175761 08/06/2009 CITY OF CARMEL, INDIANA VENDOR: 00350404 Page 1 of 1
ONE CIVIC SQUARE KELTNER ASSOCIATES, INC
CHECK AMOUNT: $628.68
CARMEL, INDIANA 46032 520 W CARMEL DRIVE
CARMEL IN 46032 CHECK NUMBER: 175761
CHECK DATE: 8/6/2009
DEPARTM V A CCOUNT PO N INVOICE NUMBE AM OUNT DESCRIPTION
2201 4356001 52047332 628.68 UNIFORMS
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E')
is Lockbox R
P.O. Box 11588 INVOICE
Fort Wayne, IN 46859 -1588
KELTNMinC. 317 844 -0510
Ph:317- 733 -2001 Fx:317- 733 -2005 s e
Customer H
s
1442 s Carmel Street Department
L F Attn: Jim Hobbs
D Carmel Street Department T 3400 W. 131st
Attn: Jim Hobbs o Westfield IN 46074
Job T 3400 W. 131st
104922 o Westfield IN 46074 via UPS GroundTrak
FOB Factory i
i
Unit Customer po Salesperson Order date Invoice date Date shipped Invoice
0 34 C huck Ford 07/10/09 07/28/09 07/10/09 135098
Ordered Shipped Qty BO Item Description Price Per Amount
25 25 SVL3M -04 HI VIS VESTS 23.850 EA 596.25
L 15, XL 5, XXL 5
Terms Net 30 PLEASE PAY
Tax 0031201550 596.25 0.00 32.43 0 00 THIS AMOUNT 628.68
Sub -total Insurance Shpq/HdIq Sales tax Total
Any amount not paid within 30 days will be assessed a finance charge of 1.5 %per month, 18% per year. Future orders will be held if account is past due. CUSTOMER I w",O'^ C
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))
07/28/09 1035098 $628.68
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
VOUCHER NO. WARRANT NO.
ALLOWED 20
Keltner, Inc
IN SUM OF
520 W. Carmel Drive
Carmel, IN 46032
$628.68
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members
2201 1035098 43- 560.01 $628.68 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
T rsd uly 30, 2009
/1
tregt pommjss' r
trees Commissle
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund