32189 John MolitorCi
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
32189
THIS NUMBER MUST APPEAR ON INVOICES, AR
VOUCHER, DELIVERY MEMO, PACKING ;SLIPS,
SHIPPING LABELS AND ANY CORRESPONDENCE.
PURCHASE ORDER DATE
DATE REQUIRED
REQUISITION NO.
VENDOR NO.
DESCRIPTION
12/16/2014
VENDOR
John Molitor
9465 Counselors Row, Suite 200
Indianapolis, IN 46240 -6150
SHIP
TO
DOCS Department
1 Civic Square
Carmel, IN 46032
(317) 571-2418
CONFIRMATION
BLANKET
CONTRACT
PAYMENT TERMS
FREIGHT
QUANTITY
UNIT OF MEASURE
DESCRIPTION
UNIT PRICE
EXTENSION
Account 43- 400.00
1 Each Retainer
Send Invoice To:
DOCS Department
1 Civic Square
Carmel, IN 46032-
PLEASE INVOICE IN DUPLICATE
$42,000.00
Sub Total:
$42,000.00
$42,000.00
DEPARTMENT
ACCOUNT
PROJECT
PROJECT ACCOUNT
AMOUNT
1192 DOCS
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.
ORDERED BY
TITLE
PAYMENT'
$42,000.00
• 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 AFFIDAVIT ATTACHED.
I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
THIS APPROPRIA IO TENT TO PAY FOR THE ABOVE ORDER,
Director
CLERK - TREASURER
DOCUMENT CONTROL NO. 32189 SIGN AND RETURN TO CLERK'S OFFICE