HomeMy WebLinkAbout214908 11/28/2012 CITY OF CARMEL, INDIANA VENDOR: 064915 Page 1 of 1
ONE CIVIC SQUARE CONVEY COMPLIANCE SYSTEMS, INC
CARMEL, INDIANA 46032 9800 BREN ROAD SUITE 300 CHECK AMOUNT: $1,407.00
t?� MINNETONKA MN 55343
CHECK NUMBER: 214908
CHECK DATE: 11/28/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1701 4463202 5432 1, 407 . 00 SOFTWARE
Convey Compliance Systems,Inc Phone; 100-334-1099
9800 Bren Rd E Ste 300 Fax: 100-329-1099
Minnetonka MN 55343-4712 Convey Email: financedept @convey.com
USA Website: www.convey.com
Invoice:5432 --—-_ `f-INVQIC Page: 1 of 1
Date: 8/28/2012
Sold To: Ship To:
Cindy Sheeks City Of Carmel
City Of Carmel One Civic Square
One Civic Square Clerk Treasurer Office
Clerk Treasurer Office Carmel IN 46032
Carmel IN 46032 USA
USA
Fax: 317-571-2410 EMall:csheeks @carmel.in.gov
Customer ID: 1867 c PO Number: Terms: Net 30r ���
Line >°PartNumberlDescn Unft:Price. EztF�ce
1 AP500-650 Taxport A/P-Up to 500 Forms
For tax year beginning April 1, 2012 through March 31, 2013.
Subtotal: 1,407.00
:Peymenf:Scliedule.
Dug Date :;-= ._ Arr0
i 9/27/2012 1,407.00; Total: $1,407.00 USD
Convey
Taxport A/P
Order Form
Tax Year 2012
Date: 0/7/2012
Company: city of Carmel Implementation Requirements
CID: 1867 (Enter email address and select access level)
Primary Contact: Cindy Sheeks Email Address /Access Level
Primary Contact Phone: (317) 571.2428 csheeks @carmel.in.gov
Select Access Level
Primary Contact Email: csheeks0carmeLin.gov Select Access Level
Billing Address: One Civic Square Sele4t Access Level
Select Access Level
Clerk Treasurer Office Select Access Level
City, State, ZIP Code: Carmel, IN 46032
Billing Contact Email: csheeks(�)car•mel.in.gov Overage Fees and Payments
Package: Taxport A/P-AP500 1.All pricing includes TIN services, print and transmit.
1.1 Corrections and reprints(in excess of the
Price: 1,407.00 contracted form volume)through print services are
included for up to 5%of total form volume.Overages
i SKU Price Per Form will be charged at the price per form rate.
(for overages)
aP500 $2.61 1.2 A total of 3 print file submissions and 3 transmit
file submissions are allowed.Additional submissions
AP1000 $2.56
will be charged a fee up to$300 per occurrence.
AP1750 Sz.15 1.3 Clients are given unlimited access to TIN services
AP2500 $2.os during their contracted period.
AP3750 $2.03 2.Activation fees can be charged for either re-instating
i
service or setting up new service.
AP5000 $1.99 3.W-9 and backup withholding notice solicitation
AP7500 $1.94 services are additional and not included in the pricing
AP100o0 $1.90 tiers above.Services are charged at time of usage.
AP12500 $1.8a
AP15000 $1.87 4 tj
Year One Activation Fee:
Client Signature: I Al W.
Payment Method: Select a method 0
Notes/Promo Code: Date:
Title: �U14'L r '-�� ��
Convey Comptiance Systems, Inc.
9800 Bren Road East, Suite 300
800-334-1099 Fax: 888-329-1099
Minnetonka, MN 55343
www.convey.com
sates@convey.com
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Farm No.201(Rev 1995)
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
V Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
i
Total
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.
20
Clerk-Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
f/ L IN SUM OF $
mwa fimki
1 401,
ON ACCOUNT OF APPROPRIATION FOR
7,02,
Board Members
PO#or INVOICE NO. ACCT#!TITLE AMOUNT
DEPT.# I hereby certify that the attached invoice(s), or
Z l` 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
20
i n ure
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund