101698 HOLLYWOODS BUMP & GRIND INDIANA RETAIL TAX EXEMPT Page 1 of 1
Citof Iiarrnie1 CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 101698
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
5131/2018 372102
HOLLYWOODS BUMP&GRIND Carmel Police Department
VENDOR 10550 JESSUP BLVD SHIP 3 Civic Square
TO Carmel, IN 46032-
INDIANAPOLIS, IN 46280- Blaine Mallaber
PURCHASE ID BLANKET CONTRACT PAYMENT TERMS FREIGHT
26311
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Department: 1110 Fund: 101 General:Fund
Account: 43-510.00
1 Each Auto Repairs $800.40 $800.40
Sub Total $800.40
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Send Invoice To: �` u _ . ; , ,,... 'i, ...�_„ ,.,._
Carmel Police Department -'% Flaming-car 33 ..
Accounts Payable
3 Civic Square s k ,,,"
Carmel, IN 46032- ..,,
PLEASE INVOICE IN DUPLICATE
DEPARTMENT I ACCOUNT I PROJECT I PROJECT ACCOUNT I AMOUNT
PAYMENT $800.40
*NP VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O. NUMBER IS MADE A
SHIPPING INSTRUCTIONS
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 \�.J{r_-, ..,, la,4w401.%1 �
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. ORDERED BY \,
Jim Barlow - V
TITLE Chief C 1 i •J
CONTROL NO. 101698 CLERK-TREASURER W