29291 Carmel Clay Schools (2) PAGE
INDIANA City 0 Carmel. CERTIFICATE NO.003120155 5 0 2 0
�1 f �!!lk✓E Sys PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 29291
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
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
12/18/12 N/A 04{25% Equip
.T 1.
Carmel Clay Schools Maint DEC 1 8 2012
I
VENDOR
520 / E• /14 .�Q .A SHIP
TO _ ._e+OVInd JAL 46032 _
,
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION I UNIT PRICE l EXTENSION
1 EA Diesel Fuel $200.00 $200.00
1 EA Gasoline Fuel $1,200.00 $1,200.00
.
Send Invoice To
p0 0.
0) PLEASE INVOICE IN DUPLICATE $1,400.00
DE ARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
1125-4-01-4231300/423140Q-Diesel/Gasoline PAYMENT
• 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 SWORD AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS • I HEREBY CERTIFY THAT THERE IS/N UNDBLIGATED BALANCE IN
THIS APPROPRIATION SUFFICIENT TD PAY FOR THE ABOVE ORDER.
•SHIP REPAID.
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED. Michael Klitzin - DK •J
•PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY g �� T\Q ` (Z 1(�I Z
SHIPPING ORDER ISSUED i ! 4 y nt L
•THIS ORDER ISSUED IIJ COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE !,
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. / Pr-
29291 CLERK-TREASURER
DOCUMENT CONTROL NO. VENDOR COPY