103079 DON HINDS FORD INDIANA RETAIL TAX EXEMPT Page 1 of 1
:ii:City of Carmel CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 103079
ONE CIVIC SQUARE 35-6000972 THIS NUMBER MUST APPEAR ON INVOICES,A/P
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
8/22/2019 00352042
DON HINDS FORD Carmel Police Department
VENDOR 12610 FORD DRIVE SHIP 3 Civic Square
TO Carmel, IN 46032-
FISHERS, IN 46038- Blaine Mallaber
PURCHASE ID BLANKET CONTRACT PAYMENT TERMS FREIGHT
39138
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Department: 1110 Fund: 101 General Fund
Account: 42-370.00
1 Each steering gear $682.71 $682.71
Sub Total $682.71
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Send Invoice To: . , °% °:y`'
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Carmel Police Department 'Car 76
Accounts Payable
3 Civic Square
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Carmel, IN 46032-
PLEASE INVOICE IN DUPLICATE
DEPARTMENT a ACCOUNT 1 PROJECT PROJECT ACCOUNT AMOUNT
PAYMENT $682.71
SHIPPING INSTRUCTIONS *A/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
*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
*THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 194
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. ORDERED BY
Jim Barlow
TITLE Chief
CONTROL NO. 1 03079 CLERK-TREASURER OIC:-.)