316732 09/29/17 o
CITY OF CARMEL, INDIANA VENDOR: 201250
ONE CIVIC SQUARE MID STATE TRUCK EQUIP CORP CHECK AMOUNT: $*****5,781.00*
CARMEL, INDIANA 46032 11020 ALLISONVILLE RD CHECK NUMBER: 316732
FISHERS IN 46038 CHECK DATE: 09/29/17
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4350100 100736 96294 5,781.00 BUILDING REPAIRS & MA
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MID-STATE TRUCK EQUIPMENT Invoice
11020 Allisonville Road Invoice Number:
Retail#: 001104675-001-0 96294
Fishers, IN 46038
stB-sc,tcu Yrwk£gwpra';eatt inV01Ce Date:
Phone: 317.849.4903
www.mid-statetruck.com 9/19/2017
Fax : 317.849.6441
Bill To Ship To
CITY OF CARMEL CLAYTON BELL
ONE CIVIC SQUARE cbell@carmel.in.gov
CARMEL, IN 46032 '17 F250
Handling charge added to Credit Customer P.O. No._ i Terms I
Card orders over$500.00: 2.5%
Visa, MIC, AMEX& DiscoverIDD 73 ? NET 25 Days
Sales Rep ID Shipping Method Ship Date Due Date
BE cust. pick-up 9/11/2017 10/14/2017
Qty Item Code Description Price Ea. Extension
***MUNICIPAL SALE***
1 BOSS82VXT BOSS 8'2 POWER V-XT PLOW w/SH2, LOCKING 5,331.00 5,331.00
CYLINDERS & SL3 LED LIGHTING
1 MSC 10182B BOSS 812 STEEL V-XT BLADE CRATE 0.00
S/N_401341758
1 MSC15005C V-PLOW BOX; 7'6, 8'2, 9'2; W/LED SL3 Submitted To 0.00
S/N_401311487
1 MSCO1565 BOSS RUBBER SNOW DEFLECTOR SEP 2 6 2017 0.00
1 LTA10200 BOSS 2017 RT3 FORD SUPER DUTY 0.00
UNDERCARRIAGE
I MSC10230 BOSS 2017 FORD HALOGEN L/A 13 PIN Clerk Treasurer 0.00
1 6410A-MG ECCO Strobe Beacon: low profile, 12-80VD 0.00
joules, replaceable U flashtube, magnet mount, amber
1 MSC 15100 V-PLOW CONTROL KIT SMARTTOUCH2 0.00
1 LABOR COMPLETE ASSEMBLY & INSTALLATION 450.00 450.00
Serial # Building Maintenance
Account #
Serial # Department #
Subtotal $5,781.00
Cash [ ] Check [ ] # Sales Tax (7.0%) $0.00
Credit Card [ ] Auth. # Total Invoice Amount $5,781.00
Payment Received $0.00
Received by Date _._.____. _.__.___..... ___ .
Balance Due $5,781.00
3
Thank you for your business!
Page 1 of I
TAIL
CERTIFICA ENO 003 201 5M
EPT
02 0 PURCHASE ORDER NUMBER
eity ®f Carmel
I FEDERAL EXCISE TAX EXEMPT _ 100736
ONE CIVIC SQUARE 35-6000972- -_ THIS NUMBER MUST APPEAR ON INVOICES,A/P
CARMEL, INDIANA 46032-2584 VOUCHER,DELIVERY MEMO,PACKING SLIPS,
SHIPPING LABELS AND ANY CORRESPONDENCE
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL-1997
I
!PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
9/19/2017 201250
MID STATE TRUCK EQUIP CORP General Administration
VENDOR 11020 ALLISONVILLE RD SHIP 1 Civic Square
TO Carmel,IN 46032-
FISHERS,IN 46038-
' PURCHASE ID BLANKET CONTRACT PAYMENT TERMS FREIGHT
19139
QI UANTITY MEASURE EA
OF --- --- - -- ---- ------
- _ SURE _ DESCRIPTION UNIT PRICE EXTENSION
Department: 1205 Fund: 101 General Fund
Account: 43-501.00
1 Each Building Repairs and Maintenance $5,781.00 $5,781.00
Sub Total $5,781.00
7
jjd 1
T
Send Invoice To: s
Dept of Administration
1 Civic Square `
Carmel,IN 46032-
PLEASE INVOICE IN DUPLICATE
DEPARTMENT P ACCOUNTPROJECT PROJECT ACCOUNT I AMOUNT
PAYMENT $5,781.00
SHIPPING INSTRUCTIONS A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O. NUMBER IS MADE A
PART OF THE VOUCHER AND EVERY INVOICE AND VOUCHER HAS THE PROPER SWORN
'SHIP PREPAID. AFFIDAVIT ATTACHED. I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
'C.O.D.SHIPMENT CANNOT BE ACCEPTED. THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
'PURCHASE ORDER NUMBER MUST APPEAR ON ALL SHIPPING LABE
'THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 194
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. ORDERED BY
TITLE
CONTROL NO. 100736 CLERK-TREASURER
it
Cityof Carmel
Inventory Acquisition Notification
SECTION I
Department Name: Fund Source: Transaction Date:
General Administration
Type of Transaction: 1)Purchase: 2)Transfer: 3) Location Change 5)Other:
(check one) X (Complete transfer section) (Complete transfer/location
section
SECTION II
Description of Asset: Asset Number:
Item: Manufacturer/Brand:
Serial#: Model#: VIN#:
(Where Apoplicable)
Location: Estimated Life Expectancy Value of Asset:
(miles,hours,months,years) (Please attach or forward a copy of the invoice with
document cost,K donated fair market value)
SECTION III
Transfer or Location Change: Permanent: Transfer Date:
Temporary:
Department Transferred From: Previous Location of New Location of property:
property:
Dept. Director's Signature: Date: 9/19/2017
Clerk-Treasurer's Signature: Date:
Quotation
MID-STATE TRUCK EQUIPMENT INC
Date Quotation #
11020 ALLISONVILLE ROAD - FISHERS, IN 46038 8/29/2017 7956
MHt.d-sw'%9e,'T'r.u.9kgrpmcnc PHONE 1-800-540-4479 1-317-849-4903
�M+m.x►apais
FAX 1-317-849-6441
1 DQWI TRUCK fQV^*M&%0VAT*N
Name /Address Ship To
CITY OF CARMEL CLAYTON BELL
ONE CIVIC SQUARE cbell@carmel.in.gov
CARMEL, IN 46032 '17 F250
Purchase Order# Terms Rep Project Good Thru
NET 25 Days BE 10.31.17
Qty Item Description Rate Total
1 BOSS80SU... BOSS RT3 8'0" SUPER-DUTY SNOWPLOW WITH 4,590.00 4,590.00
SMARTHITCH2& SL3 LED LIGHTING
--INC. RUBBER DEFLECTOR,ALL TRUCK-SIDE
EQUIPMENT& STROBE LIGHT
1 BOSS82VXT BOSS 8'2 POWER V-XT PLOW w/SH2, LOCKING 5,331.00 5,331.00
CYLINDERS & SL3 LED LIGHTING
--INC. RUBBER DEFLECTOR, ALL TRUCK-SIDE
EQUIPMENT& STROBE LIGHT
1 LABOR COMPLETE ASSEMBLY& INSTALLATION 450.00 450.00
--EITHER PLOW PKG.
***ALL QUOTED UNITS IN STOCK, READILY
AVAILABLE
Subtotal $10,371.00
Sales Tax (7.0%) $0.00
Total $10,371.00