248499 08/12/15 CITY OF CARMEL, INDIANA VENDOR: 366725
® it _ ONE CIVIC SQUARE RANGE SYSTEMS CHECK AMOUNT: 5.....2,648.80*
CARMEL, INDIANA 46032 PO BOX 28342 CHECK NUMBER: 248499
9��TON, ` OAKDALE MN 55128 CHECK DATE: 08/12/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
210 4357000 32994 17177 2,648.80 DURA BLOC
SYSTEMS
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Invoice
5121 W innetka Ave N RMD . Q
New Hope, MN 55428 7/13/2015 17177
Carmel Police Dept. Carmel Police Range
Pat Young Sgt. Ryan Jellison
3 Civic Square 9609 Hazeldell Pkwy
Carmel, IN 46032 Indianapolis, IN 46280
317-727-9862, 317-571-2599
po0o 1uzmg 04P ! M& Qo0oE3o
Net 15 BE 7/14/2015 Lift Gat. . .
R331008 DURA-BLOC, 36" X 12" X 9" 24 ea 101.20 2,428.86
NSN: 9320-01-565-6452
001 Shipping & Handling Charges VIA UPS 1 220.00 220.00
F Carmel Police Range [778100455]
ETA 7/17/15
Note Lift gate 1 0.00 0.00
Note ship with SO 4852 1 0.00 0.00
We accept Visa, Mastercard, Discover and American Express. Total $2,648.80
GSA Contract#GS-07F-0139K Balance Due (US Dollars) $2,648.80
DUNS#965573421
Tax ID#41-1811798
Cage Code:08QN6 -
�T7R:j nge Systems, Inc:-
Phone # 763-533-9200P:0:;BOx-28342--r-
www.range-systems.comY
Fax # 763-537-6657 `Oakdale.,�1VIN_�55128;e
INDIANA RETAIL TAX EXEMPT PAGE
City of C CERTIFICATE NO.003120155 002 0
PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 3i4
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.
'URCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
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Rwoo Systoms Carmol Pollao Dopartmort
VENDOR
SHIP 3 CIVIC sguam
6121 Nnnothm Avanuo North TO Camol, IN
Now Hop@, RAN W428 (397)671-M
CONFIRMATION BLANKET CONTRACT PAYMENTTERMS FREIGHT
QUANTITY I UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Account 50-670.00
9 Each Dura43loc RM 00s $2,648.80 $2,645.80
Sub Total: $2,648.80
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Send Invoice To:
Attn: Pato Young
3 CIT Isgum
Camol, IN 462= PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT I PROJECTACCOUNT AMOUNT
C:$mel Police Dept.
� �`� PAYMENT U,640AJ
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 I HEREBY CERTIFY THAT jTHERE IS AN UNOBLIGATED BALANCE IN
SHIP REPAID.
THIS APPROPRIAT 0 kI-FICIENT TO-PAY FOR THE ABOVE ORDER.
•
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED. ORDERED BY
•PURCHASE ORDER NUMBER MUST APPEAR ON ALL �,
SHIPPING LABELS. lof Of
Pollen
•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. • '
CLERK-TREASURER
DOCUMENT CONTROL NO. 32994 A.P.V. COPY-SIGN AND RETURN TO CLERK'S OFFICE
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))
07/13/15 17177 Dura-Bloc $2,648.80
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
Range Systems
IN SUM OF $
`�Oakdali3'�MN�551'28'=
$2,648.80
ON ACCOUNT OF APPROPRIATION FOR
CPD Continuing Ed Fund
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
32994 I 17177 I -570.00 I $2,648.80 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
Wednesday, August 05, 2015
r�
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund