308511 02/28/17 CITY OF CARMEL, INDIANA VENDOR: 358637
® ONE CIVIC SQUARE CUMMINS CROSSPOINT CHECK AMOUNT: $*********2.21
CARMEL, INDIANA 46032 75 REMITTANCE DR,SUITE 1701 CHECK NUMBER: 308511
CHICAGO IL 60675-1701 CHECK DATE: 02/28/17
roN a
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4237000 001-66564 2.21 REPAIR PARTS
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201 (Rev.1995)
Vendor# 358637 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
CUMMINS CROSSPOINT IN SUM OF$ CITY OF CARMEL
75 REMITTANCE DR, SUITE 1701 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.
CHICAGO, IL 60675-1701
Payee
$2.21
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
001-66564 42-370.00 $2.21 1 hereby certify that the attached invoice(s),or 2/21/17 001-66564 $2.21
1120 101 1120 101
bill(s)is(are)true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
Tuesday, February 21,2017
David Haboush
Fire Chief
I hereby certify that the attached invoice(s),or bill(s),is(are)true and correct and I have
audited same in accordance with IC 5-11-10-1.6
, 20
Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
Payment terms are 30 days from invoice date unless otherwise
Sales and agreed upon in writing.
Remit To:Cummins Crosspoint
Service 75 Remittance Dr-Ste1701
® Chicago, IL 60675-1701
INDIANAPOLIS BRANCH INVOICE NO
3621 W MORRIS STREET
INDIANAPOLIS, IN 46242-0917
(317)244-7251 001-66564
Remit To:75 Remittance Dr-Ste1701
Chicago,IL 60675-1701
SOLD TO SHIP TO
CARMEL FIRE DEPARTMENT CARMEL FIRE DEPARTMENT
2 CIVIC SQUARE 2 CIVIC SQUARE PAGE 1 OF 1
CARMEL, IN 46032 CARMEL, IN 46032
CONTACT Eric Marroon ON ACCOUNT CHARGE
HT
DATE CUSTOMER ORDER NO. DATE IN SERVICE ENGINE MODEL PUMP NO. EQUIPMENT MAKE
16-FEB-2017
CUSTOMER NO. SHIP VIA FAIL DATE ENGINE SERIAL NO. CPL NO. EQUIPMENT MODEL
400706 CUSTOMER PICK UP 2
REF.NO. SALESPERSON PARTS DISP. MILEAGE/HOURS PUMP CODE UNIT NO.
CE-1 00-621190 1115
QUANTITY BACK QUANTITY et
0 ORDERE.1 SHIPPED NUMBER DESCRIPTION CODE UNIT PRICE AMOUNT
1 1 145530 SEAL,O RING CECO 2.21 2.21
THANK YOU VERY MUCH FOR YOUR BUSINESS.
A MINIMUM 15%RESTOCKING FEE WILL BE ASSESSED ON
PARTS ACCEPTED FOR RETURN.
NO RETURNS ALLOWED ON OPEN ELECTRONIC
COMPONENTS,OR SPECIAL ORDER PARTS WHICH ARE NOW
RETURNABLE TO THE VENDOR.RGA NUMBER MUST BE
OBTAINED BEFORE RETURN IS MADE.
TRACKING# SUB TOTAL: 2.21
Billing Inquiries?Call(877)480-6970 or email CBSCrossPointReceivables@cummins.com
THERE ARE ADDITIONAL CONTRACT TERMS ON THE REVERSE SIDE OF THIS TOTAL AMOUNT: US$ 2.21
DOCUMENT, INCLUDING LIMITATION ON WARRANTIES AND REMEDIES,WHICH ARE
EXPRESSLY INCORPORATED HEREIN AND WHICH PURCHASER ACKNOWLEDGES HAVE
BEEN READ AND FULLY UNDERSTOOD.
RECEIVED BY(print name) SIGNATURE DATE