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nn DATE: PURCHASE <br /> ��01+,cow <br /> L�MINERALS, & GEOLOGY ?0-13-95 <br /> 1313 SHERMAN STREET , ROOM 215 IMPORTANT ORDER- <br /> D E NV E R, CO 80203 The PO#and Line Item# ** ** STATE OF COLORADO <br /> must appear on all 1876 - <br /> Buyer: invoices,packing slips, <br /> Phone Number: MAGG I E VAN C L E E F cartons,and P O, # Page# <br /> Agency Contact: 3 0 3—8 6 6—3 5 6 7 correspondence. PD PKA 96000000011 01 <br /> Phone Number: D E B B I E M U L L O Y State Award# <br /> FEIN Phone: BID# <br /> Vendor Co&4:178012 970-882-4383 <br /> Purchase RequisiArTgVE RENNER Invoice in <br /> Triplicate To: DIV OF MINERALS & GEOLOGY <br /> V 1313 SHERMAN STREET, ROOM 215 <br /> E RAY WARD TRUCKING DENVER, CO 80203 <br /> N <br /> D 30193 HIGHWAY 184 <br /> O Payment will be made by this agency <br /> R DOLORES CO 81323 Ship <br /> INSTRUCTIONS TO VENDOR: To: DESIGNATED JOB SITE, PER SPECS <br /> 1.If for any reason,delivery of this order Is delayed beyond the delivery/installation date <br /> shown,please notify the agency contact named at top left.(Right of cancellation is <br /> reserved In Instances in which timely delivery is not made.) <br /> 2.AN chemicals,equipment and materials must conform to the standards required by OSHA <br /> Delivery/Installation Date: <br /> 3.NOTE:Additional terms and conditions on reverse side. FOB 10—11—9 5 <br /> DESTINATION POINT <br /> SPECIAL:INSTRUCTIONS: <br /> lJIE COMg10DITYATEM 11NR OF 0UANTrrY UNIT COST TOTAL REM COST - <br /> rtEM ', CODE MEASURE <br /> 001 96273000000 EACI 23,000.000 1.000000 $23,000. 00 <br /> MID—CONTINENT/COAL BA IN C-81-017 <br /> DUTCH CREEK FUME EMER ENCY MAINTAIN. PR J/S RENNER <br /> DOCUMENT TOTAL $23,000. 00 <br /> THIS PO IS ISSUED IN ACCORDANCE WITH STATE AND FEDERAL REGULATIONS. FOR THE STATE OF COLORADO <br /> FORM DP-01(M5) Cz <br /> 395-30-554233 REQUISITIONING AGENCY Authorized Sig <br />