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HomeMy WebLinkAbout25368 Public Safety Medical Service A INDIANA RETAIL TAX EXEMPT PAGE City c Carmel CERTIFICATE NO.003120155 002 0 1x1 \L/IaVL 1�La PURCHASE ORDER NUMBER FEDERAL EXCISE TAX EXEMPT 25369 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 7/15/2013 Public Safety Medical Services Carmel Pollee Department VENDOR SHIP 3 Civic Square 324 E. New York Street, Suite 300 Carmel, IN 46032 Indianapolis, IN 48204 (317)571-2559 CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION Account 43-419.99 1 Each' physical for applicant $675.19 $675.19 1 Each psychological evaluation $370.13 $370.13 Sar t Sub Total: $1,045.32 o %.H.s/' kii 4 °# Send`WOrlice`io ham 0 u‘11 ©° re j Cannel Police Department Attn: Teresa Anderson 3 Civic Square Cannel, IN 48032- PLEASE INVOICE IN DUPLICATE DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT l2 Cannel Police Dept. c �/ PAYMENT $1,045.32 • 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 CERTIFY T TT H NO FOR BALANCE ORDER THIS APPROPRIA FFICIENT TO PAY FOR THE ABOVE ORDER. •SHIP REPAID. •C.O.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 let of Pollen AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. 25368 CLERK-TREASURER • •' DOCUMENT CONTROL NO. OFFICE COPY