217672 02/26/2013 CITY OF CARMEL, INDIANA VENDOR: 129000 Page 1 of 1
ONE CIVIC SQUARE HOLDER MATTRESS CO, INC CHECK AMOUNT: $4,363.60
CARMEL, INDIANA 46032 130 W MORGAN STREET
' KOKOMO IN 46901
CHECK NUMBER: 217672
CHECK DATE: 2/26/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 4463000 020713CFD2 1, 745 . 44 FURNITURE & FIXTURES
102 4463000 021413CFD3 2, 618 . 16 FURNITURE & FIXTURES
Holder Mattress Factory
Built for Comfort — Designed to Last
Since 1947
Invoice
Carmel Fire Department
2 Civic Square
Carmel, IN 46032
Invoice Number: 020713cfd2
Invoice Date: 2/7/13
Invoice Due Date: 3/7/13
Customer Approval: Michael Lux
Item: Description: Quantity Item Price Total Price
#1 Keystone XL Twin 4 $436.36 $1,745.44
Station#43
Invoice Sub-Total $1,745.44
IN Sales Tax 7% EXEMPT
Total Invoice Due $1,745.44
• Payment terms Net 10 from date of delivery
• Proof of Deliveries, Signed Quote Approval Attached
Deliveries to the Following:
4 Sets to Station 43 at 3242 E. 106th St.
Please remit to:
130 West Morgan Street
Kokomo, IN 46901
Phone (765) 236-1492; Fax (765) 236-1495
r a. older Mattress factory lot
00
Built for Comfort Designed to Last
Since 1947
Invoice
Carmel Fire Department
2 Civic Square
Carmel, IN 46032
Invoice Number: 021413cfd3
Invoice Date: 2/14/13
Invoice Due Date: 3/14/13
Customer Approval: Denise Sawyer
Item• Description: Quantity Item Price Total Price
#1 Keystone XL Twin 6 $436.36 $2,618.16
Station#44
Invoice Sub-Total $2,618.16
IN Sales Tax 7% EXEMPT
Total Invoice Due $2,618.16
• Payment terms Net 10 from date of delivery
• Proof of Deliveries, Signed Quote Approval Attached
Deliveries to the Following:
6 Sets to Station 44 at 5032 East Main St.
Please remit to:
130 West Morgan Street
Kokomo, IN 46901
Phone (765) 236-1492; Fax (765) 236-1495
VOUCHER NO. WARRANT NO.
ALLOWED 20
Holder Mattress
IN SUM OF $
130 West Morgan Street
Kokomo, IN 46901
$4,363.60
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1120 021413cfd3 102-630.00 $2,618.16 1 hereby certify that the attached invoice(s), or
1120 020713cfd2 102-630.00 $1,745.44 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
FEB 2 5 2W
Fire Chief
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
vhom, 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))
021413cfd3 44 $2,618.16
020713cfd2 43 $1,745.44
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