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Home My WebLink About210408 07/05/2012 CITY OF CARMEL, INDIANA VENDOR: 051125 Page 1 of 1 ONE CIVIC SQUARE ICE MOUNTAIN SPRING WATER Q� CHECK AMOUNT: $117.26 CARMEL, INDIANA 46032 PROCESSING CENTER PO Box 856680 CHECK NUMBER: 210408 LOUISVILLE KY 40285 -6680 CHECK DATE: 7/5/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1091 4350900 33.75 2FO121202766 1125 4350900 38.77 2FO120095351 2201 4238900 44.74 02FO119252823 service.icemountainwater.com D Llogi Uyl 215 6661 DIXIE HWY, SUITE 4 05/13/12 06/12/12 02F0119252823 LOUISVILLE KY 40258 B e ADDRESS SERVICE REQUESTED 11I11111II'I11I11111II11111111I11I II IN �I'I II� MO JUL 06 0119252823 MON- AUG 06 WED- SEP 05 THU- OCT 04 CITY OF CARMEL STREET DEPARTMENT Customer Service: 1- 800 472 -9888 BONNIE CALLAHAN Pay your bill online at: service.icemountainwater.com or 3400 W 131ST ST by phone at: 1- 800 -472 -9888. It's free! CARMEL IN 46074 -8267 III'lllllllll'I'I'llllll' III' III "'I'I "'lllllllll'lllllll l'I'l ll Refreshen D'inks Refres inSaYin s For a limited me, en`o of eleccases of TRADEWINDS LL 9, g 9 J y S111iE fi�EAF- Beverages s c With prices thioo1jbring.on the service icemountainwater.comuor P00 ,7400 9888 to ad&to your next orderl Offer eXpires 8/31112. w ACCOUNT ACTIVITY For questions or a report on water quality and information, call 1- 800 472 -9888 or visit service. icemountainwater.com. B 8 B 8 8 Delivery address: CITY OF CARMEL STREET DEPARTMENT, 3400 W. 131ST ST, CARMEL IN 46032 PREVIOUS BALANCE 66.23 6/10 909552 PAYMENT -THANK YOU -66.23 6/06 0775278294 3 BOTTLE CRATE .00 8 5 GAL ICE MOUNTAIN DIRK W /HANDLE 27.92 8 5 GALLON ICE MOUNTAIN BOTTLE DEPOSIT 48.00 8 5 GALLON ICE MOUNTAIN DEPOSIT RETURN -48.00 3 9 OZ PLASTIC CUP 50C /SLV 9.87 6/12 0781244702 1 OIL/FUEL SURCHARGE 2.96 F2837826 RENT 3.99 TOTAL 44.74 ACCOUNT SUMMARY PREVIOUS BALANCE PAYMENT ADJUSTMENT CURRENT ACTIVITY -PAY THIS AMOUNT Subject to terms on reverse side. 66.23 66.23 44.74 44.74 BILLING RIGHTS SUMMARY YOUR INVOICE 4 WAYS TO HELP US SERVE YOU BETTER IN CASE OF ERRORS OR QUESTIONS ABOUT YOUR BILL, OR FOR I Please remember payment is due by the "pay by" date noted to ensure the smoothest service. A REPORT ON WATER QUALITY AND INFORMATION, PLEASE 2, Remember, if you are renting equipment, your equipment rental is charged one month in advance. That means CALL I- 800472 -9888 OR WRITE US AT: your first invoice will include a pro -rated fee for the current month, plus the next month's rental. ICE MOUNTAIN SPRING WATER CO. 3. Kindly fill in the amount enclosed, include your account number on your check, and do not send cash. 6216 6661 DIXIE HWY., SUITE 4 If you prefer, you can pay your bill online at service.icemountainwater.com LOUISVILLE, KY 40258 4. Never hesitate to call us with comments, questions, or concerns. If you think your bill is wrong, or if you need more information about a transaction on your bill, write us on a separate sheet of paper. We must hear from you in writing no later than thirty (30) days after we SA MPLE I NV OI CE sent you the first bill on which the error or problem appeared. You can telephone us, but doing so will not preserve your rights. In your letter, give us the following information: Your name, address, telephone and account numbers. Date range of this invoice The dollar amount of the suspected error. Describe the error and explain if you can, why you believe there is an error. You are obligated to pay the parts of your bill that are not in question. T23AS6raso Your Account Number You do not have to pay the disputed amount while it is being I a010awo- 00 rta/ OD investigated. During the investigation, we cannot report your account as delinquent or take any action to collect the amount in question. THR «T o1/ 2N5678 MDH OCT s9 Watch here for a GENERAL INFORMATION SDK personalized account 1. Payments received after the billing (INVOICE) date will appear on Important I&I1g6.41M„lj�,ttAdU se,,kea.aoo- An -veae o ff., message your next invoice. Past due invoices (not paid within 30 days of news and billing date) may be assessed a late fee as allowed by law not to offers 123M-3-S exceed S20 per month. Additionally, third party collection/attorney aw s-e 00000 n.t..6661«La expenses may be assessed at a rate not to exceed 100% of the unpaid balance or the maximum allowed by law. 1 :'N x Pay electronically 2. Each returned check is subject to a service charge subject to the dt6 '"„';,;,,�e�rda A maximum check return charge allowable in your State. ,ice u�, M Make sure this 3. All bottle and equipment deposits are shown as CURRENT Activity° „w amount has been ACTIVITY. since your AccoUNrACnvTY cChY W,opp00 paid in full to 4. Equipment replacement costs will be charged for bottles lost, ce1 r Am— last invoice stolen, damaged or not returned.„ avoid late fees 5. In accordance with NWNA's Terms and Conditions "T &C your bI898 s 6 P r „nmHa,�sv�^9` Yi° -s°p° /11 31]BBSIM S keMwna•^S� Equipment Lease and/or Service Agreement account may be Monthly Oil subject to minimum monthly purchases and/or early cancellation 09 J11 s F°"w""°B` tg Surcha a Fuel fees. (A complete version of the current T &C may be viewed on the a9 /'r 'M' Surcharge or Delivery website listed below) Upon service discontinuation, rent for the HITAr Fee (see #6 under Leased Equipment is charged through the end of the billing cycle "General in which service is discontinued. TTMS Information 6. You will be charged a monthly Oil Surcharge, Fuel Surcharge or 4A.kT s1/ Delive Fee as described in our T &C. Only one of these fees Pa stub ACCOUNT SUMMARY rY Y Y Y ment PAY THIS AMOUNT ,1c will apply to each account. The fee that applies to your account cWNr NuMnrn PATRY s is stated on the front of the invoice. For further information please "'16711 0 ewN�c DATE rENcwD D INVOICE NU MBER visit the website listed below or contact our customer service 12MS67 center. 7. As a food product, bottled water is subject to the rules and 042009630”] 0428271261 000391049 zODV 16 Amount due regulations promulgated by the Federal Food and Drug tau_ Administration FDA). I cr�MOaN*aN'"" K 1 r M e Submit your 8. Your first invoice indicates the products delivered on your first CUSr oMr•'r°"'cECA" j00° ]vem delivery, along with any applicable bottle and account deposits, 6�`6.661.6J.0 wR payment by this redemption fees, and any dispenser charges. All future invoices m' ,„s;,u,P•^0n^"""S°`- 0 date will reflect charges for water delivered and dispenser rental, bottle ku,w H>wexelw deposits and credits plus charges for any additional products ordered by you. Deliveries are made every three or four weeks, for a total of 16 -17 deliveries per year. You will only receive invoices 12 times per year, so approximately 5 of those invoices will reflect two deliveries. 2008 Ice Mountain Spring Water Company, a Division of Nestl6 Waters North America Inc. Form No. NW 709 11/08 service. icemountainwater.com 1 service.icemountainwater.com B W111 215 6661 DIXIE HWY SUITE 4 05/01/12 05/31/12 02FO120095351 LOUISVILLE KY 40258 ADDRESS SERVICE REQUESTED B e THU- JUN 21 0120095351 MON- JUL 23 TUE- AUG 21 THU- SEP 20 6 /5//,z CARMEL CLAY PARKS AND REC DEPT. Customer Service: 1- 800 472 -9888 AUDREY KOSTRZEWA Did you forget about us? Kindly pay upon receipt. 