HomeMy WebLinkAbout102532 MALINOWSKI CONSULTING INC v INDIANA RETAIL TAX EXEMPT Page 1 of 1
ciCity of IIiriniiie1 CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 102532
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 /^
,114. 2
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
1/14/2019 366749 Medicaid Ambluance Cost Reporting 2018 S\‘‘
MALINOWSKI CONSULTING INC Fire Department
VENDOR 755 W CARMEL DRIVE STE 203 SHIP 2 Civic Square
TO Carmel, IN 46032-
CARMEL, IN. 46032-
PURCHASE ID BLANKET CONTRACT PAYMENT TERMS FREIGHT
32977
QUANTITY UNIT OF MEASURE DESCRIPTION 1 UNIT PRICE EXTENSION
Department: 1120 Fund:•101. General Fund
Account: 43-404.00
1. Each Recoup Medicaid Fees Year End $9,500.00 $9,500.00
Sub Total $9,500.00
__w�
F#'r C .
/
-, .. g2
(
\ ,:v. V,,(.x -, 4.,:, ,„ .7.,, ,,,,,v,---; . , J i
1 I
\'''''''1':,,t1')-4 -___
yam#}. -E.. -1,-,1:'; �',A r A:
Send Invoice To: '4-:. _ : < - i
11
Fire Department ,
2 Civic Square ~, / ` A "r`-i`'. � ,
Carmel, IN 46032 '` .� I �g ``
PLEASE INVOICE IN DUPLICATE
DEPARTMENT 1 ACCOUNT 1 PROJECT D. PROJECT ACCOUNT AMOUNT
PAYMENT $9,500.00
SHIPPING INSTRUCTIONS' 'NP 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 LABE -^� C.-_,e,0
' _
*THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 194 - + � /Oi
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. ORDERED BY
i Denise Snyder James Crider
TITLE • Budget&Accreditation Manager Administration
CONTROLNO. 102532 CLERK-TREASURER