26567 Gerg-Ottenweller Contracting LLC 'INDIANA RETAIL TAX EXEMPT PAGE
City ®f C alr ei CERTIFICATE NO.003120155 002 0
ul PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 2/ D c
35-60000972 lU J
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
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VENDOR '� SHIP '� C
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CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
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Send Invoice To: l 00
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PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
. , ; PAYMENT
i-r • 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 TI�IAT/THERE IS AN UNOBLIGATED BALANCE IN
THIS APPROPRIATION4UFFIGIENTTO PAY FOR THE A:OVE ORDER.
•SHIP REPAID.
/.
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED.
•PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY
SHIPPING LABELS. / /•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
CLERK-TREASURER
DOCUMENT CONTROL NO. 26567 OFFICE COPY