26327 City of Carmel Street Department 00 INDIANA RETAIL TAX EXEMPT PAGE
1111 of ' arme 'tyli+ttERTIFICATE.NO.003120155 002 0 PURCHASE ORDER NUMBER•
FEDERAL EXCISE TAX EXEMPT 26327
35-60000972
ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES,A/P
CARMEL, INDIANA46032-2584 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
12/19/2012 ` ` "
City of Carmel Street Department Street Department
VENDOR SHIP 3400.W. 131st Street
TO
3400 W. 131st St Carmel, IN 46074
Westfield, IN 46074 (317) 733-2001
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
o-
QUANTITY UNIT OF MEASURE • DESCRIPTION UNIT PRICE EXTENSION
Account 0041-120.03 4 ZOO, cO. 0p
1 Each encumbered overtime $200700 $200-00
Sub Total: $200.00
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Send Invoice To: ',.
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Street Department
3400 W. 131st Street -
Carmel, IN 46074- 41 �Z '
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PLEASE INVOICE IN DUPLICATE., Oct
DEPARTMENT ACCOUNT _,P,ROJECT ,.../�
„ PROJECT ACCOUNT AMOUNT
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Carmel Street Department PAYMENT $200:00
. • 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
THIS APPROPRIATO ' 4FFICENTTO PAY F•RT EABOVEORDER.
•SHIP REPAID. _ iH
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED. , - !
•PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY
SHIPPING LABELS. &;-1. �
•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE id :v ‘ --
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
CLERK-TREASURER
DOCUMENT CONTROL NO. 26327 OFFICE COPY '