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4 CERTIFICATE NO.003120155 002 0
of
,Carmel
FEDERAL EXCISE TAX EXEMPT PURCHASE ORDER NUMBER
53551
35-60000972
ONE CIVEC SQUARE
CARMEL,:IIDI NA 4...32-2 S4 THIS NUMBER MUST APPEAR ON VOUCHER,DELIVERYINVOICES,MEMO,ACKINGSUPS,
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
9/18/2019 07/27/19 20810 00350268 Emergency Service Call-Flowing Well Pump
Peerless-Midwest, Inc. Parks Maintenance
55860 Russell Industrial Parkway 1427 E. 116th Street ATTN: Courtney
VENDOR Mishawaka, In 46545 SHIP Carmel, IN 46032
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE I EXTENSION
1.000 each Labor- Pull Pump out and Install New $2,000.000 $2,000.00
1.000 each Material-230v 3Phase Pump $702.000 $702.00
GLAccount#1125407-4350100
SCANNED
OCT - 7 2019
Send Invoice To:
$2,702.00
PLEASE INVOICE IN DUPLICATE
DEPARTMENT I ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
PAYMENT
• MP 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 AND SUPPLEMENT THERETO. TITLE
CLERK-TREASURER
DOCUMENT CONTROL NO. 53551 VENDOR COPY