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CERTIFICATE NO.003120155 002 0
CitY fPURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 54524
35-60000972
ONE CIVIC SQUARE
CARMEL INDIANA 4.6O,32-2S84 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
6/15/2020 06/20/20 23452 355990 Weekly Water Sample Testing for Midtown Spray Plaza-
5/20/20-9/25/20
Environmental Laboratories Inc MCC- East
P.O. Box 968 1235 Central Park Drive East
VENDOR Madison, IN 47250 SHIP Carmel, IN 46032
TO
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
19.000 each Weekly Pick up fee per sample $ 5.000 $ 95.00
19.000 each Weekly sample anaylsis $20.000 $ 380.00
1.000 each First Sample-Weekend Charge $ 75.000 $ 75.00
GLAccount#1125422-4238900
Send Invoice To:
$550.00
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 Eric Mehl
• THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. TITLE
CLERK-TREASURER
DOCUMENT CONTROL NO. 54524 VENDOR COIII:3Y