101963 GODBY HOME FURNISHINGS INDIANA RETAIL TAX EXEMPT Page 1 of 1
CityofI1arinnie1 CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 101963
ONE CIVIC SQUARE 35-6000972 THIS NUMBER MUST APPEAR ON INVOICES,A/P
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
9/21/2018 00351374 Mattress Rotation
GODBY HOME FURNISHINGS Fire Department
VENDOR 13610 N MERIDIAN SHIP 2 Civic Square
TO Carmel, IN 46032-
CARMEL, IN 46032-
PURCHASE ID BLANKET CONTRACT PAYMENT TERMS FREIGHT
29446
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Department: 1120 Fund: 102 Ambulance Capital Fund
Account: 44-630.00
1 Each 3 Sets to Station 45-10701 N. College Avenue $0.00 $0.00
1 Each 4 Sets to Station 41 -2 Civic Square $0.00 $0.00
1 Each 4 Sets to Station 43-3242 E. 106th Street $0.00 $0.00
1 Each 5 Sets to Station 42-3610 W. 106th Street $0.00 $0.00
16 Each Bedgear Matt Pad 3/3 XL I Protect $59.95 $959.20
16 Each Chesterton Twin XL $569.95 $9,119.20
2 Each Delivery&Set Up $99.95 $199.90
1 Each Discount ($432.00) ($432.00)
16 Each Simmons Beauty Sleep 6/6 Foundation $135.00 $2,160.00
Sub Total $12,006.30
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Send Invoice To: �'4
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Fire Department
2 Civic Square
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Carmel, IN 46032- ems . ` t
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT 1 PROJECT ACCOUNT AMOUNT
PAYMENT $12,006.30
SHIPPING INSTRUCTIONS '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
'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 ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 \\'"~`~"~-~�.,,,,,'''=^'-• "'` . `,,.-.. .�'" ~'l. C% C::: /el 110
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. ORDERED BY ")
Denise Snyder James Crider (�
TITLE Budget&Accreditation Manager Administration AU1
CONTROL NO. 101963 CLERK-TREASURER