229503 2/25/2014 CITY OF CARMEL, INDIANA VENDOR: 355628 Page 1 of 1
ONE CIVIC SQUARE HOOSIER HERITAGE PORT AUTHORITYCHECKAMOUNT: $25,850.00
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CARMEL, INDIANA 46032 33 N 9TH ST SUITE 215 NOBLESVILLE IN 46060 CHECK NUMBER: 229503
CHECK DATE: 2/25/2014
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1202 4351501 31681 187 25, 850 . 00 TOB DUES
Invoice - Page 1 of 1
o Invoice
HHPA-Technology Oversight Board
33 North 9th Street DATE INVOICE#
Suite 215 1/21/2014 187
Noblesille,IN 46060
BILL TO SHIP TO
City Of Carmel
Attn: Terry Crockett
Three Civic Square
Carmel, IN 46032
DUE DATE_ -P.O.-NUMBER
I 2/20!2014
ITEM DESCRIPTION QTY RATE AMOUNT
2014 HHPA-TOB Dues 25,850.00
Subtotal 25,850.00
Thank you for your business! Phone 317-776-8268 0% Tax 0.00
Total 25,850.00
INDIANA RETAIL TAX EXEMPT PAGE
Cit ( I' Carmel
CERTIFICATE NO.003120155 002 0� 1i PURCHASE ORDER NUMBER
FEDERALrEXCISE TAX EXEMPT
35-60000972 31681
ONE CIVIC SQUARE S THIS NUMBER MUST APPEAR ON INVOICES,A/P
CARMEL, INDIANA 46032-2584 VOUCHER, DELIVERY MEMO, PACKING SLIPS,
-
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL- 1997 SHIPPING LABELS AND ANY CORRESPONDENCE.
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
2J7120`14 I County Fiber Ring Support
HHPA-Technology Oversight Board Carmel Communications
VENDOR SHIP Terry Crockett
33 North 5th Street, Suite 215 TO 3 Civic Square
Noblesville, IN 46030 Carmel, IN 46032
317 571-2567
CONFIRMATION BLANKET CONTRACT PAYMENTTERMS FREIGHT
QUANTITY --[UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
h
Account 43-515.01
1 Each 2014 HHPA TOB Dues $25,850.00 $25,850.00
Sub Total: $25,850.00
Send Invoice To:
City of Carmel
Terry Crockett
3 Civic Square
Carmel, IN 46032-
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT I PROJECT ACCOUNT AMOUNT
1202 Carmel IS Dept. PAYMENT $25,650.00
• A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O. I
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
• I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
SHIPPING INSTRUCTIONS THIS APPgOPRI ION SUFFICIENTTO PAY FOR THE�OV,E:ORDER.
•SHIP REPAID. � �y�'�
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED. ORDERED BY �
•PURCHASE ORDER NUMBER MUST APPEAR ON ALL
SHIPPING LABELS. Director
•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. w
CLERK-TREASURER
DOCUMENT CONTROL NO. 3 1 6 8 1 A.P.V. COPY-SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER NO.____.__._WARRANT NO.
ALLOWED 20
l IN THE SUM OF$
I
$
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT.# I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except__
20
Signature
..-............................-.... ---- --- ----— —
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Prescribed by State Board of Accounts City Form No.201 (Rev.1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
01/21/14 187 $25,850.00
1 hereby certify that the attached invoice(s), or bill(s), is(are)true and correct and I have audited same in accordance
with IC 5-11-10-1.6
20
Clerk-Treasurer
VOUCHER NO. WARRANT NO.
ALL-OWED 20
HHPA -Technology Oversight Board
�L�„ � IN SUM OF $
33 North 9th Street, Suite 215 '
Noblesville, IN 46060 —
$25,850.00
ON ACCOUNT OF APPROPRIATION FOR
IS Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
31681 I 187 ( 43-515.01 I $25,850.00 1 1 iereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
Friday, February 21, 201.4-
I ector , IS
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund