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PR# 4 5`-)u <br /> PUBLIC WORKS Pr7# <br /> DP's Initial Date 1 <br /> op <br /> REQUEST FOR GOODS & SERVICES <br /> Today's Date: q,/' 21/f Date Needed: <br /> Vendor Information Deliver To <br /> Name: c" �g f rj� liver ie r e-- <br /> Address: / 41 f r �b4 f iert / ' ` 201 <br /> City/State/Zip: L"at-it 7I <br /> r <br /> Phone: <br /> FAX: Attention: fin /didi A <br /> Item. Item Descdptiort Part/ GL1 �f Tonal <br /> # (ke sped#icy Catalog Code/Job Cost# Qty„ Pr...ice Price <br /> Si or ?i 2 3.2 .25- <br /> Purpose/Comments: <br /> O-r-r r A i er t,e- ?Iasir a iv,. <br /> *Please use as many lines as you need for the description,or attach a separate page. <br /> The iteAns will be based on your description For purchases of$1,000 please note purpose. <br /> .}ff`'y,v i 6284„,, <br /> Requester Approval Signature <br /> White Copy-Processor Green Copy-Requestor <br />