26280 Brenntag Mid-South City 'l am./ O ty o f v acme l INDIANA RETAIL TAX EXEMPT PAGE
CERTIFICATE NO. O. 003120155 155 00 002 0
PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT
35- 60000972
ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES, AP
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 2.6.233
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
5!10(2012 SHIP
VENDOR
TO
Brenntag Mid -South Inc Street Department
3400 W 131st Street
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
^.L @.e. Lira 17 7 C -2001
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Justin Latta
Account 0043-604.00 !ry
1 Each Reflecting pool chemicals (/�f AVAI $27,503.54 $27,503.54
Sub Total: $27,503.54
ii
Send Invoice To: �1Si f� ff 1
Street Department PLEASE INVOICE IN DUPLICATE
DEPAiiiUEfh 131 arreei ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
Carmel, IN 46074- PAYMENT
NP VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER H E PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS 1 HEREBY C: R T THERE IS AN UNOBLIGATED BALANCE IN
§'7a'r I Department THIS APPR 1 FFICIENT TO
I P 5OR THE ABOV$y 3.54
M M 'j
C.O.D. SHIPMENTS CANNOT BE ACCEPTED. ORDERED BY h
PURCHASE ORDER NUMBER MUST APPEAR ON ALL ^bL
SHIPPING IPPING LABELS.
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE i
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
DOCUMENT CONTROL NO. 26280 CLERK-TREASURER
COPY