HomeMy WebLinkAbout101036 ST VINCENT HOSPITAL INDIANA RETAIL TAX EXEMPT
- . Page 1 of 1Iii of IIiirrrie1CO PURCHASE ORDER
UMBE_R_
FEDERAL EXCISE TAX EXEMPTi® O � _
ONE CIVIC SQUARE 35-6000972 THIS NUMBER MUST APPEAR ON INVOICES,ARP
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
12/11/2017 360209 02 Refill Units
ST VINCENT HOSPITAL Fire Department
VENDOR ATTN: KRISTINE BROWN,ACCT.:RPTNG SHIP 2 Civic Square
TO
10330 N MERIDIAN ST SUITE 430 Carmel, IN 46032
INDIANAPOLIS, IN 46290-
PURCHASE ID BLANKET CONTRACT : PAYMENT TERMS
-FREIGHT
21458
QUANTITY : UNIT OF MEASURE DESCRIPTION " UNIT PRICE EXTENSION
Department: 1120 Fund: 102 Ambulance Capital Fund
Account: 44-670.06
1 Each Homefill Units and D Bottles $3,400.00 $3,400.00
Sub Total $3,400.00
Send Invoice To:
Fire Department
2 Civic Square
Carmel, IN 46032-
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT N AMOUNT
PAYMENT $3,400.00
SHIPPING INSTRUCTIONS 'A/P 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
BY
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. ORDERED
Denise Snyder
TITLE Budget&Accreditation Manager _)
CONTROL NO. 101036 CLERK-TREASURER