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ofCairmel 1 1 CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 1004.69
ONE CIVIC SQUARE 35-6000972 THIS NUMBER MUST APPEAR ON INVOICES,NP
I 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
1PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
5/24/2017 364088 136th/Keystone Repairs
CONCRETE TAILORS LLC Street Department
VENDOR PO BOX 3 SHIP 3400 W. 131st Street
TO Carmel, IN 46074-
NOBLESVILLE, IN 46061 - (317)733-2001
PURCHASE ID j BLANKET r CONTRACT] PAYMENT TERMS FREIGHT
15669 f
QUANTITY I UNIT OF MEASURE ` DESCRIPTION UNIT PRICE EXTENSION
Department: 2201 Fund: 2201 Motor Vehicle Highway FND
Account: 43-509.00
1 Each 136th/Keystone Repairs $2,800.00 $2,800.00
Sub Total $2,800.00
Send Invoice To:
Street Department
3400 W. 131st Street
Carmel, IN 46074-
(317)733-2001 PLEASE_ INVOICE IN DUPLICATE
DEPARTMENT I ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
PAYMENT $2,800.00
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 - — --
Dave Huffman
TITLE Director 4)4k1
CONTROL NO. 100469 CLERK-TREASURER