1411 E 116TH ST Remember, past due accounts are subject to a late fee. CARMEL IN 46032 -3455 Your prompt payment is appreciated. For your 'll�ll�l "'�I�II' ICI' I 'I'IIIII�'ll�l�lllll "Illlliliii convenience, pay online: service. icemountainwater.com. If payment has been made, we thank you. Refreshing,,Prinks�4Refresh1ng Savings ;For a limlted.time, enjoy $1 off select cases of TRADEWINDS =SWEET LEAF =6evenages. Withpnces a ths cool, ring b" Sri theheat!Lo onto senrice .icemounta om or inwater c1, cal 1 800 -472 -9888 to add to your next order) Offer expires 7/31/12.. K E ACCOUNT ACTIVITY For questions or a report on water quality and information, call 1- 800 472 -9888 or visit service. icemou ntainwater.com. e e Delivery address: P CARMEL CLAY PARKS AND REC DEPT., 1427 5 116TH ST, VAML IN 46052 PREVIOUS BALANCE 77.34 5/13 761650 PAYMENT -THANK YOU -34.66 5/22 0776961559 4 5 GAL ICE MOUNTAIN DIRK W /HANDLE 15.96 3 9 OZ PLASTIC CUP 50C /SLV 9.87 BOTTLE DEPOSIT: 4- CHARGED, 4 CREDITED .00 5/31 0779280312 1 OIL/FUEL SURCHARGE :JUN 2.96 E2673392 RENT C E 9.98 TOTAL 1 1 2 01 2 81.45 Purch se Description 1J U Li (L l� J l P.O. P orf L? 0 Budge t e y Line scr Purchaser Date Approval Date ACCOUNT SUMMARY PREVIOUS BALANCE PAYMENT A9JU!§TMENT CURRENT ACTIVITY PAY THIS AMOUNT Subject to terms on reverse side. 77.34 Z 34.66 38.77 81.45 BILLING RIGHTS SUMMARY YOUR INVOICE 4 WAYS TO HELP US SERVE YOU BETTER IN CASE OF ERRORS OR QUESTIONS ABOUT YOUR BILL, OR FOR I Please remember payment is due by the "pay by" date noted to ensure the smoothest service. A REPORT ON WATER QUALITY AND INFORMATION, PLEASE 2. Remember, if you are renting equipment, your equipment rental is charged one month in advance. That means CALL 1- 800472-9888 OR WRITE US AT: your first invoice will include a pro -rated fee for the current month, plus the next month's rental. ICE MOUNTAIN SPRING WATER CO. 3. Kindly fill in the amount enclosed, include your account number on your check, and do not send cash. #216 If you prefer, you can pay your bill online at service.icemountainwater.com 6661 DIXIE HWY., SUITE 4 LOUISVILLE, KY 40258 4. Never hesitate to call us with comments, questions, or concerns. If you think your bill is wrong, or if you need more information about a transaction on your bill, write us on a separate sheet of paper. We must hear from you in writing no later than thirty (30) days after we sent you the first bill on which the error or problem appeared. You can SAMPLE INVOICE telephone us, but doing so will not preserve your rights. In your letter, give us the following information: Your name, address, telephone and account numbers. Date range of this invoice The dollar amount of the suspected error. Describe the error and explain if you can, why you believe there is an error. You are obligated to pay the parts of your bill that are not in question. t za4s63R90 You do not have to pay the disputed amount while it is being 00100100 00100100 Your Account Number investigated. During the investigation, we cannot report your account as delinquent or take any action to collect the amount in question. rHe ecT a 123,456789 MoN.cx* 39 Watch here for a wro -Nov 21 GENERAL INFORMATION NE<'e personalized account I. Payments received after the billing (INVOICE) date will appear on Important ao0.4n -96 1F 111 „gMIfUW.,iI11,WpG „dpp „ll „ildau Cmmmn s °^�LnuNP�un' your next invoice. Past due invoices (not paid within 30 days of news and �,a"Lr0�1n.0 +729'•• message billing date) may be assessed a late fee as allowed by law not to offers ��2 }m-m s "m`e.. exceed $20 per month. Additionally, third party collection/attorney o a,e a, sl O0009 1 dO.L.d m dl aL.IL.6tl 1 ILWd u expenses may be assessed at a rate not to exceed 100% of the ,.,e„,.N. unpaid balance or the maximum allowed by law. T Aroum!r,„m xa a Pay electronically 2. Each returned check is subject to a service charge subject to the a... ra+r� a :,fs•%t'� maximum check return charge allowable in your State. Make Sure this 3. All bottle and equipment deposits are shown as CURRENT Activity amount has been ACTIVITY. since your A CCOUNTAarv 1 n a •1• Soh "po¢, 123M nStreet' Now paid paid in full to 4. Equipment replacement costs will be charged for bottles lost, last invoice cer„enn°°,es.'. stolen, damaged or not returned. °zO5 avoid late fees Paymms r1,an6rw som 5. In accordance with NWNA's Terms and Conditions "T &C your oanl w3a96 5 sGal'unwmmisn w /1, 3136051°°°° Ice MOOnuln$Gal De Wu' 3.96 Equipment Lease and/or Service Agreement account may be 117"11 s I 7299 Monthly Oil subject to minimum monthly purchases and/or early cancellation o9 ;',10g51"" 5u 111-'rie Surcharge, Fuel 09/,3 03636011 fees. (A complete version of the current T &C may be viewed on the "9723 '66°72°93 s3 m Surcharge or Delivery website listed below) Upon service discontinuation, rent for the 3oTAL Fee (see #6 under Leased Equipment is charged through the end of the billing cycle in which service is discontinued. N M N6uH General 6. You will be charged a monthly Oil Surcharge, Fuel Surcharge or M _._w Information') Delivery Fee as described in your T &C. Only one of these fees Payment stub ACCOUNT SUMMARY t PAV BY PAY THI5 AMOUNT M -er• •a. "o x o. MUrn,vun,a+P• I will apply to each account. The fee that applies to your account s�,,,a AccouHr NUM6ER sz472 00 072 /00 is stated on the front of the invoice. For further information please 12345636 Mr ENCLOSED 1N otCE NUM8ur BILLING t3ATE visit the website listed below or contact our customer service 1234563690 7201 720100 center. :7. As a food product, bottled water is subject to the rules and 042GO96307 092E23L2619 000391049 2009 1° Amount due regulations promulgated by the Federal Food and Drug 0"ooe Administration (FDA). IcEMOUNraNwnrE'6c°M" "Y„c 113 8. Your first invoice indicates the products delivered on your first w Submit your 106 cus3oML6 sE6vKL c "LL,"67272 delivery, along with any applicable bottle and account deposits, 1 „YaL.„dL.dL.,U.La+L +LLLLJ „a• s payment by this redemption fees, and any dispenser charges. All future invoices 0 o 6Ar.5OPA<9"'e date will reflect charges for water delivered and dispenser rental, bottle 61e „"n,.,e.,A deposits and credits plus charges for any additional products ordered by you. Deliveries are made every three or four weeks, for a total of I6 -17 deliveries per year. You will only receive invoices 12 times per year, so approximately 5 of those invoices will reflect two deliveries. 2008 Ice Mountain Spring Water Company, a Division of Nestle Waters North America Inc. Form No. NW 709 11/08 service. icemountainwater.com 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)) 06/14/12 02FO119252823 $44.74 I 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 JT N ALLOWED 20 IN SUM OF ROPRIATION FOR t Department ACCT# /TITLE AMOUNT Board Members ?823 I 42- 389.001 $44.74 1 hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except s) /7 Thursday, June 28.2012 f; Street °Comm ssionerner Title Cost distribution ledger classification if claim paid motor vehicle highway fund service.icemountainwater.com 0 0 171TA "�A 215 6661 DIXIE HWY, SUITE 4 05/01/12 05/31/12 02F0121202766 LOUISVILLE KY 40258 ADDRESS SERVICE REQUESTED e THU JUN 21 0121202766 MON- JUL 23 TUE- AUG 21 05(19, THU- SEP 20 f CITY OF CARMEL PARKS DEPARTMENT Customer Service: 1- 800 472 -9888 MANDY SPADY Did you forget about us? Kindly pay upon receipt. 1411 E 116TH ST Remember, past due.accounts are subject to a late fee. CARMEL IN 46032 -3455 Your prompt payment is appreciated. For your IIII��III'I'll'll'll��l'I' I I 'IIIIIII 'IIIJill Il'I IIIll convenience, pay online: service.icemountainwater.com. If payment has been made, we thank you. Refreshing Drinks R freshsng Savings Fora hr►ilted tm�e;�en�oy$i�1off select cases ofTRADEWINDS�� 5 SWEET LEAFBeverages W th paces this�cool bang on the neat SW onto service Icemountainwater corn or call_1 800- 47.2= 9888_toP'add toL! next: order.-O.4erk xpIres 4ou a� a O m ACCOUNT ACTIVITY For questions or a report on water quality and information, call 1.800- 472 -9888 or visit service.icemountainwater.com. oil Delivery address: CITY OF CARMEL PARKS DEPT /MONON CENTER, 1235 CENTRAL PARK DR EAST, CARMEL IN 46032 PREVIOUS BALANCE 111.38 5/13 761651 PAYMENT -THANK YOU -60.71 5/22 0776961609 2 .5 L NATURAL SPRING WATER ICE MTN 12.98 3 9 OZ PLASTIC CUP 50C /SLV 9.87 5 5 GAL ICE MOUNTAIN DIRK W /HANDLE 19.95 BOTTLE DEPOSIT: 5 CHARGED, 8 CREDITED -18.00 5/31 0779296912 1 OIL /FUEL SURCHARGE Q 2.96 E2752830 RENT JUN 0 8 2 01 Z 5.99 Purchase j]j7 U L1e Crt (AJa TOTAL Description 84.42 1s P.O.# PorF G.L., Budoet 'Line Descr (_Ci�� Purchaser Date Approval D ACCOUNT SUMMARY PREVIOUS BALANCE PAYMENT/ ADJUSTMENT CURRENT ACTIVITY PAY THIS AMOUNT Subject to terms on reverse side. 111.38 60.71 33.75 84.42 g BILLING RIGHTS SUMMARY YOUR INVOICE 4 WAYS TO HELP US SERVE YOU BETTER IN CASE OF ERRORS OR QUESTIONS ABOUT YOUR BILL, OR FOR 1. Please remember payment is due by the "pay by" date noted to ensure the smoothest service. A REPORT ON WATER QUALITY AND INFORMATION, PLEASE 2, Remember, if you are renting equipment, your equipment rental is charged one month in advance. That means CALL 1- 800472 -9888 OR WRITE US AT: your first invoice will include a pro -rated fee for the current month, plus the next month's rental. ICE MOUNTAIN SPRING WATER CO. 3. Kindly fill in the amount enclosed, include your account number on your check, and do not send cash. #216 If you prefer, you can pay your bill online at service.icemountainwater.com 6661 DIXIE HWY., SUITE 4 LOUISVILLE, KY 40258 4. Never hesitate to call us with comments, questions, or concerns. If you think your bill is wrong, or if you need more information about a transaction on your bill, write us on a separate sheet of paper. We must hear from you in writing no later than thirty (30) days after we SA MPLE I sent you the first bill on which the error or problem appeared. You can telephone us, but doing so will not preserve your rights. In your letter, give us the following information: Your name, address, telephone and account numbers. Date range of this invoice The dollar amount of the suspected error. Describe the error and explain if you can, why you believe there is an error. You are obligated to pay the parts ofyour bill that are not in question. F 1 2 3 56 7 890 Your Account Number You do not have to pay the disputed amount while it is being 00/00100-001°0I°° investigated. During the investigation, we cannot report your account i 123456 as delinquent or take any action to collect the amount in question. ,H.o 29 Watch here for a GENERAL INFORMATION nE-DE 'a personalized account I t ana,ml „,n1q tldlJdll Curio n ervk -,'gpp b)2 -9898 1. Payments received after the billing (INVOICE) date will appear on Im P message your next invoice. Past due invoices (not paid within 30 days of news and 0.nw'n n E m u n9 keMOUn alnw•^� billing date) may be assessed a late fee as allowed by law not to offers 1127 wI s' aria exceed $20 per month. Additionally, third party collectiontattomey o u0000 L. NJ.. J. a6..,A,..A4.t1..4a.,L,.66W.�•6 expenses may be assessed at a rate not to exceed 100% of the »+rte^° unpaid balance or the maximum allowed by law. n_wr'm =a.i�� No, 2 1 Pay electronically 2. Each returned check is subject to a service charge subject to the z?��"� en"6 maximum check return charge allowable in your State. Make sure this 3. All bottle and equipment de oasts are shown as CURRENT Activit P amount has been ACTIVITY. since our AttouarAan't BOOBB paid in full to 4. Equipment replacement costs will be charged for bottles lost, last i voice p¢1meryAddress: wnnooe, $Q stolen, damaged or not returned. Ae ,;,,,,a k 5 avoid late fees 5. In accordance with N WNA's Terms and Conditions "T &C your oer3I X 1898 I' 99 Mo nthly Oil Equipment Lease and/or Service Agreement account may be n7easibw4 s e�nwn,a�nscai Y subject to minimum monthly purchases and/or early cancellation 09 j8851 11 g Surchar e, Fuel 9m, r 9 fees. (A complete version of the current T &C may be viewed on the mn2 Surcharge or Delivery website listed below) Upon service discontinuation, rent for the roTra Fee (see #6 under Leased Equipment is charged through the end of the billing cycle "General in which service is discontinued. 6. You will be charged a monthly Oil Surcharge, Fuel Surcharge or Information Deliver as described in our T &C. Onl one of these fees Pay ment stub ACC suMMAaY ry Y Y Y OUrrr PAY BY PAY THIS WWW will apply to each account. The fee that applies to your account ,p,,, ACco UM9E8 w 00 s749 is stated on the front of the invoice. For further information please NVOIC ,zsbs67890 II WIMIN LnNG -n`r T. ENCLOSED IE NUMBER visit the website listed below or contact our customer service ,234567890 center. 7. As a food product, bottled water is subject to the rules and 0,20096361 04282.12619 000391 2004 1 Amount due regulations promulgated by the Federal Food and Drug innnDce Administration (FDA). iCEM OUrrrNNwATE cc o ,K c'srs�aies`Woo H� YMm 8. Your first invoice indicates the products delivered on your first Submit your i0n a C apoMFASEBVKE CA r p61t a°' delivery, along with any applicable bottle and account deposits, payment by this 6..+6.ew6a,6.uwul.a.0 redemption fees, and any dispenser charges. All future invoices 4dll.4nt 6mov6nsq�uc 9•wB.aO^""""yde will reflect charges for water delivered and dispenser rental, bottle s date deposits and credits plus charges for any additional products ordered by you. Deliveries are made every three or four weeks, for a total of 16 -17 deliveries per year. You will only receive invoices 12 times per year, so approximately 5 of those invoices will reflect two deliveries. 2008 Ice Mountain Spring Water Company, a Division of Nestle Waters North America Inc. CSr service.icemountainwater.com fD i 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. 051125 Ice Mountain Terms P.O. Box 856680 Louisville, KY 40285 -6680 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) PO Amount 6/5/12 2FO120095351 Drinking water cooler- Maint 38.77 6/5/12 2FO121202766 Drinking water cooler MCC 33.75 Total 72.52 I 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. 051125 Ice Mountain Allowed 20 P.O. Box 856680 Louisville, KY 40285 -6680 In Sum of 72.52 ON ACCOUNT OF APPROPRIATION FOR 101 General 109 Monon Center PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members Dept 1125 2FO120095351 4350900 38.77 1 hereby certify that the attached invoice(s), or 1091 2FO121202766 4350900 33.75 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 28 -Jun 2012 Signature 72.52 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund