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: P T IA�HA�.�E , <br />P o10 �r. .j.; .. . -.. " TInc; t t 7 r,.: iifY r ,s. T OW ( � R- <br />IMPORTANT <br />• 4ami b,d . a. < < . r � <br />'T •y h. <br />i <br />5 The. PO#,and LUte.item IE * * S r,I,ATEi,a �b qta+ <br />,. ,•. ' , r.,: 01 ��COLORADO <br />�,f must eaf On' I u �r f SS a j bvl:l tbi r... <br />Buyer: UQU� '` cc ` invoic sPPadctng slips, . y3 rc: flJ ur t1 t� zc ntxla <br />�; lry .3SYI�EKr? <br />mber., � and - <br />:. P�. #, �� . <br />Phone Nu <br />'Agency ContacI th�f' correspondence.. ; <br />Phone Number:�C ��� a S' ` �` State Award <br />FEIN Phone: <br />Vendor Contact <br />Purchase Requisition*': < <br />E T) t. <br />O <br />R <br />. INSTRUCTIONS TO VENDOR: <br />1. If for any reason,, delivery of this order is delayed beyond the deliveryMstallation date <br />shown, please hotly "the agency contact named at top. left. (Rlght of cancellation is <br />reserved'in Instances In which timely delivery is not made.) <br />2. All chemkals, equipment and materials must conform to." standards required by OSHA. <br />3. NOTE: Additional terms and conditions on rse side. <br />BID #. - /�v� <br />invoke. in <br />Triplicate <br />To:. <br />Payment will be made by this, agency.. <br />Ship <br />To: <br />Delivery/Installation Date: 0? <br />F.O.B._I <br />LINE COMMODf1Y/ITEM UNIT OF <br />REM CODE MEASURE- m UNIT COST UN COST TOTAL REM COST <br />L <br />lannen L <br />462 <br />THIS PO IS ISSUED IN ACCORDANCE WITH STATE AND FEDERAL REGULATIONS. <br />FORM DP -01 (5195) <br />395 -3055 -0233 <br />VENDOR <br />FOR THE STATE OF COLORADO <br />Authorized Signature <br />