217195 02/13/2013 CITY OF CARMEL, INDIANA VENDOR: 357179 Page 1 of 1
0 ONE CIVIC SQUARE ID VILLE
CARMEL, INDIANA 46032 5376 52ND ST SE CHECK AMOUNT: $92.45
GRAND RAPIDS MI 49512
CHECK NUMBER: 217195
CHECK DATE: 2/13/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4239099 2508070 92 .45 OTHER MISCELLANOUS
SALES PERSON ORDER DATE TERMS., SHIP VIA CUSTOMER P.O.
Sarah Domico 1/30/2013 Net 30 UPS GROUND SPELBRIN 01/30/13
SHIPPED UOM ITEM NO. DESCRIPTION
UNIT PRICE- EXT.PRICE !
1 EACH 43254CM ClearLook Elite-6 x 6 Wall-Chrome 82.95 82.95
Note: 3683297 This item has been customized
• s • • • • •
82.95 9.50 0.00 0.00 92.45 JUSID 92.45
IDS1508282
D Q �
FEB 11 2013
By
U Received too late for use ® No reason-changed my mind
® Product damaged/defective upon arrival ® Duplicate order shipped
® Not as pictured in catalog ® Poor quality
® Received wrong item(s) ® Ordered too many
® Product not as expected for price ® Other—Please Specify:
2. Peel off the return label from the top right-hand corner on the reverse side of this packing or invoice slip.
Place it on your return package along with the appropriate postage due and your return address.
If you don't have the return label, please send your RETURN TO: Merchandise Return Dept.,
5380 52nd St SE, Grand Rapids, MI 49512.
3, We recommend that you return your package by a carrier that requires a signature (FedEx, UPS or
Certified U.S. Mail). Please retain your tracking information until credit has been received.
Credit Policy: If invoice is outstanding, credit will be applied to that invoice. If paid with a credit card, credit will be
issued on that card. If paid with a check, a credit to your account will be issued unless a refund check is requested".
"You will receive a credit invoice in the mail within two weeks after we receive your return.
INVOICE DATE: 1/31/2013
MALE INVOICE®I`VE INVOICE NUMBER: 2508070
S376 52M St.SE,G,and Rapids,M149512 I Tel 1.866.438.4553 1 Fax 616.698.6937 CUSTOMER NUMBER: 1528887
www.[Dville.com PLEASE ENTER THE AMOUNT YOU ° T
ARE REMITTING IN THIS BOX � �iv�� „
BILL JIM SPELBRING SHIP JIM SPELBRING
TO: CITY OF CARMEL TO: CITY OF CARMEL
1 CIVIC SQ 1 CIVIC SQ
CARMEL,IN 46032 CARMEL,IN 46032
PLEASE SUBMIT THIS TOP STUB WITH YOUR PAYMENT
Sarah Domico 1/30/2013 Net 30 UPS GROUND SPELBRIN 01/30/13
1 EACH 43254CM ClearLook Elite-6 x 6 Wall-Chrome 82.95 82.95
Note: 3683297 This item has been customized
• Ila 11111 . o o e • •
82.95 9.50 0.00 1 0.00 92.45 USD 92.45
IDS1508282.
D
F F6 1 1 2013
By
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))
01/31/13 2508070 $92.45
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
120
Clerk-Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
IDVille
IN SUM OF $
5376 52nd ST. S.E.
Grand Rapids, MI 49512
$92.45
ON ACCOUNT OF APPROPRIATION FOR
Administration Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1205 2508070 42-390.99 $92.45 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
Monday, February 11, 2013
Director, Ad inistration
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund