Office of Fleet and Asset Management

STATE OF CALIFORNIA DEPARTMENT OF GENERAL SERVICES OFFICE OF FLEET AND ASSET MANAGEMENT EQUIPMENT MODIFICATION REQUEST OFA 155 (Rev 10/03) OFFICE OF FLEET AND ASSET MANAGEMENT EQUIPMENT MODIFICATION REQUEST

Date: ______

OWNING AGENCY ______Address ______City ______State______Zip______Telephone ______Contact Person ______

LICENSE NUMBER ______VIN or SERIAL NUMBER ______PROPERTY NUMBER ______

YEAR ______MAKE and MODEL ______TYPE of EQUIPMENT ______MILEAGE ______TRANS. STD or AUTO ______ENGINE # of CYLINDERS ______TIRE SIZE ______EQUIPMENT G.V.M. ______TOWED EQUIP G.V.M. ______

TYPE of MODIFICATION REQUESTED Include drawings, specs, etc. when appropriate ______

JUSTIFICATION ______

ATTACH THREE (3) WRITTEN BIDS FOR ABOVE DESCRIBED MODIFICATIONS Supervisor’s name and title (print) ______

SUPERVISOR’S SIGNATURE ______