171771 04/29/2009 F CITY OF CARMEL, INDIANA VENDOR: 361638 Page 1 of 1
ONE CIVIC SQUARE CARBONE'S CUSTOM FIREARMS
CHECK AMOUNT: $5,159.00
s o CARMEL, INDIANA 46032 6810 FRONT STREET
KEY WEST FL 33040 CHECK NUMBER: 171771
CHECK DATE: 4/29/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESC RIPTION
1110 R4467003 16719 492 5,159.00 REFLES ACCESSORIES
Invoice
f
CARBONE'S CUSTOM FIREARMS
6810 FRONT ST
KEY WEST, FL 33040
ROCK RIVER ARMS LEIINT'L FACTORY REP
Phone: 305 923 -5455
FAX 305 292 -5452 Invoice No:
Email: me@ TOMEGLOCK @EARTHLINK.NET 492
Date
Tax Registration 54- 8012969408 -2 4/20/2009
Ship To: Bill To: Terms Net 15
CITY OF CARMEL POLICE DEPARTMEN' .,Due Date: 5/512009
ATTN: TERESA ANDERSON Order No:
3 CIVIC,SQUARE Territory: INTERNATIONAL
CARMEL, IN 46032 Salesperson. TOM CARBONE
FOB Ship Date Ship,Via Tracking No
4/20/2009
Code Description Qty/Hours Rate Amount
PO# 16719 1.00 $5,159.00 $5,159.00"
Indicates non taxable item
R iSubtotal $5,159.00
Tax (7.50 %0) $0.00
Shipping $0.00
Total $5,159.00
Deposit $0.00
Balance Due $5 159.
Page S of 1
Ci A INDIANA RETAIL TAX EXEMPT PAGE
CERTIFICATE NO. 003120155 002 0 o f
f 11 PURCHASE ORDER NUMBER
ty Police 'Degartment FEDERAL EXCISE TAX EXEMPT
35- 60000972 t+
3 O'NE=aCIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES, A!P
CARMEL INDIAINA'46032 -2584 VOUCHER, DELIVERY MEMO, PACKING SLIPS,
t 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
J11ne 19 7 nR -eif1pq and arrog onri as
i
VENDOR Carbone's Custom Firearms SHIP City of Carmel Police Department
6810"Front Street TO 3 Civic Square
Key West FL 33040 Carmel, IN 46032
ATTN: Lt. Dwight Frost
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
k
6 AR1224 FET OUT 725.00 4,350.00
6 COC33B Elite Survival 33" M4 Case 76.00 456.00
12 AR0116LE30RD Mag 16.00 192.00
6 shipping handling 171.00
t
Jilt
Send Invoice To: City of Carmel Po r>:�
ATTN: Teresa Andersa f j
3 Civic Square
Carmel, IN 46032
PLEASE INVOICE IN DUPLICATE 5,169
DEPARTMENT ACCOUNT PROJECT/ PROJECT ACCOUNT AMOUNT
1110 490 firearms PAYMENT
1
J,D A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
7 D
Q3 r NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
f VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
SHIP REPAID.
THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
C.O.D. SHIPMENTS CANNOT BE ACCEPTED.
PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY
SHIPPING LABELS.
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE Cbbef of Police
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
CLERK- TREASURER
DOCUMENT CONTROL NO.1 6 7 1 9A.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 #MTLE 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 ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
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
Carbone`s Custom Firearms Purchase Order No. 16719RF
6810 Front Street Terms
Key West, FL 33040 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
4120/09 492 payment for riflesand accessories 5,159.00
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
C arhone's Custom Firearms IN SUM OF
6810 Front Street
Key West, FL 33040
5,159.00
ON ACCOUNT OF APPROPRIATION FOR
p olic e g
Board Members
PO# or INVOICE NO. ACCT /TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
1671 9R 492 670 -03 5,159.00 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
April 24 2009
Signature
Chief of Police
Cost distribution ledger classification if
Title
claim paid motor vehicle highway fund