Laserfiche WebLink
STATE OF HAWAII <br />REQUISITION & PURCHASE ORDER <br />DEPARTMENT OF HEALTH DECEIVED SEP <br />EXECUTIVE OFFICE ON AGING <br />ORGANIZATION FUNCTION AND ACTIVITY <br />NOTICE TO VENDORS <br />Conditions of purchase are listed on the back side of this purchase order. Please read <br />carefully. Payments may be delayed if all steps are not followed. <br />County of Hawaii <br />Office of Aging <br />1055 Kino'ole Street, Room 101 <br />Hilo, HI 96720 <br />The State of Hawaii is an EQUAL EMPLOYMENT OPPORTUNITY and AFFIRMATIVE ACTION employer. We encourage the <br />participation of women and minorities in all phases of employment. <br />PURCHASE <br />ORDER NO. <br />n <br />lli(11 tr., ► +t Pi llIt4ti <br />3 2011 <br />Date 9/7/11 <br />E0A06059 <br />Deliver Before <br />DELIVERY ADDRESS <br />No. 1 Capitol District <br />250 South Hotel St., Suite 406 <br />Honolulu, HI 96813 -2831 <br />BILLING ADDRESS <br />same as above <br />QUAN. <br />UNIT <br />DESCRIPTION <br />UNIT PRICE <br />AMOUNT <br />2 <br />Cycle of Chronic Disease Self Management Program (CD$MP) <br />Administrative Costs <br />O Caroline Cadirao 114' 808- 586 -0100 <br />REQUISITIONER TELEPHONE <br />GOODS /SERVICES RECEIVED IN GOOD ORDER AND CONDITION BY DATE <br />VOUCHER <br />NUMBER <br />AUTHENTICATED BY: <br />$4,249.00 $ 8,498.00 <br />2,052.00 <br />$10,550.00 <br />AUTHORIZED SIGNATURE <br />REQUISITION NO. <br />VENDOR <br />NUMBER <br />SFX <br />XXXXXXXXXX <br />XX <br />229436 <br />05 <br />FOR DEPARTMENT USE ONLY <br />.. 0" . - -,?-o 7 <br />SFX <br />TC <br />F <br />YR <br />APP <br />D <br />OBJECT <br />CC <br />PROJNO. <br />PH <br />ACT <br />ESTIMATED COST <br />ACTUAL COST <br />M <br />R <br />OPT DEPT DATA <br />XX <br />XXX <br />X <br />XX <br />XXX <br />XX <br />XXXX <br />XXXXXXXXXXXXXXXXXXXXXXXXXXHXX <br />XXXXXXXXXXXiXX <br />X <br />X <br />XXXXXXXXXXX <br />01 <br />621 <br />S <br />11 <br />381 <br />H <br />2990 <br />019 <br />10,550 00 <br />COP7 r 1-- VENDOR <br />STATE ACCOUNTING FORM C -03 <br />JULY, 19$3 (REVISED) <br />,t /i 11 <br />