212011 08/14/2012 CITY OF CARMEL, INDIANA VENDOR: 129000 Page 1 of 1
4 � ONE CIVIC SQUARE HOLDER MATTRESS CO, INC CHECK AMOUNT: $5,400.00
S � CARMEL, INDIANA 46032 130 W MORGAN STREET
KOKOMO IN 46901 CHECK NUMBER: 212011
CHECK DATE: 8/14/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 4463000 24376 072612CFD1 3 , 150 . 00
102 4463000 24377 072612CFD1 2, 250 . 00
Molder Mattress Factory
Built for Comfort — Designed to Last
Since 1947
Invoice
Carmel Fire Department
2 Civic Square
Carmel, IN 46032
Invoice Number: 072612cfdl
Invoice Date: 7/26/12
Invoice Due Date: 8/26/12
Customer Approval: Ernie Maroon
Item• Description: Quantity Item Price Total Price
41 Keystone XL Twin 12 $450.00 $5,400.00
Invoice Sub-Total $5,400.00
IN Sales Tax 7% EXEMPT
Total Invoice Due $5,400.00
• Payment terms Net 10 from date of delivery
• Proof of Deliveries, Signed Quote Approval Attached
Deliveries to the Following:
5 Sets to Station 45 at 10701 N. College, Carmel, IN
7 Sets to Station 42 at 3610 W. 106`x' St., Carmel, IN
Please remit to:
130 West Morgan Street
Kokomo, IN 46901
Phone (765) 236-1492; Fax (765) 236-1495
)rescribed 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
vhom, 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))
072612cfd 1 $2,250.00
072612cfd 1 $3,150.00
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
Holder Mattress
IN SUM OF $
130 West Morgan Street
Kokomo, IN 46901
$5,400.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
24377 072612cfd1 102-630.00 j $2,250.00 1 hereby certify that the attached invoice(s), or
24376 072612cfd1 102-630.00 $3,150.00 bill(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received exce UG- I 2 ,M12
r V
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund