247367 07/15/15 i
CITY OF CARMEL, INDIANA VENDOR: 178620
} ONE CIVIC SQUARE KUSTOM SIGNALS, INC CHECK AMOUNT: $*******133.00*
?a; CARMEL, INDIANA 46032 PO BOX 411882 CHECK NUMBER: 247367
ATTN:ACCTS REC CHECK DATE: 07/15/15
KANSAS CITY MO 64141-1882
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4350000 32800 510944 133.00 RADAR REPAIRS
Invoice Number 510944
KUSTOM SIGNALS, INC.
II I III I I I I I'I'II III j
' Invoice Date 03/11/15
A PUBLIC SAFETY EQUIPMENT COMPANY REMIT TO - Customer Number 16673
1010 W.Chestnut/P.O.Box 947 KUSTOM SIGNALS, INC.
Chanute, KS 66720-0947 PO BOX 411882 Order Number 202184 SR
(620)431-2700 Fax(620) 31-2734 KANSAS CITY,MO 6414.14882, Customer PO 32800
Page 1 of 1
SOLD TO SHIP TO
CARMEL POLICE DEPT CARMEL CLAY COMMUNICATIONS
POLICE DEPT HDQTRS CENTER
3 CIVIC SQUARE 31 1 STAVE NW
CARMEL IN 46032 CARMEL IN 46032
Net Due Date 04/10/15 Terms-net 30 Shipping UPS
Quantity Part Number DESCRIPTION Serial # Price Extended
Shipped " . Price
1 200-2072-0 OR PRO-LITE REPAIR
LP02221
OW 3-2-09
Recalibration only
Brian Smith 317-571-2594
bmsmith@carmel.in.gov
........EST.......
1 TRACKING DATE SUMMARY FOR THIS REPAIR
DATE RECEIVED 2-26-15
POHOLD 2-26-15
Technician Start/End Date:2/27/2015
Technician Start/End Date:3/3/15
Emailed estimate 3/5/15
Estimate approved 3/9/15
1 888-8888-33 CS FREIGHT GROUND 18.00 18.00
OUTBOUND SHIPPING
18 111-1111-11 OOW Laser Labor tenths of hr
OOW Laser Labor tenths of hr
Pro-Lite Laser Serial#LP02221 Assessment Finding:
Customer has specified(RECERTIFICATION ONLY)
Regression test found NO minor or major operating inadequacy
fCompleted verify functions check HUD realignment/Road Test
Recertified
1 222-2312-01 CS ROAD TEST ASSESSMENT
5 111-1111-11 OOW Laser Labor tenths of hr
OOW Laser Labor tenths of hr
7mm TOTAL Pulse Width PRF Calibration
14.75 139.1 25.8 200 19.999703
1 222-2320-00 RECERTIFICATION,PRO-LITE+ 115.00 115.00
REMIT TO: FEDERAL ID# 43-1757730 Subtotal 133.00
KUSTOM SIGNALS, INC. %Tax 0.00
PO BOX 411882 III IIIIIII II IIIIIIIIIII III
KANSAS CITY,MO 64141-1882 WWW.KUSTOMSIGNALS.COM TOTAL 133.00
PAGE.. ..
INDIANA RETAIL TAX EXEMPT
City ®f ar el CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 3.12800
35-60000972
ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES,A/P
CARMEL, INDIANA 46032-2584 VOUCHER, DELIVERY MEMO, PACKING SLIPS,
I 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
Kustorn Signals Cannel Police Depwtrtant
VENDOR SHIP
3 CIVIC squaw
P.O. Box 411892 ! TO Cw--mol, IN 46032
KanBaC City, PAO 64°141-16 (397)571-2559
CONFIRMATION BLANKET CONTRACT PAYMENTTERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Account 43 .0
2 Each radar repair $133.00 $266.00
Sulo Total: $266.00
' 10
y„q,�'
"t> 1'.." f."tua •— y�__ Yea^, L�f!t\\{},§
Send Invoice To: f/ I '_ } r h �V
Carmel Polio Depailtment '✓J �f ! J _f
Attn: Pat Young
3 Civic Square
Carmel, IN 46M- PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT I PROJECTACCOUNT AMOUNT
Carmel Police Dept. 52%.U_
PAYMENT
• A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS (,HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
•SHIP REPAID.
THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
• C.O.D.SHIPMENTS CANNOT BE ACCEPTED. _ —
•PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY._ .C. p�_ "ti, __ 4
SHIPPING LABELS. "1 Chlof of Polico
•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. \ }
CLERK-TREASURER
DOCUMENT CONTROL NO- 32800 A.P.V. COPY-SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN THE SUM OF$
ON ACCOUNT OF APPROPRIATION FOR
(D
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
20
Signature
---- Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
VOUCHER NO. WARRANT NO.
ALLOWED 20
Kustom Signals
IN SUM OF$
P.O. Box 411882
Kansas City, MO 64141-1882
$133:00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
32800 I 510944 I 43-500.00 I $133.00 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
which charge is made were ordered and
received except
Thursday, July 09, 2015
V41Z Chief of Police
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))
03/11/15 510944 radar repair $133.00
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