102414 KROGER CO •
0 INDIANA RETAIL TAX EXEMPT Page 1 of 1
LII .City of C.arrriel CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 102414
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
12/14/2018 178002
KROGER CO Dept of Community Service
VENDOR CENTRAL CUSTOMER CHARGES SHIP 1 Civic Square
PO BOX 644467 TO Carmel, IN 46032-
PITTSBURG, PA 15264-4467
PURCHASE ID BLANKET CONTRACT PAYMENT TERMS FREIGHT
32235
QUANTITY UNIT OF.MEASURE DESCRIPTION UNIT PRICE EXTENSION
Department: 1192 Fund: 101 General Fund
Account: 42-390.99
1 Each Misc office needs,committee meetings $681.62 $681.62
Sub Total $681.62
Send Invoice To:
Dept of Community Service ,
1 Civic Square "N 4,5f
Carmel,IN 46032-
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT I PROJECT I PROJECT ACCOUNT AMOUNT
PAYMENT $681.62
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 /� p ,J
*THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 ( 2�7
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. ORDERED BY ^\
Mike Hollibaugh l D \v
TITLE Director \v
CONTROL NO. 102414 CLERK-TREASURER