250481 10/08/15 ,Cqq
CITY OF CARMEL, INDIANA VENDOR: 361361
® { ONE CIVIC SQUARE HELMETS R US CHECK AMOUNT: S'"'"*741.00'
CARMEL, INDIANA 46032 2705 PACIFIC AVE CHECK NUMBER: 250481
TACOMA WA 98402 CHECK DATE: 10/08/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1192 4467099 45243 308.85 OTHER EQUIPMENT
1192 R4467099 31603 45243 432.15 HELMETS
Top Gear Inc. Invoice
DBA Helmets R Us Inc
2705 Pacific Avenue Date Invoice#
Tacoma, WA 98402
9/9/2015 45243
253-627-2121 Fax#253-572-4225
Federal ID: 26-0491227
Bill To Ship To I
City of Carmel `-1 City of Carmel I
Lisa M Stewart Lisa M Stewart
I Civic Square
1 Civic Square Carmel IN 46032
Carmel IN 46032
S.O. X40. ! P.O. Number , Torms Rep/PROMO Ship
31603 ( Due on receipt 9/9/2015
Quantity Item Code Description Price Each Amount
20 02SMYL 02(P-23)Supreme Bicycle Helmet with Rear Vents and Slide Guide,Small 7.95 159.00
Yellow
40 02MDBL 02(P-23)Supreme Bicycle Helmet with Rear Vents and Slide Guide, Medium 7.95 318.00
Blue
20 02LGYL 02(P-23)Supreme Bicycle Helmet with Rear Vents and Slide Guide,Large 7.95 159.00
Yellow
80 S hipping cost Shipping Charges 1.25 100.00
Handling Handling 5.00 5.00
Event Date 9/19
Shipment Date: 09/09/2015
UPS Tracking# 1Z410EF80341323632; 1Z410EF80342367647;
I1Z410EF80340786055; IZ410EF80341714862
I
Total $741.00
SEE US AT www.helmetsrus.net
NOTICE: RETURNS Subject to a MINIMUM 15%restocking fee. Must have"RMA" Balance due subject to from invoice date
%per month
Authorizatiion Number for Returns. DAMAGED or MISSING items must be reported FINANCE charges,30 days from
within 20 days of shipment.
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))
09/09/15 45243 $308.85
09/09/15 45243 $432.15
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
Helmets R Us, Inc.
IN SUM OF $
2705 Pacific Avenue
Tacoma, WA 98402
$741.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel DOCS
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
--r
1192 45243 44-670.99 $308.85 I hereby certify that the attached invoice(s), or
Encumbered bill(s) is(are)true and correct and that the
31603 45243 44-670.99 $432.15
materials or services itemized thereon for
which charge is made were ordered and
received except
Monday, Octo er 05,'2015
Directo
iki—
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund