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<S> <C> <C>
DEPARTMENT OF CORRECTION STATE OF NORTH CAROLINA
PURCHASING SECTION
4227 MAIL SERVICE CENTER PURCHASE ORDER PAGE
RALEIGH, NC -------------- ----
27699-4227 4250016451 1
CORRECT PURCHASE ORDER AND
------------------------------ BLANKET RELEASE STOCK NUMBERS MUST APPEAR ON
NC DEPARTMENT OF CORRECTION --------------- ALL PACKAGES, INVOICES, SHIPPING
PH 919-716-3300 PAPERS AND CORRESPONDENCE.
2020 YONKERS RD CHANGE NOTICE PACKING SLIPS MUST ACCOMPANY
4220 MAIL SERVICE CENTER ------------- ALL SHIPMENTS.
RALEIGH, NC CHANGE #: 1
27699-4220 SEE REVERSE SIDE
------------------------------ FOR ADDITIONAL
INSTRUCTIONS
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TO: SHIP TO:
UNITED STATES MEDICAL GROUP OF DIV. OF PRISONS ADMIN. 2005
1405 S. ORANGE AVE NC DEPARTMENT OF CORRECTION
FLORIDA
ORLANDO FL 32806 831 WEST MORGAN STREET
RALEIGH, NC
27603-0940 919-733-3226
DATE PRINTED TERMS OF SALE TAX CERTIFICATION NUMBER TAX
--------------------------------------------------------------------------------
6/28/2000 NET 30 0.00
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SHIP VIA F.O.B. FREIGHT TERMS ADDITIONAL COST
--------------------------------------------------------------------------------
BEST WAY DESTINATION PREPAID 0.00
--------------------------------------------------------------------------------
LINE QUANTITY VOM ITEM NUMBER UNIT PRICE AMOUNT
DUE DATE
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REQUISITION 4250016451 AUTHORIZED ADDITIONAL NURSING
STAFF TO ACCOMODATE AN INCREASE IN SURGERIES AT THE
MOBILE UNIT. CONTRACT INCORPORATES TERMS INACCORDANCE
TO LETTER SIGNED BY VENDOR 05/16/00. DATE OF CHANGE IS
FROM 07/01/2000 TO 06/30/2001 FOR THE SUM NO GREATER
THAN $21,000 PER YEAR FOR THE ADDITIONAL NURSE.
THIS PURCHASE ORDER IS ISSUED IN CONJUNCTION WITH IFB#
4200283, MOBILE OPERATING ROOM/SVC, P&C*802779.
THIS IS A ONE YEAR AGREEMENT WITH THE OPTION TO
RENEW AN ADDITIONAL FOUR YEARS IN ONE YEAR INCREMENTS.
THE EFFECTIVE DATE OF THIS AGREEMENT IS ON OR ABOUT
OCTOBER 15, 1999 THROUGH OCTOBER 14, 2000.
0001 1 EA G21864 1,061,005.00000 1,061,005.00
11/01/1998
OPERATING ROOM TRUCK FOR CP
FISCAL YEAR OCTOBER 15, 1999 THROUGH JUNE 30, 2000.
0003 1 EA GN94855 1,512,720.00000 1,512,720.00
06/30/2001
OPERATION OF SURGICAL MOBILE TRUCK AT CP
REQUISITION 4250024911 AUTHORIZED ADDITION AND EXERCISE
OF OPTION YEAR 1 WHICH BEGINS IN OCTOBER 2000 ALL TERMS
AND CONDITIONS REMAIN THE SAME WITH IFB 42000283
PREVIOUS PO TOTAL ==> 1,533,720.00
PO NET CHANGE (+) ==> 1,061,005.00
2,594,725.00
------------
TOTAL
REMARKS:
BUYER: JOHN OUTEN
PHONE: 919-716-3250
By: /S/ John Outen
-----------------------
AUTHORIZED SIGNATURE
