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103063 INDIANA BRICK CO INDIANA RETAIL TAX EXEMPT Page 1 of 1 Cit yof Carmel CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER FEDERAL EXCISE TAX EXEMPT 103063 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 8/13/2019 083080 INDIANA BRICK CO Street Department VENDOR 430 W CARMEL DR SHIP 3400 W. 131st Street TO Carmel, IN 46074- CARMEL, IL 46032- (317)733-2001 PURCHASE ID BLANKET CONTRACT PAYMENT TERMS FREIGHT 38855 QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION Department: 2201 Fund: 2201 Motor Vehicle Highway FND Account: 42-350.00 1 Each Maintenance Supplies $5,925.15 $5,925.15 Sub Total $5,925.15 Ns .7-ZrOF C411.--. Is ill k. ,gyp '' D�e�.+'L--..rw:'' ) may.` Send Invoice To: " Street Department 3400 W. 1:1: ::et t1 ..---1:re,.../. F Carmel, I (317)733-2001 PLEASE INVOICE IN DUPLICATE DEPARTMENT I ACCOUNT PROJECT I PROJECT ACCOUNT I AMOUNT PAYMENT $5,925.15 SHIPPING INSTRUCTIONS *AIP 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 LABE OCi.c.----.... /44—"N--"" 'THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 194 AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. ORDERED BY Dave Huffman James Crider TITLE Director Administration CONTROL NO. 1 03063 CLERK-TREASURER