218046 03/13/2013 CITY OF CARMEL, INDIANA VENDOR: 00353338 Page 1 of 1
ONE CIVIC SQUARE GEMPLER'S INC
G CHECK AMOUNT: $187.70
�5•�,%: CARMEL, INDIANA 46032 PO BOX 5176
off JANESVILLE WI 53547-5176 CHECK NUMBER: 218046
CHECK DATE: 3/13/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4238900 1019339239 187 . 70 OTHER MAINT SUPPLIES
Order By Phone: 1-800-382-8473 Geinpler's
GEMPLER S° FEI#39.A.53718
7 Order Online: �v%vcv.Gemplers.com
Order B�Fax: 1-800-551-1128 1125 Deming Way
> Madison,WI U.S.A.53717
PO Box 44993 2
Madison,WI USA 53744-4993 3
000330 PAGE 1 OF 1
B CITY OF CARMEL S CITY OF CARMEL
i
ACCOUNTS PAYABLE i ATTN: PARRS PIFER
L 1 CIVIC SQ P 1 CIVIC SQ
T CARMEL IN 46032-2584 T CARMEL IN 46032-2584
0 0
Order No. P.O. No. Sold To No. Invoice No. Invoice Date Due Date
SC10102692 PIFER020913 5208827 - 1 1019339239 02/11/2013 1 03/13/2013
Buyer Carrier Freight Terms Ship Date Payment Terms
PIFER,PARRS +UPSGNDHAZ MANUAL 02/11/2013 Net 30
QTY, QTY. UNIT
LINE PRODUCT NO. DESCRIPTION B.O. SHIP U.O.M. AMOUNT AMOUNT
1 R97100 BIRD RPLLNT FLASH TPE TANGLE 0 5 RL 21.95 109.75
2 3001PROSP 3001 GEM JAN 2013 MASTER 0 1 EA 0.00 0.00
3 R40703 BIRD RPLLNT FLASH TPE WILDLI 0 5 RL 11.60 58.00
D
MAR 1 12013
By
SUBTOTAL: 167.75
Thank you for your order. FREIGHT: 19.95
TAXES: 0.00
PN9063534029 ML
PAYMENT TERMS: Net 30 TOTAL AMOUNT DUE BY 03/13/2013 187.70 USD
These items are sold for domestic consumption in the United States. If exported, purchaser
assumes full responsibility for compliance with US export controls. ORIGINAL
After JO days from invoice date, GHC Specialty Brands, LLC:will not be responsible :c) t;nc.).,v
TITLE TO ALL MERCHANDISE SHIPPED PASSES TO THE PURCHASER UPON DELIVERY TO TH
NO CLAIMS, DEDUCTIONS OR RETURNS ACCEPTED WITHOUT OUR WRITTEN CONSENT. kLL C.LAiP✓lS MUST DE MADE
WITHIN 15 DAYS AFTER RECEIPT OF GOODS. ALL PRICES SUBJECT TO CHANGE vNITf-IOUT NOT!CE: PRICES
PREVAILING ON TIME OF DELIVERY. THE GOODS COVERED BY THIS INVOICE WERE PRODUC'FLp IN COMPLIANCE
WITH THE REQUIREMENTS OF THE FAIR LABOR S TANDARDS ACT OF 1939 AS AMENDED.
THESE COMMODITIES ARE LICENSED FOR THE ULTIMATE DESTINATION SHOWN. DIVERSION CONTRARY TO THE
UNITED STATES LAW IS PROHIBITED, CUSTOMER HEREBY UNCONDITIONALLY AND WIT HOUT RESERVATION AGREES
THAT GHC SPECIALTY BRANDS, LLC IS ENTITLED TO ENFORCE THE TERMS OF THIS SHIPPING ORDER UNDER THE LA�,VS
OF THE STATE OF ILLINOIS AND IN AN ILLINOIS FORUM.
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))
02/11/13 1019339239 $187.70
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
WARRANT NO. 20 I,
VOUCHER NO —_ ALLOWED �
GEMPLER'S IN SUM OF $
Account# 5208827
PO Box 5176
Janesville, WI 53547-5176
I
$187.70
i
ON ACCOUNT OF APPROPRIATION FOR
Administration Department
PO#/Dept INVOICE NO. ACCT#/TITLE AMOUNT
Board Members
$
42-389 00 187.70 1 hereby certify that the attached invoice(s), or
1205 1019339239 bill(s) is (are) true and correct and that the
materials or services itemized th ereon for �
»:. which charge is made were ordered and
received except
Monday, March 11, 2013
/ ,.
r
Director, Administration
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund