232360 05/07/14 CITY OF CARMEL, INDIANA VENDOR: 00352717
ONE CIVIC SQUARE TSI INC CHECK AMOUNT: $*******691.19*
CARMEL, INDIANA 46032 SDS 12-0764 CHECK NUMBER: 232360
PO BOX 66 CHECK DATE: 05/07/14
MINNEAPOLIS MN 55486-0764
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4350900 24577 90636707 691.19 CLEAN FIT TEST MACHIN
500 Cardigan_Road- _ Tek_(651)483-0900 .—___Page 1 of 1
Shoreview, MN 55126 Fax:(651)481-1220
USA Web:www.TSl.com
E/N_41-0843524 _ __Email.answers@TSLcom_
® DUNS 00-625-3124
Manufacturer of TSI®, Alnor@ and Airflow branded I nyo i ce
R_emitjo If payment'bby—Wire:
Remit=To.M~ �� _ US Bank National Association
TSI Incorporated 225 S. Sixth Street
SDS 12-0764 P.O. BOX 86
Minneapolis, MN 55402
MINNEAPOLIS MN 55486-0764
A.B.A. No. 091000022
SWIFT No. USBKUS441MT
Bill-To-Party Account No. 1-502-5005-9915
CARMEL POLICE DEPT
3 CIVIC SQ Invoice Number 90636707
CARMEL, IN 46032 Invoice Date 04/22/2014
USA Reference Order 486025/04/16/2014
Delivery Note No./Date /04/22/2014
PO No. 24577
Shi -To Pa �- ��--- Customer No. 5112824
--p— --� 6 -- -- ---- - — - CurrencyUSD
CARMEL POLICE DEPT
3 clvlc SQ Term of Payment Net 30 days
CARMEL,IN 46032 Incoterm 2010 CPT: Prepay&Add
USA CONSIGNEES PREMISES
Ship Via UPS GROUND
Bill of Lading 1Z7W697A0361142112
Item Material/Description'-- . _ ..: Quantity. Unit Price Value
1 CL-8030 1 EA 680.00 680.00
Clean and Calibrate Model 8030
Delivery Num:80562384 SN:(8030091708)
Net Total 680.00
Freight 11.19
Invoice Amount 691.19
These commodities, technology or software are controlled under the Export Administration Regulations. If the goods
are exported or reexported, it must be in accordance with the Export Administration Regulations. Diversion contrary
to U.S. law is prohibited.
WE HEREBY CERTIFY THAT THESE GOODS WERE PRODUCED IN COMPLIANCE WITH ALL APPLICABLE REQUIREMENTS OF THE FAIR LABOR STANDARDS ACT,AS AMENDED AND
APPLICABLE RULES,REGULATIONS AND ORDERS OF THE UNITED STATES DEPARTMENT OF LABOR OR OTHER ADMINISTRATIVE AGENCIES ISSUED PURSUANT THERETO.TSI Tenns
and Conditions apply and are incorporated by reference. See http:/lwww.tsi.com/tc.pdf
1
VOUCHER NO. WARRANT NO.
ALLOWED 20
TSI Incorporated
SDS 12-0765 IN SUM OF$
P.O. Box 86
Minneapolis, MN 55486-0764
i
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#!TITLE AMOUNT Board Members
24577 90636707 43-509.00 ��\ 1 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
MAY - 5 2014
l'
y I
Fire Chief
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))
90636707
I 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