: 4494 Purchase Order Northern Illinois University Purchase Order 103084 Page 1 Procurement Services Date 02/04/2009 Cowden Fal 07 | Revsion 580 Cato Ave PaymontTems Ne dora es ua | Pela Oni, ropa Ad Shin Untod Stats 815/753-1671 Ship To: Northern Ilinois University Central Receiving JOSTENS INC Devan 609 ATTN DARFYL POLAK 180 Stam Dr G40 W33145 CONNEMARA DR oS , Dekalb I 6015-2854 DOUSMAN WI 53118. Bye BilTe: Nore toi Universty Genet Accounting Lowden Hall 204 DeKalb IL 60115 Fax: 815/783-2007 Due Date | (ine tem/Deserption Guantiy__UOM Unit Price Extended 1 Independence Bowl Rings (107 Player Rings 136.00 EA 18568 21,172.48 02/27/2009 & 29 Staff Rings) (Rings = $139 + $16.68 (12%) royalty fee for use of Independence Bow! Logo = $155.68 each.) 2 Independence Bow! Staff Pendants 300 EA 83.00 249,00 02/27/2009 2 Total PO Amount [21,401.48 Pricing per Darryl Polak Quote dated 1/23/09. VENDOR: NIU's PO# MUST BE ON OUTSIDE SHIPPING LABEL. VENDOR ALERT: Public Act 95-0971 requires all vendors to register who do $50,000.00 worth of business annually with the State of Ilinois, including state universities to, register with the State Board of Elections, www.elections.il gov; submit a copy of their Registration Certificate to the Chief Procurement Officer for Higher [Al shipmonts, sipping papers, invoices, and cortespondance must be Kentiied wth our Purchase Order Nurmbor. Ary Shipments witout te Purchase ‘Order Numbor may be rejected. Oversigments wil act be accepted unless authorized by Buyer prior o shipment. “This purchase ordris subject to all applicable ilinois and Federal statutes and regulon, including the Winois Procurement Code and the Higher Education Procurement Rules, and all applicable regulations and procedures of Nore imino University. Pease contact NIU-Procurement Services for copies needed Vendor corti that itis not deingvent inthe payment of any debt othe State or certs thatthe vendor has entered into a deterred payment plan to pay off the debt, n accordance withthe lois Procurement Cod (30 ILGS SOQISC:11). - ‘Authorized Signature ‘Chartfelds (fund, cost entr, class, projeel/grant, account, total $ for each) b=] me Woe { Kec Brent — OT, ee euscttimeromn fy Ol SS eee a POType: LSTD PORe!: DEPT REF #ase1 NIUFEIN: 965008480 I Tax Exempt# £9990-9601-05