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CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 101047
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
12/11/2017 367400 Repairs to Main St./Illinois
INDIANAPOLIS CONCRETE Street Department
VENDOR 5363 W 8611-IST SHIP 3400 W. 131st Street
TO Carmel, IN 46074-
INDIANAPOLIS, IN 46268- (317):733-2001
PURCHASE ID BLANKET CONTRACT PAYMENT TERMS FREIGHT
21490
QUANTITY UNIT OF MEASURE :: DESCRIPTION UNIT PRICE EXTENSION
Department: 2201 Fund:.2201 :Motor Vehicle Highway FND
Account: 43-509.00
1 Each Repairs to roundabouts $3,005.00 $3,005.00
Sub Total $3,005.00
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Send Invoice To: 4
Street Department
3400 W. 131st Street
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Carmel, IN.46074-
(317)733-2001 PLEASE INVOICE IN DUPLICATE
DEPARTMENT I ACCOUNT I PROJECT I PROJECT ACCOUNT I AMOUNT
PAYMENT $3,005.00
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 7 D \<1
Dave Huffman \\
TITLE Director p A
CONTROL NO. 101047 CLERK-TREASURER \' V