36804 Hoosier Portable Restrooms City {(\/��,1 INDIANA RETAIL TAX EXEMPT PAGE 1
Cit of " "�+i��cl CERTIFICATE
EXCISE TAX EXEMPTO
PURCHASE ORDER NUMBER
35-60000972 36804
EL __ TIED... O-0s NUMBER MUST APPEAR ON INVOICES.A/P
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 1 REQUISITION ND. VENDOR NO. DESCRIPTION
3/31/2014 04/02/14 963 354857 Porlalels for West Park reslroom remodel project
Hoosier Portable Restrooms Inc Parks Maintenance
2201 E 99th Street 1427 E. 116th Street ATTN: Courtney
VENDOR Indianapolis, IN 46280 ToIP Cannel, IN 46032
CONFIRMATION BLANKET CONTRACT PAYMENT IERN.S recto 1T
QUANTITY UNIT OF MEASURE I DESCRIPTION [ UNIT PRICE I EXTENSION
4.000 each Regular unit portalet for use at West Park from April 7 - May 4. $ 25.00 $ 100.00
Includes 1 cleaning each week_
4,000 each ADA portalet unit for West Park restroorn remodel from April 7 - $40.00 $ 160.00
May 4. Includes 1 cleaning per week
GLAccount# 1125419-4350400
Send Invoice To:
$ 260.00
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT I PROJECT L__ PROJECT ACCOUNT I AMOUNT
PAYMENT
RE`;T m 77-Ex 2'T-,fl • AIP VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.NUMBER IS MADE
t
1 PAR1 OF THE VOUCHER AND EVERY INVOICE AND VOUCHER HAS THE PROPER SWORN
SHIPPING INSTRUCTIONS 1 AFFIDAVII ATTACHED.
MAR 1
AR 3 2014 . I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN THIS APPROPRIATION
• SHIP REPAID. SUFFICIENT 10 PAY FOR THE ABOVE ORDER.
. C.O.D SHIPMENTS CANNOT BE ACCEPTED T'�\�
PURCHASE ORDER NUMBER MUST APPEAR ON ALI.SHIPPIN D-1
• •:II:RED By Courtney SchlaegelY.eu %1cc;. 31,- t li .�
ANDORDERIENDTINY THEREOF E W S PDLEMEN9T.ACTS 77�
• THIS AND ACTS AMENDATORY THEREOF AND SUPPLC'MENI THERE IC
.
TITLE
CLERK-TREASURER
DOCUMENT CONTROL NO. 36804