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Check One <br />PURCHASE ORDER <br />E1 Paso <br />DEPARTMENT OF <br />_~ ,~ j X3170 /Century, Colo. <br />~ller_ D <br />County <br />PUBLIC WORKS <br />Spgs., Colo. 80907 <br /> <br />Gravel <br />Water <br />Soil ~] <br />Other (~ <br />NUMBER <br />D/ /y Z <br />Dated , i ~ 19~ <br />Refer to the above number or <br />provide a copy of this order <br />with any claim you may find <br />necessary to file. <br />declare that I am o-+vner of the real property wherein ~,L,~J~ <br />fists and is located in Township // (s), Range ~/> W, <br />ction ftf Quarter ' ~{ The Department of <br />blic Works may purchase from me, _~ in the quantity <br />timated below, during the period ~~=,2~_/~ QU to include <br />.D ~_/p&'1 subject to the following Special Provisions: <br />f none this will be so noted hereon). L~.~~_cs__i1 .~~~ ~~,/,~ ,~ <br />.t of <br />sure <br /> <br />Approx. No. <br />of Units <br />Cost <br />Per Unit <br />/O cl <br />_~ <br />~-,. ca~ <br />ments to be made monthly by Warrants issued by E1 Paso County based upon <br />number of units purchased during prior month. ~ ~ <br />phase Order Acouired by <br />/ / Signature <br />U Titl ~v~ <br />7 ~~ <br />(Purchasing Agent) <br />~~,, ~. <br />hale Order Approved by //«j'~ f / ~ .~--f <br />Max L: Rothschild. P.E. <br />Director of Public WorY.e/County Engineer <br />