Quisao Elementary School Tender

Description Rfq No. 2024-01-001 Request For Quotation The Department Of Education – Division Of Rizal – Quisao Elementary School Through Its Bids And Awards Committee, Will Undertake An Alternative Method Of Procurement Through Negotiated Procurement For The Item/s Stated Below, In Accordance With Section 52.1(b), Of The Revised Implementing Rules And Regulations (irr) Of Republic Act (ra) No. 9184 Or The Government Procurement Reform Act (gpra): Description Approved Budget For The Contract (abc) Inclusive Of Vat Supply And Delivery Of Various Supplies And Equipments To Quisao Elementary School For The First Quarter Of 2024. Php 269, 450.00 Delivery Date: Batch 1 -january 15 – 19, 2024; Batch 2 & 3, Every 1st Working Day Of The Month. Delivery Venue: Quisao Elementary School, Jp Rizal Street Quisao, Pililla, Rizal Award Of Contract Shall Be Made To The Bidder With The Lowest Quotation For The Subject Items Which Comply With The Minimum Technical Specifications And Other Terms And Conditions Stated Herein: Documents For Submission Technical Eligibility Requirements Valid Mayor’s Permit Valid Dti/sec Registration Valid Bir Certificate Of Registration & Proof Of Annual Bir Registration Renewal (bir Form 0605 – Payment Form) Price Quotation Form (prices Valid For 30 Days) Financial Eligibility Requirements Photocopy Of Passbook / Latest Audited Financial Statement Or Any Proof Of Availability Of Fund To Sustain The Contract Quotations/proposals And Documentary Requirements Shall Be Put Separately In 2 Sealed Envelopes (technical And Financial Respectively) And Must Be Delivered/submitted To The Address Below On Or Before January 10, 2024, 10:00 A.m. Late Proposals Shall Not Be Accepted. Incomplete Documents Will Be A Ground For Disqualification. Opening Of Quotations / Proposals And Post Qualification Shall Be On January 11, 2024, 3:00 P.m. At Quisao Elementary School, Jp Rizal Street Quisao, Pililla, Rizal. Bidders May Join The Bid Opening On The Date Stated Above. Please Quote Your Lowest Net Price To The Government, Taxes/ Vat Included, Stating The Terms Of Payment And The Shortest Time Of Delivery Of The Items Per Specifications Indicated Above And Furnishing Description, Brochures, Catalog And/or Literature, If Available. In Case You Are The Exclusive Manufacturer/distributor/dealer In The Locality, State So In Your Quotation. Note: Please Submit Quotation (hard Copy) And Required Documents In A Sealed Envelope To: Contact Person  : dr. Laarni G. Enriquez Bac - Secretariat Contact No.   : 09153667079 Place Of Submission : quisao Elementary School The Quisao Es – Bac Reserved The Right To Accept Or Reject Any Quotations / Proposals, And To Annul The Procurement Process And Reject All Quotations / Proposal At Any Time Prior To Contract Award, Without Thereby Incurring Any Liability To The Affected Bidder Or Bidders. Quisao Es – Bac Also Reserves The Right To Waive Any Required Formality In The Proposals Received And Select The Proposal Which It Determines To Be The Most Advantageous To The Government. For Further Information, Please Refer To: Dr. Laarni G. Enriquez Bac - Secretariat Quisao Elementary School Jp Rizal Street, National Road Brgy. Quisao, Pililla, Rizal Contact Nos. 09153667079 Email Address: Quisaoes.109459@deped.gov.ph Dr. Reynold M. Libato Chairperson, Bac Annex A Price Quotation Form Date: _____________________ Dr. Reynold M. Libato Bac Chairperson Quisao Elementary School Quisao, Pililla, Rizal Sir: After Having Carefully Read And Accepted The Terms And Conditions In The Request For Quotation, Hereunder Is Our Quotation/s For The Item/s As Follows: Quantity Item Description Unit Of Measure Unit Cost Total Amount   Batch 1 Delivery - January 2024   4 Printer-epson L121 Unit/s   25 Manipulative Mathematics Toys-fraction Cube Unit/s   25 Manipulative Mathematics Toys-calculation Beads Unit/s   25 Eva Foam Sheets-a4, Assorted Color, 10's Pack/s   25 Manipulative Mathematics Toys-multiplication Table, Wooden Unit/s   Batch 2 Delivery - February 2024   5 Ink - Epson - 003-4-color Set (black, Yellow, Cyan, Magenta) Set/s   130 Bond Paper-70gsm,500's,hardcopy,8 1/4" X 11 3/4" (a4) Ream/s   110 Bond Paper-70gsm,500's,hardcopy,8 1/2" X 13" (legal) Ream/s   20 File Magazine Box-single, Dark Blue, 15.5" X 9.5" X 4.5" Piece/s   30 Specialty Paper-200gsm, White, 100's, 8 1/4" X 11 3/4" (a4) - In Ream Ream/s   10 Caligraphy Pen-2.0 Piece/s   200 Glue Stick-big Piece/s   3 Binder Clips-51 Mm Box/es   5 Binder Clips-41 Mm Box/es  5 Binder Clips-25 Mm Box/es  5 Binder Clips-19 Mm Box/es 1 Glue Gun-big Piece/s 2 Rubber Band-big And Thick, 350g Box/es 1 Television-55" Lg Smart / Android Tv (4k Ultra Hd, Wifi, Lan Port, Hdmi, Screen Mirroring Function, Cable Ready) Unit/s  2 Ink - Epson - 664-4-color Set (black, Yellow, Cyan, Magenta) Set/s 73 Expanding Envelope-kraft, Long, With Garter, Brown Piece/s  1 Stamp Pad-rubberized, "cancelled" Piece/s  1 Stamp Pad-rubberized, "file Copy" Piece/s  1 Sign Pen-pilot G-tec, 0.4 Roller Ball Needle, Black, 12's Box/es 1 Marker-permanent, Black, 12's, Broad Box/es 1 Sticker Paper-glossy, 135 Gsm A4, 50's Pack/s  1 Colored Paper-a4, Assorted Colors, 250's Ream/s   2 Scissors-high Quality, 8.5 Inches Pair/s  10 Scissors-5.5 Inches, Small Pair/s  50 Intermediate Pad-grade 5 & 6 Pad/s 1 Ruler-30cm Long Piece/s  20 Plastic Envelope-long, Clear Piece/s  50 Certificate Holder / Jacket-a4 Piece/s  batch 3 Delivery - March 2024  5 Ballpen-black, 12's Box/es 83 Bond Paper-70gsm,500's,hardcopy,8 1/4" X 11 3/4" (a4) Ream/s  32 Bond Paper-70gsm,500's,hardcopy,8 1/2" X 13" (legal) Ream/s  8 Fastener-50's, Plastic, 8.5" Long X 70mm Width Box/es  2 Stapler-heavy Duty, With Staple Wire Remover Piece/s  2 Puncher-2 Hole, Heavy Duty, Big Piece/s  16 Staple Wire-no. 35, Full Strips, 5000 Staples Box/es  30 Scotch Tape-1 Inch, 50m Roll/s  9 Sign Pen-pilot G-tec, 0.4 Roller Ball Needle, Black, 12's Box/es  10 Cartolina-assorted Colors, 10's Roll/s  2 Marker-permanent, Black, 12's, Broad Box/es 10 Ink-pentel Pen Refill, 30ml, Black Bottle/s  4 Scissors-high Quality, 8.5 Inches Pair/s  10 Double-sided Tape-1 Inch Roll/s 100 Plastic Envelope-long, Clear Piece/s  50 Story Books-for Kids, Adarna (publisher) Copie/s  4 Storage Box-143 L Capacity, With Wheels And Lid Cover Unit/s  200 Manila Paper-36" X 48" , Folded Sheet/s 10 Ink - Epson - 003-4-color Set (black, Yellow, Cyan, Magenta) Set/s  3 Printer-epson L121 Unit/s 2 Flash Drive-256gb Unit/s 2 Laminating Films-100's, Legal, 125 Microns Ream/s 120 Folder-white, Legal Piece/s 120 Folder Jacket-legal Piece/s  3 Specialty Paper-200gsm, White, 100's, 8 1/4" X 11 3/4" (a4) - In Ream Ream/s  6 Ink - Epson - 664-4-color Set (black, Yellow, Cyan, Magenta) Set/s  1 Brown Envelope-long, 500's Box/es  2 Toner-hp Laserjet Model 56a, For Hp Photocopier Mfp M436nda Box/es 1 Toner-develop Ineo - Compatible For Tn116 Tn118 Tn117 Box/es  2 Riso Z Type Ink-for Rv, Rz, Ez, Mz Series Duplicator, Model S-4253, 2's Box/es 2 Riso Z Type Master Roll-for Rv/mv, A4-l, Model No. S-4250 