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OURON BUSINESS FORMS (714) 878-5140 <br />PURCHASE REQUISITION REQUISITION 21403 <br />CITY OF COTTON <br />FINANCE DEPARTMENT <br />Awarded to: <br />W Acquire ❑ Sell For: DepartmenvDivision <br />Human Services/Family Services <br />Date of Requisition: <br />3-13-90 <br />Required Date: <br />6-1-90 <br />Deliver To: <br />Colton Cam Lenity Childcare <br />Wilson Elementary School <br />Attentio"iW. S. 8th St. Colton <br />Reche Canyon Elementary <br />3101 Canyon Vista, Colton <br />Work Order No. <br />Direct Questions To: <br />Sue <br />Ext: 5086 <br />Suggested Vendors/Buyers <br />Requested by: (Signature) <br />Item <br />No. <br />Quan. <br />Description of Item or Service <br />(Be Specific) <br />Account <br />Number <br />Unit <br />Price <br />Estimated <br />Cost <br />06-8027-42 <br />5,778 <br />11,556 <br />handicap , set-up <br />with skirting. Room needs to <br />have commercial carpeting, <br />heating, air conditioning, <br />recessed lighting <br />Send white copy to Purchasing. <br />Keep Pink copy for reference. <br />Use separate set of forms for each type of goods. <br />Received by Purchasing <br />Date: <br />Finance Approval by: <br />Date: <br />Item <br />VENDOR/BUYER <br />Quote <br />Date and Terms of delivery <br />P.O. No. <br />Date of P.O. <br />