HomeMy WebLinkAbout26257 Belfor Property Restoration �l f� INDIANA RETAIL TAX EXEMPT PAGE
1 1 l ll l CERTIFICATE NO. 003120155 002 0
PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT
35- 60000972
ONE CIVIC SQUARE THIS NUMBER MIJEr2> 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 r
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
12120/2011
VENDOR Belfor Property Restoration SHIP Street Department
J.
TO 3400 W. 131st Street
6205 Morenci Trail Carmel, IN 46074
CONFIRMATION BLANKETird4a I pV, s, IN 46268 PAYMENT TERMS (317) 733 -2001 FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
i
A ccount 0043-501.00
1 Each insurance deductible for wash bay $25,000.00 $25,000.00
accident
Sub Total: $25,000.00
..°/:#107
Send Invoice To:
p
ll
Street Department I
3400 W. 131st Street i Carmel, IN 46074- PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT 1 PROJECT PROJECT ACCOUNT AMOUNT
PAYMENT
Carmel Street Department NUMB IS MADE ARP T OF THE AND EVERY INVOICE AM0,000.00
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS i I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
THIS APPROPRIA f UFFICIENT TO PAY FORT E BOVE ORDER.
SHIP REPAID. e
C.O.D. SHIPMENTS CANNOT BE ACCEPTED. ORDERED BY
PURCHASE ORDER NUMBER MUST APPEAR ON ALL 1
SHIPPING LABELS. t b4;11
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE F
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
i CLERK TREASURER
DOCUMENT CONTROL NO. 26257 OFFICE COPY