Department of the Interior and Local GovernmentForm Prov 2A Assessment for the Seal of Good Local Governance Local Accounting Office CY 2017 SGLG Form Prov 2A Local Accounting Office C E R T I F I C A T I O N This is to certify that the Province of _______________________________ has the following (please supply required information): On the 20% Component of annual Internal Revenue Allotment (IRA) or Development Fund (CY 2015 Current Fund): Total amount of LGU’s Development Fund is : PhP __________________ Out of the above-indicated amount indicated, total amount utilized is : PhP __________________ Percent-utilization is : _____ % On the LGU’s Total Revenue from regular sources: CY 2015 CY 2016 Estimated amount of LGU’s Total Revenue from regular sources : PhP ________________ PhP _______________ LDRRRM Fund allocated : PhP ________________ PhP _______________ Percent-allocation for LDRRMF is : _______% _______% On the Local Disaster Risk Reduction and Management (LDRRM) Fund Utilization: CY 2015 Total Amount Amount Utilized In % Continuing PhP _________________ PhP _________________ ____% Current PhP _________________ PhP _________________ ____% Special Trust Fund PhP _________________ PhP _________________ ____% Certified by: Noted by: ______________________________________ ______________________________________ Provincial Accountant Provincial Director 1 of 1 Department of the Interior and Local Government Form Prov 2A Assessment for the Seal of Good Local Governance Local Accounting Office CY 2017 CY 2016 Total Amount Amount Utilized In % Continuing PhP _________________ PhP _________________ ____% Current PhP _________________ PhP _________________ ____% Special Trust Fund PhP _________________ PhP _________________ ____% This Certification is issued for the purpose of the Seal of Good Local Governance assessment. Certified by: Noted by: ______________________________________ ______________________________________ Signature over Printed Name Signature over Printed Name Provincial Accountant Provincial Director 1 of 1 . 2017 at the ___________________________________________. Issued on ____________. whether contained in a separate ADAC Action Plan or integrated in the Local Peace and Order. Budget for this program is: ☐ Specifically appropriated ☐ Incorporated in an environmental. Department of the Interior and Local Government Form Prov 2C Assessment for the Seal of Good Local Governance Local Budget Office CY 2017 SGLG Form Prov 2C Local Budget Office C E R T I F I C A T I O N This is to certify that the Province of _______________________________ has budget appropriation for (please tick items with appropriation): ☐ Approved Local Disaster Risk Reduction and Management (LDRRM) Plan ☐ Activities to strengthen illegal drug awareness and related LGU program(s) . educational or cultural activity. This Certification is issued for the purpose of the Seal of Good Local Governance assessment. and Public Safety Plan ☐ A cultural program to conserve and preserve cultural property in the LGU. 2017 at the ___________________________________________. title of activity where it is incorporated: __________________________________________________________ as integrated in CY 2017 Annual Budget and CY 2017 Annual Investment Program. Certified by: Noted by: ______________________________________ ______________________________________ Signature over Printed Name Signature over Printed Name Provincial Budget Officer Provincial Director 1 of 1 . Issued on ____________. project. Department of the Interior and Local Government Form Prov 2D Assessment for the Seal of Good Local Governance DepEd Representative CY 2017 SGLG Form Prov 2D DepEd Representative C E R T I F I C A T I O N This is to certify that the Local School Board (LSB) Plan for CY 2016 of Province of _______________________________ has the following status of the 2016 plan implementation (Please supply required data): _____% of programs. Issued on _____________________. 2017 at the _________________________. Please specify: This Certification is issued for the purpose of the Seal of Good Local Governance assessment. ___________________________________. the said Plan completed. the following items (tick appropriate items): ☐ Operation and maintenance of public schools ☐ Construction and repair of school buildings ☐ Facilities and equipment ☐ Educational research ☐ Purchase of books and periodicals ☐ Sports development ☐ Others. Accordingly. Certified By: _____________________________________________ Signature over Printed Name DepEd Schools Division Superintendent/ designated Representative to LSB 1 of 1 . and _____% of the total amount appropriated to finance the LSB Plan is utilized. or its fund utilized for. and activities are completed. 2017 at the _________________________. Issued on _____________________. Department of the Interior and Local Government Form Prov 2F Assessment for the Seal of Good Local Governance Local Planning and Development CY 2017 Coordinator (LPDC) SGLG Form Prov 2F Local Planning and Development Coordinator C E R T I F I C A T I O N This is to certify that the Province of ______________________________ has the following (Please tick if item is available): ☐ There is a program to conserve and preserve cultural property in the LGU. Please indicate title of the program: __________________________________________________ This Certification is issued for the purpose of the Seal of Good Local Governance assessment. ___________________________________. Certified By: Noted by: __________________________________________ ________________________________________ Signature over Printed Name Signature over Printed Name Provincial Planning and Development Officer Provincial Director 1 of 1 . the LPOC met at least once in the (please tick applicable choice(s)): ☐ 4th quarter CY 2016 ☐ 1st quarter CY 2017 ☐ The LGU has adopted a Local Anti-Criminality Action Plan for CY 2016 (whether a separate plan or embodied in the Integrated Area Community Public Safety Plan or Local Peace & Order. and Public Safety Plan). Accordingly. and activities were completed. Department of the Interior and Local Government Form Prov 2G Assessment for the Seal of Good Local Governance Local PNP Office/Station CY 2017 SGLG Form Prov 2G Local PNP Office/ Station C E R T I F I C A T I O N This is to certify that the Province of ______________________________ has undertaken the following (Please tick applicable items only): ☐ The Governor convened the Local Peace and Order Council (LPOC). and _____% of the total amount appropriated to finance the plan was utilized. the following are the forms of support given (please tick applicable choices only): ☐ Ammunition ☐ Police station ☐ Communication ☐ Supplies ☐ Vehicle ☐ Others (please specify): _________________ Certified by : Noted by : Local PNP Chief Provincial Director 1 of 2 .): _____% of programs. In particular. here is the status of the 2016 plan implementation (please supply required data. Accordingly. ☐ The LGU has provided logistical support to the PNP Local Police Office/Station in CY 2016. project. Department of the Interior and Local Government Form Prov 2G Assessment for the Seal of Good Local Governance Local PNP Office/Station CY 2017 Such support was particularly provided in and/or utilized until the (please tick applicable choice(s)): ☐ 4th quarter CY 2016 ☐ 1st quarter CY 2017 ☐ The LGU has implemented (please indicate appropriate number) _____ joint activities with the PNP as contained in the Local Anti-Criminality Action Plan for 2016 (whether a separate plan or embodied in the Integrated Area Community Public Safety Plan or Local Peace and Order. the ADAC met at least once in the (please tick applicable choice(s)): ☐ 4th quarter CY 2016 ☐ 1st quarter CY 2017 This Certification is issued for the purpose of the Seal of Good Local Governance assessment. Local PNP Office/Station Provincial Director 2 of 2 . Certified By: Noted by: __________________________________________ ________________________________________ Signature over Printed Name Signature over Printed Name Chief. and Public Safety Plan). ☐ The Governor activated its Anti-Drug Abuse Council (ADAC) In particular. ___________________________________. Issued on _____________________. 2017 at the _________________________.