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�- STATE OF CALIFORNIA AGENCY BILLING CONTRACT/DEL N NO. PAGE OF PAGE <br /> +CONTRACT/DjrLEGATION PURCHA•ORDER CODE <br /> ti <br /> 0 :I. I i!)Fc <br /> 0 0 <br /> STD.BE(REV.492) TI <br /> (CONNUOUS) 1, 't <br /> S DEPT. HQAT INu & WA(ERWAYS B DE:f'1'„ B0A'r 1 Ni.; & WATERWAYS IM <br /> TN. Y.xAA ) <br /> " 000 EVERGREEN STRE:h`..1' � X7.004 E'VE:RL"tif�E:Ei:t! aE�>TYiF,.F'T' asl <br /> P SACRAMENTO, CA 99615- 5896 L sACRAMEiN rO, GA I.J 8 1.!5 <br /> AGENCY ORDER NUMBER <br /> TD ADMINISTRATIVE: SERVICES TD t":D99-206Y <br /> (300 A.M. — 5sOO P.M. VENDOR: THIS NUMBER MUST BE <br /> ► , SHOWN ON INVOICE. <br /> II) E.XP DATE',s / COMPLETE ONLY <br /> FCOUNTY OF' SAN JOAl'AJ .N WHEN TO BE USED AS VENDOR'S INVOICE <br /> VEN <br /> TO OFFICE OF E:.ME:.ROENCY I hereby cerNry that this is a true NUMBERS INVOICE <br /> FIRM <br /> ADDRESS ROOM 6101 COURTHOUSE HOUSE'_ and just bill and payment has net <br /> (Type or <br /> 222 F. WEBER AVENUE. been received. <br /> Pint STOCKTON, CA 9"5202 VENDOR'S SIGNATURE <br /> Legibly) I , <br /> L st J TITLE(OWNER, MGP..CLENR,ETC.) <br /> VENDOR NUMBER I 9/B '%all ETH <br /> I a. Vendor's Federal Employer Identification Number <br /> 1. Show the Agency order number and Contract) <br /> I is repairer. <br /> NOTICE Delegation cash number is your IIIVOILa. VENDOR'S TAXPAYER I.D. NUMBER/FEIN) <br /> I 5. Submit original raceipter expense bills if your <br /> TO 2. Show t invoice <br /> viscounts offered I on your invoice. <br /> I invoice inclutlas prepaid trenaparletion chargee. <br /> MERCHANT I 3. Submit invoice in triplicate.If not an printed bill e. All shipments shell be F.O.B. destination unless <br /> /lJJg¢ I hear,vendor please sign invoice. otherwise stated on this order. .RMS <br /> SHIP VIA l�ill'. 1 .•'.0 DAYS <br /> ITEM NO. QUANTITY UNIT COMMODITY CODE DESCRIPTION UNIT PRICE EXTENSION <br /> .40lla< iardcs Matyiais Management <br /> !.50 <br /> Program (HMMP) latei fti for <br /> the Witter-Hyacinth Control <br /> V,v oclram Account. i! 8146 <br /> yAV 9 I3M LU ' <br /> AY <br /> Y ) I <br /> I){ P.:tinal :i.rlri FORe WatFar Vivac:inth¢ Nicole:, Dolyt . ca 0.00 <br /> SALES TAT <br /> A PROGRAM CATEGORY(CODE AND TRLD FUND TITLE (OPTIONAL USE) 1' I <br /> C <br /> G it f) ('l�l('t r I I!all la ('('./l g 1 OJUO TO'PAL I VS'/ 50 <br /> A A <br /> ATUT <br /> R I ITT E .E"M CHAPTER STE FISCAL YEAR OBJECT OF EXPENDITURE(CODE AND TITLE) <br /> E ;'S660-00 516 `:.0 ^]`?9 >9/00 2,5,6 El O.E. ❑ Eo. <br /> T <br /> CERTIFICATION AND APPROVAL OF EXECUTIVE OFFICER UNENCUMBERED REMAINDER AFTER <br /> I HEREBY CERTIFY,On erown sonal knowledge that this order or the rchase POSTING T.I.ORDER TO ALLOTHENT <br /> y per g f pn IXPENDRURE LEDGER <br /> of the items specified abode u teamed in accordance with the procedure prescribed by law <br /> governing the purchase of such items for the State of California; that all such legal <br /> ADJUSTMENT <br /> requirements have been fully COm(IRed with. INCREASING ENCUMBRANCES <br /> A:=11+37.1Tt??9?3 S*1!t`VAC:e?s Officcaar (1?16)26..',--0(370 wwUaTMENT <br /> .�� DECREASING ENCUMBRANCES <br /> SIGNATURE CERTIFIED CORRECT IeIGNATURE) <br /> 1► <br /> 'DISTAIBUTION: Copy I r Copy y- Procurement; Copy 3 - Packing Slip;6es 4-7 - Miscellaneous(Agency) <br />