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209686 06/05/2012 CITY OF CARMEL, INDIANA VENDOR: 360690 Page 1 of 1 ONE CIVIC SQUARE JOHN THOMAS 0 CARMEL, INDIANA 46032 11576 CREEKSIDE LANE CHECK AMOUNT: $171.00 CARMEL IN 46033 CHECK NUMBER: 209686 CHECK DATE: 615/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 211 4462838 171.00 STORM WATER PHASE II art Save money. Live better. 317 844 0096 MANAGER LINDSEY MACLEAN 2001 E 161ST ST CARMEL IN 46033 ST# 1601 OP# 00004696 TE# 97 TR# 06547 M SHOES 005624816868 24.00 0 REPEL MAX AE 001142300338 3.88 0 25FT LVRLOCK 007617430826 8.88 0 W SHOES 069573523064 18.00 0 M SHOES T- 085671800052 46.97 0 TMOBILE 10' 079936661964 9.92 0 E -911 FEE 060538898856 0,25 0 TMOBILE 10 079936661964 9.92 0 E -911 FEE 060538898855 0.25 0 SUBTOTAL 122.07 TOTAL 122.07 u TEND 122.07 ACCOUNT S APPROVAL 034930 REF 215000409711 TRANS ID 0162150590899257 VALIDATION G25G PAYMENT SERVICE E TERMINAL MX005792 05/29/12 12:24:50 CHANGE DUE 0.00 ITEMS SOLD 9 TC# 5236 9586 6541 5923 3259 4 II I II I I I I II I I I II l i IIII I I I III III II II IIII III New, Place your order at Walmart.com and Pay with cash at your store. 05/29/12 12:24:52 *CUSTOMER COPY Neville, Katie From: Fernandez, Rachel Sent: Thursday, May 17, 2012 7:58 AM To: Neville, Katie Subject: FW: FreshWaterSystems.com Receipt Hi Katie, Here is the receipt for an order I placed for supplies using John's credit card. He asked me to give you a copy for reimbursement. I can give you hard copies for these types of purchases if you prefer. Thanks, Rachel From: Orders ma i Ito: ordem Wreshwatersystems.corn Sent: Thursday, May 17, 2012 7:50 AM To: Fernandez, Rachel Subject: FreshWaterSystems.com Receipt FreshWaterSystems.com Receipt PLEASE. PRINT RECEIPT OUT AND RETAIN IT FOR FUTURE REFERENCE Order Number: 337876 Check Order Status Entail: rfernandez�carmel.in.Qov (337876) Date: 5/17/2012 7:50:04 AM Account Billing Address Shipping Address Name: Rachel Fernandez Rachel Fernandez Company: City of Carmel City of Carmel Address: One Civic Square 1 CIVIC SQ Address: Engineering Carmel, IN 46032 CARMEL, IN 46032 -2584 Phone: 317 -571 -2459 317 -571 -2459 Product Qty Each Sub Total Pool Check R Phosphate (50 /bottle) 2 $11.99 $23.98 Part 481349 .30 Estimated Weight: .60 lbs. Subtotal: $23.98 Tax: $0.00 US Mail Shipping: $4.95 Total: $28.93 Paid by i We use recycled packaging! Thank you for choosing FreshVVaterSystemsxom! Return Policy: prior authorization required for returns and freight must be prepaid. Returns must be received within 30 days of original invoice date. Returns must be unused and in the original packaging with all documentation. Orders that received free shipping are subject to a $9.95 fee or the actual shipping charge whichever is greater. Shipping, Handling and Installation charges are not refundable. Returned Goods may be subject to a I5 -25% restocking fee. Zip =N, Addr —N: -1.00 _U4F4_ 2 T— MOBILE 9536 14641 -13 US -31 Register #6 CARMEL, IN 46032 -1020 Trans #4116 (317)575 -8184 05 -22 -2012 11:53:01 Fax: (317)575 -8284 John Thomas Mobile 3173323520 Sales Rep: 4440454 Quantity Unit SKU Description Price Extension (Reflects Any Discounts) 1 EACH 000000610214628367 $3.34 LOOSE ACTIVATION KIT 10.00 10.00 E V1011 Serial 56497695 Not Discount Eligible 1 EACH ZZZ260R034 SIM PLUG 128K T— MOBILE UICC 0.00 0.00 T w/ GBA Serial# 8901260543542955831F Pre —paid Activation Not Discount Eligible SALE AMOUNT 10.00 TAX 0.00@ 0% 0.00 TOTAL 10.00 —10.00 Reference 898297691 It's your phone, make it your own with T— Mobile accessories! Shop for cases, chargers, headsets, memory and more at your T— Mobile store, or visit us online at www.T— Mobile.com Service availability and usage limits vary see your plan for details. Partial minutes rounded up, and data usage rounded up to nearest KB. Data roaming not available for prepaid plans. No cash value; no refunds. Not liable if lost/stolen. Service use is your agreement to T— Mobile's Terms and Conditions. Plan features apply to service on T— Mobile's Network in the U.S. For international add —on features, calls must originate on T— Mobile's Network in the U.S and text messages must originate in U.S. International roaming rates apply. For Intl Talk Text add —on feature, international calling is unlimited to landlines in select countries if added to an unlimited domestic calling plan, but decrements minutes if added to a limited minute plan (domestic overage rates apply); text messaging applies to mobile phones only other types of international messages (e.g., picture messages) are charged per message. See www.T— Mobile.com for lists of countries. T— MOBILE 9536 14641 -13 US -31 Register #6 CARMEL, IN 46032 -1020 Trans #4116 (317)575 -8184 05 -22 -2012 11:53:01 Fax: (317)575 -8284 John Thomas Mobile 3173323520 Sales Rep: 4440454 e If I haven't signed up for a specific data plan, I will be charged for all data used on a per MB basis(rounded up to the nearest MB) unless I opt out of data service. If I have the 200MB Data (web) Plan, I will be charged 10¢ per MB for overage. Data plans may also have throughput and other limits, including Rate Plan Allotments. Domestic Off Network data Allotments are: (1) 5MB if my data plan has 1MB to 199MB of full speed data; (2) LOMB if my data plan has 200MB to 1.99GB of full speed data; (3) 50 MB if my data plan has 2GB to 4.99GB of full speed data; (4) 100MB if my data plan has 5GB to 9.99GB of full speed data; (5) 200MB if my data plan has I OGB of data and above; or (6) l OMB if I use Mobile Web Pay Per Use. Return Policy: Device Refunds or Exchanges. Devices Purchased with Annual Service: To receive a refund or exchange a Device purchased with an annual service agreement, you must return or exchange the Device within 14 days of the original purchase date (30 days in CA). You may return a Device without cancelling your service activation or upgrade contract extension. Devices Purchased without Annual Service: To receive a refund or exchange a Device purchased without an annual service agreement, you must return or exchange the Device within 30 days of the original purchase date. Requirements for All Device Refunds and Exchanges: You must return your Device in its package with all original contents, undamaged and in good working condition, and you must provide the original receipt. You must return all Devices to the Sales Channel through which you received the Device. All Devices received as part of a promotional offer (e.g. "Buy One Get One" etc.) must be returned for a refund or exchange. Limited Edition and other Devices may not be refunded or exchanged. You may also be required to pay a restocking fee as follows: The restocking fee shall be $75 for advanced, data focused devices that are designed for web browsing (e.g. tablets, netbooks); the restocking fee shall be $50 for "smart phone" devices, which are high end phones that are designed for web and social media use in addition to standard phone features such as voice and text messaging (e.g. myTouch devices, Samsung Vibrant/Galaxy devices); and for all other devices, the restocking fee shall be $25 (e.g. basic phone devices, data sticks). Accessories. To receive a refund of any accessories purchased, you must return the accessories within 30 days of purchase with your original sales receipt to the Sales Channel through which you purchased the accessories. (i.e., retail store, web, telesales, etc.) Prepaid airtime and e— coupons are non refundable. As cardholder of the card used in this transaction and referenced below, I acknowledge receipt of goods and/or services in the amount of the total shown on this receipt and agree to the obligations set forth above and in my agreement with the card issuer. 0jstomer Receipt Page 1 of 2 T- MOBILE Monthly 4G /No Annual Contract SERVICE CONFIRMATION Welcome to T- Mobile® You will receive a text message within 24 hours to confirm that your new T- Mobile No Annual Contract account has been fully activated. Make sure your phone battery is charged so you can begin talking as soon as you receive your new number. About your plan You have been activated on Pay As You Go plan. On this plan, you get great wireless value with: Per minute rates vary Text messaging $0.10 to send and receive Picture Messaging at $0.25 to send and receive Refill Minutes Availability Amount $10 30 90 days $30 160 90 days $50 400 96 days $100 1000" 1 year "$100 refill includes Gold Rewards 15% bonus minutes. Your new phone number is 3173323520 You have an account balance of $3.34 By using prepaid service, or if you fail to activate service within 30 days from purchase, you accept T- Mobile's Terms and Conditions, available at T- Mobile.com or www.T- mobile.com /pr for Puerto Rico customers. Refilling is easy Refill regularly for continuous service. For monthly plans, ensure continuous service by refilling before the end of the month. Refill in four easy ways: Via Web Sign up for convenient automatic refill payments on my.t- mobile.com Via Text fastest way to refill; see my.t- mobile.com for details Via Phone call *233 (*ADD) or use My Account In Store buy refills at more than 120,000 convenient locations nationwide. Refills are available for $10, $30, $50, and $100. Take control of your account Manage your Prepaid plan and track your balance and service availability through any of the following ways: Online —log into my.T- mobile.com( www.T- Mobile.com /pr for Puerto Rico customers) t- zones* select t -zones on your phone menu and choose My Account Dial #BAL# and hit send to check your remaining balance Dial #WEB# and hit send to check your data usage and remaining balance Dial *TOGO *8646) from your T- Mobile Prepaid phone to refill your account t -zones service not available on all handsets Using your Voicemail The best way to set up Voicemail (VM) the first time is from your phone. https:/ /ppy.t- mobile.comfWelcomeMsgE.j sp 5/22/2012 Customer Receipt Page 2 of 2 To access VM, press and hold the (1) key if this doesn't work or the phone is not capable of this function, call 1- 805 MESSAGE (1- 805 637 7243). The VM system will prompt you to enter a password, which will be the last four digits of your mobile number. After you are in the VM box, follow the tutorial to set up your VM and change your password to any four- to seven -digit code. Other great features of your T- Mobile Monthly4G /No Annual Contract plan Nationwide long distance (including to Alaska Hawaii) National voice and text roaming (not including data) on the T- Mobile USA network (See www.T- Mobile.com or www.T- Mobile.com /pr for Puerto Rico customers for personal coverage check.) Text, video, picture, and instant messaging availability on select handsets International Long Distance to over 150 countries at great rates (See www.T- Mobile.com or www.T- Mobile.com /pr for Puerto Rico customers for details and international calling charges.) International Roaming in Mexico and Canada at low rates (See www.T- Mobile.com or www.T- Mobile.com/pr for Puerto Rico customers for details and roaming rates.) t -zones gives you access to My Account, and the ability to download MegaTones games, and more (See www.T- Mobile.com or www.T- Mobile.com /pr for Puerto Rico customers for details and download charges; not available on all handsets) VoiceMail, Caller ID, Call Waiting, and 3 -Way Calling Visit www.T- Mobile.com or www.T- Mobile.com /pr for Puerto Rico customers, or refer to your Prepaid services brochure for other useful tips. You can also dial 877 -778- 2106 to reach T- Mobile Customer Care if you have additional questions. Initial balance and refill purchases are non refundable. A full refund is limited to the purchase price of the phone, less the cost of any used minutes and service. You must provide valid proof of purchase for a refund. Ask a representative for complete details on our refund policy. `Capable device required to achieve 4G speeds. T- M obi le's HSPA 4G network not available everywhere. See www.T- mobile.com or www.T- mobile.com /pr for coverage details. Limited -time offer; subject to change. Taxes and fees additional. Plans provide domestic use only; separate charges apply for international use. Not all features or plans available on all devices. Pay As You Go: Service available for 90 days (one year for Gold Rewards) after activation /refill. After that, your account will be suspended and no service will be available. Gold Rewards requires activation of $100 in refills; you must refill while on Pay As You Go plan to obtain full Gold Rewards benefits. Plan Changes and Renewals: If you switch between plans, features or credits associated with your prior plan will no longer be available. If you renew a monthly plan, unused services under your prior months' plan will no longer be available. Prepaid General Terms: Sufficient balance required to use service. Calls rated on a per minute basis; partial minutes rounded up for billing. If you transfer your number to another carrier, your account will be deactivated and no service will be available. No cash redemption value. Non refundable. Not responsible if lost or stolen. If you purchase a Device that is sold for use on T- Mobile Prepaid Service, you agree that you intend it to be activated on our Service, and do not intend to, and will not, resell, modify and /or export the Devices, or assist someone in these activities. Messaging: You will be charged for all data sent by or to you through the network, regardless of whether received. Character length /file size of messages /attachments may be limited. T- Mobile not liable for content of messages /attachments or for any failures, delays or errors in any T- Mobile- generated alerts or notifications. Coverage: Service is not available everywhere; see a Coverage Map, available at T- Mobile.com, for details. Abnormal Usage: Service may be limited or terminated for misuse, abnormal usage, or significant roaming. By using service, you accept T- Mobile's Terms and Conditions (including arbitration provision). See brochures, and Terms and Conditions at www.T- Mobile.com (T- Mobile.com /pr for Puerto Rico customers), for additional information. T- Mobile, t- zones, and the magenta color are registered trademarks of Deutsche Telekom AG. MegaTones is a registered trademark of T- Mobile USA, Inc. https:// ppy .t- mobile.com/WelcomeMsgE.jsp 5/22/2012 I MOBILE 9536 14641 -13 US -31 Register #6 CARMEL, IN 46032- 1020 n n Trans #4117 (317)575 -8184 �J U 05 -22 -2012 11:55:28 Fax: (317)575 -8284 John Thomas obile 3173323080 Sales Rep: 4440454 Quantity Unit SKU• Description Price Extension (Reflects Any Discounts) 1 EACH 000000610214628367 $3.34 LOOSE ACTIVATION KIT 10.00 10.00 E V1011 Serial 56497694 Not Discount Eligible 1 EACH ZZZ260R034 SIM PLUG 128K T— MOBILE UICC 0.00 0.00 T w/ GBA Serial 8901260542555793279F Pre —paid Activation Not Discount Eligible SALE AMOUNT 10.00 TAX 0.00@ 0% 0.00 TOTAL 10.00 —10.00 Reference 8982982 1 It's your phone, make it your own with T— Mobile accessories! Shop for cases, chargers, headsets, memory and more at your T— Mobile store, or visit us online at www.T— Mobile.com Service availability and usage limits vary see your plan for details. Partial minutes rounded up, and data usage rounded up to nearest KB. Data roaming not available for prepaid plans. No cash value; no refunds. Not liable if lost/stolen. Service use is your agreement to T— Mobile's Terms and Conditions. Plan features apply to service on T— Mobile's Network in the U.S. For international add —on features, calls must originate on T— Mobile's Network in the U.S and text messages must originate in U.S. International roaming rates apply. For Intl Talk Text add —on feature, international calling is unlimited to landlines in select countries if added to an unlimited domestic calling plan, but decrements minutes if added to a limited minute plan (domestic overage rates apply); text messaging applies to mobile phones only other types of international messages (e.g., picture messages) are charged per message. See www.T— Mobile.com for lists of countries. T— MOBILE 9536 14641 -13 US -31 Register #6 CARMEL, IN 46032 -1020 Trans #4117 (317)575 -8184 05 -22 -2012 11:55:28 Fax: (317)575 -8284 John Thomas Mobile 3173323080 Sales Rep: 4440454 If I haven't signed up for a specific data plan, I will be charged for all data used on a per MB basis(rounded up to the nearest MB) unless I opt out of data service. If I have the 200MB Data (web) Plan, I will be charged 10¢ per MB for overage. Data plans may also have throughput and other limits, including Rate Plan Allotments. Domestic Off Network data Allotments are: (1) 5MB if my data plan has 1MB to 199MB of full speed data; (2) l OMB if my data plan has 200MB to 1.99GB of full speed data; (3) 50 MB if my data plan has 2GB to 4.99GB of full speed data; (4) 100MB if my data plan has 5GB to 9.99GB of full speed data; (5) 200MB if my data plan has l OGB of data and above; or (6) l OMB if I use Mobile Web Pay Per Use. Return Policy: Device Refunds or Exchanges. Devices Purchased with Annual Service: To receive a refund or exchange a Device purchased with an annual service agreement, you must return or exchange the Device within 14 days of the original purchase date (30 days in CA). You may return a Device without cancelling your service activation or upgrade contract extension. Devices Purchased without Annual Service: To receive a refund or exchange a Device purchased without an annual service agreement, you must return or exchange the Device within 30 days of the original purchase date. Requirements for All Device Refunds and Exchanges: You must return your Device in its package with all original contents, undamaged and in good working condition, and you must provide the original receipt. You must return all Devices to the Sales Channel through which you received the Device. All Devices received as part of a promotional offer (e.g. "Buy One Get One" etc.) must be returned for a refund or exchange. Limited Edition and other Devices may not be refunded or exchanged. You may also be required to pay a restocking fee as follows: The restocking fee shall be $75 for advanced, data focused devices that are designed for web browsing (e.g. tablets, netbooks); the restocking fee shall be $50 for "smart phone" devices, which are high end phones that are designed for web and social media use in addition to standard phone features such as voice and text messaging (e.g. myTouch devices, Samsung Vibrant/Galaxy devices); and for all other devices, the restocking fee shall be $25 (e.g. basic phone devices, data sticks). Accessories. To receive a refund of any accessories purchased, you must return the accessories within 30 days of purchase with your original sales receipt to the Sales Channel through which you purchased the accessories. (i.e., retail store, web, telesales, etc.) Prepaid airtime and e— coupons are non refundable. As cardholder of the card used in this transaction and referenced below, I acknowledge receipt of goods and/or services in the amount of the total shown on this receipt and agree to the obligations set forth above and in my agreement with the card issuer. Customer Receipt Page 1 of 2 T- MOBILE Monthly 4G /No Annual Contract SERVICE CONFIRMATION Welcome to T- MobileO You will receive a text message within 24 hours to confirm that your new T- Mobile No Annual Contract account has been fully activated. Make sure your phone battery is charged so you can begin talking as soon as you receive your new number. About your plan You have been activated on Pay As You Go plan. On this plan, you get great wireless value with: Per minute rates vary Text messaging $0.10 to send and receive Picture Messaging at $0.25 to send and receive Refill Minutes Availability Amount $10 F 90 days $30 160 90 days $50 400 90 days $100 1000* 1 year *$100 refill includes Gold Rewards 15% bonus minutes. Your new phone number is 3173323080 You have an account balance of $3.34 By using prepaid service, or if you fail to activate service within 30 days from purchase, you accept T- Mobile's Terms and Conditions, available at T- Mobile.com or www.T- mobile.com /pr for Puerto Rico customers. Refilling is easy Refill regularly for continuous service. For monthly plans, ensure continuous service by refilling before the end of the month. Refill in four easy ways: Via Web Sign up for convenient automatic refill payments on my.t- mobile.com Via Text fastest way to refill; see my.t- mobile.com for details Via Phone call *233 *ADD) or use My Account In Store buy refills at more than 120,000 convenient locations nationwide. Refills are available for $10, $30, $50, and $100. Take control of your account Manage your Prepaid plan and track your balance and service availability through any of the following ways: Online —log into my.T- mobile.com(www.T- Mobile.com /pr for Puerto Rico customers) t- zones* select t -zones on your phone menu and choose My Account Dial #BAL# and hit send to check your remaining balance Dial #WEB# and hit send to check your data usage and remaining balance Dial *TOGO *8646) from your T- Mobile Prepaid phone to refill your account t -zones service not available on all handsets Using your Voicemail The best way to set up Voicemail (VM) the first time is from your phone. https:// ppy .t- mobile.com/WelcomeMsgE.jsp 5/22/2012 �►1 Customer Receipt Page 2 of 2 To access VM, press and hold the (1) key If this doesn't work or the phone Is not capable of this function, call 1- 805 MESSAGE (1- 805 637 7243). The VM system will prompt you to enter a password, which will be the last four digits of your mobile number. After you are in the VM box, follow the tutorial to set up your VM and change your password to any four- to seven -digit code. Other great features of your T- Mobile Monthly4G /No Annual Contract plan Nationwide long distance (including to Alaska Hawaii) National voice and text roaming (not including data) on the T- Mobile USA network (See www.T- Mobile.com or www.T- Mobile.com /pr for Puerto Rico customers for personal coverage check.) Text, video, picture, and instant messaging availability on select handsets International Long Distance to over 150 countries at great rates (See www.T- Mobile.com or www.T- Mobile.com /pr for Puerto Rico customers for details and international calling charges.) International Roaming in Mexico and Canada at low rates (See www.T- Mobile.com or www.T- Mobile.com/pr for Puerto Rico customers for details and roaming rates.) t -zones gives you access to My Account, and the ability to download MegaTones games, and more (See www.T- Mobile.com or www.T- Mobile.com /pr for Puerto Rico customers for details and download charges; not available on all handsets) VoiceMail, Caller ID, Call Waiting, and 3 -Way Calling Visit www.T- Mobile.com or www.T- Mobile.com /pr for Puerto Rico customers, or refer to your Prepaid services brochure for other useful tips. You can also dial 877 -778- 2106 to reach T- Mobile Customer Care if you have additional questions. Initial balance and refill purchases are non refundable. A full refund is limited to the purchase price of the phone, less the cost of any used minutes and service. You must provide valid proof of purchase for a refund. Ask a representative for complete details on our refund policy. `Capable device required to achieve 4G speeds. T- M obi le's HSPA 4G network not available everywhere. See www.T- mobile.com or www.T- mobile.com /pr for coverage details. Limited -time offer; subject to change. Taxes and fees additional. Plans provide domestic use only; separate charges apply for international use. Not all features or plans available on all devices. Pay As You Go: Service available for 90 days (one year for Gold Rewards) after activation /refill. After that, your account will be suspended and no service will be available. Gold Rewards requires activation of $100 in refills; you must refill while on Pay As You Go plan to obtain full Gold Rewards benefits. Plan Changes and Renewals: If you switch between plans, features or credits associated with your prior plan will no longer be available. If you renew a monthly plan, unused services under your prior months' plan will no longer be available. Prepaid General Terms: Sufficient balance required to use service. Calls rated on a per minute basis; partial minutes rounded up for billing. If you transfer your number to another carrier, your account will be deactivated and no service will be available. No cash redemption value. Non refundable. Not responsible if lost or stolen. If you purchase a Device that is sold for use on T- Mobile Prepaid Service, you agree that you intend it to be activated on our Service, and do not intend to, and will not, resell, modify and /or export the Devices, or assist someone in these activities. Messaging: You will be charged for all data sent by or to you through the network, regardless of whether received. Character length /file size of messages /attachments may be limited. T- Mobile not liable for content of messages /attachments or for any failures, delays or errors in any T- Mobile- generated alerts or notifications. Coverage: Service is not available everywhere; see a Coverage Map, available at T- Mobile.com, for details. Abnormal Usage: Service may be limited or terminated for misuse, abnormal usage, or significant roaming. By using service, you accept T- Mobile's Terms and Conditions (including arbitration provision). See brochures, and Terms and Conditions at www.T- Mobile.com (T- Mobile.com /pr for Puerto Rico customers), for additional information. T- Mobile, t- zones, and the magenta color are registered trademarks of Deutsche Telekom AG. MegaTones is a registered trademark of T- Mobile USA, Inc. https: /ppy.t- mobile.comJWelcomeMsgE.j sp 5/22/2012 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 John Thomas Purchase Order No. Terms Date Due Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s) Amount 1/0/1900 0 Supplies for Interns; Safety Equipment 122.07 1/0/1900 0 IDDE Stormwater testing supplies 28.93 1/0/1900 0 prepay phone activation; Intern Emerg phones 20.00 e 4' I 9 5 d r f Total 171.00 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 VOUCHER NO WARRANT NO. John Thomas ALLOWED 20 IN SUM OF 171.00 ON ACCOUNT OF APPROPRIATION FOR Board Members PO# or INVOICE NO ACCT /TITLE AMOUNT DEPT# I hereby certify that the attached invoice(s), or 0 0 211- 4462838 122.07 bill(s) is (are) true and correct and that the materials or services itemized thereon for 0 0 211 4462838 28.93 which charge is made were ordered and 0 0 211 446283 20 received except 5/21 /2012 Signature City Engineer Cost Distribution ledger classification if Title claim paid motor vehicle highway fund