102364 INNOVATIVE CORP Page 1 of 1
City of Charm/ CERTIFICATE
INDIANA NO.RETAIL003120155TAXEXEMPT 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 102364
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 �V
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION �
12/12/2018 163550 Lockers.1
Sta.43
INNOVATIVE CORP Fire Department
VENDOR 17401 TILLER CT SHIP 2 Civic Square
SUITE H TO Carmel, IN 46032-
WESTFIELD, IN 46074-
PURCHASE ID BLANKET CONTRACT PAYMENT TERMS FREIGHT
32134
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Department: 1120 Fund: 101 General Fund
Account: 43-501.00
1 Each Fabricate and Install 4 Sets of Lockers-Station 43 Per Quote $5,996.00 $5,996.00
Sub Total $5,996.00
tea• 4 e.
a
f
X59. i
I r
Send Invoice To: n,,4 �,x
Fire Department
z,,
2 Civic Square ', .F14k
Carmel, IN 46032-
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
PAYMENT $5,996.00
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 ATCHED. I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
'C.O.D.SHIPMENT CANNOT BE ACCEPTED. THIS APPROPTARIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
'PURCHASE ORDER NUMBER MUST APPEAR ON ALL SHIPPING LABEL , t ,
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 -.... _
ORDERED BY
/G'1
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
Denise Snyder James Crider
TITLE Budget&Accreditation Manager Administration
CONTROL NO. 102364 CLERK-TREASURER