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INDIANA RETAIL TAX EXEMPT Page 1 of 1
City of Iariririe1 CERTIFICATE NO.003120155 0020 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 102665
ONE CIVIC SQUARE 35-6000972 THIS NUMBER MUST APPEAR ON INVOICES,ANP
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
1/25/2019 361470
CHILD SOURCE Trinity Clinic
VENDOR 305 LAKE ROAD SHIP 1045 W 146th St.Suite-B
TO Carmel, IN 46032-
MEDINA, OH 44256- • Ann Gallagher
PURCHASE ID I BLANKET CONTRACT PAYMENT TERMS FREIGHT
33290
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Department: 1110 Fund: 900 Grant Fund
Account: 43-590.05
10 Each 3492198 Maestro Sport combination booster(20-100Ibs) $58.30 $583.00
1 Each shipping charges $87.00 $87.00
2 Each 3472198 Sonus Convertible Seat 2PK. $57.75 $115.50
Sub Total $785.50
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Send Invoice To: , -�. ._ .4 .. .�_ '...,
Police Department
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3 Civic Square ''', ` n k g
Carmel, IN 46032-
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT 1 PROJECT ACCOUNT @ AMOUNT
PAYMENT $785.50
SHIPPING INSTRUCTIONS 'ASP 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
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. ORDERED BY
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Jim Barlow
TITLE Chief
CONTROL NO. 102665 CLERK-TREASURER ,,vl