302915 09/12/16 CITY OF CARMEL, INDIANA VENDOR: 361361
d ONE CIVIC SQUARE HELMETS R US CHECK AMOUNT: $*****1,039.00*
�. =q CARMEL, INDIANA 46032 2705 PACIFIC AVE CHECK NUMBER: 302915
TACOMA WA 98402 CHECK DATE: 09/12/16
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1192 4342100 48275 155.00 POSTAGE
1192 4350900 33660 48275 884.00 BIKE HELMETS
VOUCHER NO. WARRANT NO. Prescribed by state Board of Accounts City Form No.201(Rev.1995)
HELMETS R US ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
2705 PACIFIC AVE IN SUM OF$ CITY OF CARMEL
An invoice or bill to be properly itemized must show:kind of service,where performed,dates service
TACOMA, WA 98402 rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc.
$1,039.00 Payee
ON ACCOUNT OF APPROPRIATION FOR Purchase Order#
Dept of Community Service 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
33660 48275 43-509.00 $884.00 1 hereby certify that the attached invoice(s),or 9/1/16 48275 Shipping costs for Public Safety Day bike $155.00
1192 101 1192 101 helmets
48275 43-421.00 $155.00 bill(s)is(are)true and correct and that the 9/1/16 48275 Helmets Public Safety Day $884.00
1192 1 1 101 1 materials or services itemized thereon for 1192 1 101
which charge is made were ordered and
received except
Friday,September 02,2016
Mike Hollibaugh
Director
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 distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
Top Gear Inc. Invoice
DBA Helmets R Us Inc
2705 Pacific Avenue Date invoice#
Tacoma, WA 98402
253-627-2121 Fax#253-572-4225 8/25/2016 48275
Federal ID: 26-0491227
Bill To Ship To
City of Carmel City of Carmel
Accts Payable Receiving
1 Civic Square
1 Civic Square Carmel IN 46032
Carmel IN 46032
S.O. No. P.O. Number Terms Rep/PROMO Ship
33660 Due on receipt 8/25/2016
Quantity Item Code Description Price Each Amount
24 02SMYL 02(P-23)Supreme Bicycle Helmet with Rear Vents and Slide Guide,Small 7.95 190.80
Yellow
24 02MDBL 02(P-23)Supreme Bicycle Helmet with Rear Vents and Slide Guide,Medium 7.95 190.80
Blue
24 02MDRD 02(P-23)Supreme Bicycle Helmet with Rear Vents and Slide Guide,Medium 7.95 190.80
Red
20 02LGRD 02(P-23)Supreme Bicycle Helmet with Rear Vents and Slide Guide,Large Red 7.95 159.00
28 15BL 15 Blue Toddler TX-3AA Helmets 5.45 152.60
120 S hipping cost Shipping Charges 1.25 150.00
Handling Handling 5.00 5.00
Shipment Date:08/25/2016
UPS Tracking# 1Z410EF80341763596; 1Z410EF80340350006;
1Z410EF80340366811; 1Z410EF803405�,00?4. iZ_4Z�F80341235639
i-'EDEItiEp 1
SEP ' M6
D®cs
Total $1,039.00
SEE US AT www.helmetsrus.net
NOTICE: RETURNS Subject to a MINIMUM 15%restocking fee. Must have"RMA" Balance due is subject to 1.5%per month
Authorizatiion Number for Returns. DAMAGED or MISSING items must be reported FINANCE charges,30 days from invoice date
within 20 days of shipment.