36930 Belson Outdoors Inc INDIANA RETAIL TAX EXEMPT PAGE 1
� -{�y�y CERTIFICATE NO.Q031209 55 002 0 o C _fir f 1' i _ PURASEORDERCity ��../J 11 A aaaLLL ILL���.✓✓+ 35-60000972
. :-, i- -.- THIS NUMBER MUST APPEAR ON INVOICES.NP
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 Na DESCRIPTION
5/2/2014 04/30/14 1268 Founders Pavilion Picnic Tables
Belson Outdoors Inc. Administration Office
36810 Eagle Way 1411 E. 116th Street
VENDOR Chicago, IL 60678-1368 7HHIP Carmel, IN 46032
O
CONFIRMATION
BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION _ L UNIT PRICE 1 EXTENSION
1.000 each HT-100 Recycled Plastic Hexagon Picnic Table $ 740.00 $ 740.00
1.000 each HT-100H Handicap Accessible Recycled Plastic Hexagon $ 690.00 $ 690.00
Table
1.000 each Shipping Charges $ 137.28 $ 137.28
GLAccount# 1060000-5023990
Send Invoice To:
$ 1,567.28
PLEASE INVOICE IN DUPLICATE
-�UEPARTMENT ACCOUNT 1 PROJECT PROJECT ACCOUNT AMOUNT
l O Q.3 oa3CICA0 RE C.-.7' PAYMENT
i • AIP 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
SHIPPING INSTRUCTIONS MAY 0 2 2014 i AFFIDAVIT ATTACHED_
I
. I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN THIS APPROPRIATION
• SHIP REPAID, # y- SUFFICIENT TO PAY FOR THE ABOVE ORDER.
C.0.0 SHIPMENTS CANNOT BE ACCEPTED. D `� 06c..1/44/0c__Oa• PURCHASE ORDER NUMBER MUST APPEAR ON ALL SHIPPING LABELS, ORDERED BY Michael Klitzing ) /2'l C./• /HIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS/945
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
TITLE
CLERK-TREASURER
DOCUMENT CONTROL NO. 36930 ',./E11`(...I%;:, )l•'r'