211825 08/14/2012 CITY OF CARMEL, INDIANA VENDOR: 364209 Page 1 of 1
ONE CIVIC SQUARE JOHNSON HEALTH TECH NA INC
CARMEL, INDIANA 46032 1600 LANDMARK DRIVE CHECK AMOUNT: $166.14
COTTAGE GROVE WI 53527 CHECK NUMBER: 211825
CHECK DATE: 8/14/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4238000 9001024209 166 . 14 SMALL TOOLS & MINOR E
Johnson Health Tech NA Inc. INVOICE
OZ02N1600 Landmark Drive Document 9001024209
Cottage Grove,WI 53527
JOHNSON Phone: 608-839-1240 Date 07/17/2012
Fax: 608-839-1260 Page 1 of 1
D
Bill-To: 33001910 JUL 20 2012 Ship-To: 33001910
CARMEL-CLAY PARKS AND RE OX CARMEL-CLAY PARKS AND REC
1411 E 116th St Dawn Koepper
Carmel, IN 46032 1411 E 116th St
Carmel, IN 46032
Comment: CRM User:Amy Rath;CRM Order#: ORD-450591;Case#:CAS-392562-1XYTXX;
Shipping Comment:
Purchase Order No. Sales Order No. Sales Person ID Shipping Method Terms Due Date
CAS-392562-1XYTXX 100584643 GLTM(GreatLakes-TM) UPS GROUND 100%PTS 07/17/2012
LN# Qty. Model Number Item Number Description List Price Net Unit Price Ext.Price
10 1 0000093108 Control Box;TV07 129.90 129.90
20 1 0000093285 Digital Dispatch Roll Wire;800L;RJ45;TV0 23.25 23.25
30 1 ZMS2000042 Parts Return Form 0.00 0.00
Pur:hase r G�t,-Pi'Yle4 ky- p-mess I k(�TV
Dc�cription
P.C.# I DCn�7 P06
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Put..haser Date
Apl roval Date
Remit To: Discounts 0.00 Freight 12.99
Johnson Health Tech NA Inc. Misc./Duty 0.00 Freight Disc. 0.00
1600 Landmark Drive Other Fees 0.00 Tax 0.00
Cottage Grove, WI 53527 :r - ,
Subtotal 153.15 ,Total USD :��, � ,�����,166.14
.A Service Charge of 1.5% Per Month
Will Apply To All Delinquent Balances
o vrsio FITNESS. M -r Fz 1 X
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H®euz®m
FITNESS
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.
364209 Johnson Health Tech NA, Inc. Terms
1600 Landmark Drive
Cottage Grove, WI 53527
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO# Amount
7/17/12 9001024209 Equipment for Fitness bike TV 31069 $ 166.14
Total $ 166.14
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.
364209 Johnson Health Tech NA, Inc. Allowed 20
1600 Landmark Drive
Cottage Grove, WI 53527
In Sum of$
$ 166.14
ON ACCOUNT OF APPROPRIATION FOR
109 - Monon Center
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1096-21 9001024209 4238000 $ 166.14 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
9-Aug 2012
Signature
$ 166.14 ' Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund