52227 INDIANA DEPT. WORKFORCE DEVELOP INDIANA RETAIL TAX EXEMPT PAGE 1
CityCERTCATE N0.0031201550020 PURCHASE ORDER NUMBER
� j� FEDERAL EXCISE TAX EXEMPT
F 52227
35-60000972
OHE CIVIC..SQUARE
CARMEL.ii'17i ..tIA 4€022-2564 THIS UST APPEAR ON INVOICES.NP
VOUCHER.DELIAVERYMEMO,PACKING SUPS.
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
12/7/2018 12/12/18 18358 146500 Unemployment Claims
Indiana Dept.Workforce Develo Administration Office
10 N Senate Ave. SE106 1411 E. 116th Street
VENDOR Indianapolis, IN 46204-2277 TO
Carmel, IN 46032
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE I EXTENSION
$ 1.0000 each Umemployment Claims 2018 20,280.000 $20,280.00
GLAccount#1125101-4110000
Send Invoice To:
$20,280.00
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
PAYMENT
• 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
SHIPPING INSTRUCTIONS AFFIDAVIT ATTACHED.
▪ I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN THIS APPROPRIATION
• SHIP REPAID. SUFFICIENT TO PAY FOR THE ABOVE ORDER.
. C.O.D SHIPMENTS CANNOT BE ACCEPTED.
• PURCHASE ORDER NUMBER MUST APPEAR ON ALL SHIPPING LABELS. ORDERED BY Dawn Koepper
• THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. TITLE
CLERK-TREASURER \,1k
/
DOCUMENT CONTROL NO. 52227 VENDOR COPY