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STATE OF COLORADO Page of 2 <br /> Department of Natural Resources <br /> • • I' • ' <br /> Number: PO,PKAA,202400002620 The order number and line number must appear on all <br /> Date: 8/l/23 invoices, packing slips, cartons, and correspondence. <br /> Description: • <br /> Hanna Pit Bond Forfeiture DIVISION OF RECLAMATION, MINING AND <br /> SAFETY <br /> 1313 SHERMAN STREET, ROOM 215 <br /> Denver, CO 80203 <br /> Effective Date: 07/21/23 <br /> Exiairation Date: 10/17/23 <br /> BUYER SHIP TO <br /> Buyer: DIVISION OF RECLAMATION, MINING AND <br /> Email: SAFETY <br /> • ' 1313 SHERMAN STREET, ROOM 215 <br /> RIO GRANDE CIVIL LLC Denver, CO 80203 <br /> PO BOX 760 <br /> WESTLAKE, LA 70669 <br /> SHIPPING • <br /> Delivery/Install Date: - <br /> Contact: Sabrina Golding FOB: <br /> Phone: 719-850-0405 <br /> VENDOR INSTRUCTIONS <br /> EXTENDED DESCRIPTION <br /> Per written contract: Vendor/Contractor liability policy(ies) shall list the State and DNR as an additional insured, <br /> have waivers of Subrogation in favor of the State and DNR, and be primary and noncontributory over any <br /> insurance/self-insurance covering the State and DNR. <br /> This project is funded through monies made available to the State of Colorado through revocation of bond <br /> monies retained by the Division of Reclamation, Mining and Safety for reclamation of this previously permitted <br /> mining operation and by Severance Tax collected by the State of Colorado. <br /> Line Item Commodity/Item Code UOM Unit Cost Total Cost I MSDS Req. <br /> 96273 0 0.00 $11,400.00 ❑ <br /> Description: Hanna Pit Bond Forfeiture PCO103200 <br />