HomeMy WebLinkAbout308436 02/22/17 CITY OF CARMEL, INDIANA VENDOR: 367794
ONE CIVIC SQUARE TAKEFORM CHECK AMOUNT: $*******708.01*
® ?�; CARMEL, INDIANA 46032 11601 MAPLE RIDGE ROAD CHECK NUMBER: 308436
9y�TeN MEDINA NY 14103 CHECK DATE: 02/22/17
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1093 4350100 58481 708.01 BUILDING REPAIRS & MA
Voucher No. Warrant No.
367794 Takeform Allowed 20
11601 Maple Ridge Road
Medina, NY 14103
In Sum of$
$ 708.01
ON ACCOUNT OF APPROPRIATION FOR
109 -Monon Center
PO#or INVOICE NO. kCCT#/TITLE AMOUNT Board Members
Dept#
1093 58481 4350100 $ 708.01 1 hereby certify that the attached invoice(s), or
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
February 16, 2017
Signature
$ 708.01 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
4 qy Inuoi�c_e_#,_•t _84.87=1.-
OWN
ri�11601 MapleRadge Road �"
Y�14103
Medlna NF 6 20 In�olce=Date /17
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80015284198�-= " PO#: 40982
�`- Paymen erms: Net 30
Bill To: Carmel Clay Parks & Recreation Ph: (317) 573-4026
Fax: (317) 571-4136
Attn: Eric Mehl Email: emehl@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 E.2-Changing Room ID 3 135.30 405.90
2 Type E.2-Restroom ID 2 135.30 270.60
3 A0100 Silicone Adhesive Tube 1 10.89 10.89
Net Subtotal: $687.39
Shipping and Handling: $20.62
Net Total:
Ba aI nce due(US.D)D): $708.01
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
r
- Payment Options: - - — --Carmel Clay-Parks-&-Recreation ----- ---- — --
Visa [_�MasterCard Discover American Express Invoice #
Cardholder's Name: Balance Due: $708.01
Card Number:
CVV2#:
Expiration Date:
Card Billing Address:
Signature:
Print Date:2/3/2017 7:53:07AM Page 1 of 1