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INDIANA RETAIL TAX EXEMPT PAGE 1
CERTIFICATE NO.003120155 002 0
N PURCHASE ORDER NUMBER
U FEDERAL EXCISE TAX EXEMPT
55874
35-60000972
ONE CIVIC SQUARE
CARMEL,INDIANA 4E0 32-2584 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
9/2/2021 08/30/21 26379 00352025 Fleet Maintenance and Repair,2019 Chevy Silverado Truck
#4191
PFM Car&Truck Care Parks Maintenance
1441 Guilford Rd., Suite 100 1427 E. 116th Street
VENDOR Carmel, IN 46032 SHIP Carmel, IN 46032
To
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
1.000 each oil change#4191 mileage 25444 $ 59.740 $ 59.74
1.000 each Inspection of all non working lighing $ 120.950 $ 120.95
1.000 each tire rotation if needed $ 19.950 $ 19.95
1.000 each Remove and replace backup lights $ 185.420 $ 185.42
GLAccount# 1125401-4351000
Send Invoice To:
$ 386.06
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 Neil Whitehead
• THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. TITLE Park Maintenance Foreman
CONTROLLER
DOCUMENT CONTROL NO. 55874 VENDOR COPY