215640 12/18/2012 �.f CITY OF CARMEL, INDIANA VENDOR: 355214 Page 1 of 1
0 ONE CIVIC SQUARE GENUINE PARTS COMPANY-INDIANA P%LI�
CARMEL, INDIANA 46032 5959 COLLECTIONS CENTER DRIVE L�1ECK AMOUNT: $211.87
CHICAGO IL 60693 CHECK NUMBER: 215640
CHECK DATE: 12/18/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4237000 25550 0858537 211 . 87 RADIATOR
100006017 Time: 10:04 - Date: 12/10/2012 Page: 1/1•
CARMEL NAPA
1441 S GUILFORD AVE STE 140
m PA 1111111;.' man= REF BY VER BY Employee: 14 Anna
a.
CARMEL, IN 46032-2922 Sales Rep: 36 TIGE
:., (317) 844-3973
Accounting Day: 10
LCARMEL, Promised Time: Our Truck W- 99-22:04 €� O
F CARMEL POLICE DEPT Attention:
C SQ Tax Exemption:
IN 46032-7570 PO#:
Terms: NET 10
I CD
U
>.c -Part Number:,-. "_Line:
:,i''•:;>< ri " ri"ceo:; t=<<_::;: . ota1:"_,.;;';' ")c.'...
> Description °<Qua tity•� P Ne � T O
CU2837 'NR NAPA RADIATOR 1.00: 403.56 211.8700' 211.87` g
2008 Chevrolet Impala 3.9 L 237 CID V6 OHV w?th € ' O
;VVT j O >
I O
Ln
P
4 LO i
� Subtotal ,211.87.
Indiana Sales Tax 7.0000% 0.00
' s #
Customer Signature
ALL GOODS RETURNED MUST BE ACCOMPANIED BY THIS INVOICE r
TO
r
�>
j REMIT:GPC-IND
Charge Sale• ., 211.87
5959 COLLECTION 'CTR.DR. a
i CHICAGO ILL. 60693
CUSTOMER COPY o
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H i
INDIANA RETAIL TAX EXEMPT PAGE
City o Carmel CERTIFICATE NO.003120155 002 0 Jl PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT
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
Q/7=2
0mulm We ftft Gamed Pollee Depaltmelt
VENDOR SHIP 3 Civic Square
AM gg.�qq,gqCo IN 466
pp j
Collection Center Drive To Carmeel,
�
��i.
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY f� UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Account 42.370,0 p�y J
9 Each radiator $211.87 $211.87
Sub Total: $211.87
�, a 4r2 'H4A
-4 °
i0.Yp E
�'�r�,y � a ate,. u s i a a n .."'•�• �` :f+
Car 9/namiaS
d,
Send Invoice To: a
Camel Police Deparkmont
Attu: Temsa Anderson
3 Civic Squab
Calci, IN 6032- PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
Carmel Police Dept. _ �_� PAYMENT $211.87
gg A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE PO.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS _ I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
SHIP REPAID.
THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
• /
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED. ORDERED BY ,f•�}✓, r��
•PURCHASE ORDER NUMBER MUST APPEAR ON ALL
SHIPPING LABELS. // Chief �j THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE of r`olle@
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. t/
5 5 5® CLERK-TREASURER
DOCUMENT CONTROL NO. A.P.V. COPY-SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER NO. WARRANT
ALLOWED 20
IN THE SUM OF$
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
received except.----------------------------------- ---- —----------- -
20
-...... ... ........... .. .... .............
Signature
....................................................................................................................... .. ..
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
VOUCHER NO. WARRANT NO.
ALLOWED 20
Genuine Auto Parts '
IN SUM OF $
5959 Collection Center Drive
Chicago, IL 60693
$211.87
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
25550 I 858537 I 42-370.00 I $211.87 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, December 14, 2012
//7 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))
12/10/12 858537 repair parts $211.87
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