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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 ASAP 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 49,500.00$ Project Manager: Kyle Lei TOTAL 49,500.00$ 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 Newman, CA 95360 2518 Shiells Road Jason R. Zalinski PO Box 876 CITY OF SAN LEANDRO REQUISITION P.O. NUMBER _________________ ENGR & TRANSP Please issue a Purchase Order for the following: 17-Jun-21 ATTACH QUOTES TO REQUISITION PROJECT NAME: Police Building & South Offices Modifications PROJECT NO.: 2014.0481 210-18-145-5120 DESCRIPTION OF WORK: The Public Safety Building is an Essential Services Building that requires an Inspector of Record to be onsite during construction. This CSA will be with Jason R. Zalinski - Inspection/ Construction Services for provisions of Inspector of Record services during construction at the Public Safety Building. These services will be funded by account 210-18-145-5120 (contract amount $49,500). X 6/21/21