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CERTIFICATE NO.003120155 002 0 ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 100980
ONE CIVIC SQUARE 35-6000972 THIS NUMBER MUST APPEAR ON INVOICES,A/P
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
11/29/2017 360209 Drugs
ST VINCENT HOSPITAL Fire Department
VENDOR ATTN: KRISTINE BROWN,ACCT.RPTNG SHIP 2 Civic Square
10330 N MERIDIAN ST SUITE 430 TO Carmel,IN 46032-
INDIANAPOLIS, IN 46290-
PURCHASE ID BLANKET CONTRACT PAYMENT TERMS FREIGHT
21051
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Department: 1120 Fund: 102 Ambulance Capital Fund
Account: 42-390.11.
1 Each Drugs and Narcotics $3,453.33 $3,453.33
Sub Total $3,453.33
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Send Invoice To:
Fire Department
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2 Civic Square
Carmel, IN 46032- 4„...,,, ,,
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PLEASE INVOICE IN DUPLICATE
DEPARTMENT . ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
PAYMENT $3,453.33
SHIPPING INSTRUCTIONS 'NP VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O. NUMBER IS MADE A
'SHIP PREPAID. PART OF THE VOUCHER AND EVERY INVOICE AND VOUCHER HAS THE PROPER SWORN
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 ' '`"
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AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
ORDERED BY
Denise Snyder N,
TITLE Budget&Accreditation Manager
CONTROL NO. 100980 CLERK-TREASURER