213167 09/25/2012 - CITY OF CARMEL, INDIANA VENDOR: 00350177 Page 1 of 1
0 ONE CIVIC SQUARE SEARS HARDWARE
CARMEL, INDIANA 46032 DEPT 53-000004369 CHECK AMOUNT: $205.83
®o�` PO BOX 689134 CHECK NUMBER: 213167
DES MOINES IA 50368-9134
CHECK DATE: 9/25/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4238000 T225644 205 . 83 5405534007491408
SearsAft prima Page 1 of 2
Sequence#-500
Commercial®nW ACCOUNT NUMBER 5405 5340 0749 1408
CUSTOMER SERVICE 1-800-599-9712
Account Total Available Billing Cycle Payment Minimum
Balance Credit Line Credit Closing Date Due Date Payment Due
$205.83 $5,000 $4,794 09/05/12 09/30/12 $205.83
Account Summary Payments Received
(Payments received since the last statement period.)
Previous Balance $149.99 Post Date Check Number Amount
Payments -$149.99 08/09 211455 -$149.99
Returns/Exchanges/Adjustments $0.00 Total -$149.99
Purchases& Debits $205.83
Account Balance $205.83
Purchasing Account# 5405 5320 0108 0128
Current Purchases and Debits
® Detail enclosed for new purc hase items since last statement.
Trans Post I Sears Purchase
® Date Date Purchase Location Invoice# Customer PO# Order# Amount
® 08/07 08/07 SEARS HARDWARE 5340 FISHERS IN T225644 SHOPP/BENTLEY212 $205.83
20120807005340'900R7391
Total Purchases and Debits for Account Number 5405 5320 0108 0128 $205.83
® Total Account Activity for Account Number 5405 5320 0108 0128 $205.83
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In Case of Errors or Questions About Your Bill Payment Information
If you think your invoice or billing statement is wrong, Payment must be mailed to us at the payment address
or if you need more information about a transaction shown on the reverse side. Payments that are received
thereon, write us on a separate sheet at the inquiry in the mail at the designated address before 9:00am (CST)
address listed on the reverse side as soon as possible. on any Monday through Friday that is not a holiday will be
We must hear from you no later than 30 days after we credited as of the day of receipt. If payment is not made
first sent you the invoice or billing statement on which as provided herein, crediting may be delayed up to 5 days.
the error or problem appeared.
You agree not to send us partial payments marked
You must contact us in writing in order to preserve your "paid in full","without recourse", or similar language
rights. In your letter, give us at least the following information: unless such payments are marked for special handling
•Your name and account number and sent to the inquiry address on the reverse side.
•The dollar amount of the suspected error This Account is Issued by Citibank, N.A.
• Describe the error and explain, if you can, why
you believe there is an error. If you need more
information, describe the item you are unsure about.
Sears Page 2 of 2
Sequence#-500
Commercial®nW ACCOUNT NUMBER 5405 5340 0749 1408
CUSTOMER SERVICE 1-800-599-9712
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SEND BILLING ERROR NOTICES TO: SEND INQUIRIES TO: CALL 1-800-599-9712
PO BOX 6282 PO BOX 6282 FAX 1-800-599-9711
SIOUX FALLS,SD SIOUX FALLS, SD
57117-6282 57117-6282
Please contact us at: 1-800-599-9712 with account reconciliation instructions. Purchases,returns and payments made just prior to the
generation of this account statement may not appear until the generation of next month's account statement.
In Case of Errors or Questions About Your Bill Payment Information
If you think your invoice or billing statement is wrong, Payment must be mailed to us at the payment address
or if you need more information about a transaction shown on the reverse side. Payments that are received
thereon, write us on a separate sheet at the inquiry in the mail at the designated address before 9:00am (CST)
address listed on the reverse side as soon as possible. on any Monday through Friday that is not a holiday will be
We must hear from you no later than 30 days after we credited as of the day of receipt. If payment is not made
first sent you the invoice or billing statement on which as provided herein, crediting may be delayed up to 5 days.
the error or problem appeared.
You agree not to send us partial payments marked
You must contact us in writing in order to preserve your "paid in full","without recourse",or similar language
rights. In your letter, give us at least the following information: unless such payments are marked for special handling
-Your name and account number and sent to the inquiry address on the reverse side.
The dollar amount of the suspected error This Account is Issued by Citibank, N.A.
o Describe the error and explain, if you can, why
you believe there is an error. If you need more
information, describe the item you are unsure about.
PLEASE ENTER NEW ADDRESS,TELEPHONE NUMBER OR E-MAIL ADDRESS BELOW:
NAME
ADDRESS
/CITY STATE ZIP
l
HOME PHONE BUSINESS PHONE E-MAIL ADDRESS
SCOGBG00000112 Rev.01t12
VOUCHER NO. WARRANT NO.
ALLOWED 20
Sears
IN SUM OF $
P. O. Box 689131
Des Moines, IA 50368-9131
$205.83
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO#/Dept. INVOICE NO. I ACCT#/TITLE AMOUNT Board Members
2201 I T225644 1 42-380.001 $205.83 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
/)/J/pby Friday/Se ber 21, 2012
`Y 1'r/
Street Commis o er
Title'is
Cost distribution ledger classification if
claim paid motor vehicle highway fund
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))
08/07/12 T225644 $205.83
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