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CERTIFICATEINDIAA NO.ETAI 003120155TAEXEMPT 002 0 PAGE 1
C itY 0 ku i N PURCHASE ORDER NUMBER
U FEDERAL EXCISE TAX EXEMPT 54424
35-60000972
ONE CIVIC SQUARE
CARMEL,INDIAILIA 4/90 32-258 4 THIS NUMBER MUST APPEAR ON INVOICES,A/P
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
Possible New Vendor
5/18/2020 05/23/20 23256 W-9 attached Portable Hand Sanitizing Stations for Monon Blvd (COVID19)
Anytime Outhouse Administration Office
5503 N 500 W 1411 E. 116th Street
VENDOR Thorntown, IN 46071 SHIP Carmel, IN 46032
TO
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
30.000 each Single Portable Hand Sanitizing Station Monthly Rentals(Qty $ 70.000 $2,100.00
10 x 3mos)- May 22, 2020-Aug 22, 2020
2.000 each Foaming Hand Sanitizer Refill (Gallon) $ 60.000 $ 120.00
GLAccount# 1125101-4359016
Send Invoice To:
$2,220.00
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
PAYMENT
• 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
SHIPPING INSTRUCTIONS AFFIDAVIT ATTACHED.
▪ I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN THIS APPROPRIATION
• SHIP REPAID. SUFFICIENT TO PAY FOR THE ABOVE ORDER.
. C.O.D SHIPMENTS CANNOT BE ACCEPTED.
• PURCHASE ORDER NUMBER MUST APPEAR ON ALL SHIPPING LABELS. ORDERED BY Dawn Koepper
• THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. TITLE
CLERK-TREASURER
DOCUMENT CONTROL NO. 54424 VIE lNlDO1R GOODY