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INDIANA RETAIL TAX EXEMPT PAGE 1
City CERTIFICATE N0.003120155 002 0
tC i� PURCHASE ORDER NUMBER
LL FEDERAL EXCISE TAX EXEMPT 53716
35-60000972
OHS CIVIC SQUARE
CARMEL,il'iDtAtI 4S 2-2E1•=..- 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
10/25/2019 10/28/19 21777 369825 Replacement Playground Parts for West Park
GameTime do Sinclair Recreation Parks Maintenance
128 East Lakewood Blvd Suite 40 1427 E. 116th Street ATTN: Courtney
VENDOR Holland, MI 49424 SHIP Carmel, IN 46032
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE I EXTENSION
1.000 each Item#153746 GameTime Fully Enclosed Tot Seat $277.000 $277.00
4.000 each Item#211721 GameTime Expression Sw Caution Ili $9.400 $37.60
1.000 each Estimated Freight $30.000 $30.00
GLAccount#1125419-4237000
Send Invoice To:
$344.60
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT I 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 UNOBLIGATED BALANCE IN THIS APPROPRIATION
• SHIP REPAID. SUFFICIENT TO PAY FOR THE ABOVE ORDER. r`
▪ C.O.D SHIPMENTS CANNOT BE ACCEPTED. ` 'n
.. .\\'4
• PURCHASE ORDER NUMBER MUST APPEAR ON ALL SHIPPING LABELS. ORDERED BY Neil Whitehead / \\V!
• THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. TITLE
CLERK-TREASURER `O
DOCUMENT CONTROL NO. 53716 VENDOR COPY