State of Washington



State of Washington

Current Contract Information

Issue Date: June 2, 2010

|Contract number: |04408 |Commodity code: |2310 |

|Contract title: |Vehicles, 2010 Hybrid, Alternative/Flexible Fuel |

|Purpose: |Order Period Extension for the Ford Escape |

|Term: |October 7, 2008 |through: |October 31, 2010 |

|Ordering Period: |October 7, 2008 Through March 31, 2010 or Factory Cutoff, whichever is Later |

|For use by: |See Special Conditions #1 |

|Scope of contract |Hybrid, Gas/Electric Vehicles, Flexible Fuel Vehicles |

|Contractor : |See Vehicle Price Sheets | | |

|Products available: |Honda Civic Hybrid Sedan, Honda Insight Hybrid Sedan, Toyota Prius, and Ford Escape Hybrid SUV |

|Ordering information: |See page 2 |

|Ordering procedures: |See Special Conditions Number 2 |

|Contract exclusions: |See Special Conditions #1 |

|Special notes: |Vehicles may be ordered on the Internet at: |

|Related product contracts: |03602 Batteries, 09506 Vehicle Glass, 08805Partitions & Push Bumpers, 13303 Tire Chains, 00108 Tires, New, 06302 |

| |Automotive, Light Vehicle Parts & Supplies, 07705 Fuel, 04907 Vehicles, Hybrid, Alternative/Flexible Fuel |

|Reference |Contract Amendment no. 1 signed by Honda Auto Center (Mick Hanlon) dated July 23, 2009, Toyota of Yakima (John |

| |Slater) dated July 31, 2009 and Columbia Ford (Marie Tellinghiusen) dated August 6, 2009. |

This page contains key contract features. Find detailed information on succeeding pages. For more information on this contract, or if you have any questions, please contact your local agency Purchasing Office, or you may contact our office at the numbers listed below.

|Contractor |Breann Aggers |Order |Christine Schoepfer |

|Administrator: | |Placement: | |

|Phone Number: |(360) 902-7421 |Phone Number: |(360) 902-7193 |

|Fax Number: |(360) 586-2426 |Fax Number: |(360) 586-2426 |

|Email: |baggers@ga. |Email: |cschoep@ga. |

|Payment address: |See Vehicle Price Sheets |

|Order placement address: |See Special Conditions Note 2 |

|Minimum orders: |One Vehicle |

|Delivery time: |See Vehicle Price Sheets |

|Payment terms: |See Vehicle Price Sheets |

|FOB Point |FOB Destination – Vehicle will be prepared for delivery and unless otherwise requested driven to purchaser’s in |

| |state location by Dealer’s agent at no additional cost. (FOB selling dealership orders for Oregon Political |

| |Subdivisions) |

|Freight: |Prepaid and included in unit pricing |

|Contract pricing: |See vehicle price pages. |

| |Payment for the total amount of the invoice is due and payable to the dealer within 30 days of delivery of vehicle. |

| |Prompt Payment Discount May be Deducted if Paid within 20 Days. |

| |NOTE: PURCHASING ADMINISTRATIVE FEE IS NO LONGER INVOICED TO THE CUSTOMER. |

|Term worth: |$6,900,000.00 |

|Current participation: |$0.00 MBE |$0.00 WBE |$6,900,000.00OTHER |$0.00 EXEMPT |

| |MBE 0% |WBE 0% |OTHER 100% |Exempt 0% |

|Recovered material : |None |

Notes:

I. This contract is subject to RCW 43.19.190(2) & RCW 43.19.1905(7): which authorizes state agencies to purchase materials, supplies, services, and equipment of equal quantity and quality to those on state contract from non-contract suppliers. Provided that an agency subsequently notifies the Office of State Procurement (OSP) State Procurement Officer (SPO) that the pricing is less costly for such goods or services than the price from the state contractor.

If the non-contract supplier's pricing is less, the state contractor shall be given the opportunity by the state agency to at least meet the non-contractor's price. If the state contractor cannot meet the price, then the state agency may purchase the item(s) from the non-contract supplier, document the transactions on the appropriate form developed by OSP and forwarded to the Contracts Specialist (CS) administering the state contract. (Reference paragraph 6.11 State Purchasing Manual

If a lower price can be identified on a repeated basis, the state reserves the right to renegotiate the pricing structure of this agreement. In the event such negotiations fail, the state reserves the right to delete such item(s) from the contract.

II. Only authorized purchasers included in the State of Washington Purchasing Cooperative (WSPC) listings published and updated periodically by OSP may purchase from this contract. A list of Washington members is available on the Internet at Contractors shall not process state contract orders from other than the Office of State Procurement State Procurement Officer.

Special Conditions:

1. This contract contains the following model year 2010 vehicles:

FOR USE BY

| | | |State Agencies (1) |PS/WA (2) |NPC/WA (3) |PS/OR (4) |

|2310-930-001 |Hybrid (Gas/Electric) Compact Sedan Honda Civic HEV* | | Yes | Yes | Yes | Yes |

|2310-935-001 |Hybrid (Gas/Electric) Midsize Hatchback Toyota Prius HEV | | Yes | Yes | Yes | Yes |

|2310-962-001 |Hybrid (Gas/Electric) Small Utility/Crossover Ford Escape HEV | | Yes Yes Yes No |

| | | | |

| | | | |

1) State Agencies, Colleges & Universities

2) Political Subdivisions State of Washington

3) Non Profit Corporations State of Washington

4) Political Subdivisions State of Oregon

*Contains dedicated CNG Civic GX Option, Insight HEV Option

All current vehicle contracts are available for viewing at:



2. You may submit your orders via automated interactive requisition forms where you create your order on-line via the internet and transmit the requisition directly to OSP via e-mail. Templates for each vehicle classification are located at .

You may also order vehicles, by completing contract price sheet/order forms and faxing or mailing them, with a Form A-15A Purchase Requisition, to the Office of State Procurement for processing. Please make sure you have the most recent contract document prior to ordering as changes may be made at any time.

Users are strongly advised to order as soon as possible due to restrictions on plant capacity and fleet allocations. All orders need to be processed through the Office of State Procurement If your purchase order is not received back within 3 days, call (360) 902-7193.

State Purchase Orders will be created and transmitted by the OSP to the Dealer and Customer via Vehicle Rapid Online Ordering Messaging (VROOM) System emails. Emails will be sent from ospvehicles@ga. with subject lines of “Customer Purchase Order” or “Dealer Purchase Order.” Within the email a link will be provided to your current vehicle orders.

3. Note: Customer is to pay all Titles and Licensing fees directly to the Department of Licensing (DOL) or their local sub agent. Dealer will not invoice customer for such fees, including the trauma care fee which will be paid to DOL per RCW 46.12.042 (2). Dealer check previously made out to DOL for a portion of the Licensing Fees will not be provided.

4. For information regarding lease/purchase financing through the State Treasurers Office, contact Wendy Kancianich at 360-902-9022. Information on their "Local" funding program may be found at or for state agencies.

5. For information regarding the sale or purchase of surplus vehicles contact the Commodity Redistribution Office at (253) 333-4900.

COPIES OF ALL OSP CONTRACTS ARE AVAILABLE FOR VIEWING, DOWNLOADING AND PRINTING AT OUR INTERNET WEB SITE AT (HELP DESK IS AT (360)-902-7400). FOR INFORMATION SPECIFIC TO VEHICLES VISIT OUR VEHICLE ACQUISITION TEAM (VAT) WEBSITE AT

Attachments

TO ORDER COMPLETE PRICE SHEETS AND SUBMIT WITH STATE FORM A-15A PURCHASE REQUISITION TO OFFICE OF STATE PROCUREMENT. TO MINIMIZE PRODUCTION DELAYS ORDER AS EARLY AS POSSIBLE AND NO LATER THAN MARCH 31, 2010. NOTE: Due to the High Demand for Hybrid Vehicles Significant Delays May Occur in the Delivery of Ordered Vehicles. Contact Dealer for Availability of In Stock and Pre Ordered Vehicles.

AUTOMOBILE: COMPACT SEDAN, HYBRID (GAS/ELECTRIC)

VEHICLE TYPE: 4 DOOR SEDAN MAKE/MODEL: HONDA CIVIC HYBRID

EQUIPMENT INCLUDED IN NET PRICE

| | |

|- Air Bags, Driver & Front Passenger w/Side Curtain Airbags Front & Rear |- AM/FM Radio w/CD & MP3 Playback |

|- 1.3 Liter 4 Cylinder Gas Engine/Permanent Magnet Electric Motor |- Set of 4 Keys (RKE w/2 Masters, 2 Valet) |

|- Automatic Transmission, Continuously Variable |- Mirrors, Dual Power |

|- Power Steering |- Electric Rear Window Defroster |

|- Cruise Control |- All Factory Standard Equipment Including: |

|- P195/65R15 Steel Belted Radial All Season Tires (1) |Cloth Bucket Front Seats, Drivers Seat Height Adjustable, |

|- Compact Spare Tire and Wheel |Electronic Stability Control(Hybrid Only) |

|- Power Regenerative Brakes, 4 Wheel Anti Lock Brake System |Rear Bench Seat |

|- Power Door Locks |Inside Emergency Trunk Release |

|- Power Windows |Child Protection Rear Door Locks |

|- Intermittent Wipers |Energy Monitoring Display Panel |

|- Air Conditioning |Daytime Running Lights |

|- Carpeted Floormats (F &R) |Tire Pressure Monitoring System |

|- Light Tinted Glass All Around |3 yr/36,000 mile warranty, 5Yr/60,000 mile |

|- Tilt Steering Wheel |Powertrain, 8Yr/100,000 mile IMA |

|- Auxiliary Power Source | |

| |NHTSA CRASH TEST RATINGS |

| |FRONTAL (D/P) 5/5 |

| |SIDE (F/R) 4/5 |

| |ROLLOVER 4 |

CA EMISSION CERTIFICATION AT-PZEV GAS MILEAGE 40 CITY 45 HWY MERCURY FREE VEHICLE “High MPG” Vehicle COATED LEAD WHEEL WEIGHTS

|DEALER: |HONDA AUTO CENTER (W11732) |DEALER CONTACT: |Mick Hanlon or Mike Lavigne |

| |13291 SE 36th ST |PHONE: |1-425-643-3770 |

| |BELLEVUE, WA 98006 |EMAIL: |mickh@ |

|DELIVERY: |60-90 Days |FEDERAL TAX ID NO.: |91-1088631 |

| | |PAYMENT TERMS: |$235 discount for payment within 20 days of delivery,|

| | | |net 30 * |

NET PRICE: (Vehicle equipped as above, delivered to any point within the State of Washington, exclusive of Federal Excise and before 9.5% sales tax:

|COMMODITY CODE |VEHICLE DESCRIPTION |ORDER QTY |PRICE EACH |PRICE EXTENSION |

|2310-930-001 |Automobile, Compact 4 Door Sedan, 2010 Honda Civic Hybrid | | | |

| |(FA3F2) | |$23,490.00 * |$ |

NO COST EXTERIOR COLORS INDICATE QUANTITY OF COLOR(S) SELECTED White , Silver , Black______, Magnetic Pearl(Dark Blue)_____, Polished Metal (Gray)______ , Atomic Blue _____.

NO COST EXTERIOR COLORS (Civic GX) (Available only w/ Option 2310-930-012) INDICATE QUANTITY OF COLOR(S) SELECTED Black______, White______, Silver______, Polished Metal______, Royal Blue_____.

NO COST EXTERIOR COLORS (Insight) (Available only w/ Option 2310-930-017 or 018) INDICATE QUANTITY OF COLOR(S) SELECTED Alabaster Silver_____, Polished Metal______, Crystal Black_____, Atomic Blue_____,

Tango Red_____, Spectrum White (EX Model Only)_____.

(Complimentary standard interior color will be selected by Dealer)

(1) Tire Chain Compatible

NOTE: IF NATIONAL ENERGY BILL FEDERAL TAX CREDITS ARE PROVIDED TO THE SELLING DEALER FOR THE SALE OF HYBRID GOVERNMENT FLEET VEHICLES ON THIS CONTRACT, DEALER WILL PAY THE STATE AT LEAST 50% OF THE PER VEHICLE CREDIT RECEIVED.

|COMMODITY CODE |OPTION DESCRIPTION |ORDER QTY |PRICE EACH |PRICE EXTENSION |

|2310-930-010 |Credit for pickup from selling Dealer instead of vehicle being | |$(100.00) |$ |

| |driven to customer (Orders for Eastern WA,) (DLR) (Deduct)* | | | |

|2310-930-011 |Credit for pickup from selling Dealer instead of vehicle being | |$(50.00) | |

| |driven to customer (Orders for Western WA, (DLR) (Deduct)* | | | |

|2310-930-012 |Alternative Sedan, Civic GX Dedicated Natural Gas Vehicle | |$1,585.00 | |

| |(Includes CNG 1.8L 4 Cylinder Engine, (24 MPG CITY, 36 MPG HWY | | | |

| |200-220 Mile Range) (Fuel Tank in Trunk Reduces Cargo Space) | | | |

| |(7.8 Gas Equivalent Gallons at 3600 psi) (FA4F5) NOTE: | | | |

| |Production starts June 2009 due to plant relocation. | | | |

|2310-930-013 |Remote Keyless Entry, Additional Transmitter coded to vehicle | |$120.00 | |

| |(DLR)* | | | |

|2310-930-014 |Deleted | |$0.00 | |

|2310-930-015 |Undercoating (DLR)* | |$299.00 | |

|2310-930-016 |Deleted | |$0.00 | |

|2310-930-017 |Alternative Hybrid Compact Sedan 2010 Honda Insight EX (40mpg | |$(1,840.00) | |

| |City 43 Hwy)(Includes heated mirrors, traction control, center | | | |

| |console)(Deduct) | | | |

|2310-930-018 |Alternative Hybrid Compact Sedan 2010 Honda Insight LX (no | |$(3,290.00) | |

| |traction/stability control, heated mirrors, cruise control, | | | |

| |center console)(Deduct) | | | |

| | | |SUBTOTAL | |

| | | |+9.5% SST | |

| | | |TOTAL | |

TO ORDER COMPLETE PRICE SHEETS AND SUBMIT WITH STATE FORM A-15A PURCHASE REQUISITION TO OFFICE OF STATE PROCUREMENT. TO MINIMIZE PRODUCTION DELAYS ORDER AS EARLY AS POSSIBLE AND NO LATER THAN MARCH 31, 2010. NOTE: Due to the High Demand for Hybrid Vehicles Significant Delays May Occur in the Delivery of Ordered Vehicles. Contact Dealer for Availability of In Stock and Pre Ordered Vehicles.

AUTOMOBILE: MIDSIZE HATCHBACK, HYBRID (GAS/ELECTRIC)

VEHICLE TYPE: 4 DOOR HATCHBACK MAKE/MODEL: TOYOTA PRIUS

EQUIPMENT INCLUDED IN NET PRICE

| | |

|- Air Bags, Driver & Front Passenger w/Side Curtain Airbags Front & Rear |- AM/FM Radio w/CD |

|- 1.5 Liter 4 Cylinder Gas Engine/Permanent Magnet Electric Motor |- Remote Keyless Entry, 2 Smart Keys |

|- Automatic Transmission, Continuously Variable |- Mirrors, Dual Power |

|- Power Steering |- Electric Rear Window Defroster |

|- Cruise Control |- All Factory Standard Equipment Including: |

|- P185/65R15 Steel Belted Radial Tires (1) |Cloth Bucket Front Seats, 4-way Manual Adjustable, |

|- Compact Spare Tire and Wheel |Split Folding 60/40 Rear Bench Seat |

|- Power Regenerative Brakes, 4 Wheel Anti Lock Brake System |Power Outlets |

|- Power Door Locks |Rear Window Wiper/Washer |

|- Power Windows |Inside Emergency Trunk Release |

|- Intermittent Wipers |Child Protection Rear Door Locks |

|- Air Conditioning |Energy Monitoring Display Panel |

|- Carpeted Floormats (F &R)(CF) |Tire Pressure Monitoring System |

|- Light Tinted Glass All Around |3 yr/36,000 mile warranty, 5Yr/60,000 mile Powertrain & Battery |

|- Tilt Steering Wheel | |

| |NHTSA CRASH TEST RATINGS (2009) |

| |FRONTAL (D/P) 4/4 |

| |SIDE (F/R) 4/4 |

| |ROLLOVER 4 |

2009 CA EMISSION CERTIFICATION AT-PZEV-1 GAS MILEAGE 51 CITY 48 HWY MERCURY FREE VEHICLE “High MPG” Vehicle (2009) LEAD WHEEL WEIGHTS

|DEALER: |TOYOTA OF YAKIMA (W6870) |DEALER CONTACT: |Justin Russell or John Slater |

| |914 S. FIRST ST |PHONE: |1-509-575-4868 or 509-833-7066 |

| |YAKIMA, WA 98901 |EMAIL: |jrussell@ |

|DELIVERY: |90 Days ARO |FEDERAL TAX ID NO.: |91-2164306 |

| | |PAYMENT TERMS: |$200 per vehicle discount for payment within 20 days |

| | | |of delivery, net 30 * |

NET PRICE: (Vehicle equipped as above, delivered to any point within the State of Washington, exclusive of Federal Excise and and before 8.1% sales tax).

|COMMODITY CODE |VEHICLE DESCRIPTION |ORDER QTY |PRICE EACH |PRICE EXTENSION |

|2310-935-001 |Automobile, Midsize 4 Door Hatchback, 2010 Toyota Prius | | | |

| |Hybrid (1224) | |$22,596.00 * |$ |

NO COST EXTERIOR COLORS (Prius) INDICATE QUANTITY OF COLOR(S) SELECTED Blizzard Pearl(White) , Black , Barcelona Red , Sandy Beach____, Blue Ribbon_____, Winter Gray_____.

(Complimentary standard interior color will be selected by Dealer)

(1) Not Tire Chain Compatible

NOTE: IF NATIONAL ENERGY BILL FEDERAL TAX CREDITS ARE PROVIDED TO THE SELLING DEALER FOR THE SALE OF HYBRID GOVERNMENT FLEET VEHICLES ON THIS CONTRACT, DEALER WILL PAY THE STATE AT LEAST 50% OF THE PER VEHICLE CREDIT RECEIVED.

|COMMODITY CODE |OPTION DESCRIPTION |ORDER QTY |PRICE EACH |PRICE EXTENSION |

|2310-935-010 |Credit for pickup from selling Dealer instead of vehicle being | |$(50.00) |$ |

| |driven to customer (Orders for Eastern WA,) (DLR) (Deduct)* | | | |

|2310-935-011 |Credit for pickup from selling Dealer instead of vehicle being | |$(50.00) | |

| |driven to customer (Orders for Western WA, (DLR) (Deduct)* | | | |

|2310-935-012 |Deleted | |$0.00 | |

|2310-935-013 |Fire Extinguisher, 2.5# Dry Chemical ABC Rated w/mounting | |$28.00 | |

| |Bracket, Delivered w/vehicle, Uninstalled(DLR)* | | | |

|2310-935-014 |Flare Kit, 3 Piece Triangle w/storage box for roadside | |$30.00 | |

| |emergency use, Delivered w/vehicle, Uninstalled (DLR)* | | | |

|2310-935-015 |Remote Keyless Entry, Additional Set of 2 Smart Keys (DLR)* | |$475.00 | |

|2310-935-016 |Spare Tire, Full Size (DLR)* | |$145.00 | |

|2310-935-017 |Quantity Discount 10 or more like Vehicles, Single Destination,| |$(50.00) | |

| |Multiple Vehicle order (DLR)*(Deduct) | | | |

|2310-935-018 |Deleted | |$0.00 | |

|2310-935-019 |Trunk Cargo Net (GOV) | |$35.00 | |

|2310-935-020 |Shop Service & Parts Manual (Paper)(DLR)* | |$500.00 | |

|2319-935-021 |Extra Cost Paint, Blizzard Pearl (White) | |$176.00 | |

| | | |SUBTOTAL | |

| | | |+8.1% SST | |

| | | |TOTAL | |

TO ORDER COMPLETE PRICE SHEETS AND SUBMIT WITH STATE FORM A-15A PURCHASE REQUISITION TO OFFICE OF STATE PROCUREMENT BEFORE MARCH 31, 2010. ONLINE ORDERS MAY BE PLACED AT . TO MINIMIZE PRODUCTION DELAYS ORDER AS EARLY AS POSSIBLE

HYBRID SMALL UTILITY VEHICLE

VEHICLE TYPE: UTILITY VEHICLE, FRONT WHEEL DRIVE MAKE/MODEL: FORD ESCAPE HEV FWD

EQUIPMENT INCLUDED IN NET PRICE

| | |

|- 4 door, 5 passenger seating |- Dome Light w/Map Lights and Rear Cargo Light |

|- front bucket seats w/ adjustable seat backs, split bench rear seat, cloth |- Tinted glass, front, privacy glass rear |

|material manufactured from 100% recycled materials. |- Remote keyless entry w/ two key FOBS w/Integrated Keys plus Two separate Keys |

|- 2.5 liter, 4 Cylinder Hybrid Gas/Electric engine |- All Factory Standard Equipment including: |

|- Airbags, driver and front passenger, side air cushions w/ rollover sensor & |Power door locks/windows |

|front & second row side bags |Power Driver’s seat, Height adjustable |

|- Automatic transmission, electronically controlled, continuously variable |Power Outlet 110V w/front console |

|- P235/70R16 all season steel belted radial tires, Aluminum wheels (1) |3.04:1 Rear Axle Ratio |

|- Compact size spare tire & wheel, underbody mounted |Washer/wiper, rear window |

|- Full length hardtop, cloth headliner |Tachometer |

|- Carpeted floor covering |Roof Rack Side Rails |

|- Cruise control/Tilt Steering Wheel |HD Rear Bumper |

|- Air conditioning (CFC free) |Compass/Outside Temp. |

|- Power brakes, four wheel anti lock, disc, regenerative braking |Overhead Console |

|- Power steering |Fog Lamps |

|- Auxiliary power sources (2) |Height Adjustable Front Seat Belts |

|- Dual power exterior mirrors, black |AM/FM/Single disc CD w/MP3 Capability |

|- Electric rear window defroster |3 yr/36,000 mile warranty (8 yr/100,000 on hybrid system & battery pack) |

|- Intermittent wipers |Rear lift gate door |

|- Electronic Stability Control |Engine Oil Cooler |

| |Sync Communications System |

| |Carpeted Floor Mats, front & rear |

| |Tire Pressure Monitoring System |

| |My Key, Programmable Key System |

| |NHTSA Crash Test Ratings |

| |Frontal (D/P) 5/5 |

| |Side (F/R) 5/5 |

| |Rollover 3 |

SULEV II CA EMISSION CERTIFICATION, GAS MILEAGE 34 CITY 31 HWY MERCURY FREE VEHICLE

LEAD FREE WHEEL WEIGHTS

VEHICLE MEETS DEPARTMENT OF ECOLOGY SPECIFICATIONS FOR LOW EMISSION VEHICLES

|DEALER: |Columbia Ford (W403) |DEALER CONTACT: |Marie Tellinghiusen or Steve Sari |

| |700 7th Ave |PHONE: |(360) 423-4321 |

| |Longview, WA 98632 |EMAIL: |mariet@ |

|DELIVERY: |120 days ARO |FEDERAL TAX ID NO.: |91-0650166 |

| | |PAYMENT TERMS: |*$200 per vehicle discount for payment within 20 days|

| | | |of delivery, Net 30 |

NET PRICE: (Vehicle equipped as above, delivered to any point within the State of Washington, exclusive of Federal Excise and before 8.2% State Sales Tax):

|COMMODITY CODE |VEHICLE DESCRIPTION |ORDER QTY |PRICE EACH |PRICE EXTENSION |

|2310-962-001 |Hybrid Small Utility Vehicle, 2011 Ford Escape HEV FWD | |$27,983.00 * |$ |

| |(U4K/500A) | | | |

NO COST EXTERIOR COLORS: INDICATE QUANTITY OF COLOR(S) SELECTED Oxford White ,

Tuxedo Black (UH) _____, Steel Blue_____, Lime Squeeze (SQ)_____, White Suede_____, Ingot Silver_____.

(Complimentary standard interior color will be selected by Dealer)

(1) Tire Chain Compatible

|COMMODITY CODE |OPTION DESCRIPTION |ORDER QTY |PRICE EACH |PRICE EXTENSION |

|2310-962-010 |Credit for pickup from selling dealer instead of vehicle being | |$(135.00) |$ |

| |driven to customer (Orders for Eastern WA Area Code 509) (DLR) | | | |

| |(Deduct)* | | | |

|2310-962-011 |Credit for pickup from selling dealer instead of vehicle being | |$(30.00) | |

| |driven to customer (Orders for Western WA Area Codes 206, 253, | | | |

| |360, 425, (DLR) (Deduct)* | | | |

|2310-962-012 |Cargo Area Cover (DLR)* | |$125.00 | |

|2310-962-013 |Cargo Area Tray (DLR)* | |$105.00 | |

|2310-962-014 |Daytime Running Lights (942) | |$38.00 | |

|2310-962-015 |Heater, Engine Block (41H) | |$30.00 | |

|2310-962-016 |Keys, Set of 2 Instead of 4(Deduct)(DLR)* | |$(20.00) | |

|2310-962-017 |Manuals, Parts and Service, CD (DLR)* | |$221.00 | |

|2310-962-018 |Roof Rack Cross Bars (Black)(61X) | |$38.00 | |

|2310-962-019 |Remote Keyless Entry, Additional Transmitter | |$56.00 | |

| |(No Key)(DLR)* | | | |

|2310-962-020 |Remote keyless Entry, Additional Key w/Integrated Key FOB | |$113.00 | |

