HomeMy WebLinkAbout180392 12/16/2009 CITY OF CARMEL, INDIANA VENDOR: 359348 Page 1 of 1
ONE CIVIC SQUARE CALLAWAY GOLF COMPANY
CHECK AMOUNT: $5,213.00
�o CARMEL, INDIANA 46032 Po aox sooz
CARLSBAD CA 92018 -9002 CHECK NUMBER: 180392
CHECK DATE: 12116/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4356007 1402084192 462.00 GOLF HARDGOODS
1207 4356007 920092072 775.00 GOLF HARDGOODS
1207 4356007 920128011 75.00 GOLF HARDGOODS
1207 4356007 920260293 6,375.00 GOLF HARDGOODS
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BROOKSHIRE GOLF CLUB
CITY OF CARMEL G O L F
12120 BROOKSHIRE PKWY
CARMEL IN 46033 OOYSSEY`
(11P� ✓VPQGisti
346 Q
CITY OF CARMEL
BROOKSHIRE GOLF CLUB
12120 BROOKSHIRE PKWY
CARMEL IN 46033 -3314
INVOICE NO. PG. INVOICE DATE DATE OF ORDER CUSTOMER P.O. NO. RWU@M
CUSTOMER NO. SLSMN. ORDER NO. TERMS SHIP VIA
15546 755 30461630 Net Due Ma 31, 2010 No C C aLLaw j y BRIAN
DESCRIPTION
DELIVERY NO 810902336
10 61000461216 BL TF LTD FLIGHT Y 09 1,500 1,50 4.25 0.00 4.25 6,375.00
TRACKING NO 694454025
Additional tracking numbers exist. Please contact Cus Omer Service or log
onto Call wayconnect.com and click "Order Status" for ore information
I ,.•s D 3 .'Il l
1!
All sales are F.O.B. origin. Return authorization required SUB TOTAL 6,375.00
All U.S. Sales made by and shipped by Callaway Golf Sales Company.
FORM 800268 REV. 7/08 TOTAL DUE 6-375.00
NOTICE TO CUSTOMERS RE: CALLAW'AY GOLF'S SALES P
Customers purchase products with knowledge of the Sales Policy set out below
a) C:alkmity Go It' Corn piny and its wholly owned Sit bsidiarw, Callaway Go It' SaIes Company (co IIectiveI "CaIIaway Golf' or the "Company") reserNe the rii4lu
to refuse to do business with anyone for any lawful reason including, but not limited to, those who fail to pay invoices when duc, sell the Company's
products from unauthorized locations (including unauthorized Internet locations), or violate any other policy of the Company.
b) All dealings are on an order -by -order hasis. No order is accepted until product ships.
c) Callaway Golf has valunble intellectual properly rights and chooses not to do business with those who infringe upon those rights, or aid, abet or assist others.
directly or indirectly, in infringing upon those rights.
d) Callaway Golf chooses not to Ilk) business with those whose sales practices violate the law, deceive or are otherwise unfair trade practices. The Company
chooses not to do business writh those "ho disparage its products or fail to fully promote them.
c) Callaway Golf chooses not to do business with those that violate any of its sales policies.
1) Point of purchase displays belong to Callaway Golf and must be surrendered upon re(IuCSt.
g) Unpaid balances will bear interest at the rate of I. °'i for each month or portion of a month they arc overdue. Customer consents to the sole and exclusive
urisdiction of the federal and state courts in San Diego, California, for any suit, action or proceeding arising from the sale or purchase of Callaway Goll`s
products.
h) Callaway Golf not to do business with those that resell its products for export outside the continental United States. Call nvav Golfatso chooses not
to do business with those that sell to persons other than consumers. By accepting deliver of product, Customer understands that it is prohibited from
selling such products for resale outside the continental United States and will not sell such products without approval from Callaway Golf to
persons other than consumers or from other than approved locations.
i) Consent to telephone monitoring: To ensure that it provides the hig,hest level of service, Callaway Golf may monitor and record customer telephone calls.
Calling Callaway Goll'ionstitUtCs Customer's consent to monitoring and recording. if Customer does not ~want a call monitored and recorded, please inform
the rcpresontativc who answers the call.
j) Credits on account will he applied in accordance with policie, determined by Callaway Golfs credit department. Please contact the credit department for
information about the policy or to ask any questions about how it is applied.
k) C`ustgmer purchasing product tree from sales tax and making it taxable use of product (i.e. any purpose other than retention, demonstration. or display while
holding for sale in the regular course of btu mess) is responsible for the reporting and payment of tax due direct to the proper taxing authority when state law=
so provides or may inform Callaway Golf ol'the desire fin' added tax billing. For example, product purchased six personal use, for use as rental club stock or
drop shipped to a consumer in the state of California is considered taxable. Am questions concernini sales tax should be directed to the Callaway Golf Tax
Department.
1) Custcxncr acknowledges that (i) Callaway Golf's shipping terms are F.O.B. Shipping point and legal title and risk of loss transfers to the Customer upon
dcliecr by Callaway Gott of the purchased products to the carrier, (it) Callawa} GOOF (as Customer's agent) has obtained transit insurance on behalfol'the
Customer listing the customer as an insured party, (iii) in the event of a transit IOSS, the Customer authorizes Gallaway Golf (as Customer's agent) to assist
in negotiating and processing any such claims with the insurance company on the Customer', behalf', and apply proceeds (corn any such claim to the
Customer's accounts receivable account and (iv) the Customer is fully responsible fix all amounts related to purchased products regardless ofthe amount of
available insurance proceeds, ifany. Requests for damage claims vv°ith carriers must be made within 21 days of invoice date.
m) Delivery refusals may be still eel to it 10% processnng lee. All returns are at the sole discretion of Callaway Golf' and are subject to its policy on returns
which is incorporated herein by reference. If'you want a copy, please call customer service.
n) Callaway Golf tvill not accept return of custom logo product unless dclictive in material or workmanship. In the normal course of production, Callaway
Goll'may produce custom logo products in excess of tlhe quantity ordered by the CnslOnlCr. CUSYOmer grants Catlaw�ay Golf the right to sell any excess
custom logo products ordered by Customer and /or hearing the Customer's trademarked or copyrighted IoLo.
o) Callaway Golf Beall Operations, Inc ("Agent"") is a disclosed ae�cnt ol'Callaway Golf: l!nder the aeency aarcement now in ellect, Agent does not bear right
or title to tini,hcd goods held in its possession held out for sale h\ Calla way Golf or its all Agent is not the seller or shipper of record for goods
listed on the invoice.
p) Claims for short ship and mis -ship adjustments or proof' of delivery must: be made before the due date of the invoice reflecting when the product:
originally shipped. Cn,tOnlCr understands that Callaway Golf' will investigate claims of short shipments, includinL verifying box weights recorded in
Callaway Golfs system to actual weights recorded by carriers, reviewin a seriat numbers scanned for Inc item(s) in question, and physical inventory counts
(when applicable), among other steps. Customer acknowledges that resolution of'such claims shall he made solely by Callaway Golf:
q) Additional requirements apply to all customers with routing. guides. Plcasc request a copy of the full Sales Policy from your Sales Representative or
Customer Service.
r)
This Sales policy applies to all of Callaway Goll "s products, and Callaway Golf reserves the right to change or discontinue thi, Sales Policy at any time, with
or without reason or cause.
BROOKSHIRE GOLF CLUB atjaiv
CITY OF CARMEL G O L F
12120 BROOKSHIRE PKWY
CARMEL IN 46033 ODYSSEY'
dJ.P� :No�G�sri
652 v
CITY OF CARMEL �TO�LJTE'
BROOKSHIRE GOLF CLUB
12120 BROOKSHIRE PKWY
CARMEL IN 46033 -3314
INVOICE NO. PG. INVOICE DATE DATE OF ORDER CUSTOMER P. MWA@ O. NO.
920128011 1 11/13/09 11/13/09 RESTO FEE RA #36
CUSTOMER NO. SLSMN. ORDER NO. TERMS SHIP VIA
15546 755 60803427 2% 30, Net 60 UPS GROUND /STANDAR
I= I DESCRIPTION
10 _999958 RE STOCKING FEE 15 15 _5.00 0.00_ 5 .00 75.00
RESTOCKIN FEE RA #3660496
;4
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All sales are F.O.B. origin. Return authorization required SUB TOTAL 75.00
All U.S. Sales made by and shipped by Callaway Golf Sales Company.
FORM 800268 REV. 7/08 'TOTAL DUE 75.
NOTICE TO CUST RE: C:ALLA GOLF'S SALES POL
Customers purchase products t� nth knowledge of the Sales policy set out below:
a) Callaway Golf Company and its wholly OWndel subsidiary, Callaway Golf Sales Company (collectively Callaway (;off" or the "Company reserve the ri21t,
to refuse to do business with anyone for any lawful reason including, but not limited to those who fail to pay invoices when title. sell the Company's
products from unauthorized locations (including uuaathorizcd Internet locations), or violaie anv other police ofthe Company.
b) All hearings arc on an order -by -order basis. No ol'dCl' is accepted until product ships.
C) Callaway Golf has valuable intellectual property rights and chooses not to do business kith those who infringe upon those rights, or aid, abet or assist others.
directly or indirectly, in infringing upon those rights.
d) Callaway Golf chooses not to do btlSlncsS with those v♦hose sales practices violate the law, deccice or are othemise unfair trade practices. The Company
chooses not to do business with those who disparage its products or ftil to fully promote them.
e) Call. ay Golf chooses [lot to do business with those that violate any of its sales policies.
1) point of purchase displays belong to Callaway Golf and must be surrendered upon request.
g) Unpaid balances va ill bear interest at the rate of 1.5 for each month or portion of a month they are overdue. Customer consents to the sole and exclusive
jurisdiction o'the federal and state courts its San Diego_ California, lot suit, action or proceeding arising (hint the sale or purchase ol'Callaway Golfs
products.
h) Callaway Golf chooses not to do business -,with those that resell its products for export outside the continental United States. Callaway Golf also chooses not
It) do business with those that sell to persons other than consumers. By accepting delivery of product. Customer understands that it is prohibited from
selling such products for resale outside the continental United States and will not sell such products without approval from Callaway Golf to
persons other than consumers or from other than approved locations.
i) Consent to telephone monitoring: To ensure that it provides the highest level of service, Callaway Golf may monitor and record customer telephone calls.
Calfing Callaway Golf constitutes Customer's consent to nonuoring and recordin If Customer does not want a call monitored and recorded. please inform
the representative who answers the call.
j) Credits on account will he applied in accordance with policies determined by Callareav Golt'c credo dgxmulent. please contact the credit deparumnt for
information about the police or to ask any questions about how it is applie(.
k) Customer purchasing product free from sales tax and making a taxable use of` product i.e. any purpose other than retention, demonstration, or display while
holding for sale in the regular course of bit: mess) is responsible for the reporting and payment of tax due direct to the proper taxing authority when state law
so provides or may inform Callaway Golfof the desire for added tax hitting. For example, product purchased for personal use. for use as rental club stock or
drop shipped to a consumer in the state of California is considered taxable Any questions concerning sales tax Should be directed to the Callaway Golf "Tax
Department.
1) Cuslonncr acknowledges that (i) Callaway Golf's shipping terms are F.O.B. Shipping point and legal title and risk of loss transfers to the Customer upon
ticliccry by Callaecay Golf of the purchased products to the carrier, (it) Callaway Golf (as Cnstomer's anent) has obtained transit insurance ou behaltof the
Customer listins, the customer as an insured party. (iii) in the event of a transit loss, the Customer authorizes Callaway Goff (as Customer's argent) to assist
in nc *,ousting and processing any such claims with the insurance company on the Customer's behalf, and apply proceeds from any such claim to the
Customer's accounts receivable account and (iv) the Customer is fully responsible for all amounts related to purchased products regardless of the amount of
available insurance proceeds, if any. Requests for damage claims with carriers must be made within 21 days of invoice date.
m) Delivery refusals may be subject to a I WN) processing lee. all rctunns are at the sole discretion of Callaway Golf and arc subject to its policy on returns
which is incorporated herein by reference. Ifyou want a copy, please call customer service.
n) Callaway° Golf will not accept return of custom logo product unless delectiye in material or workmanship. In the normal course of production, Callaway
Golf may produce custom logo products in excess of the quantity ordered by the Custoiucr. Customer grants Callaway Golf the right t(? sell any excess
custom Jogo products ordered by Customer and or hearing the Customer's trademarked or copyriyhtcd logo.
o) Callavrev Goll Ball Operations, Inc °A1,cnC') is a disclosed al_ cm ni Callaway Golf. Under the agcney aureement nm« in effect, gent dues not bear right
nr title to fini,hcd goods held in its pot session held out for sale by Callaway Golf or its affiliates. Agcnt is not the seller or shipper of record for goods
listed on the invoice.
p) Claims for short ship and mis -ship adjustments or proof of delivery must be made before the due date of the invoice reflecting when the product
originally shipped. Customer understands that Callaway Golf will mcestrgate claims of short shipunents, includinU verify_ ing box weights recorded its
Callaway Golf s system to actual weights recorded by carriers, rcvicrwing serial nurubers scanned for the item(s) in question, and physical inventory counts
(when applicable), annong other steps. Customer acknowledges that resolution of such claims shall be mane solely by Calkovav Golf.
q) Additional requirements apply to all customer, wide routing guides. Please request a copy of tine full Sales Policy from your Sales Representative or
Customer SerN ice.
r) ['his Sales Policy applies to all of Callaway Golfs products, and Cal l m av Golf reserve, the right to change or discontinue this Sales Policy at env time, with
or without reason or cause.
r
BROOKSHIRE GOLF CLUB �11d1U(�
CITY OF CARMEL
12120 BROOKSHIRE PKWY G O L F
CARMEL IN 46033
ODYSSEY'
dlPisr, ;No�c�sr�
478
CITY OF CARMEL
BROOKSHIRE GOLF CLUB
12120 BROOKSHIRE PKWY
o CARMEL IN 46033 -3314
INVOICE NO. PG. INVOICE DATE DATE OF ORDER CUSTOMER P.O. NO.
920092072 1 11/09/09 10/09/09 footwear return
CUSTOMER NO. SLSMN. ORDER NO. TERMS SHIP VIA
15546 755 3660496 Credit Memo UPS GROUND /STANDARD
DESCRIPTION
DEL IVERY- -NO 89722475
10 3822601385009 FT M226-01 CTECH W /W /S MR US8. 1- 1- 51.00 0.00 51.00 51.00-
20
7 3822601310509 FT M226 -01 CTECH W /W /S MR US10 1- 1- 51.00 0.00 51.00 51.00-
30 3822601311009 FT M226-01 CTECH W /W /S MR US11 1- 1- 51.00 0.00 51.00 51.00-
40 3822602390009 FT M226-02 CTECH B /B /C MR US9 1- 1- 51.00 0.00 51.00 51.00-
50 3822602395009 FT M226-02 CTECH B /B /C MR US9. 11- 1- 51.00 0.00 51.00 51.00-
60 3822120395008 FT M221 -20 SPRTERA W/B MR US9. 1- 1- 45.00 0.00 45.00 45.00-
70 3822120310008 FT M221-20 SPRTERA W/B MR US10 1- 1- 45.00 0.00 45.00 45.00-
80 3822120310508 FT M221 -20 SPRTERA W/B MR US10 1- 1- 45.00 0.00 45.00 45.00-
90 3822120311008 FT M221 -20 SPRTERA W/B MR US11 1- 1- 45.00 0.00 45.00 45.00-
100 3822121310508 FT M221 -21 SPRTERA W/R MR US10 1- 1- 45.00 0.00 45.00 45.007
110 3822812390009 F7 M228- 12;MAGNA W/B MR US9 UK 1 1 57.00 0.00 57.00. 57.00
120 3822812395009 FT M228`12 MAGNA W /B MR US9.5, 1 1 57.00 0.00 57 ^00 57.00
130 3822812310009.; FT M228 MAGNA W /B MR US10 U 1 1 57.00 0.00 tis 57.`00 <t 57.00
�1 0: 3836621395009 FT M366 -21- CHEVLP W /B /R -,MR US9 1 l 1 62.00 X0.00 62.00 62.00-
t°
150 3836621310569' ET 0366 -21 CHEVLP,'W /,B /R.,MR_US1° 1 1 `62.00 0':00 B2.:00 62.00
1 r
4
All sales are F.O.B. origin. Return authorization required SUB TOTAL 775.00
All U.S. Sales made by and shipped by Callaway Golf Sales Company.
TOTAL DUE 775.00
FORM 800268 REV. 7/08
NOTICE TO CUSTOMERS RE: CALLAW GOLF'S SALES P OLICY
(.UnOmers purchase products %yith LuoAA ledge of the Sales Policy set out helow:
a) Callaway Goll' Company and its wholly owned subsidiary, Callaway Golf Saks Company (collectively "Callaway Golf' or the "Company reserve the right
to refuse to do business with anyone for any lat%ful reason including, but not limited to, those who fail to pay invoices when due, sell the Company's
products from unauthorized location (including unauthorized interest locations), or violate tiny other policy ofthe Company.
b) All dealings are on an order -by -order basis. No order is accepted until product ships.
c) Callaway Golf has valuable intellectual property rights and chooses not to do business with those who infringe upon those rights, or aid, abet or assist others,
directly or indirectly, in infringing upon those rights.
d) Callaway Golf chooses not to (lo business with those whose sales practices violate the law, deceive or arc otherwise unfair trade practices. The Company
chooses not to do business with those who disparage its products or fail to fully promote them.
C) Callaway Golf chooses not to do business with those that violate any of its sales policies.
1) Point of purchase displays belong to Callaway Goll'and must be surrendered upon request.
g) Unpaid balances will bear interest at the rate of 1. for each month or portion of a month they are overdue. C'ustoncr consents to the sole and exclusive
jurisdiction oFthe federal and state courts in San Diego, California, for any suit, action or proceeding arising from the sale or purchase of Callaway Gall
products.
It) Callaway Golf chooses not to do business %with those that resell its products for export outside the continental United States. Callaway Golf ulso chooses not
to do business with those that sell to persons other than constuners. By accepting delivery o1' product:• Customer understands that it is prohibited from
selling such products for resale outside the continental United States and will riot sell such products without approval from Callaway Golf to
persons other than consumers or from other than approved locations.
i) Consent to telephone monitoring: To ensure that it provides the highest level of Service, Callaway Golf may monitor and record customer telephone calls.
Calling Callaway Golf constitutes Customer's consent to monitoring and recordin(_'. 11' Customer does not %want a call monitored and recorded. please inform
the representative Who an%ers the call.
j) Credits on account will he applied in accordance °ith policies determined by Callaway Golf's credit department. Please contact the credit deparunent for
inR?rmation about the policy or to ask any questions about how it is applied.
k) Customer purchasing product free from sales tax and making a taxitble use of product (i.e. any purpose other than retention, demonstration, or display %.%pile
holding fir sale in the regular course of business) is responsible for the reporting and payment of tax clue direct to the proper taxing authority when state law
so provide, or may inform Callaway Golt'of the desire for added tax hilling. For example, product purchased for personal use. for use as rental club stock or
drop shipped to it consumer in the state of C Aifornia is considered taxable. Any questions concerning Sales tax should be directed to the C allawa_y Golf Tax
Department.
1) Customer acknowledges that (i) Callaway Golf's shipping terms are F.O.B. Shipping Point and legal title and risk of loss transfers to the Customer upon
delivery by Callaway Golf of the purchased products to the carrier, (ii) Callaway Golf (as Customer's agent) has obtained transit insurance oil behalf of the
Customer listing the customer as in insured party, (iii) in the event of a transit loss, the Customer authorizes Callaway Cmlf (as Customer's agent) to assist
in ne and processing env such claims with the insurance company on the Customer's behalf, and apply proceeds from any such claim to the
Customer's accounts rccei %able account and (iv) the Customer is fully responsible for all amounts related to purchased products regardless amount of
available insurance proceeds, if any. Requests for damage claims with carriers must be made within 21 days of invoice date.
m) Delivery refusals may be subject to a 1 044, processing fee. All returns are at the sole discretion of Callaway Goff and are subject to its policy on returns
which is incorporated herein by reference. If you want at copy, pkasc call customer service.
n) Callaway Golf will not accept return of custom logo product unless defective in material or workmanship. In the normal Course of production, Catlawav
Golf may produce cusu >m logo products in excess of the quantity ordered by the Customer. CuSlpl'ner grants Calla% %ay (wit' tit e right to ,ell am excess
cusunm Iogo products ordered by Customer and' or bearing the Custonner's trademarked or copyrigfued logo.
o) Calla%%tuv Gulf Ball Operations Inc. "Agent is a disclosed agent o1'Callaway C;oli. Ender the agencv agreement no%% in effect, .Agent does not bear right
or title to tini,hcd goods h<ad in its possession held out for sale by Callaway Golf or its affiliates. Agent is not the seller or shipper of record for goods
listed on the invoice.
p) Claims for short ship and mis -ship adjustments or proof of delivery must be made before the due date of the invoice reflecting when the product
originally shipped. Customer understands that Callaway Golf will investigate claims of' short shipments. includinil� vcrifving box wet <hts recorded in
Callaway Golf S system to actual %veidhts recorded bV Carriers, re%= ic%win<g serial numhers scanned for the item(s) in questiou, and physical inventor v counts
(when applicable), among other steps. Customer acknowledges that resolution ot'such claims shall be made solely by Call ovay Golf.
q) Additional requirements apply to all customers with routing guides. Please request a copy of the tull Sales Policy trom your Sales Representative or
Customer Service.
r) This Sales Policy applies to all of Calla% %ay Goll`s products, and Callaway Golf reserves the right to change or discontinue this Sales Policy at amp time, +ith
or without reason or cause.
r
BROOKSHIRE GOLF CLUB Date Page
12120 BROOKSHIRE PKWY 12 /08/2009 2
CARMEL IN 46033
Doc.no.Transaction Date
1402084192Customer payment 09/18/2008 USD 462.00
o/a incomplete remit info CK 163510
o
G O L F
BROOKSHIRE GOLF CLUB i{ FS.I IV.�G`
CITYOF CARMEL
12120 BROOKSHIRE PKWY Date
CARMEL IN 46033 12/08/2009
Customer Account Number
15546
Fax
317 846 -9980
From
Sandra Holly
Dear Valued Customer,
On 09/18/2008, we posted an adjustment to your account that may have
resulted in a remaining balance. The documents affected are listed
below. Please update your records accordingly. If you have any
questions relating to this transaction, please contact your Credit
Representative at 1 -800- 228 -2767.
Document Amount Discount Curr. Doc.Date Remarks
914225676 1,621.40 0.00 USD 12/17/2007
914364424 231.00 0.00 USD 0111612008
914835641 846.92 0.00 USD 03/11/2008
914851254 38.20 0.00 USD 03/12/2008
914866441 31.82 0.00 USD 03/13/2008
914872823 125.96 0.00 USD 03/13/2008
914900058 4,659.49 0.00 USD 03/17/2008
914900060 1,915.02 0.00 USD 03/1712008
914917965 181.62 0.00 USD 03118/2008
914964102 51.48 0.00 USD 03/21/2008
914977706 135.15 0.00 USD 03124/2008
915037160 74.81 0100 USD 03/28/2008
915037161 290.00 0.00 USD 03/28/2008
915037163 144.75 0.00 USD 03/2812008
915063865 406.61 0.00 USD 03/31/2008
915159192 315.45 0.00 USD 04/04/2008
915159194 165.44 0.00 USD 04/04/2008
915179531 90.00 0.00 USD 04/07/2008
915314549 162.39 0.00 USD 04/17/2008
915476488 43.09 0.00 USD 04130/2008
1402082932 11,530.60 0100 USD 09/18/2008 163510
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
i9w*q Purchase Order No.
d 4��a Terms
1
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
669.7 69
X93
g d g
lqo b l ey l9t
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
IN SUM OF
ON ACCOUNT OF APPROPRIATION FOR
126:2 (<2U14-'
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
1.26 2
bill(s) is (are) true and correct and that the
1,107 dldk d V0� 775 06 materials or services itemized thereon for
d y gy 5 -p 7 s" which charge is made were ordered and
/a0'7 W 0 2 5 60 -0 received except
C o f 20
Signatu
Cost distribution ledger classification if Itle
claim paid motor vehicle highway fund