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26268 Insituform technologies USA LLC o i �r Carmel INDIANA RETAIL AX 0 PAGE /Y y CERTIFICATE NO. O. 003120155 155 00 002 0 PURCHASE ORDER NUMBER FEDERAL EXCISE TAX EXEMPT 35- 60000972 pp..�.. ONE CIVIC SQUARE I THIS NUMBER MUSTAPPEAfT INVOICES. AA. 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 1/6/2012 VENDOR Insituform Technologies USA LLC SHIP Street Department To 3400 W. 131st Street 2130 Stout Field West Drive Carmel, IN 46074 L� CONFIRMATION BLANKET A zal3oIis, IN 46241 PAYMENT TERMS (S' 1 1 I/ WIGHT OUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE I EXTENSION Account 0042 -370.01 1 Each pipe repairs $16,721.25 $16,721.2: Sub Total: $16,721.2 Off f fr rlr milk o 4 ti l r j10 At Send Invoice To: Street Department lJ 3400 W. 131st Street a Carmel, IN 46074- PLEASE INVOICE IN DUPLICATE DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT I AMOUNT PAYMENT c� NP VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O. $1 2: Carmel Street Department NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND VOUCHER HA HE PROPER SWORN AFFIDAVIT ATTACHED, SHIPPING INSTRUCTIONS I HEREBY C IFY THAT THERE IS AN UNOBLIGATED BALANCE IN THIS APPRO'• —1 9NSUF.FICIENT TO PAY FOR THE ABOVE ORDER. SHIP REPAID. •C.O.D. SHIPMENTS CANNOT BE ACCEPTED. PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY 1—... SHIPPING LABELS. l�J'1 1 4 THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. 26268 CLERK TREASURER DOCUMENT CONTROL NO. OFFICE COPY