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//}� o f Carmel CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 102850
ONE CIVIC SQUARE 35-6000972 THIS NUMBER MUST APPEAR ON INVOICES,AR
CARMEL, INDIANA 46032-2584 VOUCHER,DELIVERY MEMO,PACKING SLIPS,
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL-1997 SHIPPING LABELS AND ANY CORRESPONDENCE
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
4/29/2019 363350 Concrete Repair-Sta.43
CUSTOM CONCRETE CO INC Carmel Fire Department
VENDOR 17241 FOUNDATION PKWY SHIP 2 Civic.Square
TO .Carmel,IN 46032-
WESTFIELD, IN 46074-
PURCHASE ID BLANKET CONTRACT PAYMENT TERMS FREIGHT
35803
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Department: 1120 Fund: 101 General Fund
Account: 43-501.00
1 Each Concrete Repair-Sta.43 Per Quote $15;255.00 $15,255.00
Sub Total $15,255.00
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Send Invoice To:
Carmel Fire Department
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2 Civic Square ". '
Cannel, IN 46032-
PLEASE INVOICE IN DUPLICATE
DEPARTMENT I ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
PAYMENT $15,255.00
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 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
Denise Snyder James Crider
TITLE Accreditation Budget Administrator Administration
CONTROL NO. 102850 CLERK-TREASURER