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i INDIANA RETAIL TAX EXEMPT Page 1 of 1
Citof I1airiiiie1 CERTIFICATE NO.003120155 0020 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 100481
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
513112017 242000
Modems for Defibrillators
PHYSIO CONTROL CORP Fire Department
VENDOR 12100 COLLECTIONS CENTER DRIVE SHIP 2 Civic Square
TO Carmel, IN 46032-
CHICAGO,IL 60693-
PURCHASE ID BLANKET CONTRACT PAYMENT TERMS FREIGHT
15757
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE : EXTENSION
Department: 1120 Fund: 102 Ambulance Capital Fund
Account: 44-670.06
5 Each 21996-000073 Ositech Titan II Wireless Gateway $952.20 $4,761.00
1 Each Shipping $65.00 $65.00
Sub Total $4,826.00
Send Invoice To:
Fire Department
2 Civic Square
Carmel,IN 46032-
PLEASE INVOICE IN DUPLICATE
DEPARTMENT [ ACCOUNT I PROJECT PROJECT ACCOUNT AMOUNT
PAYMENT $4,826.00
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 ---
Denise Snyder
TITLE Budget&Accreditation Manager
CONTROL NO. 100481 CLERK-TREASURER ,,