HomeMy WebLinkAbout253918 01/26/16 y W,44A,y
CITY OF CARMEL, INDIANA VENDOR: 00351406
ONE CIVIC SQUARE L E I U CHECK AMOUNT: $*******595.00*
CARMEL, INDIANA 46032 ATTN:CAPTAIN STEVEN S SAMBAR CHECK NUMBER: 253918
9�;�TON 100 WEST FIRST STREET SUITE 973 CHECK DATE: 01/26/16
LOS ANGELES CA 90012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4355300 16-20 595.00 ORGANIZATION & MEMBER
0
INDIANA RETAIL TAXEXEMPT Pagel of 1
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CERTIFICATE N0.003120155 0020 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 33367
ONE CIVIC-SQUARE 35.-6000972 THIS NUMBER MUST APPEAR ON INVOICES,AIP
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
MM/2016' 00351406
L E.I.0 Carmel Police '
VENDOR :ATTN: CAPTAIN STEVEN S SAMBAR.. . -SHIP 3 Civic-Square
160 WEST FIRST STREET SUITE 073 To . Carmel,IN 46032-
..LOS,
CONFIRMATION BLANKET' . CONTRACT PAYMENT TERMS FREIGHT
QUANTITY. UNIT,OF MEASURE DESCRIPTION UNIT PRICE EXTENSION.
Department: 1110 Account.,. 43=553:00 Fund: 101 "General Furid
_
1 Each Annual membership dues _ $596.00, 4595.00.
Sub Total
:$595.00
Send Invoice To:
Carmel Police
3 Civic Square
Carmel,IN 46032-
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
PAYMENT
SHIPPING INSTRUCTIONSQJ
'AO VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.D.. NUMBER IS MADE A'
PART OF THE VOUCHER AND EVERY INVOICE AND.VOUCHER HAS THE:PROPER SWORN .
'SHIP PREPAID. AFFIDAVIT ATTACHED. I HEREBY CERTIFY THAT THERE IS ANUNOBLIGATED BALANCE IN
-C.O.D.SHIPMENT CANNOT BE ACCEPTED. THIS APPROPRIATIO SU FICIENT TO PAY.FOR THE ABOVE ORDER.
`PURCHASE ORDER NUMBER MUST APPEAR ON ALL SHIPPING LABS
'THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 194
AND ACTS AMENDATORY THEREOF.AND SUPPLEMENT THERETO. ORDERED BY' /
TITLE
CONTROL NO. 33367 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))
01/22/16 16-20 annual membership dues $595.00
1110 101
I hereby certify that the attached invoice(s),or bill(s), is(are)true and correct and I have audited same in accordance
with IC 5-11-10-1.6
, 20
Clerk-Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
L E I U
ATTN: CAPTAIN STEVEN S SAMBAR
IN SUM OF$
100 WEST FIRST STREET SUITE 973
LOS ANGELES, CA 90012
$595.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police
CEO#'/Dept. INVOICE NO. ACCT#/Fund AMOUNT
Board Members
16-20 I 43-553.00 I $595.00 1 hereby certify that the attached invoice(s), or
1110 101
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
Friday, January 22, 2016
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Cost distribution ledger classification if
claim paid motor vehicle highway fund