102129 ROGUE FITNESS INDIANA RETAIL TAX EXEMPT Page 1 of 1
City of Carniel CERTIFICATE NO.0031201550020 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 102129
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
11/1912018 365865
ROGUE FITNESS Fire Department
VENDOR 545 E 5TH AVENUE SHIP 2 Civic Square
TO Carmel, IN 46032-
COLUMBUS, OH 43201 -
PURCHASE ID ( BLANKET CONTRACT PAYMENT TERMS FREIGHT
31177
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
L
Department: 1120 Fund: 102 Ambulance Capital Fund
Account: 44-670.99
2 Each AB0004 Abmat Pro $25.00 $50.00
12 Each AD0133 Rogue Basic Yoga Mat $10.00 $120.00
1 Each A00005 Rope Gone Wild with Bulldog Jacket $249.95 $249.95
1 Each Shipping $45.66 $45.66
4 Each SR-3 Bushing Speed Rope,AD0075 $14.96 $59.84
1 Each RA0501 V2 Gun Rack with Plastic $93.58 $93.58
Sub Total $619.03
�'
Send Invoice To: ,. , , :.„ ," e1
Fire Department
2 Civic Square
Carmel, IN 46032-
PLEASE INVOICE IN DUPLICATE
DEPARTMENT I ACCOUNT PROJECT I PROJECT ACCOUNT I AMOUNT
PAYMENT $619.03
SHIPPING INSTRUCTIONS '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
'SHIP PREPAID. AFFIDAVIT ATTACHED. I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
*C.0 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 "'~'"`.-'''"''' . -`"' �`"` -
it
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
ORDERED BY
Denise Snyder
TITLE Budget&Accreditation Managerlkg ‘
CONTROL NO. 102129 CLERK-TREASURER