102220 HOLLYWOOD BUMP & GRIND INDIANA RETAIL TAX EXEMPTPage 1 of 1
City
of IInr]r]r]Ie1
CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 1 02220
ONE CIVIC SQUARE 35-6000972 THIS NUMBER MUST APPEAR ON INVOICES,ARCARMEL,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
1214/2018 372102
HOLLYWOODS BUMP&GRIND Carmel Police Department
VENDOR 10550 JESSUP BLVD SHIP 3 CivicSqua
TO Carmel, IN 46re
032-
INDIANAPOLIS, IN 46280- Blaine Mallaber
PURCHASE ID BLANKET CONTRACT PAYMENT TERMS FREIGHT
31578
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Department: 1110 Fund: 101 General Fund '
Account: 43-510.00
1 Each vehicle repairs $1,440.40 $1,440.40
Sub Total $1,440.40
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Send Invoice To: \'''::1,7;:''''''''''''
s. ` ''''''"''''''''4:4'""--- ... . .. _
Carmel Police Department Car 34 White L
Accounts Payable 7.x '
3 Civic Square r
Carmel, IN 46032- z '''
PLEASE INVOICE
DEPARTMENT I ACCOUNT
PAYMENT PROJECT INDUPLICATE
I
PROJECT ACCOUNT AMOUNT
$1,440.40
SHIPPING INSTRUCTIONS
*
AI
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 ATCHED. I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
'C.O.D.SHIPMENT CANNOT BE ACCEPTED. THIS APPROPRIATIONTASUFFICIENT 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
ORDERED BY
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. \±
Jim Barlow
TITLE Chief \ -
CONTROL NO. 102220 CLERK-TREASURER