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REQUEST FOR: <br />CHECK <br />P.O. <br />CHANGE ORDER <br />DATE OF REQ. <br />5/30/2018 <br />DELIVER GOODS TO: <br />QTY/UNIT <br />1 LS <br />ATTACH QUOTES TO REQUISITION <br />VENDOR <br />NO. 1 o <br />VENDOR <br />NO. 2 o <br />QUOTED PRICE $_______________________ <br />VENDOR <br />NO. 3 o <br />QUOTED PRICE $_______________________ <br /> DESCRIPTION OF SERVICES OR ITEMS <br />Please issue a CHECK for the following: <br />DESCRIPTION OF WORK: Provides for emergency food and housing to homeless women and children along with additional lsupportive services in accordance with Amendment No. 1 to CSA effective <br /> January 23, 2018 and expiring on June 30, 2018 and by Resolution No. 2017-019. <br />Agreement Nos. 3237 (original) and 3351 (Amendment No. 1) <br />An approved budget item. <br />Not an approved item, appropriation <br />transfer within budget. <br />Not an approved item, requires <br />additional appropriation. <br />Building Futures with Women <br />and Children <br />1395 Bancroft Avenue <br />San Leandro, CA 94577 <br /> ATTN: Liz Varela, Exec. Director <br />NOTE: REQUIRED FIELDS ARE HIGHLIGHTED IN BLUE <br />SEND COMPLETED AND APPROVED REQUISITION TO PURCHASING <br />X <br /> <br />DEPARTMENT <br />RHS <br />CITY HALL 835 E. 14TH STREET <br />PUBLIC WORKS SERVICE CENTER, <br />WATER POLLUTION CONTROL PLANT, 3000 DAVIS STREET <br />COMMUNITY LIBRARY CENTER, 300 ESTUDILLO AVENUE <br />MARINA OFFICE <br />MARINA COMMUNITY CENTER <br />OTHER <br /> <br />CITY OF SAN LEANDRO <br />REQUISITION <br /> City Manager Approval <br /> City Manager Approval <br />DATE OF DELIVERY NEEDED <br /> F.O.B. <br />DESTINATION <br />FACTORY <br />SAME, FRT ALL'D <br />OTHER <br />DELIVERY <br /> P.O. NUMBER _________________ <br />CHARGE T0 ACCOUNT CODE <br />ACTIVITY <br />FUND <br /> <br /> <br /> <br /> <br /> <br /> <br />010-61-014-5120 <br /> <br /> <br /> <br /> <br /> <br /> <br />DELIVER CHECK TO: <br />RETURN TO DEPT. <br />MAIL TO VENDOR <br />DEPARTMENTAL REQUISITION NUMBER <br />WILL PICK UP <br />HAVE PICKED UP <br />GOODS ALREADY DELIVERED <br />CONFIRMS PHONE REQUEST <br />ITEM <br />APPROVAL <br />I hereby certify that the items requested <br />are necessary for the operation of this <br />department. <br />AUTHORIZED SIGNATURE <br />DATE <br /> <br />UNIT PRICE <br />TOTAL <br />Accounting Approval <br />EXTENSION <br />0 <br />20868 <br />20868