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INTERNAL PURCHASE REQUISITION
STATE OF CONNECTICUT
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0F-95 REV. 06/22
CT TECHNICAL EDUCATION & CAREER SYSTEMS
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Page 1 of 1
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REQUISITIONING UNIT: Print or Type. Retain Part 2 (Canary). Forward
REQUISITION NO.
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Part 1 to Office Issuing Purchase Order.
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ISSUED BY (Agency/School)
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Bullard Havens Tech
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AGENCY BILLING ADDRESS
DATE OF REQUISITION
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500 Palisade Avenue Bridgeport, CT 06606
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SHIP TO
(Above agency of address shown, unless other address is entered here.)
Attention:
DATE MATERIAL REQUIRED
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SAME AS BILL TO
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VENDOR FEIN/SSN
DELIVERY HOURS Except Sat.,Sun., & Holidays
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RECOMMENDED VENDORS AND ADDRESSES
BID SHEET ATTACHED
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PLEASE BID
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SOLE SOURCE
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COMMODITY CODE NO.
(ENTER NUMBERS IN BOXES)
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PLEASE X ON LINE, IF ITEM NOT ON CURRENT CONTRACT AWARD
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ITEM DESCRIPTIONNO. OFUNIT
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NO.UNITUNITSPRICEAMOUNT
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1Ea1$1.00$1.00
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2
24
3
25
4
26
5
27
6
28
7
29
8
30
9
31
10
32
11
33
12
34
13
35
14
36
15
37
16
38
17
39
18
40
19
41
20
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TOTAL$1.00
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TOTAL - Pages 1 and 2
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LINECOMMITTED
COST CENTER
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NO.AMOUNTFUNDSIDACCOUNTDEPARTMENTPROGRAMVendor Phone:
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TEC64628
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Vendor Fax:
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PROJECTBUDGET REF.Vendor Contact Person:
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TEC4
Principal / Assistant Principal
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52
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APPROVED BUSINESS MANAGER FUNDS ARE AVAILABLE
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DPA NO.
CONTRACT AWARD NO.
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APPROVED PURCHASE ORDER NUMBER
AUTHORIZED SIGNATURE
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Superintendent / Assistant Superintendent
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Print Requisitioner Name
Requisitioner Signature
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INTERNAL PURCHASE REQUISITION
STATE OF CONNECTICUT
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0F-95 REV. 06/22
CT TECHNICAL EDUCATION & CAREER SYSTEMS
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Page 2 of 2
63
REQUISITIONING UNIT: Print or Type. Retain Part 2 (Canary). Forward
REQUISITION NO.
64
Part 1 to Office Issuing Purchase Order.
65
ISSUED BY (Agency/School)
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ITEM DESCRIPTIONNO. OFUNIT
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NO.UNITUNITSPRICEAMOUNT
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1$0.00
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2$0.00
71
3$0.00
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4$0.00
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5$0.00
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6$0.00
75
7$0.00
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8$0.00
77
9$0.00
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10$0.00
79
11$0.00
80
12$0.00
81
13$0.00
82
14$0.00
83
15$0.00
84
16$0.00
85
17$0.00
86
18$0.00
87
19$0.00
88
20$0.00
89
21$0.00
90
22$0.00
91
23$0.00
92
24$0.00
93
25$0.00
94
26$0.00
95
27$0.00
96
28$0.00
97
29$0.00
98
30$0.00
99
31$0.00
100
32$0.00