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CERTIFICATEINDIAA NO.ETAI 003120155TAEXEMPT 002 0 PAGE 1
C itY 0 i N PURCHASE ORDER NUMBER
U FEDERAL EXCISE TAX EXEMPT 54441
35-60000972
ONE CIVIC SQUARE
CARMEL,INDIANA 46032-2584 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
5/21/2020 05/25/20 23285 359478 Hand Sanitizer Equipment and Supplies for Parks(COVID19)
Hillyard Parks Maintenance
P.O. Box 803658 1427 E. 116th Street ATTN: Courtney
VENDOR Kansas City, MO 64180-3658 SHIP Carmel, IN 46032
TO
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
10.000 each Automatic contact free hand sanitizer dispensers $ 0.000 $ 0.00
3.000 each Case(4 per case)Hand Sanitizer with spray pump $ 71.440 $214.32
1.000 each Delivery Fee $40.000 $40.00
GLAccount# 142 OQ
1125-4359016
Send Invoice To:
$254.32
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 Courtney Weintraut
• THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. TITLE
CLERK-TREASURER
DOCUMENT CONTROL NO. 54441 VlliliiilNlD 0IR CO IPY