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25506 BGI Fitness I'® C�� INDIANA RETAIL TAX EXEMPT PAGE (� CERTIFICATE NO.003120155 002 0 City 1i \1.iJL PURCHASE ORDER NUMBER FEDERAL EXCISE TAX EXEMPT - - - 35-60000972 ..It; 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 10/1712012 BSI Fltnoss ' Como) Pollco Dopartmont VENDOR Carporition Drlvo SHIP 3 Civic Squaro TO Connol, IN 46032 Indianapolis, IN 46266 (317)571255 CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION Account 420.00 -_ 4 Each Continental Town &CountryTire $32.00 $128.00 1 Each HD replacement Rear Wheel $180.00 $180.00 - 1 Each Sram Chain _ - - _ $20.80 $20.80 10 Each Shimano VBrake Pad Set l'. $12.80 $128.00 1 Each Park Poiyluhe Grease #r�.....°}}�` •°© /� ./'°� $8.00 $8.00 1 Each TrIFlovo Chain Luba - 12oz . "°° </° -P $20.80 $20.80 1 Each shipping charges r %•.' °•.t $26.55 $28.85 r' a° F a Sub Total: $512.15 * i "A A .4 : * 1 ._ kw AL ;i L. . • 4 s , Now•.- •.. li ' -\,00 ,e% ,?.......•••,,..-.0 0440 i M -441 joy Send Invoice To: CATMOI Pallce Dopatmont Attn: Teresa Anderson 3 Civic 0quan Cammol, IN 46032= PLEASE INVOICE IN DUPLICATE DEPARTMENT • ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT Cannel Police Dept. C:47- PAYMENT $512.15 • NP VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O. 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.SGFFICIENT 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. F� •THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE ��aa b d of f Police AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. 2.5506 CLERK-TREASURER- -/ DOCUMENT CONTROL NO. OFFICE COPY I. sx T. . +• . ' • 4. rt ao •k 1 r 1 .. • • { .. .. �(' x'11 Y a