306902 01/06/17 CITY OF CARMEL, INDIANA VENDOR: 371296
ONE CIVIC SQUARE STAKEHOLDER INTERNATIONAL LLC CHECK AMOUNT: $••`"12,875.00'
s ;a CARMEL, INDIANA 46032 510 E 96TH ST CHECK NUMBER: 306902
SUITE 180 CHECK DATE: 01/06/17
INDIANAPOLIS IN 46240
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 20167 12,875.00 OTHER EXPENSES
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Invoice
To: Carmel Utilities
30 W Main Street, 2"d Floor
Carmel, IN 46032
From: Stakeholder International LLC December 6, 2016
510 East 96th Street,Suite 180
Indianapolis, IN 46240
317.660.9244
Cell: 317.727.0333
EI N: 45-4251685
Project Name: Satisfaction Survey--Trash and Recycling
Invoice No. 2016-7
Purchase Order No. W10016
Goods Services
Person Date Goods/Service Description of Goods/Services Cost per item Hourly Total
Providing Provided Provided Rate/Hours
Goods/ServicesWorked
11/17/2016 Trash and Recycling 12,875.00 12,875.00
Survey and Analysis
TOTAL 12,875.00
Signature
5 t -{-lte(J
Printed Name
City of Carmel INDIANA RETAIL TAX EXEMPT PAGE 1
CERTIFICATE NO. 003120155 002 0 PURCHASE ORDER NUMBER
ONE CIVIC SQUARE W10016
CARMEL, INDIANA 46032 FEDERAL EXCISE TAX EXEMPT
THIS NUMBER MUST APPEAR ON INVOICES,A/P
35-6000972 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
11/4/2016 371296
STAKEHOLDER INTERNATIONAL LLC Carmel Utilities
VENDOR 510 E 96TH ST STE 180 SHIP 30 W Main St
INDIANAPOLIS IN 46240 To 2nd Floor
Carmel, IN 46032
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNITOF MEASURE DESCRIPTION UNIT PRICE F)CTENSION
1.00 Each TRASH SURVEY 15,000.00 15,000.00
01-1420-00
PLEASE INVOICE IN DUPLICATE Credit 0.00
Department Account Project I Project Account AMOUNT
PAYMENT 15,000.00
SHIPPING INSTRUCTIONS 'A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P O.
SHIP PREPAID NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
C.O.D.SHIPMENTS CANNOT BE ACCEPTED VOUCHER HAS THE PROPER SWORN AFFADAVIT ATTACHED.
PURCHASE ORDER NUMBER MUST APPEAR ON ALL 'I HEREBY CERTIFY THAT THERE IS AN OBLIGATED BALANCE IN
SHIPPING LABELS THIS APPROPRIATION SUFFICIENT T4 PAY FOR T ABO f ORDER
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO ORDERED BY
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TITLE '
DOCUMENT CONTROL NO. W10016 CLERK-TREASURER