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STATE OF COLORADO <br />~~ ~ ~/u~~~ PURCHASE REQUISITION <br />SUGGESTED VENDOR qND ADDRESS PU RCMASE <br />ORDER NUMBER SUGGESTED VENDOR AND ADDRESS PURCHASE '~. <br />ORDER NUMBER <br />DIRT-N-IRON <br />1417 326 RD VENDOR NUMBER VENDOR NUMBER <br />DO zIP 81652 <br />SILT COLORA zIP <br />I <br />TERMS TAX IDI~ SZZ-31-6989 FOB TERMS FOB <br />DOC ID CODE NO. <br />G/~ciaov 3a ~ <br />P ~ ~ ~ T PR B~D F3 ~ PV~TYPE <br />FUND AGENCY ORG SUB-O RG APPR CODE BS ACCT OBJECT <br />2 7 0 P K A C C 8 m 1 0 8 ~ 2 8 2 0 SUB-OBJ REV SRC <br />m <br />GB <br />REPOR <br />SU <br />FUNCTI <br />PROJIJOB NO <br />P <br />M OFFOFF RE <br />T <br />M N <br />R C <br />~ <br />~ <br />m ~ <br />BILL TO - Nama aM Atltlrass SHIP TO -Name antl Atltlfess <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 /> <br />I FAx <br /> 832-8106 <br />I here0y cenity that the sup Plies Or services list ar n esspry br tna succes ul pper m pt.(ne agenyy antl the <br />Ruanuty reauastetl is the minimum amount antl fu tl sig ate/y/y s sufficient Ip c r e ~ <br />Nj"/ <br />AUTHO RIZEp N TU <br />INO OUANTITV UNIT COMPLETE OE CRRPTfON OF TEM OA SERVICE COST AMOUNT <br />: ! REFERENCE PRICE AG REE MENT a I <br />Ref. Bid Number RN-MINES- 302 <br />i <br />1 1 Project 1{DfDii&XD(#dD9t~X~~MX%XB(~%~~(7f%~D(XP(9(~~~~'1; N/A $24,000.00 <br />L & L Energy/Blue Flame Revoked Site <br />Permit No. C-81-053 <br />i <br />i <br /> <br /> <br />This project is subject to advertising before f <br />I <br />fanal 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 />- 6252FREOUESTEO DELIVE RV GATE <br />J95-5J-05-21a1 <br />WHITE ~ Purchasing Copy VELLOW -Accounts 8 Cpntml Copy FINN ~ Agency Copy GOLDENROD -Department Copy <br />