37164 Landscape Forms INDIANA RETAIL TAX EXEMPT PAGE 1
CERTIFICATE NO.003120155 002 0
City ity� o �, arm -
_� PIIRCHASF ORDER NWd6FN
FEDERAL EXCISE TAX EXEMPT 37164
35-60000972
I IIIS NUMBLH MUSE APPEAR ON INVOICES.NI'
VOUCI iE N,DI I EVERY MEMO,HACKING SE IPS.
SHIPPING I N iE:I.S ANT)ANY COHRPSHONDI!NCI_
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL- 1997
PURCI IASr ORDER DATE BA F REQUIRED r REQUISITION NO VENDOR NO DESCRIPTION
6/10/2014 06/14/14 1883 Arms for Central Park bench repairs
Landscape Forms, Inc_ Parks Maintenance
431 Lawndale Ave 1427 E. 116th Street ATTN: Courtney
VENDOR Kalamazoo, MI 49048 SHIP Carmel, IN 46032
TO
CONHNMAIION lil l)NKEI CON IIinGI HAYML-NI ILRA45 � GiL ICI li
OUAN rnY I UNIT OF ME:ASO-TIT OESGNII I ION I UNn PRICE EXTENSION
2.000 each Backless Arms- Pal #GB00642 -Silver Powder Coated $ 95.00 $ 190.00
2.000 each Back Arms - Part //GB00644 - Silver Powder Coated $ 105.00 $ 210.00
1.000 each Shipping $ 100.00 $ 100.00
GLAccounti01125404-4237000
Send Invoice To:
$ 500.00
PLEASE INVOICE IN DUPLICATE nrPnitlMl-NI ACCOUNT I PROJI-CI HHOJrC1 ACCOUNT AMOUNT
f 1 25- LI-23100o PAYMENT
AIP VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.NUMBER IS MADE A
PARI OF THE VOUCHER AND EVERY INVOICE AND VOUCHER HAS THE PROPER SWORN
SHIPPING INSTRUCTIONS AFFIDAVIT ATTACHED.
. 1 HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN THIS APPROPRIATION
• SI TIP REIPNO. SUFFICIENT 10 PAY FOR THE ABOVE ORDER.
. COI15111PMI-NISCANNOI IIr ACCT.I'II Ti
PURCI IATE OTFD1 H NUMB!N MUSE AWE AR ON Al ST TlIPINO I AEI IN ORDERED BY Courtney Schlaegel Lc,7t1 '''���}(((���� (c ILL,Ile(
• IUISOTt014<ISSUE 0 IN COMP!IANCI WU.ICITAP II H 99_AC IS 1915 � �� �A
AND ACTS AMI N I)A I OHY/I I I HI-01 AND SUPPI I MI N I 1111"0 I O.
TITLE
CLERK-TREASURER
DOCUMENT CONTROL NO. 37164