174557 07/08/2009 CITY OF CARMEL, INDIANA VENDOR: 343004 Page 1 of 1
ONE CIVIC SQUARE XEROX CORP CHECK AMOUNT: $499.13
CARMEL, INDIANA 46032 PO BOX 827598
PHILADELPHIA PA 19182 -7598 CHECK NUMBER: 174557
hon co
CHECK DATE: 7/8/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4230200 21019 106818826 499.13 BUSINESS CARD STOCK
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305569055 106818826 06/20/09 xerox
C' XEROX CAPITAL p p 3 t Customer No. Invoice No. Invoice Date
SERVICES, LLC 21019 06/05/09
PO BOX 660502 Purchase Order No. Date GSA Contract No,
DALLAS, TX A183740 06/18/09
Xerox Order No. Date Processed Registration No. O
75266 R
4 z. 0 Telephone 888 435 -6333 NET 30 DAYS 1
Direct Billing Inquiries To: Special Reference No. Tax Terms of Sale G
I
Ship To Bill To N
a CARMEL POLICE DEPT CARMEL POLICE DEPT DL505599 A
3 CIVIC SQUARE Master Order No. t
TIM ZELLLERS CARMEL IN
,Q 3 CIVIC SQUARE 46032 -7570 Bill Code
v1 CARMEL IN
V 46032 --0000
CALLER:TIM ZELLERS 317- 571 -2562
R
E
M
4
R
K
S Quantity Quantity
Reorder No. Description Ordered Shipped Unit Price Amount
AGREEMENT GRJ10
003R12321 PREMIUM BUSINESS CARD 20 19 26.27 499.13
INVOICE TOTAL $499.13
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INDIANA RETAIL TAX EXEMPT PAGE C i t y of C 1�,.•lt rme l CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
Police Department FEDERAL EXCISE TAX EXEMPT
35- 60000972 1
3 NaCIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES, A(P
CARMEL INDIANA 46032 -2584 VOUCHER, DELIVERY MEMO, PACKING SLIPS,
SHIPPING LABELS AND ANY CORRESPONDENCE.
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL 1997
PURCHASE GIRDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
June 9, 2009 business cards stock
VENDOR Xerox SHIP City of Carmel Police Department
TO 3 Civic Square
Carml, IN 46032
ATTN: Jet. Tim Zellers
CONFIRMATION BLANKET I CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
20 boxes business card card stock 26°27 525°44
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4
VA
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c�99.13
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Send Invoice To:
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECTACCOUNT AMOUNT
1110 _3P,4 office supplies
PAYMENT
1� A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
r E 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
THIS APPROPRIATIOWSUFFICIENT TO PAY FOR THE ABOVE ORDER.
SHIP REPAID. op
C.O.D. SHIPMENTS CANNOT BE ACCEPTED. ORDERED BY
PURCHASE ORDER NUMBER MUST APPEAR ON ALL
SHIPPING LABELS. „ff/
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE ALs t'' nt Chief Of Police
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
,j,' CLERK- TREASURER
DOCUMENT CONTROL NO. A• COPY SIGN AND RETURN TO CLERKS OFFICE
VOUCHER NO. WARRANT
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
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
Xerox Corporation Purchase Order No. 21019F
P.O. Box 827598 Terms
Philadelphia, PA 19182 -7598 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
6/20/09 106818826 a ent for business card stock 499.1,E
Total
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
Xerox Corporation IN SUM OF
P.O. Box 827598
Philadelphia, PA 19182 -7598
492.13
ON ACCOUNT OF APPROPRIATION FOR
police general fund
Board Members
Po# or INVOICE NO. ACCT /TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
21019F 106818826 302 499.13 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
June 29 20 09
&44,d -b.
Signature
Chief of Police
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund