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103003 BOUND TREE MEDICAL LLC o INDIANA RETAIL TAX EXEMPT Page 1 of 1 1III it ®f Carmel CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER FEDERAL EXCISE TAX EXEMPT 103003 ONE CIVIC SQUARE 35-6000972 THIS NUMBER MUST APPEAR ON INVOICES,AIP CARMEL, INDIANA 46032-2584 VOUCHER DELIVERY MEMO,PACKING SLIPS, SHIPPING LABELS AND ANY CORRESPONDENCE - RM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL-1997 PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION 7116/2019 00352626 EMS Supplies BOUND TREE MEDICAL LLC Fire Department VENDOR 23537 NETWORK PLACE SHIP 2 Civic Square TO Carmel, IN 46032- CHICAGO, IL 60673--1235 PURCHASE ID BLANKET CONTRACT PAYMENT TERMS FREIGHT 38020 QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION Department: 1120 Fund: 102 Ambulance Capital Fund Account: 42-390.11 10 Each 177268 Smart Capnoline Plus Non Intubated Oral Nasal w/02 $935I00 $9,350.00 Tubing-100 Box Sub Total $9,350.00 I f / 1. 4 r Send Invoice To: 3 - Fire Department /4. 2 Civic Square Carmel, IN 46032- ., � , PLEASE INVOICE IN DUPLICATE C_ - DEPARTMENT I ACCOUNT I PROJECT PROJECT ACCOUNT I AMOUNT PAYMENT $9,350.00 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 ATTACHED. I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN ',D.SHIPMENT CANNOT BE ACCEPTED. THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER. _';CHASE ORDER NUMBER MUST APPEAR ON ALL SHIPPING LABEL 'THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 �L`--ti�e/ri1 AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. ORDERED BY Denise Snyder James Crider TITLE Accreditation Budget Administrator Administration \ CONTROL NO. 1 03003 CLERK-TREASURER " \ ` I