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

sffrn{{NoeNr usD #377