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IICityof II1r]flflIe1 F CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 100412
ONE CIVIC SQUARE L _ 35-6000972 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
5/4/2017 060650 Project 17-SW-10;Contract Date 05.04.16
CLARK DIETZ,INC City Engineering's Office
VENDOR 8900 KEYSTONE CROSSING#900 SHIP 1 Civic Square
TO Carmel, IN 46032-
INDIANAPOLIS, IN 46240- Kate Lustig
PURCHASE ID BLANKET CONTRACT PAYMENT TERMS FREIGHT
l i
15108 I
r QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION 1
Department: 2200 Fund: 2200 Motor Vehicle Highway
Account: 43-401.00
1 Each ASA 9-106th Street and Hussey Lane Survey and Evaluation $6,200.00 $6,200.00
Sub Total $6,200.00
Send Invoice To:
City Engineering's Office
Kate Lustig
1 Civic Square
Carmel, IN 46032-
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
PAYMENT $6,200.00
SHIPPING INSTRUCTIONS '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
*SHIP PREPAID. AFFIDAVIT ATTACHED. I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
*C.O.D.SHIPMENT CANNOT BE ACCEPTED. THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
'PURCHASE ORDER NUMBER MUST APPEAR ON ALL SHIPPING LABEL
'THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 ' - _ `
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. ORDERED BY - //// �
Jeremy Kashman Douglas Haney N.
TITLE Director Corporation Counsel
CONTROL NO. 100412 CLERK-TREASURER