33121 Champion Optical Network(City of Carmel
INDIANA RETAIL TAX EXEMPT
CERTIFICATE NO. 003120155 002 0
!- FEDERAL EXCISE TAX EXEMPT
ONE CIVIC SQUARE L 35-6000972
CARMEL. INDIANA 46032.2584
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL -1997
Page 1 of 1
PURCHASE ORDER NUMBER
33121
THIS NUMBER MUST APPEAR ON INVOICES, AF
VOUCHER DELNERY MEMO, PAQ3NG SLIPS,
SIPPING LABELS AND ANY CORRESPONDENCE
PURCHASE ORDER DATE
DATE REQUIRED ` REQUISITION NO.
VENDOR NO. '
DESCRIPTION
10/6/2015
369344
Spare SFP modules
CHAMPION OPTICAL NETWORK ENGINEERIN Information Systems
VENDOR PO BOX 636640 SHIP 3 Civic Square
TO Carmel, IN 46032 -
CINCINNATI, OH 45263-6640 (317) 571-2576
CONFIRMATION BLANKET I CONTRACT . PAYMENT TERMS
FREIGHT
L
QUANTITY UNIT OF MEASURE DESCRIPTION
1 UNIT PRICE I EXTENSION
Department: 1202 Account: 42-370.00 Fund: 101 General Fund
5 Each GESFP-LX-H3C SFP 1000BASE-LX 10KM, SYSTEMS capatible
1 Each shipping
Send Invoice To:
Information Systems
Terry Crockett
3 Civic Square
Carmel, IN 46032 -
Quote No. g888045sr
PLEASE INVOICE IN DUPLICATE
$58.00
$'15.00
Sub Total
$290.00
$15.00
6305.00
DEPARTMENT
I ACCOUNT 1 PROJECT I PROJECT ACCOUNT ( AMOUNT
SHIPPING INSTRUCTIONS
'SHIP PREPAID.
'COD SHIPMENT CANNOT BE ACCEPTED.
'PURCHASE ORDER NUMBER MUST APPEAR CR ALL SHIPPING LABELS.
'TH150R6RISSUED IN COMPLIANCE MIR CHAPTER99, ACTS 1945
AND ACTS AMENDATORY THEREOF M'D SUPPLEMENT THERETO.
DOCUMENT CONTROL NO. 33121
ORDERED BY
TI
CLERK-TREASU
PAYMENT 6305.00
• AB VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P 0.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY IN' CE ANO
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED
• I HEREBY CERTIFY THAT THERE IS AN UNOSUGATED BALANCE IN
TISRATION SUFRO' TO PAY FOR THE ABOVE ORDER