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I1t ®f IIarjriiie1 CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 103586
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
12119/2019 00351379
UNITED LABORATORIES INC General Administration
VENDOR PO BOX 410 SHIP 1 Civic.Square
TO Carmel, IN 46032-
ST CHARLES, IL 60174
PURCHASE ID BLANKET CONTRACT PAYMENT TERMS FREIGHT
42858
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Department: 1205 Fund: 101 General Fund
Account: 43-506.00
1 Each Other maintenance supplies $761.00 $761.00
Sub Total $761.00
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Send Invoice To:
Dept of Administration
1 Civic Square ,, y hs
Carmel, IN 46032w
PLEASE INVOICE IN DUPLICATE
DEPARTMENT I ACCOUNT PROJECT PROJECT ACCOUNT I AMOUNT
PAYMENT $761.00
SHIPPING INSTRUCTIONS 'AIP 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
James Crider
TITLE Administration
CONTROL NO. 103586 CLERK-TREASURER