27398 Keller Rivest C i ty ff C arme J IRTIFICA REN TAX 0 PAGE
N 1 11 1 1 11 E CERTIFICATE NO. O. 003120155 155 00 002 0
PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT
35- 60000972
ONE CIVIC SQUARE THIS NUMBER MQ/Se:EAR ON INVOICES. NP
r. CARMEL, INDIANA 46032_2564 t'' VOUCHER, DELIVERY MEMO, PACKING SLIPS,
SHIPPING LABELS AND ANY CORRESPONDENCE.
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL -',1997
i
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO VENDOR NO. DESCRIPTION
r
11/912011
it
VENDOR Keller RiveSt SHIP Street Department
To 3400 W. 131st Street ;x
6935 Brookville Road Carmel, IN 46074 iF
GONHRNATION BLANKEv 1j f R IN 46239 PAYMENT TERMS (317) 733.2001 FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Account 0042-370.00 2008 19() *wgS 0D
zt 1 Each pump repairs 'Se° $C2?e.A
Sub Total': $230
011
r
1 'V /4+
I
i :us sal j
0
Se Invoice To: p
4
Street Department
3400 W. 131st Street
Carmel. IN 46074- PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
C PAYMENT .4 Oq e, Qu
Street
y NP VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE PO. nn nr�
Carmel S Department C C NUMBER IS MADE ADEAPARTOFTHEVOUCHERANDEVERYINVOICEAN. 3
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE ISANUNOBLIGATED BALANCE IN
THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
SHIP REPAID.
,CO.D. SHIPMENTS CANNOT BE ACCEPTED. ORDERED BY it 1 1 1 g AI 'i. 0
PURCHASE ORDER NUMBER MUST APPEAR ON ALL
SHIPPING LABELS.
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE i Li- ,s_ I -j
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. I 1
DOCUMENT CONTROL NO. 27398
CLERK-TREASURER v
OFFICE COPY