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FY 2002 VEHICLE ORDER FOIC~I <br />MN/DOT COOPERATIVE PROCUREMENT FOR SMALL, <br />MID-SIZED & MEDIUM-DUTY ACCESSIBLE BUSES <br /> <br />MN/DOT Agreement Number: <br /> <br /> Contract Amount $ <br />RecipientName:C8$SC~o.,.~, .Sh~.v,'g~-s Oep'l- <br />Ad.ess: <br /> <br />CID', State, Zip: <br />Contact Name: <br /> <br />Bus Manufac~er: <br />Model: ~O <br /> <br />5310 <br />5311 <br /> <br />Phone Number: '70 <br />Fax Number: 70t <br /> <br />Bus GVWR: / ql <br />Chassis Wheelbase: <br />Chassis Length: ~ <br /> <br />Vehicle Spec. U 10. ~ Bus //-e, Passenger seats (drivers seat not included) .T., WC Position(s) <br /> <br /> Lilt Position: Front / Rear <br />Base Price (includes freight - manufacturer to vendor) 53 q <br /> <br />OPTIONS: Select from vehicle specifications optional equipment list. <br /> (Section 5310 - fill out attached form (page 2) for options not paid for by MnDOT) <br /> <br /> Option = Description <br /> <br /> q7 A .,ooo <br /> <br />TOTAL FROM PAGE 2 - 5311 RECIPIENTS <br /> <br />DeliveW Ch~ge - Vendor to Recipient ~, O, ~. F~ <br /> <br />License and Transfer fees <br /> <br />Extended W~ties <br /> <br />ITOTAL <br /> <br />80% Mn/Dot Share $ <br /> <br /> 20%Recipient Share $ <br />100% - 5310 Options from page 2 $ <br /> <br />Recipient Signature: <br /> <br />Please send this form to DPM: <br /> <br />MN/DOT APPROVAL <br />Project Manager <br />Date of Approval. <br /> <br />(Signature) <br /> <br /> (Title) (Date) <br />DPM - Forward completed, signed form to: <br /> <br /> James Anderson <br /> MN/DOT Office of Transit <br /> 395 John lreland Boulevard, M.S. 430 <br /> St. Paul, MN 55155-1899 <br /> <br />N:\TR.A',TRANSITWEHICLES2002~Buse~\Veh. Ordcr Form (use additional sheets as needed) <br /> <br /> <br />