216055 01/09/2013 CITY OF CARMEL, INDIANA VENDOR: 114000 Page 1 of 1
ONE CIVIC SQUARE GRAYBAR ELECTRIC CO, INC
CARMEL, INDIANA 46032 12431 COLLECTIONS CENTER DRIVE CHECK AMOUNT: $5,647.26
CHICAGO IL 60693 CHECK NUMBER: 216055
CHECK DATE: 1/9/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 R4350080 26315 964069176 2, 915 . 00 LIGHTS
1115 R4350900 26629 964184014 2, 732 .26 NETWORK CAMERAS
Remit to 49
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INVOICE
....................
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® 317-821-5700
12431 COLLECTIONS CENTER DRIVE
CHICAGO IL 60693-2431 Invoice No: 964069176
Invoice Date: 12/18/2012
Account Number: 152110
Account Name: CARMEL, CITY OF/ELEC
Bill-To: Ship-To:
CARMEL, CITY OF/ELEC CARMEL, CITY OF/ELEC
ACCOUNTS PAYABLE CARMEL UTILITIES, CITY OF
9609 HAZEL DELL PARKWAY CARMEL STREET DEPT
INDIANAPOLIS IN 46280-2935 3400 W. 131 ST ST
USA CARMEL IN 46074
USA
Page 1 of 2
rder No: 26315 SO##: 341586970
De1.Doc.#s PRO # Routin Date Shi ed Shi ed From F.O.B. Rt. To
341586970 FACTORY
Quantity Catalog # / Description Unit Price / Unit Amount
1 LOT HOLOPHANE CORPORATION HOLOPHANE / ACUITY BRANDS 2,915.00 / 1 2,915.00
ROAM LIGHTING CONTROLS
Terms of Payment Sub Total: 2,915.00
Net 30 Days Freight: 0.00
As a condition of the sales agreement, a monthly Handling: 0.00
service charge of the lesser of 1-1/2b or the maximum Tax: 0.00
permitted by law may be added to all accounts not paid Total Due: 2,915.00
by net due date. visa, MasterCard, American Express,
and Discover credit cards are accepted at point of
purchase only.
Return this copy with your payment .
Remit to
I NVOI C$ ?:
Gr%4koM. 317-821-5700
12431 COLLECTIONS CENTER DRIVE
CHICAGO IL 60693-2431 Invoice No: 964069176
Invoice Date: 12/18/2012
Account Number: 152110
Account Name: CARMEL, CITY OF/ELEC
Bill-To: Ship-To:
CARMEL, CITY OF/ELEC CARMEL, CITY OF/ELEC
ACCOUNTS PAYABLE CARMEL UTILITIES, CITY OF
9609 HAZEL DELL PARKWAY CARMEL STREET DEPT
INDIANAPOLIS IN 46280-2935 3400 W. 131ST ST
USA CARMEL IN 46074
USA
Page 2 of 2
rder gNo; 26C3T15 C M qq SO#: 341586970
TERMS AND CONDITIONS OFNSAI!EC.
I. ACCEPTANCE OF ORDER;TERMINATION-Ace once of any order istbject to credit approvyaal and aeceptanc0 ofaybar Electric Company hoc. ('Groybat')ardY wtt�n applicable.
Graybar's suppliers. I(credit of the buyer of the goods Guyer')becomes unsatisfactory to Graybar,Graybar reserves the riglmt Zr to terrturate upmm notice to Buyer and it iabi l to ra
2. PRICES AND SHIPMENTS- Unless otherwise quoted,prices shall be those in effect at time of shipment,which shall be trade F.O.B. shipping point,prepaid and bill.
3. RETURN OF GOODS•Credit nay be allowed for goods returned with prior approval. A deduction may be made from credits issued to cover cost of handling.
4. TAXES- Prices shown do rot include sales or other gazes i d on the sale of nods.Taxes now or hereafter imposed upon sales or shipments will he added to the purchase price. Buyer agrees to
reimburse Graybar for any such tax or provide Graybar with acce able tax exemption tertiffcate.
5. DELAY IN DELIVERY Graybar is not to be account le for delis in delivery oc asioned by acts of God, failure of its 2flietts to ship or deliver on time,or other circumstags beyond Graybar's
reasonable control. Factory shipment or delivery dates are t�e best estnates of our supp�iers,and m no case shall Graybar be l able for any consequential or special damages arising om any delay in
shipment or delivery.
6. L��I��MIITED WAR�RApNTIIES p- rragy�bar��warrants that �Iy oo�ods sold are
(pfree of any secuurriittyy interest gad will make available to Bupe�rTryp77apRll tranryso7pf�erapbl�eF wRarramm's mpcI d without ti nation w ties with
Isr S FE'l APPA CATIINON O TIIrL�CONT�AI EREP E OF IV UUCFLt�EARDFAORTIP�7'ypDORCTpS IN LD ERE/CDE A NICA DONE WHERE H�GO DS fRAN OpNOTEC NON SWIR REAN,Y
PATIENT CONTACT OR W14F,RL A SIX(6)FOOT CLEARANCLNFROM A PAT��NT CRNN Be MAINTAINED AT ALL TIMES. O
7. LIMITATION OF LIABILITY-Quyer's,remedies�dCr the agreement are subject to any limitations contained in manufacturer's teens and conditions to Graybar, a cope of whit wil fu shed upon
written request. Furthermore Grayba(s liability shall be limited to either re�ppotas or reDlacement of the goods or refund of the purchase price,all at Graybar's option.,and IN NO CA E f$ L GRAYBAR
BE LIABLE FOR INCIDEtSTAL, SPECIAL, OR CONSEQUENTIAL DA AGES. Ili addition,claims for shortages,other than toss in transit.must be made in writing not more than ivo O days after
receipt of shipment.
g, WAIVER-The fails of Graybar t Insist upon the perfgniance of an of the terms or conditions of this agreement or to exercise any right hereunder shall not be deemed to be a waiver of such terms.
conditions,or rights in the future, nor shall it be deemed to be a waiver o�any other term,condition,or right order this agreement.
9. MODIFICATION-OF TERMS ANQ CONDITIONS-The terns and conditions supersede all other communicate Is.negotiations, and prior oral or written statements regarding the,subject matter of these
terms arul Conditions. No Fhangt(godfication, rescission,discharge,abandonment,or waiver of these terms and corrrYitions shall be binding ugm Graybar,unless made in wiling and sign on its behalf by a
duly authorized represegtative o rayba. No conditions,usage o,trade course of dealinit or performance,understanding or agmemept,purpo ing to modtfy, vary,ex 1 in,qr suppl ment I F toTms aid
cot ydhion shall be bindir unl ss herea7er made in wihin aid signed b the party to t�f bound. Any proposed modifications or addiupnal terms are specificall re'eCP atxf deerm a material p tt eranon
hereof. Its this document shall tic deemed an acceptance ofga prior offer dy Buyer,such acceptance is expressly conditional upon Buyer s assent to any addmonayl o�differe nt Terms set forth herein.
M. REELS-When Graybar ships returnable reels,a reel deposit nay he included in the invoice. The Buyer should contact the nearest Graybar service location to return reels.
It. CFrRTIFICATION-Graypar,Ix:reby certifies that these g�nds we iced in compliance with all applicable,requirements of Sections 6,7 12 of the F it Labor Standards Act, as amended, and of
resgu��B8lrons and orders Qf t(,e Umted gta�ps Department of Lalmr issuerQ�(mttndder Section 14 thereof.This a rYement is sab'eCIS9 Executive Under 11246 amendrl tM Retabilitation Act of IY�3 as amended,
thb I.temam VeteranF' Kead1'u5trnenf Assistance Act of 1974,as amet>ded E.O. 13496 29 CFR Part 47�, Appendix A'{o Sunpart A, and the correspoi>ing regu anions, to he CA
required by law. 41 CFR
60-1.4,64741.5,aria 60-250.5 are incorporated herein by reference,to the extent legally required.
12. PpoggEIGN CORRUPT PRACPICES ACT-Buyer shall con ty with a licable laws apd regulations relatumg to anti<orrupion, including,,without limitaiinn. (i)the United States Foreign ce=t('radices
Act(f(:PA (.IS U.S.0 p$78dd I,et. seq.) irr;sp�tuve q(thel��ace of peronrratrce, aid ri laws and.regulatiais nmpicmenung tlx Oreamzanon for Economic Cooperation and Development's CortveMion on
CombatmR I ribery of t'oreign Public Officials in tmernahonal gsmesy'I ransacuons, the lS.�. Convent Ain't Corruption,and the inter-American Convention Against Corruption in Buyer's country m any
country where performance of this agreement or delivery of goads wits occur.
13. ASSIGNMENT- Buyer shall not assign its rights or delegate its duties hereunder or any interest herein without the prior written consent of Graybar, and any such assignment,without such consent,shall
be void.
14. GE ERAL PROVISIONS•All ly aphicaI clerical errgrg made h Graybar in iatign acknowledgment or publication are subject to comeSlion.This agreement shall b€Tvern ed by,the laws
of the gNlate of Missouri applicable to�pporg��rracts to pr formed aid lull �erfomxd within the Slate of I'vtissouri, without, iyirm�ef(eet to the choice or conflict of law provisions thereof. II suits arising from
or crnrQem, this aaggreement shall be filed in the Circuit newt Court of Sty[.Dais Couruy,Missouri or the United States Dslnct tiourt for tea Eastern District o Missouri. and do other pi a umess otherwise
determined=Graybar's sole discretion. Buyer hereby irrevocably consents to the jurisdiction of such court or courts and agrees to appear N any such action upon written notice tbereot
15. EXPORTING-Bu r aclmowlFFd e5 that thus order,and the performance thereof are 5ub1'ect to compliance with any and all applicable United States taws, regulations,or orders. Buyer a reel to comp)
with all such laws, regulations,aZ orders including,if applicable,all requirements of the lmentatioral Traffic in Arms Regulations and/or the Ezpon Administration Act, as may be amend. Buyer,fun�ier
01axmes that if the export laws are pplicabfo, it will not disclose or re-e n any technical data mcgrved ender this order to countries for which the United States government requires an export Incense or
oilmen supporting documentation at I�te time of export or transfer, unless Buyer has obtained prior written authorization from the Inked States Office of Export Control or other authority responsible for such
miners.
Return this copy with your payment .
VOUCHER NO. WARRANT NO.
ALLOWED 20
Graybar
IN SUM OF $
12431 Collections Center Drive
Chicago, IL 60693-2431
$2,915.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
26315 I 964069176 I 43-500.801 $2,915.00 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
r'l r / 1f1
kJ
�F�riday, January 04, 2013
l
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))
12/18/12 964069176 $2,915.00
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
Remit To: 12431 COLLECTIONS CENTER DRIVE :;::<< <<:;«2 ;>:::;;:: „,.,.,:a
GrqybELRCHICAGO IL 60693-2431 317-821-5700
INVOICE Invoice No: 964184014
MB 01 001914 89379 B 13 A Invoice Date: 12/2612012
Account Number: 0000154108
CARMEL CLAY COMM CENTER Account Name: CARMEL CLAY COMM
JANET ARNONE
31 FIRST AVE N.W. CENTER
CARMEL IN 46032-1715
Ship to: CARMEL CLAY COMM CENTER
CARMEL CLAY COMMUNICATION
31 FIRST AVE N.W.
CARMEL IN 46032-1715
- Page 1 of 1
Order No:26629 SO#:341615423
Del. Doc.#: PRO# Routing Date Shipped Shipped From F.O.B. Rt.To
0341615423 112/21/2012 IFACTORY -
Quantity Catalog#1 Description Unit Price / Unit Amount
2 5014-204 POE T8124 TECH DATA CORPORATION 104.11 / 1 208.22
High PoE 30 W Midspan 1-port
2 0371-001 P3346-VE TECH DATA CORPORATION 1262.02 / 1 2524.04
network camera-superb HDTV 1080p vandal-resistant fixed
dome with remote focus and zoom for outdoor use
Terms of Payment Sub Total 2732.26
Freight 0.00
Net 30 Days Handling 0.00
As a condition of the sales agreement,a monthly service charge of the lesser of Tax 0.00 N
1-1/2%or the maximum permitted by law may be added to all accounts not paid Total Due 2732.26
by net due date.Visa,MasterCard,American Express,and Discover credit cards
are accepted at point of purchase only.
Subject to standard terms and conditions on the reverse side.
GRAYBAR ELECTRIC COMPANY,INC.
TERMS AND CONDITIONS OF SALE
1. ACCEPTANCE OF ORDER,TERMINATION-Acceptance of any order is subject to credit approval and acceptance of order by Graybar Electric
Company,Inc.(`Graybar')and,when applicable,Graybar's suppliers.If credit of the buyer of the goods("Buyer")becomes unsatisfactory to Graybar.
Graybar reserves the right to terminate upon notice to Buyer and without liability to Graybar.
2, PRICES AND SHIPMENTS-Unless otherwise quoted,prices shall be,those in effect at time of shipment,which shall be made F.O.B.shipping point,
prepaid and bill.
3. RETURN OF GOODS-Credit may be allowed for goods returned with prior approval.A deduction may be made from credits issued to cover cost of
handling.
4. TAXES-Prices shown do not include sales or other taxes imposed on the sale of goods.Taxes now or hereafter imposed upon sales or shipments will
be added to the purchase price. Buyer agrees to reimburse Graybar for any such tax or provide Graybar with acceptable tax exemption certificate
5. DELAY IN DELIVERY-Graybar is not to be accountable for delays in delivery occasioned by acts of God;failure of its suppliers to ship or deliver
on time,or other circumstances beyond Graybar's reasonable control. Factory shipment or delivery dates are the best estimates of our suppliers,
and in no case shall Graybar be liable for any consequential or special damages arising from any delay in shipment or delivery.
6. LIMITED WARRANTIES - Graybar warrants that all goods sold are free of any security interest and will make available to Buyer all transferable
warranties(including without limitation warranties with respect to intellectual property infringement)made to Graybar by the manufacturer of the goods-
GRAYBAR MAKES NO OTHER EXPRESS OR IMPLIED WARRANTIES.AND SPECIFICALLY DISCLAIMS ALL IMPLIED WARRANTIES INCLUDING
BUT NOT LIMITED TO THE IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR PURPOSE. UNLESS OTHERWISE AGREED
IN tA:RiTING BY AN AUTHORIZED REPRESENTATIVE OF GRAYBAR, PRODUCTS SOLD HEREUNDER ARE NOT INTENDED FOR USE IN OR
IN CONNECTION WITH (1)ANY SAFETY APPLICATION OR THE CONTAINMENT AREA OF A NUCLEAR FACILITY, OR (2) IN A HEALTHCARE
APPLICATION, WHERE THE GOODS HAVE POTENTIAL_FOR DIRECT PATIENT CONTACT OR VVHERE A SIX(6) FOOT CLEARANCE FROM A
PATIENT CANNOT BE MAINTAINED AT ALL TIMES.
7. LIMITATION OF LIABILITY-Buyers remedies under this agreement are subject to any limitations contained in manufacturer's terms and conditions
to Graybar,a copy of which will be furnished upon written request. Furthermore, Graybar's liability shall be limited to either repair or replacement of
the goods or refund of the purchase price,all at Graybai's option,and IN NO CASE SHAL L GRAYBAR BE LIABLE FOR INCIDENTAL.,SPECIAL,OR
CONSEQUENTIAL DAMAGES. In addition:claims for shortages,other than loss in transit, must be made in writing not more than five(5)days after
receipt of shipment.
8. WAIVER-The failure of Graybar to insist upon the performance of any of the terms or conditions of this agreement or to exercise any right hereunder
shall not be deemed to be a waiver of such terms,conditions,or rights in the future;nor shall it be deemed to be a waiver of any other term,condition,
or right under this agreement.
9. MODIFICATION OF TERMS AND CONDITIONS-These terms and conditions supersede all other communications,negotiations,and prior oral
or written statements regarding the subject matter of these terms and conditions. No change,modification, rescission, discharge, abandonment,
or waiver of these terms and conditions shall be binding upon Graybar unless made€n writing and signed on its behalf by a duly authorized represen-
tative of Graybar.No conditions,usage of trade,course of dealing or performance,understanding or agreement,purporting to modify.vary,explain,
or supplement these terms and conditions shall be binding unless hereafter made in writing and signed by the party to be bound.Any proposed
modifications or additional terms are specifically rejected and deemed a material alteration hereof.if this document shall be deemed an acceptance
of a prior offer by Buyer;such acceptance is expressly conditional upon Buyer's assent to any additional or different terms set forth herein.
10. REELS-When Graybar ships returnable reels;a reel deposit may be included in the invoice.The Buyer should contact the nearest Graybar service
location to return reels.
11. CERTIFICATION-Graybar hereby certifies that these goods were produced in compliance with all applicable requirements of Sections 6,7,and 12 of
the Fair Labor Standards Act,as amended,and of regulations and orders of the United States Department of Labor issued under Section 14 thereof.
This agreement is subject to Executive Order 11246,as amended,the Rehabilitation Act of 1973,as amended,the Vietnam Veterans'Readjustment
Assistance Act of 1974:as amended,E.C.13496:29 CFR Part 471,Appendix A to Subpart A,and the corresponding regulations,to the extent required
by law.41 CFR 60-1.4,60-741.5,and 60-250.5 are incorporated herein by reference,to the extent legally required,
---12: FrJREIGPd CORRUPT PRACTICES ACT-Buyer shall comply with applicable laws and regulations relating to anti-corruption,including,without l€mlta-
don.(i)the United States Foreign Corrupt Practices Act(FCPA)(15 U S.C.§ r8dd-1;et.seq.)irrespective of the place of performance,and(ii)laws
and regulations implementing the Organization for Economic Cooperation and Development's Convention on Combating Bribery of Foreign Public
Officials in International Business Transactions, the U.N. Convention Against Corruption,and the Inter-American Convention Against Corruption in
Buyer's countri or amy country where performance of this agreement or delivery of goods wilt occur.
13. ASSIGNMENT-Buyer shall not assign its rights or delegate its duties hereunder or any interest herein without the prior written consent of Graybar,
and any such assignment,without such consent,shall be void.
14. GENERAL PROVISIONS-All typographical or clerical errors made by Graybar in any quotation, acknowledgment or publication are subject to
correction.This agreement shall be governed by the laws of the State of Missouri applicable to contracts to be formed and fully performed within the
State of Missouri,without giving effect to the choice or conflicts of law provisions thereof.All suits arising from or concerning this agreement shall
be filed in the Circuit Court of St.Louis County,fvlissouri,or the United States District Court for the Eastern District of Missouri,and no other place
unless otherwise determined in Graybar's sole discretion.Buyer hereby irrevocably consents to the jurisdiction of such court or courts and agrees
to appear in any such action upon written notice thereof. -
15. EXPORTING-Buyer acknowledges that this order and the performance thereof are subject to compliance with any and all applicable United States
laves, regulations, or orders. Buyer agrees to comply with all such laws, regulations, and orders, including, if applicable. all requirements of the
International Traffic in Arms Regulations and/or the Export Administration Act,as may be amended. Buyer further agrees that if the export jaws are
applicable, it will not disclose or re-export any technical data received under this order to any countries for which the United States government
requires an export license or other supporting documentation at the time of export or transfer.unless Buyer has obtained prior written authorization
from the United States Office of Export Control or other authority responsible for such matters.
r�
EXEMPT
Yl� .
t 10 f Carmel CERTIFICATE ENO.031(20155 02 0 PAGE
y ����//J li PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT
35-60000972 26629
ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES,A/P
CARMEL, INDIANA 46032-2584 VOUCHER, DELIVERY MEMO, PACKING SLIPS,
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL- 1997 SHIPPING LABELS AND ANY CORRESPONDENCE.
'URCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
1211812012 n
Graybar Electric Carmel Communication Center
VENDOR SHIP
TO 31 1 a4 Ave NW!
124431 Collections Center Drive Carmel, IN 46032
(31711571-2586
CONFIRMATION BLANKET CONTRACT PAYMENTTERMS FREIGHT
QUANTITY I UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Account 43-509.00
2 Each Camera, Network 0371-001 P3346-VE $1,262.02 $2,524.04
2 Each High PoE 30 W Midspan 1-port 5014-204 POE T8124 $104.11 .. $208.22
Sub Total: $2,732.26
.I xi r C
Send Invoice To: �v'
Carmel Communication Center
31 1 et Ave NW!
Carmel, IN 46032- PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
PAYMENT Q+�yy+�
Communications A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESSf?17PP.4?6
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
•SHIP REPAID.
THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED. ORDERED BY
•PURCHASE ORDER NUMBER MUST APPEAR ON ALL
SHIPPING LABELS.
•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. Director
CLERK-TREASURER
DOCUMENT CONTROL No. 26629 A.P.V. COPY-SIGN AND RETURN TO CLERK'S OFFICE
1
VOUCHER NO. WARRANT NO.___..-
r
ALLOWED 20
IN THE SUM OF$
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
................. .................................... ..................................................
Signature
......................................................................................----................................................ ............. —
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
VOUCHER NO. WARRANT NO.
ALLOWED 20
Graybar Electric
IN SUM OF $
12431 Collections Center Drive
Chicago, IL 60693
$2,732.26
ON ACCOUNT OF APPROPRIATION FOR
Carmel Clay Communications
PO#/Dept. INVOICE NO. I ACCT#/TITLE AMOUNT Board Members
Prior Year Encumbered I hereby certify that the attached invoice(s), or
26629 I 964184014 43-509.00 $2,732.26
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
Monday, January 07, 2013
Director
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))
12/26/12 964184014 $2,732.26
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