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' _ QRpER FOR SUPPLIES OR SERVICES AGE qF PAGES <br /> IMP• • M rk n wi n ra / r_ 1 4 <br /> 1. DATE OF ORDER 2 CONTRACT NO. (If any) 6. SHIP TO; Marlys M. Cr~rlg <br /> 09/28/2D02 a. NAME OF CONSIGNEE <br /> 3. ORDER NO_ 4. FEQUlSIT10N/REFERENClr Np. BI-M EUGENE DISTRICT OFFICE <br /> ~iEP020072 b. STREET ADDRESS <br /> 5. , ' 'DING OFFICE (Address correspondence (o) 2890 CHAD DR <br /> PO BoX 10226 <br /> BGM EUGENE DISTRICT OFFICE <br /> 2890 CHAD DR <br /> PO BOX 70226 c. CITY d. STATE e. ZIP COpE <br /> EUGENE OR 97440-222G EUGENE OR 97440-2226 <br /> .i 7-70. f. SF11P V?A <br /> a. NAME OF CONTRACTOR N!A <br /> <br /> 'I 8. TYPE OF ORDER <br /> b. COMPANY NAME x~ a. PURCHASE <br /> CITY OF EUGENE REFEl2fiNCE YOUR b. DELIVERY -Except For billing <br /> c. STREET ADDRESS Instructions on the reverse, this <br /> 858 PEARL STREET REQUISmON # HER021064 delivery order Is sub)eet to <br /> instrUCtions rgntained an this side <br /> Please furnish the following on the teRns and oply of ttus form antl is issued <br /> conditions specified on beth sides a{this order and subject ffl the terms and conditions <br /> d. CITY e. STATE f. ZIP CODE an the attached sheet, if any, inGUding delivery es of the above-numbered contract, <br /> EUGENE OR 97401 indcated. <br /> 9. ACCOUNTING AND APPROPRIATION DATA 10. REQUISITIONING OFFICE <br /> ZD02 • - • OR094 - 2572 • ~ 6333PA • - - - - - - - - <br /> - Pat Jol~nston, 541-683 618-1., ti~iEW <br /> 11.._ BUSINESS CLASSIFICATION (Check apPmprlale box(es)) - - ~ <br /> a, SMALL b. OTHER THAN SMALL ? c. DfSADVANTAGED ? d. WOMEN-OWNED. <br /> i 12. ~:O_B. POINT - 14• GOVERNMENT B/L NO. 15. DELIVER 70 F.O.B. POINT 16. DISCOUNT TERMS <br /> pestination -ON OR BEFORE (Dale)_ 10 days <br /> I. 13. PLACE OF,;,._; NIA <br /> 20 days <br /> a: INSPECTION b. ACCEPTANCE 09~30I03 30 days <br /> DESTINATION ; DESTINATION days % <br /> : ~ _ . <br /> _ 77.SGHEbULE 5eereverseforRe'ecSons <br /> QUANTITY UNIT QUANTITY <br /> ITEM NO. . - SUPPLIES:OR SERVICES ORDERED UNIT PRIG.E , ; AMOUNT ACCEPTED <br /> _ fib'. (c) (dj (e) (fl (9) <br /> .SEE LINE ITEM DETAIL <br /> i <br /> *AttachrnenL ~~1 ~.s made apart of this o der <br /> 18. SHIPPING POINT 79. GROSS SHIPPING 1NEIGHT 20_ INVOICI= O. <br /> 21. MAIL INVOICE TO:Matiys M. Cl~ig 17(hj TOT. <br /> SEE' 6JLL!/VG (Goof. <br /> lNS7•RUCTJONS a, NAME Pages) <br /> ON BLM EUGENE DISTRICT OFFICE <br /> REVERSE b- STREET ADDRESS (orP.O. Box) <br /> 2860 CHAP OR,PO BOX 70226 v(I) <br /> $12,OOD.00 GRAND <br /> c. CITY d, STATE e. ZIP CODE ToTAt <br /> EUGENE OR 97440-2226 <br /> 22. UNITED STATES OF 23. NAME (J'ypod) <br /> '!IERICA BY. (Signature) ~j~ /J - _ Marlys M. Craig <br /> ,~1 /f'/ . TffLE: CONTRACTING/ORDERING OFFICER <br /> NSN 7540-07-162.5os3 OPTIONAL FOFM 347 (REV- GI~JS) <br /> PfBVIoVS sdl~ian nol ussble Prescribed by G3A/FARAB GFR 63.213(D) <br /> <br />