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Home My WebLink About323923 04/06/18 CITY OF CARMEL, INDIANA VENDOR: 197000 CHECK AMOUNT: $*****1,102.69* .j, •;•; ONE CIVIC SQUARE CINTAS CORPORATION#18 ?q CARMEL, INDIANA 46032 PO BOX 630803 CHECK NUMBER: 323923 gMiroN co CINCINNATI OH 45263.0803 CHECK DATE: 04/06/18 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 2201 4356501 4004356052 281.69 LAUNDRY SERVICE 2201 4356501 4004675888 281.69 LAUNDRY SERVICE 2201 4356501 4004692597 393.85 LAUNDRY SERVICE 651 5023990 5010371485 145.46 OTHER EXPENSES '3 VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201 (Rev.1995) Vendor# 197000 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER- CI NTAS CORPORATION#18 IN SUM OF$ CITY OF CARMEL PO BOX 630803 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. CINCINNATI, OH 45263-0803 Payee $957.23 Purchase Order# ON ACCOUNT OF APPROPRIATION FOR Street Department 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 4004356052 43-565.01 $281.69 1 hereby certify that the attached invoice(s),or 3/12/18 4004356052 $281.69 2201 2201 2201 2201 4004675888 43-565.01 $281.69 bill(s)is(are)true and correct and that the 3/26/18 4004675888 $281.69 2201 2201 materials or services itemized thereon for 2201 2201 I 4004692597 I 43-565.01 I $393.85 3/27/18 I 4004692597 I I $393.85 2201 2201 which charge is made were ordered and 2201 2201 received except Tuesday,April 03,2018 Huffman, Dave Director I hereby certify that the attached invoice(s),or bill(s), is(are)true and correct and I have audited same in accordance with IC 5-11-10-1.6 , 20— Cost 20Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer FUR ALL NOR-PAYHERT RELATED CORRESIPO UCE: ciNrAs. GIl1TAS CORPORATIONX001"a 1001$ CINTAS FAX 1-937-630-3545C91Si® E� SUCi'aILLI��C 1-��-�74-6827 9949 PARK ORAS OR. # READY FOR THE WORKDAY'" INDIANAPOLIS, IN 406235 PAYOEOT INQUIRY Y37-237-3760 INVOICE SHIP TD: CITY OF CARMEL INVOICE D 4004692597 3400 M 131ST ST ZHUDICE DATE 031'2712010 CARMEL, IN 46074-8267 CUSTOMER REF 6 STREET DEPT SOLD TO # 12146338 PAYER D 12156723 BILL TH: CIO DONNIE CAL.LAHAN PAYNENT TERNS NET 10 EOPI SORT T 00180002550 3400E9 13151' ST STREET DEPT CINTAS CHUTE 51 1 DAY 2 / STOP 015 3400 �4 WESTFIELD, IN 46074 EOP ILQCR# HATERIAL DESCRIPTION FRED ESCH OTY UNIT PRICE LIKE TOTAL TAx 0001 X332 JEARICARHARTT CARPENTERIDETHIll 01 F 11 0.733 8.06 m SHAUN PRIVETT SUBTOTAL - 8.06 0002 X381 JEANICARHART/RELX FITIDK DENIM 01 F 11 0.683 7.51 p DAVE LUVEALL SUBTOTAL - 7.51 O003 231 JEANICARHARTI RELX FIT/DK DE14-LN 01 F :E1 0.683 7.51 H TERRY KILLER SUBTOTAL - 7.51 00011 X382 JEAN/CARHARTT CARPENTER/DEMIR 01 F 8 0.734 5.87 N 0004 X394 JEARICUTT0NIFEE RA13HED DENIM - 5? PREM 01 F 3 0.°39 2.2 9 JEFF HICKS SUBTOTAL - 8.34 0005 X382 JEAN/CARHARTT CARPENTER/DEMI 01 F 11 0.734 8.07 H RICK ALDER SUBTOTAL - 8.07 0006 X382 JEANICARHARTT CARPENTER/DENIH of F 11 0.733 3.06 N SAO NGFFITT SUBTOTAL - 8.06 0007 X382 JEAN/CARHARTT CARPENTER/DENIM 01 F 11 0.734 8.07 N JANES RUNDEL SUBTOTAL - 8.87 0008 X382 JEAHICARHARTT CARPENTER/DENIM o1. F 11 0.734 8.07 11 READ SCHERIICK SUBTOTAL - 8.07 0009 X382 JEAN/CARHARTT CARPENTERIDENIn 01 F 11 0.733 6.06 N JIIN HOBBS SUBTOTAL - 8.06 0010 X382 JEANICARHART'( CARPENTERIDENIn 01. F 11 0.734 6.07 N CHRIS STUBBS SUBTOTAL - 8.07 0011 X.82 JEAN/CARHARTT CARPENTERIDEV IR 01 F 11 0.734 8.07 N DARRELL BELL SUBTOTAL - 8.07 0012 X361 JEANICARHARTIRELX FIT/DK DENIM 01 F 'r 0.683 4.76 N 0012 X381 JEANICARHART/RELX FITIDK DENIM 01 F 4 0.683 2.73 N HER OILLIANS SUBTOTAL - 7.51 0013 X382 JEANICARHARTT CARPENTERIDENIN - Sr PIR0l 01 F 11 0.694 9.83 H ERIC RUSSELL SUBTOTAL - 9.83 0014 X362 JEANICARHARTT CARPENTER11DENIH 01 F 11 0.733 8.06 N TIO BIGHRI09 SUBTOTAL - 8.06 0015 X382 JEARICARHARTT CARPENTERIDEHIn 01 F 11 0.734 8.07 N REMIT PAYMENT TD: CINTAS I F9 BOX 63080.1 I CINCTHHATI, LH 45263-0903 Page 1 of 4 FOR ALL NON-PAYMENT RELATES} CORRESPONDENCE: , ciNrAs CIRTAS CORPORATION 30018 30018 INVOICE NV 400464259.7 3 0 9949 PARI{ DAUIS DR. IOICE DATE 0312712018 READY FOR THE WORKDAY" INDIANAPOLIS, IN 46235 INVOICE ENP#ILOCU#- €ATERIAL DESCRIPTI0N IFRER EXCH OTY UNIT PRICE LIKE TOTALTAX #RDREN DOCKERY SUBTOTAL - 0.07 0016 X382 JEANICARHARTT CARPENTERIDENIM - SZ PEEN 01 F 11 0.893 9.82 N TRAMS TABAK SUBTOTAL - 9.82 0017 X382 JEAN/CARHARTT CARPENTERIDENIN 01 F 11 0.733 8.06 N CHRIS ITOORE 2990THTAL - 8.06 00:18 X381 JEANICANHARTIRELX FITIDK DENIM 01 F 11 0.683 7.51 iF BOYD PIERCY SUBTOTAL - 7.51 001.9 X381 JEANICARHART/RELX FITIDK DENIM 01 F 11 0.881 9.69 N JADES BENTLEY SUOTOTAL - 9.89 0020 X394 JEANICUTTHNIPRE HASHED DENIM 01 F 11 0.679 7.47 N STEVE ZELLER SUBTOTAL - 7.47 0021 14382 JEAN/CARHARTT CARPENTER/DENIM - SZ PREn 07 F 11. 