102169 FIRESTONE TIRE & SERVICE CENTER ---- - --- ----- --
o INDIANA RETAIL TAX EXEMPT Page 1 of I
III lt ®f Iariirie1 CERTIFICATE NO.003120155 0020 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 102169
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 00351179
FIRESTONE TIRE&SERVICE CENTER Carmel Police Department
VENDOR PO BOX 403727 SHIP 3 Civic Square
TO Carmel, IN 46032-
ATLANTA,GA 30384--3727 Blaine Mallaber
PURCHASE ID I BLANKET CONTRACT PAYMENT TERMS FREIGHT
31389
QUANTITY —1 UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Department: 1110 Fund: 101 General Fund
Account: 42-320.00
1 Each tires x 12 $1,426.28 $1,426.28
Sub Total $1,426.28
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Carmel Police Department N,
Accounts Payable ��,-
3 Civic Square
Carmel, IN 46032-
PLEASE INVOICE IN DUPLICATE
L_ DEPARTMENT 1 ACCOUNT PROJECT PROJECT ACCOUNT 1 AMOUNT
PAYMENT $1,426.28
SHIPPING INSTRUCTIONS PART
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 –
Jim Barlow
TITLE Chief \1/
CONTROL NO. 102169 CLERK-TREASURER ` Oji_