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CERTIFICATE NO.003120155 002 0
t a 's, PURCHASE ORDER NUMBER
C aav�� FEDERAL EXCISE TAX EXEMPT 53639
35-60000972
OWE C(.IIC SQUAW.
CARMEL.INDIANA z v'S2-2SE4 THIS NUMBER MUST APPEAR ON INVOICES,A/P
VOUCHER,DELIVERY 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
•
10/8/2019 09/09/19 21352 305700 Second Repair to A01 -2014 Ford Explorer and oil change
Tom Wood Ford Parks Maintenance
3130 E 96th Street 1427 E. 116th Street ATTN: Courtney
VENDOR Indianapolis, IN 46240 SHIP Carmel, IN 46032
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
1.000 each 2nd Time for Repairs to Engine of A01 from critter damage $ 1,393.730 $1,393.73
1.000 each Oil change A01 $43.670 $43.67
GLAccount#1125401-4351000
Send Invoice To:
$ 1,437.40
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT 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 UNOBUGATED 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 Courtney Weintraut
• THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. TITLE
CLERK-TREASURER
DOCUMENT CONTROL NO. 53639 VENDOR COPY `