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l0 y F Carmel a 111iii CERTIFICATE NO. 003720155 002 0
lL V' S °mss/ PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 30241
35- 60000972
ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES, NP
VOUCHER. DELIVERY MEMO. PACKING SLIPS.
CARMEL, INDIANA 46032 -2584 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
11/30/11 M000617 Q R50 Repair parts for plows
Mid -State Truck Equipment Maint 7 f t6' I} I� —vii I
11020 ALUSONVILLE. RD SHIP IS NUV 3 0 2011 lid
VENDOR FISIUERS IN 410038 TO
1-ia:
WrJ iRMATICPI BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY I UNIT OF MEASURE DESCRIPTION 1 UNIT PRICE I EXTENSION
1 PK Carriage Bolt Set $13.95 $13.95
1 EA Plow Shoe Assembly, cast $38.00 $38.00
2 EA New style blade for V -plow, curver near point $182.00 $364.00
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Send Invoice To:
$415.95
PLEASE INVOICE IN DUPLICATE
DEPARTMENT I ACCOUNT 1 PROJECT PROJECT ACCOUNT 1 AMOUNT
1125 -4 -01- 4237000- Repair parts 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 SWORD AFFIDAVIT ATTACHED
SHIPPING INSTRUCTIONS 1 HERESY CERTIFY THAT THERE I5 /N UNOBLIGATED BALANCE IN
THIS APPROPRIATION SUFFICIENT 10 PAY fOR THE ABOVE ORDER.
SHIP REPAID.
•C.O.D. SHIPMENTS CANNOT BE AGGEPTEO. ORDERED BY Todd Synder DK W716?tiam.-I '30
PURCHASE ORDER NUMBER MUST APPEAR ON ALL
SHIPPING LABELS.
THIS ORDER ISSUED R4 COMPLIANCE WITH CHAPTER 99. ACTS 1945 TITLE
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO
30241 CLERK TREASURER
DOCUMENT CONTROL NO. VENDOR COPY