106121 FIFTH THIRD BANK-PCARD ONLY
City of Carmel
EachEachEachSub Total
Department:Account:Fund:
111Purchase Card ClaimPurchase Card ClaimPurchase Card Claim$684.90$599.00$239.88Page 1 of 1$1,523.78$684.90$599.00$239.88
120143-570.01101General Fund
INDIANA RETAIL TAX EXEMPT
Send Invoice To:
CERTIFICATE NO. 003120155 002 0PURCHASE ORDER NUMBER
Human Resources
106121
FEDERAL EXCISE TAX EXEMPT
35-6000972
1 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
$1,523.78
PAYMENT
12/17/2021372357
* 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
FIFTH THIRD BANK - PCARD ONLY Human Resources
*SHIP PREPAID.
AFFIDAVIT ATTACHED. I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
VENDORSHIP
NO ADDRESS - ACH 1 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
,
ORDERED BY
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
PURCHASE ID BLANKET CONTRACT PAYMENT TERMS
FREIGHT
Barbara Lamb
TITLE
62174Director
106121
CONTROL NO.
CONTROLLER
QUANTITYUNIT OF MEASUREDESCRIPTIONUNIT PRICEEXTENSION