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220979 06/18/2013 CITY OF CARMEL, INDIANA VENDOR: 367001 Page 1 of 1 ONE CIVIC SQUARE CAPITAL ONE COMMERCIAL CARMEL, INDIANA 46032 PO BOX 5219 CHECK AMOUNT: $313.31 CAROL STREAM IL 60197-5219 CHECK NUMBER: 220979 CHECK DATE: 6/18/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1081 4239039 213 . 60 7003731100072984 1096 4239039 99. 71 7003731100072984 Please Direct Inquiries To:1-800-220-8594 CAMSM01 COSTCO IA HOLESAISLE Amount-FOMI:Due:: Dud:b4te, ..... ............. ...... ...... . .... ... . . .. ......... ........ .......... ...... . ..... 7003-7311-00072984 1 468.38 :4.00 .06/2012013_-_ BIIIing .. . . ....... . .. ...... ... ........ .. .... ...... .... .. .......... .-..... ­ .... ..... .... ..... ..... .... ....... ............. ...... 05/26/2013: ax$5 000:::�::.. ...... U,21 a ..... ........... ...... TDD/Hearing impaired: 1-800-365-0186 STATEMENT OF YOUR ACCOUNT ............... Z IFIRANCE:CHA ...... ........... .... ... .................... ................ .......... .. ............... ..................­........... E; .. .. .. 0 0 U Credit Credit Average Daily Corres- FINANCE ANNUAL New Minimum Promo c�_ Plan Plan Daily Periodic ponding CHARGES at PERCENTAGE Balance Payment Expire Description Number Balance Rate APR Periodic Rate RATE Due I? Credit 00014 0.00000% 00.00% $.00 00.00% $1,468.38 $1,468.38 05/26/2013 Reg 00014 $20.89 0.00000% 00.00% $.00 00.00% $313.31 $.00 06/26/2013 O ACCOUNT DETAIL . ......... ............... ........... .. .... .. :::::::::;>;:::::::. User: P 0 ............Tnirlism .......... ............. .......... . ........ ...... ............ Number ........................................ ........ ...... .. . . ...... .. . ........... . ..... .... ........... ............ ....................... ............ ......... ........ ......... 05/16/2013 COSTCO WHOLESALE-346 015652 00005 $136.06 00005 SUBTOTAL: $136.06 05/06/2013 COSTCO WHOLESALE-347 055208 00006 $77.54 00006 SUBTOTAL: $77.54 05/07/2013 COSTCO WHOLESALE-346 007457 00017 $99.71 00017 SUBTOTAL: $99.71 JUN 0 3 2013 Return the below portion with payment.For billing errors or questions please refer to the back of the statement. Page 1 of 2 Important Notice:Promptly review this statement and notify Capital One Commercial in writing of any errors or unauthorized purchases.If you do not notify Capital One Commercial within 60 days of errors or unauthorized purchases,this statement will be presumed to be correct. Write to Capital One Commercial at P.O.Box 4160,Carol Stream, IL 60197-4160. You may telephone Capital One Commercial at 1-800-210-8115,but it will not preserve your rights. Notify Capital One Commercial in writing of the cancellation of a credit card or authorized user. COSI"Co. COSTCO �MMMESALE ACCOUNT SUMMARY BALANCE SUMMARY .......... ........... .. ... ........... Outstanding CURRENT* .29 DAYSPAST DUE: IPASTIDUE : Transaction $1,468.38 +New $1,468.38 $.00 $.00 Purchase(syDebk(s) $313.31 ............. ................... ....... +New Fees $.00 :..:6Q97.11AV.S.PAST:D WE: BAST 317E; 1120�1149.:IYAYS .AST ............ ...... .............. +Finance Charges $.00 $.00 $.00 $.00 Payment(s) $.00 .......... ...... ..........-.- ....... ....I —1.504.70*DAYS�PAST.00t:'::::A 80*DMSPAgTOUE Credit(s) ...... $.00 O $.00 $.00 =New Balance $1,781.69 U 0 C? O O C? C, O O O Page 2 of 2 s 1-1 F1 1:11 1 L—I.E1 El ❑ New address or phone number? Please check box and complete reverse side. Important Notice:Promptly review this statement and notify Capital One Commercial in writing of any errors or unauthorized purchases.If you do not notify Capital One Commercial within 60 days of errors or unauthorized purchases,this statement will be presumed to be correct. Write to Capital One Commercial at P.O.Box 4160,Carol Stream, IL 60197-4160. You may telephone Capital One Commercial at 1-800-210-8115,but it will not preserve your rights. Notify Capital One Commercial in writing of the cancellation of a credit card or authorized user. 22CAP720298(02/13) TO ENSURE ACCURACY, PLEASE PRINT NEATLY USING UPPER-CASE LETTERS AND NUMBERS ONLY! M 711:1❑❑❑❑❑❑1 I I 1❑❑❑❑❑❑❑❑❑❑❑❑M Email Address ❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑ Street Number if any) Street Name or the word unit or PO BOX NuNU❑❑ r ❑❑0:11: 0❑❑❑ ❑ 10❑❑❑ Cit❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑ S❑❑ Z�❑❑❑❑ Business Phone ❑❑❑i❑❑❑-EI❑❑❑ Costco Fund 108 Fund 109 - - Gen erai—j-Uenerai program program Gen Prog supplies_ supplies supplies V#361108 Invoice# 4239039,_ 4239039 4239039 I I 11081-8 1 1081-10 1096-70 _ 05/07/131 3457 �_ L $ 99.71 05/06/131 55208�� _� $ 77.54 05/16/13! 15652```_$ 136.06 __- $ 136.06 $ 77.54 $ 99.71 $ 313.31 Costco _ Fund 108 Fund 109 General General program program Gen Prog (supplies ;_supplies supplies V#361108 Invoice# �I_ 4239039� 4239039� 42390391 _._I__ �� 1081-8 1081-10 1096-70 ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice of bill to be properly itemized rate sthlrk nmbe service,where performed, ofunits, priceperunit, etd service rendered, by Cates whom, rates per day, number of hours, per hou Payee Purchase Order No. (Costco) Terms 367001 Capital One Commercial Date Due P.O. Box 5219 Carol Stream, IL 60197-5219 Invoice Invoice Description PO# Amount Date Number (or note attached invoice(s) or bill(s)) $ 136.06 5/26/13 7003731100072984 Special projects $ 77.54 5/26/13 70037311o0072984 General program supplies $ 99.71 5/26/13 7003731100072984 General program supplies Total $ 313.31 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. (Costco) 367001 Capital One Commercial Allowed 20 P.O. Box 5219 Carol Stream, IL 60197-5219 In Sum of$ $ 313.31 ON ACCOUNT OF APPROPRIATION FOR 108 - ESE / 109 - MCC PO#or Board Members Dept# INVOICE NO. ACCT#/TITLE AMOUNT 1081-8 7003731100072984 4239039 $ 136.06 1 hereby certify that the attached invoice(s), or 1081-10 7003731100072984 4239039 $ 77.54 bill(s) is (are)true and correct and that the 1096-70 7003731100072984 4239039 $ 99.71 materials or services itemized thereon for which charge is made were ordered and received except 13-Jun 2013 !- &hQ.trn/ Y)-Q Signature $ 313.31 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund