238966 11/05/14 1y W.C4gyf
%�� �• CITY OF CARMEL, INDIANA VENDOR: 00350650
ONE CIVIC SQUARE WILLIAMS COMFORT AIR INC CHECK AMOUNT: $********94.00*
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CARMEL, INDIANA 46032 1077 3RD AVE,S.W. CHECK NUMBER: 238966
°M,��oN-fib. CARMEL IN 46032 CHECK DATE: 11/05/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 94.00 OTHER EXPENSES
Williams Comfort Air YOUR SERVICE ORDER # , P/j
Q
Shelby
'� Shelby Air DATE/ / ATrN SUPERVISOR
1077 3rd Avenue SW, Carmel, IN 46032 TECH NUMBER
air conditioning"& 317-452-4543•Fax:317-848-8744
servic6@WilliamsComfortAir.com TECH NAME
HVAC License#: H0002400 a
heaUn "LoA N lambing&more 877-599-HEAT(4328) INVOICE NUMBER 30- 3 9 9
9 9 p /o rIJ
/ EQUIPMENT IDENTIFICATION CONDITION 1-5 (5 BEST) INTERNAL USE ONLY
Customer Name: 0 dA-Ir 1."'A
u � t lModel ---- –
Job Location: � 2 b..�
City: '�i — State:_Zip:
� �0 AFI Call Note: I"`
HMI/C#: 5 I HMI/C#: AC
HP
Email: Source Qty. Materials Used
Evap y
Payee: 2
Therm
Address: 3
City: State:—Zip: / 4
Hum
HMNC#: HM1/C#:
a"tdjed ❑Elect 5
Small: Filter x�� x ❑Pur
6 .
Code Qt Status Description Total $
CAIRfree Savings Agreement:
j ,r at t t,,t r This program has been explained.
❑ Current participant Exp.
❑ Decline participation
Customer's Initials
Why participate in our CAIRfree .
maintenance program? You will receive a
discount on our standard pricing for all repair
services as well as equipment discounts and
I have received a detailed proposal via the preferred
SUMMARY OF FINDINGS. initials
PAYMENT/AC�jEPTANCE OF WORK PERFORMED - $ jPA assurance that all manufacturer and WilliamsComfort Air/Shelby Air warranties will remain
valid for the duration of the warranty period.
❑ CREDIT CARD fi CASH ❑ CHECK ❑ GIFT CARD
TODAY'S PAYMENT I have
$ � $ $ discussed the
CAIRfree
Agreement with the customerhave gagvena
Authorization Code ttII Check Number REMAINING BALANCE $ copy of this invoice to the customer. I have
Signature �d �4 fr` Date/ �/ satisfactorily done all work detailed in the
Your CAIRfree SAVINGS Today proposal in compliance with Williams Comfort
My signature above acknowledges that all work has been satisfactorily completed.I agree to the _- __ __ _...__ __ ____ Air standards of excellence in workmanship
total charges that are now due and the payment method.Williams Comfort Air(WCA)retains ownership of all material listed until payment is made in full.Terms include 1.5%monthly service charge and in compliance with applicable building
if not paid in 30 days.If this invoice is not paid within 30 days,a lien against my property may be pursued and I will be responsible for practical attorney fees,collection costs and interest.WCA is codes.
not responsible for insured losses.Customer agrees that WCA may scan,fax,email,image or otherwise convert this document into an electronic format of any type or form,now known or developed Technician's Signa(ure
in the future,and any unaltered or unadulterated copy of this document produced from such electronic format will be legally binding upon all the parties and equivalent to the original for all purposes.
CUSTOMER COPY
Prescribed by State Board of Accounts
Form No.301-S(Rev.1997) ACCOUNTS PAYABLE VOUCHER
TO
ADDRESS
Invoice Date Invoice Number Item Amount
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
Mo. Day Yr. Signature Title
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.
/1 w/,,
Mo. Day Yr. Officer Title
Voucher No. Warrant No.
ACCOUNTS PAYABLE DETAILED ACCOUNTS
MUNICIPAL WASTEWATER UTILITY ANOT.
CARMEL, INDIANA
Favor Of
10`7-7 v s w
C �Pme ( TN
Total Amount of Voucher $
Deductions
Amount of Warrant $ 00
Month of Yr
VOUCHER RECORD Acct.No.
Collection System
Pumping
Treatment&Disposal
Customer Accounts
Administrative&General
Reclaimed Water Treatment
Reclaimed Water Distribution
Total
Allowed
Board Members
Filed
BOYCE FORMS•SYSTEMS 1-800-382-8702 325