248536 08/12/15 CITY OF CARMEL, INDIANA VENDOR: 367017
® r ONE CIVIC SQUARE T S I, INC CHECK AMOUNT: $****"**697.52*
�. =4 CARMEL, INDIANA 46032 500 CARDIGAN ROAD CHECK NUMBER: 248536
SHOREVIEW MN 55126 CHECK DATE: 08/12/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4342100 90734337 17.52 POSTAGE
1110 4350000 " 32997 90734337 680.00 CALIBRATE TEST
500 Cardigan Road Tel: (651)483-0900 Page 1 of 1
Shoreview, MN 55126 Fax:(651)481-1220
USA Web:www.TSI.com
EIN 41-0843524 Email:answers@TSI.com
® DUNS 00-625-3124
Invoice
Manufacturer of TSI®,A/nor®,Airflowand ChemLogix-branded products
rM
Remit-To If payment by Wire:
Remit-To US Bank National Association
TSI Incorporated 225 S. Sixth Street
SDS 12-0764 P.O. BOX 86 Minneapolis, MN 55402
MINNEAPOLIS, MN 55486-0764 A.B.A. No. 091000022
SWIFT No. USBKUS441MT
Bill-To-Party Account No. 1-502-5005-9915
Carmel Police Dept
3 Civic Square Invoice Number 90734337
Carmel, IN 46032 Invoice Date 07/22/2015
USA Reference Order 552671/07/17/2015
Delivery Note No./Date /07/22/2015
PO No. 32997
Ship-To-Party Customer No. 5112824
Carmel Police Dept Currency USD
3 Civic Square Term of Payment Net 30 days
Carmel, IN are Incoterm 2010 CPT: Prepay &Add
USA Consignee's Premises
Ship Via UPS GROUND
Bill of Lading 1Z7W697A0367034095
Item Material/Description Quantity Unit Price Value
1 CL-8030 1 EA 680.00 680.00
Clean and Calibrate Model 8030
Delivery Num:80646328 SN: (8030091708)
Net Total 680.00
Freight 17.52
Invoice Amount 697.52
These commodities,technology or software are controlled under the Export Administration Regulations. If the goods
are exported or reexported, it must be in accordance with the Export Administration Regulations. Diversion contrary
to U.S. law is prohibited.
WE HEREBY CERTIFY THAT THESE GOODS WERE PRODUCED IN COMPLIANCE WITH ALL APPLICABLE REQUIREMENTS OF THE FAIR LABOR STANDARDS ACT,AS AMENDED AND
APPLICABLE RULES,REGULATIONS AND ORDERS OF THE UNITED STATES DEPARTMENT OF LABOR OR OTHER ADMINISTRATIVE AGENCIES ISSUED PURSUANT THERETO.TSI Terms
and Conditions apply and are incorporated by reference. See http://www.tsi.com/tc.pdf
INDIANA RETAIL TAX EXEMPT PAGE
City ®f Carmet,- CERTIFICATE NO.003120155 002 0 PURCHASEORDER NUMBER
FEDERAL EXCISE TAX EXEMPT
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
'URCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
Tel Camel P®ilea Dopaltmon4
VENDOR
SHIP 3 CIVIC squm
50 Cmfdigan Road TO Carmol, IN 4M
Shoroulm, NN W28 (W)579
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY �qI UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Account 434i35b8/.00
9 Each calibrete fit fent instrument Model 8030 -POrt@Count Pro $880.00 $880.00
Sub Fetal: $680.00
k
•
Send Invoice To: C ` <
Comol Polieo®op@Kmont
Attn: Pat Young
3 CIVIC squaw
Cumol, IN 46=- PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
Gwmel Police `�w _.
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 PROPEJ3 SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY T TjT ERE IS AN UNOBLIGATED BALANCE IN
THIS APPROPRI�TIO FICIENT TO PAY FOR THE ABOVE ORDER.
•SHIP REPAID. //
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED. ORDERED BY
•PURCHASE ORDER NUMBER MUST APPEAR ON ALL 1
yliy
SHIPPING LABELS. 1®f
of pollco
•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
CLERK-TREASURER
DOCUMENT CONTROL NO. 32997 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))
07/22/15 90734337 shipping charge $17.52
07/22/15 90734337 calibrate fit test instrument $680.00
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
VOUCHER NO. WARRANT NO.
ALLOWED 20
TSI
IN SUM OF $
500 Cardigan Road
Shoreview, MN 55126
$697.52
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT
Board Members
1110 90734337 43-421.00 $17.52 I hereby certify that the attached invoice(s), or
bill(s) is (are)true and correct and that the
32997 90734337 43-500.00 $680.00
materials or services itemized thereon for
which charge is made were ordered and
received except
Thursday, August 06, 2015
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund