106158 REPUBLIC WASTE SERVICES OF INDIANA
City of Carmel
EachSub Total
Department:Account:Fund:
13-0761-0035461$7,000.00Page 1 of 1$7,000.00$7,000.00
120743-501.01101General Fund
INDIANA RETAIL TAX EXEMPT
Send Invoice To:
CERTIFICATE NO. 003120155 002 0PURCHASE ORDER NUMBER
Brookshire Golf Course
106158
Pamela Lister
FEDERAL EXCISE TAX EXEMPT
35-6000972
12120 Brookshire Pkwy.
THIS NUMBER MUST APPEAR ON INVOICES, A/P
ONE CIVIC SQUARE
VOUCHER, DELIVERY MEMO, PACKING SLIPS,
CARMEL, INDIANA 46032-2584
Carmel, IN 46033-
SHIPPING LABELS AND ANY CORRESPONDENCE
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL - 1997
(317) 846-7431
PLEASE INVOICE IN DUPLICATE
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTIONDEPARTMENTACCOUNTPROJECTPROJECT
ACCOUNTAMOUNT
$7,000.00
PAYMENT
1/4/2022358593
* 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
REPUBLIC WASTE SERVICES OF INDIANA Brookshire Golf Course
*SHIP PREPAID.
AFFIDAVIT ATTACHED. I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
VENDORSHIP
PO BOX 9001099 12120 Brookshire Pkwy.
*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 46033-
*THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 194
LOUISVILLE, KY 40290--1099Pamela Lister(317) 846-7431
ORDERED BY
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
PURCHASE ID BLANKET CONTRACT PAYMENT TERMS
FREIGHT
Bob HigginsJames Crider
TITLE
62449General Manager/SuperintendentDirector of Administration
106158
CONTROL NO.
CONTROLLER
QUANTITYUNIT OF MEASUREDESCRIPTIONUNIT PRICEEXTENSION