| |(DLR)* | | | |

|2310-962-021 |Spotlight, 6 inch, Clear Lens, Pillar Mounted, Left (DLR)* | |$337.00 | |

|2310-962-022 |Tires, All Terrain, LT225/75R16,Set/5 (DLR)* | |$741.00 | |

|2310-962-023 |Four Wheel Drive Model instead of Front Wheel Drive with all | |$1,572.00 | |

| |other contract required equipment (30 mpg city and 27 Hwy) | | | |

| |(U5K/500A) | | | |

|2310-962-024 |Undercoating (DLR)* | |$135.00 | |

|2310-962-025 |Warranty Delayed Start () (DLR)* | |$0.00 | |

|2310-962-026 |Manufacturer to Dealer Order Acknowledgement Document Faxed to | |$0.00 | |

| |Customer (DLR)* | | | |

|2310-962-027 |Stock Vehicle Up Charge, Dealer Stock Vehicle with All Contract| |$250.00 | |

| |Required Equipment, Delivery Within 7 Days When Available | | | |

| |(DLR)* | | | |

|2310-962-028 |Fire Extinguisher, 2.5# Dry Chemical ABC Rated w/ Mounting | |$33.00 | |

| |Bracket, Delivered w/ Vehicle, Uninstalled (DLR)* | | | |

|2310-962-029 |Push Bumper Steel w/ Horizontal Rubber Push Pads Installed | |$299.00 | |

| |(Setina PB400)(DLR)* | | | |

|2310-962-030 |Floor Mats, HD Rubber (Set 4)(Also retains Std Carpeted | |$62.00 | |

| |Mats)(DLR)* | | | |

|2310-962-031 |Remote Vehicle Starter System (94A) | |$293.00 | |

|2310-962-032 |Full size Spare (DLR)* | |$234.00 | |

|2310-962-033 |Step Bars (187) | |$293.00 | |

|2310-962-034 |Flare Kit, 3 Pc Triangle w/storage box for roadside emergency | |$33.00 | |

| |use, Delivery w/vehicle, uninstalled (DLR)* | | | |

|2310-962-035 |Manuals, Parts and Service, Paper (DLR)* | |$204.00 | |

| | | |SUBTOTAL | |

| | | |+8.2% SST | |

| | | |TOTAL | |

OFFICE OF STATE PROCUREMENT

PERFORMANCE REPORT

To OSP Customers:

Please take a moment to let us know how our services have measured up to your expectations on this contract. Please copy this form locally as needed and forward to the Office of State Procurement Purchasing Manager. For any comments marked unacceptable, please explain in remarks block.

|Procurement services provided: |Excellent |Good |Acceptable |Unacceptable |

|Timeliness of contract actions | | | | |

|Professionalism and courtesy of staff | | | | |

|Services provided met customer needs | | | | |

|Knowledge of procurement rules and regulations | | | | |

|Responsiveness/problem resolution | | | | |

|Timely and effective communications | | | | |

Comments:

Agency: Prepared by:

Title:

Contract No.: 04408 Date:

Contract Title: Vehicles, 2010 Hybrid, Alternative/Flexible Fuel Phone:

Send to:

Purchasing Manager

Office of State Procurement

PO Box 41017

Olympia, Washington 98504-1017

PRODUCT/SERVICE PERFORMANCE REPORT

Complete this form to report problems with suppliers or to report unsatisfactory product or services. You are also encouraged to report superior performance. Agency personnel should contact suppliers in an effort to resolve problems themselves prior to completion and submission of this report.

Contract number and title: 04408 Vehicles, 2010 Hybrid, Alternative/Flexible Fuel

Supplier’s name: Supplier’s representative:

|PRODUCT/SERVICE: |

| |Contract item quality higher than required | |Damaged goods delivered |

| |Contract item quality lower than required. | |Item delivered does not meet P.O./contract specifications |

| |Other: | | |

|SUPPLIER/CONTRACTOR PERFORMANCE: |

| |Late delivery | |Slow response to problems and problem resolution |

| |Incorrect invoice pricing. | |Superior performance |

| |Other: | | |

|CONTRACT PROVISIONS: |

| |Terms and conditions inadequate | |Additional items or services are required. |

| |Specifications need to be revised | |Minimum order too high. |

| |Other: | | |

Briefly describe situation:

|Agency Name: |Delivery Location: |

|Prepared By: |Phone Number: |Date: |Supervisor: |

| | | | |

Send To:

Bill Griffin

CONTRACTS SPECIALIST

OFFICE OF STATE PROCUREMENT

PO BOX 41017

OLYMPIA WA 98504-1017

Vehicle Contract Ordering Procedures (Non Automated)

NOTE: For internet subscribers, with E-Mail capability, an automated on line requisition form for each vehicle classification is at web site “”.

The step by step directions below with attached sample requisition and Price Sheet/ Order Form are provided as a guideline to assist you in manually placing your vehicle order on the State of Washington Automobile/ Police Vehicle/ Light Trucks & Vans contracts. The manual ordering procedure is as follows:

TO ORDER YOU NEED TO BE A SUBSCRIBER TO THE STATE PURCHASING COOPERATIVE and all orders are to be submitted on a State of Washington Purchase Requisition Form A15-A (copy attached).

NOTE: DEALERS WILL NOT ACCEPT ORDERS DIRECTLY FROM YOUR ORGANIZATION. YOUR REQUISITION IS TO BE SENT DIRECTLY TO THE OFFICE OF STATE PROCUREMENT FOR PROCESSING. FAILURE TO DO SO MAY RESULT IN THE LOSS OF YOUR ORDER AND/OR DELAY IN THE ORDERING AND DELIVERY OF YOUR VEHICLE.

To complete a manual purchase requisition, refer to the numbers below with the corresponding numbers on the attached sample requisition. You need only fill in the areas listed below.

(1) Ordering Agency Name - Enter your organization name and address

(2) Agency Number - Political Subdivisions enter the Intergovernmental Cooperative Purchasing Agreement Identification Number previously furnished to you. (if unknown call (360) 902-7415) Location and mail stop blocks may be left blank for political subdivisions and non-profit organizations.

(3) Date Ordered - Enter today’s date.

(4) Date Needed - Leave blank or enter number of days allowed for delivery as shown on the contract.

(5) Requisition Number - Enter internal requisition number assigned by your organization.

(6) Contact Person - Enter your agency contact person and phone numbers for the State Procurement Officer to call if there are any questions on your order.

(7) Ship Goods To - Enter the address where the vehicle is to be delivered (not a PO Box). If vehicle is to be picked up, enter selling dealer’s address or state “Agency will pick up”. Enter agency number, location and mail stop codes if known.

(8) Mail Invoices To - Enter the organization name/ address where bill should be sent. Indicate if more than one copy of the invoice and/or if a separate invoice for each vehicle is required. Enter agency number, location and mail stop codes if known.

(9) Body of Requisition - Organization internal Requisition/ Purchase Order and/ or vehicle numbers, if any that you want referenced on the state PO.

(10) Body of Requisition – Email Address to send PO to. Email address of the person you want us to send your copy of the PO to. (Alternatively, if no email address provide a fax #)

(11) Body of Requisition - Organization delivery contact person and phone numbers for the dealer to coordinate delivery. Indicate receiving hours/ days contact person is available.

(12) Body of Requisition - Identify Organization name/ address for title application (Legal & registered owner) exactly as you want it to appear on the title. Street Address, not PO Box, for registered owner.

(13) Signature Line - Identify person authorizing this purchase, their title in your organization, and obtain their signature.

To order the specific vehicle(s) and the options you require, make a copy and then complete the appropriate vehicle contract “price sheet/ order form.” (Please download a current copy of the document before proceeding.) Simply enter the quantity of each color and all commodity codes required in the spaces provided. (See Sample) You may order more than one vehicle per classification with like equipment, but do not mix vehicles with unlike equipment other than color, on the same requisition. To process the order it is not necessary that you calculate and total price extensions, but spaces are provided should you desire to know your total cost. (The state purchase order will show all price extensions and a subtotal before sales tax).

Once completed, you may mail your requisition and price sheet/ order form to the address in the upper right corner of the form or, preferably, fax it to (360) 586- 2426 (to avoid possible duplication of your faxed order, please do not send a confirming hard copy). After processing, the Office of State Procurement (OSP) will transmit a copy of the State Purchase Order for your vehicle(s) at the same time the dealer is sent their copy. Remember, a confirming hard copy will not be mailed. (When received, please check your order for any errors or duplication of any previous order. Advise this office of any errors or discrepancies immediately.) If you do not receive your order back within 3 days, notify this office at (360) 902-7193.

After the purchase order is issued completion of the order is the responsibility of the dealer and yourself. Please do not, however, unnecessarily contact the dealer during the delivery time period. Also, if you have a requirement for general information or equipment changes please contact this office. In case of a late delivery exceeding 14 calendar days, contact both the dealer and this office. The dealers have been instructed to notify customers via email or fax, of any delay beyond the purchase order due date.

Upon delivery, your payment is to be made directly to the dealer within 30 days of receipt/ acceptance of the vehicle(s). (If you are able to pay even sooner after delivery you may be able to reduce the price of your vehicle as some of our dealers have a Prompt Payment Discount.) It is important that payment be made within the 30-day time period as the dealers must pay significant interest charges for financing vehicles. The number of firms bidding and bid prices received in the future will be directly related to the timeliness of your payments on this contract. Additionally, by statute the contract has a provision for a 1% late payment penalty.

|FORM |[pic] | |SUBMIT TO: |DEPARTMENT OF GENERAL ADMINISTRATION |

|A15-A | |STATE OF WASHINGTON | |OFFICE OF STATE PROCUREMENT |

|(REV 5/93) | |PURCHASE REQUISITION | |Room 201, General Administration Building |

| | | | |PO Box 41017 |

| | | | |Olympia, Washington 98504-1017 |

|ORDERING AGENCY NAME |AGENCY NO. |LOCATION |MAIL STOP |DATE ORDERED |DATE NEEDED |REQUISITION NO. |

| | | | |MO DAY YR |MO DAY YR | |

|(1) |(2) | | |(3) |(4) |(5) |

| |CONTACT | PERSON |(6) |FAX: | |PHONE: |

|SHIP GOODS TO: |AGENCY | |MAIL |MAIL INVOICES TO: |COPIES |AGENCY | |MAIL |

| |NO. |LOCATION |STOP | |REQD. |NO. |LOCATION |STOP |

|(7) | | | |(8) | | | | |

| | | | | | | | | |

| | | | | | | | | |

|REQ. |COMMODITY | | | |ESTIMATED |

|ITEM NO. |CODE |DESCRIPTION |QUANTITY |UNIT | |

| | | | | |UNIT PRICE |

| | | | | |TOTAL COST |

| | |2010 STATE VEHICLE CONTRACT ORDER PER THE ATTACHED CONTRACT PRICE SHEETS/ORDER FORM | | | |

| | | | | | |

| | |ORGANIZATION INTERNAL REQUISITION/PO# OR VEHICLE(S) # | | | |

| |(9) | | | | |

| | |EMAIL STATE PO TO | | | |

| | | | | | |

| |(10) |DELIVERY CONTACT PERSON: | | | |

| | | | | | |

| |(11) |TELEPHONE# ( ) | | | |

| | |Fax # ( ) | | | |

| | |RECEIVING HOURS/DAY | | | |

(12)

|ORGANIZATION NAME/ ADDRESS FOR THE TITLE APPLICATION “LEGAL OWNER” |ORGANIZATION NAME/ ADDRESS FOR THE TITLE APPLICATION “Registered OWNER” (STREET |

| |ADDRESS REQUIRED) |

CONTINUED

|IDENTIFY PREVIOUS REQUISITIONS FOR |NAME OF AUTHORIZING OFFICIAL |I hereby certify that the goods or services requested are necessary|

|ITEMS ABOVE | |for the work and transaction of business of this agency |

| | | |

| | |(SIGNATURE) |

| |(Type or | |(13) |

| |Print) | | |

|1. DATE/REQ. NO. |TITLE | | |

|DOC DATE |PMT DUE DATE |CUR DOC. NO. |REF DOC NO. |VENDOR NO |VENDOR MESSAGE |USE |UBI NUMBER |

| | | | | | |TAX | |

| | |M |FUND |

|REF |TRANS |O | |

|DOC |CODE |D | |

|SUF | | | |

SAMPLE

TO ORDER COMPLETE PRICE SHEETS AND SUBMIT WITH STATE FORM A-15A PURCHASE REQUISITION TO OFFICE OF STATE PROCUREMENT BEFORE MARCH 31, 2006 TO MINIMIZE PRODUCTION DELAYS ORDER AS EARLY AS POSSIBLE.

