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��� of Iarrrie1 CERTIFICATE NO.003120155 0020 PURCHASE ORDER NUMBER
\ FEDERAL EXCISE TAX EXEMPT 1 O 1 122
ONE CIVIC SQUARE 35-6000972 THIS NUMBER MUST APPEAR ON INVOICES,AIP
CARMEL, INDIANA 46032-2584 VOUCHER,DELIVERY MEMO,PACKING SLIPS,
SHIPPING LABELS AND ANY CORRESPONDENCE
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OFCARMEL-1997
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
12/14/2017 369028
AQUA FALLS BOTTLED WATERTO Dept of Community Service
VENDOR PO:BOX 98. SHIP 4 Civic Square
Carmel, IN :46032-
ENON,OH 45323-
PURCHASE ID• BLANKET CONTRACT PAYMENT TERMS FREIGHT:.,
21775
QUANTITY: UNIT OF MEASURE DESCRIPTION UNIT PRICE- EXTENSION
Department; 1192 Fund: 101 Gelneral Fund
Account: 43-551.00
1 Each Coffee Service. $295.30 $295.30
Sub Total $295.30
Coffee
x
Send Invoice To:
Dept of Community Service
1 Civic Square
Carmel, IN 46032-
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT I AMOUNT
PAYMENT $295.30
SHIPPING INSTRUCTIONS 'AIP VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O. NUMBER IS MADE A
PART OF THE VOUCHER AND EVERY INVOICE AND VOUCHER HAS THE PROPER SWORN
'SHIP PREPAID. 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 �� 'Y
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. ORDERED BY
Mike Hollibaugh �/�r
TITLE Director �J
CONTROL NO. 101 122 CLERK-TREASURER