216409 01/15/2013 CITY QF CA,R.ZMEL,,1NDIANA VENDOR: 355214 Page 1 of 1
` ONE CIVIC SQUARE GENUINE PARTS COMPANY-INDIANAP_CHECK AMOUNT: $427.00
CARMEL, INDIANA 46032 5959 COLLECTIONS CENTER DRIVE
oN,�o CHICAGO IL 60693 CHECK NUMBER: 216409
CHECK DATE: 1/15/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4237000 08517983 427 . 00 REPAIR PARTS
INDIANA RETAIL TAX EXEMPT PAGE
City o Carmel CERTIFICATE NO.003120155 002 0 11 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT
35-60000972 9A4
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
Gwtuina Auto Paqs Carmel Police DepaAment
VENDOR SHIP
TO 3 Clylc Square
Collection Center Drive Carmel, IN 46 032
Chicaun_ Ifs 3 11171 674
CONFIRMATION I BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Account 42-370.00
9 Each - c-p-* $427.00 $427.00
UI� •; t nc' �t I1���� Sub Total: $427.00
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Send111n"VoicefTo98yI m'
Carfnel Police Department
Afar. Teresa AnderBan
3 Chic Square
Cannel, IN 4SM2- PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
Carmel Police Dept. �� L_>``'� PAYMENT $427.00
• A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
' NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
SHIP REPAID. THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
•
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED. � !f
•PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY /II
SHIPPING LABELS.
•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE Cltlef of Police
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
DOCUMENT CONTROL NO.
�A 1 COPY-SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER NO. WARRANT
ALLOWED 20
IN THE SUM OF$
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT.� 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.- ...-- -- ___ -- ----- -----
20
.............-..............................-_..............-...................................................................................................----......--..........
Signature
...........................................................................................................................................................................
---.................... Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
VOUCHER NO. WARRANT NO.
Genuine Auto Parts ALLOWED 20
IN SUM OF $
5959 Collection Center Drive
Chicago, IL 60693
$999.40
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
25601 860797 42-370.00 $427.00 I hereby certify that the attached invoice(s), or
bill(s) is (are)true and correct and that the
1110 42-370.00 $572.40
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
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))
01/03/13 860797 hub bearing assembly $427.00
01/10/13 repair parts $572.40
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