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185482 05/11/2010 CITY OF CARMEL, INDIANA VENDOR: 362217 Page 1 of 1 t ONE CIVIC SQUARE Z -COIL CHECK AMOUNT: $159.99 CARMEL, INDIANA 46032 1362 S RANGELINE ROAD CARMEL IN 46032 CHECK NUMBER: 185462 CHECK DATE: 5/11/2010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 2201 4356003 4320 159.99 SAFETY ACCESSORIES �1 j -J1 4/30/2010 1 1:12 AM Sales Receipt 44320 Store: 1 Z -Coil Pain Relief Footwear 1362 S. Range Line Rd. Carmel, IN 46032 (317) 843 -2645 (COIL) www.hoosiersolemate. com Bill To: Carmel Street Department Gary Jones Cashier: Sysadmin It em N Qty Price Ex Price Cofra Sheffield 1 5159.99 $159.99 W ide M09.0 Subtotal: $159.99 Exempt 0 Tax: +$0.00 RECEIPT TOTAL: $159.99 Account: $159.99 Signature I agree to pay abate amount according to card issuer agreement (merchant agreement if credit voucher). Previous Account Balance: $0.00 Account Balance: $159.99 RETURN POLICY ON Z -COIL FOOTWEAR Z -Coil Pain Relief Footwear is highly adjustable and designed for comfort and pain relief. We encourage you to get an adjustment rather than returning your footwear. Often, the problem with the shoes can be fixed and it may provide you with the comfort and pain relief you are seeking. The footwear is returnable for 14 days after purchase minus a $25 restocking fee; the shoe must be in like new /saleable condition. Footwear not in like new condition will be charged a $50 restocking fee, condition to be determined byZ -CoiL Management. NO RETURNS OR EXCHANGES ON WORN: FitFlops; MBTs; Klogs; Orthotics; Aetrex; Cofra; Socks and Accesories. Any of these brands maybe returned for store credit within 14 days of purchase if they show no visible wear /use. (317) 843 -2645 4320 V NG: WARRANT N ALLOWED 20 Z -Coil IN SUM OF 1362 S. Rangeline Road Carmel, IN 46032 $159.99 ON ACCOUNT OF APPROPRIATION FOR Carmel Street Department PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members 2201 4320 43- 560.03 $159.99 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 Thrsday, May 06 2010 Street Commissiome Title Cost distribution ledger classification if claim paid motor vehicle highway fund Prescribed 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 Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 04/30/10 4320 $159.99 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 Clerk- Treasurer