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City ®f CIIiiriririe1 CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 102798
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
4/15/2019 372964 Additional Classes
FIREFIGHTER BEHAVIORAL HEALTH ALLIA Carmel Fire Department
VENDOR 3655 W ANTHEM WAY SHIP 2 Civic Square
SUITE A-109-374 TO Carmel, IN 46032-
ANTHEM,AZ 85086-
PURCHASE ID BLANKET CONTRACT PAYMENT TERMS FREIGHT
35395
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Department: 1120 Fund: 101 General Fund
Account: 43-570.03
3 Each Saving Those Who Save Others Workshops $600.00 $1,800.00
Sub Total $1,800.00
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Send Invoice To:
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Carmel Fire Department 'I ,, ' r
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2 Civic Square '',, , r t �r_s
Carmel,,IN 46032- -�.... F P 4a ,-a'`
PLEASE INVOICE IN DUPLICATE
DEPARTMENT A ACCOUNT P PROJECT PROJECT ACCOUNT 1 AMOUNT
PAYMENT $1,800.00
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
*THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 194 'J ��`sp.."'
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. ORDERED BY
Denise Snyder
TITLE Accreditation Budget Administrator
CONTROL NO. 102798 CLERK-TREASURER