24621 TK SoftwareCi
of Carmel
ONE CIVIC SQUARE
CARMEL, INDIANA 46032 -2584
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL - 1997
INDIANA RETAIL TAX EXEMPT
CERTIFICATE NO. 003120155 002 0
FEDERAL EXCISE TAX EXEMPT
35- 60000972
PAGE
PURCHASE ORDER NUMBER
24621
THIS NUMBER MUST APPEAR ON INVOICES. NP
VOUCHER, DELIVERY MEMO, PACKING SLIPS,
SHIPPING LABELS AND ANY CORRESPONDENCE.
PURCHASE ORDER DATE
DATE REQUIRED
REQUISITION NO.
VENDOR NO.
DESCRIPTION
8/1912014
�COF
\----,1/4----
VENDOR
TK Software
11495 Pennsylvania Street, Ste. 200
Carmel, IN 46032
SHIP
TO
Carmel Fire Depament
2 Cannel Civic Square
Carmel, IN 46032
(317) 571 -2622
CONFIRMATION
BLANKET CONTRACT
PAYMENT TERMS
FREIGHT
�COF
QUANTITY MEASU
�\
DESCRIPTION UNIT PRICE
I
EXTENSION
Account 102632.02 \
3 Each Electronic Ambulance Claims
100 Each Eligibility Verification
Send Invoice To:
Cannel Fire Department
2 Carmel Civic Square
Carmel, IN 46032-
PLEASE INVOICE IN DUPLICATE
$150.00
$0.20
Sub Total:
$450.00
$20.00
$470.00
DEPARTMENT
ACCOUNT
Cannel Fire Department
SHIPPING INSTRUCTIONS
• SHIP REPAID.
• C.O.D. SHIPMENTS CANNOT BE ACCEPTED.
• PURCHASE ORDER NUMBER MUST APPEAR ON ALL
SHIPPING LABELS.
• THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
24621
DOCUMENT CONTROL NO.
PROJECT PROJECT ACCOUNT 1 AMOUNT
PAYMENT $470.00
• NP VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER I5 MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
ORDERED BY • -
TITLE
V
CLERK - TREASURER
OFFICE COPY