26317 Smock Fansler Corporation •
INDIANA RETAIL TAX EXEMPT PAGE
®� Cat e '*1 F.•, ERTIFIC,I�TE NO 003120155 002 0 PURCHASE ORDER NUMBER
w ty �a 111111
• FEDERAL EXCISE TAX EXEMPT 26317
e,4,•, 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
'URCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
12/13/2012
Smock Fansler Corporation Street Department
VENDOR SHIP 3400 W. 131st Street
TO
2910 W. Minnesota Street Carmel, IN 46074
Indianapolis, IN 46241-4541 (317) 733-2001
CONFIRMATION J04f34VeeONTRACT ' _. PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE I DESCRIPTION UNIT PRICE EXTENSION
Account 0042-390.34
1 Each 106th /Gray Roundabout Insurance . $20,115.00 $20,115.00
Sub Total: $20,115.00
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Send Invoice To: `' H
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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 $20,115.00
• NP VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
•
NUMBER IS DE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER JI�THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS • I HEREBY C..;;TIFY T-A THERE IS AN UNOBLIGATED BALANCE IN
THIS APP-o j•;':.+o,SUFFICIENT TO-AY FOR THE ABOVE ORDER.
•SHIP REPAID.
- - _
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED. Or ' '". ' / .
•PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY
SHIPPING LABELS. ,/{ .~ ..— .
•
•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE. ///J�/��Ij
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. . .
•
CLERK TREASURER .
DOCUMENT CONTROL NO. OFFICE COPY