REQUEST FOR: DELIVER CHECK TO:
CHECK
P.O. X RETURN TO DEPT.
CHANGE ORDER MAIL TO VENDOR
DATE OF REQ. DEPARTMENT DATE OF DELIVERY NEEDED DEPARTMENTAL REQUISITION NUMBER DELIVER GOODS TO:
CITY HALL 835 E. 14TH STREET WILL PICK UP
PUBLIC WORKS SERVICE CENTER, HAVE PICKED UP
WATER POLLUTION CONTROL PLANT, 3000 DAVIS STREET GOODS ALREADY DELIVERED COMMUNITY LIBRARY CENTER, 300 ESTUDILLO AVENUE CONFIRMS PHONE REQUEST
MARINA OFFICE
MARINA COMMUNITY CENTER
OTHER
CHARGE T0 ACCOUNT CODE
QTY/UNIT DESCRIPTION OF SERVICES OR ITEMS ACTIVITY UNIT PRICE EXTENSION
FUND ITEM
1 LS
$ 51,849.00
Project Manager: Mark Goralka
TOTAL $ 51,849.00
An approved budget item.
Not an approved item, appropriation Accounting Approval transfer within budget. City Manager Approval
Not an approved item, requires
additional appropriation. City Manager Approval
F.O.B. APPROVAL
VENDOR DESTINATION I hereby certify that the items requested NO. 1 o are necessary for the operation of this
FACTORY department.
VENDOR
NO. 2 o SAME, FRT ALL'D
QUOTED PRICE $_______________________
OTHER
VENDOR AUTHORIZED SIGNATURE
NO. 3 o
QUOTED PRICE $_______________________
DELIVERY DATE
Walnut Creek, CA 94596
Contact: David Goldstone
Denalect Alarm Comapny
1309 Pine Street
CITY OF SAN LEANDRO
REQUISITION
P.O. NUMBER _________________
ENGR & TRANSP
Please issue a Purchase Order for the following:
20-May-20
ATTACH QUOTES TO REQUISITION
PROJECT NAME: Farrelly Pool Replacement 210-52-123-5120 PROJECT NO.: 2016.0210
DESCRIPTION OF WORK: Provide low voltage alarm and access control system for the new facilties as described in Exhibit A - scope of services of the Consulting Service Agreement with Denalect Alarm Company
Agreement No.: 3696