Pursuant to COA Circular No. 2017-001- dated June 19, 2017 Pursuant to COA Circular No. 2017-001- dated June 19, 2017

Name of Employee Employee No. Name of Employee Employee No.

Office President Manuel A. Roxas Memorial Integrated School - SPED Office President Manuel A. Roxas Memorial Integrated School - SPED
Division Roxas City Division Division Roxas City Division
Date of Travel Date of Travel
Particulars Amount ( ₱ ) Particulars Amount ( ₱ )

TOTAL TOTAL
Purpose Purpose

I hereby certify that the above expenses are incurred as they are necessary for the above cited purpose that above I hereby certify that the above expenses are incurred as they are necessary for the above cited purpose that above
goods and services were acquired from parties not issuing receipts. And that I am fully aware that wilful falsification goods and services were acquired from parties not issuing receipts. And that I am fully aware that wilful falsification
of statements is punishable by law. of statements is punishable by law.
Certified Correct: Noted By: Certified Correct: Noted By:

Signature: Signature:
Printed Name: MARY JOY G. GUTIEREZ Printed Name: MARY JOY G. GUTIEREZ
Principal II Principal II
Date Date Date Date

Department of Education Department of Education

Region VI - Western Visayas Region VI - Western Visayas
Schools Division of Roxas City Schools Division of Roxas City
Brgy. Banica Roxas City Brgy. Banica Roxas City
PRESIDENT MANUEL A. ROXAS MEMORIAL INTEGRATED SCHOOL - SPED PRESIDENT MANUEL A. ROXAS MEMORIAL INTEGRATED SCHOOL - SPED

ANNEX A ANNEX A
CERTIFICATION OF EXPENSES NOT REQUIRING RECEIPTS CERTIFICATION OF EXPENSES NOT REQUIRING RECEIPTS
Pursuant to COA Circular No. 2017-001- dated June 19, 2017 Pursuant to COA Circular No. 2017-001- dated June 19, 2017

Name of Employee Employee No. Name of Employee Employee No.

Office President Manuel A. Roxas Memorial Integrated School - SPED Office President Manuel A. Roxas Memorial Integrated School - SPED
Division Roxas City Division Division Roxas City Division
Date of Travel Date of Travel
Particulars Amount ( ₱ ) Particulars Amount ( ₱ )

TOTAL TOTAL
Purpose Purpose

I hereby certify that the above expenses are incurred as they are necessary for the above cited purpose that above I hereby certify that the above expenses are incurred as they are necessary for the above cited purpose that above
goods and services were acquired from parties not issuing receipts. And that I am fully aware that wilful falsification goods and services were acquired from parties not issuing receipts. And that I am fully aware that wilful falsification
of statements is punishable by law. of statements is punishable by law.
Certified Correct: Noted By: Certified Correct: Noted By:
Signature: Signature:
Printed Name: MARY JOY G. GUTIEREZ Printed Name: MARY JOY G. GUTIEREZ
Principal II Principal II
Date Date Date Date
 Department of Education
Region VI - Western Visayas
Schools Division of Roxas City
Brgy. Banica Roxas City
PRESIDENT MANUEL A. ROXAS MEMORIAL INTEGRATED SCHOOL - SPED

ANNEX A
CERTIFICATION OF EXPENSES NOT REQUIRING RECEIPTS
Pursuant to COA Circular No. 2017-001- dated June 19, 2017
Name of Employee Employee No.
Office President Manuel A. Roxas Memorial Integrated School
Division Roxas City Division
Date of Travel
Particulars Amount ( ₱ )
From To

TOTAL
Purpose

I hereby certify that the above expenses are incurred as they are necessary for the above cited purpose that above
goods and services were acquired from parties not issuing receipts. And that I am fully aware that wilful falsification
of statements is punishable by law.
Certified Correct: Noted By:
Signature:
Printed Name: JOSE RICHARD C. LACHICA
Principal II
Date Date