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STATE OF CALIFORNIA <br /> AGENCY BILLING CONTRACT/DELEGA 0 PAGE OF PAGE <br /> CIUNTRAIET/DELEGATION PURCHASORDER Co,N <br /> STD. 615(RFV.421(CONTINUOUS) `i STATE ft-LOL-1 I <br /> S DE'F'T. BOATING & W011:_RWAYS B DEPT. BOATING & WATERWAYS <br /> H <br /> 2000 E:VERGREEN STREET 2000 E <br /> -VER6REEN <br /> IF SACRAMENTO, CA '?5815--3896 L SACRAMENTO, CA 9S-58TREEFET <br /> 15 AGENCY ORDER NUMBER <br /> T ADMIN1.13"T'l-RATIVE SERVICE.-E-S T <br /> 0 0 CT00 4036 <br /> 8"00 A.M. - 5.-00 P.M. VENDOR: THIS NUMBER MUST BE <br /> Do. ► SHOWN ON INVOICE. <br /> FCOMPLETE ONLY- WHEN TO BE USED AS VENDOR'S INVOICE <br /> TO Office of Emergency Services VENDOR'S INVOICE <br /> FIRM I hereby certify that this is a true NUMBER <br /> ADDRESS 222 E. Weber Avenue andjust bill and payment has not <br /> (Type or Stack-Lon, CA 95202 been received. <br /> Print VENDOR'S SIGNATURE <br /> Legibly) 01. <br /> LN TITLE(OWNER.MOR., CLERK, B-tin 2 <br /> VENDOR NUMBER LL1 L ST. LJ <br /> NOTICE 1. Show the Agency order number and Contract/ 4. Vendor's Federal Employer Identification Number sMJ0AQUINGUUWly <br /> TO Delegation number on your invo Is required. FIAPPIENCYSERVICES <br /> Show cash discounts offered oricenI,In S.Submit original mceipted expense bills if your VENDOR'S TAXPAYER Will W&MOEW-1191FIN) <br /> MERCHANT 3. Submit invoice in triplicate.If not on prionitce!bill invoice includes prepaid transportation charges. <br /> head,vendor please Buy,invoice. 6.All shipments shall be F.O.B. destination unless <br /> I othenriae stated on this order. <br /> oV!?V.P1f6oi SHIP VIA �" ',-','0 DAYS <br /> ITEM NO, QUANTITY UNIT COMMODITY CODE DESCRIPTION UNIT PRICE E% ENSION <br /> 1. EA 2001 I-I%IMF* Annual. Fee 405,.00 405.00 <br /> &Wata--Tall <br /> P'VOLVING FUND <br /> L <br /> DER't J. I-C-Ei F'aicl 1::'(')R-. Facili.-ties. Sumer Goza 1 0.00 <br /> SALES TAX I <br /> C A PROGRAM CATEGORY(CODE AND TITLE) FUND TITLE (OPTIONAL USE <br /> A 1C 'AC $405.00 <br /> H G �,LJFTDRT CL-R .F, 'T HWRF F'C 16500 TOTAL <br /> A A I I <br /> R N ITEM CHAPTER I STATUTE I FISCAL YEAR OBJECT OF EXPENDITURE(CODE AND TITLE) <br /> IS <br /> G -';1' 3 <br /> E T . 5k: 0-001--516 52 P000 1 00/01. 1 2S8 0 O.E. 0 EQ. <br /> CERTIFICATION AND APPROVAL OF EXECUTIVE OFFICER UN...UMBEFRE.REMAINDER Alan <br /> MSTING THIS ancient TO ALLOTMENT <br /> I HEREBY CERTIFY,On my own personal knowledge that this order for the purchase "ISIDI <br /> TURE LEDGER <br /> of the items specified above 0 issued in accordance with the procedure prescribed by ISw <br /> governing the purchase of such items, for the State of California: that all such legal ADI.STABRIT <br /> requirements have been fully complied with. INCREASING ENCUMBRANCES <br /> fLE <br /> lTuiEiness Services Officer (916)26-,!;--0870 DUUSTAE.T <br /> DECREASING ENCUMBRANCES <br /> SIGNATUBE, I CERTIFIED CORRECT(SIGNATURE) <br /> ► D3—f;? o .1 is. <br /> DISTRIBUTION: Copy 1 - Vendor; Copy 2 - Procurement; Copy 3 - Packing Slip; Copies 4-7 Miscellaneous(Agency) <br />