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PL£ASANTONo <br />PURCHASE ORDER AGREEMENT CITY OF PLEASANTON <br />123 MAIN STREET/ P.O. BOX 520 <br />PLEASANTON, CALIFORNIA 94566-0802 <br />PHONE NUMBER <br />SEND INVOICES TO DELIVER ITEMS TO <br />CITY OF PLEASANTON <br />P.O.B0X520 Name <br />PLEASANTON, CA 94566-0802 Address CARE OF: <br />Name <br />Department City/State/Zip <br />Agreement Number <br />PLEASE SHOW THIS NUMBER <br />ON ALL INVOICES. PACKING <br />SLIPS. PACKAGES AND <br />CORRESPONDENCES <br />This is an order for: <br />D goods <br />D goods & services <br />D services (check one) <br />ITEM NO ITEM OR SERVICE DESCRIPTION QUANTITY UNIT PRICE/ FEES SUBTOTAL <br />•Mail out the Purchase Order to Vendor/Contractor : Yes__ No <br />•Proof of Insurance required prior to start of work: Yes__ No __ <br />TOTAL __. <br />Date _______ _ <br />Terms and Conditions on Reverse are Incorporated into this Agreement <br />Authorized Contractor Signature <br />Taxpayers Identification Number: <br />City Dept Head Signature: <br />Contractor: <br />Address: <br />FY: <br />Vendor ID: <br />New Vendor:If checked, W-9 needs to be attached <br />ACCOUNT CODE <br />Dept #: <br />Estimated Start Date: <br />Estimated Completion Date: <br />PO Type:Project #: <br />DEPARTMENT __________________ _ <br />DATE ______________ _ <br />Date _______ _ <br />City Manager's Office Signature: ___________________________________Finance Signature: ______________________________________ <br />FIN Review_____ <br />2024011 <br />Page 136 of 228