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Q DATE' PURCHASE <br /> IMPORTANT ORDER <br /> The PO#and Line Item# ** ** STATE OF COLORADO <br /> Buyer v � must appear on all tare <br /> Invoices,packing slips, <br /> Phone Number: (!7 u - 35u 7 cartons,and P.O.# P D P K 1 4+ Page# <br /> Agency Contact— j(✓vL yv,,( Ac�,� correspondence. <br /> Phone Number: — 35 u / State Award# <br /> VEIN Phone:� � 7�S1JV�VQ/^. �� 3 BID# <br /> Vendor Contact <br /> Purchase Requisition#: ? -- Invoice in <br /> y /7,) Triplicate <br /> To: �� <br /> V ` <br /> N ccss�a v.� 1J l v e {� ��,,, ,� L 3 /3 bv� <br /> O Gee le--j CC) '3v Le Payment will be made by this agency <br /> R Ship <br /> To: <br /> INSTRUCTIONS TO VENDOR: <br /> 1.If for any reason,delivery of this order is delayed beyond the delivery/installation date <br /> mown,please ratify the a noy contact named at top let(Right of cancellation is <br /> reserved in instaraes in which timely delivery is not made.) �C, ` 1 <br /> 2.All chemicals,equipment and materials must conform to the standards required OSHA. `�_ ' '� <br /> 3.NOTE:Additional terms and conditions on reverse side. <br /> Delivery/Installation Date:J r 10 <br /> F.O.B. <br /> SPECIAL INSTRUCTIONS: <br /> LINE COMMODR1rrtTEM UNrr OF REM CODE MEASURE OUANT" UNrr COST TOTAL REM COST <br /> 110 C /4Y c lJ-(4 ' 1 3 C <br /> -70 <br /> 13J <br /> C-(5 L <br /> 1 <br /> THIS PO IS ISSUED IN ACCORDANCE WITH STATE AND FEDERAL REGULATIONS. FOR THE STATE OF COLORADO <br /> FORM DP-01 (5/95) <br /> 395-30-55-0233 VENDOR Authorized Signature <br />