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C it ®f C amel CERTIFICATE NO. 003120155 002 0
�1 \v PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 27894
35- 60000972
ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES, A/P
CARMEL INDIANA 46032 -2584 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
1- 08/08/2011
VENDOR Child Source SHIP Trinity Clinic
7001 Wooster Pike TO 1045 W 146th Street
Medina, =OH 44256 Carmel, IN 46032
Att: Maggie
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Account 00- 590.05
10 Safety 1st Designer Carseat ICO34AOB
10 Scemera 4 NtSPPOS (2 /PK) r I,9312OFSM 43.00 430.00
10 Voyager Highback (2 per pack) C) 4041 28.90 289.00
8 Backless ShieldlesstBooster, 93- 299FSM n 14.90 119.20
(4 per Pack) tko
s e 186
ID
<g o
Send Invoice To:
Carmel Police Department 'r 7,)
Attn: Teresa Anderson.'.-
3 Civic Square
Carmel, IN 46032
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
Carmel Police Dept. PAYMENT 1,664.00
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 AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY T' •T ERE IS AN UNOBLIGATED BALANCE IN
THIS APPROPRI o PFICIENT TO P: -FOR THE ABOVE ORDER.
SHIP REPAID
C 0 D SHIPMENTS CANNOT BE ACCEPTED.
PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY
SHIPPING LABELS.
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE Ch f of Police
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
DOCUMENT CONTROL NO. 27894 CLERK- TREASURER
OFFICE COPY
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