319176 11/30/17 CITY OF CARMEL, INDIANA VENDOR: 307600 CHECK AMOUNT: $*******650.00*
d ONE CIVIC SQUARE TREASURER OF STATE
r ?4 CARMEL, INDIANA 46032 INDIANA STATE BUDGET AGENCY 2�2 CHECK NUMBER: 319176
gMiroH E° 200 WEST WASHINGTON ROOM CHECK DATE: 1 1/30/17
INDIANAPOLIS IN 46204
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4351501 18ISDT0023 650.00 EQUIPMENT MAINT CONTR
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
Vendor# 307600 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
TREASURER OF STATE IN SUM OF$ CITY OF CARMEL
INDIANA STATE BUDGET AGENCY An invoice or bill to be properly itemized must show:kind of service,where performed,dates service
200 WEST WASHINGTON ROOM Z�Z rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc.
INDIANAPOLIS, IN 46204
Payee
$650.00
ON ACCOUNT OF APPROPRIATION FOR Purchase Order#
Carmel Police 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
18ISDT-0023 43-515.01 $650.00 I hereby certify that the attached invoice(s),or 11/29/17 181SDT-0023 annual maintenace $650.00
1110 101 1110 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
Wednesday, November 29,2017
av-,, EN. A.,
Jim Barlow
Chief
1 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
20Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
Indiana State Department of Toxicology
To: Carmel Police Department
3 Civic Square
Carmel, IN 46032
Invoice Number: 18ISDT-0023 Invoice Date: November 20, 2017
Item: 2018 Evidential Breath Test Instrument Maintenance Agreement
o� Pay this amount $650
You may pay online with a debit or credit card by going to: https://www.pgyingov.com/toxicology
If paying by check or money order,please make them payable to: Treasurer of State
Remit to: Indiana State Budget Agency
200 W. Washington Street, Rm 212
Indianapolis,IN 46204
Retain this portion for your records