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CITY OF CARMEL, INDIANA VENDOR: 00351469 Page 1 of 1
ONE CIVIC SQUARE XEROX CORP
��o CARMEL, INDIANA 46032 PO Box 602555 CHECK AMOUNT: $505.91
CHICAGO IL 60680 -2555 CHECK NUMBER: 175234
CHECK DATE: 7122/2009
DEPARTME ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1180 4353004 041271984 505.91 COPIER
XEROX CAPITAL 1740 THE EASY WAY
TO ORDER SUPPLIES NOT REQUIRED XefQX i
SERVICES, L L C CALL OUR TOLL Purchase Order Number
O PO BOX 660502 1- 800 8 2 zoo
DALLAS TX Special Reference
E 75266 -0501 DUMOOOOOX -000
L Contract Number
0 Telephone888 -435 -6333 NET 30 DAYS
Please Direct Inquiries To: 1w Terms Of Payment
Ship To /Installed At: Bill To:
L CITY OF CARMEL CITY OF CARMEL 07 01 09
a LAW OFFICE LAW OFFICE Invoice Date
1 CIVIC SQ 1 CIVIC SQ 041271984
,0 CARMEL IN CARMEL IN Invoice Number
V1 46032 46032 711428953
V Customer Number
W7655P WC 7655 COP PRNTR SER.# VDR- 548166
AMOUNT
BASE CHARGE JUNE
453.76
METER READ METER READ NET COPIES
METER USAGE 05 -21 -09 TO 06 -24 -09
TOTAL BLACK 106563 110968 4405
TOTAL COLOR 23435 24271 836
METER CHARGES
U TOTAL BLACK 4405
LESS PRINT ALLOWANCE 5000
BLACK BILLABLE PRINTS 0 .006000 .00
TOTAL COLOR 836
.:.�r LESS PRINT ALLOWANCE 250
COLOR BILLABLE PRINTS 586 .089000 52.15
NET PRINT CHARGE 52.15
ADVANCED FINISHER SER.# ADVFNSHR INCL
SER.# CBO- 999999 INCL
PR /COPY /SCAN CNTRL SER.# SCANCTRL INCL
SUB TOTAL 505.91
TOTAL 505.91
INVOICE FOR THE PERIODIC PAYMENT ON YOUR XEROX AGREEMENT
THIS AGREEMENT INCLUDES EQUIPMENT', MAINTENANCE AND SUPPLY -CPIARGE
TOTAL O F I NVO ICE MAY VA`RY AC CORDING TO_ METER__US`kGE TiI
XEROX FEDERAL IDENTIFICATION #16- 0468020
1i INDIANA RETAIL TAX EXEMPT PAGE
C i t y o Carmel CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT
35- 60000972
ONE CIVIC SOI.IARE THIS NUMBER MUST APPEAR ON INVOICES, A/P
CARMEL INDIANA 46032 -2554 VOUCHER, DELIVERY MEMO, PACKING SLIPS,
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
t"1 /eg
SHIP
VENDOR
TO
CONFIRMATION BLANKET CONTRACT I PAYMENT TERMS FREIGHT
QUANTITY UNIT O F MEASURE DESCRIPTION UNIT PRICE EXTENSION
g
aW s
ap
Send Invoice To: F_
J
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
`�L`7 JQc PAYMENT 5'
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.
y
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE f .Pf� .l"
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
1 1)A CLERK TREASURER
DOCUMENT CONTROL NO. COPY SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER NO. WARRANT NO.
ALLOWED 20
r
IN THE SUM OF
go.�y'S
F
ON ACCOUNT OF APPROPRIA ON FOR
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
1-hereby certify that the attached invoice(s), or
p.
bill(s) is (are) true and correct and that the
05, f materials or services itemized thereon for
which charge is made were ordered and
received except-----
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Title
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Cost distribution ledger classification if
claim paid motor vehicle highway fund