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26312 Concrete Tailors INDIANA RETAIL TAX EXEMPT PAGE 1 C or • sane/ . . 4,5( F1 ,t G, ; T,FICATE,NO.003120155 002 0 PURCHASE ORDER NUMBER FEDERAL EXCISE TAX EXEMPT 26312 35-60000972 ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES,A/P 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 'URCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION 12/3/2012 Concrete Tailors Street Department VENDOR SHIP 3400 W. 131st Street TO P.O. Box 3 Carmel, IN 46074 Noblesville, IN 46061 (317) 733-2001 CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION Account 0043-509.00 1 Each Driveway Repair $2,425.00 $2,425.00 Sub Total: $2,425.00 . i 0 0 F ©A r,-,3: ii, 1... ,. k ` a ±1:I/ a ' ` , .-' .4 "..,.. , ,,,... .'-, . Send Invoice To: ' Street Department 3400 W. 131st Street Carmel, IN 46074- PLEASE INVOICE IN DUPLICATE DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT Carmel Street Department PAYMENT $2,425.00 • A/P 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 SHIP REPAID. T IS APPROP IAIL• SUFFICIENT TO PAY FOR THE ABOVE ORDER. ••C.O.D.SHIPMENTS CANNOT BE ACCEPTED. IS' , ( / \ '� d 0-----"".• PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY IPA_ �..- 1 SHIPPING LABELS: •THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE 1 � I 'e.,k_( ,, oA?a,iu -- AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. > CLERK-TREASURER DOCUMENT CONTROL NO. 26 312 OFFICE COPY