Republic of the Philippines)
| _________________ | ) S.S. |
BEFORE ME, a Notary Public for and in _____________________, Philippines, on this ______ day of _______, 200____, personally appeared (LGU's Representative) and (Winning Bidder's Representative), known to be the same persons who executed the foregoing <<Type of Contractual Arrangement>> for the <<Name of the Project> which instrument consists of ______ pages including the page on which this Acknowledgment is written, and signed at the left hand margin of each and every page by the parties executing this instrument and their witnesses, and sealed with my notarial seal and aforesaid parties acknowledged to me that the same is their free act and deed . The parties exhibited to me their competent evidence of identity, (govt.-issued ID presented and ID number) issued at __________ on __________ valid until __________ and (govt.-issued ID presented and ID number) issued at _______________ on _______________ valid until _______________, respectively.