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209747 06/18/2012 CITY OF CARMEN., INDIANA VENDOR: 366176 Page 1 of 1 ONE CIVIC SQUARE BELSON OUTDOORS, INC CARMEL, INDIANA 46032 111 NORTH RIV CHECK AMOUNT: $12,754.00 N RA IN 60542 CHECK NUMBER: 209747 CHECK DATE: 6/1812012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 106 5023990 30611 94088 12,754.00 PICNIC TABLES a� Invoice 94088 B EL Invoice Date: 05/11/12 U T D 0 I R S Customer CA2208 Belson Outdoors, Inc. 111 N. River Road North Aurora, IL 60542 USA Please Remit to: Phone: 630/897 -8489 Belson Outdoors, Inc. Fax: 6301897 -0573 36810 Eagle Way FEIN 36- 2514142 Chicago, IL 60678 -1368 DUNS 00- 524 -7564 Sold To: Carmel Clay Parks Recreation Ship To: Carmel Clay Parks Recreation 1411 E 116th Street 1427 E 116th Street Carmel, IN 46032 Attn: Dawn USA Carmel, IN 46032 USA Ship Date Ship Via— F.O Be ISaIes Order-Date. Sales erson. Sales Order Number Purchase Order- Number Terms 05/11/12 ODFL Origin 03/30/12 DLTB 1 93231 1 30611 Net 10 days Quantity Item Number Unit of Measure Discount Tax Unit Price Extended Price Order Ship BO Item Description 10 10 0 RPD8 EA N 896.00 8960.00 Recycled Plastic 8' Picnic Table, 2 "x6" Planks Cedar Top Seats Black Frame 2 2 0 RPD8H EA N 781.00 1562.00 Recycled Plastic 8' Universal Access Picnic Table, 2 "x6" Planks Cedar Top Seats Black Frame T4T MAY IS 2012 By, P urchase D escription V)U2A1 O. 'fit 1 t P or© L.# 106 5023990 SCR pORS ine Descr LW Gh p1iL. DYl C]P Q�E pN� 13� °S urchase Z±' C l Date Sz ��60r01 pproval EW 21 -1 Date P EL Nontaxable 25 A h l>r TO A ,C.- pAI Taxable Subtotal 0.00 M'' r✓� y cl� I 7 V f Tax I'Z,"154 0.00 Total Invoice Customer Original Page 2 Invoice 94088 BELtGN Invoice Date: 05111112 0 U T D W0 1 R S Customer CA2208 Belson Outdoors, Inc. 111 N. River Road North Aurora, IL 60542 USA Please Remit to: Phone: 630/897 -8489 Belson Outdoors, Inc. Fax: 630/897 -0573 36810 Eagle Way FEIN 36- 2514142 Chicago, IL 60678 -1368 DUNS 00- 524 -7564 Sold To: Carmel Clay Parks Recreation Ship To: Carmel Clay Parks Recreation 1411 E 116th Street 1427 E 116th Street Carmel, IN 46032 Attn: Dawn USA Carmel, IN 46032 USA Ship Date Ship Via F.O.B. Sales Order.Date Sales erson Sales Order Numberl Purchase Order Terms. 05/11/12 ODFL Origin 03/30/12 DLTB 93231 30611 Net 10 days Quantity Item Number Unit of.Measure Discount Tax Unit Price Extended Price Order —Ship BO Item Description 1 1 0 FREIGHT EA N 974.73 974.73 Freight Prepaid Ship via Old Dominion Freight Lines per Freight Quote Phone Call 24 Hours Prior to Delivery Required Point of Contact: Dawn Koepper Phone Number: 317 573 -4026 Mark for PO 30611 4 4 0 RPD6 EA N 744.00 2976.00 Recycled Plastic 6' Picnic Table, 2 "x6" Planks Weathered Wood Top Seat Black Frame 6 6 0 RPD8 EA N 896.00 5376.00 Recycled Plastic 8' Picnic Table, 2 "x6" Planks Weathered Wood Top Seats Black Frame 2 2 0 RPD8H EA N 781.00 1562.00 Recycled Plastic 8' Universal Access Picnic Table, 2 "x6" Planks Weathered Wood Top Seats Black Frame 5 5 0 PL6 -P EA N 296.00 1480.00 Recycled Plastic 6' Portable Plank Bench With Back, 3 Legs Weathered Wood Top Seats Black Frame 3 3 0 RPD6 EA N 744.00 2232.00 Recycled Plastic 6' Picnic Table, 2 "x6" Planks Cedar Top Seat Black Frame (Continued) Customer Original Page 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. Belson Outdoors, Inc. Date Due 36810 Eagle Way Chicago, IL 60678 -1368 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) PO Amount 5/11/12 94088 Picnic tables and benches 30611 12,754.00 Total 12,754.00 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. Allowed 20 Belson Outdoors, Inc. 36810 Eagle Way Chicago, IL 60678 -1368 In Sum of 12,754.00 ON ACCOUNT OF APPROPRIATION FOR 106 Park Impact Fee Fund PO# or INVOICE NO. kCCT #/TITLI AMOUNT Board Members Dept 30611 F 94088 5023990 12,754.00 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 14 -Jun 2012 Signature 12,754.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund