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Check One <br />PURCHASE ORDER <br />E1 Paso County <br />DEPARTMENT OF PUBLIC WORKS <br />3170 Century, Colo. Spgs., Colo. 80907 <br />eller ~J~ f'~ /Q cc- Dated 'cc <br />ddress `~ ~ Refer to the above <br />/'lL`~ / ~~~C rn~3~ provide a copy of <br />( ~,J ,,( lI with any claim you <br />~ necessary to file. <br />Gravel, <br />Watez <br />Soil p <br />Other <br />NUMBER <br />G3/ a ~ <br />~19 <br />number or <br />this order <br />may find <br />declare that I am o'+~mer of the real rooerty wherein ~iLr-..•~ <br />gists and is located in Township~~(s), Range .!O W, <br />action /~ Quarter N ~ The Department of <br />iblic Works may purchase from me, in the quantity <br />~timated below, during the period e E ) /~ ~ to include <br />~e~ie. ) / sybject to the, llo ing Special Provisions •/ ,/ <br />if , ne this ~wi 1 b ~, noted hereon) . _ ~~~so ~~- .~ ~:. ~ _~P~~,e,/ ~Y <br />pit of <br />~asure <br />~~ ~/~ <br />Approx. No. <br />of Units <br />Cost <br />Per Unit <br /> <br />~a <br />~.~~ ~ <br />yments to be made monthly by Warrants issued by E1 Paso County based upon <br />e number of unite purchased during prior month. <br />(Signatu of Seller) <br />rchase Order Acquired by, <br />ignature <br />f-: <br />``~~ T i <br />- ~5.,~~ <br />(Purchasing Aqent) + <br />rchase Order Approved <br />e-~ <br />by <br />Max L. Rothschild, P.E. <br />Director of Fublic Works/County <br />Engineer <br />