173845 06/24/2009 CITY OF CARMEL, INDIANA VENDOR: 00352891 Page 1 of 1
l ONE CIVIC SQUARE GRAND CHAMPION TACK SADDLERY CWECK AMOUNT: $450.00
CARMEL, INDIANA 46032 3905 W 96TH ST, SUITE 600 -700
INDIANAPOLIS IN 46268 CHECK NUMBER: 173845
CHECK DATE: 6/24/2009
D EPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4356001 20975 224528 450.00 MOTORCYCLE BOOTS
}nvoire
CPI Invoice Date:06.17.09
CITY OF CARMEL POLICE DEPT. Page: 1
3 civic SQUARE Salesperson: I
Invoice 224528
CARMEL, IN. 46268 Due Date:06.17.09
Di Date: 06 17
sc a e: 09
Time: 2:26 PM
]uantity :Item Number :List Price :Sale Price :Extension :Tx
Ktem Description
1 MlSC 0.00 450.00 450.00 N
PATROL BOOTS
1 MISC 0.00 0.00 0.00 N
PO #20975
Subtotal 450.00
Grand Champion Tack
3905 West 96th Street Net Total 450.00
Indianapolis, IN Sales Tax
46268 invoice Total: 450.00
www.grandchampiontack.com Received
(317)872-4248 On Account 450.00'
Your Change
0 INDIANA RETAIL TAX EXEMPT PAGE
f y
C armel PURCHASE ORDER CERTIFICATE NO. 003120155 002 0 "fi UMBER N UMBER
Police Department FEDERAL EXCISE TAX EXEMPT
1 35- 60000972 20975
-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
May 2 mo t rcy cle boo
SHIP VENDOR Grand Champion Tack Saddlery SH SH City of Carmel P81ice Department
3905 West 96th Street, Suite 600 -700 3 Civic Square
Indianapolis, -IN 46266 Carmel, IN 46032
ATTN: Sgt. Charlie Driver
CONFIRMATION BLANKET CONTRACT PAYMENTTERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
1 m (ht(fircgcke boots 450.00
CD
o•� Via•
/e' /jo •°s °a• o O Q
Send Invoice To: f /J(
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
1110 560 -01 uniforms 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
THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
SHIP REPAID.
C.O.D. SHIPMENTS CANNOT BE ACCEPTED.
PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY {Lc
SHIPPING LABELS.
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE CHief of Police
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
t� J �J CLERK- TREASURER
DOCUMENT CONTROL NO A.P. COPY- SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER NO. W,IRRANT 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
Prescri�d 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
:G rand Champion Tack Purchase Order No. 20975F
;3 905 West 96th Street Terms
I ndianapolis, IN $6268 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
6/17/09 224528 payment for motorcycle boots for Sgt. Charlie Driver 450.00
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
d" and Champion Tack IN SUM OF
3905 West 96th Street
Indianap6lis, IN 46268
450.00
ON ACCOUNT OF APPROPRIATION FOR
police generafl and
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
20975F 224528 560 -01 450.00 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
Tune 18 20 09
Signature
Chief of Police
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund