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INDIANA RETAIL TAX EXEMPT Page 1 of 1
" }� of Carmel CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
�/Jl FEDERAL EXCISE TAX EXEMPT 103121
ONE CIVIC SQUARE 35-6000972 THIS NUMBER MUST APPEAR ON INVOICES,AIP
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
9/19/2019 361470
CHILD SOURCE Trinity Clinic
VENDOR 305 LAKE ROAD SHIP 1045 W 146th St.Suite-B
TO Carmel, IN, 46032-
MEDINA,OH 44256- Ann Gallagher
PURCHASE ID BLANKET CONTRACT PAYMENT TERMS FREIGHT
39823
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Department: 1110 Fund: 900 Grant Fund
Account: 43=590.05
4 Each 93-299FSM backless shieldless booster 4 pk $14.90 $59.60
4 Each IC201CHZ OnBoard 35(4-35 Ibs)with adjustable base and up front $78.00 $312.00
adjust
1 Each shipping charges $75.50 $75.50
2 Each 3472198 Sonus Convertible Seat 2PK. $57.75 $115.50
Sub Total $562.60
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Send Invoice To:
Police Department 0.`,
3 Civic Square
Carmel, IN 46032=
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT I PROJECT PROJECT ACCOUNT AMOUNT
PAYMENT $562.60
SHIPPING INSTRUCTIONS '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
'THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. ORDERED BY
Jim Barlow
TITLE Chief (�
CONTROL NO. 103121 CLERK-TREASURER