Attachment_D_-_Delivery_Addition_-_Change_Request_Form.doc
DOC document 51 KB Posted
- Attached to
- Statewide Contract CA|1-22-68-19C|0000013046
- Contract number
- 1-22-68-19C
- Issued by
- California
About this file
This document is a Delivery Addition Location Request Form issued by the California Department of General Services (DGS) Procurement Division for the Liquefied Petroleum Gas (LPG) Contract Number 1-22-68-19 (A, B & C). The form is designed to allow government departments, agencies, or districts to add, change, or delete their participation in the LPG contract, with locations committing to utilize the contract for its entire contract period.
The contract appears to cover liquefied petroleum gas procurement, with participating entities required to provide details such as department information, delivery location, tank specifications, tank ownership, and estimated annual usage. The form allows for documenting tank size, location (above or below ground), ownership status (state or contractor), and projected annual consumption. By completing this form, a location formally joins the statewide LPG contract, indicating a standardized approach to gas procurement across California government entities. The document is dated for revision on 4/29/2025, suggesting an active, current procurement mechanism.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Attachment_C_-Delivery_Locations,_Supplement_5_-__.xlsx | XLSX spreadsheet | |
| 1-22-68-19C_-User_Instructions,_Supplement_7_.docx | DOCX document | |
| Attachment_B__-_Specifications_6380-5973.docx | DOCX document | |
| Attachment_E_-_Calltrans_Districts_County_Defined.xlsx | XLSX spreadsheet | |
| Attachment_A_-_Contract_Pricing,_Standard_Locations__-_.xlsx | XLSX spreadsheet |
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Text version
Department of General Services
Attachment D
PROCUREMENT DIVISION
DELIVERY ADDITION LOCATION REQUEST FORM
To: DGS Contract Administrator 707 Third Street, 2nd Floor
Sacramento CA 95605
From:
Subject: Liquefied Petroleum Gas (LPG) 1-22-68-19 (A, B & C) By submitting this form your location elects to participate in the Liquefied Petroleum Gas (LPG) contracts and therefore, are obligated to utilize the contract for the entire contract period. The following information is being provided in order to: Add Change Delete your location to the contract.
Department Information Department Name: ________________________________________________________
Contact Name:
___________________Telephone: ____________________
District:
_________________________County: _____________________________
Business Name of Delivery Location: _____________________________________
Delivery Location (physical address):
| Tank Size |
| Tank Location |
| Tank Ownership |
| Est. Annual Usage |
| (Tank capacity) |
| (Above or Below) |
| (State or Contractor Owned) |
| (# of gallons) |
List special connections or conditions required for the above tank(s)
Print Name: ___________________________________
Date _________________________
Rev. 4/29/2025
File details come from the government source that posted it. Updated .