24-416CMS-BOSS4-P-67600:34

DOC - Corrections

Purchase Order

Vendor Number: V00003287 GRAINCO PS, Inc.

E 3107 N. State Hwy. 23 N Ottawa, IL 61350

D 3WH1TEAKER@GRA10FSC0M

null

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.

Release Order Number

24-416CMS-BOSS4-P-

67600:34

Master Contract? Y

Master Con/Ref #: 9100001817

Contract/PO #: P-67600

Michelle Grogan s 4017 E. 2603rd Road Melissa Morsch

H Sheridan, IL 60551

I US

p Email: Michelle.grogan@illinois.gov

(815) 496-2181

T

Michelle Grogan

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

L US

L Email: Michelle.grogan@illinois.gov

(815) 496-2181

T

I Shipping Method: Freight Terms:

I Shipping Terms: Payment Terms:

I Solicitation (Bid) No.: N/A I

I Release Begin Date: 08/19/2026 Release End Date: 06/30/2027 Delivery Calendar Day(s) A.R.O.: 2

Item # 1

Class-Item 405-14

GASOLINE, REG. UNLEADED RFG W/ETHANOL OR E.T.B.E. WITH MINIMUM FINISHED OCTANE OF 87

Quantity I Unit Price UOM I Discount % Total Discount

Tax Rate 'Tax Amount' Freight I Total Cost I I Amt. I

1500.00 $ 2.9741 GAL 0.00 % $0.00 $0.00 $0.00 $ 4,461.15

TAX: $0.00

FREIGHT: $0.00

TOTAL: $ 4,461.15

24-416CMS-BOSS4-p-67600:34

The undersigned agree to the Terms and Conditions as acknowledged by the Vendor and maintained in the State of Illinois' e-procurement system. This agreement consists of all terms as maintained in the state's s-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 #:

Date:

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

Official Signature:

Printed Name: 'f? L14tI) LA_9 TI5 Title: ,ircLtr 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:________ PG Cert/Disclosure Yes_________ No__________________________

APPROVED

By: Amanda Crisman

Phone#: ic 1Ort- 91R1

BUYER