102167 HOLLYWOODS BUMO & GRIND INDIANA RETAIL TAX EXEMPT Page 1 of 1
Chitof Iiarinnie1 CERTIFICATE NO.0031201550020 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 102167
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
11/29/2018 372102
HOLLYWOODS BUMP&GRIND Carmel Police Department
VENDOR 10550 JESSUP BLVD SHIP 3 Civic Square
TO Carmel, IN 46032-
INDIANAPOLIS, IN 46280- Blaine Mallaber
PURCHASE I 1 BLANKET CONTRACT PAYMENT TERMS FREIGHT
31379
QUANTITY_J UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Department: 1110 Fund: 101 General Fund
Account: 43-510.00
1 Each vehicle repairs $1,322.49 $1,322.49
Sub Total $1,322.49
$ RR
Send Invoice To: ^ x f 2 w o „' ,,„
Carmel Police Department
Accounts Payable
3 Civic Square ''` / -
Carmel, IN 46032-
PLEASE INVOICE IN DUPLICATE
rL
DEPARTMENT [ ACCOUNT 1 PROJECT 1 PROJECT ACCOUNT AMOUNT
PAYMENT $1,322.49
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.O.D.SHIPMENT CANNOT BE ACCEPTED. THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
'PURCHASE ORDER NUMBER MUST APPEAR ON ALL SHIPPING LABEL A \
'THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945ti J`•' —
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. ORDERED BY
Jim Barlow /�/
TITLE Chief \-v <).\
CONTROL NO. 102167 CLERK-TREASURER