242300 02/17/15 r Coq -
gyp,
,f CITY OF CARMEL, INDIANA VENDOR: 355628
ONE CIVIC SQUARE HOOSIER HERITAGE PORT AUTHORITY CHECK AMOUNT: S""25,850.00'
;. =4 CARMEL, INDIANA 46032 33 N 9TH ST SUITE 215 CHECK NUMBER: 242300
NOBLESVILLE IN 46060 CHECK DATE: 02/17/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1202 4351501 32660 193 25,850.00 ANNUAL DUES
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Invoice ID Page 1 of 1
177v
Invoice
I HPA-Technology Oversight Board
33 North 9th Street DATE INVOICE #
Suite 215 1/25/2015 193
Noblesille,IN 46060
BILL TO SIFHP TO
City Of Carmel
Attn: Terry Crockett
Three Civic,Square
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Carmel, IN 46032
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DUE DATE P.O. NUMBER
2/24/2015 ;
ITEM (DESCRIPTION QTY DATE AMOUNT :..,
2015 Annual 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
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City
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����� INDIANA RETAIL TAX EXEMPT PAGE
,Jl" CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 32660
35-60000972
ONE CIVIC SQUARE 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. I VENDOR NO. DESCRIPTION
21312096 County fiber ring support
HHPA-Technology Oversight Board Carmel Communications
Terry Crockett
VENDOR 33 North 9th Street Suite 215 THIP 3 Civic Square
Noblesville, IN 46080 Carmel, IN 43032
�. (317)371-2567
CONFIRMATION BLANKET CONTRACT PAYMENTTERMS
FREIGHT 1
T_
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Account 43-315,01
1 Each 2015 Annual HHPA-TOB Dues $25,850.00 $25,850.00
Sub Total: $25,850.00
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fill
',nd Invoice To: --O), L, r
City of Carmel
Terry Crockett
3 Civic Square
Carmel, IN 46032-
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
Carmel IS DepiL PAYMENT $25,1350.09
• A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING 1NSTpucTloNs • I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
THIS APPRORIATfION SUFFICIENT TO PAY FOR THE4BOVE•ORDER.
F REPAID. �t / / / 11 _�L�
D.SHIPMENTS CANNOT BE ACCEPTED. ORDERED BY �(!�,
�C1�ASE�RDJF}laVMBER MUST APPEAR ON ALL Dlr®�KO'f
SER\SS�FD\�1COMQ\.\PNCEw���Ctiae�Ee�99 PCZS\9�5 '�I P
��SOF CLERK TREPSURER
�NER�OF P�DSUPP`EMENj�HERE�o
I ORS P V.Cpp�t -SIGN AND RETURN TO CLERK S OFFICE ... -%
IF
I O� r
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN THE SUM OF$
II
I
$ J
I
ON ACCOUNT OF APPROPRIATION FOR
I
i
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___---__.
Wyk...
1
20wL
Signature '
_..-..--......--- ................. --
Title x
Cost distribution ledger classification if .
-claim paid motor vehicle highway fund
I
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.
i Payee
I
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
01/25/15 193 $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.
ALLOWED 20
Hoosier Heritage Port Authority
IN SUM OF $
33 North 9th Street, Suite 215
Noblesville, IN 46060
r
$25,850.00
ON ACCOUNT OF APPROPRIATION FOR
IS Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
32660 I 193 I 43-515.01 I $25,850.00 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
i
which charge is made were ordered and
received except
Friday, February 13, 2015
/ Director , IS
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund