216360 01/15/2013 CITY OF CARMEL, INDIANA VENDOR: 00352583 Page 1 of 1
ONE CIVIC SQUARE BROWNELLS INC
CARMEL, INDIANA 46032 200 S FRONT STREET CHECK AMOUNT: $342.65
MONTEZUMA IA 50171-1000 CHECK NUMBER: 216360
CHECK DATE: 1/15/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4239010 8329736 342 . 65 AMMUNITIONS & ACCESSO
INVOICE #: 0 8 3 2 9 7 3 6 . 0 0 6seco06
01/02/2013 08:55:48 B ROWNE L L S , INC . (46032-CITY) 736.00
200 SOUTH FRONT STREET heatherm-C
MONTEZUMA, IOWA 50171-1000 DLR GVN IAR
ACCOUNT #: 00296101 800-741-0015 INVT
24 HR. FAX # (641) 623-3896 U4 P4
SOLD TO:
CITY OF CARMEL POLICE DEPT. Federal I.D. #42 0838235
ATTN: TERESA ANDERSON * * * I N V O I C E
3 CIVIC SQUARE
CARMEL IN 46032
SHIP VIA: UPS - GROUND
PAYMENT METHOD: OPEN ACCOUNT
SHIP TO:
CARMEL POLICE DEPT. TERMS: NET 30
ATTN: SGT JELLISON
3 CIVIC SQUARE
CARMEL IN 46032
FAX #: 317-571-2507
STOCK PRODUCT QTY QTY B/O, RETAIL UNIT TOTAL
NUMBER LOCATION NAME AND DESCRIPTION ORDERED SHIPPED N OR C PRICE PRICE PRICE
100-002-868WP J06006B V-TAC WIDE PADDED SLING, BLACK 10 39.99 32.87 328.70
1 ---- 11 ------------------------------------- *** ORDER ON THE WEB AT www.brownells.com *** ------ -----
INVOICE #: 08329736.00 ORDER TOTAL: 328.70
UPS - GROUND: 13 .95
n' ----------
+ GRAND TOTAL: 342.65
*** MAIL INVOICE FROM FRONT ***
CiINDIANA RETAIL TAX EXEMPT PAGE
ty ,.of Carmel CERTIFICATE NO.003120155 002 0 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
'1110M13
Brownolls Inc. Carmal police Depaftment
VENDOR TOIP 3 CIVIC squam
South Front Street Carmel, IN 46032
Mont(Dai Ia, IA SOM (31?)571 2
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Account 42-M.10
9 Each shipping charges $13.95 $13.95
10 Each tools/slings $32.87 $328.70
Seib Total: $342.05
rj A4,
,-
a
Send Invoice To:
Camel Police Department
Attn: Tomsa Andemon
3 Civic Square
Camel, IN 460V-- PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
Carmel Police Dept. \ U5� PAYMENT $342.66
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
THIS APPROPRIATION SUFFICIENT SHIP REPAID. ICIENT TO PAY FOR THE ABOVE ORDER.
• �
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED. ORDERED BY
•PURCHASE ORDER NUMBER MUSTAPPEAR ON ALL
SHIPPING LABELS.
•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE !R`{v[F+, �$93sa13ae•,n,
�....�s ... ......�
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
0602 CLERK-TREASURER
DOCUMENT CONTROL NO. A.P.V. COPY-SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER NO.......:....- . __WARRANT NO...... ........_......._
ALLOWED 20
IN THE SUM OF$
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
receivedexcept_..---.-.-...-----...................------._....------- -------------------------------
,-.
--.-...............--..................-................._........-.........................-......................-................--.......--...--.......-.....----....... ..
20
.............................................. .. .................... ._ .- .
Signature
...._..............._......-.......--................-----....------....---..........---..........................................-.........-..
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.
I
Payee
Purchase Order No.
i
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
j 01/02/13 8329736 slings $342.65
i
I
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
20
Clerk-Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
Brownells Inc.
IN SUM OF $ i
200 South Front Street
i
Montezuma, IA 50171
$342.65
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
25602 I 8329736 I 42-390.10 I $342.65 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
Monday, January 14, 2013
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund