245846 06/03/15 a°— ,qM
J�/ CITY OF CARMEL, INDIANA VENDOR: 357205
." , ONE CIVIC SQUARE H.O. BOSTROM CO, INC
CHECK AMOUNT: $********47.62*
r. _� CARMEL, INDIANA 46032 PO Box 549 CHECK NUMBER: 245846
9,��TON�� KENOSHA WI 53141-0549 CHECK DATE: 06/03/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4237000 183725 47.62 REPAIR PARTS
H.O. Bostrom Co., Inc.
818 Progress Avenue Invoice Number: 183725
Waukesha, WI 53186 USA Page: 1 of 1
(262) 542-0222 Date: 5/15/2015
(262) 542-3784- FAX
. sales®hobostrom.com Salesperson:
www.hobostrom.com Regular Invoice
"Tell us how we can serve you better"
Fein No.:39-1212995
Fein No.:
PackNum: 73515
CA02321 Currency: US$US Dollar
B Carmel Fire Dept S Carmel Fire Dept
I 2 Civic Square H 2 Civic Square
L Carmel IN 46032 I Carmel IN 46032
L USA P USA
T T
O O
Fax: 317-571-2615
— Ordei s Parchsc Ordec Pacl .gc0' P.re'" a%d ;.l7 eigia :,Ship�1�a Terms -
99845 E344 1 1.00 UPS NET 30
LinelRel: :Qty Ordered, Qty Shipp
ed Back Order Unit Pricer`. Extended.Price=
P
1 1.000 1.000 0.000 30.0800 30.08
Cl:
Item: 8902-076
Description: KIT GAS SPRING TKR ABTS F/U
U/M: EA
Date Shipped: 05/15/2015
Tax Basis Summary Tax Rate Tax Basis
Tax Code: NT Taxable: 0.00 0.00
PLEASE REMIT TO: Sales Amount ;. 30.08
H.O. BOSTROM Co., INC. Mise Charges 0.00
P.O. BOX 549 Freight 17.54
KENOSHA, WI 53141-0549 Sales Tax 0.00
Prepaid Amount 0.00
Insurance 0.00
Pa Th>s:AM I'1 47.62
Meeting All Your Seating Needs Since 1946
"Credit availability,extension or continuation shall be in the sole discretion of H.O.Bostrom Co.,Inc. Past Due Accounts are subject to 1.5%Monthly FINANCE CHARGE(APR
18%). A$40.00 service charge will be assessed on each check(s)returned from our bank,unpaid,for any reason. In the event the account is turned over to an attorney or
collection agency(or both)for collection,or suit is brought on same,purchaser shall pay all reasonable attorney's fees,courts costs and collection fees incurred by H.O.
Bostrom Co.,Inc."
Return Goods: Restocking charge will apply to all returns.
Return Material Authorization (RMA#) must be requested prior to returning any material.
VOUCHER NO. WARRANT NO.
ALLOWED 20
H.O. Bostrom Co., Inc.
? IN SUM OF$
PO Box 549
Kenosha, WI 53141-0549
$47.62
i
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1120 183725 42-370.00 $47.62 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
JUN a 2015
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))
183725 $47.62
I
i,
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