HomeMy WebLinkAbout57361 LANDSCAPE FORMS INC 0, 1,n„ INDIANA RETAIL TAX EXEMPT PAGE 1
City.
qy CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 57361
35-60000972
ONE crnc SQUARE
C.ARMEL,IN DIAILIA 46O 32_2 84 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
11/16/2022 11/19/22 29869 00351475 Midtown Plaza Replacement Umbrella Parts
Landscape Forms, Inc. Parks Maintenance
431 Lawndale Ave 1427 E. 116th Street
VENDOR Kalamazoo, MI 49048 SHIP Carmel, IN 46032
TO
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
1.000 each TUUCI replacement components, (2)Max Cantilever Lower $ 1,818.000 $ 1,818.00
Car Assembly, (2)Scissor to Car Fastener, (2)Scissor End
Cap Replacement, (1)Scissor End Cap Tool Kit, (4)Scissor
Assembly for Easy Drive Car
1.000 each Shipping $438.000 $438.00
GLAccount# 1030000-4463000
Send Invoice To:
$2,256.00
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 Danny Griffin
• THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. TITLE PNR Foreman
CONTROLLER
DOCUMENT CONTROL NO. 57361 V N ID 0 IR COIF Y