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wP (3as;k <br /> WATER CONSERVATION BOARD DATE: 11-09-12 �_ ��`•� PURCHASE <br /> 1313 SHERMAN STREET, ROOM 721 +, 's' ORDER <br /> DENVER, CO 80203 The O#and Line#must STATE OF COLORADO <br /> appear on all invoices, • <br /> Buyer: MAGGIE VAN CLEEF packing slips,cartons <br /> Phone Number: 303-866-3292 and correspondence P.O.# OE PDA 1318C000011 Page# 01 <br /> Agency Contact DORI VIGIL <br /> Phone Number. 303 866 3441 ACC: 11-06-12 State Award# <br /> FEIN 710876751 Phone: 970-723-4401 BID# <br /> vendor Contact TOM HACRLEMAN Invoice In Triplicate <br /> Purchase Requisition(r: To DIVISION OF WATER CONSERVATION <br /> 1313 SHERMAN STREET, ROOM 721 <br /> v ENVER CO 80203 <br /> E <br /> LORAN HACKLEMAN OLSON LLC D <br /> N <br /> D PO BOX 35 <br /> 0 COWDREY CO 80434 Payment will be made by this agency <br /> R Ship DIVISION OF WATER CONSERVATION <br /> INSTRUCTIONS TO VENDOR: To: 1313 SHERMAN STREET, ROOM 721 <br /> 1. If for any reason,delivery of this order is delayed beyond the deiivery/instailadon date DENVER, CO 80203 <br /> shown,please notify the agency contact named at the top left.(Right of cancellation is <br /> reserved in Instances in which timely delivery Is not made.) <br /> 2. All chemicals,equipment and materials must conform to the standards required by OSHA. Delivery/Installation Date: 12-31-13 <br /> 3. NOTE Additional terms and conditions on reverse side. F.O.B. DESTINATION STATE PAYS NO FREIGHT <br /> SPECIAL INSTRUCTIONS: <br /> *NOTE* THIS ORDER WAS MODIFIED ON 11-08-12 <br /> LINE COMMODITY/ITEM UNIT OF OUAlITI n UNIT COST TOTAL ITEM COST <br /> ITEM CODE MEASUREMENT <br /> 001 91843000000 $57,540.00 <br /> CMS# 49734 WSRA GRANT FOR SENECCA DITCH-STRUCTURE FOR WATER <br /> CONTROL REPLACE HEADGATES IN THE NORTH PLATTE RIVER BASIN. <br /> I <br /> 7 74jCV <br /> Vty,"0\,‘ <br /> DOCUMENT TOTA = 4.-.., )557.540.00 <br /> . , <br /> THIS PO IS ISSUED IN ACCORDANCE WITH STATE AND FEDERAL REGULATIONS , FOR THE STATE COL • • '4 S <br /> This PO Is effective on the date signed by the authorized Individual. / ./4/1, /a7/,1 <br /> GSM PM <br /> Authorized Signs'i te <br /> DP-01(R-02/06) i� <br />