HomeMy WebLinkAbout32842 Public Safety Medical Serviceof 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
32842
THIS NUMBER MUST APPEAR ON INVOICES, A/P
VOUCHER, DELIVERY MEMO, PACKING SLIPS,
SHIPPING LABELS AND ANY CORRESPONDENCE.
PURCHASE ORDER DATE
DATE REQUIRED
REQUISITION NO.
VENDOR NO.
• " " DESCRIPTION
12015
•
Public Safety Medical Services
VENDOR
324 E. Niard York Street, Suite 300
Indianapolis, IN 48204
SHIP
TO
Cannel Police Department
3 Civic Square
Cannel, IN 48032
(317) 571
CONFIRMATION
BLANKET
CONTRACT
PAYMENT TERMS
FREIGHT
QUANTITY
UNIT OF MEASURE
DESCRIPTION
UNIT PRICE
EXTENSION
Account 43407.01
1 Each physical for applicant
Send Invoice To:
Carrel Police Department
Attn: Pat Young
3 Civic Square
Cannel, IN 48032=
PLEASE INVOICE IN DUPLICATE
$718.45
Sub Total:
$718.45
$718.45
DEPARTMENT
ACCOUNT
PROJECT
PROJECT ACCOUNT
AMOUNT
Cannel Police Dept.
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. 32842
ORDERED BY
TITLE
CLERK - TREASURER
OFFICE COPY
PAYMENT
•
$(16.45
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.
I HEREBY CERTIFY •T THERE ,IS AN UNOBLIGATED BALANCE IN
THIS APPROP'.A'lo) SUFFICIENT TO PAY FOR THE ABOVE ORDER.
ljief of Polio