51739 HOOSIER PORTABLE RESTROOMS INC INDIANA RETAIL TAX EXEMPT PAGE 1
CERTIFICATE NO.003120155 002 0
t0aPURCHASE ORDER NUMBER
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FEDERAL EXCISE TAX EXEMPT 51739
35-60000972
C:11 E Cc/le SOLAR=
1' RI4_i '11:314,11,4 4En„<2-2E..= THIS NUMBER MUST APPEAR ON INVOICES,AIP
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
7/25/2018 05/30/18 16508 354857 Emergency portable toilet rentals due to Fire at West Park
Hoosier Portable Restrooms Inc Parks Maintenance
2201 E 99th Street 1427 E. 116th Street ATTN: Courtney
VENDOR Indianapolis, IN 46280 TOHIP Carmel, IN 46032
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE I EXTENSION
14.500 each 2 standard portable toilet rental-7.5 weeks 5/25-7/19/18 $20.0000 $290.00
7.500 each 1 ada portable toilet rental for 7.5 weeks 5/25-7/19/18 $40.0000 $300.00
7.000 each . Additional standard units required for Restoration 6/19/18- $20.0000 $ 140.00
7/10/18
3.000 each Additional Cleanings 6/11/18 $30.0000 $90.00
3.000 each Additional Cleanings 6/17/18 $30.0000 $90.00
5.000 each Additional Cleanings 6/24/18 $30.0000 $ 150.00
5.000 each Additional Cleanings 6/29/18 $30.0000 $ 150.00
5.000 each Additional Cleanings 7/6/18 $30.0000 $ 150.00
GLAccount#1125419-4350400
Send Invoice To:
$ 1,360.00
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT I PROJECT PROJECT ACCOUNT I AMOUNT
PAYMENT
• AIP 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 Michael Allen
• THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. TITLE
CLERK-TREASURER / \)
DOCUMENT CONTROL NO. 51739 VENDOR COPY
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