252745 12/15/15 CITY OF CARMEL, INDIANA VENDOR: 367042
ONE CIVIC SQUARE PAPERLESS BUSINESS SYSTEMS CHECK AMOUNT: $*******300.00*
CARMEL, INDIANA 46032 1417 FOURTH AVE,4TH FLOOR CHECK NUMBER: 252745
SEATTLE WA 98101 CHECK DATE: 12/15/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4358300 H0001012 150.00 OTHER FEES & LICENSES
1091 4358300 H0001012 150.00 OTHER FEES & LICENSES
Invoice
.1 °' . 1417 Fourth Ave., 4th Floor Invoice Number H-0001012
Seattle, Washington 98101 —1, Invoice Date 12/7/2015
p. 206.256.0771.33Payment°� Payment Terms Net 10
paperless
siness systems f. 206.282.3312
buDC 8 2015
PO Number
-
BY:
SOLD TO: SHIP TO:
Carmel Clay Parks& Recreation Carmel Clay Parks& Recreation
1411 E 116th Street 1411 E 116th Street
Carmel, IN 46032 Carmel, IN 46032
United States United States
Description Amount
eReq Hosting (SAAS)
`Renewal Period: 12/16/15 - 05/27/16
eRequester Hosted - 5 Additional Named Users (prorated) $300.00
i
All payments and dollar amounts are in U.S. Dollars. Subtotal $300.00
Remit to:Paperless Business Systems,Inc.,1417 Fourth Avenue,4th Floor,Seattle,WA 98101 Tax $0.00
p.206.256.0771 (.206.282.3312'www.paperlessbusiness.com'ardepartment@paperlessbusiness.com Total $300.00
Bank of America,WA3-177-01-01 Wire Information: ACH Information:
408 Pike St. ABA#026009593 Routing#:125000024
Seattle,WA 98101 Swift#:BOFAUS3N Acct#:138019775709(Savings)
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.
367042 Paperless Business Systems Terms
1417 Fourth Avenue, 4th Floor
Seattle, WA 98101
Invoice Invoice Description
Date Number (or note attached invoice(s)or bill(s)) PO# Amount
12/7/15 H000101-2 eRequester Additional Users (prorated) 39308 $ 150.00
12/7/15 H0001012 eRequester Additional Users (prorated) 39308 $ 150.00
Total $ 300.00
1 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.
367042 Paperless Business Systems Allowed 20
— 1417 Fourth Avenue, 4th Floor
Seattle, WA 98101
In Sum of$
$ 300.00
ON ACCOUNT OF APPROPRIATION FOR
108 ESE/109 Monon Center
PO#or Board Members
Dept# INVOICE NO. CCT#/TITL AMOUNT
1091 H0001012 4358300 $ 150.00 1 hereby certify that the attached invoice(s), or
1081-99 H0001012 4358300 $ 150.00 bill(s)is(are)true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
December 10, 2015
1PAN"VA"
Signature
$ 300.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund