179276 11/11/2009 CITY OF CARMEL, INDIANA VENDOR: 355394 Page 1 of 1
ONE CIVIC SQUARE K A M HYDRAULICS INC
CARMEL, INDIANA 46032 2160 FLETCHER AVE CHECK AMOUNT: $1,186.67
INDIANAPOLIS IN 46203
�o �o CHECK NUMBER: 179276
CHECK DATE: 11/11/2009
DOPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMO UNT DESCRIPTION
1110 4467099 21230 34938 1,186.67 LIFT
c- iCAN HYDRAULICS, INC. Invoice
2160 FLETCHER AVENUE
INDIANAPOLIS, 46203 DATE INVOICE
317 632- 8130HFAX 317 632 -8132 10/30/2009 34938
BILL TO SHIP TO
CITY OF CARMEL POLICE DEPT. CARMEL CITY POLICE
ATTN: TERESA ANDERSON 3400 W. 131 ST. ST.
3 CIVIC SQUARE CARMEL,IN 46074
CARMEL IN 46032 JASON OGLE 733 -4600
FAX #571 -2512
PURCHASE OR... TERMS DUE DATE REP SHIP DATE SHIP VIA PROJECT
21230 NET 10 DAYS 11/9/2009 DMB 10/30/2009 DELIVERY JASON
QTY ITEM DESCRIPTION RATE AMOUNT
1 FOR 1000MCL MOTORCYCLE LIFT 1000 LBS CAPACITY W 12" 1,186.67 1,186.67
SIDE EXTENSIONS AND FULLY ADJ WHEEL VISE
AIR OPERATED
DMB THANK YOU DAVE BLANKENSHIP CELL 946 -6540 0.00 0.00
IT'S BEEN A PLEASURE WORKING WITH YOU, PLEASE CALL DAVE AT
800 359 -6514 Total $1.186.67
C 0 INDIANA RETAIL TAX EXEMPT PAGE
ity o Carmel CERTIFICATE NO. 003120155 002 0 1A PURCHASE ORDER NUMBER
Police Department FEDERAL EXCISE TAX EXEMPT 21230
35- 60000972
3.0-ft CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES, A/P
CARMEL INDIANA 46032 -2584. VOUCHER, DELIVERY MEMO, PACKING SLOPS,
SHIPPING LABELS AND ANY CORRESPONDENCE.
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL 1997
PURCHASE ORDER DATE DATE REQUIRED R 1 1EQUISITION N0. VENDOR NO. DESCRIPTION
October 14. 20C9 lift
VENDOR KAM Hydraulics, Inc. SHIP City of Carmel Maintenance Facility
2160 Fletcher Avenue TO 3400 W. 131st Street
Indianapolis, IN 46203 Westfield, IN 46074
ATTN: Dave Blankenship ATTN: Jason Ogle
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
1 Motorcycle lift 1000 lbs capacity W 12" side 1,186.67
extensions and fully adj wheel vise air operated
7
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Send Invoice To:
City of Carmel Po p
lice: petic
ATTN: Teresa Anderso`w�" p�I
3 Civic Square
Carmel, IN 46032
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT I PROJECT I PROJECT ACCOUNT AMOUNT
1110 670 -99 other m4sipment 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
I VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
SHIP REPAID.
r 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 Chief of Police
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
2 q CLERK- TREASURER
DOCUMENT CONTROL NO A.P. COPY SIGN AND RETURN 7'O CLERK'S OFFICE
VO�JCHER NO. WARRANT 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 w,
received except
i
Si nature
N'
Title
Cost distribution ledger classification if �t
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
KAM Hydraulics, Inc. Purchase Order No. 2123OF
2160 Flethcer Avenue Terms
Indianapolis, IN 46203 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
10/30/09 349381; payment for motorcycle lift 1.186.67
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.
r
F
ALLOWED 20
K AM�Hydraulics, Inc. IN SUM OF
2160 Fletcher Avenue
Indianapolis, IN 46203
1,186.67
ON ACCOUNT OF APPROPRIATION FOR
po general fund
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
2123OF 34938 670 99 1,186.67 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
November 6 20 09
AA41M ar4-
Signature
Chief of Police
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund