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City of clairiiiel CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 103518
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
12/13/2019 079150 Helmet Parts
DONLEY SAFETY Carmel Fire Department
VENDOR 5546 ELMWOOD AVE SHIP 2 Civic Square
TO Carmel,IN 46032-
INDIANAPOLIS, IN 46203
PURCHASE ID BLANKET CONTRACT PAYMENT TERMS FREIGHT
42678
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Department: 1120 Fund: 101 General Fund
Account: 42-370.00
1 Each Helmet Repair Parts Per Quote $1,147.10 $1,147.10
Sub Total $1,147.10
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Send Invoice To: • x w
Carmel Fire Department '
2 Civic Square ,
Carmel, IN 46032-
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT I PROJECT PROJECT ACCOUNT I AMOUNT
PAYMENT $1,147.10
SHIPPING INSTRUCTIONS "ASP 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 -
Denise Snyder
TITLE Accreditation Budget Administrator
CONTROL NO. 103518 CLERK-TREASURER