HomeMy WebLinkAbout239634 11/25/2014 CITY OF CARMEL, INDIANA VENDOR: 367794
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ONE CIVIC SQUARE TAKEFORM CHECK AMOUNT: $********28.38*
s ,a? CARMEL, INDIANA 46032 11601 MAPLE RIDGE ROAD CHECK NUMBER: 239634
MEDINA NY 14103 CHECK DATE: 11/25/14
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DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1091 4239099 42090 28.38 OTHER MISCELLANOUS
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�� �•� ; � Invoke# �42090
11601Maple.RidgeRoad Invotce'Date .'.'10/29/14
`Medina, NY 14103 NOV 012014
800-528-1398 BY: PO#: XX-1223 Sjyl
Payment Terms: Net 30 J
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Bill To: Carmel Clay Parks & Recreation Ph: (317) 573-4026
Fax: (317) 571-4136
Attn: Dawn Koepper Email: dkoepper@carmelclayparks.com
1411 E. 116th Street
Carmel, IN 46032
Job Name: CAR0061: Monon Community Center
Line Description Quantity Unit Net Net
Price Price Ext
1 Type L.2: WS00501-5x5 Wkstn 1 28.38 28.38
Net Total: $28.38
Balance Due(USD): `` ,:$28:38
Terms are Net 30. Past due accounts are subject to 1% interest per month. We reserve the right to hold future orders or
ship future orders COD if terms are not adhered to. Purchaser is responsible for all fees and expenses including but not
limited to, attorneys and collection fees incurred by Takeform in the enforcement of this agreement.
Credit cards accepted. Please complete form below and fax to Accounts Receivable at 585-798-8889
Payment Options: Carmel Clay Parks&Recreation
Q Visa E]MasterCard Discover nAmerican Express Invoice #
Cardholder's Name: Balance Due: $28.38
Card Number: C V V 2#:
Expiration Date:
Card Billing Address:
Signature:
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Print Date:10/29/2014 3:39:21 PM Page 1 of 1
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of 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.
367794 Takeform Terms
11601 Maple Ridge Road
Medina, NY 14103
Invoice Invoice Description
Date Number (or note attached invoice(s)or bill(s)) PO Amount
10/29/14 42090 Signage xx1223 $ 28'38
Total $ 28.38
1 hereby certify that the attached invoice(s),or bill(s)is(are)true and correct and I have audited same in accordance
with I C 5-11-10-1.6
, 20_
Clerk-Treasurer
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Voucher No. Warrant No.
367794 Takeform Allowed 20
11601 Maple Ridge Road
Medina, NY 14103
In Sum of$
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$ 28.38
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ON ACCOUNT OF APPROPRIATION FOR
109 -Monon Center
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i
I Board Members
Dept#r INVOICE NO. ACCT#/TITLE AMOUNT I
1091 42090 4239099 $ 28.38 1 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
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i 20-Nov 2014
Signature
$ 28.38 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund