322620 03/12/18 4+u CggF
CITY OF CARMEL, INDIANA VENDOR: 367794
�y 1 ONE CIVIC SQUARE TAKEFORM CHECK AMOUNT: $*"***1,354.42*
CARMEL, INDIANA 46032 11601 MAPLE RIDGE ROAD CHECK NUMBER: 322620
9y_ MEDINA;NY'14103 CHECK DATE: 03/12/18
1tnH�.
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1091 4463000 67991 1,354.42 FURNITURE & FIXTURES
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
VOUCHER NO. WARRANT NO.
An invoice of bill to be properly itemized must show;kind of service,where performed,dates service rendered,by
Vendor# 367794 Allowed 20 whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc.
Takeform Payee
11601 Maple Ridge Road
Medina, NY 14103 In Sum of$ Purchase Order#
367794 Takeform Terms
$ 1,354.42 11601 Maple Ridge Road Date Due
Medina, NY 14103
ON ACCOUNT OF APPROPRIATION FOR
109-Monon Center
PO#ornvolce Description
Dept# INVOICE NO. ACCT#ffITLE AMOUNT Invoice Date Number (or note attached invoices)or bill(s)) PO# Amount
Room Signage for Training and East
1091 67991 4463000 $ 1,354.42 Board Members 2/14/18 67991 Studio Rooms 5085 $ 1,354.42
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
$ 1,354.42 Total $ 1,354.42
March 7,2018
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
Cost distribution ledger classification if
claim paid motor vehicle highway fund Signature 20_
Accounts Payable Coordinator Clerk-Treasurer
Title
Q'u&um Group, LLC. DBA
:Invoice _ 6,799�1 I o-i -- tnvo�ceDated c7T
PO#: 50853
adtna=NY 14103 `
800-528=1`398- Payment Terms: Net 30
Bill To: Carmel Clay Parks & Recreation Ph: (317) 573-4026
Fax: (317) 571-4136
Attn: Susan Beaurain Email: sbeaurain@carmelclayparks.com
1411 E. 116th Street
Carmel, IN 46032
Job Name: CAR0061: Carmel Clay Parks & Recreation
Line Description Quantit Unit Net Net
y Price Price Ext
1 Type 1.2: Rm ID 1 Line with 8.5x11 Slide-In F55B-N1 3 252.35 757.05
2 Type M: Flag Mount 2 272.95 545.90
3 A0100 Silicone Adhesive Tube 1 12.38 12.38
Net Subtotal: $1,315.33
Shipping and Handling: $39.09
Net Total:
Balance Due (USD): $1,354.42
Terms are Net 30. Past due accounts are subject to 1% interest per month. We reserve the right to hold future orders or
ship future orders COD if terms are not adhered to. Purchaser is responsible for all fees and expenses including but not
limited to, attorneys and collection fees incurred by Takeform in the enforcement of this agreement.
Credit cards accepted. Please complete form below and fax to Accounts Receivable at 585-798-8889
-__ _P_ayment-Options: -- __ Carmel Clay-Parks&Recreation — -- --- --- --
R Visa F�MasterCard Discover American Express Invoice #
Cardholder's Name: &Bala"nWIDUe "$x;354:42
Card Number:
CVV2#:
Expiration Date:
Card Billing Address:
Signature:
Print Date:2/15/2018 8:23:33AM Page 1 of 1