32234 Public Safety Medical ServicesCi
of Carmel
{
ONE\CIVIC SQUARE
CARMEL, INDIANA 46032 -2584
FORM APPROVED BY STATE BOARD OF ACCOUNTMOR CITY OF CARMEL - 1997
INDIANA RETAIL TAX EXEMPT
CERTIFICATE NO. 003120155 002 0
FEDERAL EXCISE TAX EXEMPT
35- 60000972
PAGE
PURCHASE ORDER NUMBER
32234
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
12/10/2014
Public Safety Medical Services
VENDOR
324 E. New York Street, Suite 300
Indianapolis, IN 48204
SHIP
TO
Cannel Police Department
3 Civic Square
Cannel, IN 46032
(317) 571 -2559
CONFIRMATION
BLANKET
CONTRACT
PAYMENT TERMS
FREIGHT
QUANTITY I UNIT OF MEASURE
DESCRIPTION
Account 43-407.01
4 Each physical for applicant
Send Invoice To:
Cannel Police Department
Attn: Pat Young
3 Civic Square
Cannel, IN 46032 -.
UNIT PRICE
EXTENSION
PLEASE INVOICE IN DUPLICATE
$705.90
Sub Total:
$2,823.80
$2,823.80
DEPARTMENT
ACCOUNT
PROJECT
PROJECT ACCOUNT
AMOUNT
Cannel Police Dept.
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.
DOCUMENT CONTROL NO. 32234
ORDERED BY
TITLE
PAYMENT
$2,823.80
• NP 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 AFFIDAVIT ATTACHED.
• I HEREBY CERTIFY AT HERE IS AN UNOBLIGATED BALANCE IN
THIS APPROP .!1 FFICIENT TO PAY FOR THE ABOVE ORDER.
CLERK - TREASURER'
OFFICE COPY,_