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iii iiiiiiiiiiiu iii <br />STATE OF COLORADO "~ <br />• PURCHASE REQUISITIO• V ~,rr `~ <br />SUGGESTED VENDOR AND ADDRESS PURCHASE <br />ORDER NUMBER SUGGESTED VENDOR AND ADDRESS PURCHASE <br />ORDER NUMBER <br /> <br /> VENDOR NUMBER VENDOR NUMDER <br />ZIP ZIP <br />TERMS FOB TERMS FOB <br />DOC ID CODE NO. <br />Q <br />PV <br />~ (3 F~ ACT VTYPE <br />III-III <br />UND <br />AGENCY ORG APPR CODE BB ACCT OBJECT <br />SUB-ORG SUB-OBJ REV SpC <br />6 2 P K A ® m 0 2 9 ~ 2 3 1 1 m <br />SUB-REV PROGRAM GBL FUNCTION REPORTING CAT PpOJIJOB NO OFF REC ACCT <br />m M N R C <br />BILL 70 -Name antl Atltlrass SNIP TO Name and Atltlrass <br />Division of Minerals and Geology Designated Job Site <br />1313 Sherman St., Rm. 215 <br />Denver, CO 80203 <br />pEOUESTING AGENCY ~ Name and Atltlrass TELEPHONE PEpSON(S) TO CONTACT <br /> 866-3567 Maggie Van Cl eef <br />Same as Bill To <br /> FA% <br /> 832-8106 <br />I hereEy cert~ly Thal Iha suppli ices lisletl ar ar r the succasslul Operdlipn Ot Ina agency antl IhB <br />quantify regpostetl ,s iha min,m m amou I antl tlesi <br />X la Ito rover same. <br /> A TMOR SI E <br />ITEM QUANTITY UNIT GOM ITY NUMBER AND ' UNIT AMOUNT <br />NO. MPLETE DESCRI ON OF ITEM OR SERVICE ~ COST <br />~ REFERENCE PRICE AGREE ME ~ <br />Ref. Bid Numberl'iVGMINES-322 ~ I <br />t <br />Permit IIC-81-037 t <br />1 I 1 Job G~JEast Pit Coal Reclamation Project N/A $~,~ <br />i <br />i <br />i <br />I <br />' This project is subject to advertising before <br />final payment (CRS 38-26-107). In addition, <br />i retainage will be held at 107,. , <br />All in accordance with specifications, drawings, <br />terms and conditions of the above bid and the <br />attached BID SCHEDULE (line item price) <br />sheet which are made a part hereof by <br />reference. <br />i <br />REQUESTED DELIVERY DATE <br />WHITE ~ Pwcnasing Cppy YELLOW ~ Accounts B Control Gopy PINK -Agency Copy GOLDENROD ~ Departmam GppY <br />