Texas State Seal

CONTRACT PURCHASE ORDER

In accordance with the contract between the Contractor
and the Texas Comptroller of Public Accounts
         Agency to Invoice    
      NORTH TEXAS STATE HOSPITAL           656       Purchase Order Number  3 0 2 1 9 5
      PO BOX 2231                          001                 Requisition  53701-0-16737
      VERNON             TX 76385
                                                                             11/6/09         1


         Destination if Different  
      NORTH TEXAS STATE HOSPITAL           656
      WICHITA FALLS CAMPUS                 002
      6515 KEMP BLDG
      WICHITA FALLS TX 76308

THE STATE OF TEXAS IS EXEMPT FROM ALL FEDERAL EXCISE TAXES
STATE AND CITY SALES TAX EXEMPTION CERTIFICATE: The State of Texas claims an exemption from taxes under Texas Tax Code § 151.309(4), for purchase of tangible personal property described in this numbered order, purchased from contractor and/or shipper listed here, as this property is being secured for the exclusive use of the State of Texas.
37237
         Contractor
 VID#: 1-74-220-5722-8000
 GROVES INDUSTRIAL SUPPLY CORP
 7301 PINEMONT DRIVE
 HOUSTON TX 77040-6607
              FOR AGENCY USE ONLY:  MIM1004734 LINE 6


                      **** ENTERED BY 29SINGLETON FLOR ****
              CONTACT AT AGENCY: FLORENCE SINGLETON, PHONE: 512-206-5122
              PAYMENT CONTACT: PEGGY JONES, PHONE: 940-552-4026
              VENDOR CONTACT: RALPH COSTA, PHONE: 713 675-4747
              AGENCY DELIVERY CONTACT INFORMATION:
              NAME: SHARON PETTIT
              TELEPHONE NO: 940-689-5585
              EMAIL: SHARON.PETTIT@HHSC.STATE
              VENDOR TO PROVIDE DELIVERY CONTACT INFORMATION TO
              SHIPPING/FREIGHT PROVIDER

              ORDERING ENTITY/PURCHASER CONTACT INFORMATION:
              EMAIL: FLORENCE.SINGLETON@HHSC.STATE
              FAX NUMBER: 512-206-4711


                   Description                                  Quantity  Unit      Unit    Extended
                                                                                   Price      Amount

      200-45  PONCHO RAINWEAR. APPROX. 10MM UNSUPPORTED SINGLE
              PLY PVC, APPROX. 50 X 80, LIGHTWEIGHT, ATTACHED
              HOOD WITH POUCH FOR STORAGE, SIDE SNAP CLOSURE

     20010-0  ONE SIZE FITS ALL. COLOR: CLEAR, RIVER CITY, #042      200  EA        1.04      208.00

              DELIVERY IN  30 DAYS.

                                                                   TOTAL THIS ORDER          $208.00