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INDIANA RETAIL TAX EXEMPT PAGE
CERTIFICATE O. ATE T 003120155 002 0
PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT
35- 60000972
ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES, NP
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
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CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE I DESCRIPTION I UNIT PRICE EXTENSION
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Send Invoice To: IA S. lj 0M 0 I� �j
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PLEASE INVOICE IN DUPLICATE 2
DEPARTMENT ACCOUNT 1 PROJECT PROJECT ACCOUNT AMOUNT
PAYMENT
NP 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 CERTIFYTH' THERE IS AN UNOBLIGATED BALANCE IN
THIS APPROPRIATIO L R F 0I T TO PAY FOR T E ABOVE ORDER.
SHIP REPAID.
C. D. SHIPMENTS CANNOT BE ACCEPTED. ORDERED BY i
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PURCHASE ORDER NUMBER MUST APPEAR ON ALL
SHIPPING LABELS. Al ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99. ACTS 1945 TITLE
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AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
CLERK- TREASURER
DOCUMENT CONTROL NO. 2581 6 OFFICE COPY