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ORDER FOR SUPPLIES OR SERVICES I PAGE I PAGES 2 <br />IMPORTAN 't· Ma rt all paaages and papers wiln COlllf'Oct andlor order num1lera , I 1 <br />1 DATE OF ORDER 2. CONTRACT NO. (I/any) e SHIPTO <br />03/13/2017 B. NAME OF CONSIGNEE <br />3. ORDER NO 14. REOUISITIONIREFERENCE NO <br />L17PX00330 0040323443 81M-OR SPOKANE DISTRICT OFFICE- <br />5. ISSUING OFFICE (A~ress COtrVspondon~ 10) b. STREET ADDRESS <br />BLM OR-SPOKANE DIST OFC(ORWOO) 11 0 3 N FANCHER <br />1103 N FANCHER ROAD <br />SPOKANE WA 99212 <br />Co CITY I CI STATE Ij e , ZIP CODE <br />SPOKANE filA 9 9212-1275 <br />7 TO ATTN GOVERNMENT POC , SHIP VIA <br />a NAME OF CONTRACTOR <br />KITTITAS, COUNTY OF B. TYPE OF ORDER <br />b. COMPANY NAME X--; a. PURCHASE L b DELIVERY <br />e. STREET ADDRESS REFERENCE YOUR: <br />205 W 5TH AVE STE 108 Exc.&pi for billing InslrudiOns on Ihe <br />reverae, this d.li~e<y ordens <br />... bject to InstlUdioru CDntB lneCl on <br />this aide only 0' thl! form anClI! <br />Please ftnIish the Icllowing DII thl telml issued subject 10 the t8rms anCI <br />8nCI CDIICI ilio ns specified an both aides at COnCIlhans at the above-rlUmbered <br />d, CiTY Ie . STATE I t. ZIP CODE this ordlr .nd on lha attad1edlheet. if conlraa ELLENSBURG WA 98926-2887 anv . includino dOliverv as indicated. <br />9 ACCOUNTING AND APPROPRIATION DATA 10. REQUISITIONING OFFICE <br />01 81M-OR SPOKANE DISTRICT OFFICE <br />11 . BUSIN ESS CIJ\S8 IF IOATlO~ (CIHJcIc ,ppropriere boxl'5)) 12. F. ° B POINT , 'ir b OTHER THAN SMALL Ci c. DISADVANTAGED '::.--: d. OOMEN.oWNED <br />- <br />I a . SMALL . --' e HUBZDIIa Destinatio n <br />~ f SERVICE-DISABLEO r g . 'NO MEN·OWN ED SMALL BUSINESS (OOSS) . h. EOOOS9 <br />VETERAN-OWNED ._, ELIGIBLE UNDER THE OOSO PROGRAM <br />13. PLACE OF 14 . GOVERNMENT BIl NO . 15. DELIVER TO F 0 9 . POINT 16 DISCOUNTTERMS <br />ONf':R 9jFORE7Dllte) <br />B. INSPECTION I b ACCEPTANCE 09 30 201 <br />Destination Destination PE'30 <br />17. SCHEDULE ($ .. ,.VlI,., lOr RiljllCtJons, <br />QUANTITY <br />ITEM NO . SUPPLIES OR SERVtCES ORDERED UNIT <br />(al (bl {el (dJ <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 8LM per the attached <br />statement of work. Applicable FAR Clauses <br />Continued ... <br />Ie. SHIPPING POINT 19. GROSS SHIPPING WEIGHT <br />•. NAME <br />SEE SlUING <br />INSTRIJCTlONS b . STlIEET ADDRESS <br />ON RfiVrtRSE (or P,O. 90x) <br />,U;/lY <br />22 UNITED STATES OF <br />AMERICA BY (Sii/nature! <br />"'U1l1ORIZED FOA ~OCo\LREl'fIOO\lC'f10N <br />PREVIOUS EDITION NOT USIo.BIJi <br />21 MAIL INVOICE TO <br />Invoice Processing Platform System <br />US Department of Treasury <br />http://www.ipp.gov <br />rliTAll: <br />~~~.()~ <br />UNIT QUANTITY <br />PRICE AMOUNT ACCEPTED <br />(el If) (0) <br />20. INVOICE NO 11 ('" <br />trorAL <br />(Con/. <br />~1I$1 <br />~ $25,000.00 <br />17(;) <br />GRAND <br />TOTAl <br />it liP COOt; $25,000.00 ~ <br />:n NAME (Typad) <br />Donald Vicena <br />roLE CONTRACTING/OROERING OFFICER <br />OPTIONAL FORM ~7IR.' ='11 <br />Pr",tO'trl'tllfbyOSA/MA.te: CFR Sll1;){n