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I T NEERALS & G=OLCGY DATE: 06-22-�� �0F,Cp�O� PURCHASE <br /> 1 3 i 3 SHERMAN STREET . ROOM 215 N��%V;Ilz? 90 ORDER <br /> DENVER , CO 80203 IMPORTANT +* * <br /> The PO#and Line Item# STATE OF COLORADO <br /> Buyer: YVONNE B ^� must appear on all 1s�s <br /> ,ANNC <br /> invoices,packing slips, <br /> Phone Number: 866-3567 cartons,and P.O. # PD PKA 9800000003-0 Page If 01 <br /> Agency Contact: S P,E N N E R/D MU L LOY correspondence. <br /> Phone Number: 303 866-3567 ACC : 06-1 9-98 State Award# <br /> FEIN 840893781: Phone: 970-565-8722 BID# <br /> Vendor Contact: WA L—I E R H E N E S <br /> Purchase Requisition#: Invoice in D I V OF MINERALS & GEOLOGY <br /> Triplicate <br /> To: 1313 SHERMAN STREET , ROOM 215 <br /> v SOUTHWEST SEED INC DENVER , CO 80203 <br /> E <br /> N <br /> D 13260 COUNTY ROAD 29 <br /> o DOLOR ES CO 81323 Payment will be made by this agency <br /> R Ship DESIGNATED JOB SITE , iz 'ECS <br /> To: <br /> INSTRUCTIONS TO VENDOR: <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.All chemicals,equipment and materials must conform to the standards required by OSHA. <br /> Delivery/Installation Date: 0 6—2 4—9 8 <br /> 3.NOTE:Additional terms and conditions on reverse side. F.O.B. DESTINATION STATE PAYS FREIGHT <br /> SPECIAL INSTRUCTIONS: <br /> LINE COMMODITYATEM UNIT OF QUANTITY UNIT COST TOTAL ITEM COST <br /> ITEM CODE MEASURE <br /> VENDOR OFFSET INTERCEPT SYSTEM FOR : (A)UNPAID CHILD SUPPORT DEBT OR <br /> CHILD SUPPORT ARREARAGES: ( B )UNPAID BALANCE OF TAX , ACCRUED INTEREST ,OR <br /> OTHER CHARGES ; (C)UNPAID LOANS DUE TO THE STUDENT LOAN DIVISION OF THE <br /> DEPARTMENT OF HIGHER EDUCATION ; ( D )OWED AMOUNTS REQUIRED TO BE PAID TO <br /> THE UNEMPLOYMENT COMPENSATION FUND; AND ( E )OTHER UNPAID DEBTS OWING TO <br /> THE STATE OR ANY AGENCY THEREOF , THE AMOUNT OF WHICH IS FOUND TO BE <br /> OWING AS A RESULT OF FINAL AGENCY DETERMINATION OR REDUCED TO JUDGMENT <br /> AS CERTIFIED BY THE CONTROLLER . <br /> 001 79020000000 EACH 5 , 242 . 630 1 . 000000 $5 , 242 . 63 <br /> MID—CONTINENT/COAL BASIN BOND FORFEITURE/PERMIT C-81 -017 <br /> —SEED BID PER DOCUMENTED QUOTE AND ATTACHED BID SCHEDULE <br /> 7,0CUt,I-',4T —07A` — $5 242 63 <br /> THIS PO IS ISSUED IN ACCORDANCE WITH STATE AND FEDERAL REGULATIONS. FOR THE STATE OF COLORADO <br /> FORM DP-01 (5/95) V E N D O P. <br /> 395-30-55-0159 Authorized Signature <br />