241484 01/27/15 0]111;�.
CITY OF CARMEL, INDIANA VENDOR: 064915ONE CIVIC SQUARE CONVEY COMPLIANCE SYSTEMS LLC CHECK AMOUNT: S*******100.00*
CARMEL, INDIANA 46032 PO BOX 347977 CHECK NUMBER: 241484
PITTSBURGH PA 1 52 51-4977 CHECK DATE: 01/27/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1701 4341999 PRT-630 100.00 OTHER PROFESSIONAL FE
convey.-,
INVOICE
9800 Bren Rd E Ste 300
Minnetonka,MN 55343-4712 USA
T 800-334-1099
financedept@convey.com
www.convey.com
BILL TO: SHIP TO:
CINDY SHEEKS CINDY SHEEKS
CITY OF CARMEL CITY OF CARMEL
1 CIVIC SQUARECLERK TREASURER OFFICE 1 CIVIC SQUARECLERK TREASURER OFFICE
CARMEL, IN 46032 CARMEL,IN 46032
UNITED STATES UNITED STATES
INVOICE DATE INVOICE NUMBER PAYNIENTTERMS DATE DUE PO NUMBER
01/21/2015 PRT-630 NET 30 02/20/2015
DESCRIPTION, QUANTITY PRICE AMOUNT .
11 W-9 Solicitations 1 $100.00 $100.00
TOTAI; $100.00
PAYMENTS&'CREDITS.: $0.00
BALANCE DUE: $100.00
Please reference invoice number on the electronic confirmation and check.
ACH/WIRE INSTRUCTION:
Silicon Valley Bank
3003 Tasman Drive:' REMIT CHECKS TO: Due Date, 02/20/3015
Santa Clara,CA 95054 Convey Compliance Systems,LLC Pay this amount $1. 00.00
Phone:(408)654 7400 PO Box 347977 Invoice#c PRT-630'"
Account#3301076579 PittsbYirgli,FA 1525174977 Customer#:1867'
Router/Transit#121140399
Swift Code:SVBKUS6S
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No.201(Rev.1995)
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))
Total
I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accor-
dance with IC 5-11-10-1.6.
20
Clerk-Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN SUM OF $
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$ Ili
ON ACCOUNT OF APPROPRIATION FOR
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Board Members
PO#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT.# I hereby certify that the attached invoice(s),
4130 9 �(� or bill(s) is (are) true and correct and that
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the materials or services itemized thereon
for which charge is made were ordered and
received except
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j Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund