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TATE OF COLORADO <br />l 7J ~uu~T L PURCHASE REQUISITION <br />SUGGESTED VENDOR AND ADDRESS PURCHASE <br />OR DER NUMBER SUGGESTED VENDOR AND ADDRESS PURCHASE <br />ORDER NUMBER <br />DIRT-N-IRON <br />1417 326 RD VENDOR NUMBER VENDOR NUMBER <br />SILT COLORADO zIP 81652 zIP <br />TERMS TAX IDII 522-31-6989 FOB TERMS FOB <br />DOC ID CODE NO. <br /> G~ G c7 o v 3L~Z <br />V , ~ :t G ~ A PRD 9 3 ACT PV T YPE <br />FUND AGENCY ORG SUB-O RG APPR CO <br />2 7 0 P K A C C 8 m 1 0 DE BS ACCT OBJECT <br />8 ~ 2 8 2 0 SUB-OBJ REV SRC <br />m <br />SUB-REV PROGRAM GBL FUNCTION DEPORTING CAT ppOJ/JOB NO OFF REC ACCT <br />m M N R C <br />BILL TO -Name and Atltlress SHIP TO -Name and Atltlress <br />Mined Land Reclamation Division Designated Job Site s, Per Specs <br />1313 Sherman Street, Room 215 <br />Denver, Colorado 80203 <br />REQUESTING AGENCY -Name antl Atltlress TELEPHONE PERSON(S) TO CONTACT <br />Same as Bill TO 866-3567 MAGGIE VAN CLEEF <br /> FAX <br />q <br />C <br /> <br />f <br />832-8106 <br />I ftereby cedity Ih at the supplies or serv ¢as 1i 51 ar <br />n es;ary for [fte succes ul pper io f.(~e agenr4y antl tse <br />puanp ty rapU95fetl is the minimum ampum antl fu a sig ate s s tlin ant m r e - /~ <br />"/ / <br />AUTHORIZED N TU <br />ITEM OUANTITV UNIT COMMODITY'N UMBER AND <br />NO. COMPLETE DESCRIPTION OF ITEM OR SERVICE - UNIT AMOUNT <br />COST <br />REFE RENCE PRICE AG REE MENT 4 <br />i <br />I -' <br />i <br />Ref. Bid Number RN-MINES- 302 <br />i <br /> <br />t <br />i <br />1 ~ 1 Project aiD~91~XADfX~~(X%~O(II(XB(~%~~d('%%~MX~9(~X~~~ <br />N/A $24,000.00 <br />L & L Energy/Blue Flame Revoked Site <br />Permit No. C-81-053 <br />3 <br /> <br />1 <br />I <br /> <br />This project is subject to advertising before ( <br />f <br />~ <br />final payment (C.R.S. 38-26-107). In addition,' <br />retainage will be held at 10%. <br />All in accordance with specifications, drawings <br />terms and conditions of the above bid and the <br />attached BID SCHEDULE (Line item Price) sheet, <br />which are made a part here of by reference. <br />{ <br /> <br />~ <br /> <br />', 625ZFR EOUESTED DELIVEflY DATE . <br />395-53-OS-2141 <br />WHITE ~ Pwcn asmq Copy YELLOW -Accounts 8 Convol Copy PINH -Agency Cppy GOLDENROD -Department Copy <br />