215974 01/09/2013 a CITY OF CARMEL, INDIANA VENDOR: 362614 Page 1 of 1
ONE CIVIC SQUARE BGI FITNESS
CARMEL, INDIANA 46032 4340 EAST 82ND ST CHECK AMOUNT: $512.15
INDIANAPOLIS IN 46250
,o. CHECK NUMBER: 215974
CHECK DATE: 1/9/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 R4237000 25506 341851 512 . 15 TIRES/WHEEL/CHAIN
BGI Fitness
Work Order#: 94075
BGI Fitness
PLEASE NOTE OUR NEW ADDRESS INVOICE#: 341851
Account#: 000100024799
Bicycle Garage Indy Page: 1 of 1
4340 E. 82nd Street Date: 12/18/2012
Indianapolis, M 46250 Time: 10:19:55 AM
Cashier: LK
Register#: 1012
Reference: COM/PO#25506
Comment: PO#25506
Bill To: Carmel Police Department Ship To: Carmel Police Department
Carmel Police Department Carmel Police Department
3 Civic Sq 3 Civic Sq
Carmel, IN 46032-2584 Carmel, IN 46032-2584
317-571-2533
Alt=317-409-5866-Mike Pitman
Rep Item Lookup Code,, ,, Description Quantity _; Pride Extended
JA NOTE By JA on 101912 1 $0.00 $0.00
JA 30500097 40 CONT TC 26X2.1 Town&Country 4 $39.99 $159.96
Not
Carried/Blackwall/Skinwall/WireBead/6
5 PSI
Discount ($7.99) ($31.96)
JA SO_10_3175712533_14 ZF-Rear Wheel XT/Mavic 719 1 $199.99 $199.99
QBP#WE2753
Discount ($19.99) ($19.99)
JA 22000043 12 SRAM CH 3/32 PC-870 8s 1 $25.99 $25.99
Discount ($5.19) ($5.19)
JA SO_10_3175712533_15 ZF-Shimano V-Brake Pad Set 10 $15.99 $159.90
QBP#BR1496
Discount ($3.19) ($31.90)
JA 34200002 69 PARK POLY LUBE 4 OZ 1 $9.99 $9.99
Discount ($1.99) ($1.99)
JA 34200017 69 TFLO LB AEROSAL 120Z 1 $25.99 $25.99
AEROSAL LUBE SPRAY
Discount ($5.19) ($5.19)
JA 99900 Thanks for Your Business!I 1 $0.00 $0.00
Lavina Kautz
Thanks for choosing BGI. Sub Total $485.60
Sales Tax $0.00
Billing: 317.842.4140 x56 -7°
Service: 317.579.7933 BGI Pass Through of Manf Freight Charges $26.55
Total $512.15
www.bgifitness.com
infon @bgindy.com
I� III VIII Illil VIII VIII VIII III IIII
341851
INDIANA RETAIL TAX EXEMPT PAGE
City o Carmel CERTIFICATE NO.003120155 002 0 1i PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT
35-60000972
ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES,A/P
CARMEL, INDIANA 46032-2554 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
Doi Fitness Carmel Police Department
VENDOR Coiporation Drive SHIP 3 Civic Square
TO
Carmel, e
Ca mel, IN
Indianapolis, IN 4525 (317)
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
�y QUANTITY�j UUNIITTgOF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Account 4C �D.00
4 Each Continental Town & CountryTire $32.00 $128.00
1 Each HD replacement Rear Wheel $180.00 $180.00
1 Each Srarn Chairs $20.80 $20.80
t EI �
10 Each Shirnano V-Brake Pad Set '= ". i °3. $12.80 $428.00
1 Each Park Pol�,IlUbe grease f , .jkr' ,°�_ t,�� fxw.� =°'� $8.00 $8.00
1 Each TrIFlow Chain Lube - 12oa o-(:l ''.. >....
$20.80 $20.80
1 Each shipping charges � � � � $26.55 $26.55
Slab!Total- $512.15
' �H ` _ ✓may mL.^\' ,'�R�l�<
Send Invoice To:
51
Carmel Police Dcpartmor
Attn: Teresa Anderson
3 Civic Square
Camel, IN 460-32- PLEASE INVOICE IN DUPLICATE*
DEPARTMENT ACCOUNT PROJECT I PROJECT ACCOUNT AMOUNT
Carmel Police Dept. Ir �� � °s PAYMENT $512.15
• A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
SHIP REPAID.
THIS APPROPRIATION•SUFFICIENT TO PAY FOR THE ABOVE ORDER.
•
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED. ORDERED BY
•PURCHASE ORDER NUMBER MUST APPEAR ON ALL `. p,.
SHIPPING LABELS.
•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE C of$�a I Police
olice
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
9 5 5 0 CLERK-TREASURER
DOCUMENT CONTROL NO. A.P. • COPY-SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER NO. WARRANT
ALLOWED 20
IN THE SUM OF$
ON ACCOUNT OF APPROPRIATION FOR
Board Members
or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT.# ! 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
20
..............................................................................................................
Signature
............................................................................._......................................_-.........-.
Title
I
Cost distribution ledger classification if
claim paid motor vehicle highway fund
VOUCHER NO. WARRANT NO.
ALLOWED 20
BGI Fitness
8828 Corporation Drive
IN SUM OF $
Indianapolis, IN 46256
$512.15
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Prior Year Eneawbered I hereby certify that the attached invoice(s), or
25506 341851 I 42-370.00 I $512.15
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
Thursday, January 03, 2013
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))
12/31/12 341851 bicycle accessories $512.15
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