I.Nt.; '{-cnrmcrciBi Ulcig., Francisco Duque SI. DaBurpan City

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pF{u.rpprNrHEALTHrNsuRAN([coRpoRATroN

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I.Nt.; '{-cnrmcrciBi Ulcig., Francisco Duque SI". l, apuac District DaBurpan City

POMM-P. 006 PURCHASE ORDER

Off |C[:/lJIPA,tl'l\4[Nl:ADhalNlSI

RAI1VI SICTiON , (;ENERAL SERVICI UNIT

Supplier: [Urff s rfiAllvs

PO

Unit 405 MCg, Diego Silang Village, Ususan, Taguig

Address: Tel. Fax Nrl.;

Terms of PaYment: COD Mode of Procurement: ShoPping

(02 ) 543-? 104

Supplier Registered with

i

425-852"L49-000 V

please deliver to this office

within 3-5 doys from receipt heresf the followinS;

ca

51

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to the last copy/subjectfor reptacennent if found

UNIT PRICT

ITEM DESCRIPT'ION

UNIT

QTY

TCIner Cartrldge-HP CF28l"A, (HF 81A1, black, printer MFP M630t{ / M5032 / M604DN / rVlOo+rU

Warranty: Up

xxxxxxxxxxxxxxxxxxxxx

N

for

HP

rwr

7,975.00

TOTAL AMOUNT

406,725,00

of h i n g Fo I o ws xxxxxxxxxxxxxxxxxxxx I

18,157:37

Less: VAT {5%/ 1.12}

defeetive^ Free service &

No. i 7-229

Date 1 917 12017

C.itY

3,631".47

{L%/1.L2\

rnaintenance PR No. 17-08l3-CI408 L.aser Jet Printer PURPOSE: CY 2017 Artnucll Procurclntc'r'ti 4t (;M Nc. PRO i-20;/ AA4i

2L,788,84

prev*ntive to.rll

Asierrorner: I i ila tc lr

TOTAL

ferms & Condilions:

1". tn

case

af faiiure to make the fuli delivery within the time specified above, a penalty of one-tenth (1/10) of one percent

384,936. I 6 (1%) for every day of delay

shall be imPosed.

2. 3.

4

equipment purchased, and tax receipts For inlported items, tMP0RTATION DOCUMENTS speciflcally showinS the condition, serial numbers of the should be submitted by the supplier. No Gift Policy (Revision 1} which is The conrracring parties undertake to comply with of{ice order No. 0018-2015 entitled "Reiteration of PhilHealth any gift from any person, group, decmcd incorporate inlo this Contract. No philHealth personnel shall solicit, demand, or accept, directly or indirectly, such gift is given in the course premises where work off the privale anytime, on or public soctor, al or judicial the entity, whether from association, or actions o{ directors or employees, oi ofiicial dutles or in connection with any transaclion which may affect the functions of thier ofl'ice or influence the or crerte 1,ho appearance of a conflict of interest phill"lcalth shall have the right to re.iecl and rcturn thQ itcms and cancel the correspondin8 Po if goods delivered are defective, incomplete or noncornpliant

5

as specification when

quoted.

shall demand full refund of tn casc ot returned/rejecrod items which cannot be replaced withln seven (7) calendar days from notlce, PhilHealth (3) days' calendar three "in check" "in or cash" paymenl made

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APPROVED:

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RlrU'r/t}l rty$ii' I

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OtC-OTFJCE OF THE REGIONAL VICE PRESIDENT .:

With

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xpense {-odt

liag,ct.

Received BY:

[ienr;rks,

Elien B Tradin

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-$eplgmber 1 1, 2017

Positron of Authorized Repre sentativc