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31457 Public Safety Medical Services CO� c Carmel INDIANA RETAIL TAX015500 PAGE 1n1 111r I'1/ CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER FEDERAL EXCISE TAX EXEMPT 31457 ' 35-60000972 ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES,NP 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 1/2212014 Public Safety Medical Services Cannel Police Department VENDOR SHIP 3 Civic Square 324 E. New York Street, Suite 300 TO Cannel, IN 48032 Indianapolis, IN 48204 (317)571-2574 CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT QUANTITY UNIT OF MEASURE DESCRIPTION - UNIT PRICE EXTENSION Account 43-419.99 1 Each physical for applicant $875.19 $875.19 • 1 Each psychological evaluation $370.13 $370.13 Sub Total: $1,045.32 07 4 f. Officer Brian Roemke �Q ©©j Send Invoice To: • `( Cannel Police Department Attn: Pat Young 3 Civic Square Cannel, IN 48032- PLEASE INVOICE IN DUPLICATE DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT Carmel Police Dept. ?sLl PAYMENT $1,045.32 • 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 THE IS AN UNOBLIGATED BALANCE IN THIS APPROPRIATIONS F I ENT 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. ef of Police •THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE .AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. CLERK-TREASURER DOCUMENT CONTROL NO. 31457 OFFICE COPY