218583 03/25/2013 CITY OF CARMEL, INDIANA VENDOR: 367042 Page 1 of 1
ONE CIVIC SQUARE PAPERLESS BUSINESS SYSTEMS
+ CHECK AMOUNT: $5,904.94
CARMEL, INDIANA 46032 1417 FOURTH AVE,4TH FLOOR
«o� SEATTLE WA 98101 CHECK NUMBER: 218583
CHECK DATE: 3/25/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4355200 SO-04681 2 , 952 .47 SUBSCRIPTIONS
1091 4355200 SO-04681 2 , 952 .47 SUBSCRIPTIONS
Invoice
paperless
business systems
1417 Fourth Avenue,4th Floor Invoice Number SO-04681
Seattle,WA 98101 Invoice Date 3/19/2013
p 206.256.0771 Purchase Order 29557
f 206.282.3312 Customer Number CACL001
SOLD TO SHIP T0:
Carmel Clay Parks& Recreation Carmel Clay Parks& Recreation
Attention: Accounts Payable Attention: Accounts Payable
1411 E 116th Street 1411 E 116th Street
Carmel, IN 46032 Carmel, IN 46032
SALES ORDER TERMS PBS CONTACT
SO-04681 Contract Accounts Receivable
Description - Amount -
eRequester Hosted Subscription(SAAS)
eRequester Hosting for 50 Named Users, month 1 of 12, 3/28/13-4/27/13 713.55
Hosted Receiving Module, month 1 of 12, 3/28/13-4/27/13 164.65
Monthly Discount for 1st Year, if purchased by 3/31/13 -93.26
Remote Implementation and Web Training 5,120.00
Pat
Purchase
Description
P.O.# r
--
G.L.# — q /08� '- a95a
Budoet ,{
Line Gescr�(�,��Lt.�l9C1 lQ�l %o't�5o?•�{
Purchaser Date
Approval Date -'T /-3 6qD i/.C,LL
A 1%%monthly charge is payable on all overdue balances.
The grant of any license or right is conditioned on receipt of full payment.
All payments and dollar amounts are in U.S.Dollars
Remit to: Paperless Business Systems, Inc., 1417 Fourth Avenue, 4th Floor, Seattle, WA 98101
p 206.256.0769 f 206.282.3312 www paperlessbusiness.com info @paperlessbusiness.com TOTAL AMOUNT USD $5,904.94
Wire Information. Swift#BOFAUS3N Bank of America,WA3-177-01-01
Bank Name:Bank of America Routing#:125000024 408 Pike St.Seattle,WA 98101
ABA#026009593 Account#:138019775709(savings)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of 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.
Paperless Business Systems Terms
1417 Fourth Avenue, 4th Floor
Seattle, WA 98101
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO# Amount
3/19/13 S004681 Purchasing software, subscription Apr'13 29557 $ 2,952.47
3119113 S004681 Purchasing software, subscription Apr'13 29557 $ 2,952.47
Total $ 5,904.94
1 hereby certify that the attached invoice(s), or bill(s)is(are)true and correct and I have audited same in accordance
with 1C 5-11-10-1.6
20_
Clerk-Treasurer
Voucher No. Warrant No.
Paperless Business Systems Allowed 20
1417 Fourth Avenue, 4th Floor
Seattle, WA 98101
In Sum of$
$ 5,904.94
ON ACCOUNT OF APPROPRIATION FOR
108 - ESE
PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members
Dept#
1081-99 S004681 4355200 $ 2,952.47 1 hereby certify that the attached invoice(s), or
1091 S004681 4355200 $ 2,952.47 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
21-Mar 2013
Signature
$ 5,904.94 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund