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<br />2023 Anoka County SHIP Community Partner Award Budget and Order Form <br />Please complete and submit this form with your application. <br />Organization/Group NameCity of Centerville <br />Organization/Group contact name for Shipping: <br />Phone Number of Organization/Group contact for shipping:651-792-7933 <br />Email of Organization/Group contact for shipping:tbender@centervillemn.com <br />Shipping Address:1880 Main Street <br />Liftgate Needed? (Yes or No): <br />Order includes a single item purchase of $500 or more, requiring a MOU (Yes or No) <br />Yes <br />Total Budget Request:$ 22,396.99 <br />Total Budget Approved: <br />(for internal use - do not complete) <br />Total Spent: (For internal use - do not complete)$ - <br />Context area: Mn Moves, Eats, Wellbeing, Tobacco (For internal use - do not complete) <br />Item <br />Specifications <br />(size, color, etc.)Shipping and Actual Spent Date Item Ordered <br />Please indicate if Handling (for internal use-do not (for internal use do Misc. Notes (How item will be used, <br />alternative is ok!Costcomplete)not complete)special considerations, etc.) <br />VendorItem NameItem Website URLUnit PriceQuantityTotal Cost <br />Global IndustriesElkey Outdoor EXH20 Bottle FillerElkay ezH20 Outdoor Bottle Filler w/ Drinking Fountain & Pet Station, Freeze Resistant, Evergreen (globalindustrial.com)$ <br /> - <br />w/Drinking Fountain & Pet Station,Evergreen$ 10,791.002414.99$ 21,996.99 <br />Freeze Resistant$ - <br />$ - <br />Hugo Plumbing & Pump Service, Inc.Curb Stops$ 100.004$ 400.00 <br />$ - <br />$ - <br />$ - <br />$ - <br />$ - <br />$ - <br />$ - <br />$ - <br />$ - <br />$ - <br />$ - <br />$ - <br />$ - <br />$ - <br />$ - <br />$ - <br />Total$ 22,396.99$ - <br />