HomeMy WebLinkAbout57622 HEART REACH MEDICAL LLC 0, 1,n„ INDIANA RETAIL TAX EXEMPT PAGE 1
City.
qy CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 57622
35-60000972
ONE CIVIC 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
2/1/2023 02/04/23 30466 375705 PNR AED Equipment, Supplies,and Maintenance
Heart Reach Medical, LLC Administration Office
15147 Grassy Creek Ct. 1411 E. 116th Street
VENDOR Carmel, IN 46033 SHIP Carmel, IN 46032
TO
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
Net30
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
1.000 each G5A-80C0-S- Powerheart G5 AED with ICPR Pads $ 1,695.000 $ 1,695.00
1.000 each PlusCare 2 year Advanced Package for G5 ICPR $ 873.600 $ 873.60
1.000 each Backpack for Portable Use $ 150.000 $ 150.00
1.000 each Shipping $40.000 $40.00
GLAccount#8530000-5023990
Send Invoice To:
$2,758.60
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 Michael Allen
• THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. TITLE Parks& Natural Resources Director
CONTROLLER
DOCUMENT CONTROL NO. 57622 V N ID 0 IR COIF Y