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TRANSCRIPT
PURCHASE ORDER
and
CLAIM VOUCHER
ATCHISON COUNTY COMMUNITY SCHOOLSUNIFIED SCHOOL DISTRICT # 377
306 Main Street P.O. Box 289
Effingham, KS 66023-0289
913-833-5050 Fax 913-833-5210
No. 028920
Show this Purchase Order No.on lnvoice and on outside ofeach Package and Carton
verrroon: l-- KIRBERT ROOFING COMPANY
1035 CHEYENNE AVE
KANSAS CITY, KS 66105
L-UNIFIEDP.O. Box
TSCHOOL DISTRICT # 377289
DELIVERTO: l-- Attn: Dan coder
BILLTO:, KS 66023-0289
PAID BY WARRANT:NO. DATE:
DATE ISSUED:-'03/L3/20t5 DELTVERY BtrE, /20t5
LABOR FOR GYMNASIUM ROOFREPLACEMENT AS PER BIDLABOR TO INSTALL FASCIA GYNMASIUMROOF AS PER BID
AccounL Distribution04-4700-400-000 Outside Contract
Distri
in compliance with K.S.A. 44-1030-44-1033
l-04750.0.000
4900.0000.000
S
ution Tot
0.004, 900.00
0.00
l-09,550.0109,650.00
1. Submit two copies of your itemized invoice to this oflice.2. lnvoice ol the correct amount due, must reach our business oflice not later than the
25th day of the month to receive payment in the following month.3. Federal Excise Tax exemption certificates will be lurnished on request.4. Each shipment must be covered by separate invoice.5. lf shipment cannot be made as requested, notity us at once.6. All transportation charges, if any, are prepaid and added to the invoice.7. Show person's name to whom package is being delivered, on each package and carton.8. Show purchase order number on each package and carton.
FEDERAL TAX ID NO. 48-0720066
money available in the within named fund and lorI hereby certify that within itemized account is true and correct, and remainsdue and unpaid in the amount shown hereon.
ADI\4II'IISTRATOB
otrE-@No
FUNDSCC IJC.LOW
QUANTITYAND UNIT
CATALOGNUMBER DESCRIPTION UNIT COST
TOTALESTIMATED COST
TOTALACTUAL COST
L01l_
Federal Excise Tar
TransportationCharoes if Added
TOTAL
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