HomeMy WebLinkAbout100905 MALINOWSKI CONSULTING INC INDIANA RETAIL TAX EXEMPT Page 1 of 1
II1. of Carmel CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
_.
FEDERAL EXCISE TAX EXEMPT 100905
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
iPURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
11/9/2017 366749
MALINOWSKI CONSULTING INC Fire Department
VENDOR 755 W CARMEL DRIVE STE 203 SHIP 2 Civic Square
TO Carmel, IN 46032-
CARMEL, IN 46032-
PURCHASE ID j BLANKET CONTRACT PAYMENT TERMS FREIGHT
20566
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Department: 1120 Fund: 101 General Fund
Account: 43-404.00
1 Each Recoup Medicaid Fees Year End 2015 $9,500.00 $9,500.00
Sub Total $9,500.00
Send Invoice To:
Fire Department
2 Civic Square
Carmel, IN 46032-
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT j PROJECT ACCOUNT I AMOUNT
PAYMENT $9,500.00
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 James Crider �\
TITLE Budget&Accreditation Manager Administration
CONTROL NO. 100905 CLERK-TREASURER