176248 08/19/2009 CITY OF CARMEL, INDIANA VENDOR: 00352891 Page 1 of 1
ONE CIVIC SQUARE GRAND CHAMPION TACK SADDLERY �N
CARMEL, INDIANA 46032 3905 W 96TH ST, SUITE 600 -700 CHECK AMOUNT: $400.00
INDIANAPOLIS IN 46268
CHECK NUMBER: 176248
CHECK DATE: 8/19/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NU MBER AMOUNT DESCRIPTION
1110 4356001 21041 226003 400.00 MOTORCYCLE BOOTS
Invoice
CPD Invoice Datm:08.11.09
CITY OF'CARMEL POLICE DEPT. Page." 1
3 CIVIC SQUARE Salesperson: 1
Invoice 226003
CARMEL, IN. 46268 Due Date:08.11.09
Disc Date:08.11.09
Time: 3:43 PM
Quantity :Item Number :List Price :Sale Price :Extension :Tx
:Item Description
1 MIGC 0.00 400.00 400.00 N
PATROL BOOTS
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T
T�
Subtotal 400.00
Grand Champion Tack
3905 West 96th Street Net Total x 400.00
Indianapolis, IN Sales Tax
46268 Invoice Total: 400.00
`www.grandchampiontaok.com Received
(317)872-4248 On Account 400.00
Your Change
INDIANA RETAIL TAX EXEMPT PAGE
o I' Carmel CERTIFICATE NO. 003120155 002 0
1a. PURCHASE ORDER NUMBER
Police Department FEDERAL EXCISE TAX EXEMPT 21041
35- 60000972
3 O+ RRCIVIC 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
L 09 Tnot orcycle hoo
VENDOR Grand Champion Tack Saddlery SHIP City of Cammel.POlice Department
39915 West. 96th Street, Suite 600 -700 To 3 Civic Square
Indianapolis, IN 46268 Carmel, IN 46032
ATTN: Sgt. Charlie Driver
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
1 pair of motorcycle boots 450.00
r
a J >a
0
Send Invoice To:
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT IPROJEOT PROJECT ACCOUNT AMOUNT
1110 560 -01 uniforms PAYMENT
A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
!7 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
THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
SHIP REPAID.
C.O.D. SHIPMENTS CANNOT BE ACCEPTED. ORDERED BY �r[.'�.�":. t��•�- ��/�sf c
PURCHASE ORDER NUMBER MUST APPEAR ON ALL
SHIPPING LABELS.
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE Chief of P olice
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
g
JL O CLERK-TREASURER
DOCUMENT CONTROL NO. A. COPY SIGN AND RETURN TO CLERK 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
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
Grand Champion Tack Purchase Order No. 21041F
3905 West 96th Street Terms
Indianapolis, IN 46268 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
8/11/09 226003 payment for motorcycle boots 400.00
Total
I 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
Griand Champion Tack IN SUM OF
3905 West 96th Street
Indianapolis, IN 46268
400.00
ON ACCOUNT OF APPROPRIATION FOR
police general fund
Board Members
PO# or INVOICE= NO. ACCT /TITLE AMOUNT
.DEPT. I hereby certify that the attached invoice(s), or
21041E 226003 560 -01 400.00 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
August 14 20 09
Signature
Chief of POlice
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund