176229 08/19/2009 CITY OF CARMEL, INDIANA VENDOR: 093000 Page 1 of 1
O ONE CIVIC SQUARE FEDEX
e CARMEL, INDIANA 46032 PO BOX 94515 CHECK AMOUNT: $27.83
PALATINE IL 60094 -4515
CHECK NUMBER: 176229
CHECK DATE: 8/1912009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1192 4342100 9- 2/85 -48333 27.83 POSTAGE
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Fe Invoice Number Invoice Date
1 Of
FedEx Tax l l): 71- 0427007
Billing Address: Shipping Address:
CITY OF CARMEL /MAYOR'S OFC CITY OF CARMEL
JENNY CHASTAIN 1 CIVIC SQ
1 CIVIC S(1 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" Aug 05, 2009 Internet: www.fedex.com
FedEx Express Services
Transportation Charges 23.15
Special Handling Charges 4.68
Total Charges USD $27.83
TOTAL THIS INVOICE USD $27.83
Other discounts may apply.
Fe& I Invoice Number Invoice Date Account Number r Page
9 -285 -48333 Aug 05, 2009 2 of 4
Adjustment Request
Fax to 1800) 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 I I I I I I I I I I I I I I I I I I I I I I I I I I I I Date W W! W
n q
a Phone I I I I I I I I I I I I I Fax#
E -mail Address ❑Yes, I wantto update account contact with the above information.
Tracking Number Bill to Account S Amount
t V I I I 1 1 1 1 1 1 1 1 1{ I I I I I I I I I I I I I _I I I W
I l l l l l i l l l l l l l l l l l l l l l l l- I I I I I I I I W
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I I I I I I l I l l l l l l l i 1 1 1 1 1 1 I I I I I I I I I W
C
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 Grd Pick -up Fee PND Pwrshp Not Delivered site wwwJedex.com or call
OCS Exp Pick -up Fee SDR Saturday Delivery 18001 622 -1147
Rerate information only (round to nearest inch)
C. Tracking Number Code S Amount LBS L W H
r
I I I I I I I I I I I{ I I I f l I I I I f I I I I I I I WWLJ L1W X L1WJ X W 1J
d` I I I 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1) W f 1 1 1 WI—L -1 x I i I I x I E I I
t I I I I I I I I I I I I I{ I I I! I I I I _1 I I I L LJ I I I X 1 I I 1 X 1 I I I
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I 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 W I I I II I! l I I I I x I I I V
e x Invoice Number Invoice Date
3 of 4
FedEx Express Shipment Summary By Reference
FedEx Express Shipments (Original,)
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tliie�gt TraRspnrtaf�e3n E#and €ink �ts� €��11air
teerence S€�pmnts 1bs Clrargss; Gf�atg+sredttsl0 €her C3�sn�ur�ts, GCl rges
NO REFERENCE INFORMATION 1 23.15 4.66 27.83
trtl:Ed?cpcess:.:.... 3 15 $#8 $7A3
Total This Invoice USD $27.83
014222 212
voice T 7 A ccount Number ra
X. F In Number Invoice Da ge
l 9-285-48333 Aug 05, 2009 4 of 4
FedEx Express Shipment Detail By Reference (Original)
ERE. N
ION`:' I., I
C ilN DF
AT.
Fuel Surcharge FedEx h as applied a fuel surcharge of 2.50% to this shipment.
Distance Based Pricing, Zone 5
Automation USAB Sender Recipient
Tracking ID 063838918010 DEPT OF COMMUNITY SERVICES BRENDA ATTN ARCTNG
Service Type FedEx Priority Overnight CITY OF CARMEL PROVIDENCE BILTMORE HOTEL
Package Type FedEx Envelope 1 civic SO 11DORRANCEST
Zone 05 CARMELIN 46032-2584 US PROVIDENCERI 02903 US
Packages 1
Rated Weight NIA
Delivered J u l 28, 2009 09:16 Transportation Charge 23.15
Svc Area Al Courier Pickup Charge 4.00
Signed by N.BEAUDOIN Fuel Surcharge 0.68
FedEx Use 020800609/00002191_ Total Charge US0 S27M
NO REFERENCE INFORMATION Reference Subtotal USD $27.83
Total FedEx Express USO $27.83
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))
08105/09 9- 2/85 -48333 Scott's hotel room check $27.83
f 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
Fec1=x
IN SUM OF
PO" Box 94515
Palatine, IL 60094 -4515
$27.83
ON ACCOUNT OF APPROPRIATION FOR
Carmel DOCS Department
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
1192 9 -2185 -48333 43- 421.00 $27.83 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
Monday, August 17, 2009
Dire t r, DOCS
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund