102132 ROGUE FITNESS INDIANA RETAIL TAX EXEMPT Page 1 of 1
City ®f Carmel CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 102132
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
11/2012018 365865 Weight Equipment-All Stations
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
31199
L QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Department: 1120 Fund: 102 Ambulance Capital Fund
Account: 44-670.99
2 Each RA0539-H1805- 1.2 Ohio Bar $312.00 $624.00
Eblack
2 Each IP0004 Kettlebell 26 Lb $35.02 $70.04
2 Each IP0005 Kettlebell 35 Lb $42.23 $84.46
2 Each IP0006 Kettlebell 44 Lb $49.44 $98.88
2 Each IP0007 Kettlebell 53 Lb $57.68 $115.36
2 Each HT0004-10-2 Rogue Hi-Temp Bumper-10 lbs Pair $30.76 $61.52
2 Each HT0004-15-2 Rogue Hi-Temp Bumper-15 lbs Pair $46.67 $93.34
2 Each HT0004-25-2 Rogue Hi-Temp Bumper-25 lbs Pair $74.24 $148.48
2 Each HT0004-35-2 Rogue Hi-Temp Bumper-35 lbs Pair $103.94 $207.88
4 Each HT0004-45-2 Rogue Hi-Temp Bumper-45 lbs Pair $133.64 $534.56
1 Each Shipping ., $107.69 $107.69
Sub Total $2,146.21
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Send Invoice To:
Fire Department
2 Civic Square .,'';-. ,, , —"
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Carmel, IN 46032-
PLEASE INVOICE IN DUPLICATE
1 DEPARTMENT 1 ACCOUNT I PROJECT S PROJECT ACCOUNT A AMOUNT
PAYMENT $2,146.21
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 0.D.SHIPMENT CANNOT BE ACCEPTED. THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
'PURCHASE ORDER NUMBER MUST APPEAR ON ALL SHIPPING LABELw c--
'THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 ~" " ' ''' ' "�
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
ORDERED BY -: .''''"--4,,,,,i,.:',',,,,'_. �
Denise Snyder
TITLE Budget&Accreditation Manager
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CONTROL NO. 102132 CLERK-TREASURER V