37253 Northern Safety INDIANA RETAIL TAX EXEMPT PAGE 1
Eity .C.arm^l CERTIFICATE NO.0031201550020 of arm el PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 37253
35-60000972
:7,=!,1;;:1=j;= -LEC:2-2EE= THIS 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 REQUISITION NO VENDOR NO. DESCRIPTION
6/25/2014 06/28/14 2066 226500 Safety gloves for staff and back up inventory
Northern Safety Co. Inc. Parks Maintenance
P.O. Box 4250 1427 E. 116th Street ATTN: Courtney
VENDOR Utica, NY 13504-4250 SHIP Carmel, IN 46032
TO
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE I EXTENSION
2.000 each 26019-Work gloves- Medium $21.96 $43.92
3.000 each 26019-work gloves-large $21.96 $65.88
6.000 each 26019-work gloves-X Large $21.96 $ 131.76
1.000 each Shipping $ 16.68 $ 16.68
GLAccount# 1125401-4239012
Send Invoice To:
$258.24
PLEASE INVOICE IN DUPLICATE
DEPARTMENT f ACCOUNT ( PROJECT f PROJECT ACCOUNT J AMOUNT
( 1 2 _, 42390 )2_ PAYMENT
✓✓ • 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
SHIPPING INSTRUCTIONS AFFIDAVIT ATTACHED.
. I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN THIS APPROPRIATION
• SHIP REPAID. SUFFICIENT TO PAY FOR THE ABOVE ORDER.
. C.O.D SHIPMENTS CANNOT BE ACCEPTED.
• PURCHASE ORDER NUMBER MUST APPEAR ON ALL SHIPPING LABELS. ORDERED BY Courtney Schlaegel C\'.
,� ,.,,,k;_rDzA Lc -2• I1'-4
• THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. TITLE
CLERK-TREASURER
DOCUMENT CONTROL NO. 37253 VENDOR COPY