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1 CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
; FEDERAL EXCISE TAX EXEMPT 100611
ONE CIVIC SQUARE 35-6000972 THIS NUMBER MUST APPEAR ON INVOICES,AIP
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. I VENDOR NO. DESCRIPTION
7/27/2017 fi 369617 Computer adapters/cables
I
MONOPRICE INC Information Systems
VENDOR PO BOX 740417 SHIP 3 Civic Square
TO Carmel, IN 46032-
LOS ANGELES,CA 90074--0417 Terry Crockett (317)571-2567
PURCHASE ID BLANKET ' CONTRACT i PAYMENT TERMS T FREIGHT
17595 �
QUANTITY i UNIT OF MEASURE i DESCRIPTION UNIT PRICE EXTENSION
,
Department: 1202 Fund: 101 General Fund
Account: 42-370.00
25 Each 2396 DVI-A Dual Link Male to HD15(VGA)Female Adapter $1.49 $37.25
25 Each 2029 DVI-D Single Link Male to HDMI Female Adapter $2.99 $74.75
25 Each 3992 Select Series High Speed HDMI Cable,6ft black $2.67 $66.75
Sub Total $178.75
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Send Invoice To: f ._ � t , `
Information Systems ''
Terry Crockett
3 Civic Square " ,.
Carmel, IN 46032- ' }•k
(317)571-2567 PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT I AMOUNT
PAYMENT $178.75
*NP VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O. NUMBER IS MADE A
SHIPPING INSTRUCTIONS
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 LABE
*THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 194 7,----- e___.-- .4--
AND
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. ORDERED BY y
Timoth Renick
TITLE Director
CONTROL NO. 100611 CLERK-TREASURER