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City of Carmel CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 102549
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 i
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
1/18/2019 00352626 EMS Supplies
BOUND TREE MEDICAL LLC Fire Department
VENDOR 23537 NETWORK PLACE SHIP 2 Civic Square
TO Carmel, IN 46032-
CHICAGO, IL 60673--1235
PURCHASE ID BLANKET CONTRACT PAYMENT TERMS FREIGHT
33105 .
I
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT:PRICE EXTENSION
Department: 1120 Fund: 102 Ambulance Capital Fund
Account: 42-390.11
10 Each 177268 Smart Capnoline Plus Non Intubated Oral Nasal w/02 $929.00 $9,290.00
Tubing -100 Box
Sub Total $9,290.00
SCANNED
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JAN , 1 8 2019
4
$ 1
Send Invoice To:
Fire Department
2 Civic Square
Carmel, IN 46032-
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT 9 PROJECT ACCOUNT AMOUNT
PAYMENT $9,290.00
'NP VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O. NUMBER IS MADE A
SHIPPING INSTRUCTIONS
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 -
. �
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'THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 ��-._ .,
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. ORDERED BY
I
Denise Snyder James Crider
TITLE Budget&Accreditation Manager Administration n
CONTROL NO. 102549 CLERK-TREASURER 1