249234 09/09/15 ^-' CITY OF CARMEL, INDIANA VENDOR: 00352042
® ONE CIVIC SQUARE DON HINDS FORD CHECK AMOUNT: 5«««««"'260.57'
?� CARMEL, INDIANA 46032 12610 FORD DRIVE CHECK NUMBER: 249234
1,Mf iUN�� FISHERS IN 46038 CHECK DATE: 09/09/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4237000 33024 22598 260.57 REPAIR PARTS
REMIT TO:
• ACCOUNTS DUE AND
PAGE 1 PAYABLE BY THE
Tot 10th OF THE MONTH
4010
12610 Ford Drive " Fishers, IN 46038
Phone (317) 849-9000 " Fax(317) 8490020
ACCT. NO
1-800-64HINDS (1-800-644-4637)
CLOSING DATE
CARMEL POLICE DEPT. 25AUG15.
ACCOUNTS PAYABLE
3 CIVIC SQUARE
CARMEL IN 46032
P AMOUNT ENCLOSED
PLEASE RETURN THIS PORTION WITH YOUR CHECK $ 20 - �7
DATE.= DOCUMENT/TRANSACTION;;;;:.::._ PURCHASESPAYMENTS CREoiTs BALANCE
PREVIOUS BALANCE
18AUG15:_.; .. 22598 260. 57
ACCOUNT:_': : PAST DUE, CURRENT PLEASE PAY
STATUS 0 . 00 260 . 57 THIS AMOUNT D 260 . 57
OVER 30 OVER 60 OVER 90 OVER 120
0 . 00 0 . 00 0 . 00 0 . 00
FINANCE CHARGES will apply if the new balance is unpaid one month from the closing date of statement. The
"FINANCE CHARGES" are computed by a periodic rate of 1. 506 per month which is an ANNUAL PERCENTAGE
RATE of 180-0 applied to the unpaid balance after deducting current payments and/or credits appearing on this
statement from the previous balance.
INQUIRIES CALL DEE@EXT 1328
CUSTOMER COPY
INDIANA RETAIL TAX EXEMPT PAGE
City oCarmel CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT =4
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.
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
BMWs
Dan Hinds Ford, Inc. C@mol Pollee Dopaftonf
VENDOR SHIP 3 CIVIC Squaw
92890 Ford DfIvo TO Cool, IN 4I
Flshom, IN 48M 671.
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Account 42-370.00
1 Each Repair Pans $200.57 MOM
Sub Total: $200.57
ej
fo
I
° Ilk t �(l
ipans for wr 03
Send Invoice To:
C@fmoi Police DUP Mmont
Attn: Pat Young
3 CIVIC squm
Cannel, IN PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT I PROJECT ACCOUNT AMOUNT
dMmel Police Dept, PAYMENT r
• A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE ROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERIFIY HAT THERE IS AN UNOBLIGATED BALANCE IN
THIS�P IAT N SUFFICIENT O'PAY FOR THE ABOVE ORDER.
•SHIP REPAID.
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED.
• ORDERED BY
PURCHASE ORDER NUMBER MUST APPEAR ON ALL / �a •,,t} p
SHIPPING LABELS. / �yljlldM of�s�II�.�
•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
CLERK-TREASURER
)OCUMENT CONTROL NO. 33- 024 A.P.V. COPY-SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER NO. _WARRANT
ALLOWED 20
IN THE SUM OF$
$
ON ACCOUNT OF APPROPRIATION FOR
drlk
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
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))
08/17/15 22598 repair parts $260.57
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
Don Hinds Ford, Inc.
IN SUM OF $
12610 Ford Drive
Fishers, IN 46038
$260.57
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
33024 22598 42-370.00 $260.57
I hereby certify that the attached invoice(s), or
I I I
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, Se tember 02, 2015
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund