26091 Public Safety Medical Services C A INDIANA RETAIL TAX EXEMPT PAGE
ltY ®r Carmel CERTIFICATE NO. 003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 26091
35- 60000972
ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES, A1P
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
3/15/2012
Public Safety Medical Services Cannel Police Department
VENDOR SHIP 3 Civic Square
324 E. New York Street, Suite 300 TO Cannel, IN 48032
Indianapolis, IN 48204 (317) 5712559
CONFIRMATION BLANKET CONTRACT PAYMENTTERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Account 43-407.01
1 Each psych physical for applicant $875.19 $675.19
Sub Total: $875.19
I 107 i
Seth Goldstein f u
end Invoice To: JO
Carmel Police Department
Attn: Teresa Anderson
3 Civic Square
Carmel, IN 48032- PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
Carmel Police Dept. aCZ PAYMENT 8875.19
NP VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P0.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
THIS APPROPRIATION SUF ICIENT TO PAY FOR THE ABOVE ORDER.
SHIP REPAID. 'n1
C.O.D. SHIPMENTS CANNOT BE ACCEPTED B
Y ORDERED w-. el,
PURCHASE ORDER NUMBER MUST APPEAR ON ALL B' 1 �•r
SHIPPING LABELS. Ac�A Chief of Police
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE N.,
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
CLERK TREASURER
DOCUMENT CONTROL NO. 26091 OFFICE COPY