1

General Information















On Accountable Governance

1. What is the opinion rendered by COA on the Unqualified Qualified

LGUs CY 2011 Financial Statements? Adverse Disclaimer

Notes:
1. Reference document: CY 2011 Annual Audit Report
2. Required attachments: (a) official transmittal of AAR from COA-RO to the LCE and (b) AAR
Executive Summary


On Transparent Governance

2. In the full disclosure of local budget and finances, bids and public offerings, indicate if the
following are posted in three publicly accessible and conspicuous places, in newspaper of
general circulation within the territorial jurisdiction of the LGU, and in the LGU website.

2.1 CY 2012, Annual Budget Report CP News Web

2.2 CY 2012, Annual Procurement Plan or Procurement List CP News Web

2.3 CY 2012, Special Education Fund Income and CP News Web
Expenditure Estimates

2.4 CY 2012, Statement of Debt Service CP News Web NA

2.5 CY 2012, Gender and Development Accomplishment CP News Web
Report

Name of Province, City or Municipality :
Income Class :
Provincial Location (if city or municipality) :
Regional Location :
Name of LCE : Term of Office :
Instructions:
1. This form is to be filled-up and duly signed by the designated DILG Field personnel
and the representative from a local civil society organization.
2. For items with choices, put a check () mark on the appropriate answer.
3. Supply additional information being required.
Annex A
SGH Form 1 (Data Capture Form)
Series 2012
2



2.6 CY 2012, Statement of Receipts and Expenditures CP News Web

2.7 1
st
and 2
nd
Quarters, CY 2012 Quarterly Statement CP News Web
of Cash Flows

2.8 1
st
and 2
n2d
Quarters, CY 2012 Items to Bid CP News Web

2.9 1
st
and 2
nd
Quarters, CY 2012 Report of Special CP News Web
Education Fund Utilization

2.10 1
st
and 2
nd
Quarters, CY 2012 Trust Fund (PDAF) CP News Web NA
Utilization

2.11 1
st
and 2
nd
Quarters, CY 2012 Bid Results on Civil CP News Web
Works, and Goods and Services

2.12 1
st
and 2
nd
Quarters, CY 2012 Abstract of Bids as CP News Web
Calculated

2.13 1
st
and 2
nd
Quarters, CY 2012 20% Component of CP News Web
the IRA Utilization

2.14 CY 2012, Supplemental Procurement Plan CP News Web NA

Please indicate LGU website.



Please indicate name of
newspaper and date published.



Notes:
1. CP refers to publicly accessible and conspicuous places within the LGU.
2. News refers to newspaper of general circulation in the territorial jurisdiction of the LGU.
3. Web refers to website.
4. NA is not applicable.
5. Reference document: DILG Memorandum Circular 2011-134 dated September 19, 2011
6. Required attachments: one photo each of the three billboards in publicly and accessible places
where the documents are being posted


3. Does the LGU have an organized Bids and Awards Committee? Yes No

If yes, determine functionality using the following criteria:

3.1 Composition is based on Section 11 of RA 9184 Yes No

3.2 Procurement rules and procedure are enforced Yes No

3.3 All meetings are held at the provincial capitol, city or Yes No
municipal hall
SGH Form 1 (Data Capture Form)
Series 2012
3



3.4 Proceedings of the meetings are documented Yes No

3.5 Proceedings of the meetings are made available upon request Yes No

If the LGU has NOT yet organized a Bids and Awards Committee, please state reason.




Notes:
1. Reference documents: RA 9184 and its IRR
2. Item 3.2 covers the whole bidding process from the preparation of bidding documents to the
awarding of winning bidders.
3. Required attachments: (a) Executive issuance on the creation and composition of the Bids and
Awards Committee; and (b)at least one CY 2012 Minutes of the meeting(s); (c) at least one bidding
document; and/or (d) at least one BAC resolution, if there are any.


4. In the procurement of supplies, goods and services this year, Yes No
has the LGU utilized the online services of the Philippine
Government Procurement System (PhilGEPS)?

If yes, are the following being posted:

4.1 Bid of Notice Abstract Yes No

4.2 Notice of Awards Abstract Yes No

If the LGU is NOT utilizing the online service of PhilGEPS, please state reason.




Notes:
1. Reference documents: RA 9184 and its IRR
2. Bid Notice Abstract refers to the procurement opportunities posted in the PhilGEPS website such as
Items to Bid and Request for Quotation.
3. Notice of Award Abstract refers to the document posted indicating the winning bidder(s) through
the PhilGEPS website (www.philgeps.net).
4. Required attachments: (a) one downloaded copy of the Bid Notice Abstract; and (b) one
downloaded copy of the Notice of Awards Abstract
SGH Form 1 (Data Capture Form)
Series 2012
4



On Frontline Service Performance

5. What is the rating attained by the LGU on the Excellent Good

CSC Report Card Survey relative to the Acceptable Failed

Implementation of the Anti-Red Tape Act?

Note:
Required attachment: Report Card Survey result for the current year.





Accomplished by:


Signature over Printed Name Position/Agency Date



Signature over Printed Name Position/Agency Date

SGH Form 1 (Data Capture Form)
Series 2012