246739 06/30/15 y u�'49ggs
`/ �\. CITY OF CARMEL, INDIANA VENDOR: 369344
s ONE CIVIC SQUARE CHAMPION OPTICAL NETWORK ENGINgMfgK AMOUNT: $.....6,146.00'
9 �_�; CARMEL, INDIANA 46032 PO Box 636640 CHECK NUMBER: 246739
�'��roN�°. CINCINNATI OH 45263-6640 CHECK DATE: 06/30/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1202 4463201 32687 88266615 6,146.00 NETWORK SWITCH OPTICS
CHAMPION Invoice
� • N • ETM
Invoice: 882615
Customer: CITY OF CARMEL
Account Number: H00014
Date: June 8, 2015
Remit To: CHAMPION OPTICAL NETWORK ENGINEERING LLC Order: 882615
PO BOX: 636640
Cincinnati, OH-45263-6640
(216)831-1800
Bill To Ship To
CITY OF CARMEL CARMEL COMMUNICATIONS
ATTN: ACCOUNTS PAYABLE 3 CIVIC SQUARE
3 CIVIC SQUARE CARMEL, IN 46032
CARMEL, IN 46032
_ Track' # 581_54_48220_2.9 Ship ToAttn: TERRY CROCKETT 317-571-2567
Pu ase Order Ship Via ' FOB Order Date Sales rep Terms
32687 FedEx Ground Service C.leveland,`,bH 5/7/2015 R2 Net 30 Days
Line# Product Quantity Description Unit Price Quantity FQuantity Quantity F Net
Ordered B/O Shipped Invoiced IAmount
1 10GESFPP-LR-H3 22 SFP+ 10GBASE-LR 10km, H3C Systems 239.00 0 22 22 $5,258.00
C compatible
2 GESFP-LX-H3C 15 SFP 1000Base-LX 10km, H3C Systems 58.00 0 15 15 $870.00
compatible
3 Shipping 1 Shipping 18.00 0 1 1 $18.00
THANK YOU Sub-total $6,146.00
Seller represents that with respect to the production of the articles and/or the performance of the services covered by
this invoice,it has fully complied with the provisions of the Fair Labor Standards Act of 1938,as amended.
All returns must have written authorization. Invoice Total $6,146.00
All invoices not paid within 30 days are subject to 1.5%per month finance charge. Balance Due $6,146.00
INDIANA RETAIL TAX EXEMPT PAGE
City ®f Carmel
CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 32687
35-60000972
ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES,A/P
CARMEL, INDIANA 46032-2584 VOUCHER, DELIVERY MEMO, PACKING SLIPS,
SHIPPING LABELS AND ANY CORRESPONDENCE.
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL-1997
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
51712015 Network switch optics
Champion One Carmel Communications
Terry Crockett
SHIP
VENDOR 23645 Mercantile Ind, Suite A TO 3 Civic Square
Beachwood, OH 44122 Carmel, IN 46032
(34 7)571-2567
CONFIRMATION BLANKET CONTRACT PAYMENTTERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Account 44-632.04
1 Each Shipping $20.00 $20.00
22 Each SFP+ 10GBASE-LR 1 OKM, H3C SYSTEMS capatible 10GESFPP-LR-H3C $239.00 $5,258.00
15 Each SFP 1000BASE-LX 1 OKM, H3C SYSTEMS capatible GESFP-LX-H3C $58.00 $870.00
f/-��wa � �_ Sub Total: ® $6,148.00
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Ilk
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Quote No 852573sf
Send Invoice To:
City of Carmel
Terry Crockett
3 Civic Square
Carmel, IN 46032-
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
1202 Carmel IS Dept. PAYMENT $6,148.00
• A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT AVACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THEREUNOBLIGATED BALANCE IN
THIS APPRO'''pppRIATION SUUFFI�CII/IEE'!N TO P Y-FOR,,HEABOVE ORDER.
•SHIP REPAID.
• C.O.D.SHIPMENTS CANNOT BE ACCEPTED.
ORDERED BY
• PURCHASE ORDER NUMBER MUST APPEAR ON ALL / !
SHIPPING LABELS.
•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE,,---,"/
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
3���� CLERK-TREASURER
DOCUMENT CONTROL NO. A.P.V. COPY-SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN THE SUM OF$
ON ACCOUNT OF APPROPRIATION FOR
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
I�
I
20
Signature
— Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
VOUCHER NO. WARRANT NO.
ALLOWED 20
CHAMPION OPTICAL NETWORK ENGINEERIN
PO BOX 636640 IN SUM OF $
CINCINNATI OH 45263-6640
$6,146.00
I
ON ACCOUNT OF APPROPRIATION FOR
PO#/Dept. INVOICE NO. I ACCT#/Fund AMOUNT Board Members
32687 I 88266615 I 44-632.01 I $6,146.00 1 hereby certify that the attached invoice(s), or
1202 101
bill(s) is (are)true and correct and that the
_----- —" materials or services itemized thereon for
which charge is made were ordered and
Z , _& received except
S � Atli
Friday, June 26, 2015
:��Tery Crockett, Director
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 Date Invoice# Description Amount
Dept. Fund# (or note attached invoice(s)or bill(s))
06/08/15 88266615 $6,146.00
1202 101
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