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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 $500 or more, requiring a MOU (Yes or No) <br />Yes <br />Total Budget Request:$ 2,454.26 <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 />The Parks Facilities CatalogBike Repair Standhttps://www.theparkcatalog.com/bike-repair-stand?hsa_acc=8003768090&hsa_cam=291384908&hsa_grp=1265537989803013&hsa_ad=&hsa_src=o&hsa_tgt=pla-4582695747393 <br />000&hsa_kw=&hsa_mt=e&hsa_net=adwords&hsa_ver=3&utm_source=bing&utm_medium=cpc&utm_campaign=SHOPPING%20-%20Bike%20Racks&utm_term=4582695747393000&utm_content=Bike%20RacksPowder Coated$ <br /> 2,335.00 1119.26$ 2,454.26 <br />Air Pump w/Heavy-Duty Air Pump (w/gauge)Purple$ - <br />Freeze Resistant$ - <br />$ - <br />$ - <br />$ - <br />$ - <br />$ - <br />$ - <br />$ - <br />$ - <br />$ - <br />$ - <br />$ - <br />$ - <br />$ - <br />$ - <br />$ - <br />$ - <br />$ - <br />$ - <br />Total$ 2,454.26$ - <br />