102076 O'MALIA'S FIREPLACE SHOP, INC INDIANA RETAIL TAX EXEMPT Page 1 of 1
IIit37 of Iarrnie1 CERTIFICATE NO.0031201550020 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 102076
ONE CIVIC SQUARE 35-6000972 THIS NUMBER MUST APPEAR ON INVOICES,NP
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
11/7/2018 00351442
O'MALIA'S FIREPLACE SHOP, INC Street Department
VENDOR 115 MEDICAL DR SHIP 3400 W.131st Street
TO Carmel, IN 46074-
CARMEL, IN 46032- (317)733-2001
PURCHASE ID BLANKET CONTRACT PAYMENT TERMS FREIGHT
30792
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Department: 1206 Fund: 101 General Fund
Account: 43-509.00
1 Each Parts for fire pits $10,837.00 $10,837.00
Sub Total $10,837.00
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Send Invoice To: 3vs . � < nk,
Street Department /
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3400 W. 131st Street a
Carmel, IN 46074-
(317)733-2001 PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
PAYMENT $10,837.00
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 ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. ORDERED BY / w Zrll
Dave Huffman James Crider
TITLE Director Administration
CONTROL NO. 102076 CLERK-TREASURER