Laserfiche WebLink
;I 1 STATE OF COLORADO bk S <br /> PURCHASE REQUISITION <br /> SUGGESTED VENDOR AND ADDRESS PURCHASE SUGGESTED VENDOR AND ADDRESS PURCHASE <br /> ORDER NUMBER ORDER NUMBER <br /> Mil i <br /> VENDOR NUMBER VENDOR NUMBER <br /> i i ZIP ZIP <br /> TERMS "In* FOB TERMS FOB <br /> MEN <br /> ; Y' GODIrNC1::•, <br /> y 9Mi. �. <br /> r O O / .5 'x C <br /> YPE <br /> / T D 9 4 <br /> NO AGENCY ORG SUB-0RG APPR CODE BS ACCT OBJECT SUm REV SRC <br /> `I_I_L_J <br /> 2 7 P R 212 0 3 m 6 4 � 2 3 1 1 <br /> SUB-REV PROGRAM Gel FUNCTION REPORTING CAT pROJ/JOB NO OFF RE <br /> m L I 1 1] � <br /> 20 3E <br /> BILL TO-Name and Address SHIP TO-Name and Address <br /> Division of Minerals and Geology Designated Job Sites, per specs <br /> 1313 Sherman Street, Room 215 <br /> Denver, Colorado 80203 <br /> REQUESTING AGENCY-Name and Address TELEPHONE PERSON(S)TO CONTACT <br /> Same as Bill To 866-3567 Maggie Van Cleef <br /> FAX <br /> 832-8106 <br /> 1 hereby certify mat the supplies or services Est �aresary forme atreeessfu�rat' or a agenq and thequanOty requested fs the minmum amount and f suf(ident b coverAUTHO D S <br /> ITEM QUANTITY UNIT COMMOD NU BER AND UNIT gMOUNT <br /> NO. COMPLETE DESCRIPTI F ITEM OR SERVICE COST <br /> REFERENCE PRICE AGREEMENT N <br /> Ref. Bid Number RN-MINES-313 <br /> 1 1 Project City of Mines Inactive Mine Reclamation <br /> LIA 0 <br /> Project N/A /5 �-Y <br /> ( This project is subject to advertising be ore <br /> !! final payment (CRS 38-26-107) . In additi n, <br /> i retainage will be held at 10%. <br /> I All in accordance with specifications, drawings, <br /> E terms and conditiond of the above bid and the <br /> ( attached BID SCHEDULE (Line Item Price) sleet, <br /> ' ! which are made a part hereof by reference <br /> t � . <br /> 1 <br /> f i E <br /> REQUESTED DELIVERY DATE <br /> 395-53-05-2141 !3 <br /> WHITE-Purchasing Copy YELLOW-Accounts 6 Control Copy PINK-Agency Copy GOLDENROD-Department Copy <br />