213922 10/23/2012 CITY OF CARMEL, INDIANA VENDOR: 362355 Page 1 of 1
` ONE CIVIC SQUARE G H S CHECK AMOUNT: $1,881.75
4 CARMEL, INDIANA 46032 8349 N WASHINGTON STREET
SHERIDAN IN 46069 CHECK NUMBER: 213922
CHECK DATE: 10123/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4350100 25476 2012-1399 1, 881 . 75 LAMPS
S, Inc. �� Guaranteed
Women-Owned Business Enterprise
8349 North Washington Street Honest
Sheridan, M 46069 Service
AD
MCI-
Bill To Invoice
City of Cannel Police Department
Attn: Teresa Anderson Date Invoice#
3 Civic Square
Carmel, IN 46032 10/18/2012 2012-1399
P.O. No. Due Date Terms
25476 11/17/2012 Net 30
Quantity Descri tion Pri a Each Amount
Convert 10 2x4 fixtures to LED;rewire,remove ballasts and install 1,635.00 1,635.00
2 4'LED lamps per fixture
Install 1 new 2x2 LED reflector;remove ballast and rewire with 2 2' 130.00 130.00
LED lamps; No charge for fixture
T LED lamp 61.75 61.75
2'LED lamp 55.00 55.00
Thank you for your business. Total $1,881.75
Payments/Credits $0.00
A 1.5%Service Charge will be assessed on amounts over 30 days past due. Balance Due
$1,881.75
Co INDIANA RETAIL TAX EXEMPT PAGE
ity ® II �°,�rmel CERTIFICATE NO.003120155 002 0 Jl \��� .///l�.�S �v PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 25476
35-60000972
ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES,A/P
CARMEL, INDIANA 46032-2584 VOUCHER, DELIVERY MEMO, PACKING SLIPS,
SHIPPING LABELS AND ANY CORRESPONDENCE.
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL- 1997
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
9IM2012
GHS, Inc. Carmel Police Department
VENDOR SHIP 3 CIVIC Squam
9 North Washington Street TO Carmel, IN 462
Sheridan, IN d (317)671-2559
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Account 43al.00
1 Each LED T lamp $55.00 $55.00
1 Each LED 4'lamps $61.75 $61.75
1 Each convert 2x2 fixtures/install 24* LED lamps r $130.00 $130.00
1 Each convert 2x4 light fixtures to LED iarnpq,`r' :. :, ,'`� - $1,635.00 $1,635.00
Sub Total, $1,081.75
�Se" • � � h ( •g"m ater >�
E
*` �`.. 6a,„” J.i:I y+ a�`' y3L'�° `•;apt
.-fie o r. •< �., �i
Send Invoice To:
Carmel Police Depairtment
Attn: Toresa Andorson
3 Civic Squat
Carmel, IN 46032« PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
Carmel Police Dept. PAYMENT $1,881.75
• A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
,#' NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
�p VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
SHIP REPAID.
THIS APPROPRIATION,SUFFICIENT TO PAY FOR THE ABOVE ORDER.
•
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED. ORDERED BY
•PURCHASE ORDER NUMBER MUST APPEAR ON ALL /
SHIPPING LABELS. �Chlot o§1 pollcla
•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE '
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
2 5 4 d CLERK-TREASURER
DOCUMENT CONTROL NO. - A.P. . COPY-SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER NO..........................WARRANT NO......._..........................
ALLOWED 20
IN THE SUM OF$
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT.# I 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 Y
receivedexcept......._............................._.._._.........--.........._........_._...............
_....._........_....._..__
20
...................................................................................................................................................................................................__............................._..
Signature
..............................................................................................................................................................................................................................................
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
VOUCHER NO. WARRANT NO.
ALLOWED 20
GHS, Inc.
IN SUM OF $
8349 North Washington Street
Sheridan, IN 46069
$1,881.75
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
25476 I 2012-1399 I 43-501.00 I $1,881.75 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
Friday, October 19, 2012
Chief of Police
Title
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))
10/18/12 2012-1399 covert lights to LED's $1,881.75
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