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PR# <br /> ` PUB�/C WORKS Po,� �X �Z o ti-d _ <br /> DP's Initial Date ^� y—�3 <br /> REQUEST FOR GOODS & SERVICES <br /> Todays Date�. _ L� � � - � 3_ Date Needed: <br /> {� - � a -i3 <br /> Vendor Information Deliver To <br /> Name: ��nlT� �ILQM'1�'06L `5J-ou Cr_�u�o�� S~- <br /> Address: _ — <br /> Ciry/Siate/Zip: \ (' � <br /> Phone: zU�P �7�iU 4 � 1 S �?JC. U�VI� '�o <br /> Attention: <br /> FAX: <br /> Item Item Description'�. Part/ Unit Total � <br /> Catalo # GL Code/Job Cost# �ry� , Price Price <br /> g (be specific) 9 <br /> �'� c <br /> l I S�t.:—, ���NS � alo� - S--� IC -Il� ( a. I�QJ i � l �o <br /> Q, x f d k I �_ �-�`1 <br /> � �o � 3o3s- � � - <br /> �.� ; s �vx — <br /> �� �L a� �Jex_�5 a <br /> I �g�/ . � G U <br /> I� \l Zti -!t L. <br /> �� � i� <br /> i y-iz- l3 — - z�-�3 - <br /> - � ' u- —I z.— I � � - <br /> _ <br /> Purpose/Comments: . <br /> 'Please ose as many lines as}rou need lor the description,or attach a sepa2re page. - <br /> The items will be basetl on yow descnption.For purchases ot$7,000 p/ease note purpose. � <br /> / \ <br /> \ W / <br /> ��v—� CSJ-J n r�n_� - --- <br /> Requester Approval Signature <br /> W�ite Copy-Processor Green Copy�Requeator <br />