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51918 DRIESSEN WATER, INC (CULLIGAN) EXM #+( C }'� CERT F CAA RE NOL 033 0155 0 2 0 PAGE 1 '�t y to ,arm PURCHASE ORDER NUMBER w. +++ 111 *►/�. FEDERAL EXCISE TAX EXEMPT 51918 35-60000972 ONE CMC SQUARE CARMEL,!NOLa ttA.4SC32-2E5= THIS NUMBER MUST APPEAR ON INVOICES,NP 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 9/10/2018 09/07/18 17557 00352895 Chemical for West Commons Splash Pad Driessen Water, Inc. (CULLIGAN OF INDIANAPOLIS) MCC-West 6901 E.38th Street 1235 Central Park Drive East VENDOR Indianapolis, IN 46226 SHIP Carmel, IN 46032 CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE I EXTENSION 2.000 case Poly Guard Liquid-4gal per case $ 195.6800 $391.36 1.000 case Approximate Shipping $25.0000 $25.00 GLAccount#1125300-4238900 • Send Invoice To: $416.36 • PLEASE INVOICE IN DUPLICATE DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT PAYMENT • 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 SHIPPING INSTRUCTIONS AFFIDAVIT ATTACHED. ▪ I HEREBY CERTIFY THAT THERE IS AN UNOBUGATED 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 Terese McAninch • THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. TITLE CLERK-TREASURER DOCUMENT CONTROL NO. 51918 VENDOR COPY