0.894 9.83 N BRAD HENDERSON SUBTOTAL - 9.83 0122 X330 uNF SHTINAUYIDP CTTHILS - SZ PREM 01 F 11 0.689 7.58 N 0022 X38:1 JEANICARHART/RELX FIT/DK DENIM - SZ PREi9 01 F 11 0.843 9.27 N 0022 X912 C1]UERALLIEfRCi iN TWILL 01 F 5 0.781 3.91 N NINE HERRICNS SUBTOTAL - 20.78 0023 X3382 :JEANICARHARTT CARPENTERIDEHI€1 01 F 11 0.733 5.06 9 ADAO TOURS SUBTOTAL - 8.08 0024 X382 JEANICARHARTT CARPENTERIDERIn 01 F 11 0.734 8.07 11 RELPH BURKE SUBTOTAL - 8.07 0025 X382 JEAN/CARHARTT CARPENTER/DENY( 01 F 2 0.734 1.47 N 0025 9332 JEANICARHARTT CARPENTER/DENIM 01 F 9 0.733 6.60 N 0025 X3814 JEANICARHARTT CARPENTER/DEXIM i 01 F 2 1..950 3.90 i1 BILL HICCINBOTHAN SUBTOTAL - x.1.97 0026 X382 JEANICARHARTT CARPENTER/DENIM 01 F 11 0.733 8.06 N LEE HICCIOBETOAO SUBTOTiAL - 8.06 0027 X382 JEANICARHARTT CARPENTERIDENIN O1 F 11 0.733 8.06 N JASON MALDEN .SUBTOTAL - 0.06 0028 X382 JEAN/CARHARTT CARPENTER/DENIH 01 F 11 0.733 8.06 N JARED COLE SUBTOTAL - 8.06 0029 X382 JEAHICARHARTT CARPENTERIDENIN 01 F 11 0.733 8.06 N RYAN NUHT SUBTOTAL - 8.06 0030 X332 JEANICARHARTT CARPENTERIDENIH - SZ PEEN 01. F 11 0.893 9.32 N KEVIN SOITH SUBTOTAL - 9.€92 0031 X382 JEANICARHARTT CARPENTER/DERIN .01 F 11 0.734 8.07 N DANIAN DELPH S€9BTOTAL - 0.07 0032 X302 JEANICARHARTT CARPENTERIDENIH 01 F 6 0.733 4.=140 N 0032 X382 JEANICARHARTT CARPENTERIDENIH 01 F 5 0.733 3.67 I' RANDY JUHNSMI IUSTOTAL - 8.07 REMIT PAYnENT TO: CIHiAS I PO BOX 630303 I C-INCINHATI, P�I.H 45263-0803 Page 2 of 4 0 FOP. ALL mirm-paynENt RELATED CERESPMENCE: INVOICE # 4004S92597 C'NEAS. CINTAS CORPORAT.UH 00018 50018 INVOICE DATE 0322712010 9949 PARK DAVIS DR. READY FOR THE WORKDAY" INDIANAPOLIS, IN 46235 INVOICE ENP#ILUCK# HATERIAL DESCRIPTIO=N FRED EXCH QTY UNIT PRICE LIRE TOTAL TAX] 0033 X382 JEAHrICARHARTT CARPENTERIDERIN 01 F el 0.733 4.tic it 0.1 0033 X394 JEWCOTTOR/PRE HASHED DENIM F 9 0.679 3.40 N FRED HARTZ WB THTAL - 7.80 0034 X382 JEANICARHARTT CARPENTERIDENIN 0i r il 0.733 8.06 H ED NOIR SUBTOTAL - 8.06 0035 X382 JEAN/CARHARTT CARPENTERIDENIn 01 r 11 0.733 8.06 N IWE KALHCERUS SUBTOTAL - 8.86 0036 X382 JEANICARHARTT CARPENTERIDENIn - SZ PREN 01 F il 0.894 7.83 N TIU COFFEY SUBTOTAL - 9.83 0037 X382 JEANICARHARTT CARPENTERIDENIH 01 r 11 0.734 8.07 N MARK CARTER SUBTOTAL - 8.07 0038 X330 UNF SHTIHAVYIDP CTTHILS 01 F 11 0.529 5.82 N 0038 X382 JEAN/CARHARTT CARPEHI*ERIDERIM 01 F 11 0.733 8.06 N DAVID OCCARTHEY SUBTOTAL - 13.88 0039 V13 X182 JEANICARHARTT CARPENTER/DENIn 01 F li 0.733 8.06 N HIRE CLARK SUBTOTAL - 8.06 0040 X382 JEAN/CARHARTT CARPENTER/DENIM 01 r 11 0.733 8.06 N HILL DAVIS SUBTOTAL - 8.06 0041 X382 JEAN/CARHAETT CARPENTERIDENIN 01 F il 9.734 8.07 IN M SFELDRING SUBTOTAL - 8.07 0042 X382 JEANICARHARTT CARPENTER/DENIM 01 F 0.733 8.06 m JOSH DAVIS SUBTOTAL - 8.06 0043 X382 JEWCARHARTT GARPENTERIDENIH 01 F il 0.73? 8.06 N NATHAN HUBRIS SUBTOTAL - 8.06 SUBTOTAL 376.86 SERVICE CHARGE 16.99 H SUBTOTAL 393.35 TAX (0.00) TOTAL USD 393.85 TOTAL ADJUST. 7AX ADJUST. NET THTAL REMIT PA1NENT TO: CINTAS i PO BOX 630803 / CINCINNATI, OH 45263-0803 Page 3 of 4 ciNrAEGH ALL M—PAYNENT RELATED CURRESPEMEE: IMURICE 4 4004592597 s CIRTAS CORPORATION 0018 #0018 IMMICE DATE 03/27/2018 9949 FARM DAUIS DR. READY FOR THE WORKDAY" INDIANAPOLIS, IN 46235 INVOICE EHP#/LUK# HATERIAL DESCEIIPTIQN _ — EREG EXCN 9TY UNIT PRICE LINE MAL TAX CUST©M TOTAL CURRENT: 3.323. 39 FAST DUE: 863.79 30 DAYS: 0.0?i 60 DAYS: 0.00 90+ DAYS: 0.00 REMIT PAMENT TO: CINTAS / PO BOX 630803 CINCINNATI, UH 45153-0803 Page 4 of 4 • FUR ALL HON—PAYRENT RELATED CORRESPORDENCE: CUSTBKER SuCIBILLING 1-880-924-6827 ciNrAs CIIITAS CORPORATION 40018 #0018 CINTAS FAX # 1-937-630-3545 0 9949 PARK DAUIS DR. PAYtaENT IifeUIEiY 937-237-376Q READY FOR THE WORKDAY`" INDIANAPOLIS, IN 46235 INVOICE SHIP TO: CARMEL STREET DEPT INVOICE # 4004575388 3400 M 131ST ST INUOICE DATE 03/26/2018 CARMEL, Ie1 1,16074-8267 SOLD TO # 12147003 PAYER # 12156723 PATHENT TERNS NET 10 EON DILL TO: C/O iONNIE CALLAHAN SORT I 00180007880 CARMEL STREET DEPT CIRIAS ROUTE 33 1 DAY 1 / STOP 014 3400 N 1319T ST HESTFIELD, IN 46074 ENP#ILUCK# HATERIAL DESCRIPTION FRET! EXCH QTY KNIT PRICE LINE TOTAL TAX X2160 Sh SHOP THL—RED 01 F 140 0.261 36.54 N X2160 SH SHOP TUL—RED L 01 F 24 0.5,93 14.23 N X2271 FC1 HD FLR CLHR/DGSR 01 F 4 1.450 5.80 x X229S SRI DIS/RR CLHR— MOP 01 F 4 1.600 6.40 ill X2477 3X5 SCRAPER FLAT 01 F 3 6.617 .1.9.85 N X2650 DIET (SOP LARGE 01 F 2 1.750 3.}:,0 Ia X2963 TEA THLS—MHITE 01 F 20 0.616 12.32 N X21963 TEA TIILS—MHITE L 01 F 1 2.310 2.31 H X7500 CLEANING CHEN DISP 0i F 2- 2.000 4.00 I3 X84035 3X10 BLACK HAT 01 F 8 14.493 115.91E N X84435 4X6 BLACK LLAT 01 F 5 12.160 50.80 N SUBTOTAL 281.69 SUBTOTAL 281.69 TAX (0.00) TOTAL USD 281.69 TOTAL ADJUST. TAX ADJUST. MET TOTAL CUSTOMER TOTAL CURRENT: 064.25 PAST DUE: 28:1..69 30 DAYS: 302.'1 60 DAYS: 330.71 901 DAYS: 0.00 RE19IT PAYMENT TO: CINTAS I PO BOX 630803 / CINCINNATI.. Bli 45263-0803 Page 1. of 1 FCOR ALL MUN—MMENT RELATED CURRE:SPUMBERM CUSTHMER SUMILLIM 1-898-924-6827 CI1M3,1TA' t;11FlP[FRAilOR 80018 W-10018 CU AS FAX #1 1-917-635—MS READY FOR THE WORKDAY' ,IIHDIANAPOLIv, !N 46215 PAYHENT 11100IRY X37-237-3760 INVOICE SHU T0: "CAflyiY L S t_ET DEPT €UMC 40 011.,5,5 3m+i;10 1,11 :1.:11:5 i ST IMBUE DATE 03'1212018 SOLD TU 1 1.21.1.17003 PAYER Fr 121.56723 PAV14ENT TERNS RET 1.01 E1111 DILL T'i1: r10 [IFINt;:LC: t:ALLArr7;z SORT # 01318813073'80 i;(1: ki L .STRE ET �tEPT CINTAS RUUTE 33 1 DAY 1 1 S-TDfl 014 3010 M 131ST ST MITSTF IELL1, iia 46071 )EMPOILUCH...___ILATERIAL DESCRIFT-10 F EQ EXCH fill�MY PRICE .'LIFE TOTAL TAIXi 1 ;42160 SH SHIP THL-RED 6:111 F 110 0.261 36.E4 M X2160 Sri SHOP T WL-REIT L 01 F 24 O.593 1-4.23 H X2271. F C1 MGI FLR CL11R E GSR 01 r ;I i.450 S.itis M X2235 RE.". DISlRR CLNR•- Ii1UP 01 F 4 6.101 R {2 7 i 3X5 SCRAPER !'IAT 01 F, 3 6.617 19.85 N X2'150 WET TIOP LARGE 0i F h 1.750 3.50 0 ":2X63 ?'1_A TWL S-MUTE 01 F 21) 0.616 12.:2 is 1,2`.:+63 TEA TWLt-WHITE L 01 F ? 2.310 2.31 11 CLEAWI:r.0 CHEN DI:SP 01 F 2 -2.0013 X1.00 q,8w0 35 3X1:,.0 BLACK MAT 01 F t 1;.49-3 1�S.��i N XW35 U6 BLACK FEAT 01. F' S ;".1.611 60.E0 0 MiT;ITAL 281..169 SUBTOTAL ?cI.61 TAS MOO) TOTAL U 281. 0 TOTAL ADJUST. TAX AMU. MET TOTAL _ IR t F, 4 '� IP tom' 1 3 33 1 51 5n ti 1 .Y C3.1:�T1:1'IL:, ('iT(5L. 1.:e71�t•,ErT: l.1fi5.LI.. i A„C 1�LE.: ..0:.7.51 z0 1.I,IYS: axJ.i 1 6? 0f(,5: ai.L,� x0�. br:'?:�: L.u13 RE111T PAYt1EPT TO: CIRTAS / PO BOX 530803 1 CI1s%1.11"A'1':L, 014 M63-OU', VOUCHER NO. 185179 WARRANT NO. ALLOWED 20 Prescribed by State Board of Accounts City Form No.201(Rev 1995) Vendor # 197000 IN SUM OF$ ACCOUNTS PAYABLE VOUCHER CINTAS CITY OF CARMEL PO BOX 630803 An invoice or bill to be properly itemized must show: kind of service,where performed, LOCATION 18 dates service rendered, by whom, rates per day, number of hours, rate per hour, CINCINNATI, OH 45263-0803 numbers of units, price per unit,etc. Payee 145.46 197000 Purchase Order No. ON ACCOUNT OF APPROPRATION FOR CINTAS Terms Carmel Wasterwater Utility PO Box 630803 Due Date BOARD MEMBERS LOCATION 18 I hereby certify that that attached invoice CINCINNATI,OH 45263-0803 (s), or bill(s)is(are)true and correct and that PO# ACCT# the materials or services itemized thereon DATE INVOICE# Description DEPT# INVOICE# Fund# AMOUNT for which charge is made were ordered and DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT 5010371485 01-7200-01 $52,72 and received except 3/29/2018 5010371485 $52.72 5010371485 01-7202-05 $52.96 3/29/2018 5010371485 $52.96 5010371485 01-7202-06 $39,78 3/29/2018 5010371485 $39.78 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 Cost distribution ledger classification if claim paid motor vehicle highway fund. 20_ Clerk-Treasurer CIk, so READY FOR THE WORKDAY`"' SVC/BILLING QUESTIONS: 317-264-5103 REMIT TO: Cintas FAX : 317-644-0870 P.O. Box 630803 PAYMENT INQUIRY : (937)237-3760 CINCINNATI, OH 45263-0803 ROUTE # : LOC #0388 ROUTE 0015 INVOICE PLEASE PAY DIRECTLY FROM THIS INVOICE CITY OF CARMEL UTILITIES INVOICE # : 5010371485 CITY OF CARMEL DATE : 3/28/18 9609 HAZEL DELL PKWY PO # :N/A INDIANAPOLIS, IN 46280-2935 STORE # 317-571-2634 CUSTOMER # : 0010653296 PAYER # : 0010653296 SVC ORDER # : 8018022861 CREDIT TERMS: NET 30 DAYS MATERIAL # DESCRIPTION QTY UNIT PRICE EXT PRICE TAX 6626411 BLD B MENS RESTROOM 02184701 110 SERVICE ACKNOWLEDGEMENT 1 $0.00 $0.00 120 CABINET ORGANIZED 1 $0.00 $0.00 130 EXPIRATION DATES CHECKED 1 $0.00 $0.00 400 SERVICE CHARGE 1 $12.95 $12.95 55555 HARD SURFACE DISINFEC SVC 1 $6.95 $6.95 55556 DISINFECTANT WIPE 1 $0.00 $0.00 112029 COLD RELIEF MAX/STR SM 1 $10.17 $10.17 112229 DECONGEST NASAL/SINUS SM 1 $7.81 $7.81 119310 PEPTUM TABS SMALL 1 $11.61 $11.61 UNIT SUBTOTAL $49.49 6626412 BLD A LAB 02464455 110 SERVICE ACKNOWLEDGEMENT 1 $0.'00 $0.00- 120 CABINET ORGANIZED 1 $0.00 $0.00 130 EXPIRATION DATES CHECKED 1 $0.00 $0.00 55555 HARD SURFACE DISINFEC SVC 1 $6.95 $6.95 55556 DISINFECTANT WIPE 1 $0.00 $0.00 112029 COLD RELIEF MAX/STR SM 1 $10.17 $10.17 573772 DAYQUIL SEVERE SMALL 1 $8.66 $8.66 UNIT SUBTOTAL $25.78 6626410 BLD E OFFICE 02184616 110 SERVICE ACKNOWLEDGEMENT 1 $0.00 $0.00 120 CABINET ORGANIZED 1 $0.00 $0.00 130 EXPIRATION DATES CHECKED 1 $0.00 $0.00 55555 HARD SURFACE DISINFEC SVC 1 $6.95 $6.95 55556 DISINFECTANT WIPE 1 $0.00 $0.00 100639 HAND LOTION, SMALL 1 $5.23 $5.23 102835 DENTAL RELIEF, SMALL 1 $5.94 $5.94 111529 PAIN AWAY X-STRENGTH SM 1 $8.27 $8.27 121220 ALEVE SMALL 1 $5.77 $5.77 573772 DAYQUIL SEVERE SMALL 2 $8.66 $17.32 UNIT SUBTOTAL $49.48 6626416 BLD E RESTROOM 02184713 110 SERVICE ACKNOWLEDGEMENT 1 $0.00 $0.00 120 CABINET ORGANIZED 1 $0.00 $0.00 130 EXPIRATION DATES CHECKED 1 $0.00 $0.00 12221 LIQUID BANDAGE SMALL 1 $10.79 $10.79 130000 THERA TEARS, SMALL 1 $9.92 $9.92 UNIT SUBTOTAL $20.71 Page 1 of 2 INVOICE # 5010371485 PAYER # 0010653296, clI READY FOR THE WORKDAY"" SVC/BILLING QUESTIONS : 317-264-5103 REMIT TO: Cintas FAX : 317-644-0870 P.O. Box 630803 PAYMENT INQUIRY : (937)237-3760 CINCINNATI, OH 45263-0803 ROUTE # : LOC #0388 ROUTE 0015 REMIT TO :Cintas SUB-TOTAL $145.46 P.O. Box 630803 TAX . $0.00 CINCINNATI, OH 45263-0803 TOTAL $145.46 SIGNATURE : DATE : NAME Page 2 of 2 INVOICE # 5010371485 PAYER # 0010653296.