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c1iCity of CI1I1rI1:1e1 CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 102953
ONE CIVIC SQUARE 35-6000972 THIS NUMBER MUST APPEAR ON INVOICES,AR
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 1
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PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
6/17/2019 372939 Firefighter Physicals
ASCENSION ST VINCENT PUBLIC SAFETY Carmel Fire Department
VENDOR 6612 E 75TH STREET SHIP 2 Civic Square
SUITE 200 TO Carmel, IN 46032
INDIANAPOLIS, IN 46250-
PURCHASE ID BLANKET CONTRACT PAYMENT TERMS FREIGHT
37170
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Department: 1120 Fund: 101 General Fund ,
Account: 43-407.01
1 Each 2019 Firefighter Physicals-Not to Exceed $93,00000 $93,000.00
Sub Total $93,000.00
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Carmel Fire Department y
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PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT d PROJECT ACCOUNT AMOUNT
PAYMENT $93,000.00
SHIPPING INSTRUCTIONS PART
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 i -
'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. 1 02953 CLERK-TREASURER