HomeMy WebLinkAbout105759 MALINOWSKI CONSULTING INC
City of Carmel
EachSub Total
Department:Account:Fund:
1Recoup Medicaid Fees Year End$9,500.00Page 1 of 1$9,500.00$9,500.00
112043-404.00101General Fund
INDIANA RETAIL TAX EXEMPT
Send Invoice To:
CERTIFICATE NO. 003120155 002 0PURCHASE ORDER NUMBER
Carmel Fire Department
105759
FEDERAL EXCISE TAX EXEMPT
35-6000972
2 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
2019 Medicaid Reporting
$9,500.00
PAYMENT
11/15/2021366749
* 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
MALINOWSKI CONSULTING INC Carmel Fire Department
*SHIP PREPAID.
AFFIDAVIT ATTACHED. I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
VENDORSHIP
755 W CARMEL DRIVE STE 203 10701 N. College Avenue, Ste A
*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
CARMEL, IN 46032 -
ORDERED BY
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
PURCHASE ID BLANKET CONTRACT PAYMENT TERMS
FREIGHT
Denise SnyderJames Crider
TITLE
61086Accreditation/Budget AdministratorDirector of Administration
105759
CONTROL NO.
CONTROLLER
QUANTITYUNIT OF MEASUREDESCRIPTIONUNIT PRICEEXTENSION