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DocuSign Envelope ID:7845CF89-4637-4165-BA3D-1880C2F6F020 <br /> I <br /> P.O. REQUISITION REQUEST FORM <br /> C <br /> DATE: 1 04/14/201 1 Facility Services <br /> REQUESTED BY: I Freddy Brooks <br /> r <br /> VENDOR NUMBER: 65544 <br /> VENDOR NAME: Tile Restoration Inc. <br /> Account Number: <br /> Supplies 10240520-620000 <br /> Contract Services 10240520-630000 <br /> Capital Equip. 10240520-800000 j <br /> DESCRIPTION ACCOUNT# QUANT$/UNIT $TOTAL <br /> Jerry Passmore-460 Epic Urethane/Shiny 630000 <br /> #1.Art Studio room 1005 $1,400.00 <br /> #3. Staff Restrooms & Changing Room $1,175.00 <br /> #4. Entry Air loc- Passmore/Solty's $1,175.00 <br /> $0.00 <br /> Solty's -460 Epic Urethane/Shiny $0.00 <br /> #1. Activities/Fitness room $1,825.00 <br /> #2. Men's &Women's Restrooms/Kitchen $925.00 <br /> $0.00 <br /> Seymour Ctr. - 115 EverGlaze Rejuventation $0.00 <br /> #1. Grnd & 1st- mens &womens + unisex rr $2,450.00 <br /> #2. Grnd & 1st- mens &womens + unisex/SaniMax Sealer in Leu of SaniTech II. $1,300.00 <br /> $0.00 <br /> $0.00 <br /> $0.00 <br /> $TOTAL $10,250.00 <br /> NOTES: Pottery Studio/rn#1004 will"not" be part of this work group. <br /> h; <br /> I` <br /> l <br /> I`< <br /> 1; <br /> i <br /> E <br /> TRI_Pass more+Soltys.xls <br /> I[ <br />