Tom Kegley d/b/a Kegley & Associates/HR/8,452.64/ Adl Serv/E4H ProgramCiti ®f Carmel
INDIANA RETAIL TAX EXEMPT
CERTIFICATE NO. 003120155 002 0
Page 1 of 1
PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT
100074
ONE CIVIC SQUARE
35-6000972
THIS NUMBER MUST APPEAR ON INVOICES, AIP
CARMEL, INDIANA 46032-2584
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL - 1997
VOUCHER, DELIVERY MEMO, PACKING SLIPS,
SHIPPING LABELS AND ANY CORRESPONDENCE
PURCHASE ORDER DATE
DATE REQUIRED
REQUISITION NO.
VENDOR NO.
DESCRIPTION
1/13/2017
'
370770
- a'' t •�
KEGLEY & ASSOCIATES
General Administration
VENDOR 10431 SPRING HIGHLAND DRIVE
SHIP 1 Civic Square
TO Carmel, IN 46032 -
INDIANAPOLIS, IN 46290 -
' AIP VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O. NUMBER IS MADE A
PURCHASE ID BLANKET
CONTRACT
PAYMENT TERMS FREIGHT
12003
'C.O.D. SHIPMENT CANNOT BE ACCEPTED.
THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
QUANTITY UNIT OF MEASURE
DESCRIPTION UNIT PRICE EXTENSION
Department: 1205 Fund: 101 General Fund
Account: 43-509.00
1 Each _ E41-1 Program $8,500.00 $8,500.00
Sub Total $8,500.00
. �—
ti.
'PURCHASE ORDER NUMBER MUST APPEAR ON ALL SHIPPING LABE
VA _
'THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 194 f 1-L�� ! <
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. ORDERED BY
Barbara Lamb Douglas Haney
TITLE Director Corporation Counsel
CONTROL NO. 100074 CLERK -TREASURER
I
'i
.
Send Invoice To:
Dept of Administration
a
w
1 Civic Square
r�� . +'
'
Carmel, IN 46032-_"'
- a'' t •�
PLEASE INVOICE IN DUPLICATE
DEPARTMENT T
ACCOUNT PROJECT PROJECTACCOUNT AMOUNT
PAYMENT $8,500.00
SHIPPING INSTRUCTIONS
' AIP 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
'SHIP PREPAID.
AFFIDAVIT ATTACHED. I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
'C.O.D. SHIPMENT CANNOT BE ACCEPTED.
THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
'PURCHASE ORDER NUMBER MUST APPEAR ON ALL SHIPPING LABE
VA _
'THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 194 f 1-L�� ! <
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. ORDERED BY
Barbara Lamb Douglas Haney
TITLE Director Corporation Counsel
CONTROL NO. 100074 CLERK -TREASURER