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207049 03/13/2012 CITY OF CARMEL, INDIANA VENDOR: 362355 Page 1 of 1 ONE CIVIC SQUARE G H S I; 0 CHECK AMOUNT: $6,074.00 CARMEL, INDIANA 46032 8349 N WASHINGTON STREET o� `o SHERIDAN IN 46069 CHECK NUMBER: 207049 CHECK DATE: 3/13/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1110 R4350100 25943 2012 -1262 6,074.00 LIGHTING GIIS, Inc. Women -Owned .Business Enterprise Guaranteed 8349 North Washington Street fL, Sheridan, IN 46069 Y«e ING• Bill To Invoice City of Carmel Police Department Attn: Teresa Anderson Date Invoice 3 Civic Square Carmel, IN 46032 2/22/2012 2012 -1262 P.O. No. Due Date Terms 25943 3/23/2012 Net 30 Q uantity Description Price Each Amoun 40 LED 4' lamps 61.75 2,470.00 l Additional lighting 3,164.00 3,164.00 11 Convert existing lights to LED 40.00 440.00 Thank you for your business. Total $6,074.00 Payments /Credits $0.00 A 1.5% Service Charge will be assessed on amounts over 30 days past due. Balance Due $6,074.00 INDIANA RETAIL TAX EXEMPT PAGE Ck ®f'.a C arme l CERTIFICATE NO. 003120155 002 0 PURCHASE ORDER NUMBER FEDERAL EXCISE TAX EXEMPT 35- 60000972 ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES, A/P CARMEL INDIANA 46032 -2584 VOUCHER, DELIVERY MEMO, PACKING SLIPS, FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL 1997 SHIPPING LABELS AND ANY CORRESPONDENCE. 'URCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION 9Di�f� 9 OHS, Inc.' Camel Pollco Depwimian4 VENDOR SHIP 3 CIVIC squ O North Washington Struo4 TO C IN 4 Sho rld IN 4 Q�j 0 P) 671 CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION AceouM 43 1.00 40 Each LED fl amps $69.76 $2, 9 Each install additional lighting, $x,964.00 $3,464.00 9 9 Each sonvan existing lights to LED $40.00 $44®.00 Sub Take]: $8,074.0 0 r E- Send Invoice To: Curnel Police DepmrtmG t Attn: Teresa Anderson 3 Civic 8quare Carmel, IN 4I1 PLEASE INVOICE IN DUPLICATE DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT Cumel Police Dept. 's $6,074.40 PAYMENT A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O. NUMBER IS MADE APART 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 �T TO PA ABOVE ORDER. C.O.D. SHIPMENTS CANNOT BE ACCEPTED. ORDERED BY PURCHASE ORDER NUMBER MUST APPEAR ON ALL SHIPPING LABELS. C OF Police THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE 4� i AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. CLERK TREASURER DOCUMENT CONTROL No-25943 A.P.V. COPY SIGN AND RETURN TO CLERK'S OFFICE VOUCHER NO. ALLOWED 2© IN THE SUM OF ON ACCOUNT OF APPROPRIATION FOR Board Members PO# or INVOICE tgd. 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,__ 0 Signature Title L Cost distribution ledger classification it claim paid motor vehicle highway fund VOUCHER NO. WARRANT NO. ALLOWED 20 GHS, Inc. IN SUM OF 8349 North Washington Street Sheridan, IN 46069 $6,074.00 ON ACCOUNT OF APPROPRIATION FOR Carmel Police Department PO# 1 Dept. INVOICE NO. ACCTWTITLE AMOUNT Board Members Encumbered I hereby certify that the attached invoice(s), or 25943 2012 -1262 43- 501.00 I $6,074.00 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 Friday, March 09, 2012 J 1/� Chief of Police Title Cost distribution ledger classification if 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 Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 02/22/12 2012 -1262 light bulbs convert to LED $6,074.00 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