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N5N 7540- 01.152 -8083 OPTIONAL FORM 341 (HtV, tuaa) <br />Previous edition not usable Prescribed by GSAIFAR 4e CFR 53.213(e) <br />ORDER FC AWPLIES OR SERVICES <br />and papei vv. tract and/or order numbers. <br />AGE OF PAGES <br />1 2 <br />IMP ORTANT: Mark all acka 'es <br />1. DATE 61 -ORDER <br />41 <br />. CONTRACT NO. (If any) <br />6. SHIP TO: <br />09/29/1999 <br />LOCAL CITY GOVERNMENT <br />a. NAME OF CONSIGNEE <br />No Shipping Information <br />3. O <br />4. REQUISITION/REFERENCE NO. <br />HEP990041 <br />See Lines <br />b. STREET ADDRESS <br />5. (Address <br />correspondence to) <br />BLM EUGENE DISTRICT OFFICE <br />C. CITY <br />d. STATE <br />ZIP. CODE <br />2690 CHAD OR,PO BOX 10226 <br />EUGENE OR <br />97440 -2226 <br />7. TO: <br />f. SHIP VIA <br />N.A. <br />a. NAME OF CONTRACTOR <br />8. TYPE OF ORDER <br />b. COMPANY NAME <br />a. PURCHASE <br />b. DELIVERY • Except for billing <br />CITY OF EUGENE <br />Instructions on the reverse, this <br />REFERENCE YOUR: <br />�E,C1111.Crnnm * _R0Q7 177 <br />delivery order is subject to <br />instructions contained on this side <br />C <br />858 PEARL STREET <br />only of this form and is issued subject to the terms and conditions <br />Please famish the following on the terns and <br />conditions spec ified on both sides of this order and <br />on the attached sheet, if any, Including delivery as <br />of the above - numbered contract. <br />d. CITY <br />STATE <br />L ZIP CODE <br />EUGENE <br />I B OR <br />97401 <br />Indicated. <br />9. ACCOUNTING AND APPRO <br />RIATION DATA <br />10. REQUISITIONINO OFFICE <br />1999 - - - OR094 - - 252Z - - 633400 <br />- - - - - - - - - <br />11. BUSINESS CLASSIFICATION <br />(Check appropriate box (es)) <br />El a. SMALL <br />b. OTHER THAN SMALL c. DISADVANTAGED d. WOMEN -OWNED <br />12. F.O.B. POINT <br />14. GOVERNMENT B/L NO. <br />15. DELIVER TO F.O.B. POINT <br />16. DISCOUNT TERMS <br />Destination <br />N.A. <br />ON OR BEFORE (Date) <br />10 days % <br />13. PLACE OF <br />20 days % <br />30 days % <br />a. INSPECTION <br />b. ACCEPTANCE <br />DESTINATION <br />I DESTINTION <br />days % <br />1 7 - scHmiLF See reverse for Re ections <br />QUANTITY <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 />(d) <br />(e) <br />(0 <br />(g) <br />SEE <br />INE ITEM DETAIL <br />ATTACHMENT <br />I IS MADE A PART OF THIS ORDER. <br />18. SHIPPING <br />POINT <br />19. GROSS SHIPPING WEIG <br />20. INVOICE NO. <br />SEE BILLING <br />17(h) TOT. <br />(Coat. <br />21. MAIL INVOICE TO: Pamella M. Schiele <br />a. NAME <br />INSTRUCTIONS <br />pages) <br />ON <br />REVERSE <br />BLM EUGEN <br />DISTRICT OFFICE <br />b. STREETADDRESS <br />(or P.O. Box) <br />2890 CHAD DR,PO <br />BOX 10226 <br />17M <br />$16,000.00 <br />GRANTS <br />c. CITY <br />STATE <br />[ OR <br />e. ZIP CODE <br />TOTAL <br />EUGENE <br />97440 -2226 <br />22. UNITED STATES OF <br />AMERICA BY (Signaturdl <br />`- <br />�I -� 1 <br />) GL�ryt . /I <br />23. NAME (Typed) <br />Pamella M. Schiele <br />� x J <br />TITLE: CONTRACTING /ORDERING OFFICER <br />N5N 7540- 01.152 -8083 OPTIONAL FORM 341 (HtV, tuaa) <br />Previous edition not usable Prescribed by GSAIFAR 4e CFR 53.213(e) <br />