HomeMy WebLinkAbout209210 05/22/2012 CITY OF CARMEL, INDIANA VENDOR: 366255 Page 1 of 1
0 ONE CIVIC SQUARE INDY DANCE ACADEMY
CARMEL, INDIANA 46032 9401 NORTH MERIDIAN STREET CHECK AMOUNT: $200.00
INDIANAPOLIS IN 46260 CHECK NUMBER: 209210
CHECK DATE: 5/22/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1082 4343007 6/8/12 200.00 FIELD TRIPS
Purchase
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9401 North Meridian Street yp
Indianapolis, IN 46260
www.indydanceacademy.com
Indy Dance Academy welcomes Carmel Parks Recreation for the following camp:
Success On Stage Dance Camp
Friday, June 8, 2012
10:30 -11:30 a.m.
The total amount to be paid to IDA is 200
Please remit payment to IDA, c/o MaryAnn Pahud by Friday,���Q�
Please include signed waiver attached below.
Waiver/ Release:
1 understand and acknowledge that there is a risk of injury inherent in dance activities and that personal injury or damage
to property may result during participation in dance and related activities. 1 represent that my children are physically
able to safely participate in dance and related activities. I agree to assume all risks associated with my childrens
participation in dance instruction and all related activities. In consideration, of receiving instruction at Indy Dance
Academy, I hereby waive, release and discharge all present and future claims and liabilities of any kind, whether for
bodily injury, property damage, or other loss arising out of my childrens participation in dance and related activities. Indy
Dance Academy is not responsible for a child who leaves the premises unattended. 1 also consent to photography and
recording of my children for its usage in promotional and public relations, which may include but not limited to,
brochures, print ads, and web sites. All photographs and recordings are property of Indy Dance Academy.
r I've read the above agree. Signature of responsible party:
Carmel Clay
Parks &Recreation CHECK REQUEST
Date:
Check payable to
Name: C
Address:
City, State, Zip C y
Mail check to payee Retum check to requestor
Check Amount a )r)�� Date Required
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Check needed for E l y�d T 1 0
'S U CCQ.S on +C
To be paid from 11
PO (if applicable) V1 IPN
Budget account GL '7 3Y ,300
Budget Line Description I Fr I o S
Invoice(s) and Purchase Order (if required) MUST be attached.
Requested by (print): V L Ho 1+0
Requested by (signature):
Approved by (signature of Division Manager I
on this date 4-1
Form revised 7 -7 -08 Shared Forms Business Services Check Request Form Check Request (rev 7 -7 -08)
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.
Indy Dance Academy Terms
9401 North Meridian Street
Indianapolis, IN 46260
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
6/8/12 6/8/12 Field trip Success on Stage dance camp 6/8/12 200.00
Total 200.00
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
Ch
Voucher No. Warrant No.
Indy Dance Academy Allowed 20
9401 North Meridian Street
Indianapolis, IN 46260
In Sum of
200.00
ON ACCOUNT OF APPROPRIATION FOR
108 ESE
PO# or INVOICE NO. ACCT */TITLE AMOUNT Board Members
Dept
1082 -6 6/8/12 4343007 200.00 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
17 -May 2012
Signature
200.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund