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'♦■■JUN-19-2006 15: 16 Cf '.ANS SIGNS 916 227 6126 P.01i01 ■ ■ tE OF CALIFORNIA-DEPARTMENT OF TRANSPORTATION dC-59F ACi REGISTRATION NUMBER AGENCY ORDER NUMBER AMENDMENT NO. ■m■■RCHASING AUTHORITY PURCHASE ORDER 26600606127012 CD: 10 - 12753 ■ ■ 85(REV.72005) ■ ■ ■ P U :Agency OrKer ur must b0 iho.rn on DATE PAGE OF PAGES Invefom&pecking r<gp. 06/19/2006 1 1 1 ■ DEPARTMENT OF TRANSPORTATION B DEPARTMENT OF TRANSPORTATION AGENCY BILLING CODE HD-10 MAINTENANCE 1 D10 MAINTENANCE 1 60142 1 1976 EAST CHARTER WAY M.S. L P.O.BOX 2048 M.S. PURCHASING AUTHORITY NUMBER P STOCKTON CA 95205 L STOCKTON CA 95201 _ T PH:209-948-7259 FAX: 209-9483607 T PH: 209-948-7259 FAX: 209-948-3607 LEVERAGED PROCUREMENT AGREEMENT NO, U KENT KIBBLE O KENT KIBBLE CT'IDEFISIFICnTIaIJ t+U1eRER___._.___"---..-----'--- TO WEST AMERICAN SUPPLY AGENCY OR BUYER " ' SUPPLIER INFORMATION AD'D Ror 3036 (Type 3038 PRICE COURT AGENCY NAME DOT CONTACT NAME Print PALO ALTO CA 94,303 CONTACT E-MAIL ADDRESS Legidy) USA CON7I MBER I CONTACT FAX NUMBER SUPPLIER CONTACT NAME SUPPLIER PHONE NUMBER SUPPLIER FAX NUM9ER SUPPLIER EMAIL ADDRESS A M € 7iGv nu Certified Certified EXPIRATION DATE Cenitled EXPIRATION GATE 13223 � ;;all Business Mlcrobuslness 04/30/2007 OvBE mn SHIP G F.O.B.Destination F.O.B. CITY OF ORIGIN STATE ZIP CODE JULY 5,2006 IN Ci10NS 0 F.O.B.Desnnetlon a FRT.PPD/ADD Orlgln OiI FRT,PPD Frcight not t0 c■aood cost stated on P.O. ifill rrEM co'"C"COee a PIIOO�Mt RBLYQlD Nu"e%A ou"r^n`' t ff co0iosfwacpro"u"�p rrr � PRODUCT OR SERVICES DESCRIPTION RECEIVED UNIT PRICE EXTENSION TOTAI. 0 EA S19-921 I EYEWASH STATION, SELF CONTAINED $234.670C $4,693.4000 ( BRADLEY 0 EA 226826 FIRE EXTINGUISHER, DRY CHEMICAL,20*,ABC, $76-5600 $1,531.2000 BADGER 0 EA SE936 CABINET,FIRE EXTINGUISHER $54.330C $1,086.6000 I ALL CHEMICAL PRODUCTS ARE TO BE DELIVERED TO: STEVE RODARTE-CALTRANS MAINTENANCE SUPPORT 1604 SOUTH B STREET,STOCKTON,CA 95206 CONTACT STEVE RODARTE AT 209-948.3723 ON DELIVERY DATE. REFERENCE IS MADE TO QUOTE 00616CTR DATED JUNE 16,2006. ANY ORDER OR DELIVERY QUESTIONS,CONTACT KENT KIBBLE AT 209-948-7259. ANY PURCHASE ORDER QUESTIONS,CONTACT DIANE HULTMAN AT 916-227-6133- A-1 X Genera(Provisions are incorporated horoln by reference to; TAXABLE $7,311.20 r - SUBTOTAL u Form GSPD.401 Non-IT Commodities(Revlslan dais 1 OR � Form 08Pp-401 IT(Revision date TERMS ATTACHED OR FX Published at websile:www.d08.ca0ov/pd TAX RATE SALES AND A-2(� This order is issued under a Deparancnt of Gcrwral Services(000)Leveraged Procurement Agreement(LPA),Terme and 0.000% TAX $584.90 CONDITIONS L Conditions set forth In trial agreement(LPA number referenced in the block tilled Leveraged Prccurcr inintdoreems are incorporated heroin by referenced as If set forth In fun test. "NOTE:If there are Variable 'INSTALLATION B O Aponcy Special Prwislons aro attached and sued charges for Installation, C ^ Any omef attachments,such as specifications.Slatcmont of work,or Information Tectmdogy shipping or freight,or other •SHIPPING I Mod"Language Modules are Identified in the product or services description aroa or on non-taxable services,detail FREIGHT __ continuation per line item and enter total PROCUREMENT METHOD r I - Ildletbn Nunwr Ul'apoli`mtf) here. 'OTHE F7 LEVERAGED n DVBEMMALLBUSINESS(00tas�ebh)) NONCOMPETITIVE BID EXEMPT I NONTAXABI.E� $0.00 CERTIFICATION AND APPROVAL OF EXECUTIVE OFFICEfl ERIRED NO STATE PA10 BY CAL-CARO GRAND I HEREBY CERTIFY,on personal knowledge,that this order for purchasing tho iitoms spocifiad above i3 5URFLUS TOTAL $7,896.10 issued in accordanco with tho procedure prescribed by law governing the purchase of such items for the Stalls"Ca mia;and that A such l9gal ulrementa have been fun complied vAth. VES X NO YES O NO _ 209-948-72DATE ACCOUNTING OFFICE USE: DATE RECEIVED: AUT RIZ( G NAME(PrrR ar T TITLE DATE DATE: DHL A ` TQ ECEivEO BY: I A -- CERTIFIED MECT(SI ATURE RECEIVED VIA: -- CAL ANS ENDO ^- g ENCU ANC N0. FMS V10 rCOROERNUMDEA EOUIPMENTID UF. T.C. M SOURCE^ CHG. EXPENDITURE SUPJOS SPECIAL DESIGNATION A AGCY AMOUNT FFY NOTES p DIST UNIT DIST, AUTHORIZATION OB.I. - - ---- -51Q,5..-_ DISTRIBUTION: Copy t- Supplier, Copy 2.3•Agonoy Procurement File: Copy 4-DGS Procurement: Copes 56•Receiving Copies TOTAL P.01