205613 01/17/2012 CITY OF CARMEL, INDIANA VENDOR: 361937 Page 1 of 1
ONE CIVIC SQUARE T B A NORTH CHECK AMOUNT: $1,361.90
CARMEL, INDIANA 46032 309 GRADLE DRIVE
CARMEL IN 46032
CHECK NUMBER: 205613
CHECK DATE: 1/17/2012
DEPARTMENT A PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4237000 3KG3822 219.10 REPAIR PARTS
1110 4237000 3KG8793 162.80 REPAIR PARTS
1110 4231500 25960 3KH2597 980.00 OIL
TBA North Invoice
309 Gradle Dr. No 03KG3822
Carmel, IN 46032
317- 574 -1957 FAX: 317 -574 -1982 II II II I I I II I II i I II �I II Ill II
l I Page 1
10:41:36 Dec 22 2011
CUSTOMER N Invoice NUMBER Invoice DATE PACKING SLIP TERMS WHSE
318 03KG3822 12/22/11 03RS0211001 NET 10TH 030
BILL TO: SHIPPED TO:
CARMEL POLICE CITY GARAGE CARMEL POLICE CITY GARAGE
3 CIVIC SQUARE 3400 W 131ST
CARMEL, IN 46032 CARMEL, IN 46074
IIITIIIillllllllrlllllll lilllllllllllllrillllll�llll
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
STOCK 12/22/11, 10:41:36 1 300001 PERRY WILHITE 1 3 CARMEL /WESTFIELD A 301
ITEM DESCRIPTION BIN UNIT ORDER BACK INV LIST CORE NET NET EXT
CITY ORDERED CITY PRICE PRICE PRICE CORE PRICE
RAF ATD 1159P AT POLICE PAD SET U EA 3 0 3 92.85 0.00 40.70 0.00 122.10
D60 18A2322 19169879 KEEP 4 CARMEL U EA 2 0 2 98.88 0.00 48.50 0.00 97.00
TOTAL PURCHASE TOTAL LIST TOTAL MDSE TOTAL CORE FREIGHT TAX PCT TAX AMT INVOICE TOTAL PAYMENTS =RALANCE 219.10 476.31 219.10 0.00 0.00 0.00 219.10 0.00
2.08% service charge on past due accounts(25 per annum).
Core returns must be in original box. All new returns must
be resaleable. No return after 30 days without invoice.
TBA North Invoice
309 Gracile Dr. No 03KG8793
Carmel, IN 46032
317- 574 -1957 FAX: 317 -574 -1982 II II l I I I I I I I l I l l II II II II
Page 1
08:49:45 Jan 03 2012
CUSTOMER N Invoice NUMBER Invoice DATE PACKING SLIP TERMS W EE
318 03KG8793 1 01/03/12 03RS5529001 NET 10TH 030
BILL TO: SHIPPED TO:
CARMEL POLICE CITY GARAGE CARMEL POLICE CITY GARAGE
3 CIVIC SQUARE 3400 W 131ST
CARMEL, IN 46032 CARMEL, IN 46074
p..
11111111111111111111 �IIIIII��IIIIIIilllllf1�1111111
Dept: 002 CARMEL POLICE CITY GARAGE Contact: /317 -733 -4600 Route: CARMEL /WESTFIELD Direction:
YOUR P.O. NUMBER ORDER DATE CSR SHIPPED VIA CARTONS pPER
stock
01/03/12,08:49:45 1 200003 MATT SEGERSON 3 CARMEL /WESTFIELD A 202
ITEM DESCRIPTION 81N UNIT ORDER BACK INV LIST CORE NET NET EXT
OTY ORDERED CITY PRICE PRICE PRICE CORE PRICE
RAF ATD1159P AT POLICE PAD SET U EA 4 0 4 92.85 0.00 40.70 0.00 162.80
TOTAL PURCHASE TOTAL LIST TOTAL MDSE TOTAL CORE FREIGHT TAX PCT TAX AMT INVOICE TOTAL PAYMENTS BALANCE DUE
162.80 371.40 162.80 0.00 0.00 0.00 1.62.80 0.00. 162.80
2.08% service charge on past due accounts(25 per annum).
Core returns must be in original box. All new returns must
be resaleable. No return after 30 days without invoice.
G�
TBA North Invoice
309 Gradle Dr. No 03KH2597
Carmel, IN 46032
317 574 -1957 FAX: 317- 574 -1982 II II II I I II I I I II IIII II III I it
Page 1
09:01:22 Jan 10 2012
CUSTOMER N Invoice NUMBER Invoice DATE PACKING SLIP S WHSE
318 03KH2597 01/10/12 03RS9956001 NET 10TH 030
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
25958 01/10/12, 09:01:21 300007 BRIAN HALPER 1 3 CARMEL /WESTFIELD A 307
ITEM DESCRIPTION BIN UNIT ORDER BACK INV LIST CORE NET NET EXT
QTY ORDERED QTY PRICE PRICE PRICE CORE PRICE
SWI BPU
OIL 5W3055GALSYN SYNTHETIC BLEND NONE EA 2 0 2 1122.62 0.00 490.00 0.00 980.00
TOTAL PURCHASE TOTAL LIST TOTAL MDSE TOTAL CORE FREIGHT TAX PCT TAX AMT INVOICE TOTAL PAYMENTS BALANCE DUE
980.00 2245.24 980.00 0.00 0.00 0.00 980.00 0.00 980.00
2.08% service charge on past due accounts(25% per annum).
Core returns must be in original box. All new returns must
be resaleable. No return after 30 days without invoice.
�S
INDIANA RETAIL TAX EXEMPT PAGE
City ®f Carmel CERTIFICATE NO. 003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 2
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
9890092
SODA Nouth Cumol Pollco DGp20roG1
VENDOR
SHIP 3 CIVIC SgU@M
SM Gradlo Ddvo TO Carmol, IN 46M
Cumol, IN 46M 7) 579
CONFIRMATION BLANKET I CONTRACT PAYMENTTERMS FREIGHT
QUANTITY egg UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Account 42. 315.00
2 Each 53 gallon drum $490.00 $080.00
Sub Total: $980.00
0
Send Invoice To:
f J
Cumol Pollco DapalftaM
Attn: Toros@ Andmon
3 CIVIC squ2m
Darmol, IN 482= PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT I PROJECT ACCOUNT AMOUNT
Carmel Police Dept. PAYMENT 0.00
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 PRO
SHIP REPAID. PER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS THSAPPROP Yq I H SUFFICIENTTOPAYOOR THE ABOVE ORDER.
C.O.D. SHIPMENTS CANNOT BE ACCEPTED.
PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY
SHIPPING LABELS. IG? of 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 9 6 A.P.V. COPY SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN THE SUM OF
ON ACCOUNT OF APPROPRIATION FOR
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
VOUCHER NO. WARR NO.
TBA North ALLOWED 20
IN SUM OF
309 Gradle Drive
Carmel, IN 46032
$1,
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO# Dept. INVOICE NO. ACCT #!TITLE AMOUNT Board Members
Prior Year I hereby certify that the attached invoice(s), or
1110 3KG3822 42- 370.00 $219.1 G
bill(s) is (are) true and correct and that the
1110 3KG8793 42- 370.00 $162.80
materials or services itemized thereon for
25960 3KH2597 42- 315.00 $980.00 which charge is made were ordered and
received except
Thursday, January 12, 2012
Chief of Police
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))
12/22/11 3KG3822 repair parts $219.10
01/03/12 3KG8793 repair parts $162.80
01/10/12 3KH2597 oil $980.00
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