Laserfiche WebLink
STATE OF COLORADO I <br /> PURCHASE REQUIc TI IN <br /> SUGGESTED VENDOR AND ADDRESS PURCHASE B GGE ED VENDOR AND ADDRESS PURCHASE <br /> ORDER NUMBER <br /> AZCO Construction 1 <br /> 2055 Hwy 50 VENDOR NUMBER VENDOR NUMBER <br /> Penrose CO ZIP 81240 ZIP <br /> TERMS Tax ID #84-1023014 FOB TERMS FOB <br /> D4C'' ID CODE NO. <br /> V DATE �' (A T PPDD BUD FY A T PV TYPE <br /> L_LJ—LJ 9 4 • <br /> UND AGENCY ORG SUB-ORG APPR CODE BS ACCT OBJECT SUB-OBJ REV SRC <br /> 2 7 7 P K A IC IC I C 8 m 1 2 2 1 1 1 2 1311 1 m <br /> SUB-REV PROGRAM GBL FUNCTION REPORT PROJ/JOB NO OFF RE� <br /> mMIN R C IL <br /> BILL TO-Name and Address SHIP TO-Name and Address <br /> Division of Minerals and Geology Desingated Job Site <br /> 1313 Sherman St. , Rm. 215 <br /> Denver, CO 80203 <br /> REQUESTING AGENCY-Name and Address TELEPHONE PERSON(S)TO CONTACT <br /> Same as bill to' (303) - <br /> 866-3567 Maggie Van Cleef <br /> Ax (303) <br /> 832-8106 <br /> I hereby certify that the supplies or services s d are necessary for the successf oper tion f t agenc and the <br /> quantity requested is the minimum amounWud at is icie to cIov sam <br /> AUTHORIZED SIGNATURE <br /> ITEM QUANTITY UNIT COMMOD Y NUMBER AND UNIT AMOUNT <br /> NO- COMPLETE DESCRIPTION OF ITEM OR SERVICE COST <br /> REFERENCE PRICE AGREEMENT q <br /> Trinidad Basin Mining Company <br /> Permit #C-81-048 <br /> Emergency Sediment Pond Repair <br /> 1 1 Job Excavate embankment failure, install CSP N/A $4,385.00 <br /> and anti-seep ring. <br /> 2 80 Lin. Ft.12-inch diameter, 16 gauge CSP $12.00 960.00 <br /> 3 1 Each Larger anti-seep ring, if required N/A 50.00 <br /> TOTAL $J395.00 <br /> REQUESTED DELIVERY DATE <br /> 395-53-05-2141 <br /> WHITE-Purchasing Copy YELLOW-Accounts 8 Control Copy PINK-Agency Copy GOLDENROD-Department Copy <br />