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City of Cairirre]I CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 103221
ONE CIVIC SQUARE 35-6000972 THIS NUMBER MUST APPEAR ON INVOICES,A/P
CARMEL, INDIANA 46032-2584 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
11/8/2019 368918 Stop the Bleed Kits
PENN CARE INC. Carmel Fire Department
VENDOR 1317 NORTH ROAD SHIP 2 Civic Square
TO Carmel, IN 46032-
NILES, OH 44446-
PURCHASE ID BLANKET CONTRACT I PAYMENT TERMS FREIGHT
41367
QUANTITY i UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Department: 1120 Fund: 101 General Fund
Account: 43-590.00
1200 Each 02-536052 Combat Tourniquet $19.25 $23,100.00
100 Each 07-02764 Gauze-4"x 4.1 yds. $2.85 $285.00
1200 Each 07-21591 Gauze 12"x 30" $0.75 $900.00
48 Each 08-3264004 Gloves-Versa Pro $5.00 $240.00
1200 Each 05-4831 BK Marker-Sharpie $0.90 $1,080.00
1 Each Packaging Bag Inserts $250.00 $250.00
1200 Each 11-4031BK Shears $0.85 $1,020.00
Sub Total $26,875.00
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Send Invoice To: ..__
Carmel Fire Departments
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2 Civic Square
Carmel, IN 46032- = ' -,,,
PLEASE INVOICE IN DUPLICATE
DEPARTMENT I ACCOUNT I PROJECT PROJECT ACCOUNT AMOUNT
PAYMENT $26,875.00
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 j"S� �� .._47 i
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. ORDERED BY
Denise Snyder James Crider \
TITLE Accreditation Budget Administrator Administration
CONTROL NO. 103221 CLERK-TREASURER