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31855 AlGalCo
ED EXEMPT PAGE of Carmel aCRFICAT N0 0031201 5 020 PURCHASE ORDER NUMBER FEDERAL EXCISE TAX EXEMPT 31855 35-60000972 ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES,NP CARMEL, INDIANA 46032-2584 VOUCHER, DELIVERY MEMO, PACKING SLIPS, SHIPPING LABELS AND ANY CORRESPONDENCE. FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL- 1997 PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION 2/18/2014 AIGaICo, LLC Street Department VENDOR SHIP 3400 W. 131st Street TO P.O. Box 502768 Carmel, IN 46074 Indianapolis, IN 46250 (317) 733-2001 CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION Account 0042-311.00 1 Each 7000 Liters of Hydrogen $470.88 $470.88 Sub Total: $470.88 l 0 6\.. ... •.., 4.:,re. . ' :iu rt : Niiiik 1.. /■ Send Invoice To. �� o m ©0 Street Department 3400 W. 131st Street Cannel, IN 46074- PLEASE INVOICE IN DUPLICATE DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT Carmel Street Department PAYMENT $470.88 • NP VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O. NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED. SHIPPING INSTRUCTIONS • I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN THIS APPROPRIATION UFFICIENT 0 PAY FOR THE ABOVE ORDER. •SHIP REPAID. •C.O.D.SHIPMENTS CANNOT BE ACCEPTED. 1O/' •PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY i �:. . e N! u SHIPPING LABELS. yr-' ,}-I/ p 14 •THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE S 1 ( e C 1 Coil, I SJ I0/l f Or AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. CLERK-TREASURER DOCUMENT CONTROL NO. 31855 A.P.V. COPY-SIGN AND RETURN TO CLERK'S OFFICE