25461 Child Source CCA INDIANA RETAIL TAX EXEMPT PAGE
litY O C.arme 1 CERTIFICATE NO 003120155 002 0
Of \ 1 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT
-� 35-60000972 25461
ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES,NP
CARMEL, INDIANA 46032-2584 VOUCHER, DELIVERY MEMO, PACKING SUPS,
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
111512013 . _
Child Source -- . _ Cannel Police Department
vENboRWestem Reserve Distributing, Inc. SHIP 3 Civic Square
" P.0,. Box 73714 Cannel, IN 46032
Cleveland, OH 44193 (317)571.2559
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS / FREIGHT
j - \ ,
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Account 00-590.05
/
•1 Each shipping $147.94 $147.94
2 Each High Back Booster Front Adj 93-209FSM $47.20 $94.40
4 Each Than 5 Carseat 7Ojul : $57.75 $231.00
4 Each Backless Shieldless Booster ( 931' , $14.90 $59.80
8 Each Chase No Harness Booster 1,n'" 119& /1 $26.95 $161.70
2 Each On Board35 Infant Car Se" A4.••'f6088FSM'"-,,.••, $77.40 $154.80
OT C 0; a Sub Total: $849.44 vo.
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Send In oice To:
of l .
Cannel Police Department
Attn: Teresa Anderson
3 Civic Square
Cannel, IN 46032- PLEASE INVOICE IN DUPLICATE
/
DEPARTMENT i ACCOUNT 1 PROJECT PROJECT ACCOUNT AMOUNT
Cannel Police Dept. cr PAYMENT $349.44
• NP VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE PO.
1 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 APPROP•I'TION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
•SHIP REPAID.
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED.
a
• PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY
f.
SHIPPING LABELS.
•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 , TITLE
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
2.5 4 S 1 CLERK-TREASURER''
DOCUMENT CONTROL NO .1 N OFFICE COPY -.
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