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319165 11/30/17 (9, CITY OF CARMEL, INDIANA VENDOR: 264001 ONE CIVIC SQUARE RED WING SHOE STORES INC CHECK AMOUNT:CARMEL, INDIANA 46032 P.O.BOX 844329 CHECK NUMBER: 319165 DALLAS TX 75284-4329 CHECK DATE: 1 1/30/17 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 601 5023990 775113365 107.99 OTHER EXPENSES Voucher # 173455 Warrant # Prescribed by State Board of Account City Form No.201(Rev 1995) ALLOWED 20 264001 IN SUM OF$ ACCOUNTS PAYABLE VOUCHER RED WING SHOE CO. CITY OF CARMEL PO BOX 844329 An invoice or bill to be properly itemized must show, kind of service, where DALLAS,TX 75284-4329 performed, dates of services rendered, by whom, rates per day, number of units price per unit, itc. Payee Carmel Water Utility 264001 Purchase Order No. ON ACCOUNT OF APPROPRIATION FOR RED WING SHOE CO. Terms PO BOX 844329 Due Date Board Due Date Members DALLAS, TX 75284-4329 Description Audit Trail INVOICE (or note attached invoice(s)or PO # INV # ACCT # AMOUNT Code DATE INVOICE NUMBER bill(s)) AMOUNT 775-1-13365 01-6200-06 $107.99 11/22/2017 775-1-13365 $107.99 Voucher Total $107.99 Cost distribution ledger classification if claim paid under vehicle highway fund 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 Date Officer INS WII�.'IG ®sH��OES' CITY OF CARMEL UTILITIES/WATER Page : 2 of 5 Kerri Loveall Customer Number: 20506 3450 W 131st St Reference Number: 20171110020506 Carmel IN 46074-8267 Statement Date: 11/10/2017 United States Payment Terms : 30 Days Pay By: 12/10/2017 Please retain a copy of this report for your records. CURRENT ACTIVITY SUMMARY Unit Price Total Total Tax Purchase Total Employee Paid Subsidy Payroll Deduction Billed Total USD $107.99 $0.00 $107.99 $0.00 $107.99 $0.00 $107.99 ACCOUNT SUMMARY Previous Balance urr�l�ctwi€y � Payments Subtotal Account Balance $107.99 .Y "�... ° �;�a.-��i� Disputed Balance $0.00 Total Due: $107.99 CeZD •� For Red Wing Business Advantage Account Program Support, call 888-767-7874 or email support@redwingbusinessadvantageaccount.com ©Multi Service Technology Solutions, Inc. 2017 RED�WIiNG CITY OF CARMEL UTILITIES/WATER Page: 4 of 5 Kerri Loveall Customer Number: 20506 3450 W 131st St Reference Number: 20171110020506 Carmel IN 46074-8267 Statement Date: 11/10/2017 United States Payment Terms: 30 Days Pay By: 12/10/2017 The following is a summary of invoices for which you were billed Please retain a copy of this report for your records. INVOICE STATEMENT Account Name CITY OF CARMEL UTILITIESIWATER Invoice Statement Number 20171110020506 Billed Total $107.99 Employer Transaction Employee Voucher Employee Unit Price Purchase Employee Payroll Billed Total Date Name Code ID Total Total Tax Total Paid Subsidy Deduction USD 11/03/2017 SIMPSON,DO $107.99 $0.00 $107.99 $0.00 $107.99 $0.00 $107.99 N Total: $107.99 $0.00 $107.99 $0.00 $107.99 $0.00 $107.99 For Red Wing Business Advantage Account Program Support,call 888-767-7874 or email support@redwingbusinessadvantageaccount.com @ Multi Service Technology Solutions, Inc. 2017 CITY OF CARMEL UTILITIES/WATER Page : 5 of 5 Kerri Loveall Customer Number: 20506 3450 W 131st St Reference Number: 20171110020506 Carmel IN 46074-8267 Statement Date : 11/10/2017 United States Payment Terms : 30 Days Pay By: 12/10/2017 The following is a summary of invoices for which you were billed Please retain a copy of this report for your records. RE;D WIiNG Invoice# 775-1-13365 FA ' 10ESSale Date 11/03/2017 ffi® Invoice Amount $107.99 RED WING STORE-NOBLESVILL - - - -R CITY OF CARMEL UTILITIES/WAT 17017 MERCANTILE BLVD 3450 W 131st St NOBLESVILLE, IN 46060-3941 Carmel, IN 46074-8267 United States United States Store Location Number: 12027 Customer Number:20506 Voucher Code Employee Name DON SIMPSON Issued By Employer Employee ID Quantitv Item SKU Description Unit Price Total Amount 1 05012M 110 OXFORD,BLACK/YELLOW,ALUM TOE $107.99 $107.99 Summary of Charges Unit Price Total $107.99 Total Tax $0.00 ? Purchase Total $107.99 Employee Paid $0.00 Employee Signature Subsidy $107.99 Payroll Deduction $0.00 Billed Total $107.99 END OF REPORT For Red Wing Business Advantage Account Program Support,call 888-767-7874 or email support@redwingbusinessadvantageaccount.com ©Multi Service Technology Solutions, Inc. 2017