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wiN e o Acct. STO 2.76"' 2 <br /> z _ r <br /> Date Job Order No. I I 0 d 3 <br /> Street, City, &talo &Zip <br /> 1. <br /> WUHK TO BE DONE <<Q1rJ <br /> SHOULD BE COMPLETED BY 2 �- 19 9 Z WORK AUTHORIZED BY `��` � % �-�2 <br /> 1 <br /> Thi is o certify�hak was satisfactocil�rcofnpleted. <br /> Retailer's Signature Date Job Completed <br /> TEXACO REFINING AND MARKET INC. ONTRACTOR'S INVOICE <br /> �,D,�SCRIPTION F WORK DONE <br /> /y7 <br /> �G Description of work to be done subject to terms on revere side <br /> hereof.Performance of work by contractor shall constitute accep- <br /> Description of Materials Used From the Contractor's Stock(Use Attach- tance of terms on reverse side hereof. <br /> ment if Necessary.) <br /> S Attach Vendor's Invoice q Covering Material Purchased. MATERIAL/ MARKUP TOTAL <br /> V RENTAL COST <br /> C s 2qq Ir 3.70 , -1 <br /> N 4J.c C 30 J O <br /> T <br /> R ,�u-0 v-•�- O(J 2 o <br /> A <br /> C <br /> T <br /> MATERIAURENTAL/SUB CONTRACT TOTAL $ Q Z <br /> L NAME CLASSIF DATE TIME-AWPM HOURS RATE TOTAL <br /> A - Arrival Departure Labor Travel Total' PERMOUR <br /> B <br /> K Z-f3 e vo /i ;dU Z <br /> E �+.� 2-u /: aU 3: 04 2 Z- <br /> R <br /> E <br /> C <br /> O <br /> R <br /> D 'EXCLUDING MEAL BbEAKS TOTAL LABOR COST $31111 /0 <br /> Mileage(If applicable) Miles @ 3 t ¢ Per Mile Total Mileage TOTAL MILEAGE $ 0, 2 j� <br /> TAXBL <br /> AE AMT 7� 323, 02— $ 3,q2 <br /> AAYMr,T8� <br /> n�T,DAYS TOTAL INVOICE $ 17, 6 <br /> (we)certify that the above mentioned work was performed by me(us)in a workmanlike manner and charges are in accordance with terms agreed upon <br /> or with the Texaco Form S-240 "Hourly Rate Contract" which may be in effect and that I (we)certify that the above mentioned work was performed in <br /> accordance with all applicable federal, state, and local laws and regulations. <br /> The undersigned shall maintain accurate records pertaining to all work performed hereunder and all transactions related thereto and agrees to retain <br /> all such records for not less than two years after completion of the work performed hereunder.The undersigned shall not pay any commissions, fees,or <br /> grant any rebates to any employe or officer of COMPANY nor favor employes or officers of COMPANY with gifts or entertainment of significant cost or <br /> value nor enter into any business arrangements with employes or officers of COMPANY,other than as a representative of COMPANY,without COMPANY'S <br /> written approval.Any representative or representatives authorized by COMPANY may audit any and all records of CONTRACTOR relative to the work performed <br /> hereunder and all transactions related thereto for the purpose of determining whether there has been compliance with this agreement. <br /> Contractor agrees to reimburse Company promptly for any payments made hereunder for labor performed on and/or materials furnished to any property <br /> other than that specifically set out in this agreement. VENDOR NO. ._.2 <br /> CONTRACTOR'S <br /> NAME(Print or Type) <br /> G <br /> ADDRESS, STREET CITY &STATE ZIP <br /> WEst SavuneAtoD, lSb91 - Z <br /> AUTHORIZED S DATE Z <br /> �2 � � �1,37 <br />