HomeMy WebLinkAbout103270 PENN CARE INC. INDIANA RETAIL TAX EXEMPT Page 1 of 1
City
of Iairirinie1 CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT _ 103270
ONE CIVIC SQUARE 35-6000972 THIS NUMBER MUST APPEAR ON INVOICES,AIP
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
11/19/2019 368918 Monitor Mounts
PENN CARE INC. Fire Department
VENDOR 1317 NORTH ROAD SHIP 2 Civic Square
TO Carmel, IN :46032-
NILES,OH 44446-
PURCHASE ID. BLANKET CONTRACT PAYMENT TERMS. FREIGHT
41692
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Department: 1120 Fund: 102 Ambulance Capital Fund
Account: 44-670.99
6 Each 03-509534 Monitor-Mount-Technimount Spacer Pro 3/4" $225.00 - $1,350.00
5 Each 03-52793C Monitor.Mount Technimount LifePak 15 Pro $925.00 $4,625.00
1 Each 03-5006UN Monitor Mount,Technimount, Universal Surface Base Pro $640.00 $640.00
Sub Total $6,615.00
/ 4, 1
1
.:
Send Invoice To: '.... .M. ,,..„..... .. ..
Fire Department \.,
2 Civic Squares 4 /��
Carmel,IN 46032- � ' ��
PLEASE INVOICE IN DUPLICATE
DEPARTMENT I ACCOUNT I PROJECT I PROJECT ACCOUNT AMOUNT
PAYMENT $6,615.00
SHIPPING INSTRUCTIONS 'ANP 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 _� ' a � - � , 0
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. ORDERED BY
Denise Snyder James Crider Tif � VVV
TITLE Accreditation Budget Administrator Administratioa� (\�J`��
CONTROL NO. 103270 CLERK-TREASURER v`1