23159121-3.pdf

Purchase Order Change Notice PO No. 23159121

Order Date: 6/8/2023

Internal Tracking No.: 0000319262

Contractor Info Bill To Ship To WorkQuest, Inc.

17419760511 1011 East 53 1/2 Street Austin, TX 78751

(512) 451-8145

BILLING-6688

4001 Highway 36 South Brenham TX 77866

Health & Human Services Commission Health & Human Services Commission - 529 Richmond SSLC Whse 2100 Preston Richmond TX 77469

NOTE TO CONTRACTOR:

HHSC Purchaser:

Suzanna Garcia

Ph: 512-776-2694

Email: suzanna.garcia@hhs.texas.gov

Contact:

Whse Supvr Arturo Vasquez

Ph: 281-344-4461

Fax - 281-344-4654 arturo.vasquez@hhs.texas.gov@hhs.texas.gov

Reg Mgr Taylor Gain

Accounts Payable:

Amber Dallmeyer

Regional Business Manager

979-277-1307

712accounting@hhs.texas.gov

Delivery hours are from 8:00-11:30 AM and 1:00-4:30 PM Monday thru Friday except for designated State Holidays when the Warehouse is closed

Please follow the Texas Comptroller's Invoicing standards as seen below. Include the PO Number on invoices, bills, receipts, bill lading, packing slips, and backorder. (a) To receive payment, a contractor must submit an invoice to the State Agency receiving the goods or services. The invoice should include but is not limited to include:(1) the contractor's mailing and e-mail (if applicable) address;(2) the contractor's telephone number;(3) the name and telephone number of a person designated by the contractor to answer questions regarding the invoice;(4) the state agency's name, agency number, delivery address;(5) the state agency's purchase order number, if applicable;(6) the contract number or other reference number, if applicable;(7) a valid Texas identification number (TIN) issued by the Comptroller;(8) a description of the goods or services, in sufficient detail to identify the order which relates to the invoice;(9) unit numbers corresponding to the amount of the invoice;(10) if submitting an invoice after receiving an assignment of a contract, the TIN of the original contractor and the TIN of the successor vendor;(11) other relevant information supporting and explaining the payment requested.

REVISION HISTORY:

PO Revision #: 3 PO Change Reasons (Aggregated):6/13/2023 10:43 am-Change to Line 5: Quantity changed from 20 to 0.

Order Date: 6/8/2023

Internal Tracking No.: 0000319262

6/26/2023 1:45 pm-Change to Line 12: Quantity changed from 54 to 0.

7/13/2023 10:36 am-Item Option added for: 40573731755

Disclaimer The State of Texas is exempt from all Federal Excise Taxes except as noted in each contract.

STATE AND CITY SALES TAX EXEMPTION CERTIFICATE:

The undersigned claims an exemption from taxes under Texas Tax Code, Section 151.309(4), for purchase of tangible personal property described in this numbered order, purchased from contractor and/or shipper listed above, as this property is being secured for the exclusive use of the State of Texas, or a Texas County, City, Special District, or Other Political Subdivision.

Texas Comptroller of Public Accounts – Statewide Procurement Division

Agency/CO-OP Member Purchaser Email Phone

Health & Human Services Commission - 529

Suzanna Garcia suzanna.garcia@hhs.texas.gov (512) 776-2694

Line

NIGP

Code

Commodity Code/ Supplier Part #

Item QTY UOM Unit Price

Extended Amount

1 39091 39091350002 Water, Bottled, 16.9 Oz, 24 Bottle/ CS, Min Order 72 Cases, Order In Increments of 72 Cases, Freight Included - Additional Charge For Inside Delivery Upon Request.

Contract: 390-S1 Contract Type: Term Delivery ARO (days): 14 Delivery Date: 6/22/2023

648 CASE 6.69 $4,335.12

2 40573 40573731755 Shredder Oil, 16 Oz. Bottle, 4/CS Plus Freight Contract: 405-S1 Contract Type: Term Delivery ARO (days): 30 Delivery Date: 7/10/2023

6 CASE 52.92 $317.52

3 47541 47541481058 Glove, Nitrile Examination, Powder/ Latex Free, 9"L, Blue. Freight included.

Attribute 1: Large 47541481934 Contract: 475-S1 Contract Type: Term Delivery ARO (days): 7 Delivery Date: 6/15/2023

500 BOX 13.63 $6,815.00

Order Date: 6/8/2023

Internal Tracking No.: 0000319262

Line

NIGP

Code

Commodity Code/ Supplier Part #

Item QTY UOM Unit Price

Extended Amount

4 50525 50525740001 Bleach , Co lor Safe , T ide Professional - 2.5 gallon pail. Plu Contract: 505-S1 Contract Type: Term Delivery ARO (days): 15 Delivery Date: 6/23/2023

10 EACH 141.97 $1,419.70

5 61515 61515074505 Appointment Planner, Monthly, Black, Wire Bound, 8-7/8 X 11-1/4, Black, 100% Post-Consumer Recycled, Plus Freight Order Less Than $25 Attribute 1: 2023 Contract: 615-S1 Contract Type: Term Delivery ARO (days): 14 Delivery Date: 6/22/2023

0 EACH 14.65 $0.00

6 61519 61519130779 Calendar, Desk Pad, 22 X 17, 12 Months, Plus Freight Order Less Than $25 Attribute 1: 2023 Contract: 615-S1 Contract Type: Term Delivery ARO (days): 14 Delivery Date: 6/22/2023

MPN: HOD124

Manufacturer Name: House of Doolittle

20 EACH 8.49 $169.80

7 61562 61562381501 Note Pad, Self Stick, 1.5" x 2", Yellow, 100 Sheets/Pad, 12 Pads/ Pkg, Plus Freight Less Than 12 Pkg Contract: 615-S1 Contract Type: Term Delivery ARO (days): 14 Delivery Date: 6/22/2023

13 PKG 4.80 $62.40

8 61573 61573161108 Binder, 1" Capacity, 3 Ring, Vinyl View, Inside Front/Back Pockets, Plus Freight Order Less Than $25 Attribute 1: White-61573161108-1 Contract: 615-S1 Contract Type: Term Delivery ARO (days): 20 Delivery Date: 6/28/2023

144 EACH 3.83 $551.52

Order Date: 6/8/2023

Internal Tracking No.: 0000319262

Line

NIGP

Code

Commodity Code/ Supplier Part #

Item QTY UOM Unit Price

Extended Amount

9 61573 61573163104 Binder, 2" Capacity, 3 Ring, Vinyl View, Inside Front/Back Pockets, Plus Freight Order Less Than $25 Attribute 1: White-61573163104-1 Contract: 615-S1 Contract Type: Term Delivery ARO (days): 20 Delivery Date: 6/28/2023

36 EACH 5.35 $192.60

10 64521 64521350104-

Paper, Bond, Virgin, Premium No. 4, 20 Lb., 8-1/2" X 11" Contract: 645-S1 Contract Type: Term Delivery ARO (days): 20 Delivery Date: 6/28/2023 Manufacturer Name: Skilcraft

40 CRTN 48.89 $1,955.60

11 47541 47541481058 Glove, Nitrile Examination, Powder/ Latex Free, 9"L, Blue. Freight included.

Attribute 1: Medium 47541481553 Contract: 475-S1 Contract Type: Term Delivery ARO (days): 7 Delivery Date: 6/15/2023

500 BOX 13.63 $6,815.00

12 64085 64085312706 Towel, Food Service, Disposable, Flat-Pack, 12.5" X 14.25", Product No. 8543, 400 Towels/Cs Contract: 640-S1 Contract Type: Term Delivery ARO (days): 7 Delivery Date: 6/15/2023

0 CASE 7.85 $0.00

13 48538 48538403311 Dishwashing Detergent, Dawn, 1 Gallon, 4 Gallons/Case, Freight Included Contract: 485-S1 Contract Type: Term Delivery ARO (days): 15 Delivery Date: 6/23/2023

10 CASE 80.93 $809.30

14 62080 62080058001 Pen, Ball Point, Retractable, Bio- Based, Bio-Degradable, 12 Ea/Box, Plus Freight Order Less Than $25 Attribute 1: Medium Attribute 2: Black Contract: 620-S1 Contract Type: Term Delivery ARO (days): 14 Delivery Date: 6/22/2023

36 DOZ 8.53 $307.08

Order Date: 6/8/2023

Internal Tracking No.: 0000319262

Line

NIGP

Code

Commodity Code/ Supplier Part #

Item QTY UOM Unit Price

Extended Amount

15 40573 40573731755 ADDED TO ORDER FOR LINE: 2

DESC: Transportation and Freight Charge Delivery Date: 7/10/2023 Notes: 7.13.23 Freight added. SG

1 EACH 16.14 $16.14

Total $23,766.78