101666 SUPERION, LLC INDIANA RETAIL TAX EXEMPT Page 1 of 1
Cityof Iarinrie1 CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 101666
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
5/16/2018 372128
SUPERION, LLC Clerk-Treasurer's Office
VENDOR BANK OF AMERICA SHIP 1 Civic Square
12709 COLLECTION CENTER DRIVE TO Carmel, IN 46032-
CHICAGO,IL 60693-
PURCHASE ID BLANKET CONTRACT PAYMENT TERMS FREIGHT
25939
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Department: 1701 Fund: 101 General Fund
Account: 43-515.02
1 Each ANNUAL MAINTENANCE FEE $11,193.50 $11,193.50
Sub Total $11,193.50
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Send Invoice To: v. gk Via,.
fr
Clerk-Treasurer's Office
v
1 Civic Square
Carmel, IN 46032- '#
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT H AMOUNT
PAYMENT $11,193.50
SHIPPING INSTRUCTIONS '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
'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 LABEL
'THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 a(31X2'464421'
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AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. ORDERED BY -
Dianne Walthall
TITLE Director of Financial Reporting
CONTROL NO. 101666 CLERK-TREASURER