181991 02/03/2010 CITY OF CARMEL, INDIANA VENDOR: 178620 Page 1 of 1
1 ONE CIVIC SQUARE KUSTOM SIGNALS INC
CHECK AMOUNT: $647.17
CARMEL, INDIANA 46032 PO BOX 411882
a� ATTN: ACCTS REC CHECK NUMBER: 181991
'�'e..' KANSAS CITY MO 64141 -1882
CHECK DATE: 2/3/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4350000 21318 408244 647.17 REPAIRS
4
Invoice Number 408244
Invoice
1111111111111111111 KUSTOM SIGNALS INC. Customer Copy
RE TO Invoice Date 01/14/10
A PUBLIC SAFETY EQUIPMENT COMPANY
1010 W. Chestnut P.O. Box 947 KUSTOM SIGNALS, INC. Customer Number 16673
Chanute, KS 66720 0947 PO BOX 411882 Order Number 156209 SR
(620) 431 2700 Fax (620) 431 2734 KANSAS CITY, MO 64141 1882 Customer PO 21318
SOLD TO Page 1 of 1
CARMEL POLICE DEPT SHIP TO
POLICE DEPT HDQTRS CARMEL POLICE DEPT
3 CIVIC SQUARE POLICE DEPT HDQTRS
CARMEL IN 46032 3 CIVIC SQUARE
CARMEL IN 46032
Net .Due. Date 02/13/10 Terms net 30 Shipping UPS 36958
Ext ended
"Pa Number ��DESCRIPTION (Serial x z
Price
Shipped o m u N m m t 5 P riced
1 200 1639 -30R EYE II LOCKER
36958
ET01679
WARR DATE 05 -27 -05
JASON OGLE 317 733 -4600
FAX 317 733 -6257 jogle @carmel.in.gov
VCR CONTINUOUSLY EJECTS TAPE
ESTIMATE
2 888 8888 -36 CS FREIGHT GROUND 65.00 130.00
INBOUND AND OUTBOUND SHIPPING CHARGES
1 015 0559 -20 JVC RECONDITIONED SR -T5U 442.17 442.17
10 111 1111 -12 OOW Video Labor tenths of hr 7.50 75.00
OOW Video Labor tenths of hr
S/S ET 01679 W/SRT5U11810488 RECORDER. REPLACED
SR50169W0185, (CONTINULLAY EJECTS). FUCNTION TESTED
CHECKED OK.
REMIT TO: FEDERAL ID 43- 1757730 Subtotal 647.17
KUSTOM SIGNALS, INC.
PO BOX 411882 III IIIIIIIIIIIIIIIIIIII II III o /o Tax 0.00
KANSAS CITY, MO 64141 -1882 TOTAL 647.17
WWW.KUSTOMSIGNALS.COM
INDIANA RETAIL TAX EXEMPT PAGE
i tyr 1 of C CERTIFICATE NO. 003120155 002 0 1 of 1
1i PURCHASE ORDER NUMBER
Police Department FEDERAL EXCISE TAX EXEMPT
35- 60000972 91 11 R
30NE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES, NP
CARMEL, INDIANA 46032 -2584 VOUCHER, DELIVERY MEMO, PACKING SLIPS,
SHIPPING LABELS AND ANY CORRESPONDENCE.
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL 1997
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
Japery 8, 20 @C repairs
t
VENDOR Kustom Signals, Inc. SHIP City of Carmel Police Department
P.O. Box 411882 TO 3 CiviccSquarew
Kansas City, MO 64141 Camel, IN 46032
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
repairs to car cam for car 48 Smith 647.17
J
0 ill oi i
t....°,
°mom
i ,,-P4 Ilk
k/1
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Send Invoice To: City of Carmel Po ri
ATTN: Teresa Anders j-�rr0
,i
3 Civic Square
Carmel, IN 46032
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
1110 500 equipment repairs an main i41(IgNT
NP VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
1 NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
SHIP REPAID.
C.O.D. SHIPMENTS CANNOT BE ACCEPTED. j 1
PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY I /J r l "T l/.'� .h
SHIPPING LABELS.
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE Chief of Police
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
2 1 CLERK- TREASURER
DOCUMENT CONTROL NO. COPY SIGN AND RETURN TO CLERK'S OFFICE
OUCHER NO. c 'WARRANT NO.
ALLOWED 20
IN THE SUM OF$
ON ACCOUNT OF APPROPRIATION FOR
i
Board Members
PO# or INVOICE NO. ACCT /TITLE AMOUNT
DEPT. 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
20
Signature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
Preslribed by State Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
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.
Payee
Kustom Signals, Inc. Purchase Order No. 21318F
P.O. Box 411882 Terms
Kansas City-; MO 64141 1882 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
1/14/10 408244 payment for repairs to car cam for car 38 Smith 647.17
Total
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
Clerk- Treasurer
VOUCHER NO. c 'WARRANT NO.
4 ALLOWED 20
Kustom Signals, Inc. IN SUM OF
P.O. Box 411882
Kansas City, MO 64141 -1882
647.17
ON ACCOUNT OF APPROPRIATION FOR
police general fund
Board Members
DEPT INVOICE NO. ACCT #(TITLE AMOUNT I hereby certify that the attached invoice(s), or
21318F 408244 500 647.17 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
January 27 2 0 10
*44411 _b
Signature 1
9 44
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund