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ORDER FOR SUPPLIES OR SERVICES <br />PAGE OF PAGES <br />1 2 <br />IMPORTANT, Mark all <br />packages and papem with contract andfor order numbers. <br />1 DATE OF ORDER <br />2. CONTRACT NO, pt any) <br />6 SHIP TO <br />ORDERED <br />a. NAME OF CONSIGNEE <br />PRICE <br />03/13/2017 <br />3. ORDER NO <br />4. REOUISITIONIREFERENCE NO. <br />(c) <br />(d) <br />BLM-OR SPOKANE DISTRICT OFFICE* <br />L17PX00330 <br />0040323443 <br />Kittitas County Sheriff Department to <br />5. ISSUING OFFICE (Address cormspontlance to) <br />b. STREETADDRESS <br />HLM OR -SPOKANE DIST OFC(ORW00) <br />1103 N FANCHER <br />1103 N FANCHER ROAD <br />SPOKANE WA 99212 <br />c. CITY <br />d STATE <br />e. ZIP CODE <br />SPOKANE <br />WA <br />99212-1275 <br />I <br />7 TO ATTN GOVERNMENT POC <br />f SHIP VIA <br />a NAME OF CONTRACTOR <br />KITTITAS, COUNTY OF <br />S. TYPE OF ORDER <br />b. COMPANY NAME <br />X a. PURCHASE <br />REFERENCE YOUR: <br />b DELIVERY <br />c. STREET ADDRESS <br />205 W 5TH AVE STE 108 <br />statement of work. Applicable FAR Clauses <br />Except for billing instructions an the <br />reverse this delivery order is <br />subject to instructions contained on <br />this side only of this form and is <br />Please furnish the following on the terms <br />issued subject to the terms and <br />18. SHIPPING POINT <br />and conditions specrfied an both sides of <br />this order and on the attached sheat, d <br />conditions at the above -numbered <br />contract <br />d. CITY <br />e. STATE t. ZIP CODE <br />ELLENSBURG <br />WA 198926-2887 <br />any- indudinodeliveryasindicated. <br />9 ACCOUNTING AND APPROPRIATION DATA <br />10. REQUISITIONING OFFICE <br />01 <br />BLM-OR SPOKANE DISTRICT OFFICE <br />11 BUSINESS CLASSIFICATION (Check appropriate bos(es)) <br />12. F 0 8 POINT <br />a. SMALL ,X b. OTHER THAN SMALL e. DISADVANTAGED d. WOMEN -OWNED e. HUBZone <br />— <br />Destination <br />f SERVICE -DISABLED g. WOMEN -OWNED SMALL BUSINESS (WOSB) h. EDWOSS <br />VETERAN -OWNED ELIGIBLE UNDER THE WOSB PROGRAM <br />a. NAME <br />13. PLACE OF <br />14. GOVERNMENT BIL NO. <br />15. DELIVER TO F O.B. POINT <br />16 DISCOUNT TERMS <br />sEEeiulnrG <br />ON OR BEFORE (Oats) <br />09/30/201 7 <br />a. INSPECTION <br />b. ACCEPTANCE <br />Destination <br />Destination <br />ON REVERSE <br />(or P.D. Box) http://www.ipp.gov <br />PP30 <br />17. SCHEDULE (Sn mverse t'orRejectflons) <br />nom, nvrt�c^„rear, L�ri./1L ntrerwu� i iuri <br />PREVIOUS EDITION NOT USABLE OPTIONAL FORM 347 IR- =w. <br />ar.raro.a a os+vFAa.a CFR 13 z,xn <br />QUANTITY <br />UNIT <br />QUANTITY <br />ITEM NO. <br />SUPPLIES OR SERVICES <br />ORDERED <br />UNIT <br />PRICE <br />AMOUNT <br />ACCEPTED <br />(a} <br />(b) <br />(c) <br />(d) <br />lel <br />ff) <br />(0) <br />Kittitas County Sheriff Department to <br />provide for the enforcement of State and <br />local laws relating to the protection of <br />persons and property on public lands <br />managed by the BLM per the attached <br />statement of work. Applicable FAR Clauses <br />Continued ... <br />18. SHIPPING POINT <br />19. GROSS SHIPPING WEIGHT <br />20. INVOICE NO <br />17th) <br />TOTAL <br />(Cont <br />pages) <br />21 MAIL INVOICE TO <br />44 <br />a. NAME <br />$25,000.00 <br />Invoice Processing Platform System <br />sEEeiulnrG <br />wsrRucnoNS <br />b. STREETADORESS US Department of Treasury <br />ON REVERSE <br />(or P.D. Box) http://www.ipp.gov <br />17(i) <br />GRAND <br />TOTAL <br />c' CITY e <br />$25,000.00 <br />, <br />22 UNITED STATES OF _ <br />23. NAME (Typed) <br />AMERICABY (Signature) ' <br />Donald Vicena <br />TITLE CONTRACTING/ORDERING OFFICER <br />nom, nvrt�c^„rear, L�ri./1L ntrerwu� i iuri <br />PREVIOUS EDITION NOT USABLE OPTIONAL FORM 347 IR- =w. <br />ar.raro.a a os+vFAa.a CFR 13 z,xn <br />