Box/es 10 Glue-130g, Multi-purpose Bottle/s Amount In Words: __________________________________________________________________________________ The Above-quoted Prices Are Inclusive Of All Costs And Applicable Taxes. Very Truly Yours, ____________________________ Name / Signature Of Representative ____________________________ Name Of Company ____________________________ Contact No./email Address Annex B Technical Specifications I Hereby Certify To Comply All The Above Requirements: Quantity Unit Of Measure Item Description  batch 1 Delivery - January 2024 4 Unit/s Printer-epson L121 25 Unit/s Manipulative Mathematics Toys-fraction Cube 25 Unit/s Manipulative Mathematics Toys-calculation Beads 25 Pack/s Eva Foam Sheets-a4, Assorted Color, 10's 25 Unit/s Manipulative Mathematics Toys-multiplication Table, Wooden   Batch 2 Delivery - February 2024 5 Set/s Ink - Epson - 003-4-color Set (black, Yellow, Cyan, Magenta) 130 Ream/s Bond Paper-70gsm,500's,hardcopy,8 1/4" X 11 3/4" (a4) 110 Ream/s Bond Paper-70gsm,500's,hardcopy,8 1/2" X 13" (legal) 20 Piece/s File Magazine Box-single, Dark Blue, 15.5" X 9.5" X 4.5" 30 Ream/s Specialty Paper-200gsm, White, 100's, 8 1/4" X 11 3/4" (a4) - In Ream 10 Piece/s Caligraphy Pen-2.0 200 Piece/s Glue Stick-big 3 Box/es Binder Clips-51 Mm 5 Box/es Binder Clips-41 Mm 5 Box/es Binder Clips-25 Mm 5 Box/es Binder Clips-19 Mm 1 Piece/s Glue Gun-big 2 Box/es Rubber Band-big And Thick, 350g 1 Unit/s Television-55" Lg Smart / Android Tv (4k Ultra Hd, Wifi, Lan Port, Hdmi, Screen Mirroring Function, Cable Ready) 2 Set/s Ink - Epson - 664-4-color Set (black, Yellow, Cyan, Magenta) 73 Piece/s Expanding Envelope-kraft, Long, With Garter, Brown 1 Piece/s Stamp Pad-rubberized, "cancelled" 1 Piece/s Stamp Pad-rubberized, "file Copy" 1 Box/es Sign Pen-pilot G-tec, 0.4 Roller Ball Needle, Black, 12's 1 Box/es Marker-permanent, Black, 12's, Broad 1 Pack/s Sticker Paper-glossy, 135 Gsm A4, 50's 1 Ream/s Colored Paper-a4, Assorted Colors, 250's 2 Pair/s Scissors-high Quality, 8.5 Inches 10 Pair/s Scissors-5.5 Inches, Small 50 Pad/s Intermediate Pad-grade 5 & 6 1 Piece/s Ruler-30cm Long 20 Piece/s Plastic Envelope-long, Clear 50 Piece/s Certificate Holder / Jacket-a4  batch 3 Delivery - March 2024 5 Box/es Ballpen-black, 12's 83 Ream/s Bond Paper-70gsm,500's,hardcopy,8 1/4" X 11 3/4" (a4) 32 Ream/s Bond Paper-70gsm,500's,hardcopy,8 1/2" X 13" (legal) 8 Box/es Fastener-50's, Plastic, 8.5" Long X 70mm Width 2 Piece/s Stapler-heavy Duty, With Staple Wire Remover 2 Piece/s Puncher-2 Hole, Heavy Duty, Big 16 Box/es Staple Wire-no. 35, Full Strips, 5000 Staples 30 Roll/s Scotch Tape-1 Inch, 50m 9 Box/es Sign Pen-pilot G-tec, 0.4 Roller Ball Needle, Black, 12's 10 Roll/s Cartolina-assorted Colors, 10's 2 Box/es Marker-permanent, Black, 12's, Broad 10 Bottle/s Ink-pentel Pen Refill, 30ml, Black 4 Pair/s Scissors-high Quality, 8.5 Inches 10 Roll/s Double-sided Tape-1 Inch 100 Piece/s Plastic Envelope-long, Clear 50 Copie/s Story Books-for Kids, Adarna (publisher) 4 Unit/s Storage Box-143 L Capacity, With Wheels And Lid Cover 200 Sheet/s Manila Paper-36" X 48" , Folded 10 Set/s Ink - Epson - 003-4-color Set (black, Yellow, Cyan, Magenta) 3 Unit/s Printer-epson L121 2 Unit/s Flash Drive-256gb 2 Ream/s Laminating Films-100's, Legal, 125 Microns 120 Piece/s Folder-white, Legal 120 Piece/s Folder Jacket-legal 3 Ream/s Specialty Paper-200gsm, White, 100's, 8 1/4" X 11 3/4" (a4) - In Ream 6 Set/s Ink - Epson - 664-4-color Set (black, Yellow, Cyan, Magenta) 1 Box/es Brown Envelope-long, 500's 2 Box/es Toner-hp Laserjet Model 56a, For Hp Photocopier Mfp M436nda 1 Box/es Toner-develop Ineo - Compatible For Tn116 Tn118 Tn117 2 Box/es Riso Z Type Ink-for Rv, Rz, Ez, Mz Series Duplicator, Model S-4253, 2's 2 Box/es Riso Z Type Master Roll-for Rv/mv, A4-l, Model No. S-4250 10 Bottle/s Glue-130g, Multi-purpose _____________________  ____________________________ _______________ Name Of Company / Bidder Signature Over Printed Name   Date Of Representative Annex C Schedule Of Requirements Bidders Must State Either “comply” Or “not Comply” Or Any Equivalent Term In The Column “statement Of Compliance” Against Each Of The Individual Parameters Of Each “specification”. Please Do Not Just Place Check In The Bidder’s “statement Of Compliance”. Item Quantity Unit Of Measure Item Description Delivered   Batch 1 Delivery - January 2024   1 4 Unit/s Printer-epson L121   2 25 Unit/s Manipulative Mathematics Toys-fraction Cube   3 25 Unit/s Manipulative Mathematics Toys-calculation Beads   4 25 Pack/s Eva Foam Sheets-a4, Assorted Color, 10's   5 25 Unit/s Manipulative Mathematics Toys-multiplication Table, Wooden  batch 2 Delivery - February 2024  1 5 Set/s Ink - Epson - 003-4-color Set (black, Yellow, Cyan, Magenta)   2 130 Ream/s Bond Paper-70gsm,500's,hardcopy,8 1/4" X 11 3/4" (a4)   3 110 Ream/s Bond Paper-70gsm,500's,hardcopy,8 1/2" X 13" (legal)   4 20 Piece/s File Magazine Box-single, Dark Blue, 15.5" X 9.5" X 4.5"   5 30 Ream/s Specialty Paper-200gsm, White, 100's, 8 1/4" X 11 3/4" (a4) - In Ream  6 10 Piece/s Caligraphy Pen-2.0   7 200 Piece/s Glue Stick-big   8 3 Box/es Binder Clips-51 Mm   9 5 Box/es Binder Clips-41 Mm   10 5 Box/es Binder Clips-25 Mm   11 5 Box/es Binder Clips-19 Mm   12 1 Piece/s Glue Gun-big   13 2 Box/es Rubber Band-big And Thick, 350g   14 1 Unit/s Television-55" Lg Smart / Android Tv (4k Ultra Hd, Wifi, Lan Port, Hdmi, Screen Mirroring Function, Cable Ready)   15 2 Set/s Ink - Epson - 664-4-color Set (black, Yellow, Cyan, Magenta)   16 73 Piece/s Expanding Envelope-kraft, Long, With Garter, Brown   17 1 Piece/s Stamp Pad-rubberized, "cancelled"   18 1 Piece/s Stamp Pad-rubberized, "file Copy"   19 1 Box/es Sign Pen-pilot G-tec, 0.4 Roller Ball Needle, Black, 12's   20 1 Box/es Marker-permanent, Black, 12's, Broad   21 1 Pack/s Sticker Paper-glossy, 135 Gsm A4, 50's   22 1 Ream/s Colored Paper-a4, Assorted Colors, 250's   23 2 Pair/s Scissors-high Quality, 8.5 Inches   24 10 Pair/s Scissors-5.5 Inches, Small   25 50 Pad/s Intermediate Pad-grade 5 & 6   26 1 Piece/s Ruler-30cm Long   27 20 Piece/s Plastic Envelope-long, Clear   28 50 Piece/s Certificate Holder / Jacket-a4 29  30  batch 3 Delivery - March 2024   31 5 Box/es Ballpen-black, 12's  83 Ream/s Bond Paper-70gsm,500's,hardcopy,8 1/4" X 11 3/4" (a4)   32 Ream/s Bond Paper-70gsm,500's,hardcopy,8 1/2" X 13" (legal) 1 8 Box/es Fastener-50's, Plastic, 8.5" Long X 70mm Width   2 2 Piece/s Stapler-heavy Duty, With Staple Wire Remover   3 2 Piece/s Puncher-2 Hole, Heavy Duty, Big   4 16 Box/es Staple Wire-no. 35, Full Strips, 5000 Staples   5 30 Roll/s Scotch Tape-1 Inch, 50m   6 9 Box/es Sign Pen-pilot G-tec, 0.4 Roller Ball Needle, Black, 12's   7 10 Roll/s Cartolina-assorted Colors, 10's   8 2 Box/es Marker-permanent, Black, 12's, Broad   9 10 Bottle/s Ink-pentel Pen Refill, 30ml, Black   10 4 Pair/s Scissors-high Quality, 8.5 Inches   11 10 Roll/s Double-sided Tape-1 Inch   12 100 Piece/s Plastic Envelope-long, Clear   13 50 Copie/s Story Books-for Kids, Adarna (publisher)   14 4 Unit/s Storage Box-143 