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JL Jt oJL Iairrriie1 CERTIFICATE NO.003120155 0020 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 103292
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
11/19/2019 373735 I/O Drivers
TELEFLEX LLC Fire Department
VENDOR 3015 CARRINGTON MILL BLVD SHIP. 2 Civic Square
TO Carmel, IN 46032-
MORRISVILLE,NC 27560-
PURCHASE ID BLANKET CONTRACT PAYMENT TERMS FREIGHT.:.
41707
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Department: 1120 Fund: 102 Ambulance Capital Fund
Account: 44-670.06
4 Each 9058 EZ I/O Power Driver $210.08 $840.32
Sub Total $840.32
1
1414 k
Send Invoice To:
Fire Department.
y� .
2 Civic Square x,
Carmel, IN 46032-
PLEASE INVOICE IN DUPLICATE
DEPARTMENT I ACCOUNT PROJECT PROJECT ACCOUNT f AMOUNT
PAYMENT $840.32
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
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. ORDERED BY \J
Denise Snyder
TITLE Accreditation Budget Administrator \ U
CONTROL NO. 103292 CLERK-TREASURER lW