212664 09/12/2012 a CITY OF CARMEL, INDIANA VENDOR: 357004 Page 1 of 1
ONE CIVIC SQUARE KONICA MINOLTA BUSINESS SOLUTIO��gg
CH
0 ECK AMOUNT: $660.00
•��+ CARMEL, INDIANA 46032 DEPT CH 19188
PALATINE IL 60055-9188 CHECK NUMBER: 212664
CHECK DATE: 9/12/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1
2200 4353004 35888084 660 . 00 COPIER
Invoice Number: 35888084 Please Remit To: 17
KONICA MINOLTA BUSINESS SOLUTIONS
Invoice Date: 08/31/2012 USA INC
Page 1 of 1 DEPT. CH 19188
Subject to E.O.112478 and the regulations KONICA MINOLTA PALATINE, IL 60055-9188
of the Secretary of Labor on Affirmative For Billing Inquiries Call: 317-870-7000
Action and Equal Opporturnity
CORPORATE DUNS No. 00-170-7322 INVOICE
FEDERAL DUNS No. 62-657-8041
Bill To: Ship To:
CITY OF CARMEL ENG CITY OF CARMEL ENG
1 CIVIC SQ 1 CIVIC SQ
CARMEL IN 46032 CARMEL IN 46032
Account Nbr Purchase Order Nbr Service Order Nbr/Notif Nbr Serial Nbr
2573297 /257397 1L 5541 52280219 1115108071 SN A00K01000394 8
Service Date Equipment Serviced Equipment Number Terms of Payment
08/09/2012 BIZHUB C451 2748611 NET 30 DAYS
Quantity Unit Material Nbr Description Net Price Amount
1 EA 7670900008 Service Labor Charge - CF 160.00 135.00
1 EA A06003F IMAGING UNIT IU610K (BLACK) 500.00 500.00
SUBTOTAL 635.00
Trip Charge 1bg7 8 910 7�, 25.00
ID
c� 2p1'
ENG
�9�SZVIZ£ZZ
AMOUNT DUE 660.00
.... . .. ... ..... ..... .. ....... . . ... ...... ..... ........... ...... ... ....... ...
DETACH HERE AND RETURN WITH REMITTANCE
CUST. NO. INVOICE NO. AMOUNT
CITY OF CARMEL ENG 257397 / 257397 35888084 660.00
1 CIVIC SQ DATE ORDER REF. PAYMENT TERMS
CARMEL IN 46032
08/31/2012 52280219 NET 30 DAYS
SEND YOUR PAYMENT TO:
You may also pay on line at www.MyKMBS.com KONICA MINOLTA BUSINESS SOLUTIONS
using your Payer ID # 257397 USA INC
DEPT. CH 19188
-w -�
ISA PALATINE, IL 60055-9188
/1M vI� +
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
Konica Minolta Business Solutions Purchase Order No.
Dept. CH 19188 Terms
Palatine, IN 60055-9188 Date Due
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s) Amount
8/31/2012 35888084 service/parts for copier $ 660.00
Total $ 660.00
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.
Konica Minolta Business Solutions ALLOWED 20
Dept. CH 19188 IN SUM OF $
Palatine, IN 60055-9188
$ 660.00
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT# I hereby certify that the attached invoice(s), or
0 35888084 2200-4353004 660 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
�iVl l.0 9/10/2012
ignature
City Engineer
Cost Distribution ledger classification if Title
claim paid motor vehicle highway fund