172819 05/27/2009 f CITY OF CARMEL, INDIANA VENDOR: 088550 Page 1 of 1
j: ONE CIVIC SQUARE EVERETT J PRESCOTT INC CHECK AMOUNT: $3,121.16
CARMEL, INDIANA 46032 PO BOX 350002
•''i�onio�' BOSTON MA 02241 -0002 CHECK NUMBER: 172819
CHECK DATE: 5/27/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT D ESCRIP T ION
601 5023990 4088059 547.10 OTHER EXPENSES
206 4237001 4088734 2,514.40 STORM SEWER MAINT SUP
601 5023990 4093856 59.66 OTHER EXPENSES
Pipeline Specialists EVERETTJ. PRESCOTT, INC. E_ L�O� �nnn pO���
HOME OFFICE O pC�G uV v O
32 PR P. O. OX STREET 600 PAGE NO.
O. BOX
GARDINER, MAINE 04345 FLOW SERVICES P.O. Box 600
DAVIS D, CONCORD, NH 03301 Gardiner, ME 04345 0 0 4 4 j e "i. 4
Everett J. Prescott, Inc. TELEPHONE (207) 582 -1851 603 224 -3842 (207) 582 -5019 FAX (207) 582 -9118
IN D ATE 5 i C.-.5 09
REMIT li :AM E:JP 1-41u WAREHOUSE >('Er ;i`'I E:•_;P l{;. 7..ndicanapalis PACKINGSLIPNO. 40, 86)f34
n 1 r r rt r.
TO 1. J r f.J I .I.,t 1f� �3..; t.> •r llf k +1<_� 1 i. 1',.a �C• O t', S i t. CUS T O ME Z
.I:l• B D X 35"..(:}02 WAREHOUSE c?t'::}
P4 62
11' x-41. -C 5 C1 P Tel ,.-P or _y 7.: t, <'Y% )��C}°i ORIGINAL INVOICE
SOLD TO i °i!'1L: `._�..i i:;::_ DE 1 SHIP TO C A RME3... 13 iiEa� 1 I�kr 1 It
ry ?C) I a. Yt1 lei ::.a S
CALL ',317-
WE TA=T L_ D 'IN
CUSTOMER P.O. NO. JOB NAME JOB NO. SLS. DATE DUE DATE SHIPPED SHIPPING METHOD
C)) f1 t ```.at._ pd t.: I_}t 0 t f i 1 i f f j
,,I- f..,, ,1 ryry7 rt. Y 1
L`�lAL� O D IA/�/1'11:A 7nI L.lAL /UUL71'!! D O I:lALI l_A°/:.1/J000U I.U:UU INW7� D D �IIO
!1.? t r. 1 Y,c_.C}(.)t_t t, f.1:. t :1C0C. s
2 ,.e lYt? k._ c,i`1F' END ,_,E_C:l ":.�kld 1= ',__r�.i.ti i -.A r_. ;�:�.1,_ __c _0
,I
`(I: ll_? �-'(=lR 1'I`1UR f t. SD SS WE AMEN D0 1UNG ALL WE:: CAN AMOUN `�14• 140
SEE CONDITIONS OF SALE AND
7 f f C" E r a I t t f r 1 Ii_. [J!` O) TAX t� 0r.--. 1. ?0
lk =.ii� i� k^i..�..�I•....� I- �Fa:�,. .tk`ti ('sit: �_k.^Iry`. 'ti PAYMENT TERMS ON REVERSE
ARE Y. it's�_iE :l) N .:S(:} DAY i 1\1 YOUR HELP 1 S PLE ASE INDICATE INVOICE TO INSURE PROPER CREDIT, FREIGHT 6 Ot�.
PLEASE
AND t.k.,I- Si?i: =C :l.i k_.1), EMPLOYEES' (]E T.. L° )k NUMBER AND AMOUNT ON t_)';,t't{r`. t'
-a REMITTANCE DOCUMENT, AND
,4 service charge equivalent to 1.5% per month PROVIDE COPIES OF ANY
INVOICES WITH CHANGES OR cY .j, 4 4 0
(18% per annum) will be added to past due accounts. EXCEPTIONS. I
E. J. PRESCOTT, INC. TERMS AND CONDITIONS OF SALE
Acceptance: All orders from the Purchaser are based upon acceptance within 10 days of receipt of written
order, by authorized personnel of the Seller and with approval by Seller's Credit Department.
Prices: Subject to change without notice except where firm quotations have been approved in writing by
authorized management personnel of the Company.
Taxes: In addition to the prices stated, purchaser is responsible for any excise, retail sales, or use taxes
for which EJP may be liable.
Shipments: EJP shall not be responsible for delays caused by strikes, embargoes, fires, accidents, or
any other causes beyond our control, including delays in manufacturing or in shipment by the manu-
facturer for material not in stock at EJP warehouse at the time of sale.
Loss or Damage: EJP's responsibility ends when goods are delivered in good condition to and receipted
for by the carrier, consignee or purchaser.
Guarantee: EJP agrees to furnish new merchandise in exchange for any merchandise sold that is found
to be defective in manufacture within warrantees and or guarantees of the Manufacturer. We assume
no further liability of any kind such as for labor costs, expenses, or any type of damage, direct or
indirect, resulting from the use of the merchandise claimed defective. Written notice must be received
by this office within 14 calendar days of first becoming aware of any defective merchandise in order
to mitigate damages and allow EJP an opportunity to place the manufacturer on notice. Failure to
provide proper notice to EJP will bar any claim for defective material.
RETIIRNS: MATERIAL CANNOT BE RETURNED WITHOUT EJP'S WRITTEN CONSENT. NO RETURNS
ON PIPE ALLOWED. ALL OTHER RETURNED MATERIAL SUBJECT TO A MINIMUM 25% REHAND-
LING CHARGE, PLUS TRANSPORTATION CHARGES.
Credit: All credit for returned material will be applied to future orders unless otherwise shown and is
contingent upon approval by EJP Credit Department.
Cancellations: SPECIAL OR NON -STOCK ITEMS MAY NOT BE CANCELLED OR RETURNED AFTER
PRODUCT IS PLACED INTO PRODUCTION. All charges or costs incurred in cancellations or order
changes will be billed to the purchaser.
Shortages: Claims for shortages must be made within 10 days of receipt of shipment. EJP will not be
responsible for claims not reported within that period.
Purchaser's Terms: Purchase orders issued pursuant to an EJP quotation shall be deemed issued subject
to all EJP terms and conditions herein contained. These terms and conditions shall supersede those
of the purchaser..
Delivery Terms: Delivery. of all materials is to one given destination, for all items including pipe, unless
otherwise shown. Deliveries will be made on hard surfaces only. Any damages or towing charges
resulting from "non hard surface deliveries" shall be the responsibility of the purchaser.
Payment Terms: Net.30 days, no cash,discounts allowed. 1.5% PER MONTH (18% A.P.R.) SERVICE
CHARGE will be applied at the end of the month following first statement and is contingent upon
approval by EJP's Credit Department. UNLESS THIS IS A CONSUMER TRANSACTION, THE PUR-
CHASER AGREES TO PAY ALL COSTS AND EXPENSES OF COLLECTION, INCLUDING REA-
SONABLE ATTORNEY'S FEES, and seller claims a mechanic's lien under applicable state law. If this
is a consumer transaction a SERVICE CHARGE of 1.5% PER MONTH (18% A.P.R.) on the unpaid
balance will be applied after 30 days from the date of the statement.
Communications: Payments are to be directed to: Everett J. Prescott, Inc., P.O. Box 845346, Boston,
MA 02284 -5346, Telephone (207) 582 -1851. All other correspondence and inquiries are to be directed
to your local EJP branch.
VOUCHER NO. WARRANT NO.
ALLOWED 20
-J. Prescott
6jelftf--j IN SUM OF
P. „O. Box 350002
Boston, MA 02241 -0502
$2,514.40
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
206 4088734 42- 370.01 $2,514.40 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
Cj
Thursday, May 21, 2009
r
i �.r r '�f�'
b reet Commisslori'er
f
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))
05/05/09 4088734 $2,514.40
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
Pipeline Specialists EVERETT J. PRESCOTT, INC. EM �ETER& FA X s P 2 HOME OFFICE 'r p �J �O CE 32 PR O. BOX STREET tlon P.O. BOx 600 PAGE NO. FLOW SERVICES GARDINER, MAINE 04345 D, CONCORD, NH 03301 11Ali%LAl.:l3IA�S.h i i_,e 6 Everett J. Prescott, Inc. TELEPHONE (207) 582 -1851 603 224 -3842 07) 582 -9118
INVOICE DATE 5 C. 1.3 CJC•r�
I h I". t�J .L Y 1 J r _i 1 r_� i.) ::_1 .41
REMIT WAREHOUSE
..r1i'.3.:3Yic:d.{:��) .:1.<�. .PACKING LIP NO. -r.
r
TO> n i'it; �.1 It` C' ir;; i? i•Y 'Y CUSTOMER NO. :�..,f c::r..:
Eir'k. 2r ��(;�i,'c i•' WAREHOUSE. ;-2;-1
i. t S l_ 1 1 r:.•! Y a it r C I`'J i• 6 1
C"22 't1 -Li'_ 42' I..e I. I:? I li,rre- a :1 47 {:i=0`._ ORIGINAL INVOICE
SOLD TO> I's l° i'= sl4i'i't =i I1_i .�':i! SHIP TO >t .I. f Y t f= C'112 f~iE�.i._ R )r)1I
r
C r..... .I
_S i_,' l•4::. i. '1 x E: t: t Fa k' t. `•t s irl S. 1
t,:J e :I. i i W r s t; i' J. e 1. d 3 'TN
CUSTOMER P.O. NO. JOB NAME JOB NO., SLS, DATE DUE DATE SHIPPED SHIPPING METHOD
:.1.1;': -i" f-1(;t; Y�,t f l• 5 /t-5 01. t(r L
pr1r�..��pp it t: t_ t t ppry�1y�� :J 1' t .S'
„LYl/:LS IA1,:A11L_L7lU (idXl °J 9 l°JA171 l..A?L:11:1WUU l..lAl1U UMlA"1'S
1. 6 ('Y ._i h" r:. Lr r i....I Lr L ...Y !::1 •y t i-f I s 1 C i t
.f'!' \IK Y F YOUR BM 3 _I'K?_ St WE AR DOING ALL. WE f'f=lN SEE CONDITIONS OF SALE AND AMOUNT 5 9 :,6 6
1 —1 'kE.EP 1'I'�f.i C E—'..::k F *AI R 4 °i. f.i �_)i`�It:[�R F I I:t:;��f' f�1Y. PAYMENT TERMS ON' 'REVERSE, TAX 7 7 41
SIDE. TO INSURE PROPER CREDIT,
TI'IE: PI :I:a =?RE {ri''i I.IIyI l.j �•}ti( j �`jI`IC_IIT. �t -i�..R I'•{[_I._P I:S PLEASE INDICATE INVOICE FREIGHT "1:1:1
NUMBER AND AMOUNT ON
I \1I':R J)ED !l I' +.Isi :1 ='ial fv:wl!' =t °!'C 3i" I.'!"!PL.DYI' ES OF TEAM EJ z t_l -the .0
REMITTANCE DOCUMENT, AND
c
A service charge equivalent to 1.5 per month PROVIDE COPIES OF .ANY INVOICES WITH CHANGES OR c: ,:.a
(18% per annum) Will be added to past due accounts EXCEPTIONS. OBE
E. J. PRESCOTT, INC. TERMS AND CONDITIONS OF SALE
Acceptance: All orders from the Purchaser are based upon acceptance within 10 days of receipt of written
order, by authorized personnel of the Seller and with approval by Seller's Credit Department.
Prices: Subject to change without notice except where firm quotations have been approved in writing by
authorized management personnel of the Company.
