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CITY RECORDER'S COpy
Page 1 /1
r~'
CITY OF
A.SHLAND
20 E MAIN 8T.
ASHLAND, OR 97520
(541) 488-5300
7/19/2005
06104
VENDOR: 002930
ALCATEL INTERNETWORKING
POBOX 92203
LOS ANGELES, CA 90009
SHIP TO: Ashland Fiber Network
(541) 488-5354
90 N. MOUNTAIN
ASHLAND, OR 97520
FOB Point:
Terms: Net .
Req. Del. Date:
Speciallnst:
Req. No.:
Dept.: IT
Contact: Richard Holbo
Confirming? No
BILL TO: Account Payable
20 EAST MAl N ST
541-552-2028
ASHLAND, OR 97520
SUBTOTAL
TAX
FREIGHT
TOTAL
17 126.82
0.00
0.00
17,126.82
&X ~s(fJf.r
VENDOR COpy
CITY OF
AS:HLAND
REQUISITION FORM
Date of Req lIest:
THIS REQUEST IS A:
D Change Order( existing PO # __) Required Date of Delivery/Service:
Vendor Name 4-t _c- A T 6' L
Address
City, State, Zip
Telephone Number
Fax Number
Contact Name
SOLICITATION PROCESS
Small Procurement ~ Sole Source 0 Invitation to Bid
o Less than $5,000 ' Written findings attached (Copies on file)
o Quotes (Not required)
CooDerative Procurement 0 Reauest for ProlJosal
o State of ORIWA contract (Copies on file)
Intermediate Procurement o Other government agency contract 0 SDecial1 ExemD't
o (3) Written Quotes 0 Copy of contract attached 0 Written findings attached
(Copies attached) 0 Emeraencv
0 Contract # 0 Written findings attached
Description of SERVICES
5Ee...0iCE' CDI,-.rr~,ACt lO\ ALLitT{;"L/
1>AG~6'\ EN G /~CS -5'^-> ILL it 6 E t<1- 12.."
T.,tal Cost
IlZl Per attached PROPOSAL
/ 3".. 5"' ~/-: &2f~~ (7 #,-1L-L
/', C/ e;' -:r
.JLs
o Per attached QUOTE
(Mt?kl ilPt - 300 ,
o~ ~O g )
Project Number ______. ____
(;11 I f ~~ d2{'J ~ ~-, -<1/ h~~
Account Number ___. __. __. __. ______
* Items and services must be charged to the appropriate account numbers for the
tal Cost
By signing this requisition form, I certify that the information provideu aUUVtj 11/tjtjl~ 111tj vlLY VI M~lIIallU puum; GUfllIaGUflg requirements,
and the documentation can be provid on request.
Employee Signature:L
Supervisor/Dept. Head Signature:
flr;<- ~*cJ
G: Finance\Procedure\AP\Forms\8_Requisition form revised.doc
Updated on: 6/15/2005