53418 ENVIRONMENTAL LABORATORIES INC INDIANA RETAIL TAX EXEMPT PAGE 1
City of C armel CERTIFICATE N0.003120155 002 0
PURCHASE ORDER NUMBER FEDERAL EXCISE TAX EXEMPT 53418
35-60000972
ONE CIVIC SQUARE
CARMEL,INDIANA 46032-2584 THIS NUMBER MUST APPEAR ON INVOICES,AR
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
8/14/2019 08/14/19 21100 355990 Additional Testing for Flowing Well Water Issues
Environmental Laboratories Inc Parks Maintenance
P.O. Box 968 1427 E. 116th Street ATTN: Courtney
VENDOR Madison, IN 47250 SHIP Carmel, IN 46032
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
4.000 each Water testing Samples 8/7/19 $10.500 $42.00
4.000 each Water testing Samples 8/8/19 $10.500 $42.00
5.000 each Water testing Samples 8/9/19 $10.500 $52.50
1.000 each Weekend fee for 8/9/19 Water Test Sample $75.000 $75.00
4.000 each Water testing Samples 8/11/19 $ 10.500 $42.00
1.000 each Weekend fee for 8/11/19 Water Test Sample $75.000 $75.00
GLAccount#1125407-4350900
Send Invoice To:
$328.50
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
PAYMENT
• 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
SHIPPING INSTRUCTIONS AFFIDAVIT ATTACHED.
• I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN THIS APPROPRIATION
• SHIP REPAID. SUFFICIENT TO PAY FOR THE ABOVE ORDER.
▪ C.O.D SHIPMENTS CANNOT BE ACCEPTED.
• PURCHASE ORDER NUMBER MUST APPEAR ON ALL SHIPPING LABELS. ORDERED BY Courtney Weintraut
• THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. TITLE
CLERK-TREASURER
DOCUMENT CONTROL NO. 53418 VENDOR COPY v\ ` "