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HomeMy WebLinkAbout102759 CHILD SOURCE INDIANA RETAIL TAX EXEMPT Page 1 of 1 City ®f Carinnie1 CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER FEDERAL EXCISE TAX EXEMPT 102759 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 OF CARMEL-1997 PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION 3/27/2019 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 BLANKET CONTRACT PAYMENT TERMS FREIGHT 34953 QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION Department: 1110 Fund: 900 Grant Fund Account: 43-590.05 4 Each 3492198 Maestro Sport combination booster(20-1001bs) $58.30 $233.20 1 Each IC201CHZ OnBoard 35(4-35 Ibs)with adjustable base and up front $78.00 $78.00 adjust 1 Each shipping charges $56.00 $56.00 2 Each 3472198 Sonus Convertible Seat 2PK. $57.75 $115.50 Sub Total $482.70 I Send Invoice To: _.. f 4 .. Police Department `$331.10 from Rotary Grant, balance from Trininty Clinic 3 Civic Square ,n, Carmel, IN 46032- PLEASE INVOICE IN DUPLICATE DEPARTMENT I ACCOUNT PROJECT I PROJECT ACCOUNT I AMOUNT PAYMENT $482.70 SHIPPING INSTRUCTIONS 'A!P 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 Jim Barlow TITLE Chief CONTROL NO. 102759 CLERK-TREASURER