105571 HOLLYWOODS BUMP & GRIND
City of Carmel
EachSub Total
Department:Account:Fund:
1vehicle repairs$1,058.14Page 1 of 1$1,058.14$1,058.14
111043-510.00101General Fund
INDIANA RETAIL TAX EXEMPT
Send Invoice To:
CERTIFICATE NO. 003120155 002 0PURCHASE ORDER NUMBER
Carmel Police DepartmentCar #35 - Fogle
105571
Accounts Payable
FEDERAL EXCISE TAX EXEMPT
35-6000972
3 Civic Square
THIS NUMBER MUST APPEAR ON INVOICES, A/P
ONE CIVIC SQUARE
VOUCHER, DELIVERY MEMO, PACKING SLIPS,
CARMEL, INDIANA 46032-2584
Carmel, IN 46032-
SHIPPING LABELS AND ANY CORRESPONDENCE
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL - 1997
PLEASE INVOICE IN DUPLICATE
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTIONDEPARTMENTACCOUNTPROJECTPROJECT
ACCOUNTAMOUNT
$1,058.14
PAYMENT
9/30/2021372102
* A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O. NUMBER IS MADE A
SHIPPING INSTRUCTIONS
PART OF THE VOUCHER AND EVERY INVOICE AND VOUCHER HAS THE PROPER SWORN
HOLLYWOODS BUMP & GRIND Carmel Police Department
*SHIP PREPAID.
AFFIDAVIT ATTACHED. I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
VENDORSHIP
10550 JESSUP BLVD 3 Civic Square
*C.O.D. SHIPMENT CANNOT BE ACCEPTED.THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
TO
*PURCHASE ORDER NUMBER MUST APPEAR ON ALL SHIPPING LABE
Carmel, IN 46032-
*THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 194
INDIANAPOLIS, IN 46280 - Don Kirch
ORDERED BY
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
PURCHASE ID BLANKET CONTRACT PAYMENT TERMS
FREIGHT
Jim Barlow
TITLE
59773Chief
105571
CONTROL NO.
CONTROLLER
QUANTITYUNIT OF MEASUREDESCRIPTIONUNIT PRICEEXTENSION