L Capacity, With Wheels And Lid Cover   15 200 Sheet/s Manila Paper-36" X 48" , Folded   16 10 Set/s Ink - Epson - 003-4-color Set (black, Yellow, Cyan, Magenta)   17 3 Unit/s Printer-epson L121   18 2 Unit/s Flash Drive-256gb   19 2 Ream/s Laminating Films-100's, Legal, 125 Microns   20 120 Piece/s Folder-white, Legal   21 120 Piece/s Folder Jacket-legal   22 3 Ream/s Specialty Paper-200gsm, White, 100's, 8 1/4" X 11 3/4" (a4) - In Ream   23 6 Set/s Ink - Epson - 664-4-color Set (black, Yellow, Cyan, Magenta)   24 1 Box/es Brown Envelope-long, 500's   25 2 Box/es Toner-hp Laserjet Model 56a, For Hp Photocopier Mfp M436nda   26 1 Box/es Toner-develop Ineo - Compatible For Tn116 Tn118 Tn117   27 2 Box/es Riso Z Type Ink-for Rv, Rz, Ez, Mz Series Duplicator, Model S-4253, 2's   28 2 Box/es Riso Z Type Master Roll-for Rv/mv, A4-l, Model No. S-4250   29 10 Bottle/s Glue-130g, Multi-purpose   I Hereby Certify To Comply And Deliver All The Above Requirements: _____________________________ _______________________________ _______________ Name Of Company / Bidder  Signature Over Printed Name   date Of Representative Annex D Terms And Conditions Shape Service Provider Shall Provide Correct And Accurate Information Required In This Form. Price Quotation/s Must Be Valid For A Period Of Thirty (30) Calendar Days From The Date Of Submission. Quotations Provided Herein Shall Remain Unchanged And Shall Be Used From The Evaluation And Calculation Of The Bidder’s Total Quotation To Contract Implementation And Payment. Price Quotation/s To Be Denominated In Philippine Peso Shall Include All Taxes, Duties, And/or Levies Payable. Quotations Exceeding The Approved Budget For The Contract Shall Be Rejected. Award Of Contract Shall Be Made To The Lowest Quotation Which Complies With The Technical Specifications, And Other Terms And Conditions Stated Herein. Any Interlineations, Erasures, Or Overwriting Shall Be Valid Only If They Are Signed Or Initialed By You Or Any Of Your Duly Authorized Representatives. Liquidated Damages Equivalent To One Tenth Of One Percent (0.001%) Of The Value Of The Goods Not Delivered Within The Prescribed Delivery Period Shall Be Imposed Per Day Of Delay. The Quisao Es - Bac Shall Rescind The Contract Once The Cumulative Amount Of Liquidated Damages Reaches Ten Percent (10%) Of The Amount Of The Contract, Without Prejudice To Other Courses Of Action And Remedies Open To It. Payment For The Supplies Shall Be Made Upon Completion Of Each Delivery Schedule. The Winning Bidder Is Expected To Provide The Following Documents Before Payment Has Been Made; Valid Official Receipt With Authority To Print From The Bir, Valid Delivery Receipt With Authority To Print From The Bir, Valid Sales Invoice With Authority To Print From The Bir, Signed Statement Of Account/billing Statement, Notarized Sworn Statement Signed Letter Of Request For Payment I Hereby Certify To Comply And Deliver All The Above Requirements: ____________________________ ______________________________ _______________ Name Of Company / Bidder  Signature Over Printed Name   date Of Representative Omnibus Sworn Statement  ____________________________________________________________    Republic Of The Philippines )  City/municipality Of ______  ) S.s.   affidavit    I, ___________________, Of Legal Age, _, Filipino And Residing At _______________________________________________, After Having Been Duly Sworn In Accordance With Law, Do Hereby Depose And State That:   i Am The Sole Proprietor Or Authorized Representative Of _____________________________________ With Office Address ________________________________________    As The Owner And Sole Proprietor, Or Authorized Representative Of _________________________________, I Have Full Power And Authority To Do, Execute And Perform Any And All Acts Necessary To Participate, Submit The Bid, And To Sign And Execute The Ensuing Contract For __________________________________ Of The Quisao Elementary School, As Shown In The Attached Duly Notarized Special Power Of Attorney;  ________________________________________ Is Not “blacklisted” Or Barred From Bidding By The Government Of The Philippines Or Any Of Its Agencies, Offices, Corporations, Or Local Government Units, Foreign Government/foreign Or International Financing Institution Whose Blacklisting Rules Have Been Recognized By The Government Procurement Policy Board;    Each Of The Documents Submitted In Satisfaction Of The Bidding Requirements Is An Authentic Copy Of The Original, Complete, And All Statements And Information Provided Therein Are True And Correct;  _________________________________________ Is Authorizing The Head Of The Procuring Entity Or Its Duly Authorized Representative(s) To Verify All The Documents Submitted;  The Owner Or Sole Proprietor Is Not Related To The Head Of The Procuring Entity, Members Of The Bids And Awards Committee (bac), The Technical Working Group, And The Bac Secretariat, The Head Of The Project Management Office Or The End-user Unit, And The Project Consultants By Consanguinity Or Affinity Up To The Third Civil Degree;  ____________________________ Complies With Existing Labor Laws And Standards; And     ____________________________________ Is Aware Of And Has Undertaken The Responsibilities As A Bidder In Compliance With The Philippine Bidding Documents, Which Includes:  Carefully Examining All Of The Bidding Documents;  Acknowledging All Conditions, Local Or Otherwise, Affecting The Implementation Of The Contract;  Making An Estimate Of The Facilities Available And Needed For The Contract To Be Bid, If Any; And  Inquiring Or Securing Supplemental/bid Bulletin(s) Issued For The ____________________________________________ Did Not Give Or Pay Directly Or Indirectly, Any Commission, Amount, Fee, Or Any Form Of Consideration, Pecuniary Or Otherwise, To Any Person Or Official, Personnel Or Representative Of The Government In Relation To Any Procurement Project Or Activity.  In Witness Whereof, I Have Hereunto Set My Hand This __ Day Of ___, 20__ At ____________, Philippines.                                    ____________________________________________  Bidders’s Representative/ Authorized Signatory    Subscribed And Sworn To Before Me This _____ Day Of [month] [year] At [place Of Execution], Philippines. Affiant/s Is/are Personally Known To Me And Was/were Identified By Me Through Competent Evidence Of Identity As Defined In The 2004 Rules On Notarial Practice (a.m. No. 02-8-13-sc). Affiant/s Exhibited To Me His/her [insert Type Of Government Identification Card Used], With His/her Photograph And Signature Appearing Thereon, With No. _______ And His/her Community Tax Certificate No. _______ Issued On _____ At ______.  Witness My Hand And Seal This _____ Day Of __________.  Name Of Notary Public  Serial No. Of Commission ______  Doc. No. ___     notary Public For ____ Until_______  Page No. ___     roll Of Attorneys No. __________________  Book No. ____     ptr No. _____ [date Issued], [place Issued]  Series Of ____     ibp No. ______ [date Issued], [place Issued]