50897 STAPLES BUSINESS ADVANTAGE O 201 IPAGE1
INDIANA RETAIL TAX EXEMPT
j CERTIFICATE N 0031 55 002 0
!..City Cannel _...... I I PURCHASE i FEDERAL EXCISE TAX EXEMPT 150897
35-60000972 4 '
ONE CHIC SQUARE
CARMEL,•IND
WN46032
A: -.2E84 i 1 THIS NUMBER MUST APPEAR ON INVOICES,NP
• 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 1 REQUISITION NO. I VENDOR NO. I DESCRIPTION
2/8/2018 02/13/18 115293 # 361528 :Office Supplies
Staples Business Advantage Administration Office
Dept DET 2368 P.O.Box 83689 1411 E. 116th Street
VENDOR Chicago, IL 60696-3689 SHIP Carmel, IN 46032
TO
CONFIRMATION BLANKET I CONTRACT I PAYMENT TERMS FREIGHT
3 1-
1 i
QUANTITY i UNIT OF MEASURE i DESCRIPTION I UNIT PRICE I EXTENSION
1.000 each #332849-HP 05A(CE505D)Black Original LaserJet Toner $ 108.7100 $ 108.71
2pk
1.000 each Item#321486-Swingline®Finger Tips,Size 12 $3.5900 $3.59
1.000 each Item#122051 -Staples®Index Card File,Black,300 Card $2.0200 $2.02
Capacity, Holds 3"x 5",
1.000 each Item#433427-Staples®OOPS!TM Sidewinder Correction $6.6700 $6.67
Tape,White, 1/5"x 394",6/Pk
1.000 each Item#479074-Duracell®Procell Alkaline"AAA"Batteries, $5.6100 $5.61
1.5V,24-Pack
2.000 each Item#135848-Staples®Copy Paper;8-1/2x11 $34.7300 $69.46
1.000 each Item#129957-Post-it®Notes, 1 1/2"x 2", Canary $4.0200 $4.02
3.000 each Item#567302-Staples®BerberMat Chairmat, For Low Pile $35.1600 $105.48
Carpets,No Lip,Rectangular,46"x 60"
2.000 each Item#836622-Staples®Remanufactured Laser Toner $45.8800 $91.76
Cartridge, HP 36A
1.000 each Item#887396Pentel Oh Gel Retractable Roller Pen Black $10.9900 $ 10.99
GLAccount#1125102-4230200
Send Invoice To:
$408.31
PLEASE INVOICE IN DUPLICATE
_..,,w.,..."..•, DEPARTMENT f ACCOUNT L ......... ,.PROJECT .,.._...._.._. PROJECT ACCOUNT _-1.WAMOUNT
PAYMENT
• MP 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 UNOBUGATED 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. 50897 VENDOR COPY