37586 Northern Safety Co ///``` INDIANA RETAIL TAX EXEMPT PAGE 1
City . rIT1 1 CERTIFICATE NO.003120155 002 0
i PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 37586
35-60000972
-_, i1-;:,}'i .1,= =..,.., 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
9/11/2014 09/14/14 2873 Safety and cleaning supplies
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 EXTENSION
16.000 each 17295-Tolco 32oz. plain spray bottle $0.9700 $ 15.52
16.000 each 17286 - Tolco 32oz. bottle trigger $ 0.9100 $ 14.56
8.000 each 4164-Tychem 28•'x36•"splash apron $2.3100 $ 18.48
4.000 each 4534- 12oz Technu poison ivy wash $ 10.1900 $40.76
10.000 each 26523- Pyramex Zteck safety sunglasses $ 2.8000 $28.00
5.000 each 22888- Headband earmuffs hearing protection $24.4700 $ 122.35
1.000 each Shipping $ 21.6000 $21.60
GLAccount# 1125401-4238900
Send Invoice To:
$261.27
PLEASE INVOICE IN DUPLICATE
DEPARTMENT (� ACCOUNT 1 PROJECT PROJECT ACCOUNT AMOUNT
I a ✓ 42.36 '-loo PAYMENT
• AlP 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 Weintraut I�'` A_,,,K1 9) II/ry/
• THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. TITLE
CLERK-TREASURER I
DOCUMENT CONTROL NO. 37586 VENDOR COPY