TRUCK

16,000# GVWR REGULAR CAB & CHASSIS (4X4)

VEHICLE TYPE: 16,000# GVWR REGULAR CAB & CHASSIS (4X4) MAKE/MODEL: FORD SUPER DUTY F450XL

EQUIPMENT INCLUDED IN NET PRICE

|- 165” Wheelbase, 84” CA regular Cab & Chassis (No Bed) |- Backup Alarm, Electric * |

|- 16,000# GVWR, dual rear wheels |- Black fold away trailer tow telescoping mirrors |

|6.8 liter, 10 cylinder gas engine |- Headliner, door trim panels, vinyl floor covering |

|Air Conditioning |- Maximum cooling-radiator, engine oil, transmission |

|Air bags, driver’s and Passenger side w/passenger deactivation switch |- AM/FM radio w/clock |

|Automatic electronic overdrive transmission |- Power steering |

|2 Speed Transfer Case, Manual locking hubs |- 115 AMP alternator |

|- LT 225/70R19.5F all terrain radial tires |750 CCA battery |

|- Matching spare tire and wheel mounted on frame (All Season) |- Cigarette lighter / Auxiliary power source |

|- Skid Plate Package (413) |- Oil Pressure, Voltmeter, Temp Gauges |

|- Hydraulic bottle jack, lug wrench |- 40 gallon fuel capacity, aft axle tank |

|- HD power brakes, four wheel anti lock, disc |- Light Tinted glass all around |

|- HD shocks, springs, front & rear stabilizer bars |- All factory standard equipment including: |

|- Intermittent wipers |4.88:1 rear axle ratio as equipped |

|- Dome Light |Tachometer |

|Vinyl bench seat w/head restraints |Upfitter Electric Switches |

|- Set of Four Keys |Front Tow Hooks |

| |3 yr/36,000 mile warranty, owner’s manual |

| |Mercury Free Vehicle |

DEALER: FRONTIER FORD (2045) DEALER CONTACT: Jack Minor or Tami Fetterly

P O Box 247 PHONE: 1-800-896-5267

Anacortes, WA 98221 EMAIL: fleet@

FEDERAL ID#: 91-1496528

DELIVERY: 90-120 Days PAYMENT TERMS: $100 Discount Per Vehicle if Paid

Within 20 Days of Delivery (1)

NET PRICE: Vehicle equipped as above, delivered to any point within the State of Washington, exclusive of Federal Excise and before 8.2% sales tax including a .3% vehicle tax

|COMMODITY CODE |VEHICLE DESCRIPTION |ORDER QTY |PRICE EACH |PRICE EXTENSION |

|2319-136-001 |Truck, 16,000# GVWR HD Regular Cab & Chassis, (4x4); 2007 | | | |

| |Ford Super Duty F450 XL (F47/650A) |2 |$24,986.00 (1) |$49,972.00 |

NO COST EXTERIOR COLORS: INDICATE QUANTITY OF COLOR(S) SELECTED Oxford White 2 ,

Dark Green , Arizona Beige , Black ____, Dark Shadow Grey , Dark Toreador Red ,

Medium Wedgewood Blue ____True Blue______, Silver , Red _____, School Bus Yellow _____.

|COMMODITY CODE |OPTION DESCRIPTION |ORDER QTY |PRICE EACH |PRICE EXTENSION |

|2319-136-010 |Credit for pickup from Dealer (May Require Mud Flaps and Trip | |$(100.00) |$ |

| |Permit) (Orders for Eastern WA) (DLR) (DEDUCT) * | | | |

|2319-136-011 |Credit for pickup from Dealer (May Require Mud Flaps and Trip | |$(65.00) | |

| |Permit) (orders for Western WA) (DLR) (DEDUCT)* | | | |

|2319-136-012 |Air Conditioning (Delete) (-572)(Deduct) | |$(686.00) | |

|2319-136-013 |Alternative Diesel Engine, 6.0 Liter 8 Cylinder (Includes Dual | |$4,239.00 | |

| |750 CCA Batteries, Engine Block Heater, (99P) | | | |

|2319-136-014 |Alternative Seating, Cloth Seat Trim Instead Of Vinyl (CE) | |$142.00 | |

|2319-136-015 |Alternative Seating, Vinyl Buckets (JE) |2 |$205.00 |410.00 |

|2319-136-016 |Alternative Wheelbase/Cab to Axle (141 inch WB, 60 inch /CA) | |$(96.00) | |

| |(141WB) (DEDUCT) | | | |

|2319-136-017 |Alternative Wheelbase/Cab to Axle (189 inch WB, 108 | |$104.00 | |

| |inchCA)(189WB) | | | |

|2319-136-018 |Alternative Wheelbase/Cab to Axle (201 inch WB, 120 inch CA) | |$198.00 | |

| |(201WB) | | | |

|2319-136-019 |Back up alarm Delete (DLR)* (Deduct) | |$(45.00) | |

|2319-136-020 |Cab & Chassis, Crew Cab (176 inch WB, 60 inch CA) (16,000# | |$2,966.00 | |

| |GVWR) (W47/176WB) | | | |

|2319-136-021 |Cab & Chassis, Crew Cab (200 inch WB, 84 inch CA)(16,000# GVWR)| |$3,110.00 | |

| |(W47/200WB) | | | |

|2319-136-022 |Cab & Chassis, Extended Cab w/ Rear Bench Seat (162 inch WB, 60| |$1,863.00 | |

| |inch CA) (16,000# GVWR) (X47) | | | |

|2319-136-023 |Cruise Control/Tilt Steering Wheel (52N) |2 |$344.00 |688.00 |

|2319-136-024 |Daytime Running Lights (942) | |$39.00 | |

|2319-136-025 |Differential, Limited Slip (X8L/X5L) | |$267.00 | |

|2319-136-026 |Fuel Capacity Decreased (19 Ga. Midship) (Deduct) (65M) | |$(92.00) | |

|2319-136-027 |Heater, Engine Block (included w/Diesel) (41H) | |$31.00 | |

|2319-136-028 |Keys, Set of 2 Instead of 4 (DLR)* (Deduct) | |$(4.00) | |

|2319-136-029 |Manual, Service, Paper (DLR)* | |$195.00 | |

|2319-136-030 |Power Group (Windows, Door Locks, Heated Mirrors) (903) | |$478.00 | |

|2319-136-031 |PTO Provision (STD w/Man. Transmission) (62R) | |$223.00 | |

|2319-136-032 |Rear Axle Ratio 5.38:1 (Not Avail. W/Diesel) (X75) | |$43.00 | |

|2319-136-033 |Snow Plow Package, Power Up & Angle (MEYER C-8.5) (86M+D) | |$4,430.00 | |

|2319-136-034 |Spare Tire & Wheel Delete (-515) (Deduct) | |$(283.00) | |

|2319-136-035 |Spotlight, 6 inch, Clear Lens, Left (DLR)* | |$234.00 | |

|2319-136-036 |Towing Prep Pkg (7 Wire Harness, Trailer Brake wiring kit) (Not| |$138.00 | |

| |Avail w/2319-136-054) (531) | | | |

SAMPLE

|COMMODITY CODE |OPTION DESCRIPTION |ORDER QTY |PRICE EACH |PRICE EXTENSION |

|2319-136-037 |Transmission 6 Speed Manual (445) (Deduct) | |$(1,203.00) | |

|2319-136-038 |Undercoating (DLR)* | |$100.00 | |

|2319-136-039 |Warranty, Delayed Start (Card furnished) (DWS)* |2 |$0.00 |0.00 |

|2319-136-040 |Window, Sliding Rear (433) | |$112.00 | |

|2319-136-041 |Stakeside Bed, 14 foot (Includes 2319-136-018 120 inch CA) | |$3,145.00 | |

| |(Avail Through 12/31/05 Only) (Knapheide PVMX143C) (DS14)** | | | |

|2319-136-042 |Stakeside bed, 12 foot (Avail Through 12/31/05 Only) (Knapheide| |$2,952.00 | |

| |PVMX123C) (DS12)** | | | |

|2319-136-043 |Stakeside bed, 10 foot, (Includes 2319-136-016 60 inch CA) | |$2,651.00 | |

| |(Avail Through 12/31/05 Only) (Knapheide PVMX103C) (DS10)** | | | |

|2319-136-044 |Platform bed, 14 foot (Includes 2319-136-018 120 inch CA) | |$2,242.00 | |

| |(Avail Through 12/31/05 Only) (Knapheide PVMX143C)(DP14)** | | | |

|2319-136-045 |Platform bed, 12 foot (Avail Through 12/31/05 Only) (Knapheide | |$2,110.00 | |

| |PVMX123C) (DP12)** | | | |

|2319-136-046 |Platform bed, 10 foot (Includes 2319-136-016 60 inch CA) | |$1,916.00 | |

| |(Avail Through 12/31/05 Only) (Knapheide PVMX103C)(DP10)** | | | |

|2319-136-047 |Hoist for 10 or 12 foot beds (Avail Through 12/31/05 Only) | |$2,774.00 | |

| |(Knapheide KH1512SFE) (Power Up/Down, remote controls) (DH12)**| | | |

|2319-136-048 |Hoist for 14 foot beds (Avail Through 12/31/05 Only) (Knapheide| |$3,052.00 | |

| |KH1520SFE) (DH14)** | | | |

|2319-136-049 |Manufacturer to Dealer Order Acknowledgement Document Faxed to | |$0.00 | |

| |Customer (DLR)* | | | |

|2319-136-050 |Tires, All Season Tread Instead of On-Off Road (set 7) (Deduct)| |$(165.00) | |

| |(T91) | | | |

|2319-136-051 |Alternators, Dual 130 Amp (Avail only w/ Diesel Engine) (G3T) | |$285.00 | |

|2319-136-052 |Alternative Seating, Vinyl 40/20/40 front bench (TE) | |$357.00 | |

|2319-136-053 |Alternative Seating, Cloth Front Buckets (GE) | |$347.00 | |

|2319-135-054 |Tow Command System w/Trailer Electric Brake Controller (91T) | |$189.00 | |

| | | |SUBTOTAL |51,070.00 |

| | | |8.2% SST |4,187.40 |

| | | |TOTAL |55,257.40 |

|* TREATED YELLOW PINE DECK ON STAKESIDE & PLATFORM BEDS |

SAMPLE

|FORM |[pic] | |SUBMIT TO: |DEPARTMENT OF GENERAL ADMINISTRATION |

|A15-A | |STATE OF WASHINGTON | |OFFICE OF STATE PROCUREMENT |

|(REV 5/93) | |PURCHASE REQUISITION | |Room 201, General Administration Building |

| | | | |PO Box 41017 |

| | | | |Olympia, Washington 98504-1017 |

|ORDERING AGENCY NAME |AGENCY NO. |LOCATION |MAIL STOP |DATE ORDERED |DATE NEEDED |REQUISITION NO. |

| | | | |MO DAY YR |MO DAY YR | |

| | | | | | | |

| |CONTACT | PERSON |(6) |FAX: | |PHONE: |

|SHIP GOODS TO: |AGENCY | |MAIL |MAIL INVOICES TO: |COPIES |AGENCY | |MAIL |

| |NO. |LOCATION |STOP | |REQD. |NO. |LOCATION |STOP |

| | | | | | | | | |

| | | | | | | | | |

| | | | | | | | | |

|REQ. |COMMODITY | | | |ESTIMATED |

|ITEM NO. |CODE |DESCRIPTION |QUANTITY |UNIT | |

| | | | | |UNIT PRICE |

| | | | | |TOTAL COST |

| | |2010 STATE VEHICLE CONTRACT ORDER PER THE ATTACHED CONTRACT PRICE SHEETS/ORDER FORM | | | |

| | | | | | |

| | |ORGANIZATION INTERNAL REQUISITION/PO# OR VEHICLE(S) # | | | |

| | | | | | |

| | |Email Address to send PO to: | | | |

| | | | | | |

| | |DELIVERY CONTACT PERSON: | | | |

| | | | | | |

| | |TELEPHONE# ( ) | | | |

| | |FAX# ( ) | | | |

| | |RECEIVING HOURS/DAY | | | |

|ORGANIZATION NAME/ ADDRESS FOR THE TITLE APPLICATION “LEGAL OWNER” |ORGANIZATION NAME/ ADDRESS FOR THE TITLE APPLICATION “REGISTERED OWNER” (STREET |

| |ADDRESS REQUIRED) |

CONTINUED

|IDENTIFY PREVIOUS REQUISITIONS FOR |NAME OF AUTHORIZING OFFICIAL |I hereby certify that the goods or services requested are necessary|

|ITEMS ABOVE | |for the work and transaction of business of this agency |

| | | |

| | |(SIGNATURE) |

| |(Type or | | |

| |Print) | | |

|1. DATE/REQ. NO. |TITLE | | |

|DOC DATE |PMT DUE DATE |CUR DOC. NO. |REF DOC NO. |VENDOR NO |VENDOR MESSAGE |USE |UBI NUMBER |

| | | | | | |TAX | |

| | |M |FUND |

|REF |TRANS |O | |

|DOC |CODE |D | |

|SUF | | | |

................
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