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i <br /> 6.2A <br /> Page 14 <br /> EXHIBIT A-3 <br /> SAMPLE PURCAASE ORDER FORM <br /> (Do NOT use this paper form. Use the electronic version downloadable from <br /> !t ttp://www. baya reatrashtra cker.org/con tent/contract-resou rces] <br /> U5E ONE FORM PER VENDOR. ATTACH ADDITIONAL SHEF.TS, SHOWING ALL INSTALLA770N <br /> LOCATIONS, AS NECESSARY. <br /> THIS PURCHASE ORDER IS NOT FINAL LRVTIl, APPROVED BY ABAG <br /> P.O. No. (city/county name + 4-digit number) <br /> Date <br /> Municipalily Informalion Vendor info�mation <br /> City/County: Company namc: <br /> Attcntion: Vendar Tax ID; <br /> Address Attention: <br /> Address <br /> City Zip Ciry Slate Zip <br /> Phone Fax Phonc Fax <br /> Email �mail <br /> Order Details (Use one row for each installation. Add rows as necessary) <br /> Device ,, Delivery Install! <br /> Line If number Uescription / M19odel Localion pAte Noninstall pricc <br /> 1 <br /> 2 <br /> Tax I <br /> Shipning/Jclivery, iCapplicablc <br /> TOTAL <br /> * Location must be specific (SW coroer 6 St. & Main or GPS coordinates). See online form for specific�tion <br /> instructions. <br /> Special Conditions**: <br /> **Attach additiona{ sheets, showing all special conditions, as necessnrv. <br /> Approved by Date: <br /> (Signature of authorized Representative, Pttrticipating Entity) <br /> Name (print) Phone <br /> Approved by Date; <br /> (Signature of device vendor representative) <br /> Name (print) Phone <br /> Approved by bate: <br /> (ABAG) <br /> owP a �oiia� <br /> 10 <br />