Elffl! 12/18/2012 CITY OF CARMEL, INDIANA VENDOR: 354867 Page 1 of 1
ONE CIVIC SQUARE RUNYON EQUIPMENT RENTAL
CARMEL, INDIANA 46032 410 W CARMEL DRIVE CHECK AMOUNT: $27.90
CARMEL IN 46032 CHECK NUMBER: 215759
CHECK DATE: 12/18/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 252154 27 . 90 MATERIALS & SUPPLIES
In consideration of the payment of additional rent Classified as'damage waiver by the Rentee,Renter agrees to,and hereby does waive its right,or any right it might
Runyon have against the Rentee,arising from normal damage of the rental property,normal damage to be determined by Renter.The undersigned shall pay upon return of
A`AA property rented a sum equal to 5%of rental charge.This'damage waiver does not include damage or loss of the property as a result of the negligence of the Rentee
or in the case of abusive damage,theft or other gross negligence of the Rentee.This damage waiver shall not apply to reckless,careless or abusive operation or use
SURFACE PREP RENTAL&r SUPPLY of the Equipment,use or operation of the Equipment exceeding its rated capacity,or damage to tires,tubes and wheels caused by blowout,bruises,cuts,punctures or
other causes inherent in the use of the Equipment.It is understood the amount paid is not an insurance premium,and that this provision does not represent an insurance
410 W.Carmel Drive•Carmel, IN 46032 policy or an agreement to insure.Equipment that is stolen or damaged by Rentee will pay list for parts,labor or,if a total loss,will pay replacement cost of equipment
The Rentee further acknowledges receipt of the aforementioned equipment and materials,or covenants to use said property in a careful and prudent manner and
CARMEL•F151%7-5•INDIANAPOLIS shall not loan,sublet,mortgage or in any manner dispose of same to any person without the written consent of the owner,and further agrees to return the equipment
to Renter in substantially good condition as when received,natural wear and tear excepted.
317 - 566 — 8888 The parties agree that in the event the Rentee violates any of the terms and conditions of this agreement,the Renter may collect damages together with reasonable attorney
fees,court costs and interest of one and one half(11/2)percent per month added to accounts over ten(10)days old,ref acting an annual percentage ate of eighteen(18)percent
FAX:317-566-2990 The above equipment has been received by the undersigned for rental purposes only,and it is understood that Renter shall be held responsible for any accident or
damage resulting directly or indirectly from the leased equipment.The Renter expressly disclaims all warranties,either expressed or implied,including any implied
"Don't be a toot-Rent one" warranties of merchantability or fitness for a particular purpose,and neither assumes nor authorizes any other person to assume for it any liability connection with the
use of this equipment. The Rentee agrees to indemnify Renter,from any claim,loss,damages to property,consequential damages,loss of income or any other
www.runyonsurfaceprep.com incidental damages,even those damages caused by the negligence of Rentee,together with attorney fees for defending any action brought as a result of the lease
of this equipment.
Open 7 Days a Week Monday- Friday 7:00 am -5:30 pm •Saturday 7:00 am -4:30 pm•Sunday 9:00 am -3:00 pm
RENTED.'TO JOB "LOCATION TICKET,#
CARMEL WATER DISTRIBUTION # 161 SHOP
3450 W. 131ST STREET Con# 252154
CARMEL IN 46074
Loc 100
SSN: "PHONE DATE TIME: •
W (317) 733-2855 OUT 12/10/12 10:26 AM MS
C (317) 733-2840
ID#3 PO/JO$ ,#.:' y :: ::-r;.;;,;,`,,.; RECEIVED. BY
ISENBERGER, TONY 12110112 10:27 AM MS
***FINAL*** Page: 1
QTY.`:ITEM# . '== EXT AMT NET;.AMT,
MIN HOURLY O�Tid�ITE;`• 8-HOUR DAY. WEEK'i- 4 WEEK "
1 102 PROPANE 40 POUND REFILL „ 27 . 90 27 . 90 27 . 90
IFTHE EQUIPMENT IS NOT RETURNED BY"DUE IN"DATE,YOU WILL BE SUBJECTTO A CHARGE OF CONVERSION(TH
Use of alternative fuels,(Biodiesel,E85,etc.)in Runyon Surface Prep Rental&Supply equipment is PROHIBITED RENT 0.00
Customer is liable for all damages&repairs that result from alternative fuel. SALES 27. 90
1 HAVE BEEN INSTRUCTED&DEMONSTRATED ON THE SAFE&PROPER OPERATION OF THE ABOVE EQUIPMENT AND I OTHER 0.0 0
FULLY UNDERSTAND THOSE INSTRUCTIONS.I ALSO UNDERSTAND THAT I AM THE PERSON RENTING THIS PROPERTY,AND
THAT RUNYON SURFACE PREP RENTAL&SUPPLY DOES NOT GIVE ME PERMISSION TO LEND THIS PROPERTY TO ANY DW/FEES 0. 00
OTHER PERSON. I UNDERSTAND THAT GIVING OR LENDING THIS PROPERTY TO A Y OTHER P ON FOR ANY REASON
IS UNAUTHORIZED BY RUNYON SURFACE PREP RENTAL&SUPPLY X - Addl TAX 0.00
THE UNDERSIGNED,HAVING READ AND UNDERSTOOD THE ABOVE,HEREBY AGREES TO REN THE ARTICLE ED 0 e THE ALE S TAX 0.00
TERMS AND CONDITIONS SET FORTH IN THIS RENTAL AGREEMENT.I HAVE READ THE ABOVE FORMATION AN ACKNOWLEDGE
THAT IT IS CORRECT,COMPLETE AND ACCURATE. I PROMISE THAT AS A CONDITION OF RENTING EQUIPMENT THAT IF MY
EMPLOYMENT, ADDRESS OR PHONE NUMBER BE CHANGED, I WILL NOTIFY RUNYON SURFACE PREP RENTAL&SUPPLY DEPOSIT 0.00
IMMEDIATELY. RUNYON SURFACE PREP RENTAL&SUPPLY IS AUTHORIZED TO BILL MY CREDIT CARD FOR ANY AND ALL COSTS,
FEES,AND/OR INTEREST CHARGES ASSOCIATED WITH ANY CLAIM,LOSS,OR DAMAGES TO PROPERTY AS A RESULT OF THE
RENTAL OFTHIS EQUIPMENT.IF EQUIPMENT IS RETURNED DAMAGED,AND NOT DISCOVERED BY RUNYON SURFACE PREP RENTAL
&SUPPLY UNTIL AFTER THE CUSTOMER LEAVES AND HAS SETTLED THE BILL,RUNYON SURFACE PREP RENTAL&SUPPLY IS TOTAL DUE 27.90
AUTHORIZED TO RUN ANY FORM OF PAYMENT ON FILE TO SATISFY EQUIPMENT REPAIR.LABOR RATE CHARGED AT$85 AN HOUR.
EQUIPMENT AMT BILLED 27. 90
CELL
:r, t!,
LEASED BY X l:l5' PHONE 10—DEC-12 10:27 :50
u RETU NEDTBY X -- - - ,:_ `Q I :. .� RENTAL FEES DO NOT APPLY TO PURCHASES.
WE CHARGE FORTIME OUT NOTTIME USED. Equipment is clean and full of fuel please return as such or additional charges
YOU ARE RESPONSIBLE FOR ALL TIRES,FUEL AND ELECTRIC CURRENT. will apply. X "IAL
NO ADJUSTMENTS OR CREDITS will be made on equipment malfunctions We charge a 5% Damage Waiver on all equipment rentals.
unlace Runvnn Surfara Pran Rental R Sunnly has heen notified. 9 9
TERMS AND CONDITIONS
1.Inspection.Customer acknowledges that it has had an oppot tunity to personally inspect the equipment and finds it suitable for its needs and in good condition,and that Customer understands if's proper use.Customer further acknowledges its
duty to inspect the equipment prior to use and notify Runyon Surface Prep Supply LLC (hereinafter"Runyon')of any defects.
2.WARRANTIES.THERE ARE NO WARRANTIES OF MERCHANTABILITY OR FITNESS,EITHER EXPRESSED OR IMPLIED.THERE IS NO WARRANTYTHATTHE EQUIPMENT IS SUITED FOR CUSTOMER'S INTENDED USE.ORTHAT
IT IS FREE FROM DEFECTS.
3.Indemnification, Customer agrees to assume the risks of,and hold Runyon harmless for,property damage and personal injuries,including death and dismemberment,caused by The equipment andror arising out of Runyon's negligence
Customer shall indemnify and defend Runyon against and hold Runvon harmless from any and all claims.actions.suits,proceedings,costs,expenses,damages and liabilities including attorneys fees which(t)relate Ic injury arts,destruction of
property,or bodty inury,caress,sickness,disease or death of any person;including employees of Customer),and(2)are caused by.or claimed to be caused,in:whole or i:i pa;.by the equipment leased herein or by the liability,or conduct(indiiding
active,passive,primary or secondary)of Customer.its agents of employees,or anyone for whose acts any of them may be liable.Customer shall,at its own cost or expense,defend Runyon against all suits or proceed:ngs commenced by anyone
n w^on Runvor:is a named party for which Runyon is alleged to be liable or responsible as a result of or arising out of the equipment,or any alleged act or omission by Runyon,and Customer shall be liable and responsible fora!costs,expenses
and attorney's fees incurred in such defense anator settlement,;udgment or other resolution. In the event that such action is commenced naming Runyon as a party,Runyon may elect to defend said action on its own,beha f and Customer agrees
that it shall be liable for all costs,expenses anc attorneys fees incurred by Runyon in such defense
4.Rental Charges and Terms. Equipment with hour meters is allowed eight(8)hours use wdhm a 24-hour period of time. Rental rates for equipment are based on usage during this eight(8)hour shift. If Customer rani,the equipment For over 8
hours it ere day.Customer vAl be cha god for extra hours on equipment One day is 24 hours or eight(8)hours running time. 16 hours running time in 24 Fours=a 2-cay charge 24 hours running time in 24 hours=a 3-day charge
5.Future Rentals,Customer acknowledges that the terms of this Agreement will be deemed to apply to all Equipment Customer may rent or purchase from Runyon.,whether on the data of this Agreement or at am time in the futpre except only
as to any Equipment and/or other items with aspect in which Customer executes a new Agreement),
6.Prohibited Uses. Use of the equpment in the foi:o:ving circumstances is prohibited and constitutes a breach of this Agreement:(a)Use for illegal purpose or ri an Illegal manner,(b)Use when the equipment is in bad reps,or is unsafe;'c)
Improper,unintended use or misuse;(d)Use by anyone otter that:Customer or its employees,,vthout Ruryon's written permission,(a)Use at any location other than the address furnished Runyon without Runyon's writer permission.
7.Fuel and Oil Levels.All ecupmert is`ull of f:fel when rented to Customer and must be returned to Runyon!Lill or additional charges will apply.Also,use of alternative fuels(Biod!ese,E85,etc.)in Runyon equipment is prohibited.Customer is
able for all damages and repairs that result from alterative fuel, Runyon checks the of level in the equipment when it is rented to Customer. Maintenance of proper oil ievei in the equipment!s solely the resp-onsibility of Customs,.
8.Repossession.Upon a fa8ure to pay rent or other breach of this contract,Dealer may terminate this contract and take possession of and remove the goods from:wherever they are,and Dealer and his agents sha'.;not be!iab:e for any clams
far damage or trespass arising out of the r<moval o!the goods.
9.Tires. Customer is totally responsble far aN tire repair it is Customer's option to check over the tires before the equipment leaves and notify Runyon:of any irregularities spotted.
10.Insurance. Runyon's:nsurarce does riot cover equipment while in Customer's possess,on. Customer is iesponsible for insuring the equipment once it leaves Runyon's property and unto it has been returned:c Runyon s property zinc
payment has been rece tied.EQUIPMEN"MAY ONLY BE RETURNED DURING NORMAL BUSINESS HOURS,ANY EQUIPMENT LEFT AT RUNYON'S LOCATION OTHER T^AN NORMAL B:JSINESS HOURS REILIA:NS THE CUSTOMERS
RESPONSIBILITY.
11.Cleaning Charges. Egmpm:ent is to be returned to Runyon as dean as:when it left.A charge of sixty-five dollars(S65.00)per hour will be charged for cleanup.
12.Assignments,Subleases and Loans of Equipment.Runyon may assign its rights unoer,his Agreement without Customer's consent,but will remain bound by all obligations here'sh.Customer may rot sublease of van the equipment v"It bout
Runyon's:tribe>t permission.Any pat ported assignment oy Customer is void.
13.Time of Return. Customer's right to possession terminates on the expiration of the rental period("Due in"date&time)and retention of possession after this time constitutes a material breach of Iii s Agreement.Tinie is of the essence in this
Agreement.Any extension must be mutually agreed upon in writing.
14.Late Return.Title to equipment is and shall at a,l times r n,wri`with Ruttyor. Failure to return the equipment by the"Due in"date will subject Customer to a charge of conversion;theft)
15.Time of Payment.,Accounts are due and payable at the terminabon of the rental period,
16.Violation of Agreement and Venue Costs. Customer agrees that in the event the Customer violates any of the terms and conditions of this agreement,Runyon may collect damages together:wit!:reasorab:e ottmney's fees court ccss and
nieces;of one and one half(1 t;;)percent per month added to accounts over ten(10)days old,reflecting an annual percentage rate of eighteen(18)percent Customer agrees that this agreement is;o be construed under the laws of the State of
ird ana and that if legal action is brought to enforce this agreement,,hat Hamilton County.Indiana,shall be the jurisdiction and legal venue for said action,unless otherwise agreed by Runyon and Customer at a iatet time.
17.Waiver,Any is lure by either party to enforce any provision of this Agreement shall not constitute a waiver of such provision or prejudice the right of either party to enforce such provision thereafter.
18.Damage Waiver. In consideration of the payment of additional rent nits!fied as-damage waiver"by Customer,Runyon agrees to,and hereby does,waive its right,et any right it might have agairist Customer,arising from normal damage of the
rental property,normal damage io be determined by Runyon.Customer shall pay upon return of property rented a sum equal to 5%of rental charge This"damage waiver"does not include damage or blithe property as a result of the negligence
of Cusomer or in Me case of abusive damage,theft or other gross negligence of Customer.This damage waiver shall not apply to reckless,careless or abrasive opilrat on or use of the equipment,use or operation of the equipment exceeding its
rated capec:ty,or carnage to tires,tubes an:wheels caused by blowout.bruises,cuts,punctures or other causes inherent in the use of the eqi iipment.it is understood the amount paid is not an insurance premium.and that tris provision:does not
-epasent an insurance policy or an ag°eement to insure No damage waiver license.sales or use taxes are included in Runyon's rental rates.They are extra.
19.Damaged.Dirty.or Lost Equipment.Customer agrees to pay tar any damage to Critics of the goods,regardless of cause,except neasorab e.wear and tear.while the goods are out of Runyon's possession.Equiorhent lost,stolen or damaged
beyono repay will be paid!or at its current list price plus the cost OF rental up to the time of reporting the loss or theft to Runyon.The cost of repairs will be borne by Customer,whether performed by Runyon,Or,at Ronpon's Collar,by others.at a
charge of sixty-five Colors($65.0M per Flour plus pats.
20.Severabifity.The provisions of th s Agreefttent shaN be severahle so that the:nvaifdify unenforceability,or waiver of any o the provisions shall rot affect the remaining provisions.
21,Loading and Unloading Equipment. Custorne,is responsible!or loading and unloading equipment If Ruryor's employees assist in leading or unloading the equipment,Customer agrees to assume tee ns' of and ri'dJ :anyoll am for Its
e.mp ogees narn!ess for any property damage or personal mluces,including damage and personal injuries attnbutab e to the negligence of Runyon.
22.Property Damage, Runyon is not resporsible for any damage whatsoever as a result of on-the-job deliveries or pick-up by Ruryor.
23,Fees.Licenses,Permits Taxes and Fines.Customer shall be solely responsible for payment of any fees,licenses,permits,taxes or fines,requited by or resulting from the Customer's use or gpe!ation of the squipme°t
24,Charges,C,istomor shy'!par z'a charges monied uncer this Agreement upon demand.Customer agrees that mileage and time charges are minimum charges only and that no refund or itti, bursement is due Customs:,in the event tear fewer
days anc+or Fries are actualiv used.
25.Other Liability,Customer assumes all risks from the improper use of the equipment.Customer is responsible for damages to Customer`s property or goods in storage or in transit or for any p'party l0 or storey:r tf e egupfrort,Or?sevahere
n he rartiny cC:ftion.Customer agrees no:to hold Runyon liable for damages from down time,materials or other consequential damages resulting from the use of the equipment.Customer releases ano holes=jnyon.its agents and emr,!oyees
narr^'ess from and against any and a'losses.:iab bites,damages,injuries.claims,costs and expenses arising out of O,ustomer's use or possession of the equipment,including.but net limited to any and a!fires,penalres and forfeitures imposed by
any goaernnhentz n;ify and.to the 2xtect not covered by'nsurance-any claims or liabilities to third parties arising out of the abandonment,conversion,concealment or unauthorized sale d`the equipment by Customer,or its agents or empldVeas,
„r for G.e confscation of the equipment by any governmental atdhonty because of illegal or improper use.Customer shall addit:onaily meld Runyon harmless for all loss,liability,and expense it excess of the if^its at Itabil tv p-ov!dec for herein as a
of In,lry,Berth or property damage a-!sing out of Customer's use of the equipment. Neither Customer nor any other user of the equipment shall be deemed the agerit,servant or emp oyea of Runyon for any redson or any purpose. Ourirg
:he ter^o`Ihis Aareement.Customer ass:imes full responsibility for the equipment to the public and any regulatory body having jurisdiction.
26.DeliverylPick Up.Delivery is made to closest point truc!c can park.Extra charges`Trill result in deliveries to upstairs,elevator use or any point where extra time is:nvo'ved.Our service does not relude set up and knock oewr of tao'es and chairs.
If this service!,:requird,arrangements should be made several brays prior to delivery with a special charge quoted.If no arrangements are made and this service is desired on delivery,Our driver must call for autho l'za*'on if'!—e permits,we will
try to accen.m;date you after quoting the price On pick up where lie prior arrangements have teen made and rental items are not knocked dawn and assembled in olio sheltered area,tables-,no Chairs r,J:i be ter:Lint`the reyf day;Aden a special
crew,can be scheduled T`ere will be art and Ilona!one day rental A knock down fee will fesuit if rental items are staff up.
27.Waiver of JuryTrtal.Each party:naives its rfgnt to a;ury trial of any gram or cause of action based on or ans;ng out of this agreement or the sub:oct matter hereof.This waiver pertains c air'disp,tes that may relate F,the sub ect matte,t erect
n•duorng,wltho:4:n,hation,contract.tort.breach of outs and all other common law and statutory claims,and will no;be subject to any exceptions.Each party(A)understands that h's is a waiver of erpor;arr!ega:rents and(Bj ack;to`mieoges;fret
Fief;hevit has hau a reasgrab'e opportunity to dscuss this waiver and its effects with legal counsel.Accordirary,each party knowingly,voluntarily.irrevocably and unconditionally waives its fury tr ai rig°)ts.
28.Tickets,Fines and Penalties,You agree to fu:iy and promptly pay all tines,penalties,parking tickets,tragic tickets,tolls•court costs,attorneys'fees and other charges assessed during the-arm in connection w^th the r.>e,parking,storage,aria
possession of the Equipment,regardless of the identity of the driver of any vehicle You rent from Us.
29.Trailers and Towing.The customer is responsible for inspecting and maintaining the trailer coupling mechanism,safety Chairs,all tie downs,pins and lights is a safe and secure condition while in their possess ort.Customer agrees not to tow
ans tra ter rented from LESSORrDEALER fa)in a careless or negligent manner.(b)at excessive speed or(c)while under the influence of medication,alcohol.or illicit drugs.
30.Headings.The headings used nerein are solely for convenient reference and sha'I not be used to construe or affect the interpretation of this Agreement.
ADDITIONALTERMS AND CONDITIONS FOR SALES
All sales are also govemeq oy the parties'Ecu prnent Purchase Agreement. if the Equipment Purchase and the Terms and Conditions previously enumerated are inconsistent.then the terms from the Equipment Purchase Agreement preva:.
AS-IS—NO WARRANTY:THE WARRANTY:S THE SOLE AND EXCLUSIVE WARRANTY APPLICABLE TO THE EQUIPMENT AND ALL OTHER EXPRESS OR IMPLIED WARRANTIES.!INCLUDING,WITHOUT LIMITATION,THE IMPLIED
1NARRANTiES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSES,ARE EXCLUDED FROM THE SA!E OF THIS EQUIPMENT RUNYON SURFACE PREP SUPPLY LLC OR AFFILIATED COMPANIES W:LL NOT BE
JAKE OR RESPONSIBLE FOR ANY SPECIAL,INCIDENTAL OR CONSEQUENTIAL DAMAGES ARISING OUT OF OR RELATEDTOTHE SALE OF THIS EQUIPMENTTO CUSTOMER,REGARDLESS OFWHETHEH SUCH DAMAGES ARISE
UN:DER-N"cOH ES OF THE't.AyN OF CONTRACTS OR TORT
RETURN POLICY FOR PURCHASED ITEMS:The customer;s hap'e for all shipping costs when returning or exchanging an item to Runyon,unless the Drodgct has been damaged during shipping.Th s policy also applies to warranty rooms As
stated':f the Runvor.°Return Policy,'when customers return an from or items for credit,a 25 ti,restocking fee will be charged to your account,plus ail applicable inbound and outbound frefght.This policy also applies to shipments refused and returned.
All caccelial�ons of whole goods are suDieC:to a 25%(at total invo ced order)cancellation fee or.in stock items from Runyor.locations ONLY Return shipping of the product is not refundable.All paits purchases are non refundable Any shipment
reserved in conditions other than brand nr:v will be charged 50%restocking fee of the total arnoum.All returns must be properly boxed before they are returned.If's the customer's responsibility to report any damages shortages within 48 hours
of receiving the product.Runyon,viii not accept claims 48 hours after de!ive.ry.Runyon will not accept returns without authorization.Upon issuing a Merchandise Return Authorization(MRA).Ru!von will instruct cusomom as to the best means of
return;r g merchandise.Ri rayon's MRA's are valid for 30 days after issuarce.MRAs are not valid after the 30 day time limit expires.Runyon will absolutely noi,under any circumstances,issue an MRA for ret urns on used or damaged products.Any
fie'grit rrfatcs crantai;e rnas:be rioted ri the signed B''i of Lading AT-HE TIME OF DELIVER'.The purchase price at time of sale is final.
REPRESENTATIONS AND WARRANTIES:Seer represents and,vartarts that(at Seilet has all necessary,right,power and authority to enter into and perform the transactions referenced herein;(b)Seller has good and marketable tuie to the
cq„p—e:`i;anc ic)cr the Trens'et Date,Soler will ccrvey the santo to Brayer(save enPv;or the purchase money!Ion,if any,to be retained by Seiler should Seller,at its sole option,elect to fitaiiCe all or any portion of the Purchase Price).Buyer
°epresarrs and sarral;s that(i Euver has all necessary ndht,power and authority to enter into and perform the transactions referenced herein;Q!)Buyer has selected and carefully inspected anti examined the Eq=uipment end found the same to be
arce2rii,ie to B ape,in al respects eased on cntena es:ablfshed so:e:y by B:,yer and not based on ary recommendation by Seller;and(w)Buyer has received,carefully reviewed and is satis`:ed with,all available training,iris;rt,ctrons,Operating anc
,:se manuais wilt doer i,ifcr-ailcn tin6 ding al;training req.wed.m ter applicable OSHA andror.ANSI Standards,if any)regarding the proper and sate transportation,use,maintenance,repair anc storage of the Equipment.
VOUCHER # 123051 WARRANT # ALLOWED
354867 IN SUM OF $
RUNYON EQUIPMENT RENTAL
410 W CARMEL DRIVE
CARMEL, IN 46032
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT i Audit Trail Code
252154 01-6200-06 $27.90 j
r
Voucher Total $27.90
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
354867
RUNYON EQUIPMENT RENTAL Purchase Order No.
410 W CARMEL DRIVE Terms
CARMEL, IN 46032 Due Date 12/13/2012
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
12/13/201: 252154 $27.90
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
/z/-ell Z-
Date Officer