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City of Carirnel -- .
CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 100944
ONE CIVIC SQUARE 35-6000972 THIS NUMBER MUST APPEAR ON INVOICES,NP
CARMEL, INDIANA 46032-2584 VOUCHER,DELIVERY MEMO,PACKING SLIPS,
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL-1997 SHIPPING LABELS AND ANY CORRESPONDENCE
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
11117/2017 00350364
PUBLIC SAFETY MEDICAL SERVICES Carmel Police Department
VENDOR 324 E NEW YORK ST SUITE 300 SHIP 3 Civic Square
TO
Carmel, IN 46032-
INDIANAPOLIS, IN 46204- Blaine.Mallaber
PURCHASE ID BLANKET CONTRACT PAYMENT TERMS FREIGHT
20812
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Department:_1110 Fund: 101 General Fund
Account: 43-407.01
116 Each Officer physicals $576.17 $66,835.72
Sub Total $66,835.72
SCANNED
NOV X19 1011
,
Send Invoice To:
Carmel Police Department
Accounts Payable
3 Civic Square
Carmel, IN 46032-
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT 0 PROJECT I PROJECT ACCOUNT V AMOUNT
PAYMENT $66,835.72
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 ? 1—,c —fi' 'GlOQ�'
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. ORDERED BY \
Jim Barlow James Crider "V
TITLE Chief Administration\\I
CONTROL NO. 100944 CLERK-TREASURER