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State of California-Natural Resources Agency !�)1 i /+�D COO 1141 O <br /> DEPARTMENT OF PARKS AND RECREATION `�'( 1 V <br /> PURCHASE TYPE <br /> PURCHASING WORKSHEET No. ❑Bank Card No, MO.Nr. 1012018 <br /> See instructions for CUF, SEI Preference&DPR 74 box on Page 4. ❑PAPO No. A Q! S-0.r 9 <br /> ITEM SUPPLIER 1 SUPPLIER 2 SUPPLIER 3 <br /> SUPPLIER NAME American Valley Waste Oil, Inc Safety-Kleen Systems <br /> ADDRESS P.O. Box 340 5050 Salida Blvd <br /> CITYISTATEIZIP CODE Delhi,Ca 95315 Salida, Ca 95368 <br /> PERSON QUOTING Julie Huber Jim Plummer <br /> PHONE NO. 800-732-4645 209-408-2614 <br /> FACSIMILE NO. 209-668-3880 <br /> CONTRACT NO.(if applicable) <br /> SMALL BUSINESS,MICROBUSINESS (Check all that apply.) (Check all that apply.) (Check all that apply) <br /> or DISABLED VETERAN BUSINESS ❑SB ❑MB ❑DV13E ONIA ❑SB ❑MB ❑DVSE ❑� NiA ❑SB ❑MB ❑DVBE ❑N!A <br /> Performs Commercially Useful Number: Expires: Number: Expires: Number: Expires: <br /> Function(CUF)'*: ❑ CUF-YES ❑ CUF-NO ❑ CUF-YES ❑ CUF-N0 ❑ CUF-YES ❑ CUF-NO <br /> BIDDER INSTRUCTIONS Rev.11/9/2011 <br /> Q Referred to DGS website ❑� Referred to DGS website ❑ Referred to DGS website <br /> GENERAL PROVISIONS Rev. 612010 <br /> DATE QUOTE RECEIVED/EXPIRES 10/3/2018 1 10/18/2018 10/11/2018 / 11/10/2018 1 <br /> PAYMENT TERIV ISIDISCOUNTS % days or Net 45 % da s or Net 45 % days or Net <br /> WARRANTY PERIOD <br /> DELIVERY INSTRUCTIONS T <br /> ITEM QTy UNIT DESCRIPTION UNIT PRICE EXTENSION UNIT PRICE EXTENSION UNIT PRICE EXTENSION <br /> 1 1 ea Contaminated ScHCYB $800.00 $800.00 $925.00 $925.00 <br /> 2 1 ea GYB box lw liners $125.00 $125.00 $162.00 $162.00 <br /> 3 1 ea Recovery fee $80.00 $80.00 <br /> ❑AddiffonalPages SUBTOTAL $ 925.00 $ 1,167.00 $ <br /> LESS SMALL BUSINESS PREFERENCE" $ $ $ <br /> Enter negative(-)number <br /> EVALUATION SUBTOTAL $ 925.00 $ 1,167.00 $ <br /> FOB DESTINATION,FREIGHT PREPAID $ 0.00 $ 0.00 $ 0.00 <br /> Freight Prepaid. Freight price included in cost of commodity, no additional freight charges added by vendor. State does not accept responsibility <br /> for goods during shipment. <br /> FOB DESTINATION,FREIGHT PREPAY $ $ $ <br /> _ AND ADD <br /> Freight Prepay and Add. Supplier prepays freight and adds cost to invoice. State accepts responsibility for freight upon delivery. Contact DGS <br /> Trans ortation Mana ement for best rates. Cost of fret ht must be noted and added in rice extension. <br /> i <br /> FOB DESTINATION,FREIGHT COLLECT $ ,$ $ <br /> Freight Collect. State accepts responsibility for merchandise at the Supplier's dock and pays freight charges. This is not a suggested method, and <br /> if used you must contact DGS Transiportation Manaaement. Cost of fret ht must be noted and added in rice extension. <br /> EVALUATION TOTAL $ 925.00 $ 1,167.00 $ <br /> Tax is not an evaluation item,add tax to PAPO. <br /> AWARDED TO SUPPLIER NO. 1 - 2 DPR 74, Darfur Certification" Seller's Permit No: 770487458 aRlc DOTES OBTAINED BY <br /> Awardbased on_ ❑Low cost ❑Stock Availability El Prompt Delivery ❑SB Preference 00 <br /> �W!4— <br /> F-1 Other(Explain): DATE <br /> "*See Page 4 for instructions and information 10/15/2018 <br /> DPR 970(Rev.712015)(Excel 7115/2015) Page 1 <br />