217111 02/13/2013 CITY OF CARMEL, INDIANA VENDOR: 366922 Page 1 of 1
ONE CIVIC SQUARE DESIGN WORKS CHECK AMOUNT: $1,240.00
ro CARMEL, INDIANA 46032 208 GRADLE DRIVE
CARMEL IN 46032 CHECK NUMBER: 217111
CHECK DATE: 2/13/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4463000 25619 548 1, 240 . 00 RECOVER CHAIRS
I
Design works Invoice
208 Gradle Drive
Carmel, IN 46032 Date Invoice#
1/29/2013 548
Bill To Ship To
CARMEL POLICE DEPARTMENT
P.O. Number Terms Rep Ship Via F.O.B. Project
1/29/2013
Quantity Item Code Description Price Each Amount
4 LABOR CHAIRS 250.00 1,000.00
SUPPLIES MATERIAL TAX EXEMPT 240.00 240.00
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Total $1,240.00
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City INDIANA RETAIL TAX EXEMPT PAGE
®f (l armel CERTIFICATE NO.003120155 002 0\�J/ 11 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT
35-60000972 - 0
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
'URCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
1l13
Dosign Works Carmol Polico Department
VENDOR TOIP 3 Civic Square
20S Gradlo Dolye Carmel, IN 46032
Cmfm al� IN 4603P 13171 S7
CONFIRMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT
QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION
Account 44-630.00
4 Each reupholster ivhairs $310.00 $1,240.00
Sub Total, $1,240.00
Send Invoice To:
Carrel Police Department
Attn: Teresa Anderson
3 Civic Square
Carmel, IN 46032- PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
Cannel Police Dept. PAYMENT $1,240.00
• A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
THIS APPROPRIATION SHIP REPAID. ION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
•
•C.O.D.SHIPMENTS CANNOT BE ACCEPTED. i
ORDERED BY
•PURCHASE ORDER NUMBER MUST APPEAR ON ALL f
SHIPPING LABELS. ya �,@ q
•THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 TITLE
h1tCf 8g f �'6�11
AND ACTS AMENDATORY THEREOF AND SUPPLE MENT T_HERETO.
J 6 9 CLERK-TREASURER
DOCUMENT CONTROL NO. A. .V. COPY-SIGN AND RETURN TO CLERK'S OFFICE
VOUCHER NO. WARRANT NO._��_
ALLOWED 20
IN THE SUM OF$
ON ACCOUNT OF APPROPRIATION FOR
Y^
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
20 !
Signature
Title
i
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))
01/29/13 548 reupholster chairs $1,240.00
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
VOUCHER NO. WARRANT NO.
ALLOWED 20
Design Works
IN SUM OF $
208 Gradle Drive
Carmel, IN 46032
$1,240.00
ON ACCOUNT OF APPROPRIATION FOR
Carmel Police Department I
i
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
25619 548 44-630.00 $1,240.00
I hereby certify that the attached invoice(s), or
I I
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, February 07, 2013
Chief of Police
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund