101956 HOLLYWOODS BUMP & GRIND (2) v INDIANA RETAIL TAX EXEMPT Page 1 of 1'
CityofInritiriie1CERTIFICATE NO.003120155 002 0 PURCHASE FEDERAL EXCISE TAX EXEMPT � 0�956
ONE CIVIC SQUARE 35-6.000972 THIS NUMBER MUST APPEAR ON INVOICES,AIP
' VOUCHER,DELIVERY MEMO,PACKING SLIPS,
CARMEL;INDIANA 46032-2584 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 \0_,\e6a
9/19/2018 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
29407
QUANTITY UNIT OF MEASURE - DESCRIPTION UNIT PRICE EXTENSION-
Department: 1110 Fund: 101 General Fund
Account: 43-510.00 -
1; Each vehicle repairs - $1,059.04 $1,059.04
Sub Total $1,059.04
444 < CA
19
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Send.Invoice To: .... }�.� '
Carmel Police Department . 'car 10-Leach.
Accounts Payable
3 Civic Square
411 r 4t4 -..
)1 Tx.,"
Carmel, IN '46032- >
PLEASE INVOICE IN DUPLICATE .
DEPARTMENT ACCOUNT 1- PROJECT PROJECT ACCOUNT I AMOUNT'
PAYMENT $1,059.04
SHIPPING INSTRUCTIONS AR 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 LABE W
'THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 194 (!trf -
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
ORDERED BY
Jim Barlow
TITLE .Chief
• CONTROL NO. 1 01956 CLERK-TREASURER •