51115 SMITH PROJECTS INDIANA RETAIL TAX EXEMPT PAGE 1
CERTIFICATE N0.003120155 002 0
PURCHASE ORDER NUMBER
iii.., t, LJ. FEDERAL EXCISE TAX EXEMPT 51115
35-60000972
ONE CMC SQUARE . .
CARMEL,INDIANA-'6032-2554 THIS NUMBER MUST APPEAR ON INVOICES,NP
VOUCHER,DELIVERY MEMO,PACKING SLIPS,
SHIPPING LABELS AND ANY CORRESPONDENCE.
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL-1997
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
4/2/2018 04/02/18 15768 37 2J
a 2j1 Monon Trail Rehabilitation-Phase 1 Project
Smith Projects ) Administration Office
PO Box 189 238 N. Main Street 1411 E. 116th Street
VENDOR Maxwell, IN 46154 SHIP Carmel, IN 46032
TO
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE I EXTENSION
$ 1.0000 each Services-Repair and Resurface Asphalt 249,999.000 $249,999.00
GLAccount#1030000-4460703
Send Invoice To:
$249,999.00
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT 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 \\\??\ i<
DOCUMENT CONTROL NO. 51115 VENDOR COPY