216496 01/15/2013 CITY OF CARMEL, INDIANA VENDOR: 361937 Page 1 of 1
10J� ONE CIVIC SQUARE T B A NORTH CHECK AMOUNT: $1,642.56
CARMEL, INDIANA 46032 309 GRADLE DRIVE
+y;or CARMEL IN 46032 CHECK NUMBER: 216496
CHECK DATE: 1/15/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4231500 25585 3LB0866 1, 478 . 00 OIL
1110 4237000 3LB3963 164 . 56 REPAIR PARTS
TBA North Invoice
309 Gradle Dr. NO. 03LB3963
Carmel, IN 46032
317-574-1957 FAX: 317-574-1982 IIIIIIIIIIIIIIIIIIIIIIIIIIIIIII
I V111111dldllll 1111111111111
Page 1
CUSTOMER NUMBER Invoice NUMBER 1 1:12:54 Jan 10 2013
Invoice DATE PACKING SLIP TERMS
318 03LB3963 01/10/13 WHSE
03SQ3284001 NET 10TH 030
BILL TO:
CARMEL POLICE CITY GARAGE SHIPPED TO:
3 CIVIC SQUARE CARMEL POLICE CITY GARAGE
CARMEL, IN 46032 3400 W 131ST
CARMEL, IN 46074
Dept: 002 CARMEL POLICE CITY GARAGE Contact: /Route: NORTH Direction:
YOUR P.O.NUMBER ORDER DATE
01/ CSR SHIPPED VIA 10/13, 10:16:15 000001 ONLINE ORDERS CARTONS OPER
N NORTH A ACX
***ACX Reference No: AK9138 ***
ITEM
DESCRIPTION BIN UNIT ORDER BACK INV LIST CORE NET NET EXT
QTY ORDERED QTY PRICE PRICE PRICE CORE PRICE
RAF ATD1159P AT POLICE PAD SET
U EA 4 0 4 92.76 0.00 41.14 0.00 164.56
TOTAL PURCHASE TOTAL LIST TOTAL MDSE TOTAL CORE FREIGHT TAX PCT TAX AMT INVOICE TOTAL PAYMENTS BALANCE DUE
164.56 371.04 164.56 0.00 0.00
0.00 164.56 0.00 164.56
2.08% service charge on past due accourits(25% per annum).
Core returns must be in original box. All new returns must
be resalable. No return after 30 days without invoice.
i
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r
�TBA North
309 Gradle Invoice
\; ' Dr.
Carmel, IN 46032,.. N0. 031-130866
317-574-1957 FAX: 317-574-1982
a 11111111111111111111111111111111111111111111111 i IIIII 11111111
Page 1
CUSTOMER NUMBER 1 1:1 1:53 Jan 04 2013
Invoi�NUMBER Invoice DA TE PACKING SLIP
03 TERMS E�HSE 01/04/13 03SP9873001 NET 10TH 30
BILL TO:
CARMEL POLICE CITY GARAGE SHIPPED TO:
3 CIVIC SQUARE CARMEL POLICE CITY GARAGE
CARMEL, IN 46032 3400 W 131ST
CARMEL, IN 46074
Dept: 002 CARMEL,POLICE CITY GARAGE Contact: /317-733-4600 Route: NORTH Direction:
YOUR P.O.NUMBER ORDER DATE
SHOP CSR SHIPPE&VIA
01/04/13, 11:11:20 400005 TOM SMITH cARroNS OPER
N NO 405
ITEM
DESCRIPTION BIN UNIT ORDER BACK INV LIST CORE NET NET EXT
CUSTOMER WILL HAVE MONDAY QTY ORDERED QTY PRICE PRICE PRICE CORE PRICE
1/7/13
OIL DEXOS5W3055GAL 55 GALLON DRUM
NONE EA 2 0 2 1492.00 0.00 739.00 0.00 1478.00
TOTAL PURCHASE TOTAL LIST TOTAL MDSE OTAL CORE FREIGHT TAX PCT TAX BALANCE DUE
T INVOICE TOTAL PAYMENTS
1478.00 2984.00 1478.00 0.00 0.00
1 .4 1581.46 0.00 1581.46 j
% service on e charge past due accou (25% per annum).
Core returns must be in original box. All new returns must
be resalable. No return after 30 days without invoice.
I ® INDIANA RETAIL TAX E PA
f Ca CE EXEMPT GE
_ 1l1lJL�� CERTIFICATE NO.003120155 00
I 20
I FEDERAL EXCISE TAX EXEMPT PURCHASE ORDER NUMBER
ONE CIVIC SQUARE 35-60000972
CARMEL, INDIANA 46032-2584
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL- 1 997 THIS NUMBER MUST APPEAR ON INVOICES,A/P
DATE
VOUCHER, DELIVERY MEMO, PACKING SLIPS,
PURCHASE ORDER DATE SHIPPING LABELS AND ANY CORRESPONDENCE.
REQUIRED REQUISITION NO.
�&201 VENDOR NO.
DESCRIPTION
TBA North
VENDOR CwmGI Police Dopadmont II
Cradle Drive SHIP 3 CIVIC squam I
� TO
C@I @I, IN 460V Carmel, IN 4
((
CONFIRMATION BLANKET CONTRACT (3170 571.25% 1
PAYMENT TERMS
FREIGHT
QUANTITY UNIT OF MEASURE
6 g g A DESCRIPTION
�l+�lABUn� 4L..3(5,Qa UNIT PRICE EXTENSION
2 Each 55 gall®n drum
$738.00
$1,478.00
Sub Total:
$1,478.00
1
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C�!VO•e eoeeee •OC� I
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end Invoice To: n °
Carmel Police Department
Attn: TMOM Andorann
3 CIVIC Squ&ro
I
CatrMQl, IN 4aM. PLEASE INVOICE IN DUPLICATE
DEPARTMENT
nel �Q1lCe��� � ACCOUNT PROJECT
PROJECT ACCOUNT
AMOUNT
PAYS $1,478.00
• A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
SHIPPING INSTRUCTIONS VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
HIP REPAID. I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
O.D.SHIPMENTS CANNOT BE ACCEPTED. THIS APPROPRIA710ICIENT TO PAY FOR THE ABOVE ORDER.
JRCHASE ORDER NUMBER MUST APPIFAR ON ALL
ZIPPING LABELS. ORDERED BY
IS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 ' ' / !'
D ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. TITLE JJ i7lof 131` ®llrub
CUMENT CONTROL N0. A.P�V. COPY-SIGN AND RETURN TO CLERK'S OFFICE
I
I._ —
VOUCHER NO. NO.,___ _
ALLOWED 20
IN THE SUM OF$
f
f
f
II
ON ACCOUNT OF APPROPRIATION FOR
f
' 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
E
j -
f
20
Signature
t �~ 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))
01/04/13 3LB0866 oil $1,478.00
01/10/13 3LB3963 brake pads $164.56
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
I
VOUCHER NO. WARRANT NO.
ALLOWED 20
TBA North
IN SUM OF $
309 Gradle Drive
I
Carmel, IN 46032
$1,642.56
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
25585 3L60866 42-315.00 $1,478.00 I hereby certify that the attached invoice(s), or
bill(s) is (are)true and correct and that the
1110 3LB3963 42-370.00 $164.56
materials or services itemized thereon for
which charge is made were ordered and
received except
Friday, January 11, 2013
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund