215764 12/18/2012 CITY OF CARMEL, INDIANA VENDOR: 00351087 Page 1 of 1
ONE CIVIC SQUARE SEARS COMMERCIAL ONE
CARMEL, INDIANA 46032 PO BOX 689131 CHECK AMOUNT: $104.98
DES MOINES IA 50368-9131 CHECK NUMBER: 215764
CHECK DATE: 12/18/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4238900 39 . 99 T140464
2201 4238900 64 . 99 T495471
Page 1 4
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CommercialOnW ACCOUNT NUMBER 5405 5340 0749 1408
CUSTOMER SERVICE 1-800-599-9712
Account Total Available Billing Cycle Payment Minimum
Balance Credit Line Credit Closing Date Due Date Payment Due
$104.98 $5,000 $4,895 12/06/12 12/31/12 $104.98
Account Summary
Previous Balance $0.00
Payments $0.00
Returns/Exchanges/Adjustments $0.00
Purchases& Debits $104.98
Account Balance $104.98
Purchasing Account# 5405 5340 2161 0785
Current Purchases and Debits
® Detail enclosed for new purc hase items since last statement.
Trans Post ears Purchase
® Date Date Purchase Location invoice# Customer PO# Orden## Amount
® 11/08 11/08 SEARS HARDWARE 5340 FISHERS IN T140464 SIGN TRUCK $39.99
20121108005340*500R1700
® 11/08 11/08 SEARS HARDWARE 5340 FISHERS IN T499471 SIGN TRUCK $64.99
® 20121108005340*500R1701
® Total Purchases and Debits for Account Number 5405 5340 2161 0785 $104.98
Total Account Activity for Account Number 5405 5340 2161 0785 $104.98
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In Case of Errors or Questions About Your Bill Payment Information
If you think your invoice or billing statement is wrong, Payment must be mailed to us at the payment address
or if you need more information about a transaction shown on the reverse side. Payments that are received
thereon, write us on a separate sheet at the inquiry in the mail at the designated address before 9:00am (CST)
address listed on the reverse side as soon as possible. on any Monday through Friday that is not a holiday will be
We must hear from you no later than 30 days after we credited as of the day of receipt. If payment is not made
first sent you the invoice or billing statement on which as provided herein, crediting may be delayed up to 5 days.
the error or problem appeared.
You agree not to send us partial payments marked
You must contact us in writing in order to preserve your "paid in full","without recourse", or similar language
rights. In your letter, give us at least the following information: unless such payments are marked for special handling
-Your name and account number and sent to the inquiry address on the reverse side.
•The dollar amount of the suspected error This Account is Issued by Citibank, N.A.
• Describe the error and explain, if you can, why
you believe there is an error. If you need more
information, describe the item you are unsure about.
Sears SEARS COMMERCIAL ONE Page 3of4 CITY OF CARMEL STREET DEPT
BOX 6282 ATTN ACCOUNTS PAYABLE
commerciaiOnwpo 3400 W 131ST ST
SIOUX FALLS,SD 57117-6282 CARMEL IN 46074-8267
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Payment Due Date: 12/31/12 Purchase Location: F I SHERS S t a t e m e n t Date: 1 2 06/1 2
Name: CITY OF CARMEL STREET DEPT Customer PO#:SIGN TRUCK
T-
Invoice#:T140464 Invoice Amount:$39.99 Sears Order#:
Invoice Date: 11/08/12 Cardholder Name:CITY OF CARMEL STREET DEPT Purchase Card#:5405534021610785
Ship to Address:JAMES BENTLEY
WESTFIELD,IN
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1 00917191000 19.2V C3,CM DRILL $39.99 $39.99
Payment Address: SEARS COMMERCIAL ONE Total Price: $39.99
PO BOX 689131 Tax: $0.00
DES MOINES IA 50368-9131 Delivery: $0.00
For Customer Service Call:1-800-599-9712 Grand Total: $39.99
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In Case of Errors or Questions About Your Bill Payment Information
If you think your invoice or billing statement is wrong, Payment must be mailed to us at the payment address
or if you need more information about a transaction shown on the reverse side. Payments that are received
thereon, write us on a separate sheet at the inquiry in the mail at the designated address before 9:00am (CST)
address listed on the reverse side as soon as possible. on any Monday through Friday that is not a holiday will be
We must hear from you no later than 30 days after we credited as of the day of receipt. If payment is not made
first sent you the invoice or billing statement on which as provided herein, crediting may be delayed up to 5 days.
the error or problem appeared.
You agree not to send us partial payments marked
You must contact us in writing in order to preserve your "paid in full","without recourse", or similar language
rights. In your letter, give us at least the following information: unless such payments are marked for special handling
-Your name and account number and sent to the inquiry address on the reverse side.
•The dollar amount of the suspected error This Account is Issued by Citibank, N.A.
• Describe the error and explain, if you can, why
you believe there is an error. If you need more
information, describe the item you are unsure about.
PLEASE ENTER NEW ADDRESS,TELEPHONE NUMBER OR E-MAIL ADDRESS BELOW:
NAME
ADDRESS
CITY STATE ZIP
HOME PHONE BUSINESS PHONE E-MAIL ADDRESS
SCOGBG00000112 Rev.01/12
Sears SEARS COMMERCIAL ONE Page 4 of 4 CITY OF CARMEL STREET DEPT
CommercialOneSI SIO BOX 6282 3400 W 1310ST ST PAYABLE
UX FALLS,SD 57117-6282
CARMEL IN 46074-8267
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hi orrriatlo.n.: fansaciicrii.;2€?
Payment Due Date: 12/31/12 Purchase Location: FISHERS Statement Date: 12/06/12
Name: CITY OF CARMEL STREET DEPT Customer PO#:SIGN TRUCK
Invoice#:T495471 Invoice Amount:$64.99 Sears Order#:
Invoice Date: 11/08/12 Cardholder Name:CITY OF CARMEL STREET DEPT Purchase Card#:5405534021610785
Ship to Address:JAMES BENTLEY
WESTFIELD, IN
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1 00901360000 3DWR QG,CM INT CHST R/B $111.99 $111.99
1 000000000000 DISCOUNT -$47.00
Payment Address: SEARS COMMERCIAL ONE Total Price: $64.99
PO BOX 689131 Tax: $0.00
DES MOINES IA 50368-9131 Delivery: $0.00
For Customer Service Call:1-800-599-9712 Grand Total: $64.99
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In Case of Errors or Questions About Your Bill Payment Information
If you think your invoice or billing statement is wrong, Payment must be mailed to us at the payment address
or if you need more information about a transaction shown on the reverse side. Payments that are received
thereon, write us on a separate sheet at the inquiry in the mail at the designated address before 9:00am (CST)
address listed on the reverse side as soon as possible. on any Monday through Friday that is not a holiday will be
We must hear from you no later than 30 days after we credited as of the day of receipt. If payment is not made
first sent you the invoice or billing statement on which as provided herein, crediting may be delayed up to 5 days.
the error or problem appeared.
You agree not to send us partial payments marked
You must contact us in writing in order to preserve your "paid in full","without recourse", or similar language
rights.In your letter, give us at least the following information: unless such payments are marked for special handling
•Your name and account number and sent to the inquiry address on the reverse side.
•The dollar amount of the suspected error This Account is Issued by Citibank, N.A.
• Describe the error and explain, if you can, why
you believe there is an error. If you need more
information, describe the item you are unsure about.
PLEASE ENTER NEW ADDRESS,TELEPHONE NUMBER OR E-MAIL ADDRESS BELOW:
NAME
ADDRESS
CITY / STATE ZIP
HOME PHONE BUSINESS PHONE E-MAIL ADDRESS
SCOGBG00000112 Rev,01/12
VOUCHER NO. WARRANT NO.
ALLOWED 20
Sears
IN SUM OF $
P. O. Box 689131
Des Moines, IA 50368-9131
$104.98
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO#/Dept. INVOICE NO. ACCT#(TITLE AMOUNT Board Members
2201 T140464 42-389.00 $39.99 I hereby certify that the attached invoice(s), or
2201 T495471 42-389.00 $64.99 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
Street Commissioner
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))
11/08112 T140464 $39.99
11/08/12 T495471 $64.99
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
120
Clerk-Treasurer