22-416CMS-BOSS4-P-38710:227

DOC - Corrections Release Order Number

Purchase Order

Vendor Number: V00001631 The Pittsburgh Paints Company

E 3040 South Sixth Street N Springfield, IL 62703

D benjamin.hiltabrand@pittsburghpaints.com o (217) 757-9080

R

VENDOR INSTRUCTIONS:

PURCHASE ORDER REQUIREMENTS - STATE OF ILLINOIS AGENCIES

Prior to commencement of billable work, delivery of supplies or rendering of any service on a Purchase Order:

--Initial Purchase Order/Contract - All parties, including the State and vendor, must fully execute the contract in its entirety.

--Release from an existing Purchase Order/Contract - The vendor must receive a Purchase Order signed by the State Agency and attached in BidBuy. Note, for any additional requirements see specific State Agency instruction.

PURCHASE ORDERS REQUIREMENTS - OTHER PURCHASING ENTITIES

--Please see specific requirements provided by the purchasing entity.

22-416CMS-BOSS4-P-

38710:227

Master Contract? Y

Master Con/Ref #: 9100001422

Contract/PO #: P-38710

Michelle Grogan s 4017 E. 2603rd Road

H Melissa Morsch Sheridan, IL 60551

I US

p Email: Michelle.grogan@illinois.gov

(815) 496-2181

I

Michelle Grogan

B 4017 E. 2603rd Road Melissa Morsch Sheridan, IL 60551

L US

L Email: Michelle.groganillinois.gov

(815) 496-2181

T

Shipping Method: Best Way I Freight Terms: Freight Prepaid

Shipping Terms: I I Payment Terms: NA

Solicitation (Bid) No.: N/A I Release Begin Date: 07/14/2026 Release End Date: 06/30/2027 DeIiver' Calendar Day(s) A.R.O.: 2

Item # 1

Class-Item 630-79

PAINT, PRIMER, STAIN-BLOCKING, WATER-BASE, INTERIOR, READY MIXED WHITE, 1-GALLON CONTAINER.

Brand: PPG Model# 17-921Xl/01

Quantity I Unit Price UOM I Discount % 'Total Discount' I Tax Rate I 'Tax Amountl Freight I Total Cost I

AniL

3.00 $29.42 GAL 0.00% $0.00 $0.00 $0.00 $88.26

TAX: $0.00

FREIGHT: $0.00

TOTAL: $88.26

22-416CMS-BOSS4-P-38710:227

The undersigned agree to the Terms and Conditions as acknowledged by the Vendor and maintained in the State of Illinois' a-procurement system. This agreement consists of all terms as maintained in the state's e-procurement system inclusive of attached documents. The Vendor affirms that the Certifications and Financial Disclosures and Conflicts of Interest are true and accurate as of the date of the Vendor's execution of this Agreement. State documents will prevail in the event of a conflict between State and Vendor documents and information. The undersigned agree to the Terms and Conditions of this agreement:

OFFICIAL SIGNATURES

Vendor Name:

Vendor Signature:

Printed Name: __________________________________

Title:

Phone #:

Email:

Date:

State of Illinois Agency or Other Purchasing Entity Procuring State Agency or Entity: ___________

Official Signature:

Printed Name: CL&

Title: UJTb VY 0 fl Designee Signature: ___________________________

Printed Name:

Title:

Date: - (__

Legal Signature: -

Printed Name:

Title:

Date:

Fiscal Signature: -

Printed Name:

Title: _______

Date:

FOR STATE OF ILLINOIS USE ONLY:

Acq. Type: _________________Source Sel. Method: ________________

Using Agency Funding Source:______________________________________ Detailed Expenditure Object Code:_______________________________ Approp. Acct Code: ____________________________________________ Award Code:

Original Proc. Method:_______________________________________ Subcontractors Disclosed:__________________________________________ Subcontractors Utilized:___________________________________________ Publication Date:_______________________ Financing Needed:________ IPG Cert/Dsclosure Yes_________ No__________________________

APPROVED

By: Amanda Crisman

Phone#: (R1l 49A-21l1

BUYER