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CERTIFICATE NO.003120155 002 0
�� Carniel FEDERAL EXCISE TAX EXEMPT 38299
35-60000972
ft_:;• I _ ,� _ THIS NUMBER MUST APPEAR ON INVOICES,NP
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
416/2015 04/08/15 4740 Drinking fountain repair parts for inventory
Most Dependable Fountains Inc. Parks Maintenance
P.O. Box 587 1427 E. 116th Street ATTN: Courtney
VENDOR Arlington, TN 38002-0587 SHIP Carmel, IN 46032
O
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE 1 EXTENSION
3.000 each 305B-2-3-Valve for pet water section on water fountains $ 69.0000 $207.00
3.000 each 0-ring valve with 0-ring assebly complete $ 110.0000 $ 330.00
1.000 each Approximate Shipping $ 15.0000 $ 15.00
GLAccount# 1125413-4237000
Send Invoice To:
$552.00
PLEASE INVOICE IN DUPLICATE
DEPARTMENT 1 ACCOUNT PROJECT I PROJECT ACCOUNT 1 AMOUNT
PAYMENT
• AIP 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
SHIPPING INSTRUCTIONS AFFIDAVIT ATTACHED.
. I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN THIS APPROPRIATION
• SHIP REPAID. SUFFICIENT TO PAY FOR THE ABOVE ORDER.
• C.O.D SHIPMENTS CANNOT BE ACCEPTED.
• PURCHASE ORDER NUMBER MUST APPEAR ON ALL SHIPPING LABELS. ORDERED BY Courtney Weintraut (� 1\kLO is
• THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945
AND ACTS AMENDATORY THEREOF ANDSUPPLEMENT THERETO. TITLE
CLERK-TREASURER
DOCUMENT CONTROL NO. 38299 VEND