Attachment_D_-_Delivery_Addition_-_Change_Request_Form.doc
DOC document 51 KB Posted
- Attached to
- Statewide Contract CA|1-22-70-30|0000010762
- Contract number
- 1-22-70-30
- 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 a Liquefied Petroleum Gas (LPG) contract numbered 1-22-68-19 (A, B & C). The form is designed to allow locations to add, change, or delete their participation in the LPG contract, with participants committing to utilize the contract for its entire duration.
The contract appears to be a statewide procurement vehicle for LPG, with locations required to provide details such as department information, delivery location, tank specifications, tank ownership, and estimated annual usage. The form captures critical operational details including tank size, location (above or below ground), ownership status (state or contractor), and anticipated annual consumption. By submitting this form, a location formally elects to participate in the LPG contract and agrees to its terms for the full contract period.
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Other files
| File | Type | Posted |
|---|---|---|
| Attach._B_-_PC_Goods_Specifications_(70-30).pdf | ||
| Attach._C_¿_Postconsumer_Content_Certification_Workbook.pdf | ||
| Attach._D_-_Deployment_and_Logistics_Workbook.xlsx | XLSX spreadsheet | |
| 70-30_User_Instructions_Supplement_11.docx | DOCX document |
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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 .