HomeMy WebLinkAbout24678 Physio ControlCi
of Carmel
ONE CIVIC SQUARE
CARMEL, INDIANA 46032 -2584
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL - 1997
INDIANA RETAIL TAX EXEMPT
CERTIFICATE NO. 003120155 002 0
FEDERAL EXCISE TAX EXEMPT
35- 60000972
PAGE
PURCHASE ORDER NUMBER
24678
THIS NUMBER MUST APPEAR ON INVOICES, NP
VOUCHER, DELIVERY MEMO, PACKING SLIPS,
SHIPPING LABELS AND ANY CORRESPONDENCE.
PURCHASE ORDER DATE
DATE REQUIRED
REQUISITION NO.
VENDOR NO.
DESCRIPTION
1f22Q015
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y
•-�,-Nc:,v .. ‘. <,Kt-c,(- Q`-`1
VENDOR
Physio Control
12100 Collections Center Drive
Chicago, IL 60693
SHIP
TO
v
Cannel Fire Department
2 Carmel Civic Square
Carmel, IN 46032
(397) 571-2622
CONFIRMATION
BLANKET
CONTRACT
PAYMENT TERMS
FREIGHT
u
y
QUANTITY
•
UNI (OF MEASURE I\
Account 43-515.01
1 Each Defib. PM
Send Invoice To:
DESCRIPTION
UNIT PRICE
Carmel Fire Department
2 Carmel Civic Square
Carmel, IN 48032-
PLEASE INVOICE IN DUPLICATE
$23,874.00
Sub Total:
EXTENSION
$23,874.00
$23,874.00
DEPARTMENT
ACCOUNT
PROJECT
PROJECT ACCOUNT
AMOUNT
Carmel Fire Department
SHIPPING INSTRUCTIONS
• SHIP REPAID.
• C.O.D. SHIPMENTS CANNOT BE ACCEPTED.
• PURCHASE ORDER NUMBER MUST APPEAR ON ALL
SHIPPING LABELS.
• THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
DOCUMENT CONTROL NO. 24678
ORDERED BY
TITLE
CLERK - TREASURER
OFFICE COPY
PAYMENT 874 00
• A/P 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.
• I HEREBY CERTIFY THOTHERE IS AN UNOBLIGATED BALANCE IN
THIS APPROPRIATION/SUFFICIENT-TO PAY FOR THE ABOVE ORDER.