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ciiCity ®f Carmel CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 100671
ONE CIVIC SQUARE 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
8/22/2017 361361
HELMETS R US Dept of Community Service
VENDOR 2705 PACIFIC AVE SHIP 1 Civic Square
TO
Carmel, IN 46032-
TACOMA,WA 98402-
I PURCHASE ID I BLANKET I CONTRACT PAYMENT TERMS FREIGHT
18310
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE I EXTENSION
Department: 1192 Fund: 101 General Fund
Account: 43-421.00
1 Each Postage $150.00 $150.00
Sub Total $150.00
Account: 43-560.03
24 Each Large, Model 02 Bike Helmets -Public Safety Day- $7.95 $190.80
24 Each Medium, Model 02 Bike Helmet-BLUE $7.95 $190.80
24 Each Medium, Model 02 Bike Helmets-RED Public Safety Day $7.95 $190.80
24 Each Small, Model 02 Bike Helmet-Yellow-Public Safety Day $7.95 $190.80
28 Each Toddler, Model 15 Bike Helmet-BLUE-Public Safety Day $7.95 $222.60
Sub Total $985.80
Send Invoice To:
Dept of Community Service
1 Civic Square
Carmel, IN 46032-
PLEASE INVOICE IN DUPLICATE
DEPARTMENT I ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
PAYMENT $1,135.80
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 194579f.
ORDERED BY
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. — -
Mike Hollibaugh
TITLE Director
CONTROL NO. 100671 CLERK-TREASURER
