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CERTIFICATE NO.003120155 002 0
x
PURCHASE ORDER NUMBER
.. FEDERAL EXCISE TAX EXEMPT
55111
35-60000972
DUE UWIU SQUARE
CARMEL,, IN 11 A„1,11A„„46032-.25,8,4 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
1/20/2021 01/25/21 24715 00354893 Engagement of Services-2021 Pond Maintenance
Aquatic Control Parks Maintenance
P.O. Box 1002 1427 E. 116th Street ATTN: Courtney
VENDOR Seymour, IN 47274 SHIP Carmel, IN 46032
TO
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
6.000 each April -Sept Central Park clean lake program $433.000 $2,598.00
GLAccount# 1125404-4350400
6.000 each April -Sept- Meadowlark clean lake program $249.166 $ 1,495.00
GLAccount# 1125414-4350400
6.000 each April -Sept West Park clean lake program $249.000 $ 1,494.00
GLAccount# 1125419-4350400
Send Invoice To:
$ 5,587.00
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 ANDSUPPLEMENT THERETO. TITLE
CLERK-TREASURER
DOCUMENT CONTROL NO. 55111 II,,,;;;III DOR COPY