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ONE CIVIC SQUARE KUSSMAUL ELECTRONICS CO IN CHECK AMOUNT: $'"t"""381.76'
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CARMEL, INDIANA 46032 170 CHERRY AVE CHECK NUMBER: 302945
M��'roN-�o. WEST SAYVILLE NY 11796-1221 CHECK DATE: 09/12/16
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4350900 83355 381.76 OTHER CONT SERVICES
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
KUSSMAUL ELECTRONICS CO IN ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
170 CHERRY AVE IN SUM OF$ CITY OF CARMEL
An invoice or bill to be properly itemized must show:kind of service,where performed,dates service
WEST SAYVI LLE, NY 11796-1221 rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc.
$381.76 Payee
Purchase Order#
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Terms
Date Due
PO# ACCT# DATE INVOICE# DESCRIPTION
DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT
83355 43-509.00 $381.76 1 hereby certify that the attached invoice(s),or 9/6/16 83355 $381.76
1120 101 1120 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
Tuesday,September 06,2016
David Haboush
Fire Chief
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-
Cost
20Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
W KIEEUSSMAUL Remit To: Invoice No 0000083355.
Phone:800-346-0857 170 Cherry Ave. Sales Order No 073645-00
Fax:631-567-5826 West Sayville,
E-Mail:sales@kussmaul.com NY 11796
.Packing List No 079923
Bill to : CAR033 Ship to :
CARMEL FIRE DEPARTMENT CARMEL FIRE DEPARTMENT
2 CIVIC SQUARE 2 CIVIC SQUARE
CARMEL IN 46032 CARMEL IN 46032
United States United States
Phone(317)571-2600
Customer PO Number Invoice Date Terms FOB Ship Via Coordinator
E344 08/31/2016 NET 30 DAYS WEST SAYVILLE,NY FED-EX GROUND RESIDENTIAL CST
Item Part/Description Serial Number Quantity Unit Price Extended Price
000010 REPAIR OF 091-187-12-REMO 1.00 357.00000 357.00
S/N:A1583 REPAIR#:R042220
000020 SHIPPING 1.00 24.76000 24.76
Shipping/Freight Charge,Ref Shipper No 079923
Shipped on 08/31/2016
Thank you for your order. Total Item Price 357.00
Tracking# 700305497930 Shipping 24.76
Sales Tax 0.00
Total Inv Price US$381.76
Please pay balance due by Friday September 30 2016.
CUSTOMER COPY
Page 1 Authorized Signature