HomeMy WebLinkAbout196537 04/13/2011 CITY OF CARMEL, INDIANA VENDOR: 00350177 Page 1 of 1
ONE CIVIC SQUARE SEARS HARDWARE CHECK AMOUNT: $889.50
CARMEL, INDIANA 46032 PO BOX 689134
DES MOINES IA 50368 -9134 CHECK NUMBER: 196537
CHECK DATE: 4/1312011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
651 5023990 T194572 260.30 OTHER EXPENSES
651 5023990 T230178 151.71 OTHER EXPENSES
651 5023990 T230185 -10.00 OTHER EXPENSES
651 5023990 T302228 257.63 OTHER EXPENSES
651 5023990 T302253 -10.00 OTHER EXPENSES
601 5023990 T729830 199.99 OTHER EXPENSES
651 5023990 T839235 39.87 OTHER EXPENSES
Page 1 of 1
SEARS COMMERCIAL ONE
PO BOX 630859 S
IRVING TX 75063 -0859
Invoice Number: T729830 Comme rcialOnW
Account Number: 5405530000034389
Bin INVO To: Amount Due: $199.99
Payment Due Date: 04 -15 -11
Purchase Location: 000005340
0000056 FISHERS IN
is Merch Ref 20110316005340`504R5969
CARMEL WATER AND SEWER ULIL SRRE
3450 W 131 ST STREET a Please pay From This Invoice.
WESTFIELD IN 46074 -8267 Ship To:
Irtll�l�rl�nll�I�I1����Il f���nlI Fill 11� Ilr����'I�Ilrl���
UTILITY CITY OF CARME
9609 HAZEL BE
INDIANAPOLIS IN
Customer No, Ordered By Authorized By Purchase Order No. Purchase Dale Sears Ship Order No.
WILLIAM BELL 03 -16-11
-Stock No,SKU -Description Quantity'' Unit unit Price Extension
00934260000 260PC MTS,CRAFTSMAN 1.0000 199.99 199.99
SUBTOTAL: 199.99
Total: 199.99
This Account Issued by Citibank (South Dakota). N.A.
SEND BILLING ERROR NOTICES .TO: SEND INQUIRIES TO FOR QUESTIONS ABOUT YOUR�ACCOUNT:°
Sears Commercial One Sears Commercial One (600) 599 -9712 -CALL
PO Box 689132 PO Box 669132 (800) 599 -9711 FAX
Des Moines, IA 50368 -9132 Des Moines, IA 50368 -9132
In Case of Errors or Questions About Your Bill Payment Information
If you think your invoice or billing statement is wrong, Payment must be mailed to us at the payment address
or if you need more information about a transaction shown on the reverse side. Payments that are received
thereon, write us on a separate sheet at the inquiry in the mail at the designated address before 9:00am (CST)
address listed on the reverse side as soon as possible. on any Monday through Friday that is not a holiday will be
We must hear from you no later than 30 days after we credited as of the day of receipt. If payment is not made
first sent you the invoice or billing statement on which as provided herein, crediting may be delayed up to 5 days.
the error or problem appeared.
You agree not to send us partial payments marked
You must contact us in writing in order to preserve your "paid in full "without recourse or similar language
rights. In your letter, give us at least the following information: unless such payments are marked for special handling
Your name and account number and sent to the inquiry address on the reverse side.
The dollar amount of the suspected error The Sears Commercial One Account is issued by
Describe the error and explain, if you can, why Citibank (South Dakota), N.A..
you believe there is an error. If you need more
information, describe the item you are unsure about.
v.
i 1 ��4 �r�� 'J'��n�I i 'a pqupr 1 "f lk�
r+ ti 3`P "rK� f� fW Rf S P�' f 1� 9 1 I� r� ^r i. �'r�S�'
v
S L;AR
IIIIIIII��I� l�llil�l�Il�llli j FISHERS HDWR 05340,
1172.8 FISHERS CROSSING OR
SfALF �iL FIE •CK ►k FISHERS, °1N 4603$ =2791
UNIT CERTIFICATE OF
317 -84,1 9173;,
EXEMPT [ON
I ��I tl�lll�l�lllllllllli !'�IIIII
11� L 1
RETAIN FOR CUMPARISUN WITH h1UN1HE_V
I CERTIFY THAI i lfl S CLAIM �f ROM,�STAI E �<SALES STATEMENT OR FOR RETURN OR EXCHANGE
"l4X-IS BASED UPON THE FOLLOWING 'k
GOVERNMENT t STATE OR LOCAL) SALE=CHL( K
053405045 6
OF
LAUNDER PENALLY PERJURY AND FHE
r�. PURCHASER: Ell CITY OF CARMEL
RULES AND REGULATIONS OF THE BLLOW DRESS: 9609 HAZI_L0ALE"
LISTED TAXING�sJURISDICTIGN I DECLARE TY %STATE: INDIANAPOLIS IN
"THAT T,HE PROPERTIY�'r0E5f ER
IP CODE,
PRESENTED�BY��T [ME�A;TTACHED`.
w ?635
OCUMENT;�AND'�PUI7CH'ASED FROM SEARS
t rxt ��,d ar FOR A QUALIFIED' Yt,���a
CO. "-IS USE �TRANO PG /STORE RFC A�
FOR 'iVW'LCH°�.A TAX `EXEMPTI'ON HAS BEEN
5969, 99 05340 504
;GRANTED UNDER THE LAWS OF BELOW L ISICO 1� RINGIIG'A:SSDC '0 380
TAXING JURISDICTION AND 1 ASSUME AL E✓�
LIABILITY FOR ALL. TAXES AND PENAI_[IES IF g 34260 TOOL SE1,2 -'SAL 199 99T;
I USE OR CONSUME,THE PROPERTY IN SUCH (n UPC: 714994342601
A WAY AS TO RENDER THE SALE SUBJECT SUBTOTALS -199 :99
Ty -1 TAX. TAl EXEMPI 00
CARD TYPE: COMMERCIAL 1
aTATE: IN :ACCT ;,'W9369/0
AUTH CODE: 01 67291E
ORGANIZATION NAME: P 0 NUMBER WILLIAM BELL c
CITY OF- CARNEL:
�;;0311,Gli,11'� COMMERCIAL 1 TOTAL 99 .,99
1659 T554- 0171:0919 061.9
R ,',,PURCHASE ORDER 0 OR ACCOUNT
.St312q'15500.20
CARDHOLDER ACKNOWLEDGES RLCEIPT
HAZ. L „BE OF GOODS AND /!OR SERVICES IN THE
I fDI ANAPOLIS IN 46280 AMOUNT OF l
DESCRIPTION OF BUSTNES WITH AMOUIVTS'AS SHOWN CHARGED TO
UTILITY EACH CREDIT CAW IDENTIF HEREON,
AND AGREES TO BE BOUND BY THE TERMS
t �UTILITY CITY OF CARME r� SET FORTH IN THE CARDHOLDER'S
v'� ►REMQAN AGREEMENTS) WdTH THE. 1SSUERt 5) OF
yr�,, T,HOSEe "CREDIT CARDS,
3/16/11
iRi g 6Y1 i PpY vii r wrk f SF7 i V` 1d 15'a `s rs" 9 t f i+eiul5 C
t r S AVE. L S C H L K
„Q534'fJ5C45969
�y�`ti yf x E�+ flllllli�l�llil�lllll�llll�il�lll�l
v':
VOUCHER 104473 WARRANT ALLOWED
350177 IN SUM OF
SEARS COMMERCIAL ONE
DEPT 53- 0000034369 OP�n
PO BOX 689134
DES MOINES, IA 50368 -9134
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
T729830 01- 6200 -04 $199.99
Voucher Total $199.99
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 bill 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
350177
SEARS COMMERCIAL ONE Purchase Order No.
DEPT 53- 0000034369 Terms
PO BOX 689134 Due Date 4/4/2011
DES MOINES, IA 50368 -9134
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
4/4/2011 T729830 $199.99
I hereby certify that the attached invoice(s), or bill(s) is (are) true and
correct and I have audited same in accordance with IC 5- 11- 10 -1.6
Date Officer
Page 1 of 2
SEARS COMMERCIAL ONE
PO BOX 630859
IRVING TX 75063 -0859 swrs
C Invoice Number: T230178 CommereialOnW
Bill To: I N V OICE Amount Due: Num ber: 5405530000$
Payment Due Date: 04 -23 -11
Purchase Location: 000005340
0000873 FISHERS IN
26 Merch Ref# 20110324005340
CARMEL WATER AND SEWER ULIL SRRE Please Pay From This Invoice.
3450 W 131ST STREET e
WESTFIELD IN 46074 -8267 Ship To:
I uII�1� J Iu II I II �r�� I L 'I���u�I�I�IIIJI����l'llll'1�
BILL UTILITIES
9609 HAZELDELLPARKY
INDIANAPOLIS IN
Customer No. Ordered By Authorized By Purchase Order No. Purchase Date Sears Ship Order No.
JEFF 03 -24 -11
Stock No /SKU Description Quantity Unit Unit Price Extension
00925967000 GRINDING,WHL DRESSING SET 1.0000 9.99 9.99
00947808000 7 /8 ",GEARWRENCH 1.0000 25.89 25.89
00950671000 SOCKET,14MM12PT3 /8 "DRDEEP 1.0000 5.79 5.79
00950665000 SOCKET,1" 12PT 3 /8DR SAE 1.0000 7.29 7.29
00950668000 SOCKET,11MM12PT3 /8 "DRDEEP 1.0000 5.79 5.79
00950669000 SOCKET,12MM12PT3 /8 "DRDEEP 1.0000 5.79 5.79
00945869000 13MM LASER,SOCKET 1.0000 5.79 5.79
00945801000 SOCKET,1 /4 "DR 5/32. 6PT 1.0000 2.89 2.89
00950651000 SOCKET,1" 12PT 3 /8 "DR 1.0000 4.39 4.39
00945834000 SOCKET,1 "6PT3 /8 "DR 1.0000 4.39 4.39
00945874000 17MM I_ASER,SOCKET 1.0000 7.99 7.99
00945876000 SOCKET,19MM6PT3 /8 "DR DEEP 1.0000 7.99 7.99
00945875000 SOCKET,18MM6PT3 /8 "DR DEEP 1.0000 7.99 7.99
00950673000 SOCKET,16MM12PT3 /8 "DRDEEP 1.0000 6.59 6.59
00945872000 15MM l_ASER,SOCKET 1.0000 6.59 6.59
00945825000 1 /2 "LASER,SOCKET 1.0000 4.39 4.39
00946661000 BIT SOCKET,3 /16 "3 /8DR HEX 1.0000 6.39 6.39
00950667000 SOCKET,IOMM12PT3 /8 "DRDEEP 1.0000 5.79 5.79
00925967000 GRINDING,WI-IL DRESSING SET 1.0000 9.99 9.99
076023 SEARS HARDWARE 1.0000 10.00 10.00
SUBTOTAL: 151.71
This Account Issued by Citibank (South Dakota). N.A.
SEND BILLING ERROR NOTICES TO: SEND INQUIRIES TO: FOR QUESTIONS ABOUT YOUR ACCOUNT:
Sears Commercial One Sears Commercial One (800) 599 -9712 CALL
PO Box 689132 PO Box 689132 (800) 599 -9711 -FAX
Des Moines, IA 50368 -9132 Des Moines, IA 50368 -9132
Page 2 of 2
Seers
CommercialOnW
INVOICE 7230178
Stock No /SKU Description Quantity Unit Unit Price Extension
Total: 151.71
SEARS COMMERCIAL ONE Page 1 of 1
PO BOX 630859 scars
IRVING TX 75063 -0859
Invoice Number: T230185 CommercialOnW
Bill To: IN V OI CE Amount Due: Number: 54055300000 $0.00
Payment Due Date: 04 -23 -11
Purchase Location: 000005340
0000051 FISHERS IN
26 Merch Ref 20110324005340.90OR3403
CARMEL WATER AND SEWER ULIL SRRE Please Pay From This Invoice.
3450 W 131 ST STREET e
WESTFIELD IN 46074 -8267 Ship To:
lu ll�l�' l I����r� 'llll'I�I�
BILL UTILITIES
9609 HAZELDELL PARKY
INDIANAPOLIS IN
Customer No. Ordered By Authorized By Purchase Order No. Purchase Date Sears Ship Order No.
JEFF 03 -24 -11
Stock /SKU Description Quantity Unit Unit Price Extension
CREDIT x— CREDIT MEMO- 0.0000 0.00 0.00
109076 SEARS HARDWARE 1.0000 10.00- 10.00
SUBTOTAL: 10.00
Total: 10.00
This Account Issued by Citibank (South Dakota), N.A.
SEND BILLING ERROR NOTICES TO: SEND INQUIRIES TO: FOR QUESTIONS ABOUT YOUR ACCOUNT:
Sears Commercial One Sears Commercial One (800) 599 -9712 -CALL
PO Box 689132 PO Box 689132 (800) 599 -9711 FAX
Des Moines, IA 50368 -9132 Des Moines, IA 50368 -9132
Page 1 of 1
SEARS COMMERCIAL ONE
PO BOX 630859 SFS
IRVING TX 75063 -0859
Invoice Number: T302253 COmmerela
Bill To: I NVOICE Amount Due: Num ber: 54055300000 0 00
Payment Due Date: 04 -20 -11
Purchase Location: 000005340
0000069 FISHERS IN
23 Merch Ref 20110321005340
CARMEL WATER AND SEWER ULIL SRRE Please Pay From This Invoice.
3450 W 131ST STREET s
WESTFIELD IN 46074 -8267 Ship To:
I nII�I� J InIIiIrI 1 �n�I�J' I���n�lrl�lll�llr���l'llll'I�I�
BILL UTILITIES
9609 HAZELDELL PARKY
INDIANAPOLIS IN
Customer No. Ordered By Authorized By Purchase Order No, Purchase Date Sears Ship Order No.
JEFF 03 -21 -11
Stock No /SKU _Description Quantity Unit_ -Unit Price I Extension
CREDIT xx*CREDIT MEMOK** 0.0000 0.00 0.00
109076 SEARS HARDWARE 1.0000 10.00- 10.00
SUBTOTAL: 10.00
Total.: 10.00
This Account Issued by Citibank (South Dakota), N.A.
SEND BILLING ERROR NOTICES TO: SEND INQUIRIES TO: FOR QUESTIONS ABOUT YOUR ACCOUNT:
Sears Commercial One Sears Commercial One (800) 599 -9712 -CALL
PO Box 689132 PO Box 689132 (800) 599 -9711 -FAX
Des Moines, IA 50368 -9132 Des Moines, IA 50368 -9132
SEARS COMMERCIAL ONE Page 1 of 1 4
PO BOX 630859 s wis
IRVING TX 75063 -0859
Invoice Number: T302228 CommereiaiOne�
Bill To: INVOICE Amou t Due: Number: 5405530000 ;257 63
Payment Due Date: 04 -20 -11
0000068 Purchase Location: 000005340
FISHERS IN
23 Merch Ref 20110321005340 "90OR2990
CARMEL WATER AND SEWER ULIL SRRE Please Pay From This Invoice.
3450 W 131ST STREET e
WESTFIELD IN 46074 -8267 Ship To
I "IIIII' "I III' IIII "II'I'lll'll'IIII'llll'lIII
BILL UTILITIES
9609 HAZELDELLPARKY
INDIANAPOLIS IN
Customer No. Ordered By Authorized By Purchase Order No. Purchase Date Sears Ship Order No.
JEFF d3 -21 -11
Stock No /SKIJ _Description___ Quantity Unit Unit Price Extension
00934556000 10 PC LASER,1 /2" DR MM 1.0000 19.99 19.99
00934581000 SOCKET SET,6PC 1 /2DR METR 1.0000 44.99 44.99
00934577000 SOCKET SET,9PC 1 /2DR METR 1.0000 54.49 54.49
00945934000 11 /16 "SOCKET,1 /2DR 6PT DP 1.0000 10.19 10.19
00945833000 SOCKET,15 /16 "6PT3 /8 "DR 1.0000 4.39 4.39
00945825000 1 /2 "LASER,SOCKET 1.0000 4.39 4.39
00945834000 SOCKET,1 "6PT3 /8 "DR 1.0000 4.39 4.39
00947820000 16MM,GEARWRENCH 1.0000 16.89 16.89
00947810000 1 ",GEARWRENCH 1.0000 29.89 29.89
00947821000 17MM,GEARWRENCH 1.0000 17.89 17.89
00945838000 9 /1.6 "LASER,SOCKET I.0000 5.79 5.79
02807078000 BRUSH, WIRE POST TERML 2.0000 3.49 6.98
00942431000 9MM REV,RATCH WRNCI -I 1.0000 19.89 19.89
00945974000 WRENCH,5 /16" FUL POL 1.0000 7.47 7.47
076023 SEARS HARDWARE 1.0000 10.00 10.00
SUBTOTAL: 257.63
Total: 257.63
This Account Issued by Citibank (South Dakota), N.A_
SEND BILLING ERROR NOTICES TO: SEND INQUIRIES TO: FOR QUESTIONS ABOUT YOUR ACCOUNT:
Sears Commercial One Sears Commercial One (800) 599 -9712 -CALL
PO Box 689132 PO Box 689132 (800) 599 -9711 -FAX
Des Moines, IA 50368 -9132 Des Moines, IA 50368 -9132
VOUCHER 107491 WARRANT ALLOWED
350177 IN SUM OF
SEARS HARDWARE
P O BOX 689134
DES MOINES, IA 50368 -9134
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code Ti
T230178 01- 720T -06
T 34222 Qd C-) 09,9) T, 0
C V'rpQ T3U225 3 C,o. 00
Voucher Total -1-71
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 bill 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
350177
SEARS HARDWARE Purchase Order No.
P O BOX 689134 Terms
DES MOINES, IA 50368 -9134 Due Date 4/8/2011
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
4/8/2011 T230178 $141.71
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
SEARS COMMERCIAL ONE Page 3 of 1
PO BOX 630859 S
IRVING TX 75063 -0859
Invoice Number: T039235 Commercial
2M To: I p� V V O I CE Amou t Due: Num ber: 5405530000 $39 87
Payment Due Date: 04 -20 -11
0000070 Purchase Location: 000005340
FISHERS IN
23 Merch Ref 20110321005340 "900R2992
CARMEL WATER AND SEWER ULIL SRRE Please Pay From This Invoice.
3450 W 131 ST STREET s
WESTFIELD IN 46074 -8267 Ship To:
I II�I�' Il n II I LII �n�l�d' �F�' I���n�l�l�lll�llt���l'!I!I'I�I�
BILL UTILITIES
9609 HAZELDELL PARKY
INDIANAPOLIS IN
Customer No Ordered By Authorized By Purchase Older No. Purchase Date Sears Ship Order No.
JEFF 03 -21 -11
I —SlInck Descriplic: CuantiN Unit Linil Price __E
00947809000 15.16 GEARWRENCH 1.0000 29.89 29.89
00926991000 LINER ROLL 2.0000 9.99 19.98
SUBTOTAL: 49.87
Other Amount Tendered: 10.00
Total: 39.87
This Account Issued by Citibank (South Dakota), N.A
SEND BILLING ERROR NOTICES TO: SEND INQUIRIES TO: FOR QUESTIONS ABOUT YOUR ACCOUNT:
Sears Commercial One Sears Commercial One (800) 599 -9712 -CALL
PO Box 689132 PO Box 689132 (800) 599 -9711 FAX
Des Moines, IA 50368 -9132 Des Moines, IA 50368 -9132
Page 1 of 1
SEARS COMMERCIAL ONE
PO BOX 630859 SFS
IRVIN G TX 75063 -0859
Invoice Number: T194572 CommereialOnW
Bill To: I NVOICE Amou t Duember: 5405530000$260 30
Payment Due Date: 04 -16 -11
Purchase Location: 000001600
0000044 INDIANAPOLIS IN
19 Merch Ref 20110317001600
CARMEL WATER AND SEWER ULIL SRRE
3450 W 131ST STREET a Please Pay From This Invoice.
WESTFIELD IN 46074 -8267 Ship To:
I nII�I�r I Iu II r I II �uIII�I��I��I���nIlJ�lll�ll����ltllll�l�l�
BILL UTILITIES
9609
INDIANAPOLIS IN
Customer No. Ordered By Authorized By Purchase Order No Purchase Date Sears Ship Order No.
JEFF 03 -17 -11
Stock No/SKU Description Quantity Unit Unit Price Extension
00945749000 CRMPNG TOOL, CRAFTSMAN 1.0000 20.99 20.99
00973573000 STRIPPER,CRAFTSMAN PRO 1.0000 15.49 15.49
00934575000 SOCKET SET,6PC 1 /2DR METR 1.0000 29.99 29.99
00904197000 NUTDRIVER ST,7PC METRIC 1.0000 19.99 19.99
00904196000 NUTDRIVER ST,7PC STD 1.0000 19.99 19.99
00964832000 WIRE WHL 6 1.0000 6.99 6.99
00990747000 SPEEDBOR, 8PCBLUEGROOVE 1.0000 21.99 21.99
00945713000 PLIERS,3PC LOCKING 1.0000 31.99 31.99
00944704000 WRENCH,COMB 15/16" 1.0000 13.99 13.99
00944696000 WRENCH,COMB 9/16" 1.0000 7.99 7.99
00942939000 WRENCH 23MM,COMB 23MM 1.0000 14.99 14.99
00944695000 WRENCH,COMB 112" 1.0000 7.19 7.19
00944694000 WRENCH,COMB 7/16" 2.0000 6.49 12.98
00944692000 WRENCH,COMB 11/32" 1.0000 5.49 5.49
00944699000 WRENCH,COMB 1/4" 1.0000 4.49 4.49
00944695000 WRENCH,COMB 112" 1.0000 7.19 7.19
00942915000 WRENCH,COMB 1.1MM 2.0000 6.79 13.58
009 WRENCH,COMB 7MM 1.0000 4.99 4.99
SUBTOTAL: 260.30
Total: 260.30
This Account Issued by Citibank (South Dakota, N.A.
SEND BILLING ERROR NOTICES TO: SEND INQUIRIES TO: FOR QUESTIONS ABOUT YOUR ACCOUNT:
Sears Commercial One Sears Commercial One (800) 599 -9712 CALL
PO Box 689132 PO Box 689132 (800) 599 -9711 FAX
Des Moines, IA 50368 -9132 Des Moines, IA 50368 -9132
VOUCHER 107445 WARRANT ALLOWED
350177 IN SUM OF
SEARS HARDWARE
P O BOX 689134
DES MOINES, IA 50368 -9134
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
T194572 01- 7202 -06 $260.30
834235 0(--7)-OT-09 3"l
Voucher Total6'3�'
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 bill 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
350177
SEARS HARDWARE Purchase Order No.
P O BOX 689134 Terms
DES MOINES, IA 50368 -9134 Due Date 4/5/2011
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
4/5/2011 T194572 $260.30
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
Date Officer