Laserfiche WebLink
ORDER FOR SUPPLIES OR SERVICES <br />PAGE OF PAGES <br />2 <br />IMPORTANT- Mark all packages and papers with contract and/or order numbers. <br />1 DATE OF ORDER <br />2 CONTRACT NO. {!/arty) <br />6. SHIP TO: <br />a. NAME OF CONSIGNEE <br />BLM—OR SPOKANE DISTRICT OFFICE* <br />03/26/2018 <br />3 ORDER NO <br />140L5518PO011 <br />4. REQUISITIOWREFERENCE NO. <br />0040383106 <br />5 ISSUING OFFICE (Address awrespondence to) <br />b. STREET ADDRESS <br />BLM OR -SPOKANE DIST OFC(ORW00) <br />1103 N FANCHER <br />1103 N FANCHER ROAD <br />(c) <br />SPOKANE WA 99212 <br />fel <br />(B <br />c. CITY <br />d. STATE <br />a ZIP CODE <br />SPOKANE <br />WA <br />99212-1275 <br />7 TO ATTN GOVERNMENT POC <br />f SHIP VIA <br />a. NAME OF CONTRACTOR <br />KITTITAS, COUNTY OF <br />B. 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 />Except <br />for billing instructions on the <br />reverse, <br />this delivery order is <br />subject <br />persons and property on public lands <br />to instructions contained on <br />this <br />side only of this farm and is <br />Please (umish the following on the terms issued <br />subject to the terms and <br />and conditions specified on both sides of conditions <br />this order and an the attached she il. it contract. <br />of the above-rwmbered <br />d. CITY <br />e. STATE <br />I. ZIP CODE <br />ELLENSBURG <br />WA <br />98926-2887 <br />any inctudinodelivery asindicated <br />9. ACCOUNTING AND APPROPRIATION DATA <br />10. REQUISITIONING OFFICE <br />01 <br />BLM—OR SPOKANE DISTRICT OFFICE <br />11 BUSINESS CLASSIFICATION {Check appropriate box(es)) <br />12. F O S. POINT <br />a SMALL `X to OTHER THAN SMALL c. DISADVANTAGED d. WOMEN -OWNED e. HUBZone <br />Destination <br />I SERVICE -DISABLED g. WOMEN -OWNED SMALL BUSINESS (WOSS) h. EDWOSB <br />15 SHIPPING POINT <br />VETERAN -OWNED ELIGIBLE UNDER THE WOSB PROGRAM <br />20 INVOICE NO. <br />13. PLACE OF <br />14. GOVERNMENT BIL NO <br />15. DELIVER TO F.O.B. POINT <br />16. DISCOUNT TERMS <br />ON ORB FORE Oats) <br />09/30 201 <br />TOTAL <br />a. INSPECTION <br />b. ACCEPTANCE <br />Destination <br />Destination <br />(Cont <br />PP30 <br />17. SCHEDULE (See reverse kr Ryecrlons) <br />AUTHORIZED FOR LOCAL REPRODUCTION OPTIONAL FORM 347 (11- 2%12) <br />PREVIOUS EDITION NOT USABLE PrnaMd by 08AMAR 45 era 53 21311) <br />DUANTITY <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 />(d1 <br />fel <br />(B <br />(g) <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. <br />Continued .. <br />15 SHIPPING POINT <br />19, GROSS SHIPPING WEIGHT <br />20 INVOICE NO. <br />Wilt) <br />TOTAL <br />(Cont <br />ges) <br />21 1NAIL INVOlGE TO: <br />44a. <br />$25,000-00 <br />NAME <br />Invoice Processing Platform System <br />SEE &LUNG <br />rNsmuc oN5 <br />b. STREET ADDRESS US Department of Treasury <br />ON REVERSE <br />(or P0 Box) http://www.ipp.gov <br />17(i) <br />GRAND <br />TOTAL <br />5251000.00 <br />c CITY <br />STATE <br />@, ZIP CODE <br />22 UNITED STATES OF <br />23. NAME (Typed) <br />AMERICA BY (Signature) , <br />Donald Vicena <br />TITLE CONTRACTING/ORDERING OFFICER <br />AUTHORIZED FOR LOCAL REPRODUCTION OPTIONAL FORM 347 (11- 2%12) <br />PREVIOUS EDITION NOT USABLE PrnaMd by 08AMAR 45 era 53 21311) <br />