158928 04/30/2008 1 CITY OF CARMEL, INDIANA VENDOR: 129000 Page 1 of 1
ONE CIVIC SQUARE HOLDER MATTRESS CO, INC
O CARMEL, INDIANA 46032 130 W MORGAN STREET CHECK AMOUNT: $7,019.10
KOKOMOIN 46901 CHECK NUMBER: 158928
CHECK DATE: 4/30/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 4463000 7,019.10 FURNITURE FIXTURES
I
flool Holder Mattress Factory
Built for Comfort Designed to fast
Since 1947
Invoice
Carmel Fire Department Date: 4/15/08
2 Civic Square
Carmel, IN 46032
Delivery Schedule 4/15/08
Confirmation Attached
Item• Description: Quantity Item Price Total Price
#1 Expression XL Twin 18 $379.95 $6,839.10
#2 Delivery 3 $60.00 180.00
Invoice Sub -Total $7,019.10
IN Sales Tax 7% EXEMPT
Total Invoice Due $7,019.10
Payment terms Net 10 from date of delivery
Order must be signed and dated prior to production
Deliveries to the Following:
6 Sets to Station 44 at 5032 E. Main St., Carmel, IN
5 Sets to, Station 45 at 10701 N. College, Carmel, IN
7 Sets to Station 42 at 3610 W. 106"' St., Carmel, IN
Please remit to:
130 West Morgan Street
Kokomo, IN 46901
Phone (765) 236 -1492; Fax (765) 236 -1495
4 Holder Mattress Factor
Built for Comfort Designed to Last
Since 1947
Delivery Confirmation
Carmel Fire Department Date: 4/15/08
2 Civic Square
Carmel, IN 46032
6 Expressions Twin XL Set delivered to Station 44
Received By: 5032 E. Main St., Carmel, IN
r
Sigma re Date
5 Expressions Twin XL Set delivered to Station 45
—10701 N. College., Carmel, IN
Received By:
Signatur Date
7 Expressions Twin XL Set delivered to Station 42
3610 W. 106' St., Carmel, IN
Received B
Signature Date
130 West Morgan Street
Kokomo, IN 46901
Phone (765) 236 -1492; Fax (765) 236 -1495
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))
04/15/08 Mattresses Sta. 42, 44, 45 $7,019.10
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. WARRAN NO.
ALLOWED 20
Holder Mattress
IN SUM OF
130. West Morgan Street
Kokomo, IN 46901
$7,019.10
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT #/TITLE AMOUNT Board Members
\G� 102 630.00 $7,019.10 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
r
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund