187769 07/21/2010 CITY OF CARMEL, INDIANA VENDOR: 00352760 Page 1 of 1
ONE CIVIC SQUARE DELL MARKETING LP
e CARMEL, INDIANA 46032 C/O DELL USA LP CHECK AMOUNT: $264.66
PO BOX 802816 CHECK NUMBER: 187769
CHICAGO IL 60680 -2816
CHECK DATE: 7121/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 4463202 XDXWF36F9 264.66 SOFTWARE
I HIS Is your IIV VvlliC rayc. I Ul I
r e E FID Number. 74- 2616805 Customer Number: 098597966 Invoice Number: I XDXWF36F9
Sales Rep: ROBERT WYSOCKI Purchase Order: 24103
For Sales: (800)981 -3355 Order Number: 372949508 Invoice Date: 07/09/10
Sales Fax: (800)433 -9527 Order Dale: 07106110 Payment Terrms: NET DUE 30 DAYS
For Customer Service: (800)981 -3355 Due Date: 08/08/10
For Technical Support: (800)981 -3355 83 01 O 01 01 N Shipped Via: STANDARDGROUND
Dell Online: http: /vwvw.dell.com Waybill Number: OR SHP GROUN
o
SOLD TO: SHIP TO:
#B TERRY N CROCKETT
o
#0985 85 9 9796 65#
796
o IN -L CITY OF CARMEL FIRE DEPT
ACCOUNTS PAYABLE 2 CIVIC SQUARE
Ln
c CARMEL, IN 46032 -2584
N
a
IN -L CITY OF CARMEL FIRE DEPT
2 CIVIC SQUARE
CARMEL IN 46032
PLEASE REVIEW IMPORTANT TERMS CONDITIONS ON THE REVERSE SIDE OF THIS INVOICE
Order Shipped Item Number Description Unit Unit Price Amount
1. A A31509 01 —V' A ACRCBAT P2-- 0 W!N' L!CENSE .A 2'' ::6S 44.65
MfgPartNum: 54026356AFOl A00
MfgName: ADOBE SYSTEMS
1 1 A3150995 VLA ACROBAT PRO 9 WIN DVD MEDI A EA 20.00 20.00
Mfg PartN um: 22020688AFOOAOO
MfgName: ADOBE SYSTEMS
S #LICS #LIC
t Shi Wor Handling 0.00 FOR SHIPMENTS TO CALIFORNIA, ASTATE ENVIRONMENTAL FEE OF UP TO $25 PER ITEM WI Subtotal 264.66
LL BE ADDED TO INVOICES FOR ALL ORDERS CONTAINING A DISPLAY GREATER THAN 4 INCH Taxable: Tax:
ES. PLEASE KEEP ORIGINAL BOX FOR ALL RETURNS, COMPREHENSIVE, ONLINE CUSTOMER C
ARE INFORMATION AND ASSISTANCE IS A CLICK AWAY AT WWW.DELL.COMIPUBLIC -ECARE TO 0.00 0.00
ANSWER A VARIETY OF QUESTIONS REGARDING YOUR DELL ORDER, ENVIRO FEE 0.00
Invoice Totaf 264.66
U.S. Terms and Conditions of Sale
PLEASE READ THIS DOCUMIEN'fl CAREFULLY? IT CONTAINS VERY RMPORTANT INFOI;U (IATION ABOUT YOUR RIGHTS
AND OBLIGATIONS, AS WELL AS LIMITATIONS AND EXCLUSI THAT MAY APPLY TO YOU.
w THIS DOCUMENT CONTAINS A DISPUTE RESOLUTION AND BINDING ARBITRATION CLAUSE.
(7, NOTF: Those U.S. Terms and Conditions or SAC apply to dinxt purchascs made from Dell by phony- the Imerilet, or the Dell Direct store.
These terms and conditions "Agreement") apply to your purchase of products and/or services and support sold in the United SIMCS by DJL including its affiliates or subsidiaries. By accepting
delivery (1111112 Product, you accept and are bound to the terms and conditions of this Agreement. II you do not wish to be buund by this Agreement, you must notify Dell and return yourpurchLe e pursuaru
to Dell's Return Policy (sec www.dell.cotnlreturupolic,}'). I'IIIS AGREFNIFNIT SHALL APPLY UNLESS (I) YOU HAVF A SHARAfE PURCH,ASG AGRFENIENT WITH DFI-L, IN WI IIC CASE;
l•HE SEPARATE .AGRLENIENT SHALL GOVLRN: OR (II) OTHER DELL Tl -'RN4S AND CONDITIONS APPLY TO TI IL TRANSACTION.
I. Other Doeurnents. This Agreement may NOT be altered, supplcntvnled, u, dosed, be G you m(2nopt u) return Producl to obuor, a Return Material III. :Nut I'ur Resale or Expom- liar agree to comply "jilt edl applicable• la",
nr intandcd by the use 111 any other documcni(') vole othcru'ise agrccd to Amhunmtten Nulnbor for you to utclude uvh your Icta11. You must retell it and rcgplutioos Littflc various state. and of dt2 United tilatc,. You Ligme and
I a written agrec tit cIli signed by both you and I),II if you 00 1, aI receive us. Producl ho u] n) their original or cy or- Icnt packaging Nbu o msponsrble fur represent drat vuu arc buying f.ryoul nun Hall Ill use only, and not fat resale
invoice or aekaowledgentern in the moil, via c -mall, ur with your P—ins, risk of loss, shipping and hantllueg lies for returning or vschanging Ptoduct or -purl Dell has separate terms and conditions go, erniog resale of Product
indrnation abnul }our purchase nrdy be ObtalnoJ Lil AJdiuonal Ices clay apply. It you tail lu tullo,v the return .r exchanec by Iltitd parties and traosac0ons outside tit: Unacd Stain. Tenn, and Llnch-
http0A .ppurLdell....... .ltarrell ncuiec.asps or by conty lolg your ,ales instructions and police, provided b rca
Ddl, Dell Ls nol poiuR Ic 1m P rodu on fo
ct iis r mu sa; le located at: usvw. ddLcontlpulie ',llcgalltermsu(sals.hirn.
reprasenlativo. that is11 a Ilm.tgcd m..dili 11" other wbe pr 'd God I -dor rcsalc. 1L Grnlnmg I :ay. Ilb PARTIIiS A(dCI:F llEAf TI 115 A(iRIJ.NtGNT
At Dcll' discretion l -11L tot plIti2l I[ltlrt, Lit q be less Il an ION oice or iudi-
2. Painter[( Teruo: Orders: Quotes: Interest, Terns A p.rvmem nil "alt ctdu:d compowrt puce, Juc to hunJled.r promotional pricing. ANY SAUFS 1IIINFIINDER, OR AN) CLAIM DISPVTF. OR CONTRO-
in Dell's sole discretion, and unless othervnc agreed to by Dd1, payment VF.RSY (WH]?THER IN CONTRACT, TORT, OR OI III:RWlsl.,
must be received by DLII 1111111111 Dell's acceptance of an ordter. Payment tin 7. Changed ur Discontinnetl Producl. D211's pulse is one o €ongoing upd;ne WI IISI'I IP.K PRIlF :AISTING. PRGSI!NI OR FUCDR1 ANU IMTL9}ING
the products vtIll he made by credo cwd. wire h;ue fct ,I some other pre- ind rcvl.ion. Dell ru ,y r v ke aL J d ,c ,,nnuc Producl :n any woe N idun I S T,VIVTORY. ONSUNIP.R PR(fI LC TION, COMMON LA%I. AND F.UUI-
i arl "anged Paynreet fl unless credit terms have been agreed to by Ddl. u.Iice to you and lhi., m,L) al`cel. m1ormation Limed ill your online 'cair" Dell 1ABI..G C BhI'WLh.N CUSTOMER :AND D[-.L[. 8rise% Gum ur
Imuiccs are due and payablc within 11" lime period noleJ or, pour in,.ice. will ship Producl that bus the lincuonality and perfnrrnancc otthc Product rdat(ng w this agFecmenl, its mterprctaron. or the hreaeh, Ierlrliniltion or Nabd-
reasured felt) the dare of the invoice, Dell may in, otce parts ill' au older or'derad, hen ehanga, betwe,n uhal to shipped and ultat 1s de,ccribcct iu a spec- try /hereof, the relationships '1116 re,uh front this agrecntem. Dells ndyere,-
scpmately I or invoices nog paid wilhin dltrty (30) days of the invoice dill,, I—I I ,hQct or cat Jon arc Ise —ble. Palls used in repmrng o, 9emein, ing, et all y e1;Ital porchl,se S1IALL HI ON I RNED BY TIIL LALA OF
Dell reser the right to charge• you a Into pcuuhy charge ul 1 5'y, per nnmih P11111-1 nouy he ncu. egm,ulent -to -now- a'recanditmned- 1 If- S17V 1::OF ITXAS, W fl HOLT RFGARD T O CONFLICTS OF LAW
appltcd agmnst undi,puted 1111rduc amounts. or the in: -must rate permit-
ted by tit"_ whrlu`vcr IS Icee. Lvov thutp Jay, tIr, adtcr you a .11 continue li. Se. ,ice and Support. 1,2. Uispute I ;urd Kinding Arbitr N L. ANY CLAIM, D R
to he dwr cd an additional l ate total[ charg. Your Urdu' s 'obj Ill a
cn A. Consumer C.,(umcen, Scrv,ec nflenn in In addition 1.1 there WI F., IRP Y (W HETHh IN l FSEN T OR FL r A('T. TORT, OR
g' I' e s. (1'Tk11 ?RWISP; ❑'I- 11: "rHFK PR L•E'XISIINCi, PIiESf A'H'URI:.
ccdauun by Dall, in Dell's >Ic. di I_ Leless you and Dell Ila, e agrccd terms and cordii I,, Dd! and ,I yuI r LhuJ -p 11,) nice pa idcr -111-Y pro- AND INCLUDING S I NI L IURY. CONetIMFR PR(I IPCIION- CONI-
to j diff —Ilt discount. D ll ydard rein I liev Inr Dcll b, utd d ode such amur o ,t I 111 Ili you in aaurdooLt with 1-11I and eundi- h1UN LAW, IV "11-.N7iUAAL iT)KT AND EQ(;1TAI3Lt C'LeAIMSI
touts, wluch meld[ both hardware and scivicc. Lit s it JI—)LIoled 1 MC. won of DJI Scry i De,mproii, located al dell ctmlcerricerun-
alla[ale, (Ile discount off list price app/ calls to 1,h sv iu. pelt ou nl the leans or a, othpw tie delrvuod topuu. Dell ands your third party ,'elys8 Hhl WGGN' Cl1STU N1LR AND llLLL. Lie age °LS. mp1 Y 1 nnupd,
s}ntent m he equal Io the oral all calerdatcdl penemagc d ,count �lt hot price provider may m their di,e,cibn re, ,e thur general and upnnnal ,cry ee tmd sL Lc of as I�It ttl iliaf (mlleetil ely tut purpt c t ih 1 r>_r, ph.
on the emire ,vstein, Dell is not respoleable 1111 poem,. typogrgpludak 11 .:oppon programs and the terms and cundmon, shat govern them ,voltoct "Dell" arising Lio n1 r ral,¢m_ to this Al r el d o t tut promo -u a the
other errors in Lilly o(ter by Dell :md r�,en'c•., One nelt In eanc,l al a den poor nonce to vuu Moat pu"l —Le of xnoce, is 11ursuanl to this rArecmnn breach, I[rrniruu to or vuhdiry Ihet u,L rlle relation >lups v, "hick r r It troin
this Aereatnent (including. w Ills felt 2mcm permitted by applicable Lit,.
rasutunt lion such errors and the terms Land Condit nd nl
it It Delt Sccc Dcscnpholu. 11 applicable_ relationships with third parlie: u9) are not signaloriea to tln5 Agrtementt.
hshal thn, u d, the Inns of your pr lui Dell Iran Ill' uh1 gaol t w p r,
Ddll a
3. Shipping Charges; '1'axcs Title: Risk of Loss. tihippi!Ig and hundhng pub Jverustng, or am late
red pumha,e SHALL HL R150LN'f :D
olds a %icu ur 1 trill Dell ItI t•cused [till payment Inr the Product
arc additional unless other re expres. ly ludo[ Ind at the t no, of sale. 1,11, ur ser„ee Suppun anuraLl god p u h r,ed DLII t, 11111 nhhg: teJ to pnrvillc A('1 IJ51 1.1_N' AND FINALLY E3Y BINDING ARBITRATION adnttnis-
to products passes from Dell to C'usla nu on dupnwu It Lit Dells tu, 1,N. tri d b} the Antetman 4rl ilranon A— cianon 'AAA or JAMS
thud -part ru i d lNi III uutpurl or sei pi support For an) piod-
L.s or Jama�c th;u occur, d1, rind ,hyppmg 6y a e rr •/acted by Dell is Ail trw n prueudings shall he gore, red by thu pro t ion and the .y1ph,.r
nets rn a[tsiee, that vuu pw ch'„ed Uuou�h at third psi 1,g sad not hell. It is Ill[ I t dote, of the selected arbaxatiun admhustralwi ntcludr, any
Ihll: r ..pen tbdil Loss d t d umI c that o[ctrrc during shgtping by a coon pour responsibility 1,_t back up all existing Bata. sofreare, and plugrams P Lc g
e, sduUCd by Nor is your
r spondbihty -Neu must noufy Dell „ith t 21 days al I h Iblc procedures for ln...... -r.ked dspute in elks[ 11 the I nc the
belin'e r.e ring see Ices or support (Including; telephone support). Dell
Ill fill date tit your invoi[u nr aekno,s l„Jgcmud I }nu behave an) pail ul dam[ is tiled. ConsunAT Liuun.tnts findte tJuas chose 1 a 1s:LLLO I I, rate nl
y
and/or Naar Ihtrd -park seeds[ provider hill hace lial,ilily Ibr Inns ur
our purdtasc is mis;iny, \stung or damaged. L'nle:, you pnntde L)cll H'uh ai for personal fitmily or hot. chold LSO eta', elect m pursue lieu d;, m, I li
rectun of data pragranu or loss of use of spstent(s) :wising out Lit the
a slid and cornet mx exemption cerilieatr apphcAblc to gene purchase of iron// -clamu court rather than urhnrutiun "Ilu• ;uburnton or aural[- chino,
sCle ccs or support or any act ur omission, indndmg ucglip!cuce, he [h•II
Product atttl the PI'i,ducl hq) (5 Inealioit. vuu (u[ r p no.ible P:r d :!Lid cunt proceed ut� w ill be I mien! ,inch to the d pl 1,2 oI at nu„ar,N beI„ten
i your Third park aces "ur pro, u1er. Dell o ul.' o p oor Ihir t uh seevu'r
olhxr ta.¢cs a._o Iu dnitlo the urdhr Shopping date ar c,0mp4, ooh. I'nlc cwnmst nJ D..II In an} dnw
pa NL I rk11 L ID, T VIPR NOR DGLL
p is der not ennitrcl by I a lo p) prated or t ht ll L, a or SI1r1L1_ lit hNTI R.FD l D JOIN OR (ONSOS_7DATL CLAIMS JiS OR
to ,olnisre will re n ,iu svtdo the apph[ rble I[cea,I,r(s) to copy or r handle illegal dots._ Ike u1 D nd
Dell uar }our our o h Id p.ne >et s•ie,
to ulcr troy °bug servic, or s,,part, vourc Iesent thutyour system(+ does AGAINST OTID-R CUSTOMILRS. OR ARwrx Al[ ANY lLNIM AS
4, Al's. n'amies. TI1E L[SICh1 WARRANTIES :NI'!'LI('ABLI {TU DELL- p 1 RGPR €iSGN'1 :411VI; OR CLASS i1C [l(I11 I)R IN :A I'121ASVDi.ATTOR-
BRANDED HARUNVARE PRODIX S CAN 13E FOUND LVI sot unman ibegul files far lOeu also rcprneot that you nun the ol
n `ht ur lase a becnsc to oinks co I mall [loss on ours t n and do not INLY GHNFRAL C'APAC III' I he a [I Id I Ot 111- I l n' ture 111 this dis
srw,v del Lromhvan
OR IN fHE UUC'L'MI?N rATR)N DCl_L I'I {O- b P e y y c puts pro, stun goes !o the c,.en[c of Ih p.uucd dlrl utL is oluuon agrce-
V1DES %Vll H DFIA HRANDIi) PRODU('TS. IN ILL NLNKES NO WAR- base any daht that unuld cause lldl ur your lhuJ patty scrviu pr,',der Iu
r be liable for co ri It in trntecrncnl d ouch J:n.L ,s :IS co i d h Del] aadlor 111,2°4 `roll if lound unen liprcenble. [lie onus. hmau( and dispute msolu-
RAN 1 FOR S1 R1 ICES, SOFTWARE OR NON DELL BIUINUhI) P7 g P nun prrvisum .shall not be enforced. The arbitrator shat/ be empowered to
PRODUCTS, SERVICES. MA INTL NA NCE OR SUPPORT. Sh'Cll PROD pony third part' sli c prm ides I'miS used in repairing or ser 016
ur
1'o'da,t(,) Il N to Ile', c, "1,k t to I— i,r "nldlt Ulled_ alLl \Fstc`. :ells[ 1 a:. d h :.':3.1'1111 11[l_tia[..'L 13`1 1,e: Ill
I 1ROA 1 1)f N U b'ARE_ S K'AS I S' M NA V'CF OR
IIIIKU 1 R 5(TPCIRT ART' 1 This tmns,ut m shall be i r I d by 1,h- P dl i.I Arbor nit, Net y r
PRC)N IDLp BhL L 1S I ANU h1RfY WAR B. Comore fat
r[I uncrs. LluJing Small Atedium mul Lal gr
Business and the Public Sector Customer Semi, ambar a rt ,ce I 1 (I tk A Any a Ird of d1,, urhnl d u1..1 ,hall b. cal rd b
R 1N f 1FS.
1'.S, SI.RVI( 11 sIN fF.NANIJ AND SLPI'URI ARF PRO
A'iD- r 111111 Jr 1,h, panic, tut rI n be em t J 11u,L ram a t
Ll1 11) 1 oil. ORL INA[ N1ANt l ACR:RFK OR SUPPI IER, NO I BY oftcrirg, are ptollJul to you pu r 1 (11 DJI nr MU1 See, iccl eompcieut I w ,J e( Dell will he "'I I bl, for pin um •uty nlJn Wu i
D1 LL. DF.I.I- MAKI.S ,AO LXPRL',5 W.ARRAATILS JACI ":I'1 TIIOSL Agrc -1 t I'( NISA ll i n u d gill ill, aI w. .d[11 unulscr couuuncn arbitration 111' If au) coon wr ptcrad, on arty .Linn that
STATED IN DI_I_L S AITI.ICABLI. DELL- BRANDI'.D WAKRAis fY OR siceeouu.nls .md in[. rpor,uui I-em in its erurcly by reil -ice.
affords the p—ailing par attorneys' Ices, ur it Ilrcm is ,riven agrcamenl
SERVtC'L DI SC'RLPTION IN 61 FLCT ON I IIF DATE- UI• 1Ill- 9. Limitation of Liability, DI ::LL DOES NO'[' AC'CLPT LIABILITY providing i.1, Ices, the Arbhrale I v'.c -lia I. ti:,, In dI2 l-
PACKINCI SLIT' OR A('KNON LI•U(il-All-;V T Df-:LL BRAND- to prcn.I
INVOICE,
Lllil'OND 1'Hli RI "NIT 1.111:5 SL "f hOR'i'll 111:It I:I N. INCLUDING BUT ing party, under the _,1,a d uJs for Icc provtJed by low.
1:1) WARRA \PIPS AN;) SHRN, 1-S AKi I P.FEI.( IIVF' ON i VYNILNT Not LINil11 :1) TO ANN' LLlltILI CY FOR PRCIDUCI NOT' 131,1111(; IN FULL AND IN 11 IS NO1 OBI I( Al LD DO HONJO ANY WAR- rl1'AILAI3LI PUR USF. UST PROEM f5, LOSS OF I3LS[NFSS OR FUtt IOLAZ.KVON1 I.EDG E'1'HA'l'N'Ol ,1RE GPITNG I. P1UlB RIGHTS
Sk
ILANTY OR PRi A "IPI SLKVICI'_ l:A I it. DIII.L. RGCEIVI :S 11' %%'iAIf'NT LOSE OR C'ORRUPTIA) DNIA OR SOFTWARE, OR THF. PROVISION TO LE "fIG :ALh. CLAIMS IN ,A ('UC R'1 OR BFF(IRE.A JL'Rl OEtTQ
IN I UI_L. DELI_ MAN` RLOLLS'f CAN( GLLAIII)N Of'THIRD- PARTY OF -KVIC 'LS LS AN[) SLII'I'UK1. Ii Xt'I-.PT AS LSF'RI SSLN' PROI'IDI -D PARI'ICIP4XIL IN N f 1 ASS ACTION OR REPRESE.NTATIA E
BRANDED SOFTV6ARLLICENSFS, S[AtVICILS. MAIN "FFNANC'1'. OR OF SI 1R'. WILE.M)PBh. Ll X( ANY 1 LY -Q OVI IAL, AC"I'10N WTI' It RESPEC.F TO 5LC1I A CLAIM. 01 HER RIGILES
SUPPORT If DFLL DO1.5 NOT RALPOVI PA13II.NT If- YOD PUR- T ILA, N'OC %I Ot1LD FLUE IF NOU RENT TO COI'RS. SUC'11 AS
SPIi(.fAL. 1NTIRI. C"I, OR PGNIit%'[, DANIAC,LS, EVif N IF ADVGGLI
CHASE THIRD PARTY' BRANDED PRODUCI'S. SI'.RVICLS, MAIN I'D- OFTIIF. POSSIBILITY OI: SUC'11 DAMACd;S -OR FORANY CLAIM BY
:ACCESS 10 k71SC0N'F.RI', A7.AYALSO Bh I. V.UAILABLE OR MAN
NANCT.. OR SUPPORT, ADDI'TION'AL. TIIIRD- I!AR`PI' TERMS AND ANY THIRD PARTY. YOU AGRHi THAI FOR ANY LIAbll,( I y BE LI111'1'ED IN ARBITRATION.
CONDITIONS MAY APPLY. L A I I11) 107111: III R( ILIST. 01 PR( MLV I, DI -.I.I. IS NOf LIABILI
Per infornt.mnn on :N,NA or JAMS, contact tha lillluw ing: aNnlrncau
S. Solhsa re. All sv h,,a e poo, idce! subleet Is. a license a�`rcenpri t .md 1,111 OR KI. SlION'SIBI.1. 1 -Ok .ANN' AM 1,I '111 Of'' DANIAr GS ABOVE T111: Arbnt mmirl A It o I. 310 1lod roan Ave me loth 1•Iuor, \c„ York, NV
e, that Nf¢l w ill be b,antd Icy Such license ,igrccn),nt m adLhu. +n ¢I Ih„C AMOi Nl INVO 1 1) 1OR I HI ANNA A11I -I PRODLC T NUI'LN'I l l- IOM ad, .ue, J.NNIS, la HoIndnas, Ncss York, NY I000i, (8001 .3"-
L :nfty, -ur,r m,inc a jib If, nppl.- blehr,n "O" s t!y Df V1,, .1N11111AG INv I HIS A( 00 1 W.A' F 10 11II tU TR :AIiI. 1,' u,l ,opuo "ll.co,I,
IILI- RI VIf DII5 SI.I I )RI II IN 11115 :N(,Rl t AIf SIIAI I. APPIN'
fi. Return Policies; b;AChanges. Dell', return polcy can be found al fN "LN 11 SC('If REMIJ)IP.S PAIL 1 LSSFN'I 1Al- III KPOSI. (Re,, 1015091
wsysv.delLarndrcturnpolics and you agree to th-I, term., You must Contact
VOUCHER NO. WARRANT NO.
ALLOWED 20
bell Marketing
IN SUM OF
850 Asbury Drive
Buffalo Grove, IL 60089
$264.66
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT #!TITLE AMOUNT Board Members
24103 XDXWF36F9 102 632.02 $264.66 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
JUt 1 9 201U
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))
XDXWF36F9 $264.66
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