208704 05/10/2012 CITY OF CARMEL, INDIANA VENDOR: 355622 Page 1 of 1
ONE CIVIC SQUARE GOPHER
CARMEL, INDIANA 46032 NW5634 CHECK AMOUNT: $75.99
PO BOX 1450 CHECK NUMBER: 208704
MINNEAPOLIS MN 55485 -5634
CHECK DATE: 5/10/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4239039 8471816 75.99 GENERAL PROGRAM SUPPL
Page 1 of 1
Invoice
Phone: 1- 800 533 -0446 Fax: 1- 800 -45LAP Thank you for choosing Gopher
Online: www.00phersoort.com �D Please Remit To:
NW 5634
4 2012 PO Box 1450
Minneapolis MN 55485
Invoice Number: 8471816 Customer Number: 4050363
Invoice Date: 23- APR -12 I Order Date: 02- APR -12
Customer PO number: MC002668A Order Number: 3284647
Payment Method: Net 30 Date Shipped: 20- APR -12
Billing Address: Carmel Clay Park Recreation Shipping Address: Carmel Clay Park Recreation
1235 Central Park Dr E 1235 Central Park Dr E
Carmel IN 46032 Carmel IN 46032
i United States United States
Contact: Koepper, Dawn Contact: Koepper, Dawn
ITEM ITEM DESCRIPTION QTY QTY QTY UNIT PRICE EXTENDED
NUMBER ORDERED SHIPPED i BACK: PRICE I
p
ORDERED
67 -017 AssessPro Rep- Addition Push Up 1 1 $64.95 $64.95
Tester
Sub Total:$64 95
Tax Total $0.00
Shipping, Handling Processing $11.04
Invoice Total: $75.9
Payments Credits: $0.00
Balance Due: $75.99
Purchase
Description Ad ftriu p ll�
P.O. L) OC ELOS P or F
G.L.
i i
Line De.cr ftubd ���G1oly) n A(!5
Purchaser Date
Approval Date
P�vo�ke
Terms: Net Due in 30 days
A late payment charge of 1% per month (18% annum) may be assessed on invoices not paid within terms.
t Customer is liable for collection costs, reasonable attorney fees and court costs if the account is placed for collection.
Unconditional 100% Satisfaction Guarantee
\1 0 un a/ �cF If you are not satisfied with any Gopher® purchase for any reason at any time, contact us and we will replace
`�c�A�a�teei= the product, credit your account, or refund the purchase price.
l r No restocking fees. No hassles. No kidding.
1
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of 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.
355622 Gopher Terms
NW 5634
P.O. Box 1450
Minneapolis, MN 55485 -5634
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
4/23/12 8471816 Adaptive equipment 75.99
Total 75.99
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
Voucher No. Warrant No.
355622 Gopher Allowed 20
NW 5634
P.O. Box 1450
Minneapolis, MN 55485 -5634 In Sum of
75.99
ON ACCOUNT OF APPROPRIATION FOR
109 Monon Center
PO# or INVOICE NO. ACCT #MTLE AMOUNT Board Members
Dept
1096 -70 8471816 4239039 75.99 1 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
3 -May 2012
Signature
75.99 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund