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Home My WebLink About250417 1 0/07/1 5 CITY OF CARMEL, INDIANA VENDOR: 00353046 ® ONE CIVIC SQUARE SIMPLEXGRINNELL LP CHECK AMOUNT: $*****2,585.00* CARMEL, INDIANA 46032 DEPT CH 10320 CHECK NUMBER: 250417 PALATINE IL 60055-0320 CHECK DATE: 10/07/15 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 601 5023990 81754409 685.00 OTHER EXPENSES 601 5023990 81754411 1,900.00 OTHER EXPENSES INVOICE NO. INVOICE DATE PO NUMBER ell 81754409 09-22-15 D-U-N-S 09-4738007 FED. ID 58-2608861 SERVICE SERVICE-REQ. NATIONAL ACCOUNT NUMBER District # 331 RE UEST# CREATED 11820 Pendleton Pike 3366511 L09-14-15 INDIANAPOLIS,IN 46236-3979 317-826-2130 Billing Questions, Contact = PAYMENTTERMS 331-01725554 Due upon receipt Carmel Water Operations • • 331-01725554 3450 W 131ST ST CARMEL IN 46074-8267 Carmel Water Operations 3450 W 131ST ST CARMEL IN 46074-8267 "Let us know how we etre doing" www.simplexgrinnell.com • 317-716-3929 Fixed Price Service Request (n� Scope of work for service performed on your Dry Sprinkler Labor $285 . 00 System is not covered by your service agreement Description of work Material $400. 00 . 1 Deficiency - Fixed Price �3 Other $0 . 00 Fitter replaced (1) air maintenance device. This service is complete. Invoice Amount $685 . 00 Fixed Price - $ 685.00 (pre-tax) Thank you for your business! Taxes A�j $L�. 00 Total Invoice Amount $7 . 00 Payment Received $0 . 00 <gf5•Cb Total Amount Due D 4q-k �� INVOICE NO. INVOICE DATE PO NUMBER ' Shnp/exGtinnei/ 81754411 09-22-15 D-U-N-S 09-4738007 FED. ID 58-2608861 SERVICE SERVICE REQ. NATIONAL ACCOUNT NUMBER District # 331 RE UEST# CREATED 11820 Pendleton Pike 33436680 08-19-15 INDIANAPOLIS,IN 46236-3979 317-826-2130 Billing Questions, Contact = PAYMENTTERMS` • 331-01725554 Due upon receipt Carmel Water Operations • • 331-01725554 3450 W T S 131ST CARMEL IN ST ST 8267 Carmel Water Operations 3450 W 131ST ST CARMEL IN 46074-8267 "Let us know how we are doing" www.simplexgrinnell.com - = 317-716-3929 Fixed Price Service Request Scope of work for service performed on your Wet Sprinkler Labor $1, 900 . 00 System is not covered by your service agreement Material $0 . 00 Description of work 9-22-15 Invoicing for wet sprinkler deficiency service. Other Performed 5 year internal inspection on one wet and one dry $0' 0 0 system, replaced gauges, replaced dry chrome pendant heads and Invoice Amoun t $1, 900 . 00 adjusted head in 1 office. Taxes $0. 00 Total Invoice Amount $1, 900 . 00 Payment Received $0 . 00 Total Amount Due D $1, 900 . 00 Form ST-105 State Form 49065 RA/8-05 Indiana Department of Revenue General Sales Tax Exemption Certificate Indiana registered retail merchants and businesses located outside Indiana may use this certificate.The claimed exemption must be allowed by Indiana code. Exemption statutes of other states are not valid for purchases from Indiana vendors. This exemption certificate can not be issued for the purchase of /'h U V h AiMWA authority of the purchaser's state of residence.r Purchaser must be registered with the Department of Revenue a the appropriate taxing Sales tax must be charged unless W1 Information In each section is fully completed by the purchaser. Purchasers not able to provide information must pay the tax and may file a claim for refund(Form GA-I IOL)directly with the Department o tde all required Name of Purchaser CITY OF CARMEL of Revenue. Business Address �A5C) � ( 3 �� S'I"'- City CARMEL State IN Purchaser must provide minimum of one ID number below.* Zip L Provide your Indiana Registered Retail Merchant's Certificate 'IID and LOC Number as shown on your Certificate............................... 0031201550 — 020 If not registered with the Indiana DOR,provide your State Tax ITD#(t 0 d;g;s) ID Number from another State............... . 1_OC#(3 digits)Instructions on the reverse side If..you.......d.o not have either number. State tD# IMP State of Issue Is this a m blanket Purchase exemption request or a []single purchase exemption request? (check one) Description of items to be purchased. Purchaser must indicate the type of exemption being claimed for this purchase, (check one or explain) ❑ Sales to a retailer,wholesaler,or manufacturer for resale only. 0 Sale of manufacturing machinery,tools,and equipment to be used directly in direct production. ❑ Sales to nonprofit organizations claiming exemption pursuant to Sales Tax Information Bulletin#10. (May not be used for personal hotel rooms and meals.) ❑ Sales of tangible personal property predominate) used ' A person or corporation who is hauling under someone else's(greater rncarri C au��onty s a contradt as a school provide their SS#or FID#in lieu of a State ID#in Section#1, providing publid transportation-provide USDOT#. USDOT# bus operator.,must ❑ Sales to persons,occupationally engaged as farmers,to be used directly in production of agrlculturproducts for sale. Note:A farmer not possessing a State Business License#may enter a FID#or a SS#in lieu of a Stat�ID#in Section#1. ❑ Sales to a contractor for exempt projects(such as public schools,government,or nonprofits). m Sales to Indiana Governmental Units(agencies,cities,towns,municipalities,public schools,and st�te universities). O Sales to the United States Federal Government-show agency name. Note:A U.S.Government agency should enter its Federal Identification Number(PID#)in Section#II in lieu of a State 1D#. ❑ Other-explain. MIMI 1 hereby certify under the penalties of perjury that the Property this ex Purpose pursuant to the State Gross Retail Sales Tax Ac Indiana Code 6-2.5,and the itetnthe use f purchased isemPtinot!eecate is to be used for an exempt Act, P 1 confirm my understanding that misus tither ne li en r' utility,vehicle,'watercraft,or aircraft. and/or the business entity I re resen 8 g ter*,tan and/or fraudand/or riment use pe this eek tificate may subject both me personally 0' P e in1position ter ',and civil and/or criminal penalties Signature of Purchaser Printed Name DIANA L CORDRAY I Date The Indiana Department of Revenue may request verification o registration in another state if Title CLERK-TREAURER Seller must keep this certificate on file to sir You jarc an out-of-state purchases. PPon exempt sales, I I i 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 of service rendered, by whom, rates per day, number of units, price per unit, etc. Payee 287350 SIMPLEX GRINNELL Purchase Order No. DEPT CH 10320 Terms PALATINE, IL 60055-0320 Due Date 9/28/2015 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 9/28/2015 81754409 $685.00 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 Date Officer VOUCHER # 153162 WARRANT # ALLOWED 287350 IN SUM OF $ SIMPLEX GRINNELL DEPT CH 10320 PALATINE, IL 60055-0320 Carmel Water Utility ON ACCOUNT OF APPROPRIATION FOR Board members PO# INV# ACCT# AMOUNT Audit Trail Code 81754409 01-6200-06 $400.00 81754409 01-6360-06 $285.00 gI� 544A 11 Voucher Total Cost distribution ledger classification if claim paid under vehicle highway fund