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,[City ®f Carmel CERTIFICATE NO.003120155 002 0
PURCHASE ORDER NUMBER
,; FEDERAL EXCISE TAX EXEMPT -
•
35-60000972 31385
ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON'INVOICES,AP
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
S
11/1412013 ,
R
Public Safety Medical Services Cannel Police Department
VENDOR
SHIP 3 Civic Square
TO
324 E. New York Street, Suite 300 Cannel, IN 48032
Indianapolis, IN 46204 317)571-2559
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE I EXTENSION
Account 43419.99
1 Each psychological evaluation $370.13 $370.13
1 .Each physical for applicant $675.18 $875.19
i` -- -- - l Sub Total: $1,045.32
Ail )®/1�.••�QQ
.' 4
lie $ :
Send Invoice To: - IraQ °" 4 •
1 Cannel Police Department
Attn: Teresa Anderson
3 Civic Square .
Cannel, IN 48032- PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT•
Carmel Police Dept. CS PAYMENT 91,045.32
• 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/HAT THERE IS AN UNOBLIGATED BALANCE IN
• SHIP REPAID. /
1 .. 7, THIS APPRO R / 4N SUFFICIENT TO••Y FOR THE ABOVE ORDER./
•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 Chief of Polito
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
CLERK-TREASURER
DOCUMENT CONTROL NO. 31365 OFFICE COPY