325944 06/05/18 •a o1'�'�pM
CITY OF CARMEL, INDIANA VENDOR: 367794
•s
ONE CIVIC SQUARE TAKEFORM CHECK AMOUNT: $*****4,632.68*
CARMEL, INDIANA 46032 11601 MAPLE RIDGE ROAD CHECK NUMBER: 325944
MEDINA NY 14103 CHECK DATE: 06/05/18
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1091 4463000 69297 4,632.68 FURNITURE & FIXTURES
N
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
VOUCHER NO. WARRANT NO.
An invoice of bill to be properly itemized must show;kind of service,where performed,dates service rendered,by
Vendor# 367794 Allowed 20_ whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc.
Takeform Payee
11601 Maple Ridge Road
Medina, NY 14103 In Sum of$ Purchase Order#
367794 Takeform Terms
$ 4,632.68 11601 Maple Ridge Road Date Due
Medina, NY 14103
ON ACCOUNT OF APPROPRIATION FOR
109-Monon Center
PO#ornvolce Description
Dept# INVOICE NO. ACCT#IiITLE AMOUNT Invoice Date Number (or note attached invoice(s)or bill(s)) PO# Amount
Gymnasium and Group Fitness Schedules
1091 69297 4463000 $ 4,632.68 Board Members 5/16118 69297 Room Signage 51087 $ 4,632.68
I 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
$ 4,632.68 Total $ 4,632.68
May 24,2018
1 hereby certify that the attached invoice(s),or bill(s)is(are)true and correct and I have audited same in accordance
//A,� ,- -' / with IC 5-11-10-1.6
Cost distribution ledger classification if pic�'e� Y�/i/
claim paid motor vehicle highway fund Signature ,20
Accounts Payable Coordinator Clerk-Treasurer
Title
! j
Quorum Group, LLC. DBA
RECnvolce : 69297
kFr1 e-A t 0
_ � MAY 27-12018 Invoice Date: 5/16/18
�s 11601 Maple. id a Road PO#: 51087
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■ N�edina;NY 14T03 Y"""""
80@=528=139 Payment Terms: Net 30
Bill To: Carmel Vay Parks & Recreation Ph: (317) 57$=4026
Fax: (317) 571-4136
Attn: Eric Mehl Email: emehl@ca�melclayparks.com
1411 E. 116th Street
Carmel, IN 46032
Job Name: CAR0061: Carmel Clay Parks & Recreation
^ tion Quantity Unit Net Net
Line Descri
p tY Price Price Ext
1 Type B.2 4 429.24 1,716.96
2 Type B.2a 4 429.24 1,716.96
3 Window Backer for Type B.2a 4 47.16 188.64
4 Type 1.2 3 259.70 779.10
5 Window Backer for Type 1.2 4 22.97 91.88
6 A0100 Silicone Adhesive Tube 1 12.38 12.38
Net Subtotal: $4,505.92
Shipping and Handling: $126.76
Net Total:
Balance Due(USD): $4,632.68
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
Payment Options: Carmel Clay Parks&Recreation
Invoice #
❑Visa E]MasterCard Discover FlAmerican Express
Balance Due: $4,632.68
Cardholder's Name:
CVV2#:
Card Number:
Expiration Date:
Card Billing Address:
Signature:
Print Date:5/17/2018 9:29:25AM Page 1 of 1