102116 PYSIO CONTROL CORP INDIANA RETAIL TAX EXEMPT Page 1 of 1
City ofar�j�j JL m� e1 CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 102116
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
,__,. 2M APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL-1997
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
11/16/2018 242000 3G Modem
PHYSIO CONTROL CORP Fire Department
VENDOR 12100 COLLECTIONS CENTER DRIVE SHIP 2 Civic Square
TO Carmel, IN 46032-
CHICAGO, IL 60693-
PURCHASE ID BLANKET CONTRACT PAYMENT TERMS FREIGHT
31055
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Department: 1120 Fund: 102 Ambulance Capital Fund
Account: 44-631.00
12 Each 3G Modem (Verizon)21996-000086 $1,048.35 $12,580.20
1 Each Shipping $185.00 $185.00
Sub Total $12,765.20
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Send Invoice To: a= .. !'"
Fire Department y ^'
s
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2 Civic Square -- M
Carmel, IN 46032- ,° ` . ,•''
PLEASE INVOICE IN DUPLICATE
L DEPARTMENT ACCOUNT 1 PROJECT 1 PROJECT ACCOUNT AMOUNT
PAYMENT $12,765.20
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
PREPAID. AFFIDAVIT ATTACHED. I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
D.SHIPMENT CANNOT BE ACCEPTED. THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.RD� ,,
'PURCHASE ORDER NUMBER MUST APPEAR ON ALL SHIPPING LABEL ..w ,7":„,_- `—e-4`-""
'THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 �\�` ,t.,„,„.,,,,,:„- N."..'` 'k`-""
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
ORDERED BY
Denise Snyder James Crider rA
TITLE Budget&Accreditation Manager Administration \ ,
CONTROL NO. 102116 CLERK-TREASURER