52142 ENVIRONMENTAL LABORATORIES INDIANA RETAIL TAX EXEMPT PAGE 1
CERTIFICATE NO.003120155 002 0
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FEDERAL EXCISE TAX EXEMPT PURCHASE ORDER NUMBER52142
35-60000972
OlIE CMC SQUARE
CARMEL.ill-DIANA 4.n32-2SSTHIS NUMBER MUST APPEAR ON INVOICES,A/P
VOUCHER,DELIVERY MEMO,PACKING SLIPS,
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL-1997 SHIPPING LABELS AND ANY CORRESPONDENCE.
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
11/9/2018 11/13/18 18134 355990 Water samples @ West Commons Well
Environmental Laboratories Inc Parks Maintenance
P.O. Box 968 1427 E. 116th Street ATTN: Courtney
VENDOR Madison, IN 47250 SHIP Carmel, IN 46032
TO
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE I EXTENSION
1.000 each IOC Cyanide $50.0000 $50.00
1.000 each IOC Fluoride $ 15.0000 $ 15.00
1.000 each IOC metals $ 180.0000 $180.00
1.000 each SOC $ 1,450.0000 $ 1,450.00
1.000 each Nitrate $ 15.0000 $ 15.00
GLAccount#1125404-4350400
Send Invoice To:
$ 1,710.00
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 Michael Allen
• THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
TITLE
CLERK-TREASURER C\
DOCUMENT CONTROL NO. 52142 VENDOR COPY \�\