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City of Carmel CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 102805 "'
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
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
4/16/2019 373231 Mattresses
AFM MATTRESS CO LLC Fire Department
VENDOR 1301 SCHIFERL RD SHIP 2 Civic Square
TO Carmel, IN 46032-
BARTLETT, IL 60103--1701
PURCHASE ID BLANKET CONTRACT PAYMENT TERMS FREIGHT
35479
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Department: 1120 Fund: 102 Ambulance Capital Fund
Account: 44-630.00
1 Each Delivery/Shipping $119.98 $119.98
9 Each Mattress Cover $44.00 $396.00
6 Each Restore Meadow Trail Mattress $479.99 $2,879.94
3 Each Serta Blue 100 Mattress $475.20 $1,425.60
9 Each Simmons Box Spring $75.00 $675.00
Sub Total $5,496.52
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Carmel, IN 46032- , y t, f ;
PLEASE INVOICE IN DUPLICATE
DEPARTMENT I ACCOUNT I PROJECT I PROJECT ACCOUNT I AMOUNT
PAYMENT $5,496.52
SHIPPING INSTRUCTIONS "AIP 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 UNOBUGATED 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 - �`L—
*THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 194 �\e.'J �«<///LLLd111
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. ORDERED BY
Denise Snyder James Crider
TITLE Accreditation Budget Administrator Administration
CONTROL NO. 1 02805 CLERK-TREASURER