Republic of Philippines Departm^t of Health

DR. JOSE RIZAL li^MORIAL HOSPITAL Lawaan, Dapitan City

PURCHASE ORDER

Dr. Jose Rizal IVIemorial Hospital

irarpifv’

Entity Name

Supplier: INDUSTRIA PHILIPPINES AND GLOBAL CORP. P.O. No. 2021-06-122[Address: 158 Orchids St. Pingkian Vill. 3, Pasong Tamo, Date: June 09, 2021 |

1 Quezon City, Philippines 1107 Mode of Procurement: NEGOTIATED |[TIN "Small Value Procurement" |iGentlemen:

Please furnish this Office the following articles subject to the terms and conditions contained herein:Page 1 |

1 Place of Delivery: Delivery Term: 30 - Calendar days |

Date of Deiivery: Payment Term:

[(Total Amount in Words ]

case 0, .allure .0 ™ke .he full delivery rylthln .he .Ime specified abo.e, a penal,, e, one-,en.h (,n0) o, one peroen, for every

day of delay shall be imposed on the undelivered item/s.

Very truly yours,

NIAI^^flNNA C^ViRAY-PArInAS^IwS, FPAFP, WIHA, CSEE*^.Pc

FPAFP, WIHA,Medical Center Chief 1 ^

ICohforme:

Signature over Printed Name of Supplier

Date

iFund Cluster; Funds Available;

QUIW1|M^PIlar

AccoJitlJent

Effectivity Date: September 17, 2020

ORS/BURS No.: --------Date of the ORS/BURS: ^ Q jy|y| ------

Amount:________550> C0° ---------- ---------

DJRMH-HOPSS-PROC-POL-01-Form2 Rev.O