Taxes: In addition to the prices stated, purchaser is responsible for any excise, retail sales, or use taxes
for which EJP may be liable.
Shipments: EJP shall not be responsible for delays caused by strikes, embargoes, fires, accidents, or
any other causes beyond our control, including delays in manufacturing or in shipment by the manu-
facturer for material not in stock at EJP warehouse at the time of sale.
Loss or Damage: EJP's responsibility ends when goods are delivered in good condition to and receipted
for by the carrier, consignee or purchaser.
Guarantee: EJP agrees to furnish new merchandise in exchange for any merchandise sold that is found
to be defective in manufacture within warrantees and 1 or guarantees of the Manufacturer. We assume
no further liability of any kind such as for labor costs, expenses, or any type of damage, direct or
indirect, resulting from the use of the merchandise claimed defective. Written notice must be received
by this office within 14 calendar days of first becoming aware of any defective merchandise in order
to mitigate damages and allow EJP an opportunity to place the manufacturer on notice. Failure to
provide proper notice to EJP will bar any claim for defective material.
RET R nn 'TEo1AI rANINInT CSC P I V� CTI 10KIIED �A� ITIwvIT EJD'C 1AIMITTEKI r..nNICENT Nn RETI Ipm.q
L V
1 V RI NS: IV1/ 1 l Li 11 �INN 1 BE
ON PIPE ALLOWED. ALL OTHER RETURNED MATERIAL SUBJECT TO A MINIMUM 25% REHAND-
LING CHARGE, PLUS TRANSPORTATION CHARGES.
Credit: All credit for returned material will be applied to future orders unless otherwise shown and is
contingent upon approval by EJP Credit Department.
Cancellations: SPECIAL OR NON -STOCK ITEMS MAY NOT BE CANCELLED OR RETURNED AFTER
PRODUCT IS PLACED INTO PRODUCTION. All charges or costs incurred in cancellations or order
changes will be billed to the purchaser.
Shortages: Claims for shortages must be made within 10 days of receipt of shipment. EJP will not be
responsible for claims not reported within that period.
Purchaser's Terms: Purchase orders issued pursuant to an EJP quotation shall be deemed issued subject
to all EJP terms and conditions herein contained. These terms and conditions shall supersede those
of the purchaser..
Delivery Terms: Delivery. of all materials is to one given destination, for all items including pipe, unless
otherwise shown, Deliveries will be, made on hard surfaces only. Any damages or towing charges
resulting from "non hard surface deliveries' shall be the responsibility of the purchaser.
Payment Terrns: Net 30 days, no cash. discounts allowed. 1.5 PER MONTH (18% A.P.R.) SERVICE
CHARGE will be applied at the end of the month following first statement and is contingent upon
approval by EJP's Credit Department. UNLESS THIS IS A CONSUMER TRANSACTION, THE PUR-
CHASER AGREES TO PAY ALL COSTS AND EXPENSES OF COLLECTION, INCLUDING REA-
SONABLE ATTORNEY'S FEES, and seller claims a mechanic's lien under applicable state law. If this
is a consumer transaction a SERVICE CHARGE of 1.5% PER MONTH (18% A.P.R.) on the unpaid
balance will be applied after 30 days from the date of the statement.
Communications: Payments are to be directed to: Everett J. Prescott, Inc., P.O. Box 845346, Boston,
MA 02284 -5346, Telephone (207) 582 -1851. All other correspondence and inquiries are to be directed
to your local EJP branch.
Pipeline Specialists EVERETT J. PRESCOTT, INC. =dine n� 2 HOME OFFICE p IJ �J v LC 32 PR O. BOX soo GE STREET O� 0on .O. Box PA P NO. METER BACKFLOW SERVICES GARDINER,MAINE04345 p10SHEEPDAV /SROAD,CONCORD,NH03301 0 0 r "1 %;i Everett J. Prescott,lnc. TELEPHONE(207)582 -1851 07 582 -9118 t 603 224 25 FAX 603 224 -3842 I
INVOICE DATE
FT iv!
REMIT 7l::.'A)'al E' :-J E' ).�J I fi d:I. a i Ic�.(:1 o1 1 '.':3 WAREHOUSE f. I R W PACKING SLIP NO. "t<i.� i:i /.ri. :)s�c,C }�i')
TO lz:...c t: i_i 1 i I1' t t .a a {.+i< I'I J- T i. ci t. CUSTO NO.
1 i =j l::) u F-* I -)x r >�u�t:j C't ,i r yy WAREHOUSE -W C;
1_}Cl S I C) 1\1 Ir)t-1 .1. r:d r:,,ri['i 1•! (.l .l. s r -1_ '•I•i3r' 3.1
C; 41. 0 5 t?�'_ �;::�E_ ,a F,r.,ri� 31. ORIGINAL INVOICE
SOLD TO> F- j-:,`:2?;1;1�:.... i�.ir "i "rF l: I:`:;'" SHIP TO >C:I:T'V t: l'"' Ct1Ft!~�E�i._---11�( -�l"E r)'.1:<,: _F.
34.`�O W. 131st Street
W t_' cr :I. ii. W e z;1, E J r., 1. d t .1. T�)
)7 460
CUSTOMER P.O. NO. JOB NAME JOB NO. SLS. DATE DUE DATE SHIPPED SHIPPING METHOD
l tit} A/(
.j 3 PIP !4[' e) r t,::..f:1
t.. ry. r E::: r., r`�• f• i +.f- '3
liK F'' Yt..f L. ?l'" S.:t S.. ?i.t- j_'_*.Z: ?;_7.
1::r 1— Y. CE'_ s A.:1: R I. i4) E IS t._1!` F_ R s `'i
1- ::)'a t)....r.:1YEE r ir= ri `ti�l 1- r
2 r r• r r i r ra r, I n
P `3 ?r b' r is _:�t.)v%,ji3=.J(, 0 r,
3 i 8 f j1 l.: ,a:_ ?,:7: 1 t:, �l• I_'. i••� C� +i- v C.: Z.7'i• v 3
`'P .1. tr J. r t_.•' C i I ..L l 2 1 L 1 i i t I I Fh ft I 1 f -4. v ..3 i., C'J
`'t A ,r :.i• r.a 'Y .l.) `y i ^aI t.t ...F.. r 4
r l.Jtl '1 f•' t- ..A ['..�1 4. ft000 9'i•..80
...a 1 is 1 t 2 l R� r. t• •r r, t j f C-t '9000
i ;-t
i i t_:0 ••r n.: 4 x._ E I�. Fi; tl 1.�.�i i 1 t, i_•i.1. 1'• -t.1.l ..1 EA 3. �J 3 v C? L ttti:t v �t'7
i I •fi 1 `M, You FOR YCIUR f S.� N1E. E D(':lING ALL_ VIE +=:(-�N AMOUNT 5 4:ry 10
SEE CONDITIONS OF SALE AND
TO I'E:L_E= .':4J) ,r FAIR IN �1i'iIE k..i1:; .�:i�i l';E�I` PAYMENT TERMS ON REVERSEITAX 7: -0iO
SIDE. TO INSURE PROPER CREDIT,
r -ii PRICE f'1R ilf!t i1_.D !JN 0 :(.�A i YC)tlr'�• HE:�LP IS FREIGHT .0
PLEASE INDICATE INVOICE
!'tll':l;::DIE" f))`t)D �,11PF-i!''Ee f i:l:_.a�. r_i 1�_fil� C_:.)P NUMBER, AND AMOUNT ONE (.)�,�'t,t?? °E1�
o REMITTANCE V OICES D E CHMENT, AND.'
A service charge equivalent to 1.5 per month OF ANY ii
ANGES OR @M r 7 I 0
1
(18% per annum) will be added to past due accounts EXCEPTIONS. I I
E. J. PRESCOTT, INC. TERMS AND CONDITIONS OF SALE
Acceptance: All orders from the Purchaser are based upon acceptance within 10 days of receipt of written
order, by authorized personnel of the Seller and with approval by Seller's Credit Department.
Prices: Subject to change without notice except where firm quotations have been approved in writing by
authorized management personnel of the Company.
Taxes: In addition to the prices stated, purchaser is responsible for any excise, retail sales, or use taxes
for which EJP may be liable.
Shipments: EJP shall not be responsible for delays caused by strikes, embargoes, fires, accidents, or
any other causes beyond our control, including delays in manufacturing or in shipment by the manu-
facturer for material not in stock at EJP warehouse at the time of sale.
Loss or Damage: EJP's responsibility ends when goods are delivered in good condition to and receipted
for by the carrier, consignee or purchaser.
Guarantee: EJP agrees to furnish new merchandise in exchange for any merchandise sold that is found
to be defective in manufacture within warrantees and or guarantees of the Manufacturer. We assume
no further liability of any kind such as for labor costs, expenses, or any type of damage, direct or
indirect, resulting from the use of the merchandise claimed defective. Written notice must be received
by this office within 14 calendar days of first becoming aware of any defective merchandise in order
to mitigate damages and allow EJP an opportunity to place the manufacturer on notice. Failure to
provide proper notice to EJP will bar any claim for defective material.
�`Tv�iR�v: MATERi!` -.L CANNO RE PCT1 IONK:D XAIITWnf IIT EJP'C %A /RITTEAI r'r111,�CFRIT I�irl RETURNS
ON PIPE ALLOWED. ALL OTHER RETURNED MATERIAL SUBJECT TO A MINIMUM 25% REHAND-
LING CHARGE, PLUS TRANSPORTATION CHARGES.
Credit: All credit for returned material will be applied to future orders unless otherwise shown and is
contingent upon approval by EJP Credit Department.
Cancellations: SPECIAL OR NON -STOCK ITEMS MAY NOT BE CANCELLED OR RETURNED AFTER
PRODUCT IS PLACED INTO PRODUCTION. All charges or costs incurred in cancellations or order
changes will be billed to the purchaser.
Shortages: Claims for shortages must be made within 10 days of receipt of shipment. EJP will not be
responsible for claims not reported within that period.
Purchaser's Terms: Purchase orders issued pursuant to an EJP quotation shall be deemed issued subject
to all EJP terms and conditions herein contained. These terms and conditions shall supersede those
of the purchaser.
Delivery Terms: Delivery of all materials is to one given destination, for all items including pipe, unless
otherwise 'shown. Deliveries will be made on hard surfaces only. Any damages or towing charges
resulting from "non hard surface deliveries" shall be the responsibility of the purchaser.
Payment Terms: Net 30 days, .no .cash discounts allowed. 1.5% PER. MONTH (18% A.P.R.) SERVICE
CHARGE will be applied at the end of the month following first statement and is contingent upon
approval by EJP's Credit Department. UNLESS THIS IS A CONSUMER TRANSACTION, THE PUR-
CHASER AGREES TO PAY ALL COSTS AND EXPENSES OF COLLECTION, INCLUDING REA
SONABLE ATTORNEY'S FEES, and seller claims a mechanic's lien under applicable state law. If this
is a consumer transaction a SERVICE CHARGE of 1.5% PER MONTH (18% A.P.R.) on the unpaid
balance will be applied after 30 days from the date of the statement.
Communications: Payments are to be directed to: Everett J. Prescott, ,Inc., P.O. Box 845346, Boston,
MA 02284 -5346, Telephone (207) 582 -1851. All other correspondence and inquiries are to be directed
to your local EJP branch.
VOUCHER 091870 WARRANT ALLOWED
550
IN SUM OF
8
Prescott, Inc.
P.O. Box 350002 1�1G
Boston, MA 02241 -0002 0
�R
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
�Q 4088059 01- 6200 -06 $547.10
Iscit
Voucher Total (P 06 6
CJ6 distribution ledger classification if
c4im paid under 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 of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
88550
E.J. Prescott, Inc. Purchase Order No.
P.O. Box 350002 Terms
Boston, MA 02241 -0002 Due Date 5/18/2009
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
5/18/2009 4088059 $547.10
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
Date icer