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155210 01/10/2008 CITY OF CARMEL, INDIANA VENDOR: 354290 Page 1 of 1 ONE CIVIC SQUARE BOONE COUNTY AUTOMOTIVE, INC CARMEL INDIANA 46032 1212 w MAIN ST CHECK AMOUNT: $507.63 LEBANON IN 46052.2324 CHECK NUMBER: 155210 CHECK DATE: 1/10/2008 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1115 4232100 ACCT 7983 101.14 682548 1115 R4232100 17493 ACCT 7983 406.49 INTAKE MANIFOLD :.I �f NAPA Auto Rare ®f Carmel W� f...y. u.. 111 Medical Drive o Carmel, Indiana 46032 0 317 -844 -3973 o Fax: 317- 844 -6220 Please Remit To: EXEMPTION CERTIFICATE H H Automotive Supply 1212W. Main St. Lebanon, .IN 46052 AGRICULTURAL agricultural use EJ pp� I NDIANA DEPARTMENT OF REVENUE SALES TAX DIVISION LIMITED WARRANTY PLEASE READ I h.muy.edify under the penalties of perjury that the personal property purchased by the use of this exemption certificate will be directly used in the direct production of agricultural products for resale. Plea se examine these pads at once. Errors should be reported before using or installing. Returns "The factory warranty constitutes a e warranties respect e sae o em m titutll of the with t to the this it/ites. The Seller hereby expressly Cl must be made within TEN DAYS and must be accompanied by this INVOICE NUMBER. This disclaims all warranties, either express or implied, including any implied warranty of merchantability or fitness fora particular_ property is sold to you with the definite understanding that it is purchased for resale, unless tax purpose and the seller neither assumes nor authorizes any other person to assume for it any liability in connection will the has been added to the price. ALL RETURNS SUBJECT TO 10% RESTOCKING CHARGE. sale of this itemlitems. NO R ON ELE CTRICAL PARTS ti ACCT SOLD TO DATE TIME STORE EMP o7r�S3 CITY CIF" CnRME:L /POLIC:E: DEPT 12/14/07 100006133 33 548 SR 3 CIVIC SQUARE PURCHASE ORDER ATTENTION 4.6032 TAX EXEMPTION: AD KEEP COPY i:NV TERlIll sve i 1l iC:HARI'E. SALE 1`+ DELIVERY: t7Ll 7`ftlJCt1 PART NUMBER LN DESCRIPTION QUANTITY PRICE NET TOTAL GO O1195 1 195 BK INTAKE.. MANIFOLD 1. 773 4 r'6 0 507.630 630 r07. 1 1.9` 9 Chevrol.v't Trl -i I`ahole—K1500 1/8 Tian 4WD 5„'7 i 25% RESTOCK FEE t:ittbto1';a1. 5 07. G3 REMIT JOC 12'12 W MAIM Tax ii TAX TABLE 3 Cl- cCat:� LEA,)NON IN )5;2\ Mrs X V_1x. SIGNATURE TaTM1L 1 CHARGE= )AL -E 5 0 7. G3 ALL GOODS RETURNED MUST BEACCOMPANIED BY THIS INVOICE L 4 INDIANA RETAIL TAX EXEMPT PAGE itit -4, o II Carmel CERTIFICATE NO. 003120155 002 0 r �l PURCHASE ORDER NUMBER F I FEDERAL EXCISE TAX EXEMPT -"Vgf J J 7 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 PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION i?J19f2007 Napa Auto Parts Carmel Clay Communications SHIP 31 First Avenue NW VENDOR 119 Medical Drive TO Ca rmel, IN 46032 Carmel, In. 46032 Phone: (317) 571 -25 CONFIRMATION BLANKET CONTRACT PAYMENTTERMS FREIGHT OUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION Acc 42 -321.00 1 Each Intake Manifold for 99 Tahoe 600 -1195 $405.49 $400.49 Sub Total: $406.49 4 1 4g� Send Invoice To: Carmel Clay Communications 31 First Avenue NUN Carmel, IN 46032- PLEASE INVOICE IN DUPLICATE DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT Communications $406A9 PAYMENT 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 THAT THERE IS AN UNOBLIGATED BALANCE IN SHIP REPAID. THIS APPROPRIATION SUFFIC�IENT,TO PAY FOR THE ABOVE ORDER. C.O.D. SHIPMENTS CANNOT BE ACCEPTED. ORDERED BY PURCHASE ORDER NUMBER MUST APPEAR ON ALL SHIPPING LABELS. I THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. CLERK TREASURER DOCUMENT CONTROL NO.1 7 4 9 3A•P•V. COPY SIGN AND RETURN TO CLERK'S OFFICE _tVOUCHER NO. WARRANT NO. ALLOWED 20 IN THE SUM OF ON ACCOUNT OF APPROPRIATION FOR Board Members PO# EP ar ©EPT. 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 Signature Title Cost distribution ledger classification if claim paid motor vehicle highway fund Prescribed by State Board of Accounts City Form No. 201 (Rev. 19 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)) 12/14/07 682548 $101.14 12114/07 682548 $406.49 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 V NO. WARRAN NO_ Napa Auto Parts ALLOWED 20 IN SUM OF 111 Medical Drive Carmel, In. 46032 $507.63 ON ACCOUNT OF APPROPRIATION FOR Carmel Clav Communications PO# Dept.# INVOICE NO. ACCT#/TITLE AMOUNT Board Members 682548 42- 321.00 $101.14 1 hereby certify that the attached invoice(s), or 1.7493_ 682548 42- 321.00 $406.49 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 Wednesday, January 02, 2008 Directo Title Cost distribution ledger classification if claim paid motor vehicle highway fund