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lCERTIFICATE NO.003120155 002 0
o C
City
rm
ee FEDERAL EXCISE TAX EXEMPT PURCHASE ORDER NUMBER
53691
35-60000972
011E CMC SQUARE
CARMEL,IiIYsG`1L=°•`-.`G.32-GCS THIS NUMBER MUST VOUCHER,DELIVERY
VE Y PA
CKING CKINGPPEAR ON ISUP SUPS,
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
10/21/2019 10/21/19 21727 00351475 Monon Plaza Decking Repair Parts
Landscape Forms, Inc. Parks Maintenance
431 Lawndale Ave 1427 E. 116th Street ATTN: Courtney
VENDOR Kalamazoo, MI 49048 SHIP Carmel, IN 46032
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE I EXTENSION
1.000 each SF2929-055. Replacement Oiled IPE Board Kit Including 1 $354.500 $354.50
each of Board Profile SF2929-441 and SF2929-525, Price Per
Kit
1.000 each Shipping& Handling $250.000 $250.00
GLAccount#1125416-4237000
Send Invoice To:
$604.50
PLEASE INVOICE IN DUPLICATE
DEPARTMENT I ACCOUNT PROJECT PROJECT ACCOUNT 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 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 Courtney Weintraut A
• THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945
AND ACTS AMENDATORY THEREOF ANDSUPPLEMENT THERETO. TITLE
I: - -
CLERK-TREASURER i
DOCUMENT CONTROL NO. 53691 VENDOR COPY \\
