26090 Public Safety Medical Services CiCity INDIANA RETAIL TAX EXEMPT PAGE
f o f it e 1 CERTIFICATE No. 0031201550020
s. y �a PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 26090
35- 60000972
ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES. NP
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
3/1312012
Public Safety Medical Services Cannel Police Department
VENDOR SHIP 3 Civic Square
324 E. New York Street, Suite 300 T O Carmel, IN 46032
Indianapolis, IN 48204 (317) 5712559
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION I UNIT PRICE I EXTENSION
Account 43-407.01
1 Each psych physical for applicant $675.19 $675.19
Sub Total: $875.19
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Juan Navarreto Q
Send Invoice To: e (l�
Cannel Police Department
Attn: Teresa Anderson
3 Civic Square
Carmel, IN 48032- PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT I AMOUNT
Carmel Police Dept. PAYMENT $875.19
AJP VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER 15 MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS 1 HEREBY CERTIFY THAT THERE 15 AN UNOBLIGATED BALANCE IN
HIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
SHIP REPAID.
C.O.D. SHIPMENTS CANNOT BE ACCEPTED.
PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY
SHIPPING LABELS. C hief of Police
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
DOCUMENT CONTROL NO. 26090 CLERK TREASURER
OFFICE COPY