198280 06/06/2011 CITY OF CARMEL, INDIANA VENDOR: 361937 Page 1 of 1
ONE CIVIC SQUARE T B A NORTH
F; CHECK AMOUNT: $270.96
ra CARMEL, INDIANA 46032 309 GRADLE DRIVE
CARMEL IN 46032 CHECK NUMBER: 198280
CHECK DATE: 6/6/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4237000 3JU5874 270.96 REPAIR PARTS
TBA North invoice
309 Gradle Dr. No 03JU5874
Carmel, IN 46032
317 574 -1957 FAX: 317 574 -1982 II II II I I I I II II I� I I I II II I I II
Page 1
13:55:22 May 26 2011
CUSTOMER NUMBER Invoice NUMBER Invoice DATE PACKING SLIP TERMS WHqE
318 03JU5874 05/26/11 03RE6382001 NET 10TH
BILL TO: SHIPPED TO:
CARMEL POLICE CITY GARAGE CARMEL POLICE CITY GARAGE
3 CIVIC SQUARE 3400 W 131ST
CARMEL, IN 46032 CARMEL, IN 46074
Dept: 002 CARMEL POLICE CITY GARAGE Contact: /317- 733 -4600 Route: CARMEL /WESTFIELD Direction:
YOUR P.O. NUMBER ORDER DATE CSR SHIPPED VIA CARTONS OPER
05/26/11, 13:55:22 400012 THAD EDWARDS 3 CARMEL /WESTFIELD A 412
ITEM DESCRIPTION BIN UNIT ORDER BACK INV LIST CORE NET NET EXT
QTY ORDERED QTY PRICE PRICE PRICE CORE PRICE
RAF ATD 1159P AT POLICE PAD SET U EA 4 0 4 92.85 0.00 40.70 0.00: 162.80
D60 18A2322 19169879 KEEP 4 CARMEL U EA 2 0 2 110.24 0.00 54.08 0.00 108.16
I,
r TAL PURCHASE FREIGHT TAX PCT TAX AMT INVOICE TOTAL PAYMENTS BALANCE DUE
270.96 0.00 0.00 270.96 0.00 270.96
1.5 service charge on past due accounts(18 per annum).
Core returns must be in original box. All new returns must
be resaleable. No return after 30 days without invoice. 1
I
i
City O f Carte i CE INDIANA RETAIL TAX RTIFICATE NO. 03 201 02 0 PAGE
w PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 257M
35- 60000972
ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES, A/P
CARMEL INDIANA 46032 -2584 VOUCHER, DELIVERY MEMO, PACKING SLIPS,
SHIPPING LABELS AND ANY CORRESPONDENCE.
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL 1997
'URCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
5012011
BA North Carrroel Police DGpm tment
VENDOR SHIP 3 Civic Square
Mg Cradle Drive TO Calrmol, IN AM
Carmel, IN 4 (317) 579
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Account 42 -370.0:0
4 Each brake pads RAF AM 9159P $40.70 $102.80
2 Each rMers D6018A2322 $54.08 $108.16
Cub Total: $270.8,6
et
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Send Invoice To:
F A
T 7
Cool Pollee Dopartmont
Attn: `Fames@ Anderson
3 Civic Square
Carmel, IN 46=- PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJEC'ACCOUNT AMOUNT
Coal Police Dept. PAYMENT f .wo
A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY�TVAT HERE IS AN UNOBLIGATED BALANCE IN
SHIP REPAID. THIS APPROPR ATI N S FFICIENT TO PAY FOR THE ABOVE ORDER.
C.O.D. SHIPMENTS CANNOT BE ACCEPTED.
PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY �y
SHIPPING LABELS. lef o T police
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
CLERK- TREASURER
DOCUMENT CONTROL NO. 2 5 7 6 6 A.P.V. COPY SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER NO. WARRANT
ALLOWED 20
IN THE SUM OF
S
ON ACCOUNT OF APPROPRIATION FOR
E'cr
Board Members
PO# or INVOICE NO, ACCT #!TITLE AMOUNT
DEPT. 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
Signature
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))
05/26/11 3JU5874 payment for repair parts $270.96
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
20
Clerk- Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
TBA North
IN SUM OF
309 Gradle Drive
Carmel, IN 46032
$270.96
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
25766 3JU5874 42- 370.00 S270.96
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
Thursday. June 02
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund