211370 07/31/2012 \,f CITY OF CARMEL, INDIANA VENDOR: 361429 Page 1 of 1
ONE CIVIC SQUARE M D A
CARMEL, INDIANA 46032 PO BOX 3110 CHECK AMOUNT: $397.44
MONUMENT CO 80132 CHECK NUMBER: 211370
CHECK DATE: 7/31/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1207 4356006 95596 397 .44 GOLF SOFTGOODS
(MDA) MAXX SUNGLASSES Invoice
MAXX SUNGLASSES Date Invoice #
PO BOX 3110
MONUMENT, CO 80132 7/11/2012 95596
Bill To: Ship To:
Brookshire Golf Club IN Brookshire Golf Club IN
BRIAN BRIAN
12120 Brookshire Parkway 12120 Brookshire Parkway
Carmel, IN 46033 Carmel, IN 46033
Terms Due Rep Ship Date Via
MD 7/11/2012 UPS
Oty Description Each Amount
MD
4 Cinco Black 8.00 32.00
4 Cinco Blue 8.00 32.00
4 Cinco Red 8.00 32.00
4 Cinco White 8.00 32.00
2 Cinco Tortoise 8.00 16.00
6 Maxx 2 Black 8.00 48.00
2 Sniper Black with red 8.00 16.00
2 Sniper Black with white 8.00 16.00
3 Maxx Envy Black 8.00 24.00
3 Maxx Envy White W/Pearl Grey, Blue Rubber 8.00 24.00
3 Maxx Envy White W/Pearl Grey, Orange Rubber 8.00 24.00
3 Raven Black with White 8.00 24.00
3 Raven Silver with Black 8.00 24.00
2 Stealth Black 8.00 16.00
2 Stealth Blue 8.00 16.00
1 Stealth White with Black accents 8.00 8.00
UPS SHIPPING 13.44 13.44
Help us keep prices low! If these boxes are blank, please fill in and fax this page back to us.We will update your information!
e-mail: 13BALLARD @CARMEL.IN.G0V Fax: 317-846-9980
Total This Invoice $397.44
PLEASE MAKE CHECKS PAYABLE TO "MDA"
WE ACCEPT MASTER CARD, VISA AND DISCOVER Payments/Credits Applied to Invoice $0.00
877.550.8116 PHONE Balance Due This Invoice $397.44
719.622.1153 FAX
Total Due This Account $397.44
Please inspect product carefully.All returns are to be made within 10 days of receipt and accompanied by a return authorization number(RA#).
Any problems with your order should be gone over with your sales representative.
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))
07/11/12 95596 Sunglasses $397.44
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
M DA
IN SUM OF $
P.O. Box 3110
Monument, CO 80132
$397.44
ON ACCOUNT OF APPROPRIATION FOR
Brookshire Golf Club
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1207 I 95596 I 43-560.06 I $397.44 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
Tuesday, July 17, 2012
Director, Brookshire olf Club
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund