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City of Carie CERTIFICATE
003120155 002 O PURCHASE
FEDERAL EXC ISTAX EXEMPT 100999 OooR���UMBER
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
12/4/2017 358990 Helmets
MUNICIPAL EMERGENCY SERVICES Fire Department
VENDOR 75 REMITTANCE DRIVE SHIP 2 Civic Square
SUITE 3135 TO Carmel, IN 46032-
CHICAGO,IL 60675-
PURCHASE ID BLANKET CONTRACT PAYMENT TERMS FREIGHT
21163
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Department 1120 Fund; 101 General Fund
Account: 43-560.03
15 Each Honeywell Ben 2 Helmets $255.00 $3,825.00
Sub Total $3,825.00
Send Invoice To: a '
Fire Department
2 Civic Square
Carmel, IN 46032-
PLEASE
INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT I PROJECT PROJECT ACCOUNT AMOUNT
PAYMENT $3,825.00
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
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
ORDERED BY t \
Denise Snyder
TITLE Budget&Accreditation Manager \
CONTROL NO. 100999 CLERK-TREASURER `•