102210 AQUA FALLS BOTTLED WATER a INDIANA RETAIL TAX EXEMPT Page 1 of 1
Cit o f' Cair]rlrIiel
CERTIFICATE NO.003120155 0020 PURCHASE ORDER NUMBER
JL FEDERAL EXCISE TAX EXEMPT 102210
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
12/5/2018 369028
AQUA FALLS BOTTLED WATER Dept of Community Service
VENDOR PO BOX 98 SHIP 1 Civic Square
TO Carmel, IN 46032-
ENON,OH 45323-
PURCHASE ID BLANKET CONTRACT PAYMENT TERMS FREIGHT
31650
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Department: 1192 Fund: 101 General Fund
Account: 42-302.00
1 Each Keurig monthly lease $120.00 $120.00
Sub Total $120.00
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Send Invoice To:
Dept of Community Service
1 Civic Square
Carmel, IN 46032-
PLEASE INVOICE IN DUPLICATE
DEPARTMENT I ACCOUNT PROJECT I PROJECT ACCOUNT I AMOUNT
PAYMENT $120.00
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.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 722
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. ORDERED BY
Mike Hollibaugh �\
TITLE Director N\
CONTROL NO. 102210 CLERK-TREASURER