52106 PAVEMADE LLC INDIANA RETAIL TAX EXEMPT PAGE 1 •
CERTIFICATE N0.003120155 002 0
I C PURCHASE ORDER NUMBER
of C 111. FEDERAL EXCISE TAX EXEMPT 52106
'City 35-60000972
OWE CMC SQUARE
CARMEL.INDIANA 4SC32-2ES4 THIS NUMBER MUST APPEAR ON INVOICES,A/P
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.r DESCRIPTION
11/1/2018 10/14/18 17878 -iaaf� Park Maintenance Asphalt Equipment and Supplies
Pavemade LLC IV Parks Maintenance
106 1/2 Judge John Aiso Street#302 1427 E. 116th Street ATTN: Courtney
VENDOR Los Angeles, CA 90012 SHIP Carmel, IN 46032
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE I EXTENSION
1.000 each HotBox 10 gallon portable asphalt crack melter/applicator $985.0000 $985.00
system with torch
12.000 each Crack Fill Blocks $66.3333 $796.00
1.000 each 5% Government Discount $-89.0500 $-89.05
GLAccount#1125401-4238000
Sc. ANNED•
NOV -2 2018
Send Invoice To:
$ 1,691.95
PLEASE INVOICE IN DUPLICATE
DEPARTMENT 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 Neil Whitehead
• THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. TITLE
CLERK-TREASURER
DOCUMENT CONTROL NO. 52106 VENDOR COPY \\