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HomeMy WebLinkAbout195020 03/02/2011 CITY OF CARMEL, INDIANA VENDOR: 088550 Page 1 of 1 ONE CIVIC SQUARE EVERETT J PRESCOTT INC CARMEL, INDIANA 46032 PO Box 350002 CHECK AMOUNT: $1,126.53 BOSTON MA 02241 -0002 CHECK NUMBER: 195020 CHECK DATE: 3/2/2011 DEPARTMENT ACCOUNT PO NUMBER I NUMBER AMOUNT DESCRIPTION 601 5023990 4359018 1,099.52 MATERIALS SUPPLIES 601 5023990 4363003 27.01 MATERIALS SUPPLIES Pipeline Specialists 2P,O. E60 0] �6 t7/ p SEE CONDITIONS OF SALE AND 0 PAYMENT TERMS ON REVERSE. p� T'a"�P° FACE NO METER BACKFLOW SERVIGES P.o. Boa soo 210 SHEEABAVlSROAD, CONCORD, NH 03301 Gardiner, ME 04345 0 0 T 9 Q I 603 224 8425 FAX 603 224 3842 (207) 582 5019 FAX (207) 582 9118 INVOICE DATE 2/07/ 1 1 REMIT r1- .f -`il "f E...1 lA:lm IT1 �J 7'1c I l:) l7. WAREHOUSE >TE -�M L_..J W .I.rldickTlcd.�.�f. l PACKING SLIP NO. 43590 TO> E:' .J1., PR17GC'13T* ill;. 8309 W. WaShi. DTI S 't- CUSTOMERNO. 1 ;f` i P 0 BOX 41500C! W WAREHOUSE 2° E O ml iriciirnnitF, €,111, IN �-f�1 €..l224 Telephone, 317 ORIGINAL INVOICE SOLD TO> (.'T TY OF C1= ;F?I'lF 1.. l_1F'It._71 °t,L.3 SHIP TO >C:Lt1•I.Orf,E -1r r_i:1._ €r1 ;3 C-) W 1;31. 1; r' i E7 Clarrrle1. 1 1 ._I C 1 CUSTOMER P.O. NO- JOB NAME JOB NO. S f ra' i�� L DATE DUE DATE SHIPPED SHIPPING METHOD r�7 rr}}..W S 1 13 -l. ry�ry7- FF 0 r '•J��r-y�ijy�A�{ 11UU LULU 1rU1/r"L'] 1�r IL 2/07 L�rryf�7.I�.7-f-��y1��.�k.i:. p l'm V:1:.111,WN(:.]fUl- �UULL'L lfAl'L 5:.1A1U 6 0 O 1 50040 -i 1/2 NE_TER CHAMBER COMP A I 1 235. 33000 2,15.33 2 50875 1 1! 2 METER CASING GASKET E: 1 4.. 1 720 0 4.92 .;i 50827 1. 1/2 METER UPPER CfA.`:ill'' G E Pf 1 157. 59C700 15 i 5k Zi• 508 10 16 1 SRII CHAMBER ER TOP (-a;.aSEME t-Y EA 1 23.02000 2 3. 0 5 50 17 1. SR:I:T METER PISTON EA 3 13.10000 3 ?.39 6 50910 1 SRI I F31DI 1 011 PL -(-1TE GASKET IAA 10 2.02000 20 o 1 30 7 1CS 1 V 1 P 1 S R 1.1- CONT ROL.L_E R EA 3 1. 52000 4.7 S 5061 -6 23 5/8 SRI.I ):ailFTOM PL_t'�TE .:I:FZON EA 6 '5 "BOOM) 34.30 9� 50605 5/8 ME -F -L-: R BOTTOM PLATE: RON EA 6 :7 .34000 44.0 1. -0 '-50.i 2 4 =5 IvIXU BATTERY F-t-at.,F( `.�(.,SE� EJA 30 17.83000 534.93 I YOU F O1, YDVR BUSINE E3S WE AfRE DOING AL -L: VlE CAN THANK YOU AMOUNT 1,09 ''52 3 C? KFE P PRIC.ES FAI-R IN '1°1 °416 UNCERTAIN I C:I:IhllM'v n FOR YOUR BUSINESS! TAx 7 n 000 -00 TI -fE PRICES ARE BASED D \1 30 DAY 1' YOUR HE:L.P IS PLEASE NOTE: OUR TERMS FREIGHT 00 NEEDED AF?3=RECIwrED. [=.MPI- t:J`>'EES OF TEAM EJP. 17'11h r .00 ARE NET 30 DAYS. YOUR SERVICE CHARGE IS 1f% PER MONTH (18% A.P.R.) ON THE BALANCE OVER 30 DAYS OF AGE- THE BUYER HELP IS NEEDED AND 0 JL AGREES TO PAY ALL COSTS AND EXPENSES OF COLLECTION, INCLUDING REASONABLE ATTORNEY'S FEES, u 1. O'� 9 AND EJP CLAIMS A MECHANIC'S LIEN UNDER APPLICABLE STATE LAW. APPRECIATED. E.J. Prescott, Inc. Terms and Conditions of Sale Prices: All prices are subject to change without notice, except wher,' firm quotations have been provided in writing by authorized management personnel of E.IP. Taxes: Prices do not include any present or future federal. state, or Inril Cases (including, without IirnnMaou, s rlc s tax. use tax, excise tax, or otherwise) unless specifically stated. It is the responsibility of the Buyer to pay at] such taxes. Taxes where applicable may be added to the price of the products and shall be paid by the Buyer. unless the Buyer furnishes to EJP a tax exemption certificate in a form agrecalile to the applicable taxing authorities. If EJP is required to prepay any such tux. Buyer will reimburse EJP in full upon demand. Payment Terms, EJP Open Credit accormts are established for commercial. non- consumer use•onlyJUnless an approved commercial Open Credit account is established, payment in goes( funds or approved check must be made, before or at time of delivery. Commercial Credit terms arc Nei 30 days; no cash discounts allowed. Service Charges commence after 30 days and are calculated on the last day of the month in which the 30th day falls. SER- VICE CHARGE IS I :A PER iMON'I (I S c A -P.R.) ON THE BALANCE OVER 30 DAYS OF ACE. THE BUYER AGREES TO PAY A(...1., COSTS AND EXPENSES- OF- C'OLLEC'TTON.INCLUDING REASONABLE ATTORNEYS FEES, and EJP claims a. mechanic', lien under zapplic,athle state law. Acceptance by EJP: All orders from the Buyer are subject to'accepiance I) y authorized personncl'of EJP. and, iii the case of Open Accounf Sales. approval of the EJP Credit Department. %Cancellations-. SPECIAL OR NON- STOCK ITEl19S MAY NOT BE CANCELLED OR RETURNED AFTER THE .PRODUCT(S) IS PLACED INTO PRODUCTION. All char_es and costs incurred by EIP as a residt of cancellations or' order changes will tie billed to the Buyer. Delivery- EJP will make a good faith effort to complete delivery of the products; provided. however, that EJP assume; ho responsibility or liability for loss or damage due to delay or inability it) deliver, if such non- peil'onrrance was the result of any events or circumstances beyond the control of EJ P. inetud- ing, but not limited to, acts of God, war, labor difficulties, fire, accidents, inability to obtain materials; and delays of carriers, contractors, suppliers- or manufacturers. Under no circumstances shall EJP be liable for any special. consequential. incidental, inchrecl, or litluidaled dannages. lasses, or expensc (whether or not based on negligence) arising directly or indirectly from delays or failure to give notice of r delay. Shipment: Shipment of a11. products is to one given destlnarlon for all items including pipe, unless otherwise indicated in wrifing:Risk of loss shall trans for to the Buyer upon lender cif' goods to Buyer, Buyer's represenutative, or common carrier. The cost of any special packing or special handling caused by Buyer's requirements or requests shall he added to the amount of the order. If Buyer causes or requests a shipment delay, or if F.JP ships or deliveis the products erroneously its a result of inaccurate, incomplete or misleading information supplied by Buyer or its agents or cinployees, storage and all other additional costs and risks shi be borne solely by Buyer. Claims for products damaged or lost in nansit should be made by Buyer to the carrier, as EIP's responsibility ceases upon tender of goods to Buyer, Buyer's representative or ccrnvnon carrier. Delivery will be made on hard surfaces only. Any dam- age or towing charges resulting from "non haul surface deliveries shall be the responsibility of the Buyer. inspection and Acceptance: Claims for chunage, shortage ar CI Mrs in shipping must he reported within 10 days following delivery to Buyer. Buyer shall have' 10 slays from the date Buyer receives any products to inspect such products and services for defects and nonconformance and notify EJP, in writing, of any defects. nonconformance or rejection of.such products. After such 10 flay period, Boyer shall be deemed to have irrevocably accepted the prod uctS, if not previously accepted. After such acceptance, Buyer.shal l have no right to reject the products for any reason or to revoke acceptance- Buyer here- by agrees that such 10 day period is a reasonable amount of time for such inspection and revocation- Returns: Materials cannot be returned without EJP'S written consent. NO RETURNS ART-. ALLOIVED AND NO REFUNDS WILL BE MADE ON ti i PIPE OR (ii) SPECIALLY FABRIC.AFED OR ORDERED ITEMS. Tl IE SOLE AND EXCLUSIVE REMEDY FOR SUCH ITEJVIS ALLEGED TO BE DEFECTTVE IN WORKMANSHIP OR MATERIAL WILL BE THE REPLACEMENT OF THE ITEMS SUBJECTTO THE MANUFACTURER'S INSPEC- TION AND WARRANTY, All other returned material is subject to a MINIMUM 25 RE- HANDLING Cl IARCiE, plus transportation charges. Unless other- wise agreed by the Buyer and E1P. all credit for returned tnatei7al will be applied to future orders, subject to approval by the EJP Credit Department. Warranty: THE BUYER'S SOLE AND EXCLUSIVE WARRANTY, 11 ANY, IS Tl-INF PROVIDED 13Y THE PRODUCT'S MANUFACTURER. EJP MAKES NO EXPRESS OR IMPLIED WARRANTIES. EJP HEREBY DISCLAIMS ALL EXPRESS OR IMPLIED WARRANTIES. WHETHER IMPLIED BY OPERATION OF LAW OR OTHERWISE, ,INCLUDING. WITH0UT LIMITATION, ALL IMPLIED. WARRANTIES OF MERCHANTABILITY AND FITNESS OR FITNESS FOR A PAR'T'ICULAR PURPOSE. LINDER NO CIRCUMSTANCES, AND IN NO EVEIVI'. WILL EJP BE LIABLE FOR PERSONAL INJURY OR PROPERTY DAMAGE OR ANY OTHER LOSS, DAMAGE_. COST OR REPAITtS OR INCI- DENTAL. PUNITIVE, SPECIAL, CONSEQUENTIAL, OR LIQUIDATED DAIMAGES OF ANY KIND, WHETHER BASED UPON WARRANTY, CONTRACT. STRICT LIABILITY, NEGLIGENCE OR ANY OTHER CAUSE OF ACTION AR[Sl?4G IN CONNECTION WITH THE DFSIGN, MANCIFACTURE, SALE, TRANSPORTNI IOiN, INS`T'ALL:AT'ION,'OR REPAIR OF PRODUCT'S'SOLD BY EJP. BLI YEk ACKNOWLEDGES AND AGREES THAT UNDER .NO CIRCUMSTANCES, AND IN NO EVENT. SHALL J JP'S LIA13iLITY. IF ANY. EXCEED THE NET SALES PRICE OF THE DFFEC:TIVE PRODUCT(S), Entire Agreement: This document constitute, the entire, complete, and exclusive agreement between the parties with respect to the subject matter here of and contains all the agreements and conditions of s:de; no crnutse of stealing sir UNalge of the Irade shall he applicable unless expre,slVincorporated here- in. The terns and conditions contained herein may not be added to. modified, superseded ov o11lerwise altered except by it writteiu modification signed by authorised management personnel of EJP. All transactions shall be goverTred'solely by. the terns and conditions contained herein. Al( purchase orders issued pursuan to in EJP quotation shall be deemed issued subject to all EJP terrns'4nd conditions herein coluained. Theca tents oast ccrndjI ors shall supersede those of the Buyer. Governing Law: 'this vansaction shall be governed in all respects by due laws of the State of Mainc (excluding choice of law provisions). All actions. regardless of form, m king out of or in connection with this transaction, the products sold by 1-11 or the relationship between the Buyer and EJP Shall be brought in doe c:ourls of the Staic oi',Moioc: within the applicable statutory period. Communications: Payinenrs only should be directed to: C.J. Prescott, Inc., P.O. Box 150002, Boston. MA 02241 -0502. All other correspondence and inquiries should be directed to )'our local F.JP Division. The Horne Office address is 32 Preseolt Street. P.O. Box 600, Gardiner. Maine 04345. Telephone 1207) 582 -1851. Fax (207),582-5637. E -mail e,lp@ciprescou.com. E.JP TSC R-MJon tale x'09 Pipeline Specialists GARDINER,MAINE SCOTT, INC g �e� SEE CONDITIONS OF SALE AND FFICE PAYMENT TERMS ON REVERSE. T STREET soo PAGE NO. LLL___ JJJ +d INE 04345 tY1ETER BACKFLOW SERVICES r.o. aoXfioo Everett J. Prescott, Inc. 07 582 -1851 210 SHEEPDAVISROAD,CONCORD,NH0330i Gardiner, ME 04345 O ly _•y 6",3 i)(' 3 603 224 -6425 FAX (60') 224 -3542 (207j 582 -5019 FAX (207j 582 -9118 INVOICE DATE is /0 REMIT Ii.tlly� EW.,.)P W �.itt�ii- i- irO.F�CJlis WAREHOUSE >EE_.�;I! F.u�I� gyp!.. J.1'1t�1.i�1tr'a,�3�)], PACKING SLIP NO. �r�5 fi) t TO> 1- H ,,J.. PR 13 C, 0f I 81 30V w.. (a) d:3 shiti`:.('t: o t i st„ CUSTOMER NO. 7 r 7 P C) BOX 3 50)002 WAREHOUSE 220 E;C'fS'TDI NA Tr1diiariapolis.. IN 46231 02:'21't 1 -0502 T e :L e p 1 u r, c5 317-247-000'5 ORIGINAL INVOICE SOLD TO> CIT Y !_)I' C:£1RMEL. UT:C)_:I:TIE;S3 SHIP TO i Tl (�1•- i" FM!�t� !Ir.!__ UTILITIES 34'5 0 I e 1,, :i 1 �s t Street 1 1 4150 W,. 1._3 1st Street 4.• iY I Il•i L` .L r• .I. 1\ r a n e 1. p 1 N SL$._ DATE_DUE DATE SHIPPED SHIPPING METHOD GREGG STOCK 06 3/11, 2/09/1 Ou r TP"uct l'�U:LS 0 Ili1.:A1'd1�.L�nl L.1K1J EEu�iil e O l:lAlil l'.AJ:.11J000 U Quw lrUm,A N ,1 42 70 F 2X7.5 F'1. REP 2. 1E 1 27.01000 27. 01 it•) N r I IJ 1 -UR YLJUR BU ES S! 7 J L WE WE—U THANE( YOU AMOUNT F 7.0 1 TO KEEP PRICE (S FAIR :I N THIS UNICERTA I N En.. C N MY a FOR YOUR BUSINESS!. TAX.__..: n_00 'TFIE= PRICES ARE Bt"tc•,ED ON 30 DAY !"II'-'tYl #G:NT. YOUR I-IE L.P IS PLEASE NOTE: OUR TERMS FREIGHT A %DO IqEEE)1 -.0 A[' APPRECIATED. EMPL_C)YEI_S'OF TEAM E IP. ARE NET 30 DAYS. YOUR (�tE, €.r a Cr1`- SERVICE CHARGE IS 114% PER MONTH (18! A.P.R.) ON THE BALANCE OVER 30 DAYS OF AGE. THE BUYER HELP IS NEEDED AND AGREES TO PAY ALL COSTS AND EXPENSES OF COLLECTION, INCLUDING REASONABLE ATTORNEY'S FEES, 2 C) 1 AND EJP CLAIMS A MECHANIC'S LIEN UNDER APPLICABLE STATE LAW. APPRECIATED. E.J. Prescott, Inc. Terms and Conditions of Sale Prices: All prices are subjcCflo change without notice.. except where firm quotations Have been provided in w'ridn, by authotzed management personnel of ETR Taxes: Prices do not include any present or future federal, state. or local taxes (including, without livanation, Sales tax, use Ilia, excise tax, or otherwise) unless specifically stated. It is the responsibility of the Buyer to pay all such taxes. TaXCS where applicable may be added to the price of the products and shall be paid by the Buyer, unless the Buyer furnishes to EJPit tax exemption certificate in a form agreeable to th, :applicable taxing authorities. if EA is required to prepay any such tax. Buyer will reimburse EJP in full trpon demand. -.Payment Terms: EJP Open Credit accormts are established for commercial, coon consumer use only. finless an approved commercial Open Credil account is established. payment in good bands or approved check must be made before or at time of delivery. Commercial Credit terms are Net 30 clays, no cash discounts Alawed. Service CharaCS commence after 34 days and are calculated on the last clay of the month in which the 30111 day frills. SER- VICE CHARGE 1S 1e.-% PER MONTH (18 A.P.R.) ON „THE BALANCE OVER 30 DAYS OF AGE. T] °IE BUYER AGREES TO PAY ALL COS'l AND EXPENSES -OF- COLLECTION, hNCLLFDING REASONABLE ATTORNEY S FEES, and-EiRclah ms a mechanic's Tien under applicablesuate law. Acceptance by F,.JP? All orders from the Buyer are subject to acceptance by author izdd. personnel of'iEJR and, in the ease of Open Account Sales, approval 6f the .EJP Credit Department. Cancellations: SPECIAL OR NON- STOCK ITEMS MAY NOT BE CANCELLED OR RETURNED AFTER THE PRODUCT(S) IS PLACED INTO PRODUCTION, All charges and costs incurred by EJP as a result of cancellations or order changes will he Filled to the Buyer. Delivery: FJP will make agood faith effort to complete delivery of the products; ptovided. however, that ETP. assumes no responsibility or liability for loss or damage due to delay or inability to deliver, if such non performance %vas the result ofarty events or circuristances beyond the control of EJP, includ- ing, but nor limited to. acts of God, war, labor difficulties. fire, accidents, inability to obtain materials, and delays of carriers, contractors. Suppliers. or manufacturers. Under no circumstances shall EJP he liable for any special, consequenIiaI..irici (lei tat, indirect, or liquidated damages, losses, or expense (whether or not based on negligence) arkin©> direcdy of indirectly foam delays or failure to dice notice of delay. Shipment: Shipment of all is to one given destit for all items including pipe, unless otherwise indicated in writing. Risk of loss shall trans- fer w the Buyer upon tender of goods to Buyer, Buyer's represetuative, or comanon carrier. The cost of tiny -special packing or specizif haulling caused by Buyer's requiremeots or requests shall be added to the amount of the order. If Buyer causes or requests a shipment delay, or if EJP ships or delivers the products erroneously as a result of inaccurate, incomplete or misleading information supplied by Buyer or its agents or employees. ;forage and all tither additional costs ;in(] risks shall he borne solely by Buyer. Claims :for products damaged or lost in transit Should be made by Buyer to the earner, as FJP's responsibility ceases upon tender of goods to Buyer, Buver's representative or common cairie.r' Delivery will be made on hard surfaces only. Any darn- age or lowing charges resulting from "non hard surface deliveries` shall be the responsibility of the Buyer. Inspection and Acceptance: Claims for d:nnage. shortage or e[rors in shipping must be, reported within 10 clays fol lowing delivery Iii Buyer, Buyer shall have [0 days from the date. Buyer receives any products to inspect such products surd services for defects aid nonconfrn;manca and notify EJ.P, in writing, of any defects, nonconfortnance or rejection of such products. After such 10 day period, Buyer shall be deemed to have in•evocably accepted the prod ucts, if not previously accepted. After such acceptance, Buyer shall have no right to reject the products for any reason or to revoke acceptance. Buyer here- by agrees that such 0 day period is a reasonable amount of time for such inspection and revocation_ Returns: Materials cannot be retmied without E.IM written consent. NO RETURNS ARE ALLOWED AND NO REFUNDS WILL BE ,MADE ON (i l PIPE OR (it) SPECIALLY FABRICATED OR ORDERED ,ITEMS. THE SOLE AND EXCLUSIVE REMEDY FOR SUCH ITEMS ALLEGED TO BE DEFECTIVE IN WORKM ANSHIP OR MATERIAL. W ILLBE THE REPLACEMENT OFTHE ITEMS SUBJECT TO THE MANUFACTURER'S I NSPEC- 'T ION AND WARRANTY. All other returned material is subject to a MINIMUM 25% RE- HANDLING CHARGE, plus transportation charges. Unless other- wise agreed by the Buyer and EJP. call credit for retooled material twill be applied to future orders. subject to approval by the EJP Credit Department. Warranty:' ILIE BUYER'S SOLE AND EXCLUSIVE NVMA RANTY, IFANY, I; S THAT PROVIDED BY "THE PRODUCT'S MANUFACTURER. LIP MAKES NO EXPRESS OR IMPLIED WARRANTIES. EJP HEREBY DISCLAIMS ALL EXPRESS OR INIPLI.ED WARRANTIES, WHETHER IMPLIED BY OPERA'T'ION OF LAW OR OTHERWISE, INCLUDING, WITE1t7UT LIMITATION, ALL IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS OR FITNESS FOR A .PARTICULAR PURPOSE: UNDER NO CIRCUMSTANCES, AND IN NO EVENT. WILL EJP BE LIABLE FOR PERSONAL INJURY OR PROPERTY DAMAGE OR ANY OTHER LOSS, DAMAGE. COST OR REPAIRS OR INCI- DENTAL, PUNITIVE, SPECIAL, CONS EQUENTTAL, OR LIQUIDATED DAMAGES OF ANY KIND. WHETHER BASED UPON WARRAN'T'Y, CONTRACT. STRICT LIABILITY, NEGLIG,ENC F OR ANY OTHER CAUSE OF ACTION ARISING IN CONNECTION WITH THE DESIGN, MANUFACTURE, SALE, TRANSPOKI'SHON. INSTALLATION. OR REPATR OF THE PRODUCTS SOLD BY EJP, BUYER. ACKNOWLEDGES AND AGREES THAT UNDER NO CIRCUMSTANCES, AND IN NO EVENT. SHALI. EJP'S LIABILITY. IF ANY EXCEED THE NET SALES PRICE Of:` THE DETECTIVE PRODUCT(S). Entire Agreement: This document constitutes the entire, complete, and exclusive agrcenie-nt between the parties with respect to the subject matter here- of and contains all the agreements and conditions of sale: no course of deal ing or wage of the Made ,hall beiapplicable unless expressly incorporated heie- hn: The tennis and conditions contained herein may nor be added to, modified, superseded or otherwise altered except by a written modification signed by authorized management personnel of F..IP. All transactions shall be governed solely by the tents and conditions contained herein, Alt purchase orders issued pursuair to an EJP quotation shall be deemed issued subject to all EJP temis and conditions herein contained. _These tennis and conditions shall supersede thosa_cFi'1he Buyer. (3overning Lacy: This transaction shall be governed in all respects by the laws of the Stme= of Maine (excluding choice of law paovi -sions). All actions, regardless of form, arising out of or in connection with this transaction, the products sold by EJP, or the relationship bet +een the Buyer and EJP shall bt, brought in the court~ of the State of Maine within the applicable statutory period. Communications: Payments only should he directed to: E.3. Prescott, .Inc., RO. Boa 350002, Boston. MA 712 2 241-0541 All other correspondence and inquiries should be directed to your local EJP Division. The home Office address is 32 Prescou Street, P.O. Box 600, Gardiner, Maine 04345, Telephone (207) 582 1651. Fax -07 51+2 -%37. E -mail e;, Ip(a €tcom. EJP T &C ne,iston Oala 4.Tp9 VOUCHER 104178 WARRANT ALLOWED 88550 IN SUM OF E.J. Prescott, Inc. WATM P.O. Box 350002 OPERAnONS Boston, MA 02241 -0002 Carmel Water Utility ON ACCOUNT OF APPROPRIATION FOR Board members PO INV ACCT AMOUNT Audit Trail Code 4363003 01- 6200 -06 $27.01 43591 Voucher Total i� •z� c Cost distribution ledger classification if claim paid under vehicle highway fund Prescribed by State Board of Accounts City Form No. 201 (Rev 1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice or bili to be properly itemized must show, kind of service, where performed, dates of service rendered, by whom, rates per day, number of units, price per unit, etc. Payee 88550 E.J. Prescott, Inc. Purchase Order No. P.O. Box 350002 Terms Boston, MA 02241 -0002 Due Date 1/18/2000 Invoice Invoice Description Date Number (or note attached invoices) or bill(s)) Amount 1/18/2000 4363003 $27.01 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 Date Officer