210858 07/17/2012 CITY OF CARMEL, INDIANA VENDOR: 366407 Page 1 of 1
ONE CIVIC SQUARE GLOWGOLF
CARMEL, INDIANA 46032 49 W MARYLAND STREET#H03B CHECK AMOUNT: $100.00
> t=° INDIANAPOLIS IN 46204 CHECK NUMBER: 210858
>OM�
CHECK DATE: 7/17/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1082 4343007 8/2/12 100 . 00 FIELD TRIPS
Special Event Form
Glowgolf @ Circle Centre
49 W Maryland Street #H03B JV �
Indianapolis, IN 46204 C `�ZOj2
317-955-2808 }'
Name of event: Carmel Clay Parks & Recreation Summer Camp Event
Date of event: August 2, 2012 Time of event: 1-2PM Number of PPL 25
Contact person: Jennifer Holder Phone number: _317-679-9867
Address: 1411 E. 116`x' St. Carmel, IN
Email: JHolderaCarmel Cla Parks.com Purchase (,-;, ,.
Description
P.O.# C C2� a 2Z(0-1 P
GROUP PRICING AND DISCOUNTS: G.L.# q -'\-kc1 )
Budget \ l
Line De cr
Group Discount for 5 or more = $7.00 each Purchaser �,\� 2' iZ
Group Discount for 10 or more = $4.00 each Approval Z -2 6Z
PARTY PACKAGE:
Minimum of 10 people - $8.00 each (Includes glow bracelets, $1 off coupons, frequent
player cards, 2 hours unlimited golf and party room rental, body light prize for birthday
person, chance to win a Hole-N-One prize and Glow host or hostess as needed).
Adults with party may pay $4.00 each to play.
COST OF EVENT
Group Package of 5 $7.00 x # of players =
Group Package of 10 $4.00 x # of players 25 = $100.00
Party Package $8.00 x # of players =
Sub Total $100.00
—
PwF
"HOW
Date-
Carmel • Clay
Parks&Recreation CHECK REQUEST
Date: 6/28/12
Check payable to:
Name: Glow Golf Indv
Address: 49 West Maryland #H03B St.
City, State, Zip Indianapolis, IN 4620
_Mail check to payee X Return check to requestor
Check Amount: $ 100.00 Date Required: 8/2/12
Check needed for: Glow Golf Indv for Chillville Summer Camp on 8/2/12
To be paid from: 1
PO#(if applicable) Eo 0 `' )(0"-
Budget account-GL# 1082-9 4343007
Budget Line Description Field Trip
Invoice(s) and Purchase Order(if required) MUST be attached.
Requested by(print): Jennifer Holder q�
Requested by(signature):
Approved by (signature of Division Manager):
on this date -7-2- "
Form revised 7-7-08 Shared/Administrative/Forms/Staff forms/Check Request(rev 7-7-08)
0
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.
Glowgolf Terms
49 W Maryland Street# H03B
Indianapolis, IN 46204
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO# Amount
8/2/12 8/2/12 Field trip 8/2/12 $ 100.00
Total $ 100.00
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.
Glowgolf Allowed 20
49 W Maryland Street# H03B
Indianapolis, IN 46204
In Sum of$
$ 100.00
ON ACCOUNT OF APPROPRIATION FOR
108 -ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1082-9 8/2/12 4343007 $ 100.00 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
12-Jul 2012
Signature
Is 100.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund