251164 11/04/15 ,Coq
f CITY OF CARMEL, INDIANA VENDOR: 358122
;, ® ONE CIVIC SQUARE L-COM GLOBAL CONNECTIVITY CHECK AMOUNT: $"`*"'""86.74"
r. � CARMEL, INDIANA 46032 PO BOX 55758 CHECK NUMBER: 251 164
�4j�_ON�` BOSTON MA 02205-5758 CHECK DATE: 11/04/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1115 4237000 2602712 3.64 REPAIR PARTS
1115 4237000 33116 2602712 83.10 CATS SHEILD
Global INVOICE
Please Remit to: Bank Transfers To:
Lm C-1.911-
ConnectivitPO. 55758 Citibank,Miami,FL
y
Boston,MA 02205-5758 Branch#61-Boca Raton,FL
ABA#266-086-554
Phone-978-682-6936 Fax-978-689-9484 Account#9119834971
Swift Code CITIUS33
Accouol Name L-com.Inc.
Invoice # 2602712 Invoice Date 16-00-15 Page # I UStnnds0"1'
Sold CARMEL,CITY OF COMMUNICATIONS DEPT
To: 31 FIRST AVE NW Ship CARMEL, CITY OF COMMUNICATIONS DEPT
CARMEL, IN 46032 To: Attn: 33116
31 FIRST AVE NW
CARMEL, IN 46032
Ship Via Shin Date- - Due Date Purchase Order# Our Order# Order Date
UPS GD 16-Oct-15 15-Nov-15 33116 4221723 21-Sep-15
Shipment# Terms Buyer Account# Salespeople
5343399 NET 30 JANET ARNONE 171655 80 616
FORD QTY/
UNIT
IL`
IN/ITEM#%DESCRIPTION' CUSTOMER 1"PEni# Unl -.BALANCE;,: ,SHIPPED PRICE At10UN1' ,
Thank you for your order, we appreciate your business.
2 HGLN-CAT5J EA 3 2 41.55000 83.10
LP,INDOOR MP CATS SHIELD RJ45 0
ALL CLAINIS MUST 13E MADE SEVEN(7)DAYS AFTER RECEIPT.
CERTIFICATE OF COMPLIANCE:This is to certiry that the product shipped against Four purchase order Subtotal (USD) 83.10
conforms to the requirements of your purchase order.
CERTIFICATE OF ORIGIN:This Certifies the items listed above originated in the country indicated on the
individual packaging label.Arthur;McChesney,Quality Systems Leader,L-Cum Global Connectivity
I
Freight(USD) 3.64
Total(USD) 86.74
SI-IIPPING TRACKING 4 IZ7550610353232898
Created On: 10/16/15 1:58:48 PM Printed On: 10/19/15 8:27:18 AM
INDIANA RETAIL TAX EXEMPT Page 1 of 1
City ®f Carmel
CERTIFICATE NO.003120155 002 0 PURCHASE ORDER N,UMMBER
FEDERAL EXCISE TAX EXEMPT 33116 K
ONE CIVIC SQUARE 35-6000972 THIS NUMBER MUST APPEAR ON INVOICES,AM
CARMEL, INDIANA 46032-2584 VOUCHER,DELIVERY MEMO,PACKING SLIPS,
SHIPPING LABELS AND ANY CORRESPONDENCE
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL-1997
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
9/21/2015 358122 Data surge protectors
L-COM GLOBAL CONNECTIVITY Communications
VENDOR PO BOX 55758 SHIP 31 1st Avenue N.W.
TO Carmel, IN 46032-
BOSTON , MA 02205--5758 (317) 571-2576
CONFIRMATION BLANKET CONTRACT PAYMENTTERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Department: 1115 Account: 42-370.00 Fund: 101 General Fund IV
3 Each HGLN-CAT5J LP, Indoor MP CAT5 Shield RJ45 $41.55 $124.65
3 Each AL-CAT5SJW LP, Outdoor CAT5 Sheild RJ45 $38.43 $115.29
Sub Total $239.94
I
Send Invoice To:
Communications Quote No. 9843264
31 1st Avenue N.W.
Carmel, IN 46032-
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT I PROJECTACCOUNT AMOUNT
PAYMENT $239.94
SHIPPING INSTRUCTIONS A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
'SHIP PREPAID. VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
'C.O.D.SHIPMENT CANNOT BE ACCEPTED. I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
'PURCHASE ORDER NUMBER MUST APPEAR ON ALL SHIPPING LABELS. THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
'THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945
ORDERED BY
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
TITLE
DOCUMENT CONTROL NO. 33116 CLERK-TREASURER
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 Date Invoice# Description Amount
Dept. Fund# (or note attached invoice(s) or bill(s))
10/16/15 I 2602712 I I $3.64
1115 101
10/16/15 I 2602712 I I $83.10
1115 101
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
L-COM GLOBAL CONNECTIVITY
PO BOX 55758 IN SUM OF $
i
BOSTON, MA 02205-5758
$86.74
ON ACCOUNT OF APPROPRIATION FOR
PO#/Dept. INVOICE NO. ACCT#/Fund AMOUNT Board Members
2602712 42-370.00 $3.64 1 hereby certify that the attached invoice(s), or
1115 I 101
33116 I 2602712 I 42-370.00 I $83.10 bill(s) is (are) true and correct and that the
1115 101
materials or services itemized thereon for
which charge is made were ordered and
received except
Thursday, October 29, 2015
kit—
erry r kett, Director
Cost distribution ledger classification if
claim paid motor vehicle highway fund