C150081 Application

• Contract/PO #: C150081
• Contractor Name: Victor, City of
• Contract Type: Loan
• Water District: 12
• County: Teller
• Bill Number: HB 95-1155
• Loan Projects - Doc Type: Application

WATER CONSERVATION BOARD
1313 SHERHAN~i,STRE;E1;'_f ROOM 721
OkNVER, CO 80203

05-25-95

? 3 ~.,} ~i:i ,;

PURCHASE
FtlRDER
STATE OF COLORADO

DATE:

FEIN
Vendor Contact:
Purchase Requisition #:
V VICTOR, CITY OF
E
~ PO BOX 86
o VICTOR
R

'1Ii;..PORT ANT
The PO# and Un~,ltem.'
must appear on all
invoices,' packing slips,
cartons, and '
correspondence.
Invoice In'
Trlpliate
To:

Direct Inquiries To:
RICHARD ADAMICH
Phone Number: '303/866-2857

Phone:

Payment wilLbe ma~eby ,t/lis age~cy',
Ship
To: 1313-SHERMAN STREET; ROOM 721
OEl'{V;ER 1" qq,.80'2.03

CO 80860-0086

INSTRUCTIONS TO VENDOR:

1, On accepting verbal telephone order, purchase order number must be obtained before
making delivery,
2, All discounts must be noted on invoice"
3, All chemicals, equipment and materials must <;Onform to the standards required by QSHA.
4, NOTE: Additional terms and conditions on reverse side,

SPECIAL INSTRUCTIONS;

;'>;; ,
':::' ~,'::<\' .
F.O.B. DESTINATION,
Delivery/Installation oate: .06- 30- 9 5
Agency Contact: ',BrLL: GREEN

:;- ~

<;k~',(.,.

LINE
ITEM

COMMODITYIITEM'
: CODE

aUAimrv

T9J~rrEM'cqSr

001 .96134000000
FEASIBILITY
FEASIBILITY

':':': ' ,.,."
, ,
! EAed'
.S'l'UD~.ES (4LL'
STUDXES (A"LL
.., .
., -.

$5;0,00.00

c

DOCUMENT TOTAL .~

$5,000.00

THIS PO IS ISSUED IN ACCORDANCE WIDTH STATE AND FEDERAL REGULATIONS,

Form DP-01 (2/94)
395-53-05-0194

VENDOR