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249775 09/23/15 CITY OF CARMEL, INDIANA VENDOR: 355158 "s. ONE CIVIC SQUARE LAFAYETTE INSTRUMENT CHECK AMOUNT: $**......27.00* CARMEL, INDIANA 46032 PO BOX 5279 CHECK NUMBER: 249775 +y. = LAFAYETTE IN 47903 CHECK DATE: 09/23/15 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1110 4342100 14263 7.00 POSTAGE 1110 4350000 33038 14263 20.00 BIBKIT Lafayette Invoice No: 0000014263 Customer: 005634 Instrument R Sales Order: 013887 Lafayette Instrument Company, Inc 3700 Sagamore Parkway North Phone:(765)423-1505 Federal ID:35-1950005 Lafayette,IN 47904 USA Fax:(765)423-4111 accounting@lafayetteinstrument.com www.lafayetteinstrument.com Sold to: 113:0001 ID:0001 City of Carmel SHIPPED TO ADDRESS: Department City of Carmel Carmel Police De p Carmel Police Department 3 Civic Square 3 Civic Square Attn': Pat Young Attn: Pat Young Carmel IN 46032 Carmel IN 46032 ---- United States United States Phone(317)571-2559 Order Date:09/01/2015 Ship Date:09/01/2015 Customer PO Number Invoice Date Terms FOB Ship Via Salesperson 33038 09/01/2015 NET 30 OUR PLANT PRIORITY MAIL(2-3 D TST Item Part I Rev I Description/Details Quantity Unit Price Discount Extended Price 000010 767480 U/M EA 1.00000 20.00000 0.00 20.00 20 0 RINGS TOOL QUICK CONN/DISCONN Packing List No/Item No: 014972/000001 000020 SHIPPING 1.00000 7.00000 0.00 7.00 Shipping/Freight Charge Total Item Price 20.00 Tax Exempt#0031201550020 Shipping 7.00 Invoice in Duplicate PO must appear on all packages,invoices,and correspondence Sales Tax 0.00 Shipping charges,unless specifically noted above,will be prepaid and Total Inv Price US$ 27.00 added to your invoice. Please review the information above including item detail. If incorrect, please notify us immediately. We sincerely appreciate your order for the items described above. With best regards, Lafayette Instrument Sales LIC Original PLEASE ! NO RETURNS WITHOUT PRIOR AUTHORIZATION 1 REMIT TO ADDRESS: LAFAYETTE INSTRUMENT CO.ASSUMES NO RESPONSIBILITY P.O.BOX 5729 All invoices 30 days past due FOR ANY ITEM RETURNED WITHOUT PRIOR AUTHORIZATION. LAFAYETTE, IN 47903 will be charged at the rate of TO INSURE PROPER CREDIT TO YOUR ACCOUNT, ALL PAYMENTS MUST BE IN US$$ 1.5%interest per month. REMITTANCE COPY MUST ACCOMPANY CHECK. Page 1 C1ty0 INDIANA RETAIL TAX EXEMPT PAGE ®f Carmel CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER FEDERAL EXCISE TAX EXEMPT sm 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 ®P14�209� 6ofapf @ InstFrumnk C2mol Pellco DGpadmont VENDOR SHIP 3 Civic squm P.O. Box SM TO C51h1 ol. IN 4 6do, IN 4 (397)571 CONFIRMATION BLANKET CONTRACT PAYMENTTE RMS FREIGHT QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION Account 43 .40 9 Each Bibldt 767480 $20.00 $20.00 Sub T®td: $20.00 �%'� ._ . `- a ..... d •'° �� 5 °4V ell v;/ oaf ; Send Invoice To: Cmn©l p®lleg®gyp mo�af< Attn: Pat Yung 3 CIVIC squm Cumol, IN 4 PLEASE INVOICE IN DUPLICATE DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT Cmumel Police Dept. (,� cw 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 I HEREBY CERTIFY I AT THERE IS AN UNOBLIGATED BALANCE IN •SHIP REPAID. THIS APPROP A�10 SUFFICIENT T PAY FOR THE ABOVE ORDER. •C.O.D.SHIPMENTS CANNOT BE ACCEPTED. ORDERED BY •PURCHASE ORDER NUMBER MUST APPEAR ON ALL �,,/� Q®(�} SHIPPING LABELS. l dI Pollen THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE I� AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. CLERK-TREASURER DOCUMENT CONTROL NO. 33038 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)) 09/01/15 14263 Shipping $7.00 09/01/15 14263 O-Rings $20.00 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 Lafayette Instrument IN SUM OF $ P.O. Box 5729 Lafayette, IN 47904 $27.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Police Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1110 14263 43-421.00 $7.00 I hereby certify that the attached invoice(s), or bill(s) is (are)true and correct and that the 33038 14263 43-500.00 $20.00 materials or services itemized thereon for which charge is made were ordered and received except Tuesday, September 15, 2015 Chief of Police Title Cost distribution ledger classification if claim paid motor vehicle highway fund