HomeMy WebLinkAbout253222 01/11/16 C,q
CITY OF CARMEL, INDIANA VENDOR: 367794
ONE CIVIC SQUARE TAKEFORM CHECK AMOUNT: $********84.99*
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CARMEL, INDIANA 46032 11601 MAPLE RIDGE ROAD CHECK NUMBER: 253222
9MiTON_�. MEDINA NY 14103 CHECK DATE: 01/11/16
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1093 4350100 49710 84.99 BUILDING REPAIRS & MA
No hi rform::7 �nvoice49 '�0
REcF
EdInvoice','Date:Medha N'14103 , DEC 10
800-528-1398 PO#: XX-3035
� : Payment Terms: Net 30
Bill To: Carmel Clay Parks & Recreation Ph: (317) 573-4026
Fax: (317)571-4136
Attn: Mike Kilpatrick Email: mkilpatrick@carmelclayparks.com
1411 E. 116th Street
Carmel, IN 46032
Job Name: CAR0061: Monon Community Center
Line Description Quantity Unit Net Net
Price Price Ext
1 Type G: Room ID (1 Line) 1 67.10 67.10
2 A0100 Silicone Adhesive Tube 1 10.89 10.89
Net Subtotal: $77.99
Shipping and Handling: $7.00
Net-Total
B'alanceQue(USD)
Terms are Net 30. Past due accounts are subject to 1% interest per month. We reserve the right to hold future orders or
ship future orders COD if terms are not adhered to. Purchaser is responsible for all fees and expenses including but not
limited to, attorneys and collection fees incurred by Takeform in the enforcement of this agreement.
Credit cards accepted. Please complete form below and fax to Accounts Receivable at 585-798-8889
Payment Options: Carmel Clay Parks&Recreation
Invoice #
E]Visa [3 MasterCard Discover American Express
Balanc"ue: .. $84:99—
Cardholder's Name:
Card Number: C V V 2#:
Expiration Date:
Card Billing Address:
Signature:
Print Date:12/4/2015 4:37:03PM Page 1 of 1
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.
367794 Takeform Terms
11601 Maple Ridge Road
Medina, NY 14103
Invoice Invoice Description
Date Number (or note attached invoice(s)or bill(s)) PO# Amount
12/4/15 49710 Sign for Storage Closet XX3035 $ 84.99
Total $ 84.99
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
i
Voucher No. Warrant No.
367794 Takeform Allowed 20
11601 Maple Ridge Road
Medina, NY 14103
In Sum of$
$ 84.99
ON ACCOUNT OF APPROPRIATION FOR
109 -Monon Center
I
l
PO#or INVOICE NO. ACCT#/TITL AMOUNT i Board Members
Dept#
; I hereby certify that the attached invoice(s), or
1093 49710 4350100 $ 848i9
I 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
I
December 22, 2015
Signature
$ 84.99 Accounts Payable Coordinator
Cost distribution ledger classification if l Title
claim paid motor vehicle highway fund
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