101693 MEDIA FACTORY CairinnielINDIANA RETAIL TAX EXEMPT Page 1 of 1
it of ( CERTIFICATE NO.0031201550020 PURCHASE ORDER NUMBER
// FEDERAL EXCISE TAX EXEMPT 101693
ONE CIVIC SQUARE -- 35-6000972 THIS NUMBER MUST APPEAR ON INVOICES,NP
CARMEL, INDIANA 46032-2584 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
5/31/2018 00351085
MEDIA FACTORY Carmel Police Department
VENDOR 481 GRADLE DRIVE SHIP 3 Civic Square
TO Carmel, IN 46032-
CARMEL, IN 46032- Blaine Mallaber
PURCHASE ID BLANKET CONTRACT PAYMENT TERMS FREIGHT
26295
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Department: 1110 Fund: 101 General Fund
Account: 42-301.00
1 Each mental health referal guides $1,392.00 $1,392.00
Sub Total $1,392.00
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Send Invoice To:
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Carmel Police Department
Accounts Payable \ �
3 Civic Square q
Carmel, IN 46032- �2 w,
PLEASE INVOICE IN DUPLICATE
DEPARTMENT I ACCOUNT 1 PROJECT 1 PROJECT ACCOUNT AMOUNT
PAYMENT $1,392.00
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 n
'THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 / V�
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. ORDERED BY \/\
Jim Barlow lh
TITLE Chief
CONTROL NO. 101693 CLERK-TREASURER •A