217542 02/26/2013 a CITY OF CARMEL, INDIANA VENDOR: 360390 Page 1 of 1
�. ONE CIVIC SQUARE AMERICAN TECHNOLOGY SOLUTIONS
CARMEL, INDIANA 46032 ACCOUNTS RECEIVABLE CHECK AMOUNT: $1,292.62
1212 S NAPER BLVD SUITE 119-201 CHECK NUMBER: 217542
NAPERVILLE IL 60540
CHECK DATE: 2126/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1701 4341999 10055-26 17 . 68 OTHER PROFESSIONAL FE
1701 R4341999 26484 10055-26 1, 274 . 94 W-2 HOSTING
A r7
AMERICAN TEC14NC1EC5c.''<All.l.flONS
1212 S.Naper Blvd
Suite 119-201
Naperville,IL 60540 Invoice
Client City of Carmel Invoice # 10055-26
Accounts Payable
One Civic Square Invoice Date: 2/12/2013
Carmel, IN 46032 Po#: 26484
Phone: 630-548-1970
Fax: 630-839-7252
Qty Description Unit Price Cost
1 2012 W-2 Database Load with Production and Test File 50.00 50.00
1 2012 W-2 Datamap 250.00 250.00
1 ATS MyW-2 Annual Online Hosting and Storage 100.00 100.00
177 ATS MyW-2 Print and Mail Services (includes postage) 0.86 152.22
476 ATS MyW-2 Online Hosting-Employee Consent 0.40 190.40
1 SSA W-2 Electronic Filing Fee for a single EIN 250.00 250.00
1 ATS Provides Client Custom EFW2 Format(Client does Indiana State Filing) 300.00 300.00
Balance Due: $1,292.62
Payment Due Upon Receipt
Please make check payable to: American Technology Solutions, Corp.
1212 S. Naper Blvd.
Suite 119-201
Naperville, IL 60540
Thank You! - We truly appreciate your business.
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No.201(Rev.1995)
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))
Total
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
. 'a4q Le , 11s
U IN SUM OF
$
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$
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT.# I hereby certify that the attached invoice(s), or
6 n ,�7 � 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
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund