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25572 Public Safety Medical Services INDIANA RETAIL TAX EXEMPT PAGE Ci ® I' C�� (�� CERTIFICATE NO.003120155 002 0 of �V 1i PURCHASE ORDER NUMBER FEDERAL EXCISE TAX EXEMPT 25672 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 DURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION 711312012 Public Safety Medical Services Carmel Police Department VENDOR SHIP 3 Civic Oqua>r TO 324.E. New York Street, Suite 300 Carmel, IN 46032 Indianapolis, IN 46204 (317)571 CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION Account 434107.01 1 Each physical for applicant $3,500.00 $3,500.00 1 Each Offier Physicals $3,500.00 $3,500.00 Sub Total: $7,000.00 01 / • . ilirW''\? ....*.....-*".•(:1.1- 100k 'C • ° rir , 1 * i a )0A :1.1 * . * 4. � : , ,1'Ali i k \'!rte © 1:; ��. Send Invoice To: A ----00 Carmel Police Department Attn:Terrsa Anderson 3 Civic Squairo CaIRTtei, IN - PLEASE INVOICE IN DUPLICATE DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT Carmel Police Dept. PAYMENT $7,000.000 • 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 T/IAT THERE IS AN UNOBLIGATED BALANCE IN THIS APPRO ATIpON''SUFFICIENT TO PAY FOR THE ABOVE ORDER. •SHIP REPAID. •C.O.D.SHIPMENTS CANNOT BE ACCEPTED. ORDERED BY / •PURCHASE ORDER NUMBER MUST APPEAR ON ALL SHIPPING LABELS. Chief o1 PoI1CG •THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. 572 CLERK-TREASURER DOCUMENT CONTROL NO. OFFICE COPY