180805 12/30/2009 CITY OF CARMEL, INDIANA VENDOR: 093000 Page 1 of 1
ONE CIVIC SQUARE FEDEX
CHECK AMOUNT: $23.00
CARMEL, INDIANA 46032 Po BOX s451s
o ,�o PALATINE IL 60094 -4515 CHECK NUMBER: 180805
CHECK DATE: 12/30/2009
DEPARTMENT ACCOU P N UMBER INV N AMOUNT D ESCRIPTIO N
1205 4342100 9 -434 -53129 23.00 POSTAGE
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FedE x. I Invoice Number Invoice Date
Bill Address: Shipping Address:
CITY OF CARMEL /MAYOR'S 0 F CITY OF CARMEL
JENNY CHASTAIN 1 CIVIC SQ
1 CIVIC SQ CARMEL IN 46032 -2584 Invoice Questions?
Contact FedEx Revenue Services
CARMEL IN 46032 -2584 Phone: (800) 622 -1147 M -Sa 7 -6 (CST)
Fax: (800) 548 -3020
Invoice Summary Dec 16, 2009 Internet: www.fedex.com
Fed Express Services FedEx News!
Transportation Charges 17.20 FedEx First Overnight® Beat the Competition Get It
Special Handling Charges 5.80 There Early Need to deliver a critical shipment by first
Total Charges USD $23.00 thing tomorrow morning? FedEx First Overnight provides
TOTAL THIS INVOICE USD $23.00 delivery by 8 a.m. to more ZIP codes than UPS Next Day
Air Early A.M.
Other discounts may apply.
i
FedE Invoice Number Invoice Date
2o14
Adjustment Request
Fax to (800) 548 -3020
Use this form to fax requests for adjustments due to the reasons indicated below. Requests for adjustments
due to other reasons, including service failures, should be submitted by going to www.fedex.com or calling
800.622.1147. Please use multiple forms for additional requests.
Please complete all fields in black ink.
Re uestor Name L I 1 1 1 1 1 1 1 1 1( I l l l l l l l l l l L I I I Date W/ W/ W
Phone I I I I WWW I I l l) Fax I
E -mail Address yes 1 wantto update account contactwith the above information.
Tracking Number Bill to Account Amount
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ADR Address Correction INW Incorrect Weight OVS Oversize Surcharge For all Service failures or other
o DVC Declared Value INS Incorrect Service RSU Residential Delivery surcharges please use our web
a IAN Invalid Acct OCF Gird Pick -up Fee PND Pwrshp Not Delivered site www.fedex.com or call
OCS Exp Pick -up Fee SOR Saturday Delivery (800) 622 -1147
Rerate information only (round to nearest inch)
Tracking Number Code Amount LSS L W H
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E:Invoice Num Invoice Date F Account Number Pa ge
9-434-53129 Dec 16, 2009 3 of 4
FedEx Express Shipment Summary By Reference
FedEx Express Shipments I Original)
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NO REFERENCE INFORMATION 1 14.0 .20 5,80 23.00
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Total This Invoice USD $23.00
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9- 434 -53129 Dec 16, 2009 4 of 4
FedEx Express Shipment Detail By Reference (Original)
wo: Placed. ulp 17�c 1D Q 9 Ct1sE Eiet NQ I EFERENCE 1f ,OR VfA 0 �l f
Payer �e�3
Fuel Surcharge FadExhas applied a fuel surcharge of 8.50% to this shipment
Distance Based Pricing, Zone 2
Automation USAB Sen r Recipient
Tracking ID 861994324041 SHELLY LINGELBAUGH BAS
Service Type FedEx 20ay CITY OF CARMEL 17475 JURONNA OR
Package Type Customer Packaging 1 CIVIC SO HOMEWOOD IL 60430 US
Zone 02 CARMEL IN 46032 -2584 US
Packages 1
Rated Weight 14.0 Ibs, 6.4 kgs
Delivered Dec 14, 200908:40 Transportation Charge 17.20
Svc Area A] Fuel Surcharge 1.80
Signed by D.ARTHUR Courier Pickup Charge 4.00
FedEx Use 0344 01 5 6 6/00 05 9 80% Total Charge USD 523.00
NO REFERENCE INFORMATION Reference Subtotal USD $23.00
Total FedEx Express USD $23.00
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))
12/16/09 9- 434 -53129 Open Enrollment Forms to BAS $23.00
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: WARR NO.
ALLOWED 20
FedEx
IN SUM OF
P.O. Box 94515
Palatine, IL 60094 -4515
$23.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Administration
PO# I Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
1205 I 9- 434 -53129 I 43- 421.00 $23.00 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
Tuesday, December 22, 2009
Director, Administration
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
u