187072 06/23/2010 CITY OF CARMEL, INDIANA VENDOR: 360941 Page 1 of 1
p 0 ONE CIVIC SQUARE UNDERWRITERS LABORATORIES INC CHECK AMOUNT: $1,250.00
CARMEL, INDIANA 46032 PO BOX 75330
CHICAGO IL 60675 -5330 CHECK NUMBER: 187072
CHECK DATE: 6/23/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4351000 710150503857 1,250.00 AUTO REPAIR MAINTEN
L
Remit to:
Customer Information
Underwriters Laboratories Inc.
P.O. Box 75330 Invoice 710150503857
Chicago IL 60675- 5330 Bill To Account 554355
United States Invoice Date: 29 MAY 2010
Payment Terms: Due On Receipt
Accounts Payable
CARMEL FIRE DEPT Amount Due: 1,250.00 USD
2 CIVIC SO
CARMEL IN 46032 Amount. Remitted:
71015050385700125000753309
Please detach and return upper portion with payment. Please reference Invoice Number with payment.
Customer Information ORIGINAL
Underwriters Laboratories Inc. Invoice 710150503857
P.O. Box 75330 Bill To Account 554355
Chicago IL 60675- 5330
United States Invoice Date: 29 MAY 2010
Payment Terms: Due On Receipt
UL's US Tax ID 36-1892375 Customer Contact: Accounts Payable
Wam
Line Description Amount
Mfg 554355 Mfg Name: CARMEL FIRE DEPT Mfg Address: 2 CIVIC SQ
P.O. Mfg Subscriber 100236- 228 CARMEL IN 46032
1 INSPECTION SERVICE 1,250.00
inspection Center: 227- FES EAST SITE AREA OFFICE
Product Inspected/Test Desc: Certificate Number NA, Model Number(s)
Aerial Device 2002 Ladder Towers Inc., 75 ft., Aerial Ladder,
Unit# Eng 42
File Volume FS2353- 1
Date of VisiUTest Date: 29- APR- 2010
CCN AZYS
Product Category: [Automotive Fire Apparatus and Ground Ladders for
Fire Department Use] Service Testing of Fire Equipment at Fire
Departments
Field Rep /Employee /Office: Burger, Brett
Total Amount Due 1,250.00 USD
Additional Information:
elnvoice ID: 1563097
Applicant:
CARMEL FIRE DEPT
2 CIVIC SO
CARMEL IN 46032
United States
Subscriber Number for Applicant For reference only: 100236-228
Subscriber Number for Bill- to For reference only: 100236- 228
1000 -61 06101
Page f of 2
U 0 L
r
FUS
Invoice 710150503857 Invoice Date: 29 MAY 2010 Bill To Account 554355
For information regarding our services, please visit our website at www.ui.com
For billing questions and address changes, please contact your Customer Service Professional (CSP),
at 1- 877- 854- 3577 or by fax at 1- 360- 817- 6278.
Addifioiial Paym6nt hifor
Please remit wire transfers to:
NORTHERN TRUST
50 S. LaSalle
Chicago, IL 60675
SWIFT Number: CNORUS44
Account Name: Underwriters Laboratories Inc. Account Number: 413860
ABA# 071000152
*!VOTE: All payments are to be made directly from an institution and from an account that are
not subject to any United Nations, local or U.S. sanction.
If you would like to use ACH as your method of payment (such as ACH, or FedEx), please refer to our website www.ul.com
for further information.
1000-61 06101
Page 2 of 2
VOUCHERNO. WARRANT NO.
ALLOWED 20
U nderi Laboratories, Inc.
IN SUM OF
P.O Box 75330
Chicago, IL 60675
$1,250.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO, ACCT #/TITLE AMOUNT Board Members
1120 710150503857 43- 510.00 $1,250.00 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
JUN 21 2�IQ
Fire Chief
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))
710150503857 $1,250.00
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