26319 Ritz Safety l 4:
p ,I. INDIANA,RETAILTAX EXEMPT PAGE
IL l ®i 'C amine�'! � . .+♦ 'I{CERTIFICATE'NO.,003120155 002 0
Y PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 26319
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
12/14/2012
Ritz Safety Street Department
VENDOR SHIP 3400 W. 131st Street
TO
P.O. Box 713139 Carmel, IN 46074
Cincinnati, OH 45271-3139 (317) 733-2001
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Account 0043-560.01
1 Each safety coats $2,932.20 $2,932.20
Sub Total: $2,932.20
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Send Invoice To:
C) [M CO-5
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Street Department
3400 W. 131st Street
Carmel, IN 46074-
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
Carmel Street Department PAYMENT $2,932.20
• 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
THIS APPROPRIATIOf�SUFFICIENT T PAY FOR THE ABOVE ORDER.
•SHIP REPAID. r /�1+ //�� �// (,, //
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED. ORDERED BYE" I `/r,(I .a, r( �. �'-"�"'" -
•PURCHASE ORDER NUMBER MUST APPEAR ON ALL l/
SHIPPING ORDER R ISSU. pn i�f( v ^, c•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE 'IKI� (lJ� a..4-04--
yyy
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. - /J
CLERK-TREASURER U
DOCUMENT CONTROL NO. 26319 OFFICE COPY