52027 STAPLES BUSINESS ADVANTAGE INDIANA RETAIL TAX EXEMPT PAGE 1
f y� CERTIFICATE NO.003120155 002 0
`� t�. opt Carmel PURCHASE ORDER NUMBER
" ... VVV.ti `v✓/ FEDERAL EXCISE TAX EXEMPT 52027
35-60000972
ONE CMC SQUARE
CARMEL,INDIANA 4 u32-2c 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
10/9/2018 10/10/18 17849 361528 Office supplies for maintenance
Staples Business Advantage Parks Maintenance
Dept DET 2368 P.O. Box 83689 1427 E. 116th Street ATTN: Courtney
VENDOR Chicago, IL 60696-3689 SHIP Carmel, IN 46032
TO
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE I EXTENSION
1.000 each IM1VM1352-StarTech VGA to HDMI adapter with USB Audio $52.5900 $52.59
and power converter
1.000 each 1115610-Fellowes Saturn 3i 125 Thermal and cold laminating $ 167.9700 $167.97
machine
1.000 each 489526-Staples laminating pouches 5 mil 9x11 100pk $9.8500 $9.85
1.000 each 677045-Staples laminating pouches 3 mil 9x11 50pk $3.3600 $3.36
1.000 each 019710-Staples laminating pouches 3 mil 12x18 25pk $ 19.8400 $ 19.84
1.000 each 490351 -Sharpie twin tip permanent markers, fine and ultra $25.6900 $25.69
fine black 12 pk
1.000 each 1804211 -Staples loose leaf rings $20.5900 $20.59
2.000 each 459795-Zebra retractable gel pen black $8.8500 $ 17.70
6.000 each 112383-Staples hardboard clipboard $ 1.1900 $7.14
1.000 each 2476235-Stapkes 6"displayPort to HDMI adapter $ 15.3900 $ 15.39
GLAccount#1125413-4230200
Send Invoice To:
$340.12
PLEASE INVOICE IN DUPLICATE
DEPARTMENT I ACCOUNT I PROJECT PROJECT ACCOUNT I AMOUNT
PAYMENT
• 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
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 Courtney Weintraut
• THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. TITLE \\(k),
CLERK-TREASURER A
DOCUMENT CONTROL NO. 52027 VENDOR COPY
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