249281 09/09/15 0,G�9 .
"'R CITY OF CARMEL, INDIANA VENDOR: 357205
;; ij ONE CIVIC SQUARE H.O. BOSTROM CO, INC CHECK AMOUNT: S"''""186.35'
?� CARMEL, INDIANA 46032 PO Box 549 CHECK NUMBER: 249281
�M- a��, KENOSHA WI 53141-0549 CHECK DATE: 09/09/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4237000 185502 186.35 REPAIR PARTS
H.O. Bostrom Co., Inc.
818 Progress Avenue Invoice Number: 185502
Waukesha, WI 53186 USA Page: 1 of 1
o (262) 542-0222 Date: 8/26/2015
(262) 542-3784 - FAX Salesperson:
sates@hobostrom.com
www.hobostrom.com Regular Invoice
"Tell us how we can serve you better"
Fein No.:39-1212995
Fein No.:
PackNum: 75248
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 1 Carmel IN 46032
L USA P USA
T T
O O
Fax: 317-571-2615
—(3'r`derj PuretiNs��Oi:Ier Tacl<ag&�: - Prepaid,; NYei6lit' - .. sr:;. Shi yEa': }, •, _. terms
101397 H sensors Bob V 1 4.00 UPS NET 30
Line/Rel,= .,. Qty Ordered Qty:Shipped. Back Order: Unit Price ` -, ,Extended Price
z.
1 4.000 4.000 0.000 41.2200 164.88
Cl:
Item: 8902-116
Description: KIT SEAT SWITCH SHI
U/M: EA
Date Shipped: 08/26/2015
ok to pack in 1 box
"Tax Basis Summary Tax Rate Tax Basis
Tax Code: NT Taxable: 0.00 0.00
PLEASE REMIT TO: `. Sales'Amoufit: 164.88
H.O. BOSTROM Co., INC. Misc Charges 0.00
P.O. BOX 549 Freight 21.47
KENOSHA, WI 53141-0549 Sales Tax 0.00
Prepaid Amount 0.00
Insurance 0.00
Pay'This'Aiiiount. 186.35
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.
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))
185502 $186.35
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
H.O. Bostrom Co., Inc.
IN SUM OF $
PO Box 549
Kenosha, WI 53141-0549
$186.35
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1120 185502 42-370.00 $186.35 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
SEP - 4 2095
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund