101044 INDIANAPOLIS CONCRETE C i� ® pro Carme1 INDIANA RETAIL TAX EXEMPT Page 1 E 1
y JIIl. CERTIFICATE
FEDERAL EXCISE TAX EXEMPT 101044 PURCHA1SEoOROD�R�UMBER
ONE CIVIC SQUARE 35-6000972 THIS NUMBER MUST APPEAR ON INVOICES,NP
CARMEL,INDIANA 46032-2584 VOUCHER,DELIVERY MEMO,PACKING SLIPS,
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL-1997 SHIPPING LABELS AND ANY CORRESPONDENCE
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
12/11/2017 367400 Repairs to Cherry Tree Rd./Main St.
INDIANAPOLIS CONCRETE Street Department
VENDOR 5363 W 86TH ST SHIP 3400 W. 131st Street
TO
Carmel, IN 46074-
INDIANAPOLIS,IN 46268'
(317)733-2001
PURCHASE ID BLANKET CONTRACT PAYMENT TERMS FREIGHT
21484
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Department: 2201 Fund: 2201 Motor Vehicle Highway FND
Account: 43-509.00
1 Each Repairs to roundabouts $1,340.00 $1,340.00
Sub Total $1,340.00
day/
+
t r
x 3
A +
Send Invoice To:
Street Department
3400 W. 131st Street
Carmel, IN 46074-
(317)733-2001 PLEASE INVOICE IN DUPLICATE
DEPARTMENT I ACCOUNT I PROJECT I PROJECT ACCOUNT I AMOUNT
PAYMENT $1,340.00
SHIPPING INSTRUCTIONS 'NP VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O. NUMBER IS MADE A
'SHIP PREPAID. 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
*C.O.D.SHIPMENT CANNOT BE ACCEPTED. THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
'PURCHASE ORDER NUMBER MUST APPEAR ON ALL SHIPPING LABEL
'THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 � �
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. ORDERED BY /// ✓ ""Y Il
Dave Huffman �\
TITLE Director \-.1)
CONTROL NO. 101044 CLERK-TREASURER