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STATE OF CALIFORNIA-GENERAL SERVICES PROCUREMENT DIVISION PURCHASING AUTHORITY PURCHASE ORDER CONTRACT REGISTRATION NUMBER AGENCY ORDER NUMBER AMENOMENTNO STD 65(REV 712003) 4500510840 00000000 SUPPLIER: The numbers Identified above DATE PAGE OF PAGE MUST be shown on Invoice&Packing Slip. 11/19/2019 1 1 1 S Northern California YCF B Dept.of Corrections and Rehabilitation AGENCY BILLING CODE H 7662 S. Newcastle Road I Attn: Accounts Payable 84059 P Stockton,CA 95215 L P.O. BOX 187021 -- INFORMATION TECHNOLOGY PROJECT IDENTIFICATION NUMBER TO SUPPLIER' ELITE SUPPLY SOURCE AGENCYORBUYER AGENCY TRACKINCMeQUISrt{oNNUMBERIOptional) ADDRESS 2675 LAND AVE INFORMATION , 10574738 ('l}pe,,r SACRAIVIENTO,CA95815PROPERTY A©ENOYINAME CONTACT NAME' !'rim CDCR Anne.Lao '.CONTACT E-MAA,ADDRESS anne.lao@cdavea,gov CONTACT PHONE NUMBER .:OONTACTFAX NUMBER, (209),944-vW3 x'# SUPPLIER CONTACT NAME SUPPLIER PHONE NUMBER SUPPLIEl Z FAX NUMBER SUPPLIERE-MAIL ADDRESS 9168530000 9168535800 SALES ei)ELITESUPPLYSOURCE.0 PAYMENT TERMS CERTIFICATION NUMBER �I Certified Certified EXPIRATION DATE Certified EXPIRATION DATE Net 45 1749074 h{Small Business � Microbusiness 1 1/30/2020 DVBE REQUIRED DELIVERY DATE SHIPPING 1171 F O B Oeatu�ation F O B Des—1— FOB CITY OF ORIGIN STATE ZIP CODE FRT PFO/ADD 2019-12-16 INSTRUCTIONS FRT PPD Freight not to exceed cost stated on P O. ORIGIN ITEM COMMWITYCOM a PRODUCT CODE RECYCLED NI'MR, 'QUANTITY UNIT Cr2ERMLISI0NOMSER PRODUCT PRODUCT OR ERVICESDESCRIPIIUN ,;,UN{T ERICE;', EXTFNiI006TAL 1 2 EA 420KY21 25 GALLON FLUID DRAIN CART 544.00 1,088.00 ASSETS 510000368067-510000368068 A-1 General Provisions are incorporated herein by reference to TAXABLE R Form GSPO-401Non-IT Commodibes(revision date ) OR Form GSPO.4011T(revision date ) SUBTOTAL 1,088.00 M ATTACHED OR 11 Published at website:v dds.ca Dov/pd TERMS A-2 This order is issued under a Department of General Services(DGS)Leveraged Procurement Agreement(tPA).Terms and Conditions set forth in TAX RATE SALES AND This agreement(LPA number referenced In the block Wed Leveraged Procurement Agreement No.)are incorporated herein by reference as if set CONDITIONS forth in full text 7,75 1 TAX 84,32 B❑Agency Special Provisions are attached and idled *NOTE; * 0.00; If are variabl®,; INSTAL4A7iON C O Any other attachments,such as specifications,Statement of Work,or Information Technology Model charges foranstailatian,' ---- Language Modules,are identified in the product or services description area or on continuation pages Shipping or Freight,or Other :, *SHIPPINot '0.00 PROCUREMENT METHOD COMPETITIVE:Solicitation Number(if applicable) No11-Taxable Services,detail.; FREIGHT per ltne item avid a--for total OTHER 0,00 ®LEVERAGED ❑DVBE I SMALL BUSINESS IGC 14838.5(.)] R NON-COMPETITIVELY 810 ❑EXEMPT here. PROGRAM I CATEGORY(Code and Title) FUND TITLE VERIFIED NO STATE SURPLUS I PAID BY CAL-CARD FACILITY OPERATIONS 19 GEN FUND 001 AVAILABLE ®VES [-]NO I E]YES ®NO GRAND TOTAL 1.172.32 ITEM CHAPTER STATUTE FISCAL YEAR I 08JECT OF EXPENDITURE(CODE AND TITLE) ®O.E 5225-2019-0001-001 23/19 2019 2019/20201 226.01 NON-DATA PROCESSING �Eo. CERTIFICATION AND APPROVAL OF E.ITCUT111E OFFICER UNENCUMBERED REMAINDER AFTER HEREBY CERIl-Y,on personal knowledge. that this or er or purchasing file itents POSTING THIS ORDER TO ALLOTMENT specified aboiv is issuer]in accordance with file procedure prescribed by law governing EXPENDITURE LEDGER lire purchase of such items for the State of California: and that all such legal ADJUSTMENT requirements have been f:dly complied lrilh. INCREASING ENCUMBRANCES AUTHORIZING NAME (Print or Type) TITI:-- Teresa AUSTIN 1� ADJUSTMENT V 111 DECREASING ENCUMBRANCES AUTH ZGSIGNA CERTIFIED CORRECT(SIGNATURE) oh),I-Supplier; Copy 2-DGS Procurement; Copy 3-Pacb-ing Slip; Copies 6-6-Agency Procurement File