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WATER CONSERVATION BOARD DATE: 02-23-12 0>'C6;o\ PURCHASE <br /> 1313 SHERMAN STREET, ROOM 721 Q �- o <br /> DENVER, CO 80203 IMPORTANT �* (s *I ORDER <br /> The PO#and Line#must ',-0( ,e*/ STATE OF COLORADO <br /> Buyer: ALLAN SMITH appear on all invoices, <br /> Phone Number: 303-866-3292 <br /> packing slips,cartons <br /> and correspondence P.O. # OE PDA 12000000062 Page# 01 <br /> Agency Contact: STEVEN SHULL <br /> Phone Number: 303 866 3441 ACC: 02-22-12 State Award # <br /> FEIN 840177040 Phone: 303-238-0451 BID # <br /> Vendor Contact: Invoice in Triplicate <br /> Purchase Requisition#: To: DIVISION OF WATER CONSERVATION <br /> 1313 SHERMAN STREET, ROOM 721 <br /> e CONSOLIDATED MUTUAL WATER CO DENVER, CO 80203 <br /> N <br /> D PO BOX 150068 <br /> O LAKEWOOD CO 80215-0068 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 delivery/installation 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. <br /> Delivery/Installation Date: 06-30-12 <br /> 3. NOTE:Additional terms and conditions on reverse side. F.O.B. DESTINATION STATE PAYS NO FREIGHT <br /> SPECIAL INSTRUCTIONS: ' <br /> LINE COMMODITY/ITEM UNIT OF <br /> ITEM CODE MEASUREMENT QUANTITY UNIT COST TOTAL ITEM COST <br /> 001 91843000000 $8, 000 .00 <br /> SEV TAX GRANT-PERFORM A DAM BREACH MODELING & FLOOD INUNDATI <br /> ON FOR 2 DAMS WITHIN THE VENDORS AREA. PER SOW. CMS#41235. <br /> DOCUMENT TOTAL // $8, 000. 00 <br /> THIS PO IS ISSUED IN ACCORDANCE WITH STATE AND FEDERAL REGULATIONS „F.011.-THE STATE OF COLO A'6 <br /> This PO is effective on the date signed by the authorized individual. / 2C7� /EPSPO PAA �/ �/ 0--Authori -.Signature Date <br /> DP-01(R-02/06) <br />