219674 05/07/2013 CITY OF CARMEL, INDIANA VENDOR: 357200 Page 1 of 1
ONE CIVIC SQUARE CANNON IV, INC CHECK AMOUNT: $379.84
�.o CARMEL, INDIANA 46032 PO BOX 697
INDIANAPOLIS IN 46206-0697 CHECK NUMBER: 219674
CHECK DATE: 5/7/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1202 4341955 INV342023 379 . 84 INFO SYS MAINT/CONTRA
Service Invoice
with Details
OInvoice Number: INV342023
Date: 04/22/2013
950 Dorman Street Indianapolis, IN 46202-3544 Account Number: 5712414
P: 317-951-0500 F: 317-951-0600 PO Number:
Invoice Total: $379.84
Bill To:
City Of Carmel
One Civic Square a --n erRFAW,-Y- -A P,�im 9�u
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Carmel, IN 46032
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SC210508 u217568 SG19S1312J. c6075a-DesignJet 10550M Refubished options only a 200.00 $ 55.06 $ 124.84-, 0.00 —$-379.84
'Service Date: 04/22/2013 Contract Number: Description: Switch'Power Off/Ch I eck print head path/Type I error.Printer is down.
Location: City Of Carmel PO#: ***********please contact Terri on her cell phone 317.313.6352 if she is not at her
760 Third Ave SW Caller:,Terri Krueskamp,--317-1 desk when you arrive.
6-ive.
Carmel,IN 46032 Contact: Terri Krueskamp,
Phone: 317-571-2565 Remarks: replaced belt cleaned and tested
Fax: 317-571-2410
Labor Charges $200.00
"service Start End Standard Standard Standard Overtime Overtime Overtime Labor --------------
Technician Date Time Time Hours Rate Charge Hours Rate Charge Charge
John Otte 04/22/2013 9:47 am 11:23 am EDT 1.60 $ 125.00 $200.00 0.00 $ 125.00 $0.00 200.00
Material Charges, -$-1-24.84
Item Description Quantity um Price Discount Amount
CIV-C6072-60198 Belt E SERV HP D3 1055 DJ 1050#HEW 2 EA $ 62.42 0.00 $ 124.84
Totals: $200.00 $ 55.00 $ 124.84. $0.00 $ 379.84
PLEASE REMIT ALL PAYMENTS TO: Invoice Subtotal: $379.84
CANNON IV, INC. Tax: $0.00
P.O. BOX 697
INDIANAPOLIS, IN 46206-0697 Invoice Total: $379.84
Balance Due: $379.84
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Page 1 of 1
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))
04/19/13 INV342023 $379.84
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
VOUCHER NO. WARRANT NO.
ALLOWED 20
Cannon IV
IN SUM OF $
950 Dorman Street
Indianapolis, IN 46202-3544
$379.84
ON ACCOUNT OF APPROPRIATION FOR
IS Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1202 I INV342023 I 43-419.55 I $379.84 I 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
Friday, May 0 13
Dlre t , IS
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund