50636 CARMEL CITY SCHOOLS/ FUEL INDIANA RETAIL TAX EXEMPT PAGE 1
City
q:� l
CERTIFICATE N0.003120155 002 0 PURCHASE ORDER NUMBER j.
./Y FEDERAL EXCISE TAX EXEMPT 50636
35.60000972
ONE CIVIC SQUARE . , _._ .- ._ .,..�::_____
CARMEL,INDIANA46032:2ES4 THIS NUMBER MUST APPEAR ON INVOICES.A/P
VOUCHER,DELIVERY MEMO,PACKING SUPS,
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL-1997 SHIPPING LABELS AND ANY CORRESPONDENCE.
V PURCHASE ORDER DATE DATE REQUIRED 1 REQUISITION N0, I VENDOR NO. DESCRIPTION
12/12/2017 12/17/17 '114731 `042595 2017 Fuel Charges
Carmel Clay Schools/Fuel Administration Office
5201 E Main Street 1411 E. 116th Street
VENDOR Carmel, IN 46033 SHIP Carmel, IN 46032
TO
CONFIRMATION BLANKET 1 CONTRACT 1 PAYMENT TERMS
�. ...._... ......_,......._.____..___......v..,...__.._,.._w._.- - i FREIGHT
-
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
1.000 each Diesel Fuel $700.0000 $;700.00
GLAccount#1125401-4231300
1.000 each Gasoline Fuel $2,600.0000 ;:$2,600.00
GLAccount#1125401-4231400
Send Invoice To:
$3,300.00
PLEASE INVOICE IN DUPLICATE
DEPARTMENT 1 ACCOUNT { PROJECT I - PROJECT ACCOUNT -1 AMOUNT -
PAYMENT
• 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
SHIPPING INSTRUCTIONS AFFIDAVIT ATTACHED.
▪ I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN THIS APPROPRIATION
• SHIP REPAID. SUFFICIENT TO PAY FOR THE ABOVE ORDER.
. C.O.D SHIPMENTS CANNOT BE ACCEPTED.
• PURCHASE ORDER NUMBER MUST APPEAR ON ALL SHIPPING LABELS. ORDERED BY Dawn Koepper
• THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 \\
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. TITLE
`\.
CLERK-TREASURER \
DOCUMENT CONTROL NO. 50636 VENDOR COPY \.