101829 HOLLYWOODS BUMP & GRIND ity INDIANA RETAIL TAX EXEMPT Page 1 of 1
ofCarme CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
J� FEDERAL EXCISE TAX EXEMPT 101829
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
7/31/2018 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
28012
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Department: 1110 Fund: 101 General Fund.
Account: 43-510.00
1 Each vehicle repairs $750.80 $750.80
Sub Total $750.80
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Send Invoice To:
Carmel Police Department Vicar 56-pool car, Keinsley
Accounts Payable „
3 Civic Square
Carmel,IN 46032I 41,4
-
PLEASE INVOICE IN DUPLICATE
DEPARTMENT I ACCOUNT PROJECT I PROJECT ACCOUNT I AMOUNT
PAYMENT $750.80
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 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 le1 ` a
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. ORDERED BY
Jim Barlow
TITLE Chief ,�1
CONTROL NO. 101829 CLERK-TREASURER