101775 HOLLYWOODS BUMP & GRIND c, INDIANA RETAIL TAX EXEMPT Page 1 of 1
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CERTIFICATE NO.003120155 0020 PURCHASE ORDER NUMBER
C✓ FEDERAL EXCISE TAX EXEMPT 101775
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
7/10/2018 372102
HOLLYWOODS BUMP&GRIND Carmel Police Department
VENDOR 10550 JESSUP BLVD SHIP 3 Civic Square
TO Carmel, IN 46032-
INDIANAPOLIS, IN 46280- Blaine Mallaber
PURCI IA' =ID BLANKET I CONTRACT PAYMENT TERMS FREIGHT
274Ci; ___i_
QUANTI FY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Departmont: 1110 Fund: 101 General Fund
Account: 43-510.00
1 Epcli vehicle repairs $2,382.22 $2,382.22
Sub Total $2,382.22
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Send Invo,cc. To: w _. ,,_ ,. -'
Carmel Police Department car 85-KeinsleyMr
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Accounts Payable
9
3 Civic Square
Cannel, IN 46032- !I ,
PLEASE INVOICE IN DUPLICATE
DL_FARTMENT L ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
PAYMENT $2,382.22
SHIPPING INSTRUCTIONS 'A/P 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 PF'r_PA'',.i' AFFIDAVIT ATTACHED. I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
*C.O.I).:: !i CANNOT BE ACCEPTED. THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
'PURCHASE C:.i,ER NUMBER MUST APPEAR ON ALL SHIPPING LABEL
'THIS ORDER"S!.IFD IN COMPLIANCE WITH CHAPTER 99,ACTS 1945
AND'.r.'CI S A'NDATORY THEREOF AND SUPPLEMENT THERETO. ORDERED BY I
Jim Barlow
TITLE Chief f\
CO`ITF No. 101775 CLERK-TREASURER