24587 Malinowski Consulting C Y�. Of Carmel' INDIANA RETAIL TAX EXEMPT 155 0 PAGE \ `�\
\\\,/ CERTIFICATE NO.003120155 002 0
PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 265$7
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. 7 VENDOR NO. DESCRIPTION �\
5/512016 s•\c a-. *r;�� �¢,o_ S---.4,---o--aQ
—.Malinowski Consulting;, —....__ _ __ Cannel Fire Department
VENDOR SHIP �~l 2 Cannel Civic Square
755 West Carmel Drive, Ste.-300 TO Cannel, IN 46032
Cannel, IN 46032 (317)571-2622 '
CONFIRMATION BLANKET CONTRACT CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF ME I DESCRIPTION UNIT PRICE EXTENSION
Account 43.509
1 Each Medicare Ambulance Cost Reporting $19,000.00 $19,000.00
Sub Total: $19,000.00
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Send Invoice To: � Rn coo
Cannel Fire Department
2 Cannel Civic Square . •
Cannel, IN 46032-
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT ? PROJECT ACCOUNT AMOUNT
Cannel Fire Department PAYMENT $19,000.00
• NP VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE PO.
,. NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS • I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
•SHIP REPAID. 1 THIS APPROP ARr YI ISDFF ENT PA ORTHE ABOVE OBOES.
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED. C/
•PURCHASE ORDER NUMBER MUST APPEAR ON ALL • ORDERED BY
r--
SHIPPING LABELS. A 'I
•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE 2 \I 'LI in 01
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. I
t'' 1 5 8 7 CLERK-TREASURER' -
DOCUMENT CONTROL NO. OFFICE COPY ;