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Home My WebLink About250460 1 0/07/1 5 r_C_._IA - *`V ` CITY OF CARMEL, INDIANA VENDOR: 00352108 L� j; ® ONE CIVIC SQUARE WAL-MART COMMUNITY CHECK AMOUNT: $*****1,203.30* ?� CARMEL, INDIANA 46032 PO BOX 530934 CHECK NUMBER: 250460 4j�roN�. ATLANTA GA 30353-0934 CHECK DATE: 10/07/15 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1081 4239039 02020232570 1,203.30 GENERAL PROGRAM SUPPL U RRICEIVED WNMaTEC�Y%'l Save money.Live better. SEP 2 8 2015 BY: Walmarr CARMEL CLAY PARKS AND RECR Visit us at walmart.com/credit Community Card Account Number: 6032 2020 2023 2576 Customer Service: 1-877-294-1086 AuT!�aryLo 1�6_�.4hQAc!ivi( 2, L _y �406!!�fr'Li Previous Balance $3,479.59 New Balance $4,735.08 +Purchases/Debits $1,203.30, Amount Past Due $3,479.59 +Interest Charges $52.19 Total Minimum Payment Due $4,735.08 New Balance $4,735.08 Payment Dug Date 10/18/2015 Credit Limit $15,000 Available Credit $10,264 Statement Closing Date 09/22/2015 Days in Billing Cycle 31 L2 Tran Post Date Date Reference Number Description of Transaction or Credit Amount 08/19 08/23 P9273007BO1302FLN WALMART001601 CARMEL IN $256.63 TOTAL FOR AUTHORIZED BUYER NO 05 $256.63 09/16 09/16 P9273008701QRL5F0 WALMART001601 CARMEL IN $187.13 TOTAL FOR AUTHORIZED BUYER NO 06 $187.13 08/25 08/25 P9273007G01 58BGKP WALMART001601 CARMEL IN $43.94 08/25 08/25 P9273007G01 58BGKZ WALMART 002787 INDIANAPOLIS IN $205.17 08/28 08/28 P92730071<016138049 WALMART 002787 INDIANAPOLIS IN $69.34 09/15 09/15 P9273008501QHG13Y WALMART 002787 INDIANAPOLIS IN $55.29 09/18 09/18 P9273008801DJM9DK WALMART001601 CARMEL IN $203.63 TOTAL FOR AUTHORIZED BUYER NO 07 $577.37 09/14 09/14 P9273008401Q3Q40A WALMART 002787 INDIANAPOLIS IN $182.17 TOTAL FOR AUTHORIZED BUYER NO 09 $182.17 109/22 09/22 *LATE CHARGE* $52.19 tate"ChAr§&'iS6M ma f -At. E Annual Percentage Balance Subject to Late Charge Rate Late Charge 18.00% $3,479.59 $52.19 YOUR ACCOUNT HAS 2 PAYMENTS DUE. PLEASE MAIL THE MINIMUM PAYMENT DUE TODAY. PLEASE DISREGARD IF PAYMENT HAS ALREADY BEEN MAILED. ,n qy, -waived kt.&4V� V3 IoOl (— --)Q PAYMENT DUE BY 5 P.M.(ET)ON THE DUE DATE. NOTICE:We may convert your payment into an electronic debit. See reverse for details, Billing Rights and other important information. 5404 0003 BEH 3 7 22 150922 0PAGE 1 of 5 9273 2000 N122 010X5404 19415 Customer Service:For account information,call the number on the front of this statement.For Hearing or Speech disabilities,use a TRS.Unless your name is listed on this statement,your access to information on the account may be limited.You may also mail questions(but not payments)to: P.O.Box 965022,Orlando,FL 32896-5022.Please include your account number on any correspondence you send to us. Payments.Send payments to the address listed on the remit portion of this statement or pay online. ® Notice:See below for your Billing Rights and other important information.Telephoning about billing errors will not preserve your rights under federal law. To preserve your rights,please write to our Billing Inquiries Address,P.O.Box 965023,Orlando,FL 32896-5023. Purchases,returns,and payments madejust priorto billing dale may not appear until next month's statement.When you provide a check as payment,you authorize us eitherto use information from your check to make a one-time electronic fund transfer from your account orlo process the payment as a check ® transaction.When we use information from yourcheck to make an electronic funcltransfer,funds may bewithdrawn firom youraccountas soon asthesame day we receiveyourpayment,andyouwill not receive your check back from your financial institution.You maychoose nolto have your payment collected electronically by sending your payment(with the payment stub),In your own envelope—not the enclosed window envelope,addressed to: P.O.Box 960095,Orlando,FL 32896-0095 and not the Payment Address. Information About Payments:You may at any time pay,In whole or Payments in part, the total unpaid balance without any additional charge for All Purchases charged to this Account made during a monthly billing period prepayment.Payments received after 5:00 p.m.(ET)on any day will be and any service fees will be shown on the Statement for that period and credited as of the next day.Credit to your Account may be delayed up to payment of the entire balance(the'New Balance')is due in full promptly. five days if payment(a)is not received at the Payment Address,(b)is not When there is a New Balance shown on your Statement,you agree to pay made in U.S.dollars drawn on a U.S.financial institution located in the U.S., the entire New Balance by 5:00 p.m.(ET)on the Payment Due Date shown ® (c)is not accompanied bythe remittance coupon attached to your statement, on the Statement. (d)contains more thanonepayment orremihancecoupon,(e)isnot received Bankruptcy Notice: If you file bankruptcy you must send us notice, in the remittance envelope provided or(f)includes staples,paperclips,tape, including account number and all information related to the proceeding a folded check,or correspondence of any type.Conditional Payments:All to the following address: Retail Finance Credit Services, LLC, Attn: written communications concerning disputed amounts,including any check Bankruptcy Dept.,P.O.Box 965060,Orlando,FL 32896-5060. or other payment instrument that:(i)indicates that the payment constitutes °payment in full'or is tendered as full satisfaction of a disputed amount:or Your account is owned and serviced by Retail Finance Credit ii) is tendered with other conditions or limitations ("Disputed Services,LLC. yments"), must be mailed or delivered to us at P.O. Box 965023, Orlando,FL 32896-5023. Credits To Your Account,An amount shown in parentheses or preceded by a minus(-)sign is a credit or credit balance unless otherwise indicated. Credits will be applied to your previous balance immediately upon receipt, I. but will not satisfy any required payment that may be due. Credit Reports And Account Information:If you believe that we have reported inaccurate information about you to a credit bureau, please e contact us at P.O. Box 965024, Orlando, FL 32896.5024. In doing so, please identify the inaccurate information and tell us why you believe it is incorrect.If you have a copy of the credit report that includes the inaccurate information,please include a copy of that report.We may report information about your account to credit bureaus.Late payments,missed payments, or other defaults on your account may be reflected in your credit report. s r• e oinX5dnd-1.n7l?911A 0003 0006 CARMEL CLAY PARKS AND RECR AUTHORIZED BUYER#:05000 ACCOUNT M 6032 2020 2023 2576 P.O.M 38935 INVOICEM 001030 DATE OF SALE#: 081915 STORE M 00001601 TRANSACTION#: 1030 AUTHORIZATION#: 019696 REGISTER M 10 S.K.0 DESCRIPTION QUANTITY UNIT PRICE EXT. PRICE 038169467 BA SHEER 5.000 EA 1.9700 9.85 BANDAGES 049175236 BA PLASTIC 3.000 EA 1.9700 5.91 BAND-AIDS 054391827 HSY KISS HUGS MED 1.000 EA 3.5400 3.54 052449867 BENADRYL D LIQ 4OZ 1.000 EA 5.4200 5.42 063367946 CROSSOVER RD BB 1.000 EA 10.4700 10.47 29.5 066624537 GV EVERYDAY FLAT 5.000 EA 3.9400 19.70 3PK 083251312 ST 12.7Q MOD LCH 4.000 EA 4.9700 . 19.88 BAM N 088403711 DX 5OZ 10OCT CUP 1.000 EA 2.5800 2.58 088769394 ADVENTURES IN AN 1.000 EA 3.7400 3.74 089565441 EPIC DVD WS 1.000 EA 7.5000 7.50 091171609 MEAD FASHION 1.000 EA 0.5000 0.50 COMM WR 091171611 MEAD FASHION 6.000 EA 0.5000 3.00 COMM CR 091651809 GRMX ALOE 30OZ HL 2.000 EA 3.9700 7.94 092585725 ZIPLOC STORBOX 5.000 EA 10.9200 54.60 26.5Q 093338941 CAMO FOOTBALL 1.000 EA 14.9700 14.97 093430715 SPA NBA BSKB NOB 1.000 EA 12.9700 12.97 1B 093919391 HEX STING 5 SBALL 1.000 EA 9.9700 9.97 BL 093919467 HEX STING 5 SBALL 1.000 EA 9.9700 9.97 SL 094296326 PADDINGTON 1.000 EA 12.9600 12.96 095541734 LEGO MOVIE SE 1.000 EA 12.9600 12.96 095542013 PENGUINS MAD 1.000 EA 12.9600 12.96 095825319 HOME(15)DVDOP 1.000 EA 15.2400 15.24 SUB$256.63 TAX$0.00 TOTAL INVOICE $256.63 CREDITS TOTAL $0.00 BALANCE DUE $256.63 CARMEL CLAY PARKS AND RECR AUTHORIZED BUYER#:07000 ACCOUNT#:6032 2020 2023 2576 P.O.M 38989 INVOICEM 006692 DATE OF SALE M 082515 STORE M 00001601 TRANSACTION#:6692 AUTHORIZATION#:025504 REGISTER#:9 S.K.0 DESCRIPTION QUANTITY UNIT PRICE EXT.PRICE 032619228 FILLER PAPER WR 15.000 EA 0.8200 12.30 076258351 6PL MINI MARKER 5.000 EA 3.2400 16.20 081440432 25CT HF LTR ASST 1.000 EA 8.4400 8.44 094580087 18"X6'GOWRITE ROLL 1.000 EA 7.0000 7.00 SUB$43.94 TAX$0.00 TOTAL INVOICE $43.94 CREDITS TOTAL $0.00 BALANCE DUE $43.94 - CARMEL CLAY PARKS AND RECR AUTHORIZED BUYER M 07000 ACCOUNT M 6032 2020 2023 2576 P.O.M 38989 INVOICEM 003709 DATE OF SALE#: 082515 STORE M 00002787 TRANSACTION#:3709 AUTHORIZATION#:025030 REGISTER M 17 S.K.0 DESCRIPTION QUANTITY UNIT PRICE EXT.PRICE 005498829 CRAYOLA CRAYONS 10.000 EA 0.5000 5.00 24CT 036361052 UNI VSN BLK.7 4CT 1.000 EA 6.8800 6.88 037265760 SH FINE BILK 12BOX 1.000 EA 8.9700 8.97 047784297 DCK BLACK 20YD 2.000 EA 3.3700 6.74 TAPE 063875884 SHARPIE PEN ASST 1.000 EA 4.9700 4.97 4CT 5404 0003 BEH 3 7 22 150922 0 PAGE 2 of 5 9273 2000 N122 OlUX5404 19415 mramm 0004 0006 S.K.0 DESCRIPTION QUANTITY UNIT PRICE EXT. PRICE 070759859 ELM SCH GLUESTK 3.000 EA 3.9200 11.76 ® 12PK 075711869 METAL BOOKENDS 2.000 EA 8.2200 16.44 078714814 DUAL EVENT TIMER 1.000 EA 9.9700 9.97 079732478 MS CLOTHESPINS 1.000 EA 0.9700 0.97 50PK 081731925 LIME GRN DUCK TP 1.000 EA 3.3700 3.37 CFT 081731989 ELEC BLUE DUCKTP 1.000 EA 3.3700 3.37 CFT 082693598 RV IRON 2.000 EA 6.9400 13.88 LIGHTWEIGHT ® 083303177 GV SANDWICH 2OOCT 4.000 EA 3.9700 15.88 085219085 BIC 4PK WITEOUT 1.000 EA 5.4700 5.47 TAPE 088528088 MINI DIGITAL TIMER 4.000 EA 4.9700 19.88 089022110 GLD WAX WARMER 1.000 EA 9.9300 9.93 BLUE 089341175 SB COINS 80CT-BLK 3.000 EA 6.4700 19.41 089507278 PUFF LOTION CUBE 3.000 EA 1.4700 4.41 089894562 BIC 24PK XLIFE 6.000 EA 2.9700 17.82 BLACK 089894570 BIC 24PK XCOMFRT 1.000 EA 3.9700 3.97 BLK 091534192 GLD WAX CASHMERE 1.000 EA 2.9800 2.98 6CT 093587020 91NCH BOOKEND 1.000 EA 8.2200 8.22 093842567 GLD OIL KIT LV FREE 1.000 EA 4.8800 4.88 ME SUB$205.17 TAX$0.00 TOTAL INVOICE $205.17 ®_ CREDITS TOTAL $0.00 BALANCE DUE $205.17 CARMEL CLAY PARKS AND RECR AUTHORIZED BUYER M 07000 ACCOUNT#:6032 2020 2023 2576 P.O.M 38989 INVOICEM 005538 DATE OF SALE#: 082815 STORE#:00002787 TRANSACTION#:5538 AUTHORIZATION#:028996 REGISTER M 12 S.K.0 DESCRIPTION QUANTITY UNIT PRICE EXT. PRICE 042190044 DUR ALK AAA8 1.000 EA 6.1800 6.18 044255129 10OCT SHIPPING 1.000 EA 4.4400 4.44 LABEL 061287278 MITRE WHISTLE 3.000 EA 3.9700 11.91 COMBO 063562013 DAWN ORIGINAL 1.000 EA 2.4800 2.48 21.6FO 076258351 6PL MINI MARKER 7.000 EA 3.2400 22.68 083239993 MS HNGR 10WH WIRE 2.000 EA 1.2400 2.48 090201461 PARCHMENT PAPER 3.000 EA 3.4800 10.44 45 090956600 GV 18X37.5 HD FOIL 1.000 EA 2.7600 2.76 091005573 MRCLN ERASER TUB 1.000 EA 5.9700 5.97 7CT SUB$69.34 TAX$0.00 TOTAL INVOICE $69.34 CREDITS TOTAL $0.00 BALANCE DUE $69.34 CARMEL CLAY PARKS AND RECR AUTHORIZED BUYER M 09000 ACCOUNT#:6032 2020 2023 2576 P.O.M 6497 INVOICEM 009049 DATE OF SALE M 091415 STORE#:00002787 TRANSACTION M 9049 AUTHORIZATION M 014278 REGISTER M 15 S.K.0 DESCRIPTION QUANTITY UNIT PRICE EXT. PRICE 042675918 COKE 12Z12F 1.000 EA 4.4400 4.44 042675922 DT COKE 12Z1 2F 1.000 EA 4.4400 4.44 051263486 SNICKERS FUNSIZE 2.000 EA 2.4800 4.96 053364311 HERSHEY KISSES 1.000 EA 9.9800 9.98 055804048 PURE BREW 8-12 CUP 1.000 EA 1.2800 1.28 055804058 PURE BREW 4 CUP 1.000 EA 1.2800 1.28 059808895 TBASE ORIGINAL 3PK 1.000 EA 2.2400 2.24 059808897 TRDNT SPRMINT MP 1.000 EA 2.2400 2.24 076188916 GV 180Z PTY CP 2.000 EA 6.3400 12.68 10OCT 076611321 SWD FISH PEG 4.000 EA 1.7800 7.12 5404 0003 BEH 3 7 22 150922 D PACE 3 of 5 9273 2000 N122 OIDX5404 19415 0005 0006 S.K.0 DESCRIPTION QUANTITY UNIT PRICE EXT. PRICE 080328329 EMC ORANGE 1 OCT 3.000 EA 4.4700 13.41 082505636 BD 12C PGR COFFEE 1.000 EA 17.8800 17.88 WH 083431123 GV SLIDER FZ GL 1.000 EA 2.9800 2.98 25CT 088496072 SOUR PATCH KID 1.000 EA 4.4800 4.48 1.9BG 088633280 BUTTERFINGER 2.000 EA 2.6800 5.36 FUNSIZE 089114835 KLX FT 6PK 160 BTS 2.000 EA 8.4400 16.88 089163759 NV OATS&HNY XXL 1.000 EA 6.9800 6.98 089957671 TRIDENT PPPRMNT 2.000 EA 2.2400 4.48 GUM 092210185 GV 9"PAPER PLA 6.000 EA 2.1400 12.84 90CT 092712347 GV SANDWICH 30OCT 2.000 EA 4.8400 9.68 094162291 WIN 16OZ CUPS 60CT 1.000 EA 2.7800 2.78 094295070 BW BLUETRCE 1.000 EA 13.8800 13.88 MOUSE BL N 094734617 CHOC MIX FS 33.90Z 2.000 EA 9.9400 19.88 SUB$182.17 TAX$0.00 TOTAL INVOICE $182.17 CREDITS TOTAL $0.00 BALANCE DUE $182.17 CARMEL CLAY PARKS AND RECR AUTHORIZED BUYER #:07000 ACCOUNT#:6032 2020 2023 2576 P.O.M 38989 INVOICEM 002036 DATE OF SALE M 091515 STORE#:00002787 TRANSACTION#:2036 AUTHORIZATION M 015502 REGISTER#:21 S.K.0 DESCRIPTION QUANTITY UNIT PRICE EXT, PRICE 062287392 SH PCKT HL AST 4CT 1.000 EA 1.7400 1.74 076254886 STICKY LIST PAD 1.000 EA 0.9700 0.97 078719938 WONKA MIX UPS 1.000 EA 9.9400 9.94 093388109 POSTIT NOTES 1.000 EA 3.9700 3.97 COMBO 094401706 POSTIT 2X2 NOTE 1.000 EA 2.8800 2.88 CUBE 094796670 MED WM PLNR WB 1.000 EA 7.9700 7.97 095342406 REESE KITKAT 1.000 EA 14.9400 14.94 ASSORT 095759943 COLORAMA 1.000 EA 12.8800 12.88 SUB$55.29 TAX$0.00 TOTAL INVOICE $55.29 CREDITS TOTAL $0.00 BALANCE DUE $55.29 CARMEL CLAY PARKS AND RECR AUTHORIZED BUYER#:06000 ACCOUNT M 6032 2020 2023 2576 P.O.#:2701 INVOICEM 005530 DATE OF SALE#: 091615 STORE#:00001601 TRANSACTION#: 5530 AUTHORIZATION M 016741 REGISTER M 10 S.K.0 DESCRIPTION QUANTITY UNIT PRICE EXT. PRICE 036093182 POSTIT 3X3 LINED 1.000 EA 2.5700 2.57 3PK 036124160 PEARSONS MINT 1.000 EA 2.3800 2.38 PATTY 040494277 SSAVER ROYAL 1.000 EA 2.8800 2.88 - 063842344 GV HD FORKS 10OCT 1.000 EA 2.8400 2.84 063842346 GV HD SPOONS 2.000 EA 2.8400 5.68 10OCT 065262847 SSAVER WHITE 1.000 EA 2.8800 2.88 065262857 SSAVER CHERRY 1.000 EA 2.8800 2.88 RED 077258039 WELCHS FRT PNCH 3.000 EA 3.9800 11.94 22CT 077502052 M&M'S PEANUT FS 1.000 EA 2.6800 2.68 078169563 WELCHS TANGY FT 2.000 EA 3.9800 7.96 22CT 078292325 HACKY SACKS 4CT 2.000 EA 1.9700 3.94 078292342 NEON SPRINGS BCT 2.000 EA 1.9700 3.94 078292359 MOTORCYCLES 4CT 2.000 EA 2.9700 5.94 078485554 4CT PEACE 4.000 EA 0.9700 3.88 NECKLACE 5404 0003 BEH 3 7 22 150922 D PAGE 4 of 5 9273 2000 N122 010X5404 19415 S.K.0 DESCRIPTION QUANTITY UNIT PRICE EXT.PRICE 078651911 BUTTERFLY PURSE 1.000 EA 1.9700 1.97 4CT 078651916 GLITTER PURSE 4CT 2.000 EA 1.9700 3.94 079503942 EQ FLEX FABRIC 4.000 EA 1.7700 7.08 BNDGS 080382780 ECLIPSE SPRMNT 1.000 EA 5.9800 5.98 GST 082530727 3CT ERASER 4.000 EA 0.5000 2.00 085583317 GV GUMMI BEARS 1.000 EA 3.8700 3.87 40OZ 085999919 CAREBAND ULTRA 1.000 EA 6.8800 6.88 20OCT ® 088006461 CELENCILS 6PK 2.000 EA 1.2500 2.50 PENCIL 088273648 PD BAG 2.000 EA 5.8800 11.76 088453312 FRUIT ROLLUPS MINI 5.000 EA 2.0000 10.00 088786763 4 STICKY BALLS 3.000 EA 0.9700 2.91 089923971 EQ EX ANTIITCH 10Z 2.000 EA 2.8600 5.72 089925189 30CT FASHION 1.000 EA 2.9700 2.97 PENCILS 090001893 8 LIP GLOSS CAN 2.000 EA 2.9700 5.94 091162629 WHOOPIE CUSHION 2.000 EA 1.9700 3.94 091478992 6 PK PUTTY 2.000 EA 1.9700 3.94 092186190 AVENGERS FAVOR 1.000 EA 8.9700 8.97 PACK ®_ 092186198 FROZEN FAVOR 1.000 EA 8.9700 8.97 PACK 092280597 50CT VALUE PACK 1.000 EA 4.9700 4.97 092488419 RICE KRISPY TREATS 2.000 EA 6.9800 13.96 094547757 48 SMILEY FACE FAV 1.000 EA 6.4700 6.47 SUB$187.13 TAX$0.00 TOTAL INVOICE $187.13 CREDITS TOTAL $0.00 ® BALANCE DUE $187.13 CARMEL CLAY PARKS AND RECR AUTHORIZED BUYER#:07000 ACCOUNT M 6032 2020 2023 2576 P.O.M 38989 INVOICEM 002857 DATE OF SALE#: 091815 STORE M 00001601 TRANSACTION M 2857 AUTHORIZATION#:018620 REGISTER M 6 S.K U DESCRIPTION QUANTITY UNIT - PRICE EXT. PRICE 032431607 6PK HANES BRIEF 1.000 EA 5.9700 5.97 2/3T 032619228 FILLER PAPER WR 34.000 EA 0.5800 19.72 036392437 ZIP SLDR FZR GL 4.000 EA 2.8400 11.36 1OCT 041762684 ZIP TAB FZR 2GAL 10 3.000 EA 4.4600 13.38 069264404 ZIP SLDR FRZR QT 2.000 EA 4.4600 8.92 34C 075190078 THERMAL 8.5X11 1.000 EA 12.8800 12.88 50PK 075695929 FG P5 BRIEF 2.000 EA 6.4700 12.94 075858802 70CT MINI BINDR CLIP 1.000 EA 3.8800 3.88 077023254 THERMAL 1.000 EA 19.9700 19.97 LAMINATOR 081440432 25CT HF LTR ASST 2.000 EA 8.4400 16.88 089901945 HANES TB P5 BRIEF 2.000 EA 7.9700 15.94 089949854 LIC P5 ANGRY BRD 4 2.000 EA 7.0000 14.00 093206928 FG 9PK BRIEF 2.000 EA 7.9700 15.94 093206935 FG 9PK BRIEF 2.000 EA 7.9700 15.94 093206936 FG 9PK BRIEF 1.000 EA 7.9700 7.97 095228374 ADHESIVE ROLL 2PK 2.000 EA 3.9700 7.94 SUB$203.63 TAX$0.00 TOTAL INVOICE $203.63 CREDITS TOTAL $0.00 BALANCE DUE $203.63 5404 0003 BEH 3 7 22 150922 D PAGE 5 of 5 903 2000 N122 01DX5404 19415 ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice of 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. 00352108 Walmart Community/RFCSLLC Terms P.O. Box 530934 Atlanta, GA 30353-0934 Invoice Invoice Description Date Number (or note attached invoice(s)or bill(s)) PO# Amount 9/22/15 6032202020232570 Program supplies $ 256.63 9/22/15 6032202020232570 Program supplies $ 577.37 9/22/15 16032202020232570 Program supplies $ 187.13 9/22/15 6032202020232570 Program supplies $ 182.17 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 To $ 1,203.30 120 Clerk-Treasurer Voucher No. Warrant No. 00352108 Walmart Community/RFCSLLC Allowed 20 P.O. Box 530934 Atlanta, GA 30353-0934 In Sum of$ $ 1,203.30 ON ACCOUNT OF APPROPRIATION FOR 108 ESE PO#or INVOICE NO. ACCT#TTITLE AMOUNT Board Members Dept# 1081-2 6032202020232570 4239039 $ 256.63 1 hereby certify that the attached invoice(s), or 1081-3 6032202020232570 4239039 $ 577.37 bill(s)is(are)true and correct and that the 1081-5 603220202023257o 4239039 $ 187.13 materials or services itemized thereon for 1081-10 603220202023257o 4239039 $ 182.17 which charge is made were ordered and received except October 1, 2015 Signature $ 1,203.30 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund