102226 FIRESTONE TIRE & SERVICE CENTER INDIANA RETAIL TAX EXEMPT Page 1 of 1
City o f Iiirinnie1 CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 102226
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 00351179
FIRESTONE TIRE&SERVICE CENTER Dept of Community Service
VENDOR PO BOX 403727 SHIP 1 Civic Square
TO Carmel, IN 46032-
ATLANTA,GA 30384--3727
PURCHASE ID BLANKET CONTRACT PAYMENT TERMS FREIGHT
31689
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Department: 1192 Fund: 101 General Fund
Account: 42-320.00
1 Each Misc.auto repairs $2,067.53 $2,067.53
Sub Total $2,067.53
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,04 X31
Send Invoice To: ..
Dept of Community Service \./
1 Civic Square
Carmel, IN 46032- » n
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
PAYMENT $2,067.53
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 l/
4;:
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. ORDERED BY . I )
Mike Hollibaugh
TITLE Director
CONTROL NO. 102226 CLERK-TREASURER \'V