24631 VerathonCi
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
N a L
PURCHASE ORDER NUMBER
24631
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
912212014
S — -c--O\,,_---
VENDOR
Verathon
20001 North Creek Parkway
Bothell, WA 98011
SHIP
TO
Carrel Fire Department
2 Cannel Civic Square
Cannel, IN 46032
(317) 571 -2622
CONFIRMA1ION
BLANKET
CONTRACT
PAYMENT TERMS
FREIGHT
QUANTITY UNITAOF MEASURE
DESCRIPTION
UNIT PRICE
EXTENSION
Account 102670.06
1 Each AC Power Supply, Glidescope Ranger
1 Each Shipping
Send Invoice To:
0400 -0065
Cannel Fire Department
2 Cannel Civic Square
Cannel, IN 46032 -
PLEASE INVOICE IN DUPLICATE
$283.00
$8.12
Sub Total:
$263.00
$8.12
$271.12
DEPARTMENT
ACCOUNT
PROJECT
PROJECT ACCOUNT
AMOUNT
Carmel 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.
24631
DOCUMENT CONTROL NO.
ORDERED BY
PAYMENT $271.12
• NP VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE RO.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
TITLE \ of V -o�.� ��.‘./ /
.
CLERK - TREASURER
OFFICE COPY