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Cityof CInr]r1r1Ie10ERTIFICATEO PURCH ___
FEDERAL EXCISE TAX EXEMPT10048
1 �RNUMBER
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 108335 Repairs to 96th St./Westfield Blvd.
GLOBE ASHPHALT PAVING CO Street Department
VENDOR PO BOX 19168 : SHIP 3400 W. 131st Street
TO
Carmel, IN .4607:4-
INDIANAPOLIS, IN 46219 (317)733-2001
PURCHASE ID BLANKET CONTRACT. PAYMENT TERMS FREIGHT
21491
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Department: 2201 Fund: 2201 Motor Vehicle Highway FND
Account: 43-509.00
1 Each Repairs $3,987.13 $3,987.13
Sub Total $3,987.13
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Send Invoice To:
Street Department
3400 W. 131st Street
Carmel, IN 46074._
(317)733-2001 PLEASE INVOICE IN DUPLICATE
DEPARTMENT I ACCOUNT PROJECT - I PROJECT ACCOUNT I AMOUNT
PAYMENT $3,987.13
SHIPPING INSTRUCTIONS 'MP 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
Dave Huffman
TITLE Director
CONTROL NO. 101048 CLERK-TREASURER