178920 10/28/2009 CITY OF CARMEL, INDIANA VENDOR: 00351469 Page 1 of 1
ONE CIVIC SQUARE XEROX CORP CHECK AMOUNT: $519.51
CARMEL, INDIANA 46032 PO BOX 802555
CHICAGO IL 60680 -2555 CHECK NUMBER: 178920
CHECK DATE: 10/28/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
'1180 4353004 043265332 519.51 COPIER
XEROX CAPITAL 0372 THE EASY WAY NOT REQUIRED xerox�
TO ORDER SUPPLIES A"
SERVICES, L L C CALL OUR TOLL Purchase Order Number
FREE PO BOX 660502 1- 8 00
DALLAS TX Special Reference
75266 -0501 DUMOOOOOX -000
L Contract Number
Telephone888- 435 -6333 NET 30 DAYS
Please Direct Inquiries To: Terms Of Payment
Ship To /Installed At: Bill To:
L CITY OF CARMEL CITY OF CARMEL 10 -01 -09
LAW OFFICE LAW OFFICE Invoice Date
1 CIVIC SQ 1 CIVIC SQ 043265332
CARMEL IN CARMEL IN Invoice Number
46032 46032 711428953
V Customer Number
W7655P WC 7655 COP PRNTR SER.# VDR- 548166
AMOUNT
BASE CHARGE 09 -01 -09 TO 09 -30 -09
453.76
METER READ METER READ NET COPIES
METER USAGE 08 -22 -09 TO 09 -30 -09
TOTAL BLACK 118159 122019 3860
TOTAL COLOR 26027 27078 1051
METER CHARGES
TOTAL BLACK 3860
LESS PRINT ALLOWANCE 6166
V BLACK BILLABLE PRINTS 0 .006000 .00
TOTAL COLOR 1051
LESS PRINT ALLOWANCE 308
COLOR BILLABLE PRINTS 743 .089000 66.13
NET PRINT CHARGE 66.13
LESS SERVICE CREDITS 25 a .015000 .38CR
ADVANCED FINISHER SER.# ADVFNSHR INCL
SER.# CBO- 999999 INCL
PR /COPY /SCAN CNTRL SER.# SCANCTRL INCL
SUB T O T A L _,w_ 51 9.51
C INDIANA RETAIL TAX EXEMPT PAGE
1 y ®f C CERTIFICATE NO. 003120155 002 0
PURCHASE ORDER NUMBER
j.j Z FEDERAL EXCISE TAX EXEMPT km 35- 60000972 J
ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES, A/P
CARMEL INDIANA 46)032 -2584 VOUCHER, DELIVERY MEMO, PACKING SLIPS,
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL 1997 SHIPPING LABELS AND ANY CORRESPONDENCE.
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
r
VENDOR �f� SHIP
TO
t�
CONFIRMATION BLANKET CONTRACT PAYMENTTERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
31V V 09
Co t Q pis
N"
Send Invoice To: d
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
t' 'C,� —'.5 34r� 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
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. '.*TM•;�f'
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE t..�.<4..+�t „t✓•1 f:..• p
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. f
2 CLERK TREASURER
DOCUMENT CONTROL NO. A.P. COPY SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER NO WARRANT NO.---_._...._._.....-
ALLOWED 20
IN THE SUM OF
O ACCOUNT OF APPR RIATION FOR
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
S materials or services itemized thereon for
which charge is made were ordered and
received except
20 0 C l
M
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund