214447 11/07/2012 �yf CITY OF CARMEL, INDIANA VENDOR: 314125 Page 1 of 1
ONE CIVIC SQUARE UPS CHECK AMOUNT: $18.40
a LOCKBOX 577 CARMEL, INDIANA 46032
o�`o CAROL STREAM IL 60132-0577 CHECK NUMBER: 214447
CHECK DATE: 11/7/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 76V77A412 18 .40 CONT SERVICES OTHER
Delivery Service Invoice
Invoice date October 13, 2012
Shipped from: Invoice number 000076V77A412
CARMEL UTILITIES DISTRIBUTION Shipper number 76V77A
3450 W 1031ST ST Control ID OG64
WESTFIELD,IN 46074
Page 1 of 3
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0249A000076V77A9 77401200028401 Visit ups.com/billing
AT 01 024536 94453H 79 D**3DGT For questions about your invoice,call:
(800)811-1648
Monday-Friday
CARMEL UTILITIES 8:oo am.-9:oop.m.E.T.
3450 W 131ST ST or write:
CARMEL, IN 46074-8267 UPS
P.O.Box 7247-0244
�k Philadelphia,PA 19170-0001
Account Status Summary
Weekly Payment Plan Thank you for using UPS
Amount Due This Period $18.40 Summary of Charges
Amount Outstanding(prior invoices) $23.59 age Charge
Total Amount Outstanding $41.99 Outbound
Please include the Return Portion of each outstanding invoice with 3 UPS Internet Shipping $18.40
your payment.See Account Status for details. Amount due this period $18.40
Questions about your charges?
To get a better understanding of the charges on your invoice, UPS payment terms require payment of this invoice by October
visit our invoice guide and glossary of billing charges at 24,2012'
ups.com/invoiceguide. Note:This invoice may contain a fuel surcharge as described at
ups.com. The published fuel surcharge is 8.0%for UPS Ground
Services and 13.5%for UPS Air Services,UPS 3 Day Select,and
International services.For more information, visit ups.com.
i
Delivery Service Invoice
Invoice date October 13, 2012
Invoice number 000076V77A412
Shipper number 76V77A
TM
Page 2 of 3
Account Status
Weekly Payment Plan
Payments Applied
Amount
Invoice Number Invoice Date Paid
000076V77A372 09/15/2012 $38.28
Account Status
Weekly Payment Plan
Amount Outstanding(prior invoices):
Please include the Return Portion of each outstanding invoice
with your payment.
Balance
Invoice Number Invoice Date Due
000076V77A392 09/29/2012 $23.59
Total $23.59
Outstanding balances reflect any payments received as of
10/12/2012.Please ignore this message if a recent payment has
been made for any outstanding invoices.
Delivery Service Invoice
Invoice date October 13, 2012
1 Invoice number 000076V77A412
Shipper number 76V77A
Tw
Page 3 of 3
Outbound
UPS Internet Shipping
Pickup ZIP Billed
Date Tracking Number Service Code Zone Weight Charge
10/05 1 Z76V77A0399874737 Ground Commercial 46202 2 2 8.52
Fuel Surcharge 0.68
Total 9.20
1st ref:Weekly Fluoride UserlD:CarmelWater
Sender :Michelle Breedlove Receiver:Environmental Sample
Carmel Utilities Distributin Indiana State Dept of Health
3450 w 131 st 550 West 16th Street
Carmel IN 46074 INDIANAPOLIS IN 46202
10/11 1Z76V77A0391489285 Ground Commercial 46202 2 2 8.52
Fuel Surcharge 0.68
Total 9.20
1st ref:Weekly Fluoride Samples UserlD:CarmelWater
Sender :Michelle Breedlove Receiver:Environmental Sample
Carmel Utilities Distributin Indiana State Dept of Health
3450 w 131 st 550 West 16th Street
Carmel IN 46074 INDIANAPOLIS IN 46202
Total for Internet-ID:CarmelWater 18.40
Total UPS Internet Shipping 2 Package(s) 18.40
Total Outbound 2 Package(s) 18.40
VOUCHER # 122576 WARRANT # ALLOWED
314125 IN SUM OF $
UPS
LOCKBOX 577
CAROL STREAM, IL 60132
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
s
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
76V77A412 01-6360-03 $18.40
{
Voucher Total $18.40
Cost distribution ledger classification if
claim paid under 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 of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
314125
UPS Purchase Order No.
LOCKBOX 577 Terms
CAROL STREAM, IL 60132 Due Date 10/29/2012
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
10/29/201: 76V77A412 $18.40
I 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
Date Officer