27005620-0.pdf
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- Attached to
- TX|615-C1|27005620
- Contract number
- 27005620
- Issued by
- Texas
About this file
Purchase Order Summary
This is a Purchase Order (PO No. 27005620) issued by the State of Texas, Department of State Health Services (Agency 537), to Staples Contract & Commercial LLC on October 7, 2026. The order was placed by Debra Burns, the agency purchaser, with delivery directed to Rosalinda Wilczynski at the HHS Warehouse in Austin, Texas. The purchase is made under Contract 615-C1, a term contract with Staples, and qualifies for Texas state and city sales tax exemption as the materials are for exclusive use by a Texas state agency.
The purchase order encompasses two office supply items totaling $35.59. Line 1 specifies one Staples Tech Non-Skid Mouse Pad (Beach Scene, 8.27" x 8.27") at $4.70, and Line 2 includes one pack of Pilot G2 Retractable Gel Pens (Bold Point, 1.0mm, Black Ink, 36-pack) at $30.89. Both items are scheduled for delivery within three days by October 12, 2026. The contractor is required to provide order confirmation and include a packing list with the PO number (0000416205) and contact information, with invoices to be submitted to the state's invoices email address for payment processing.
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Text version
Purchase Order PO No. 27005620
Order Date: 10/7/2026
Internal Tracking No.: 0000416205
Contractor Info Bill To Ship To Staples Contract & Commercial LLC 10433908166 500 Staples Drive Framingham, MA 01702
(888) 212-7219
PO BOX 149347
Fiscal Division/Accounts Payable
AUSTIN TX 78714-9347
ATTN Wilczynski, Rosalinda
(512) 776-6457 1111 W North Loop Austin, TX 78756
NOTE TO CONTRACTOR: ***PACKING LIST REQUIRED TO SHOW PO NUMBER 0000416205 AND ATTN CONTACT INFO ***
***ORDER CONFIRMATION REQUIRED FROM VENDOR***
SHIP TO ATTN Wilczynski,Rosalinda 512-776-6457 rosalinda.wilczynski@dshs.texas.gov **send invoice to invoices@dshs.texas.gov and include the PO number for payment processing
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 Purchaser Email Phone
Dept Of State Health Services -
Debra Burns Debra.Burns@hhs.texas.gov (512) 406-2564
Purchase Order PO No. 27005620
Order Date: 10/7/2026
Internal Tracking No.: 0000416205
Line
NIGP
Code
Commodity Code/ Supplier Part #
Item QTY UOM Unit Price Extended Price
1 64561 926582 Staples Tech Non-Skid Mouse Pad, Beach Scene, Rubber Base, Optical Mouse Friendly, 8.27” X 8.27” Square Contract: 615-C1 Contract Type: Term Delivery ARO (days): 3 Delivery Date: 10/12/2026 Notes: ***PACKING LIST REQUIRED
TO SHOW PO NUMBER AND ATTN
CONTACT INFO ***
***ORDER CONFIRMATION
REQUIRED FROM VENDOR***
SHIP TO ATTN Wilczynski,Rosalinda 5 1 2 - 7 7 6 - 6 4 5 7 rosalinda.wilczynski@dshs.texas.gov HHS WAREHOUSE 1111 W North Loop Austin TX 78756
MPN: 926582-1855753
Manufacturer Name: Worklife Brands
1 EACH 4.70 $4.70
2 62080 2724465 Pilot G2 Retractable Gel Pens, Bold Point, 1.0Mm, Black Ink, 36/Pack (Pil84095) Contract: 615-C1 Contract Type: Term Delivery ARO (days): 3 Delivery Date: 10/12/2026 Notes: ***PACKING LIST REQUIRED
TO SHOW PO NUMBER AND ATTN
CONTACT INFO ***
***ORDER CONFIRMATION
REQUIRED FROM VENDOR***
SHIP TO ATTN Wilczynski,Rosalinda 5 1 2 - 7 7 6 - 6 4 5 7 rosalinda.wilczynski@dshs.texas.gov HHS WAREHOUSE 1111 W North Loop Austin TX 78756
MPN: 2724465-1855753
Manufacturer Name: PILOT CORP
1 PACK 30.89 $30.89
Total $35.59
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