214389 11/07/2012 a" CITY OF CARMEL, INDIANA VENDOR: 362032 Page 1 of 1
ONE CIVIC SQUARE PAPER-LITE
CARMEL INDIANA 46032 1711 WOOD VALLEY DRIVE CHECK AMOUNT: $6,176.00
,
CARMEL IN 46032 CHECK NUMBER: 214389
CHECK DATE: 11/7/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1202 4351502 4567 6, 176 . 00 RIO FORMS
1-
i IT BnQ9®Bce
1711 Wood Valley Drive
Carmel, IN 46032 DATE INVOICE#
10/26/2012 4567
BILL TO
City of Carmel
Attn:Terry Crockett
One Civic Square
Carmel,IN 46032
P.O. NO. TERMS DUE DATE
27715 Net 30 11/25/2012
DESCRIPTION QTY RATE AMOUNT
Laserfiche Product Rio Forms-Internal and External 10%Users 80 70.00 5,600.00
License
LSAP-Laserfiche Software Assurance Plan--prorated until 80 7.20 576.00
4/29/2013
Subtotal $6,176.00
Sales Tax (0.00) $0.00
Total $6,176.00
Phone# Fax# E-mail
812-350=5044 317-581-9409 nancy @gopaperlite.com
i
Ck ®� Carmel INDIANA RETAIL TAX EXEMPT PAGE
CERTIFICATE NO.003120155 002 0,J,`r PURCHASE ORDER NUMBER
' FEDERAL EXCISE TAX EXEMPT
35-60000972 27715
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
'URCHASE ORDER DATE DATE REQUIRED REQUISITION NO. F VENDOR NO. DESCRIPTION
1012412012 Laserfiche Forms Support
Paper-Lite Divison of Mathes Assoc., Inc. Carmel Communications
VENDOR SHIP Terry Crockett
1711 Wood Valley Drive TO 3 Civic Square
Carmel, IN 46032 Carmel, IN 46032
(317)571-2567
CONFIRMATION BLANKET CONTRACT PAYMENTTERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Account 43.515.02
9 Each Laserfiche forms annual support $6,176.00 $6,176.00
Sub Total: $6,976.00
r y A,
NL
Send Invoice To:
City of Carmel
Terry Crockett
3 Civic Square
Carmel, IN 46032- PLEASE INVOICE IN DUPLICATE
DEPARTMENT 'f ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
Carmel IS Dept. PAYMENT $6,176.00
• A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
SHIP REPAID.
THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
•
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED.
•PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY A.
SHIPPING LABELS. DIPeCtOP
•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
Q���� CLERK-TREASURER
DOCUMENT CONTROL NO- 27715 A.P.V. COPY-SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER NOWARRANT
NO�____
ALLOWED 20__-
iN THE SUM OF$
'
^
{)N ACCOUNT{lF APPROPRIATION FOR
. ^
'
_ Board Members
PO#or INVOICE NO. ACCT#MTLE AMOUNT
/ hereby certify that the attached invoioe(e)' or
biUkAiobare\ true and correct and that the '
materials or services itemized thereon for '
which charge ia made were ordered and
receivedexnop�
/
. '
�.
20____
'
.
`
^
Signature '
. �
. Title
Cost mamuunoo ledger classification if
claim paid motor vehicle oighwdyfund �
VOUCHER NO. WARRANT NO.
ALLOWED 20
Paper-Lite Divison of Mathes Assoc., Inc.
IN SUM OF $
1711 Wood Valley Drive
Carmel, IN 46032
$6,176.00
ON ACCOUNT OF APPROPRIATION FOR
IS Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
27715 I 4567 I 43-515.02 I $6,176.00 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
Thursday, November 01, 2012
Director , IS
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))
10/26/12 4567 $6,176.00
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