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,~ <br />a ;~ <br />Check One <br />PURCBASE ORDER <br />E1 Paso County <br />DEPARTMENT OF PUBLIC WORKS <br />3170 Century, Colo. Spgs., Colo. 80907 <br />eller (~ a~./nuJ ~ . /f C~ ~JGFi~/ <br />ddress ~•~ <br />~J~C 7 ~ ~ /~~ C~~ c.~'~~ac, <br />c~~~~-~ <br />3ad~3 <br />Dated .~/7~ ~~' 19 <br />T <br />Refer to the above number or <br />provide a cony of this order <br />with any claim you may find <br />necessary to file. <br />declare that I am o•+~mer of the real property wherein / /•'w...~~ <br />xists and is located in Township (s), Range / S W, <br />ection ~ Quarter ~[ The Department of <br />ublic Works may purchase from me, ,..• in the quantity <br />stimated below, during the period '3 /) kZ to include <br />~S'/)-f'/ subject to the following Special Provisions: <br />If none this will pe so noted hereon) ; ~~._ ~ r ~-,!~ ~~L-i-~y;L{~~ ~'~ <br />r .i <br /> <br />ait of <br />~asure <br />~L~~~~~~ <br />Approx. No. <br />of Units <br /> <br />Cost <br />Per Unit <br />l~~ <br />(ran ~n,..-~i <br />3yments to be made monthly by Warrants issued by E1 Paso County based upon <br />~e number of units purchased during prior month. <br />irchase Order Acquired <br />(Signature of ller) <br />~~ ~~~~1 <br />ignature <br />~ v..V_~ <br />Title <br />(Purchasing Aqent) <br /> <br />irchase Order Approved <br />Max L:"Rothschild, P: <br />Director of Public Works/County Engineer <br />Gravel p <br />Water <br />Soil [~ <br />Other (~ <br />NUMBER <br />