186785 06/23/2010 CITY OF CARMEL, INDIANA VENDOR: 364214 Page 1 of 1
ONE CIVIC SQUARE DATA LTD, INC
CARMEL, INDIANA 46032 PO BOX 761 CHECK AMOUNT: $450.00
LA PORTE IN 46352 -0761 CHECK NUMBER: 186785
QOM
CHECK DATE: 6/23/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4230200 26919 55217 450.00 OFFICE SUPPLIES
Invoice 55217; Ref 344; PO 26919 Page 1 of 1
DLI Invoice
703 Data Ltd Parkway Date Invoice
6/7/2010 55217
PO Box 761 P.O. Ref
La Porte, IN, 46352
USA 26919 344
Tel: 800 526 -1299
Fax: 219 362 -1937
Billing Address Shipping Address
City of Carmel Police Dept. City of Carmel Police Dept.
Attn: Teresa Anderson Attn: Robert Robinson
3 Civic Square 3 Civic Square
Carmel, IN, 46032 Carmel, IN, 46032
USA USA
317 571 -2548 317 571 -2548
Acc Sales Rep Payment Terms Shi Date Exp. Date Carrier Carrier Acc
Chris Havens Net 30 1 6/7/2010 6/18/2010 Fed -Ex Grd
INol SKU Product I Weight I Qty Price Total
1 LB3fifi3 Perforated Roll 6 Roll Pack (100 Sheets Per Roll) 1 01 10 45.00 450.00
Sub Total 450.00
Shipping 0.00
Adjustment 0.00
Tax 0.00
GRAND TOTAL 450.00
Received 0.00
Amount Due 450.00
We thank you for your business look forward to future orders. Any omissions or errors must be reported within 5 business
days from receipt of merchandise. All returns require written authorization. No returns will be accepted after 30 days.
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C"', INDIANA RETAIL TAX EXEMPT PAGE
C Of I YTt rme� CERTIFICATE NO.003120155 002 0
PURCHASE ORDER NUMBER
Police Department FEDERAL EXCISE TAX EXEMPT
35- 60000972
ACIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES, A/P
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
DURCHASE'ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
June 2, 2010 office supplies
VENDOR EL Bt.' "td, o ':'Tn�' SHIP City of Carmel Police Department
TO 3 divineSquare
Carmel, IN 46032
A'rr Chr s Havens ATTN: Robert Robinson
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
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QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
10 LB3663 Perforated rolls (6 pk) 45.00 450.00
40
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Send Invoice To: City of Carmel Pcartment, F
ATTN: Teresa Anderso
3 0ivic Square
Carmel, IN 46032
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
1110 302 office supplies PAYMENT
A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
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
SHIP REPAID.
THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
C.O.D. SHIPMENTS CANNOT BE ACCEPTED. ORDERED BY
PURCHASE ORDER NUMBER MUST APPEAR ON ALL f
SHIPPING LABELS.
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE Chief of Police
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
91 A. P.V. CLERK TREASURER
DOCUMENT CONTROL NO. COPY SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER NO.. WARRANT NO.
ALLOWED 20
IN THE SUM OF
ON ACCOUNT OF APPROPRIATION FOR
Board Members
D EP T INVOICE NO. ACCT #!TITLE AMOUNT
o1=PT. !hereby certify that the attached invoices 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
Prescribed �y State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
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
DLI Purchase Order No. 26919F
P.O. Box 761 Terms
LaPorte, IN 46352 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
6/7/10 55217 payment for office supplies 450.00
ti
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. WARRANT NO.
ALLOWED 20
DJ,I IN SUM OF
P.O. BOX 761
LaPorte, IN 46352
450.00
ON ACCOUNT OF APPROPRIATION FOR
police general fund
Board Members
Poi or INVOICE NO. ACCT# /TITLE AMOUNT
DEPT. 1 hereby certify that the attached invoice(s), or
26919F 55217 302 450.00 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
June 14 20 10
Signature
Chief of Police
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund