HomeMy WebLinkAbout52762 MID STATE TRUCK EQUIP ;a INDIANA RETAIL TAX EXEMPT PAGE 1
CERTIFICATE NO.003120155 002 0
I e= PURCHASE ORDER NUMBER
11 RRR���.. LL 11
FEDERAL EXCISE TAX EXEMPT 52762
35-60000972
ONE C tMC SQUARE
CARMEL,!€ LAU]A=3032-2584 THIS NUMBER MUST APPEAR ON INVOICES,A/P
VOUCHER,DEUVERY 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
4/26/2019 04/29/19 19568 201250 Additional Truck Equipment for Vehicle#3183
Mid State Truck Equipment Inc. Parks Maintenance
11020 Allisonville Rd 1427 E. 116th Street ATTN: Courtney
VENDOR Fishers, IN 46038 TOHIP Carmel, IN 46032
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE I EXTENSION
1.000 each Item#5232412-step,two run steel black powdercoat $80.0000 $80.00
1.000 each Item#PARTS1 -Replacement fuel fill w/Cap $ 175.0000 $ 175.00
1.000 each Item#shop-001 -shop supplies including extra material for $25.0000 $25.00
ladder
2.000 each Labor-assemble ladder for use with stake pocket/rub rail. $ 100.0000 $200.00
Remove existing fuel fill neck and install new neck with cap
GLAccount#1125401-4351000
Send Invoice To:
$480.00
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT I PROJECT PROJECT ACCOUNT I AMOUNT
PAYMENT
• 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
SHIPPING INSTRUCTIONS AFFIDAVIT ATTACHED.
• I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN THIS APPROPRIATION
• SHIP REPAID. SUFFICIENT TO PAY FOR THE ABOVE ORDER.
• C.O.D SHIPMENTS CANNOT BE ACCEPTED.
• PURCHASE ORDER NUMBER MUST APPEAR ON ALL SHIPPING LABELS. ORDERED BY Neil Whitehead
• THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945
AND ACTS AMENDATORY THEREOF ANDSUPPLEMENT THERETO. TITLE
CLERK-TREASURER
DOCUMENT CONTROL NO. 52762 VENDOR COPY