211495 07/31/2012 CITY OF CARMEL, INDIANA VENDOR: 314125 Page 1 of 1
ONE CIVIC SQUARE UPS
CARMEL, INDIANA 46032 LOCKBOX 577 CHECK AMOUNT: $19.34
s'? CAROL STREAM IL 60132-0577
CHECK NUMBER: 211495
CHECK DATE: 7/31/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1115 4350900 170AT6282 19 . 34 OTHER CONT SERVICES
Delivery Service Invoice
Invoice date July 14, 2012
Invoice number 0000170AT6282
Shipper number 170AT6
Control ID F809
Page 1 of 3
Sign up for electronic billing today!
0249A0000170AT64 77401200021 148 Visit ups.com/billing
AT 01 023193 33081H 76 A**3DGT For questions about your invoice,call:
(800)811-1648
Monday-Friday
_ CARMEL CLAY COMMUNICATION CTR 8:00 a.m.-9:00 p.m.E.T.
31 1ST AVE NW or write:
CARMEL, IN 46032-1715 UPS
P.O. Box 7247-0244
Philadelphia,PA 19170-0001
Account Status Summary
Weekly Payment Plan Thank you for using UPS.
Amount Due This Period $19.34 Summary of Charges
Amount Outstanding(prior invoices) $0.00 P age C arge
Total Amount Outstanding $19.34 Outbound
questions about your charges? 3 UPS Shipping Document $ 12.83
To get a better understanding of the charges on your invoice, 3 Adjustments&Other Charges $6.51 —
visit our invoice guide and glossary of billing charges at Amount due this period $ 19.34
ups.com/invoiceguide.
UPS payment terms require payment of this bill by July 25,2012.
Note:This invoice may contain a fuel surcharge as described at
ups.com. The published fuel surcharge is S.W.for UPS Ground
Services and 12.090 for UPS Air Services,UPS 3 Day Select and
International services.For more information, visit ups.com.
Delivery Service Invoice
Invoice date July 14, 2012
Invoice number 0000170AT6282
Shipper number 170AT6
TM
Page 2 of 3
Account Status
Weekly Payment Plan
Payments Applied
Amount
Invoice Number Invoice Date Paid
0000170AT6222 06/02/2012 $13.11
0000170AT6232 06/09/2012 $ 15.28
Delivery Service Invoice
Invoice date July 14, 2012
Invoice number 0000170AT6282
Shipper number 170AT6
TM
Page 3 of 3
Outbound
UPS Shipping Document
Pickup ZIP Billed
Date Tracking Number Service Code Zone Weight Charge
07/11 K1440955030 Ground Commercial S.D.P. 07005 5 2 11.88
Fuel Surcharge 0.95
Total 12.83
1st ref:132495
Sender :BRIAN SMITH Receiver:L 3 COMMUNICATIONS
CARMEL POLICE DEPT
INDIANAPOLIS IN 46268 BOONTON NJ 07005
Total UPS Shipping Document 1 Package(s) 12.83
Total Outbound 1 Package(s) 12.83
Adjustments & Other Charges
On-Call Pickup Requests
Date of Billed
Date Request Pickup Request No. Service Charge
06/20 06/20 2935R4DCMQQ Same Day Pickup-Web Request 6.00
Fuel Surcharge 0.51
Total 6.51
Pickup Address:Todd
Carmel Clay Communications —_
31 1 st Ave. NW.
Carmel IN 46032
Total On-Call Pickup Requests 1 Request(s) 6.51
Total Adjustments&Other Charges 6.51
023193 2/2
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))
07/14/12 0000170AT6282 $19.34
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
United Parcel Service
IN SUM OF $
Lockbox 577
Carol Stream, IL 60132
$19.34
ON ACCOUNT OF APPROPRIATION FOR
Carmel Clay Communications
PO#/Dept. INVOICE NO. I ACCT#/TITLE AMOUNT Board Members
1115 10000170AT62821 43-509.00 I $19.34 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 24, 2012
Director
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund