158257 04/15/2008 (9). CITY OF CARMEL, INDIANA VENDOR: 359957 Page 1 of 1 C ONE CIVIC SQUARE BLOCKOMS GOLF MANAGEMENT CO LLC HECK AMOUNT: $9,677.16
CARMEL, INDIANA 46032 7033 SEA OATS LANE
INDIANAPOLIS IN 46250 CHECK NUMBER: 158257
CHECK DATE: 4/15/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
905 4347500 913.00 GENERAL INSURANCE
905 4353099 102328000 8,764.16 GOLF CART LEASE
i
i
PAGE NUMBER: 1
is
LEASE NUMBER: 102328000
G O L F F I N A N C E INVOICE DATE: 04/01/2008
995 DALTON AVENUE, CINCINNATI, OH 45203 DUE DATE: 05/01/2008
Return Service Requested
BILL TO: REMIT TO:
6283006250 PRESORT MAAD P1 C29 <B> NATIONAL CITY GOLF FINANCE P
6250 1 MB 0.360 O BOX 931034
If I,,,II „11,,,,11 „11,,,11,1 „1,1 CLEVELAND, OH 44193
BLOCKOMS GOLF MANAGEMENT COMPANY, LLC
PAUL BLOCKOMS
7033 SEA OATS LANE
INDIANAPOLIS IN 46250 -4131
INVOICE
RENT DUE:
1026
740
375
BLOCKOMS GOLF MANAGEMENT CO. Off, 10 is 7/
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01 0000 1 39010002030208000000 01977256 0000876416 1
LEASE NUMBER: 102328000
TOTAL DUE: $8,764.16 AMOUNT ENCLOSED:
BILL TO REMIT TO
BLOCKOMS GOLF MANAGEMENT COMPANY, LLC
PAUL BLOCKOMS NATIONAL CITY GOLF FINANCE
7033 SEA OATS LANE PO BOX 931034
INDIANAPOLIS. IN 46250 CLEVELAND, OH 44193 -0004
NEW ADDRESS OR PHONE NUMBER? PLEASE
CHECK BOX AND COMPLETE REVERSE SIDE. Please return this portion with your payment
nanP�. nt 4
HAona CR PAGE NUMBER: 3
A�� 61A6�®
G O L F F I N A N C E LEASE NUMBER: 102328000
INVOICE DATE: 04/01/2008
995 DALTON AVENUE, CINCINNATI, OH 45203 DUE DATE: 05101/2008
Return Service Requested
LEASE 102328000 DESCRIPTION ,GOLF
OPEN IN VOI C ES
INVOICE 1977256 DUE DATE: 05/01/2008
RENTAL PAYMENT: 8, 76 4.16
INVOICE TOTAL: $8,764.16
LEASE TOTAL: $8,764.16
TOTAL DUE: $8,764.16
oaoe: 3 of 4
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Prescribed.tiy 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
l
Purchase Order No.
g5k i V Go (.F d" Terms
r
Date Due
Invoice Invoice Description Amount,
Date Number (or note attached invoice(s) or bill(s))
a oha &0GV F'j AV_ 5 �iq, Fi 0,
ca v
Total D 164. 16
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.
I Co 20
�J Oc�O V,6 �D MOMtA e �i Co. IN SUM OF
k
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO#
EP or
DEPT. INVOICE NO. ACCT #!TITLE AMOUNT
I 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
20
J ^Sicat rip e
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
WALKER ASSOCIATES INSURANCE April 2, 2008
Po BOX -19445 Page 1
QN IAI*POLIS, 1N• 46219-0445 SELEC 1 T 1 pT V d
Y'
IRSin ante
Phone No. 317- 353 -8000
?e
BLOCKOMS GOLF MANAGEMENT CO LLC DBA BR
7033 SEA OATS LN
INDIANAPOLIS IN 46250 -4131
ACCOUNT 893- 876 -356 SUMMARY
Save Time In Your Day,
Use SelectPayTM
Previous Amount Due S 458.00
Payment Received 03/16 Thank You 458.00
5
fµ
1025
BLOCKOMS GOLF MANAGEMENT CO.
20-6
—375
,DATE aq- 10 OS
5�1-e' C- v'6' 4 5uyao(le V, �c>A 9 r3 .ob
PAXT®'E'HE ORDER OF a
u I v�2 U►� y e I v- I- -�:�v1 IQO) f A135 6 U�
National City®
FOR
�.�+,v': -:..,s r�- ?p' ;T i i K�� �k �;k?� .s:_ 2� y,
>:c a` ,,'�'.c,_,�.?.1� Y" r u gg.,,s. .r ,._L'�:e
Y ,.vui �a�u.clll. 11Gd5C .vrt your a number on your check.
Name on Account Account Number Account Balance Minimum Amt. Due Due Date Amount Enclosed
BLOCKOMS GOLF MANA 893 876 -356 2,720.00 913.00 04/23/08
Make Check Payable To Selective Insurance Company of America Mail Payment to:
Selective Insurance Company of America
Box 371468
Pittsburgh PA 15250 -7468
1893876356040220080000091300000027200000008
DB -40 (07106 00- 13090 -00000 893 876 -356
WALKER ASSOCIKI'iS INSURANCE April 2, 2008
PO BOX 19445 Page I
1NDIAr�',POLIS, IN 46219-0445 SELECTIVE
Insurance
Phone No. 317 353 -8000
BLOCKOMS GOLF MANAGEMENT CO LLC DBA BR
7033 SEA OATS LN
INDIANAPOLIS IN 46250 -4131
ACCOUNT 893- 876 -356 SUMMAR
Save Time In Your Day,
Use SelectPayTM
Previous Amount Due 458.00
Payment Received 03/16/08 Thank You 458.00
w 4 k:.r.- F,, R e �w �4 t' i. ;'t'+ .':(w e -s.. '.•�F' 4 i �j.•j, "�,t� "L V+'+ %Nt ;e,''..#�n: �C i- 'X �i,
ry 1025
BLOCKOMS GOLF MANAGEMENT CO.
20-6
—375
IDATIE 04 V b X 740
Wuvao a C'a 913
PAxTOTHEORDEROF V1a
1 V1� I��� l V-�-� >aalri�s 6 a�
National Clay®
FOR
lid. x c 1 a
yti a ccount u oer On your check.
Name on Account Account Number Account Balance Minimum Amt. Due Due Date Amount Enclosed
BLOCKOIVIS GOLF MANA 893 876 -356 2,720.00 913.00 04/23/08 1
Make Check Payable To Selective Insurance Company of America Mail Payment to:
Selective Insurance Company of America
Box 371468
Pittsburgh PA 15250 -7468
1893876356040220080000091300000027200000008
DB -40 (07/06) 00- 13090 -00000 893 876 -356'
Prescribed'by State Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
e
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 Inn
�{�brMS &Our WM i e Ca Purchase Order No.
C IA� Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
6ej Ivi VY40 f 9(3-0
by .eVCA.
Total 12 .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
VOUCHER NO. WARRANT NO.
ALL WED 20
oc;Co �s 670 W k4 e Z
IN SUM OF
ON ACCOUNT OF APPROPRIATION FOR
Board Members
Po# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
q 3 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
T)3.06
Cost distribution ledger classification if
Title
claim paid motor vehicle highway fund